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Complex operating environments are becoming prevalent within industry and the military. Concomitantly, the development of advance technologies is increasing, enabling the simulation of complex environments and presenting exciting training opportunities. What is lacking is strong guidance from training science for how to focus and enhance the use of simulation technologies for training system design. The focus of this paper is to continue the discussion of this long-standing problem by focusing on three causes: the lack of integration of training research, training practice and technology development; the difficulty of translating research findings into useful design artefacts; and fundamental, culturally based differences between the stakeholders involved in training system development, including programme managers, engineers, psychologists and domain experts. The causes are addressed both to raise awareness and to begin envisioning solutions. [ABSTRACT FROM AUTHOR]

Background: Neer and Foster previously described the inferior capsular shift procedure for treating multidirectional instability of the shoulder and reported preliminary results that were quite satisfactory. The purpose of our study was to perform a longer-term follow-up evaluation of the efficacy of the inferior capsular shift procedure for treating multidirectional instability of the shoulder.Methods: An inferior capsular shift procedure was used to treat multidirectional instability of the shoulder in forty-nine patients (fifty-two shoulders). All patients had failed to respond to an exercise program. In this series, the operative approach (anterior or posterior) was based on the major direction of the instability, as determined by the preoperative history and physical examination and as verified by examination with the patient under anesthesia. In all of the patients, the inferior capsular shift was the primary attempt at operative stabilization. The repair consisted of a lateral-side (or humeral-side) shift of the capsule to reduce capsular redundancy and, when necessary, a reattachment of the avulsed labrum to the anteroinferior aspect of the glenoid.Results: A redundant capsular pouch was seen in all of the shoulders in this series. In addition, detachment of the anteroinferior aspect of the labrum was found in ten shoulders and an anterior fracture of the glenoid rim was seen in two shoulders. At an average of sixty-one months (range, twenty-four to 132 months), results were available for forty-nine shoulders (forty-six patients). Thirty shoulders (61 percent) had an excellent overall result, sixteen (33 percent) had a good result, one (2 percent) had a fair result, and two (4 percent) had a poor result. Forty-seven (96 percent) of the forty-nine shoulders remained stable at the time of follow-up. Two of the thirty-four shoulders that had been repaired through an anterior approach began to subluxate anteroinferiorly again. None of the fifteen shoulders that had been repaired through a posterior approach had recurrent instability. Full function, including the ability to perform strenuous manual tasks, was restored to forty-five shoulders (92 percent). A return to sports was possible after thirty-one (86 percent) of the thirty-six procedures done in athletes; however, a return to the premorbid level of participation was possible after only twenty-five (69 percent) of the thirty-six procedures.Conclusions: The results in this series demonstrate the efficacy and the durability of the results of the inferior capsular shift procedure for the treatment of shoulders with multidirectional instability. The procedure directly addresses the major pathological feature - a redundant joint capsule. Similar results were seen with either an anterior or a posterior approach, and we continue to approach shoulders with multidirectional instability on the side of greatest instability. A postoperative brace was reserved for patients in whom a posterior approach had been used or in whom an anterior approach had involved extensive posterior capsular dissection (ten of the thirty-four shoulders treated with the anterior approach). [ABSTRACT FROM AUTHOR]

