Femorotibial angle scan-rescan reproducibility: A high-precision calculation on a large cohort.

PURPOSE: Femorotibial angle (FTA) is a convenient measure of coronal knee alignment that can be extracted from a short knee radiograph, avoiding the additional radiation exposure and specialist equipment required for full-leg radiographs. While intra- and inter-reader reproducibility from the same image has been reported, the full scan-rescan reproducibility across images, as calculated in this study, has not. METHODS: In this study, 4589 FTA measurement pairs from 2586 subjects acquired a year apart were used to estimate FTA scan-rescan reproducibility using data from the Osteoarthritis Initiative. Subjects with radiographic progression of osteoarthritis or other conditions that may cause a change in coronal knee alignment were excluded. Measurement pairs were analysed using paired-samples  t $t$ tests to detect differences and compared to symptomatic changes in Western Ontario and McMaster Universities Arthritis Index scores for joint pain, stiffness and physical function to detect correlations. RESULTS: The 95% limit of agreement and the paired-samples correlation were calculated with high precision to be [-1.76°, +1.78°] and 0.938, considerably worse than the corresponding figures for intra- and inter-reader reproducibility, without relation to symptomatic or radiographic changes in knee condition. This error will weakly attenuate R 2 ${R}^{2}$ and r $r$ values from their true values in correlative studies involving FTA. The realistic maximum value for R 2 ${R}^{2}$ is 87% and for Pearson's r $r$ is 93%. CONCLUSION: The scan-rescan reproducibility in FTA is almost double the intra- and inter-reader reliability from a single scan. At almost ±2° accuracy, FTA is inappropriate for surgical use, but it is sufficiently reproducible to produce good correlations in studies predicting disease incidence and progression. LEVEL OF EVIDENCE: Level II, retrospective study.

Single-Shot Diagnosis of Electron Energy Evolution via Streaked Betatron X Rays in a Curved Laser Wakefield Accelerator.

We report on an experimental observation of the streaking of betatron x rays in a curved laser wakefield accelerator. The streaking of the betatron x rays was realized by launching a laser pulse into a plasma with a transverse density gradient. By controlling the plasma density and the density gradient, we realized the steering of the laser driver, electron beam, and betatron x rays simultaneously. Moreover, we observed an energy-angle correlation of the streaked betatron x rays and utilized it in diagnosing the electron acceleration process in a single-shot mode. Our work could also find applications in advanced control of laser beam and particle propagation. More importantly, the angular streaked betatron x ray has an intrinsic spatiotemporal correlation, which makes it a promising tool for single-shot pump-probe applications.

Active osseointegration in an ex vivo porcine bone model.

Achieving osseointegration is a fundamental requirement for many orthopaedic, oral, and craniofacial implants. Osseointegration typically takes three to 6 months, during which time implants are at risk of loosening. The aim of this study was to investigate whether osseointegration could be actively enhanced by delivering controllable electromechanical stimuli to the periprosthetic bone. First, the osteoconductivity of the implant surface was confirmed using an in vitro culture with murine preosteoblasts. The effects of active treatment on osseointegration were then investigated in a 21-day ex vivo model with freshly harvested cancellous bone cylinders (n = 24; Ø10 mm × 5 mm) from distal porcine femora, with comparisons to specimens treated by a distant ultrasound source and static controls. Cell viability, proliferation and distribution was evident throughout culture. Superior ongrowth of tissue onto the titanium discs during culture was observed in the actively stimulated specimens, with evidence of ten-times increased mineralisation after 7 and 14 days of culture (p < 0.05) and 2.5 times increased expression of osteopontin (p < 0.005), an adhesive protein, at 21 days. Moreover, histological analyses revealed increased bone remodelling at the implant-bone interface in the actively stimulated specimens compared to the passive controls. Active osseointegration is an exciting new approach for accelerating bone growth into and around implants.

Narrow bandwidth, low-emittance positron beams from a laser-wakefield accelerator.

