Correction: A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study.

[This corrects the article DOI: 10.2196/50146.].

A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study.

BACKGROUND: Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. OBJECTIVE: The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. METHODS: This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an "audit and feedback" process. The implementation of "Back@Home" will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. RESULTS: As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). CONCLUSIONS: This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50146.

RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol).

INTRODUCTION: Most simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based on retrospective observational studies have reported that virtual fracture clinics can deliver follow-up care that is safe and cost-effective. However, no randomised controlled trial has investigated if a virtual fracture clinic can provide non-inferior physical function outcomes compared with an in-person clinic for patients with simple fractures. METHODS AND ANALYSIS: 312 participants will be recruited from 2 metropolitan hospitals located in Sydney, Australia. Adult patients will be eligible if they have an acute simple fracture that can be managed with a removable splint and is deemed appropriate for follow-up at either the virtual or in-person fracture clinic by an orthopaedic doctor. Patients will not be eligible if they have a complex fracture that requires a cast or surgery. Eligible participants will be randomised to receive their follow-up care either at the virtual or the in-person fracture clinic. Participants at the virtual fracture clinic will be reviewed within 5 days of receiving a referral through video calls with a physiotherapist. Participants at the in-person fracture clinic will be reviewed by an orthopaedic doctor within 7-10 days of receiving a referral. The primary outcome will be the patient's function measured using the Patient-Specific Functional Scale at 12 weeks. Secondary outcomes will include health-related quality of life, patient-reported experiences, pain, health cost, healthcare utilisation, medication use, adverse events, emergency department representations and surgery. ETHICS AND DISSEMINATION: The study has been approved by the Sydney Local Health District Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The trial results will be submitted for publication in a reputable international journal and will be presented at professional conferences. TRIAL REGISTRATION NUMBER: ACTRN12623000934640.

Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study.

BACKGROUND: Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model. OBJECTIVE: We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. METHODS: We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. RESULTS: A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. CONCLUSIONS: The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.

Perfluoroalkyl Acids in Follicular Fluid and Embryo Quality during IVF: A Prospective IVF Cohort in China.

BACKGROUND: Perfluoroalkyl acids (PFAA) have been measured in ovarian follicular fluid from women using in vitro fertilization (IVF), although associations between follicular fluid PFAA and IVF outcomes have been inconsistent. OBJECTIVES: We investigated the association between follicular fluid PFAA and embryo quality in women undergoing IVF. METHODS: We prospectively enrolled 729 women undergoing IVF treatment in Guangxi province, China, from July 2018 to December 2018. We measured 32 PFAA, including branched isomers, in follicular fluid using ultra-performance liquid chromatography coupled to tandem mass spectrometry. We applied restricted cubic splines, linear regression, and log-binominal regression models to investigate associations between follicular fluid PFAA and embryo quality, adjusting for confounding variables and investigated oocyte maturity as an intervening variable using causal mediation analysis. We further estimated the overall effect of the PFAA mixture on outcomes using Bayesian kernel machine regression (BKMR). RESULTS: We detected 8 of 32 measured PFAA in >85% of follicular fluid samples. Higher PFAA concentrations were associated with fewer high-quality embryos from IVF. The high-quality embryo rates at the 50th percentile of linear perfluoro-1-octanesulfonate acid (n-PFOS), all branched PFOS isomers (Br-PFOS) and linear perfluoro-n-octanoic acid (n-PFOA) were -6.34% [95% confidence interval (CI): -9.45, -3.32%], -16.78% (95% CI: -21.98, -11.58%) and -8.66% (95% CI: -11.88, -5.43%) lower, respectively, than the high quality embryo rates at the reference 10th percentile of PFAA. Oocyte maturity mediated 11.76% (95% CI: 3.18, 31.80%) and 14.28% (95% CI: 2.95, 31.27%) of the n-PFOS and n-PFOA associations, respectively. The results of the BKMR models showed a negative association between the PFAA mixture and the probability of high-quality embryos, with branched PFOS isomers having posterior inclusion probabilities of 1 and accounting for the majority of the association. DISCUSSION: Exposure to higher PFAA concentrations in follicular fluid was associated with poorer embryo quality during IVF. Branched PFOS isomers may have a stronger effect than linear PFOS isomers. More studies are needed to confirm these findings and to directly estimate the effects on pregnancy and live-birth outcomes. https://doi.org/10.1289/EHP10857.

Management of patients with low back pain admitted to hospital: An observational study of usual care.