Background: Anatomic patellar components for total knee arthroplasty (TKA) have demonstrated favorable in vivo kinematics. A novel failure mechanism in TKA patients with an anatomic patellar component was observed prompting an investigation to identify patient- and implant-related factors associated with suboptimal performance., Methods: A retrospective evaluation was performed comparing 100 TKA patients with an anatomic patellar component to 100 gender-, age-, and body mass index-matched patients with a medialized dome component. All surgeries were performed with the same posterior-stabilized TKA system with minimum of 1-year follow-up. Several radiographic parameters were assessed. A separate computational evaluation was performed using finite-element analysis, comparing bone strain energy density through the patella bone remnant., Results: Patients with an anatomic patellar component had significantly higher rates of anterior knee pain (18 versus 2%, P < .001), chronic effusions (18 versus 2%, P < .001), and superior patellar pole fragmentation (36 versus 13%, P < .001) compared to those with a dome component. Radiographically, the anatomic group demonstrated more lateral patellar subluxation (2.3 versus 1.1 mm, P < .001) and lateral tilt (5.4 versus 4.0 mm, P = .013). Furthermore, there were more revisions in the anatomic group (7 versus 3, P = .331). On computational evaluation, all simulations demonstrated increased bone strain energy density at the superior patellar pole with the anatomic patella. Resection thickness <13 mm resulted in over 2-fold higher strain energy density, and negative resection angle of 7° resulted in 6-fold higher superior pole strain energy., Conclusions: Patients with an anatomic patellar component showed higher rates of anterior knee pain, chronic effusion, and superior pole fragmentation compared to patients with a dome patella, with higher superior patellar pole strain energy confirmed on computational evaluation. Avoiding higher resection angles and excessive patellar resection may improve the performance and survivorship of the anatomic patella., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The challenges in reliably removing the sacrificial material from fully enclosed microfluidic channels hinder the use of three-dimensional (3D) printing to create microfluidic devices with intricate geometries. With advances in printer resolution, the etching of sacrificial materials from increasingly smaller channels is poised to be a bottleneck using the existing techniques. In this study, we introduce a microfabrication approach that utilizes centrifugation to effortlessly and efficiently remove the sacrificial materials from 3D-printed microfluidic devices with densely packed microfeatures. We characterize the process by measuring the etch rate under different centrifugal forces and developed a theoretical model to estimate process parameters for a given geometry. The effect of the device layout on the centrifugal etching process is also investigated. We demonstrate the applicability of our approach on devices fabricated using inkjet 3D printing and stereolithography. Finally, the advantages of the introduced approach over commonly used injection-based etching of sacrificial material are experimentally demonstrated in direct comparisons. A robust method to postprocess additively manufactured geometries composed of intricate microfluidic channels can help utilize both the large printing volume and high spatial resolution afforded by 3D printing in creating a variety of devices ranging from scaffolds to large-scale microfluidic assays., Competing Interests: There are no conflicts of interest to declare., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Background: Alpha-defensin (AD) is a synovial biomarker included in the 2018 consensus criteria for diagnosing periprosthetic joint infection (PJI). Its value in assessing eradication of infection prior to second stage reimplantation is unclear. The purpose of this study was to evaluate the impact of AD on eligibility for reimplantation following resection for chronic PJI., Methods: This study included patients who previously underwent resection arthroplasty for PJI. Synovial fluid aspirated from 87 patients was retrospectively reviewed. All patients completed a 6-week course of intravenous antibiotics and an appropriate drug holiday. Synovial white blood cell count, percentage neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 consensus criteria was used, including white blood cell count, percentage neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then added to determine if it changed diagnosis or clinical management., Results: Four patients were categorized as "infected" (score >6), none exhibited a positive AD or positive culture. Sixty eight patients were diagnosed as "possibly infected" (score 2 to 5), none had a positive AD, and one had a positive culture (Cutibacterium acnes). AD did not change the diagnosis from "possibly infected" to "infected" in any case or alter treatment plans. Fifteen patients had a score of <2 (not infected) and none had a positive AD., Conclusion: The routine use of AD in the work-up prior to a second-stage arthroplasty procedure for PJI may not be warranted., (Copyright © 2022 Elsevier Inc. All rights reserved.)

We continued direct morphological studies of the canid coxofemoral joint, considering early-life spatial relationships around the locus of the proximocaudal joint capsule insertion. Our primary goal was to elucidate the postnatal developmental gross anatomy of the proximocaudal femur, among juveniles across Canidae. From an original database of 267 independent (museum) specimens from 11 canid taxa and 1 hybrid taxon, we identified 29 ancient or modern candidate juvenile specimens (nine taxa and one hybrid taxon). Based on optimal ability to recognize landmarks, the best photographic data were categorized into five groups of four each (n = 20). The data groups approximated early juvenile, early-mid juvenile, mid-juvenile, mid-late juvenile; and young adult stages. In this descriptive photographic essay, we demonstrate the developmental spatial proximity among (a) the dorsal meeting of the respective lateral and medial extensions from the growth centers of the femoral head and greater trochanter; (b) the caudodorsal aspect of the coxofemoral joint capsule attachment; (c) a segment of the proximocaudal femoral shaft physis; and (d) an eventual associated mineralized prominence. The latter occurs frequently but not universally, suggesting natural population variability across taxa. Across taxa and juvenile age categories, the morphology thus supports developmental conservation among ancient and modern Canidae. The biomechanical and biological cause-effect implications are not yet clear. For zoological purposes, we apply the term postdevelopmental mineralized prominence to the residual caudolateral surface feature. We extend the original anatomical work of Morgan in zoological and phylogenic arenas, using direct observation of cleared skeletal specimens., (© 2021 American Association for Anatomy.)

Competing Interests: Conflict of Interest and Sources of Funding: The authors of this article do not declare any conflicts of interest. This analysis was made possible through the support of Centers for Disease Control and Prevention's Strengthening Sexually Transmitted Disease Prevention and Control for Health Departments Grant (No. 6 MH25PS005175-01) and Grant or Cooperative Agreement Number 1NU62PS924546-03. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Driving is central to adult independence and autonomy; yet most autistic young adults do not acquire driver's licenses. It is important to understand barriers to achieving this milestone for autistic adults. Differences in negative affect and emotion dysregulation associated with autism may interfere with managing difficult driving situations. The current study compared perceived driving difficulty (DD), emotion dysregulation, and negative affect in emerging drivers with and without autistic traits (AT), and investigated how emotion dysregulation and negative affect relate to perceived DD. We expected (1) greater perceived DD, emotion dysregulation, and negative affect in participants with AT and (2) a positive correlation of perceived DD with both emotion dysregulation and negative affect in the whole sample. Thirty-seven adolescents and young adults (15 AT) self-reported perceived DD in 15 scenarios and completed the Difficulty in Emotion Dysregulation Scale (DERS) and the Depression, Anxiety, and Stress Scale (DASS). Autistic participants scored significantly higher on mean perceived DD, DERS Impulse subscale, DASS total and DASS Stress subscale scores. Perceived DD positively correlated with the DERS and DASS total scores, all DASS subscales, and DERS Nonacceptance, Goals, and Impulse subscales across the whole sample. The findings highlight the roles of emotion dysregulation and negative affect in perceived DD in emerging drivers with AT. In particular, emotional stress and impulsivity may map onto mechanisms of over-reactivity to negative affect and explain why autistic people perceive particular situations as difficult when driving. Implications and directions for future research are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fok, Owens, Ollendick and Scarpa.)