The rapid progress that plasma wakefield accelerators are experiencing is now posing the question as to whether they could be included in the design of the next generation of high-energy electron-positron colliders. However, the typical structure of the accelerating wakefields presents challenging complications for positron acceleration. Despite seminal proof-of-principle experiments and theoretical proposals, experimental research in plasma-based acceleration of positrons is currently limited by the scarcity of positron beams suitable to seed a plasma accelerator. Here, we report on the first experimental demonstration of a laser-driven source of ultra-relativistic positrons with sufficient spectral and spatial quality to be injected in a plasma accelerator. Our results indicate, in agreement with numerical simulations, selection and transport of positron beamlets containing N e + ≥ 10 5 positrons in a 5% bandwidth around 600 MeV, with femtosecond-scale duration and micron-scale normalised emittance. Particle-in-cell simulations show that positron beams of this kind can be guided and accelerated in a laser-driven plasma accelerator, with favourable scalings to further increase overall charge and energy using PW-scale lasers. The results presented here demonstrate the possibility of performing experimental studies of positron acceleration in a laser-driven wakefield accelerator.

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants.

Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant-cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.

Dephasingless plasma wakefield photon acceleration.

Sandberg and Thomas [Phys. Rev. Lett. 130, 085001 (2023)0031-900710.1103/PhysRevLett.130.085001] proposed a scheme to generate ultrashort, high-energy pulses of XUV photons though dephasingless photon acceleration in a beam-driven plasma wakefield. An ultrashort laser pulse is placed in the plasma wake behind a relativistic electron bunch such that it experiences a comoving negative density gradient and therefore shifts up in frequency. Using a tapered density profile provides phase-matching between driver and witness pulses. In this paper, we give the details of the wakefield solutions and phase-matching conditions used to generate the phase-matching density profile. The short, high-density, and weak driver limits are considered. We show, explicitly, the numerical algorithm used to calculate the density profiles.

Retrospective Analysis of Pelvic Limb Fracture Management in Companion Psittacine Birds (60 Cases).

Pelvic limb fractures carry significant morbidity in avian patients, and although management options are well researched, published data on long-term complication rates and mortality outcomes are limited. Here, we present a cross-sectional study evaluating pelvic limb long bone fractures in companion psittacine birds presenting to an exotic-only veterinary hospital in the United Kingdom between 2005 and 2020, focusing on fixation techniques and long-term outcomes. Of the 60 cases that met the inclusion criteria, 22 separate species were represented, with an age range of 8 weeks to 25 years and an even distribution of sexes, among those that had been sexed. The majority of fractures (71.7%) were tibiotarsal; femoral (15%) and tarsometatarsal (13.3%) bones represented the other fracture sites. Several different fracture management methods were used, including external coaptation, surgery, or cage rest. Average time from fracture identification to healing was 33 days, with a median of 31 days and a range of 11-121 days. Satisfactory resolution of fracture repair was achieved in 85.5% (47/55) of cases that were able to be followed to conclusion. Complications were identified in 41.7% (25/60) of fractures of all pelvic long bones. Complications during fracture management were more common in cases treated with external coaptation. The most common complication reported was patient interference with bandages, splints, or both. This study provides an overview of pelvic limb long bone fracture management outcomes, which should prove useful for avian practitioners in clinical practice.

Electromechanical and biological evaluations of 0.94Bi0.5Na0.5TiO3-0.06BaTiO3 as a lead-free piezoceramic for implantable bioelectronics.

