Circulating Tumor DNA Assessment for Treatment Monitoring Adds Value to PSA in Metastatic Castration Resistant Prostate Cancer.

PURPOSE: Enzalutamide after abiraterone progression is commonly used in metastatic castration resistant prostate cancer (mCRPC) despite a low rate of clinical benefit. Analyzing IMbassador250, a phase III trial assessing enzalutamide with or without atezolizumab after abiraterone, we hypothesized that baseline and early changes in circulating tumor DNA (ctDNA) tumor fraction (TF) may identify patients more likely to exhibit survival benefit from enzalutamide. EXPERIMENTAL DESIGN: ctDNA was quantified from plasma samples using a tissue-agnostic assay without buffy coat sequencing. Baseline ctDNA TF, changes in ctDNA TF from baseline to cycle 3 day 1 (C3D1), and detection at C3D1 alone, were compared vs overall response rate (ORR), radiographic progression-free survival (rPFS), median OS (mOS), and 50% reduction in PSA. RESULTS: ctDNA TF detection at baseline and/or C3D1 was associated with shorter rPFS and OS in 494 evaluable patients. Detection of ctDNA TF at C3D1, with or without detection at C1D1, was associated with worse rPFS and mOS than lack of detection. When ctDNA TF and PSA response at C3D1 were discordant, patients with [ctDNA TF undetected/PSA not reduced] had more favorable outcomes than [ctDNA TF detected/PSA reduced] (mOS 22.1 months vs. 16 months, p<0.001). CONCLUSIONS: In a large cohort of mCRPC patients receiving enzalutamide after abiraterone, we demonstrate the utility of a new tissue-agnostic assay for monitoring molecular response based on ctDNA TF detection and dynamics. CtDNA TF provides a minimally-invasive, complementary biomarker to PSA testing and may refine personalized treatment approaches.

Can pyrolysis handle biomedical wastes?: Assessing the potential of various biomedical waste treatment technologies in tackling pandemics.

Globally, COVID-19 has not only caused tremendous negative health, social and economic impacts, but it has also led to environmental issues such as a massive increase in biomedical waste. The biomedical waste (BMW) was generated from centralized (hospitals, clinics, and research facilities) and extended (quarantine camps, COVID-19 test camps, and quarantined homes) healthcare facilities. Many effects, such as the possibility of infection spread, unlawful dumping/disposal, and an increase in toxic emissions by common BMW treatment facilities, are conjectured because of the rise in waste generation. However, it is also an opportunity to critically analyze the current BMW treatment scenario and implement changes to make the system more economical and environmentally sustainable. In this review, the waste disposal guidelines of the BMW management infrastructure are critically analyzed for many functional parameters to bring out possible applications and limitations of individual interventions. In addition, an investigation was made to select appropriate technology based on the environmental setting.

3D-Printable Sustainable Bioplastics from Gluten and Keratin.

Bioplastic films comprising both plant- and animal-derived proteins have the potential to integrate the optimal characteristics inherent to the specific domain, which offers enormous potential to develop polymer alternatives to petroleum-based plastic. Herein, we present a facile strategy to develop hybrid films comprised of both wheat gluten and wool keratin proteins for the first time, employing a ruthenium-based photocrosslinking strategy. This approach addresses the demand for sustainable materials, reducing the environmental impact by using proteins from renewable and biodegradable sources. Gluten film was fabricated from an alcohol-water mixture soluble fraction, largely comprised of gliadin proteins. Co-crosslinking hydrolyzed low-molecular-weight keratin with gluten enhanced its hydrophilic properties and enabled the tuning of its physicochemical properties. Furthermore, the hierarchical structure of the fabricated films was studied using neutron scattering techniques, which revealed the presence of both hydrophobic and hydrophilic nanodomains, gliadin nanoclusters, and interconnected micropores in the matrix. The films exhibited a largely (>40%) ß-sheet secondary structure, with diminishing gliadin aggregate intensity and increasing micropore size (from 1.2 to 2.2 µm) with an increase in keratin content. The hybrid films displayed improved molecular chain mobility, as evidenced by the decrease in the glass-transition temperature from ~179.7 °C to ~173.5 °C. Amongst the fabricated films, the G14K6 hybrid sample showed superior water uptake (6.80% after 30 days) compared to the pristine G20 sample (1.04%). The suitability of the developed system for multilayer 3D printing has also been demonstrated, with the 10-layer 3D-printed film exhibiting >92% accuracy, which has the potential for use in packaging, agricultural, and biomedical applications.