BACKGROUND: Knowledge gaps exist around diagnostic and treatment approaches for patients admitted to hospital with low back pain. METHODS: Medical record review of patients admitted to three Sydney teaching hospitals with a provisional emergency department diagnosis of non-serious low back pain, from 2016 to 2020. Data on demographic variables, hospital costs, length of stay (LOS), diagnostic imaging and analgesic administration were extracted. Logistic regression was used to identify predictors of longer hospital stay, advanced imaging, and concomitant use of sedating medicines. RESULTS: Median inpatient LOS for non-specific low back pain was 4 days (interquartile range [IQR] 2-7), and for radicular low back pain was 4 days (IQR 3-10). Older patients with non-serious low back pain were more likely to stay longer, as were arrivals by ambulance. Plain lumbar radiography was used in 8.3% of admissions, whereas 37.6% of patients received advanced lumbar imaging (computed tomography or magnetic resonance imaging). Opioids were administered in ~80% of admissions; 49% of patients with radicular low back pain were given an antiepileptic in addition to an opioid. In all, 18.4% of admissions resulted in at least one hospital-acquired complication, such as an accidental fall (3.1%) or a medication-related adverse effect (13.3%). Physiotherapists saw 82.6% of low back pain admissions. Costs of inpatient care were estimated at a mean of AU$ 14 000 per admission. CONCLUSIONS: We noted relatively high rates of concomitant use of sedating pain medicines and referrals for advanced lumbar imaging and laboratory tests. Strategies to address these issues in inpatient care of low back pain are needed.

Molecular-Shape-Controlled Binary to Ternary Resistive Random-Access Memory Switching of N-Containing Heteroaromatic Semiconductors.

In organic resistive random-access memory (ReRAM) devices, deeply understanding how to control the performance of π-conjugated semiconductors through molecular-shape-engineering is important and highly desirable. Herein, we design a family of N-containing heteroaromatic semiconductors with molecular shapes moving from mono-branched 1Q to di-branched 2Q and tri-branched 3Q. We find that this molecular-shape engineering can induce reliable binary to ternary ReRAM switching, affording a highly enhanced device yield that satisfies the practical requirement. The density functional theory calculation and experimental evidence suggest that the increased multiple paired electroactive nitrogen sites from mono-branched 1Q to tri-branched 3Q are responsible for the multilevel resistance switching, offering stable bidentate coordination with the active metal atoms. This study sheds light on the prospect of N-containing heteroaromatic semiconductors for promising ultrahigh-density data-storage ReRAM application.

Investigating the efficacy of attentional bias modification on individuals with spider phobia through the emotional attention network test.

OBJECTIVES: This study aimed to investigate the attention network function of spider phobics before and after attentional bias modification (ABM) through conduction of an emotional attention network test (eANT). METHODS: Scores from an eANT, an approach-avoidance task, and various scales were used to examine the training effect of a single ABM session among participants (30 individuals with spider phobia and 30 controls). RESULTS: At baseline, alertness scores in response to spider images were higher in the phobia group than in the control group (x̄ = 51.81 vs. 30.35 ms). After ABM, this score decreased in the phobia group, indicating their lower susceptibility to distraction by images of spiders. However, ABM training did not considerably alleviate their fear of and avoidance behavior toward spiders. CONCLUSION: This study elucidates the (1) vigilance-avoidance pattern among individuals with spider phobia when encountering spider-related stimuli and (2) change in underlying attentional mechanisms after ABM training.

Effective enhancement of electron migration and photocatalytic performance of nitrogen-rich carbon nitride by constructing fungal carbon dot/molybdenum disulfide cocatalytic system.

To find a cocatalyst that can replace noble metals, fungal carbon dot (CD) modified molybdenum disulfide (MoS2) cocatalyst system was designed. The composites were prepared by hydrothermal and calcination methods with different ratios of CDs, MoS2 and nitrogen-rich carbon nitride (p-C3N5). p-C3N5 has excellent electronic properties, and MoS2 modified by CDs (D-MoS2) can significantly enhance the photocatalytic performance of p-C3N5 by improving the photogenerated electron migration efficiency. The experiments showed that the developed CDs/MoS2/C3N5 composites exhibited excellent performance in both photocatalytic hydrogen (H2) evolution and methylene blue (MB) degradation, with CMSCN5 (D-MoS2 with 5% mass fraction) showing the best photocatalytic activity. The corresponding H2 evolution rate of CMSCN5 was 444 µmol g-1h-1 and 1.45 times higher than that of unmodified p-C3N5, by 120 min, the removal rate of MB was up to 93.51%. The 5 cycle tests showed that CMSCN5 had great stability. The high charge mobility and high density of H2 evolution active sites of MoS2 nanosheets, together with the electron storage and transfer properties of CDs can obviously improve electron migration and reduce the photogenerated carrier recombination on the p-C3N5 surface. The design and preparation of such composites offer broad prospects for the development of photocatalytic systems with noble metal-free cocatalysts.