This study aimed to explore the preferences, experiences and restraint practices of Australian parents travelling with their children in rideshare vehicles. Six hundred and thirty-one participants completed an online survey (M = 39.2 years, SD = 10.5, Range = 18.0-70.0 years; Female: 63.4%). Most participants (59.1%) reported that they had not travelled in a rideshare vehicle with their youngest child (M = 7.2 years, SD = 5.2, Range = 0.0-17.0 years; Male: 54.2%). Participants who reported that they have travelled with their youngest child in a rideshare vehicle tended to: be younger, identify as male, have completed an Undergraduate or Postgraduate degree, reside in the Australian Capital Territory, earning a higher yearly household income, and were involved in an at-fault crash in the past two years. In addition, these participants were: less likely to have a 'younger' youngest child, less likely to 'always' wear a seatbelt while travelling in their private motor vehicle, and also less likely to 'always' restrain their child in an appropriate restraint while travelling in their private motor vehicle. Prohibitive reasons for not travelling in a rideshare vehicle included: cost (29.3%), concerns over driver safety (27.5%), concerns over travelling with children in a rideshare service (24.8%), or inconvenience (24.3%). Participants who reported that they had travelled in a rideshare vehicle with their youngest child reported lower rates of appropriate restraint use within the rideshare vehicle (57.3%) than when travelling in their private motor vehicle (85.6%). Reasons associated with inappropriate restraint use within the rideshare vehicle included: unavailability of a child restraint (39.6%), travelling a short distance (33.0%), were not required to use one in this situation (33.0%), or the parent did not have a restraint with them (26.4%). Given the increasing popularity of rideshare services in Australia, and globally, the urgent adaption of rideshare-specific policy, legislation, education, and design in relation to child restraint requirements is needed to ensure the safety of child occupants.

Aim: The number of online graduate nursing programs across the United States has increased to address a critical shortage of nurse educators. Web-based learning appeals to nurses returning to school as a means of gaining an education at their convenience. More schools are offering compressed courses to meet this demand. Although students have a preference toward shorter intensive online courses, it is unclear how that affects the quality of the learning experience such as student engagement. The study explored the effect of course length on the student learning experience in a graduate online nurse educator course., Design: Using the community of inquiry framework, this study examined the effect of course duration (8-week versus traditional 16-week timeframes) on student engagement, student perceptions of the learning experience and self-reported learning behaviors. Study participants were enrolled in an online graduate nurse educator program located in the northwest United States., Methods: Data were collected using a background information form, a course evaluation form and the Community of Inquiry Questionnaire which measured teaching presence, social presence and cognitive presence. Data were analyzed using descriptive and inferential statistics., Results: High mean scores on the questionnaire showed that a community of inquiry was established regardless of course duration. However, there were differences in terms of the social and teaching presence subscales but not in the cognitive presence subscale suggesting that students in the traditional course were better able to establish the type of rapport with each other that increased comfort and engagement with peer interactions. Independent t-tests revealed statistically significant differences in perceptions of time to complete course activities. Students in the 16-week course were more likely to report that they had adequate time to complete course teachings, think critically about course content, complete course assignments and thoughtfully engage in course discussion and that they performed their best on assignments., Conclusions: The findings support the traditional course duration over an intensive 8-week format because it allows for students to build a better rapport and greater student engagement with the course materials and peers. The study reinforces previous work on distance education noting social presence and connectedness as essential to optimal online learning. Using the community of inquiry framework and best-practice pedagogies for online education in the design and development of online courses can contribute to greater collaboration and deeper learning., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Duchenne muscular dystrophy (DMD) is a severe genetic disorder caused by mutations in the DMD gene. Absence of dystrophin protein leads to progressive degradation of skeletal and cardiac function and leads to premature death. Over the years, zebrafish have been increasingly used for studying DMD and are a powerful tool for drug discovery and therapeutic development. In our study, a birefringence screening assay led to identification of phosphodiesterase 10A (PDE10A) inhibitors that reduced the manifestation of dystrophic muscle phenotype in dystrophin-deficient sapje-like zebrafish larvae. PDE10A has been validated as a therapeutic target by pde10a morpholino-mediated reduction in muscle pathology and improvement in locomotion, muscle, and vascular function as well as long-term survival in sapje-like larvae. PDE10A inhibition in zebrafish and DMD patient-derived myoblasts were also associated with reduction of PITPNA expression that has been previously identified as a protective genetic modifier in two exceptional dystrophin-deficient golden retriever muscular dystrophy (GRMD) dogs that escaped the dystrophic phenotype. The combination of a phenotypic assay and relevant functional assessments in the sapje-like zebrafish enhances the potential for the prospective discovery of DMD therapeutics. Indeed, our results suggest a new application for a PDE10A inhibitor as a potential DMD therapeutic to be investigated in a mouse model of DMD., Competing Interests: Declaration of Interests L.M.K is a consultant for Pfizer, Dyne Therapeutics, and Myofinity for muscle disease drug therapies. J.E.C and J.M.O are employees of Pfizer. The remaining authors declare no competing interests., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