First-Line Ipatasertib, Atezolizumab, and Taxane Triplet for Metastatic Triple-Negative Breast Cancer: Clinical and Biomarker Results.

PURPOSE: To evaluate a triplet regimen combining immune checkpoint blockade, AKT pathway inhibition, and (nab-) paclitaxel as first-line therapy for locally advanced/metastatic triple-negative breast cancer (mTNBC). PATIENTS AND METHODS: The single-arm CO40151 phase Ib study (NCT03800836), the single-arm signal-seeking cohort of IPATunity130 (NCT03337724), and the randomized phase III IPATunity170 trial (NCT04177108) enrolled patients with previously untreated mTNBC. Triplet therapy comprised intravenous atezolizumab 840 mg (days 1 and 15), oral ipatasertib 400 mg/day (days 1-21), and intravenous paclitaxel 80 mg/m2 (or nab-paclitaxel 100 mg/m2; days 1, 8, and 15) every 28 days. Exploratory translational research aimed to elucidate mechanisms and molecular markers of sensitivity and resistance. RESULTS: Among 317 patients treated with the triplet, efficacy ranged across studies as follows: median progression-free survival (PFS) 5.4 to 7.4 months, objective response rate 44% to 63%, median duration of response 5.6 to 11.1 months, and median overall survival 15.7 to 28.3 months. The safety profile was consistent with the known toxicities of each agent. Grade ≥3 adverse events were more frequent with the triplet than with doublets or single-agent paclitaxel. Patients with PFS >10 months were characterized by NF1, CCND3, and PIK3CA alterations and increased immune pathway activity. PFS <5 months was associated with CDKN2A/CDKN2B/MTAP alterations and lower predicted phosphorylated AKT-S473 levels. CONCLUSIONS: In patients with mTNBC receiving an ipatasertib/atezolizumab/taxane triplet regimen, molecular characteristics may identify those with particularly favorable or unfavorable outcomes, potentially guiding future research efforts.

Waste to energy: Trending key challenges and current technologies in waste plastic management.

Due to the 'forever' degrading nature of plastic waste, plastic waste management is often complicated. The applications of plastic are ubiquitous and inevitable in many scenarios. Current global waste plastics production is ca. 3.5 MMT per year, and with the current trend, plastic waste production will reach 25,000 MMT by 2040. However, the rapid growth in plastic manufacture and the material's inherent nature resulted in the accumulation of a vast amount of plastic garbage. The current recycling rate is <10 %, while the large volumes of discarded plastic waste cause environmental and ecological problems. Recycling rates for plastic vary widely by region and type of plastic. In some developed countries, the recycling rate for plastics is around 20-30 %, while in many developing nations, it is much lower. These statistics highlight the magnitude of the plastic waste problem and the urgent need for comprehensive strategies to manage plastic waste more effectively and reduce its impact on the environment. This review critically analyses past studies on the essential and efficient techniques for turning plastic trash into treasure. Additionally, an attempt has been made to provide a comprehensive understanding of the plastic upcycling process, the 3Rs policy, and the life-cycle assessment (LCA) of plastic conversion. The review advocates pyrolysis as one of the most promising methods of turning plastic trash into valuable chemicals. In addition, plastic waste management can be severely impacted due to uncontrollable events, such as Covid 19 pandemic. Recycling and chemical upcycling can certainly bring value to the end-of-life plastic. However, the LCA analysis indicated there is still a huge scope for innovation in chemical upcycling area compared to mechanical recycling. The formulation of policies and heightened public participation could play a pivotal role in reducing the environmental repercussions of plastic waste and facilitating a shift towards a more sustainable future.

Wood biochar enhances methanogenesis in the anaerobic digestion of chicken manure under ammonia inhibition conditions.

The process of breaking down chicken manure through anaerobic digestion is an effective waste management technology. However, chicken manure can be a challenging feedstock, causing ammonia stress and digester instability. This study examined the impacts of adding wood biochar and acid-alkali-treated wood biochar to anaerobically digest chicken manure under conditions of ammonia inhibition. The results highlighted that only the addition of 5 % acid-alkali-treated wood biochar by volume can achieve cumulative methane production close to the typical methane potential range of chicken manure. The treated wood biochar also exhibited highest total ammonia nitrogen removal compared to the Control treatment. Scanning Electron Microscope revealed growing interactions between biochar and methanogens over time. Real-time polymerase chain reaction showed that treated wood biochar produced the highest number of bacterial biomass. In addition, 16S amplicon-based sequencing identified a more robust archaeal community from treated biochar addition. Overall, the acid-alkali treatment of biochar represents an effective method of modifying biochar to improve its performance in anaerobic digestion.