Biomimetic nitrogen-rich photocatalyst based on cadmium sulfide for photocatalytic hydrogen evolution.

A novel N-rich sugarcane-like photocatalyst CdS/C3N5 (CCN) was prepared by a thermal polymerization method and tested for generating H2 and realizing antiphotocorrosive performance. The best photocatalytic H2 evolution is obtained for a CdS to C3N5 mass ratio of 1:1 (CCN3), which is nearly 33 and 3 times higher than that of pure C3N5 and CdS, respectively. CCN3 can be used to effectively reduce CdS photocorrosion and increase stability because of its N-rich performance and sugarcane-like structure, which can affect electron transport and enhance the internal binding force, respectively. CCN3 can maintain a high H2 evolution ability after 5 cycles, while still maintaining the original sugarcane-like shape, which has an anti-photocorrosive ability.

Integrated Instillation Technology for the Synthesis of a pH-Responsive Sodium Alginate/Biomass Charcoal Soil Conditioner for Controlled Release of Humic Acid and Soil Remediation.

In this work, pH-responsive gel spheres for controlled release of humic acid (CSGCHs) were prepared by an integrated instillation technology using a composite material of sodium alginate (SA) and charcoal activated carbon (CAC) as a carrier, and their slow-release performance, pH-responsive performance, and soil amendment performance were investigated. The results showed that the prepared CSGCH was uniform in size with obvious base responsiveness. Soil remediation experiments revealed that CSGCH could play a good role in the remediation of different types of soils. After 50 days of remediation, the content of nutrients and organic matter in the soil increased significantly and the pH and salt content of saline soils decreased by 15.2 and 29.8%, respectively. The plant experiment showed that CSGCH could effectively promote the growth of crops. Therefore, the prepared soil conditioner has a great potential value for improving soil conditions and promoting crop growth in agricultural applications.

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study.

OBJECTIVE: To develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery. DESIGN: Mixed-methods study outlining the development of a patient decision aid. SETTING: We assembled a multidisciplinary steering group, and used existing decision aids and decision science to draft the decision aid. Participants were recruited through social media (not restricted by country nor setting), local hospitals and the authors' collaboration network. PARTICIPANTS: People with shoulder pain and health professionals who manage people with shoulder pain. PRIMARY AND SECONDARY OUTCOMES: We interviewed participants to gather feedback on the decision aid, assessed useability and acceptability (using qualitative and quantitative methods) and performed iterative cycles of redrafting the decision aid and reinterviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively. RESULTS: We interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid acceptability as adequate-to-excellent (eg, length, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (eg, treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited divergent views among health professionals (eg, causes and symptoms of shoulder pain, evidence on benefits and harms). CONCLUSION: This decision aid could be an acceptable and valuable tool for helping people with subacromial pain syndrome make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people's intentions to undergo shoulder surgery and facilitates informed treatment choices is underway.Trial registration number ACTRN12621000992808.

Effect of CAD/CAM Guide Plate Combined With Socket-Shield Technique in Immediate Implantation of Anterior Teeth Aesthetic Area and Its Influence on Aesthetics.

PURPOSE: The purpose of this study is to discuss the effect of computer-aided design or computer-aided manufacturing (CAD/CAM) guide plate combined with socket-shield technique (SST) in immediate implantation of anterior teeth aesthetic area and its influence on aesthetics. METHODS: A total of 102 patients with immediate implantation in our hospital from March 2017 to March 2020 were selected. According to different repair methods, patients were divided into conventional group (n = 51) and observation group (n = 51). Traditional immediate implantation was performed in conventional group. The observation group underwent immediate implantation with CAD/CAM guides combined with SST. Immediately after operation and 12 months after operation, the success rate, implant deviation, periodontal index, absorption of labial bone plate, complications, aesthetic effects, and satisfaction of the two groups were observed. RESULTS: There was no significant difference in the success rate between the two groups (p > 0.05). The implant deviation values in the observation group were all lower than those in the conventional group (p < 0.05). PD, PLI, and SBI in the observation group were all lower than those in the conventional group (p < 0.05). The absorption value of labial bone plate in the observation group were all lower than those in the conventional group (p < 0.05). The total incidence of complications in the observation group (5.88%) was lower than that in the conventional group (19.61%) (p < 0.05). The PES and WES in the observation group were higher than those in the conventional group (p < 0.05). The total satisfaction in the observation group (92.16%) was higher than that in the conventional group (76.47%) (p < 0.05). CONCLUSION: : The application of CAD/CAM guide plate combined with SST in immediate implantation of anterior teeth aesthetic area has a good effect, which can improve the accuracy of implantation, improve the periodontal environment, reduce bone resorption, reduce complications, improve aesthetics, and have high patient's satisfaction.