This study compared newly licensed drivers with and without autism spectrum disorder (ASD) and experienced drivers. Twenty new drivers (8 with ASD) and 16 experienced drivers completed the Driving Attitude Scale (DAS) and drove a simulator and an instrumented vehicle. Heart rate (HR), galvanic skin response (GSR), wrist movement, eye-gaze and driving performance were monitored. ASD drivers had more negative attitudes toward driving and greater change in HR, GSR and wrist movement. In a driving simulator, drivers with ASD scored lower than NT drivers and were rated less safe. There were fewer differences during on-road driving. Poorer driving and greater anxiousness in the new drivers with ASD indicates the need for a large-scale study of driving performance and apprehension to formulate remediation.

Isolation and analysis of circulating tumor cells (CTCs) from blood samples present exciting opportunities for basic cancer research and personalized treatment of the disease. While microchip-based negative CTC enrichment offers both sensitive microfluidic cell screening and unbiased selection, conventional microchips are inherently limited by their capacity to deplete a large number of normal blood cells. In this paper, we use 3D printing to create a monolithic device that combines immunoaffinity-based microfluidic cell capture and a commercial membrane filter for negative enrichment of CTCs directly from whole blood. In our device, stacked layers of chemically-functionalized microfluidic channels capture millions of white blood cells (WBCs) in parallel without getting saturated and the leuko-depleted blood is post-filtered with a 3 μm-pore size membrane filter to eliminate anucleated blood cells. This hybrid negative enrichment approach facilitated direct extraction of viable CTCs off the chip on a membrane filter for downstream analysis. Immunofluorescence imaging of enriched cells showed ∼90% tumor cell recovery rate from simulated samples spiked with prostate, breast or ovarian cancer cells. We also demonstrated the feasibility of our approach for processing clinical samples by isolating prostate cancer CTCs directly from a 10 mL whole blood sample.

Case: A 22-year-old man sustained complete transection of his right distal biceps femoris tendon by a hockey skate. He experienced persistent pain and disability, symptoms of peroneal neuritis, and an inability to return to hockey. At 3-months postinjury, he underwent biceps femoris repair and peroneal neurolysis. At 9-months postoperatively, the patient returned to full activity and played a full season collegiate hockey., Conclusions: Isolated distal biceps femoris transection is rare and may be associated with peroneal neuritis. Primary repair and peroneal neurolysis is a viable treatment option (even 3 months postinjury), with satisfactory outcomes and full return to high-level activity.

Background: The purpose of this study was to perform a systematic review and meta-analysis to quantitatively assess the association between tobacco use and the risk of any wound complication and periprosthetic joint infection (PJI) after primary total hip and total knee arthroplasty procedures., Methods: Relevant articles published before January 2018 were identified by systematically searching PubMed, EMBASE, and Cochrane library databases. Pooled odds ratios (OR) and 95% confidence intervals were calculated for end points of any wound complication and PJI. Additional analyses were performed to evaluate risks between current, former, and non-tobacco users., Results: Fourteen studies were included in the meta-analysis. Tobacco users had a significantly higher risk of wound complications (OR, 1.78 [1.32-2.39]) and PJI (OR, 2.02 [1.47-2.77]) compared to non-tobacco users. Compared to non-tobacco users, there was an increased risk of PJI among current (OR, 2.16 [1.57-2.97] and former (OR, 1.52 [1.16-1.99]) tobacco users. Current tobacco users also had a significantly increased risk of PJI compared to former tobacco users (OR, 1.52 [1.07-2.14])., Conclusion: Tobacco use before total hip and total knee arthroplasty significantly increases the risk of wound complications and PJI. This increased risk is present for both current and former tobacco users. However, former tobacco users had a significantly lower risk of wound complications and PJI compared to current tobacco users, suggesting that cessation of tobacco use before TJA can help to mitigate these observed risks., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Diversity within the field of orthopedic surgery has been slow to progress, even well into the 21 st century. Despite the barriers broken in 1932 by Ruth Jackson - the first female member of the American Academy of Orthopedic Surgeons (AAOS) - gender, racial and ethnic diversity continues to be lacking. Research has shown there are clear advantages of a diverse physician population, not only in medicine and patient care but in commercial industry as well. Although the representation of females and underrepresented minorities (URM) in orthopedics is increasing, it is doing so at a slower rate as compared to other surgical subspecialties. Targeted efforts have been made to investigate and promote gender and cultural diversity in orthopedic surgery. New programs and initiatives have been developed to promote diversity in orthopedics through mentorship and enhancing visibility of females and URM in the field., Competing Interests: Disclosures: The authors report no potential conflicts of interest related to this study.