Is There a Critical Dorsal Lunate Facet Size in Distal Radius Fractures That Leads to Dorsal Carpal Subluxation? A Biomechanical Study of the Dorsal Critical Corner.

PURPOSE: Intra-articular distal radius fractures are common and can be associated with carpal instability. Failure to address articular fragments linked to maintaining carpal stability can lead to radiocarpal subluxation or dislocation. The purpose of this study was to evaluate the size of a dorsal osteotomy in the dorsal/volar plane of the lunate facet that leads to dorsal carpal subluxation. METHODS: Dorsal lunate facet fractures were simulated twice in each of nine fresh-frozen cadavers. After completing a partial dorsal osteotomy in the radial/ulnar plane between the scaphoid and lunate facets, an osteotomy in the dorsal/volar plane was completed. Using a cutting jig, first an estimated 5-mm osteotomy, and then a 10-mm osteotomy (from the dorsal rim of the distal radius) were completed. The wrist was mounted in a custom jig and loaded with 100 N. Displacement of the lunate in the dorsal/volar plane compared with displacement in an intact specimen was evaluated and used to assess carpal subluxation. RESULTS: Lunate translation was 0 mm ± 0 mm in the intact state. The 5-mm osteotomy averaged 29% of the distal radius dorsal lunate facet in the dorsal/volar plane, and lunate translation was 0.7 mm ± 1.7 mm. The 10-mm osteotomy averaged 54% of the dorsal lunate facet in the dorsal/volar plane, and lunate translation was 2.8 mm ± 2.6 mm. Assuming a linear relationship from the osteotomies created, an osteotomy of an estimated ≥40% of the distal radius in the dorsal to volar plane resulted in substantial dorsal subluxation, although this specific osteotomy was not assessed in our study. CONCLUSIONS: Sequentially increased dorsal osteotomies of the dorsal lunate facet result in increased dorsal carpal subluxation. CLINICAL RELEVANCE: Distal radius fractures that include >40% of the "dorsal critical corner" are at risk for dorsal carpal subluxation and may require supplementary fixation.

A study of biochar physiochemistry and particle size distribution influencing the properties of water-based slurry fuels.

Biochar-based slurry is a fossil-free-liquid fuel derived from a renewable source, biomass. This study aims to examine the properties of this fuel as an alternative to coal-water slurries. The slurries were produced by suspending 40 wt% biochar in a solution made of water and a surfactant. Two biochar types from chemically treated and untreated rice straw (RS) were utilized to assess the impact of particle-particle interactions and biochar physicochemical composition on slurry properties, including stability, rheology, and heating value. Additionally, three particle size distributions (PSD), two unimodal and a bimodal, were used to analyze the effect of PSD on the abovementioned properties. All slurries had an average energy content of 7.32 ± 0.27 MJ/kg. The stability of the slurry was higher for fine particles from treated RS with unimodal PSD (Dv50 8.8 ± 0.68 µm). However, slurries containing fine and coarse particles with bimodal PSD (Dv50 15.8 ± 0.64 µm) had relatively lower apparent viscosities of 342.1 and 336.55 mPa.s at a shear rate of 100 s-1 for slurries made of biochar from treated and untreated RS, respectively. Slurries containing coarse particles from treated and untreated RS with unimodal PSD (Dv50 18.6 ± 0.32 µm) led to higher viscosities and particle settling rates. Biochar morphology and chemical surface constitution significantly influenced slurry stability, while PSD greatly impacted rheological results.

Failure of humeral shaft fixation: construct characteristics.