Foundry-compatible thin film lithium niobate modulator with RF electrodes buried inside the silicon oxide layer of the SOI wafer.

Ever-increasing complexity of communication systems demands the co-integration of electronics and photonics. But there are still some challenges associated with the integration of thin film lithium niobate (TFLN) electro-optic modulators with the standard and well-established silicon photonics. Current TFLN platforms are mostly not compatible with the silicon photonics foundry process due to the choice of substrate or complicated fabrication requirements, including silicon substrate removal and formation of radio-frequency (RF) electrodes on the top of the TFLN. Here, we report on a platform where all the optical and RF waveguiding structures are fabricated first, and then the TFLN is bonded on top of the silicon photonic chip as the only additional step. Hence, the need for substrate removal is eliminated, and except for the last step of TFLN bonding, its fabrication process is silicon foundry compatible and much more straightforward compared to other fabrication methods.

Constructing CeO2/nitrogen-doped carbon quantum dot/g-C3N4 heterojunction photocatalysts for highly efficient visible light photocatalysis.

Ternary CeO2/nitrogen-doped carbon quantum dot (NCQD)/graphitic carbon nitride (g-C3N4) heterojunction nanocomposites were prepared by a high-temperature calcination and hydrothermal method and tested for degrading tetracycline (TC) and generating H2. Compared with CeO2 and g-C3N4, the Z-scheme CeO2/NCQDs/g-C3N4 (CSNx, where x represents the amount of CeO2 in wt%) nanoparticles showed a higher TC photodegradation capacity and H2 evolution ability owing to enhanced efficient charge separation and photocatalytic stability. CSN5 showed the best photodegradation activity for TC degradation (100 mL, 20 mg L-1; 100% degradation in 60 min; λ≥ 420 nm) and the highest H2 evolution rate of 1275.42 µmol h-1 g-1 was approximately 3.73- and 32.25-times higher than those of pristine g-C3N4 (341.85 µmol h-1 g-1) and pure CeO2 (39.55 µmol h-1 g-1), respectively. Superoxide (˙O2-) and hydroxyl (˙OH) radicals were also confirmed to be formed on the sample surface for TC photocatalytic degradation. As an electronic medium, NCQDs transferred electrons between the g-C3N4 and CeO2 interface to promote the electron-hole separation. This work affords a helpful perspective for synthesizing efficient charge separation and environmentally friendly photocatalysts by controlling the surface heterostructure.

No association between dietary acrylamide and renal cell carcinoma: an updated meta-analysis.

BACKGROUND: The relationship between dietary acrylamide intake and renal cell carcinoma risk is inconclusive. In consideration of the recent findings, we conducted an updated meta-analysis to assess the association between acrylamide intake and renal cell carcinoma risk. RESULTS: PubMed, EMBASE, and Cochrane databases have been used to identify epidemiological studies on dietary acrylamide intake and renal cell carcinoma risk. This meta-analysis study included eight studies, 2843 cases, and 309 920 controls/participants. We performed meta-analyses to calculate the summary relative risk (RR) for the highest versus lowest intake of dietary acrylamide. No meaningful association was found for renal cell carcinoma; RR was 1.12 (95% confidence interval (CI): 0.97-1.28). Among participants who never smoked, no association was found between dietary acrylamide and renal cell carcinoma; the RR for highest versus lowest intake of dietary acrylamide was 1.11 (95% CI: 0.93-1.32). CONCLUSION: This meta-analysis study indicates that dietary acrylamide is not related to the risk of renal cell carcinoma. © 2020 Society of Chemical Industry.

Modified Disk-Up Sinus Reamer for Sinus Floor Elevation and Simultaneous Implant Placement: An Animal Study with Miniature Pigs.