Background: Few studies have evaluated the impact of preoperative opioid use on risk of subsequent revision following primary total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative opioid use is associated with an increased risk of early revision TKA., Methods: The Humana administrative claims database was queried to identify patients who underwent unilateral TKA during the years 2007-2015. Patients were tracked for the occurrence of an ipsilateral revision procedure within 2 years. Preoperative opioid use was defined as having an opioid prescription filled within the 3 months before TKA. Age, sex, diabetes, obesity, chronic kidney disease, and anxiety/depression were also analyzed. Univariate and multivariate analyses were performed., Results: A total of 35,894 primary TKA patients were identified and 1.2% (n = 413) had a revision TKA procedure within 2 years. 29.2% of patients filled an opioid prescription within the 3 months before TKA. Preoperative opioid users were significantly more likely to undergo early TKA revision (1.6% vs 1.0%, P < .001). Preoperative opioid use (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.25-1.88; P < .001), younger age (OR, 2.46; 95% CI, 1.43-3.95; P < .001), obesity (OR, 1.25; 95% CI, 1.01-1.56; P = .04), and smoking (OR, 1.66; 95% CI, 1.22-2.22; P < .001) were associated with early revision TKA., Conclusion: This study identified preoperative opioid use as being independently associated with a greater risk for an early revision TKA. Younger age, obesity, and smoking were also associated with elevated risk. These findings support efforts to reduce inappropriate opioid prescribing., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: There is a paucity of literature evaluating the impact of smoking on revision total hip arthroplasty (THA) outcomes. The purpose of this study was to identify the effect of smoking on complications after revision THA., Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent revision THA between 2006 and 2014. Patients were divided into current smokers and nonsmokers. Each cohort was compared in terms of demographics, preoperative comorbidities, and operative time. Multivariate logistic regression analysis was utilized. Adjusted odds ratios (OR) for the outcomes of any wound complication, deep infection, and reoperation within 30 days of revision THA were calculated., Results: In total, 8237 patients had undergone a revision THA. Of these patients, 14.7% were current smokers and 85.3% were nonsmokers. Univariate analyses demonstrated that smokers had a higher rate of any wound complication (4.1% vs 3.0%, P = .04), deep infection (3.2% vs 1.9%, P = .003), and reoperation (6.8% vs 4.8%, P = .003). Multivariate analysis controlling for confounding demographic, comorbidity, and operative variables identified current smokers as having a significantly increased risk of deep infection (OR, 1.58; 95% CI, 1.04-2.38) and reoperation (OR, 1.37; 95% CI, 1.03-1.85)., Conclusion: Smoking significantly increases the risk of infection and reoperation after revision THA. The results are even more magnified for revision procedures compared to published effects of smoking on primary THA complications. Further research is needed regarding the impact of smoking cessation on mitigation of these observed risks., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolism) is a known complication following total knee arthroplasty (TKA). Recent literature has identified differences in VTE risk based on race with African Americans having higher risk of VTE. This study evaluated the impact of race on VTE following TKA using a large multicenter database., Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program to identify patients who underwent primary TKA in 2010-2014. Patients were stratified based on race: Asian, Black/African American, White, and Other. Demographics were compared to determine the impact on 30-day postoperative complications. Multivariate logistic regression analysis was performed to control for confounding demographics and comorbidities between races. Primary outcomes included overall complications and VTE., Results: In total, 96,230 patients were included. Univariate analysis demonstrated that Blacks had a significantly higher rate of any complication (5.5%), deep venous thrombosis (1.3%), and pulmonary embolism (1.1%) than other races (P = .007, P < .001, and P < .001, respectively). Overall mortality rate did not differ between races (P = .26). Multivariate regression analysis identified that Blacks were significantly more likely to have a VTE than Whites (odds ratio 1.7, 95% confidence interval 1.4-2.0). Overall complications were significantly higher for Blacks than Whites (odds ratio 1.1, 95% confidence interval 1.02-1.3). There were no differences in the rates of VTE or overall complications between Asians/Other races and Whites., Conclusion: Blacks have a significantly higher risk of VTE following primary TKA than other races. Future studies should investigate causes for this disparity., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The purpose of this study is to evaluate the impact of preoperative opioid use on the risk of subsequent revison after primary total hip arthroplasty (THA)., Methods: The Humana database was queried for unilateral THA between 2007-2015. Patients were tracked for the occurrence of an ipsilateral revision THA for 2 years. Factors analyzed included preoperative opioid use (defined as a history of opioid prescription filled within 3 months preceding primary THA), age, sex, diabetes, anxiety/depression, chronic kidney disease, and obesity (body mass index > 30 kg/m 2 ). Multivariate logistic regression analysis was used to determine odds ratios., Results: A total of 17,695 primary THA patients were analyzed and 0.88% (n = 155) underwent revision THA within 2 years. Preoperative opioid use occurred in 36.7% of all. Females comprised 58.7% of the total cohort and 80% were >50 years. Preoperative opioid users were significantly more likely to undergo early THA revision (1.2% vs 0.7%, P < .001). Other patient factors that significantly increased the risk of early THA revision included obesity (1.3% vs 0.8%, P = .03) and a preoperative diagnosis of anxiety/depression (1.9% vs 0.8%, P = .006)., Conclusion: Opioid use within 3 months preceding THA independently predicts an increased risk of early revision. Additionally, independent predictors of early revision include obesity and a diagnosis of anxiety/depression. Factors such as these will need to be considered in risk adjustment models when assessing quality of care or implementing bundled payment initiatives. Further research is needed to evaluate whether discontinuing opioids before surgery mitigates this risk., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The benefits of discharge to a skilled nursing facility (SNF) in Medicare-eligible patients after total joint arthroplasty (TJA) have recently been scrutinized. The purpose of this study was to determine short-term complication and readmission rates for SNF versus home discharge in patients eligible for Medicare and SNF discharge., Methods: Patients who underwent TJA between 2012 and 2013 were identified in the National Surgical Quality Improvement Project database. Patients over 65 years and who discharged at or after postoperative day 3, and thus SNF eligible by Medicare rule, were included. Patient demographics and comorbidities were compared in the 2 cohorts (home versus SNF), and subsequent univariate and multivariate analyses were used to determine risk factors for short-term complications., Results: We identified 34,610 Medicare- and SNF-eligible TJA patients; 54.8% discharged home. Patients with SNF discharge were older, had higher rates of comorbidities, and were more frequently American Society of Anesthesiologists class 3 or 4 (P < .001). Univariate analysis revealed that patients with SNF discharge had higher rates of any complication (7.9% vs. 4.7%, P < .001) and readmission (5.3% vs. 3.3%, P < .001). Multivariate regression analysis identified SNF discharge (adjusted odds ratio 1.9, 95% confidence interval 1.7-2.0) as an independent risk factor for a 30-day complication and readmission., Conclusions: In a cohort of Medicare- and SNF-eligible patients, SNF discharge was the strongest predictor of 30-day complication after TJA. SNF discharge was also an independent predictor of readmission after TJA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Although there are several studies concerning manipulation under anesthesia (MUA) after primary total knee arthroplasty, there is a paucity of literature evaluating MUA after revision total knee arthroplasty (rTKA). The purpose of this study was to determine the incidence, timing, and risk factors associated with MUA after rTKA., Methods: The Humana database was reviewed from 2007 to 2015 for all patients who underwent rTKA. Patients who underwent rTKA followed by ipsilateral MUA were identified. Time to MUA was calculated monthly. Possible risk factors analyzed included preoperative narcotic use, smoking, anxiety and/or depression, diabetes, obesity, age, and sex. Multivariate logistic regression was used to determine odds ratio., Results: In total, 5414 rTKAs were included in the study and 1.7% (n = 96) underwent MUA after surgery. Sixty-nine percent of MUAs occurred within the first 3 months after rTKA. Young patients (<50 years) had significantly higher odds of MUA after rTKA (6.5, P < .0001). No difference in odds of MUA (1.0, P = .85) occurred between males and females. A diagnosis of obesity, diabetes, anxiety and/or depression, previous history of narcotic use, or a history of smoking demonstrated no increased risk of MUA after rTKA. Multivariate logistic regression analysis demonstrated that younger age remained predictive of higher odds of MUA after rTKA., Conclusion: In this large multicenter cohort study, 1.7% of patients underwent MUA after rTKA and younger patients were 6 times more likely to have a MUA than patients over 50 years old. These data should serve to help counsel patients regarding their risk of MUA after rTKA., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Apicomplexan tick-borne pathogens that cause disease in companion animals include species of Babesia Starcovici, 1893, Cytauxzoon Neitz & Thomas, 1948, Hepatozoon Miller, 1908 and Theileria Bettencourt, Franca & Borges, 1907. The only apicomplexan tick-borne disease of companion animals that is known to occur in Australia is babesiosis, caused by Babesia canis vogeli Reichenow, 1937 and Babesia gibsoni Patton, 1910. However, no molecular investigations have widely investigated members of Apicomplexa Levine, 1980 in Australian ticks that parasitise dogs, cats or horses, until this present investigation., Results: Ticks (n = 711) removed from dogs (n = 498), cats (n = 139) and horses (n = 74) throughout Australia were screened for piroplasms and Hepatozoon spp. using conventional PCR and Sanger sequencing. The tick-borne pathogen B. vogeli was identified in two Rhipicephalus sanguineus Latreille ticks from dogs residing in the Northern Territory and Queensland (QLD). Theileria orientalis Yakimov & Sudachenkov, 1931 genotype Ikeda was detected in three Haemaphysalis longicornis Neumann ticks from dogs in New South Wales. Unexpectedly, the exotic tick-borne pathogen Hepatozoon canis James, 1905 was identified in an Ixodes holocyclus Neumann tick from a dog in QLD. Eight novel piroplasm and Hepatozoon species were identified and described in native ticks and named as follows: Babesia lohae n. sp., Babesia mackerrasorum n. sp., Hepatozoon banethi n. sp., Hepatozoon ewingi n. sp., Theileria apogeana n. sp., Theileria palmeri n. sp., Theileria paparinii n. sp. and Theileria worthingtonorum n. sp. Additionally, a novel cf. Sarcocystidae sp. sequence was obtained from Ixodes tasmani Neumann but could not be confidently identified at the genus level., Conclusions: Novel species of parasites in ticks represent an unknown threat to the health of companion animals that are bitten by these native tick species. The vector potential of Australian ticks for the newly discovered apicomplexans needs to be assessed, and further clinical and molecular investigations of these parasites, particularly in blood samples from dogs, cats and horses, is required to determine their potential for pathogenicity.