PURPOSE: Fixation failure following open reduction and internal fixation (ORIF) of humeral shaft fractures can be a challenging complication. We aimed to identify the modes of failure and characteristics of failed fixation constructs. METHODS: We queried our institutional database for patients > 18 years old with fixation failure after ORIF with single plate and screw constructs of humeral shaft fractures from 2006 to 2017. Demographics, fracture characteristics, fixation construct design and mode of failure were recorded. RESULTS: Twenty-three failures were identified. Mean age was 55.9 years (SD 19.2 years) with 15 (65%) women. Twelve patients (52%) had midshaft fractures; the remainder had distal-third shaft (8 pts, 35%) or proximal-third shaft (3 pts, 13%) fractures. Midshaft fractures were most commonly fixed through an anterolateral approach with plates and all non-locking screws (83%), while distal-third shaft fractures were fixed with a combination of locking and non-locking screws from a posterior approach. Distal-third shaft fractures failed by plate breakage (63%) or screw pullout (38%) and all midshaft failures occurred by screw pullout proximal (92%) or distal (8%) to the fracture. Resultant varus deformity occurred in 20 (87%) fractures. CONCLUSION: Screw pullout in midshaft fractures suggests that fixation to bone was insufficient or biomechanically disadvantageous. Varus moments contribute significantly to the failure of humeral shaft fracture ORIF. Plate breakage in distal fractures suggests high concentrations of stress over a narrow working length of constructs with inadequate plate strength. Recognizing how these constructs fail can aid proper implant selection and application for humeral shaft fracture. LEVEL OF EVIDENCE: Treatment level IV.

Synthesis and application of manganese-doped zinc oxide as a potential adsorbent for removal of Congo red dye from wastewater.

Synthetic dyes are considered toxic compounds and as such are not easily removed by conventional water treatment processes. This study demonstrated the synthesis of pure and manganese- (Mn), silver- (Ag), and iron- (Fe) doped zinc oxide (ZnO) nanoparticles via the wet chemical route. In particular, it investigated the batch adsorption studies and physiochemical properties of synthesized pure and doped ZnO materials for removing toxic congo red (CR) dye. X-ray diffraction (XRD), Raman spectroscopy, and energy-dispersive X-ray spectroscopy (EDS) confirmed the synthesis of the pure and doped ZnO materials. The batch adsorption investigation revealed adsorption efficiencies of 99.4% for CR dye at an optimal dose of 0.03 g/30 ml for Mn-doped ZnO at a solution pH of 2. The adsorption capacity of each of the synthesized materials was found to be in order Mn-doped ZnO (232.5 mg/g) > Ag-doped ZnO (222.2 mg/g) > pure ZnO (212.7 mg/g) > Fe-doped ZnO (208.3 mg/g). Both pseudo-second-order kinetics model and the Langmuir isotherm model accurately explained the adsorption behaviors of CR dye. As such, Van der Waal interactions, H-bonding, and electrostatic interaction were found to be the adsorption mechanisms responsible for dye removal. In addition, the desorption-regeneration investigation indicated the successful reuse of the exhausted Mn-doped ZnO material for five cycles of CR dye adsorption with an efficiency of 83.1%. Overall, this study has demonstrated that Mn-doped ZnO could be considered a viable adsorbent for the cleanup of dye-contaminated water.

Antegrade Fixation of Distal Metaphyseal Ulnar Shortening Osteotomy.

The ulnar shortening osteotomy (USO) is a common procedure used to treat ulnar impaction syndrome secondary to static or dynamic ulnar-positive variance. There are many described techniques for the USO. The distal metaphyseal ulnar shortening osteotomy (DMUSO) with retrograde cannulated screw fixation was described to reduce complications seen with other techniques. Biomechanical analysis of fixation constructs demonstrates 2-screw constructs are significantly stiffer than 1 screw and antegrade constructs have similar or greater stiffness when compared with retrograde constructs. Here, we describe a technique of antegrade cannulated screw fixation for DMUSO that obviates the need for the disruption of the distal radioulnar joint for intra-articular exposure of the ulnar head. Similar to the traditional retrograde DMUSO technique, this construct may also decrease the risk of delayed union, symptomatic implants associated with diaphyseal osteotomies, and disruption of triangular fibrocartilaginous complex in wafer procedures.

Green synthesis of zinc oxide nanoparticles using lychee peel and its application in anti-bacterial properties and CR dye removal from wastewater.