Objective: The disk-up sinus reamer (DSR) is a modified instrument used to elevate the maxillary sinus floor. This study aimed to compare the effects of modified DSR sinus floor elevation (DSFE) with osteotome sinus floor elevation (OSFE), both with simultaneous implant placement. Methods: Twelve miniature pigs were treated with DSFE on one side and OSFE on the other. Implants 9 mm in length were placed in six pigs without grafting, while implants 11 mm in length were placed in the other six pigs with grafting. After submerged healing for 3 months, vertical bone gain (VBG), general and histological observation, and bone contact ratio (BCR) were analyzed. Results: The mean maxillary residual bone height (RBH) when implants were placed was 6.45 ± 0.36 mm. In the no-grafting group, DSFE and OSFE had a similar VBG after 3 months. The grafting group with DSFE recorded a significantly higher VBG (VBG0: 7.83 ± 0.44 mm, VBG1: 7.54 ± 0.40 mm) than the graft group with OSFE (VBG0: 5.45 ± 0.56 mm, VBG1: 4.34 ± 2.15 mm) (p < 0.05). One implant became loose and the sinus mucosa of three pigs appeared metallic in color on the control side (OSFE). Conclusions: The effect of OSFE and DSFE is similar when there is no need for grafting. DSFE seems a better alternative method for sinus floor elevation with grafting when more VBG is needed.

Optogenetic Modulation of a Catalytic Biofilm for the Biotransformation of Indole into Tryptophan.

In green chemical synthesis, biofilms as biocatalysts have shown great promise. Efficient biofilm-mediated biocatalysis requires the modulation of biofilm formation. Optogenetic tools are ideal to control biofilms because light is noninvasive, easily controllable, and cost-efficient. In this study, a gene circuit responsive to near-infrared (NIR) light was used to modulate the cellular level of bis-(3'-5') cyclic dimeric guanosine monophosphate (c-di-GMP), a central regulator of the prokaryote biofilm lifestyle, which allowed the regulation of biofilm formation by using NIR light. The engineered biofilm was applied to catalyze the biotransformation of indole into tryptophan in submerged biofilm reactors and NIR-light-enhanced biofilm formation resulted in an approximately 30 % increase in tryptophan yield, which demonstrates the feasibility of the application of light to modulate the formation and performance of catalytic biofilms for chemical production. The c-di-GMP-targeted optogenetic approach to modulate catalytic biofilms showcases applications for biofilm-mediated biocatalysis.

Comparative evaluation of BioHPP and titanium as a framework veneered with composite resin for implant-supported fixed dental prostheses.

STATEMENT OF PROBLEM: High rates of veneering chipping are a common prosthodontic complication of restorations with a titanium framework. A new bio high-performance polymer (BioHPP) based on polyetheretherketone (PEEK) has been introduced for denture superstructures. Clinical reports suggest that BioHPP could be used as an alternative framework material to support complete-arch restorations. However, peer-reviewed information is lacking regarding the performance of BioHPP as a framework material for implant-supported screw-retained fixed dental prostheses (FDPs) veneered with composite resin. PURPOSE: The purpose of this in vitro study was to evaluate and compare the bond strength of modified PEEK (BioHHP) and titanium with a veneering composite resin and compare the marginal fit and fracture resistance of implant-supported screw-retained FDPs fabricated by using computer-aided design and computer-aided manufacturing (CAD-CAM) frameworks veneered with composite resin. MATERIAL AND METHODS: A composite resin was bonded to 2 framework materials (n=20/group): pure titanium (Ti) and BioHPP (Bi). The shear bond strength (SBS) was determined after 24-hour wet storage. Furthermore, 20 3-unit CAD-CAM BioHPP and titanium frameworks were fabricated (n=10/group). The marginal fit between frameworks and abutments was evaluated by scanning electron microscopy by using the single-screw test. After thermocycling and mastication simulation, the fracture resistance of FDPs veneered with the composite resin was examined. The independent sample t test was used to evaluate differences (α=.05). RESULTS: Significantly higher shear bond strengths were obtained in group Bi (31.1 ±3.5 MPa) than in group Ti (20.5 ±1.8 MPa). The mean marginal gap width was 19 ±4 µm in group Bi and 16 ±6 µm in group Ti. Statistical tests showed no significant differences (P>.05). After loading, veneering chipping was observed at a load of 1960 ±233 N in group Ti. Although the BioHPP frameworks fractured at 1518 ±134 N, no chipping occurred. CONCLUSIONS: The bond strength of BioHPP with the composite resin was greater than that of titanium. CAD-CAM BioHPP frameworks exhibit good marginal fit and fracture resistance. BioHPP may be a suitable alternative to metal as a framework to be veneered with composite resin.