Nemaline myopathy (NM) is a heterogeneous congenital skeletal muscle disease with cytoplasmic rod-like structures (nemaline bodies) in muscle tissue. While weakness in NM is related to contractile abnormalities, myofiber smallness is an additional abnormality in NM that may be treatable. We evaluated the effects of mRK35 (a myostatin inhibitor developed by Pfizer) treatment in the TgACTA1D286G mouse model of NM. mRK35 induced skeletal muscle growth that led to significant increases in animal bodyweight, forelimb grip strength and muscle fiber force, although it should be noted that animal weight and forelimb grip strength in untreated TgACTA1D286G mice was not different from controls. Treatment was also associated with an increase in the number of tubular aggregates found in skeletal muscle. These findings suggest that myostatin inhibition may be useful in promoting muscle growth and strength in Acta1-mutant muscle, while also further establishing the relationship between low levels of myostatin and tubular aggregate formation., (© The Author(s) 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Problem: Distracted driving has become a topic of critical importance to driving safety research over the past several decades. Naturalistic driving data offer a unique opportunity to study how drivers engage with secondary tasks in real-world driving; however, the complexities involved with identifying and coding relevant epochs of naturalistic data have limited its accessibility to the general research community., Method: This project was developed to help address this problem by creating an accessible dataset of driver behavior and situational factors observed during distraction-related safety-critical events and baseline driving epochs, using the Strategic Highway Research Program 2 (SHRP2) naturalistic dataset. The new NEST (Naturalistic Engagement in Secondary Tasks) dataset was created using crashes and near-crashes from the SHRP2 dataset that were identified as including secondary task engagement as a potential contributing factor. Data coding included frame-by-frame video analysis of secondary task and hands-on-wheel activity, as well as summary event information. In addition, information about each secondary task engagement within the trip prior to the crash/near-crash was coded at a higher level. Data were also coded for four baseline epochs and trips per safety-critical event., Results: 1,180 events and baseline epochs were coded, and a dataset was constructed. The project team is currently working to determine the most useful way to allow broad public access to the dataset., Discussion: We anticipate that the NEST dataset will be extraordinarily useful in allowing qualified researchers access to timely, real-world data concerning how drivers interact with secondary tasks during safety-critical events and baseline driving., Practical Applications: The coded dataset developed for this project will allow future researchers to have access to detailed data on driver secondary task engagement in the real world. It will be useful for standalone research, as well as for integration with additional SHRP2 data to enable the conduct of more complex research., (Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.)