In nanoscience and nanobiotechnology, using plant extracts in synthesizing metal nanoparticles (NPs) has recently come to light as an exciting opportunity with several benefits over traditional physicochemical methods. In the present work, zinc oxide (ZnO) based nanoparticles (NPs) were synthesized by green chemistry route using lychee peel extract to capture hazardous congo red dye from wastewater and illustrate their antimicrobial behavior. The X-Ray Diffraction (XRD) spectra confirm the wurtzite crystal structure, and Fourier Transform Infrared (FTIR) spectra confirm the functional group in ZnO, which is suitable for dye adsorption. It was found that the NPs were spherical and had a size of <10 nm. The synthesized ZnO NPs could effectively remove >98% of CR dye from wastewater within 120 min of contact time at a wide pH range from 2 to 10. The primary mechanism involved in removing dye was the electrostatic interaction between ZnO adsorbent and CR dye. The antimicrobial performance of synthesized ZnO NPs was found to show 34% inhibition against Bacillus subtilis (ATCC 6538), 52% against Escherichia coli (ATCC 11103), 58% against Pseudomonas aeruginosa (ATCC 25668) and 32% against Staphylococcus aureus (ATCC 25923) using well diffusion assay. ZnO demonstrates a suitable anti-bacterial property over both gram-positive and gram-negative pathogenic bacteria. Overall, the green synthesized method for developing ZnO NPs shows promising and significant anti-bacterial performance and is a highly potential adsorbent for removing CR dye from wastewater.

Is Hand Surgery in the Procedure Room Setting Associated With Increased Surgical Site Infection? A Cohort Study of 2,717 Patients in the Veterans Affairs Population.

PURPOSE: Procedure rooms (PRs) are increasingly used for hand surgeries, but few studies have directly compared surgical site infection (SSI) rates between the PR and operating room. We tested the hypothesis that procedure setting is not associated with an increased SSI incidence in the VA population. METHODS: We identified carpal tunnel, trigger finger, and first dorsal compartment releases performed at our VA institution from 1999 to 2021 of which 717 were performed in the main operating room and 2,000 were performed in the PR. The incidence of SSI, defined as signs of wound infection within 60 days of the index procedure, which was treated with oral antibiotics, intravenous antibiotics, and/or operating room irrigation and debridement, was compared. We constructed a multivariable logistic regression analysis to assess the association between procedure setting and SSI incidence, adjusting for age, sex, procedure type, and comorbidities. RESULTS: Surgical site infection incidence was 55/2,000 (2.8%) in the PR cohort and 20/717 (2.8%) in the operating room cohort. In the PR cohort, five (0.3%) cases required hospitalization for intravenous antibiotics of which two (0.1%) cases required operating room irrigation and debridement. In the operating room cohort, two (0.3%) cases required hospitalization for intravenous antibiotics of which one (0.1%) case required operating room irrigation and debridement. All other SSIs were treated with oral antibiotics alone. The procedure setting was not independently associated with SSI (adjusted odds ratio, 0.84 [95% confidence interval, 0.49, 1.48]). The only risk factor for SSI was trigger finger release (odds ratio, 2.13 [95% confidence interval, 1.32, 3.48] compared with carpal tunnel release), which was independent of setting. CONCLUSIONS: Minor hand surgeries can be performed safely in the PR without an increased rate of SSI. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Development of a ZnOS+C Composite as a Potential Adsorbent for the Effective Removal of Fast Green Dye from Real Wastewater.

Wastewater treatment is becoming increasingly important due to the potential shortage of pure drinking water in many parts of the world. Adsorption offers a potential technique for the uptake of contaminants and wastewater purification. In the last two decades, several efforts have been made to remove fast green (FG) dye from wastewater via different adsorbent materials. However, adsorption capacity shown by these adsorbents is low and time-consuming. Herein, we have synthesized for the first time a new powdered adsorbent ZnOS+C, modified zinc peroxide with sulfur and activated carbon to effectively remove FG dye from wastewater. Results of batch adsorption experiments have suggested that ZnOS+C has the maximum adsorption potential of 238.28 mg/g for FG dye within 120 min of adsorption equilibrium for a wide range of pH ranging from 2 to 10 pH. The adsorption process conforms to the Freundlich isotherm model, suggesting a multilayered adsorption process on the outer surface of ZnOS+C. The adsorption kinetics study indicates that the kinetics of the reaction are the intraparticle diffusion model. Briefly, this study shows proof of the application of ZnOS+C powder as a new eco-friendly adsorbent with extremely high efficiency and high surface area for removing FG dye.

Helping Surgeons' Hands: A Biomechanical Evaluation of Ergonomic Instruments.

PURPOSE: "Ergonomic" is a common descriptor for a desk or computer workspace but is a term rarely used to describe a surgical instrument. Instead, surgeons spend many hours in inconvenient positions, often using instruments that are not ergonomic. Improving the ergonomics of surgical instruments may decrease the required force for simple tasks and allow for more efficient surgery. METHODS: To evaluate the impact of ergonomic surgical instruments, the authors developed ergonomic screwdriver handles. The shape and size of these handles were engineered using previous dental studies and 3-dimensional modeling to create an ideal handle for specific glove sizes. Participants were recruited to test 3 different ergonomic handle sizes against a standard screwdriver while assessing digital peak force, digital contact area, and participant preference. Ten participants (3 women) with glove sizes ranging from 6 to 8 were evaluated. RESULTS: Ergonomic screwdriver handles sized for glove sizes 6 and 7 required significantly less thumb peak force than the standard screwdriver for all participants (702 N for glove size 6 and 567 N for glove size 7 ergonomic screwdrivers, vs 1780 N for "one size fits all" standard screwdriver). Participants consistently preferred screwdrivers that required lower thumb and index finger forces. All ergonomic handles required lower thumb and index finger force. Eighty percent of participants preferred a screwdriver modeled within 1 glove size of their own. CONCLUSIONS: Improved ergonomic handles require less force and are preferred by surgeons. CLINICAL RELEVANCE: The significant decrease in thumb peak force for glove sizes 6 and 7 suggests that there is room for ergonomic improvement in instruments, especially for surgeons with smaller hands. Manufacturing ergonomic screwdriver handles and using the evolving convenience of 3-dimensional printing may help to develop a more comfortable work environment for surgeons.

Production of H2 and CNM from biogas decomposition using biosolids-derived biochar and the application of the CNM-coated biochar for PFAS adsorption.

Anaerobic digestion is a popular unit operation in wastewater treatment to degrade organic contaminants, thereby generating biogas (methane-rich gas stream). Catalytic decomposition of the biogas could be a promising upcycling approach to produce renewable hydrogen and sequester carbon in the form of carbon nanomaterials (CNMs). Biosolids are solid waste generated during the wastewater treatment process, which can be valorised to biochar via pyrolysis. This work demonstrates the use of biosolids-derived biochar compared with ilmenite as catalysts for biogas decomposition to hydrogen and CNMs. Depending on the reaction time, biosolids-derived biochar achieved a CH4 and CO2 conversion of 50-70 % and 70-90 % at 900 °C with a weight hourly space velocity (WHSV) of 1.2 Lg-1h-1. The high conversion rate was attributed to the formation of amorphous carbon on the biochar surface, where the carbon deposits acted as catalysts and substrates for the further decomposition of CH4 and CO2. Morphological characterisation of biochar after biogas decomposition revealed the formation of high-quality carbon nanospheres (200-500 nm) and carbon nanofibres (10-100 nm) on its surface. XRD pattern and Raman spectroscopy also signified the presence of graphitic structures with ID/IG ratio of 1.19, a reduction from 1.33 in the pristine biochar. Finally, the produced CNM-loaded biochar was tested for PFAS adsorption from contaminated wastewater. A removal efficiency of 79 % was observed for CNM-coated biochar which was 10-60 % higher than using biochar and ilmenite alone. This work demonstrated an integrated approach for upcycling waste streams generated in wastewater treatment facilities.

What Program Characteristics Are Associated with Resident Racial Diversity in Orthopaedic Surgery? An Analysis of Association of American Medical Colleges Data.