Background: Citizen science, scientific research conducted by non-specialists, has the potential to facilitate biomedical research using available large-scale data, however validating the results is challenging. The Cell Slider is a citizen science project that intends to share images from tumors with the general public, enabling them to score tumor markers independently through an internet-based interface., Methods: From October 2012 to June 2014, 98,293 Citizen Scientists accessed the Cell Slider web page and scored 180,172 sub-images derived from images of 12,326 tissue microarray cores labeled for estrogen receptor (ER). We evaluated the accuracy of Citizen Scientist's ER classification, and the association between ER status and prognosis by comparing their test performance against trained pathologists., Findings: The area under ROC curve was 0.95 (95% CI 0.94 to 0.96) for cancer cell identification and 0.97 (95% CI 0.96 to 0.97) for ER status. ER positive tumors scored by Citizen Scientists were associated with survival in a similar way to that scored by trained pathologists. Survival probability at 15 years were 0.78 (95% CI 0.76 to 0.80) for ER-positive and 0.72 (95% CI 0.68 to 0.77) for ER-negative tumors based on Citizen Scientists classification. Based on pathologist classification, survival probability was 0.79 (95% CI 0.77 to 0.81) for ER-positive and 0.71 (95% CI 0.67 to 0.74) for ER-negative tumors. The hazard ratio for death was 0.26 (95% CI 0.18 to 0.37) at diagnosis and became greater than one after 6.5 years of follow-up for ER scored by Citizen Scientists, and 0.24 (95% CI 0.18 to 0.33) at diagnosis increasing thereafter to one after 6.7 (95% CI 4.1 to 10.9) years of follow-up for ER scored by pathologists., Interpretation: Crowdsourcing of the general public to classify cancer pathology data for research is viable, engages the public and provides accurate ER data. Crowdsourced classification of research data may offer a valid solution to problems of throughput requiring human input.

Endolysins are lytic enzymes encoded by bacteriophage that represent an emerging class of protein therapeutics. Considering macromolecular thermoresistance correlates with shelf life, PlyG, a Bacillus anthracis endolysin, was thermally characterized to further evaluate its therapeutic potential. Results from a biophysical thermal analysis revealed full-length PlyG and its isolated domains comprised thermal denaturation temperatures exceeding 63°C. In the absence of reducing agent, PlyG was determined to be kinetically unstable, a finding hypothesized to be attributable to the chemical oxidation of cysteine and/or methionine residues. The presence of reducing agent kinetically stabilized the endolysin, with PlyG retaining at least ~50% residual lytic activity after being heated at temperatures up to 80°C and remaining enzymatically functional after being boiled. Furthermore, the endolysin had a kinetic half-life at 50°C and 55°C of 35 and 5.5h, respectively. PlyG represents a thermostable proteinaceous antibacterial with subsequent prolonged therapeutic shelf life expectancy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In 2015, the Patient Protection and Affordable Care Act of 2010 will mandate reduced Medicare reimbursements for hospitals with Chronic Obstructive Pulmonary Disease (COPD) readmissions that are higher than expected. Several studies identified social issues as a concern and possible contributor to readmissions. This study calculated readmission rates for patients with COPD following an enhanced psychosocial assessment. With 26 participants serving as their own historical controls, a paired t-test of the mean of admissions 90 days prior to the assessment and 90 days postassessment was conducted. The study group had a significantly lower number of readmissions in the 90 days postintervention.

Introduction: Orthodontists depend on perceptions derived from education and clinical experience to judge the optimal forces in patient treatment. The purpose of this study was to survey practicing orthodontists to determine the interarch latex elastic forces they prescribe in different malocclusion scenarios., Methods: Thirty orthodontists were presented with 4 clinical scenarios on study models, including Class II and Class III malocclusions in edgewise and light wires. These orthodontists described the size and location of the elastics they would use. The forces produced by the prescribed elastics were measured and compared with actual dry forces measured on a testing machine., Results: The orthodontists' force recommendations were a mean of 277 ± 89 g and a median of 256 g (range, 132-464 g) for a Class II malocclusion with edgewise wires; a mean of 183 ± 59 g and a median of 177 g (range, 59-284 g) for a Class II malocclusion with light wires; a mean of 290 ± 83 g and a median of 305 g (range, 151-562 g) for a Class III malocclusion with edgewise wires; and a mean of 216 ± 66 g and a median of 209 g (range, 119-344 g) for a Class III malocclusion with light wires. The force levels for light wires were statistically significantly lower than for edgewise wires., Conclusions: There were considerable variations in the forces selected for all cases. "Expert" recommendations fell within 1 SD of the mean of the orthodontists' recommendations except for the light-wire Class III scenario. Since latex elastic force decays significantly during a patient's use, elastics should be selected with initially higher forces than desired., (Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

This study presents an evaluation of driver performance while text messaging via handheld mobile phones and an in-vehicle texting system. Participants sent and received text messages while driving with an experimenter on a closed-road course, using their personal mobile phones and the vehicle's system. The test vehicle was an instrumented 2010 Mercury Mariner equipped with an OEM in-vehicle system that supports text messaging and voice control of mobile devices via Bluetooth, which was modified to allow text message sending during driving. Twenty participants were tested, 11 younger (19-34) and 9 older (39-51). All participants were regular users of the in-vehicle system, although none had experience with the texting functions. Results indicated that handheld text message sending and receiving resulted in higher mental demand, more frequent and longer glances away from the roadway, and degraded steering measures compared to baseline. Using the in-vehicle system to send messages showed less performance degradation, but still had more task-related interior glance time and higher mental demand than baseline; using the system's text-to-speech functionality for incoming messages showed no differences from baseline. These findings suggest that using handheld phones to send and receive text messages may interfere with drivers' visual and steering behaviors; the in-vehicle system showed improvement, but performance was not at baseline levels during message sending., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

In a 2007 report, the US Surgeon General called for health care professionals to renew efforts to reduce underage drinking. Focusing on the adolescent patient, this review provides health care professionals with recommendations for alcohol-related screening, brief intervention, and referral to treatment. MEDLINE and published reviews were used to identify relevant literature. Several brief screening methods have been shown to effectively identify underage drinkers likely to have alcohol use disorders. After diagnostic assessment when germane, the initial intervention typically focuses on education, motivation for change, and consideration of treatment options. Internet-accessible resources providing effective brief interventions are available, along with supplemental suggestions for parents. Recent changes in federal and commercial insurance reimbursement policies provide some fiscal support for these services, although rate increases and expanded applicability may be required to prompt the participation of many practitioners. Nevertheless, advances in clinical methods and progress on reimbursement policies have made screening and brief intervention for underage drinking more feasible in general health care practice.

Beta1-containing adhesions at the plasma membrane function as dynamic complexes to provide bidirectional communication between the cell and its environment, yet commonly are used by pathogens to gain host cell entry. Recently, the cholesterol-lowering drug simvastatin was found to inhibit host invasion through beta1-containing adhesion complexes. To better understand the regulatory mechanisms controlling adhesion formation and uptake and the use of these complexes by Staphylococcus aureus, the primary etiologic agent in sepsis, bacteremia and endocarditis, we investigated the mechanism of inhibition by simvastatin. In response to simvastatin, adhesion complexes diminished as well as beta1 trafficking to the plasma membrane required to initiate adhesion formation. Simvastatin stimulated CDC42 activation and coupling to p85, a small-guanosine triphosphatase (GTPase) activating protein (GAP), yet sequestered CDC42 coupled to p85 within the cytosol. Loss of p85 GAP activity through use of genetic strategies decreased host cell invasion as well as beta1 trafficking. From these findings, we propose a mechanism whereby p85 GAP activity localized within membrane compartments facilitates beta1 trafficking. By sequestering p85 within the cytosol, simvastatin restricts the availability and uptake of the receptor used by pathogenic strains to gain host cell entry., (Copyright 2009 Elsevier Inc. All rights reserved.)