In orthopaedic surgery, there are fewer Black or African American (4%) and Hispanic or Latino (4%) residents compared with general surgery, internal medicine, family medicine, and pediatrics (5%-7% Black residents and 7%-9% Hispanic/Latino residents, respectively). There are also fewer underrepresented in medicine minority (URiM) faculty in orthopaedic surgery (6.1%) compared with general surgery (8.9%), otolaryngology (7.8%), internal medicine (9.7%), and obstetrics and gynecology (15.6%). Identifying program characteristics that are associated with the percentage of URiM residents could reveal strategies for improving diversity. Methods: Using Association of American Medical Colleges orthopaedic resident and faculty race/ethnicity data from 2007 to 2016, we analyzed the racial diversity of 166 of 207 residency programs. The primary outcome was program racial diversity, measured as the percentage of URiM residents per program. The top quartile of programs was compared with the other quartiles. Characteristics analyzed included percentage of URiM faculty, affiliation with a university/top 40 medical school/top 40 orthopaedic hospital, geographic region, city type, and city size. We used a multivariable linear regression model to evaluate program characteristics associated with diversity and a linear mixed-effects model with program-specific random effects to evaluate time trends. Results: The mean percentage of URiM residents per program was 9.3% (SD = 10.5%). In the top quartile of programs, URiM residents composed 20.7% ± 2.5% of the program compared with 5.8% ± 0.3% in other quartiles (p < 0.001). After adjusting for program and faculty size, the only factor associated with the number of URiM residents per program was the number of URiM faculty. For every 5 additional URiM faculty members, there was an associated increase in the number of URiM residents per program by 3.6 (95% confidence interval [CI]: 2.3-5.0). There was a small but statistically significant annual increase in the percentage of URiM residents per program of 0.207 (95% CI: 0.112-0.302) percentage points during the study period. Conclusion: URiM representation remains low among orthopaedic residents. Efforts to increase the URiM faculty base represent a potential strategy for programs to increase URiM representation among residents by attracting more diverse applicants.

Investigations into valorisation of trade wastewater for biomethane production.

Biogas production from wastewater is one way that industrial sites can work towards the UN Sustainable Development Goals, while recovering a valuable resource. The objective of this study was to investigate the suitability of data collected by municipal wastewater service providers as a method of classifying and screening waste producers as potential sites for biogas resource recovery by anaerobic digestion. Industrial wastewater samples, including raw effluent and treated waste ready for discharge, were examined, and biomethane potential assays performed. Results of chemical analysis and lab-scale digestion were compared to historical service provider data, and patterns were observed. Biomethane yields of up to 357 mL/gVS and 287mL/gVS were achieved from raw and treated effluent respectively. Digestion at the top four prospects could produce over 4690 GJ of methane and save $47,000 in natural gas costs, offsetting 490 tonnes of CO2 equivalent annually. These streams, from logistics, waste management, food and animal product businesses, combined high levels of degradable substrates and low levels of inhibitory components. While it is unlikely that this type of screening program can be completely accurate, certain parameters, including high sodium concentration, are applicable for discounting the potential for biogas production. This knowledge can be a valuable tool in the process of selecting sites for future resource recovery, therefore increasing the uptake of these processes, resulting in economic, environmental, and climate change mitigation benefits.

Distal Metaphyseal Ulnar Shortening Osteotomy Fixation: A Biomechanical Analysis.

PURPOSE: Ulnar shortening osteotomy can be used to treat ulnar impaction syndrome and other causes of ulnar wrist pain. Distal metaphyseal ulnar shortening osteotomy (DMUSO) is one technique that has been proposed to reduce the complications seen with a diaphyseal USO or a wafer resection. However, to our knowledge, the optimal fixation construct for DMUSO has not been studied. We sought to characterize the biomechanical stiffness and rotational stability of different DMUSO constructs. METHODS: A DMUSO was performed on 40 human cadaveric ulnas using 4 different fixation constructs (10 specimens per group): one 3.0 mm antegrade screw; two 2.2 mm antegrade screws; one 3.0 mm retrograde screw; and two 2.2 mm retrograde screws. Biaxial testing using axial load and cyclical axial torque was performed until failure, defined as 10° of rotation or 2 mm displacement. Specimens were assessed for stiffness at failure. Bone density was assessed using the second metacarpal cortical percentage. RESULTS: Bone density was similar between all 4 testing groups. Of the 4 groups, the 2 antegrade screw group exhibited the highest rotational stiffness of 232 ± 102 Nm/deg. In paired analysis, this was significantly greater than 1 retrograde screw constructs. In multivariable analysis, 2-screw constructs were significantly stiffer than 1 screw and antegrade constructs were significantly stiffer than retrograde. Maximum failure torque did not differ with orientation, but 2 screws failed at significantly higher torques. CONCLUSION: Using 2 screws for DMUSO fixation constructs may provide higher stiffness and maximum failure torque, and antegrade screw constructs may provide more stiffness than retrograde constructs. CLINICAL RELEVANCE: Antegrade screw fixation using 2 screws may provide the strongest construct for DMUSO. Antegrade fixation may be preferred because it avoids violating the distal radioulnar joint capsule and articular surface of the ulna.