Smart implantable electronic medical devices are being developed to deliver healthcare that is more connected, personalised, and precise. Many of these implantables rely on piezoceramics for sensing, communication, energy autonomy, and biological stimulation, but the piezoceramics with the strongest piezoelectric coefficients are almost exclusively lead-based. In this article, we evaluate the electromechanical and biological characteristics of a lead-free alternative, 0.94Bi0.5Na0.5TiO3-0.06BaTiO3 (BNT-6BT), manufactured via two synthesis routes: the conventional solid-state method (PIC700) and tape casting (TC-BNT-6BT). The BNT-6BT materials exhibited soft piezoelectric properties, with d33 piezoelectric coefficients that were inferior to commonly used PZT (PIC700: 116 pC/N; TC-BNT-6BT: 121 pC/N; PZT-5A: 400 pC/N). The material may be viable as a lead-free substitute for soft PZT where moderate performance losses up to 10 dB are tolerable, such as pressure sensing and pulse-echo measurement. No short-term harmful biological effects of BNT-6BT were detected and the material was conducive to the proliferation of MC3T3-E1 murine preosteoblasts. BNT-6BT could therefore be a viable material for electroactive implants and implantable electronics without the need for hermetic sealing.

Predicting hip-knee-ankle and femorotibial angles from knee radiographs with deep learning.

BACKGROUND: Knee alignment affects the development and surgical treatment of knee osteoarthritis. Automating femorotibial angle (FTA) and hip-knee-ankle angle (HKA) measurement from radiographs could improve reliability and save time. Further, if HKA could be predicted from knee-only radiographs then radiation exposure could be reduced and the need for specialist equipment and personnel avoided. The aim of this research was to assess if deep learning methods could predict FTA and HKA angle from posteroanterior (PA) knee radiographs. METHODS: Convolutional neural networks with densely connected final layers were trained to analyse PA knee radiographs from the Osteoarthritis Initiative (OAI) database. The FTA dataset with 6149 radiographs and HKA dataset with 2351 radiographs were split into training, validation, and test datasets in a 70:15:15 ratio. Separate models were developed for the prediction of FTA and HKA and their accuracy was quantified using mean squared error as loss function. Heat maps were used to identify the anatomical features within each image that most contributed to the predicted angles. RESULTS: High accuracy was achieved for both FTA (mean absolute error 0.8°) and HKA (mean absolute error 1.7°). Heat maps for both models were concentrated on the knee anatomy and could prove a valuable tool for assessing prediction reliability in clinical application. CONCLUSION: Deep learning techniques enable fast, reliable and accurate predictions of both FTA and HKA from plain knee radiographs and could lead to cost savings for healthcare providers and reduced radiation exposure for patients.

Heterotopic Ossification Bone Formation in the Frontal Bones of an African Grey Parrot (Psittacus erithacus).

A 5-year-old, male African grey parrot (Psittacus erithacus) was presented with multiple, slow-growing, firm, bilateral masses around the dorsal orbital rims. Computer tomographic imaging revealed mild, incomplete bridging bone formation on the rostrodorsal aspects of the head. A moderate amount of smooth bone formation was identified at the rostrodorsal aspect to the left orbit, with minimal associated soft tissue swelling. Surgical biopsies were collected from the masses and histopathological analysis of the most rostral right mass showed well-differentiated bone, surrounded by dense fibrous connective tissue. Scattered, well-differentiated osteocytes were present within the bone. No evidence of neoplastic changes or infectious agents were identified. The histopathological changes were consistent with metaplastic bone formation. History obtained from the owner revealed recent head trauma, which likely induced the cranial heterotopic ossification in the African grey parrot.

Observation of Monoenergetic Electrons from Two-Pulse Ionization Injection in Quasilinear Laser Wakefields.

The generation of low emittance electron beams from laser-driven wakefields is crucial for the development of compact x-ray sources. Here, we show new results for the injection and acceleration of quasimonoenergetic electron beams in low amplitude wakefields experimentally and using simulations. This is achieved by using two laser pulses decoupling the wakefield generation from the electron trapping via ionization injection. The injection duration, which affects the beam charge and energy spread, is found to be tunable by adjusting the relative pulse delay. By changing the polarization of the injector pulse, reducing the ionization volume, the electron spectra of the accelerated electron bunches are improved.

Photon Acceleration from Optical to XUV.

The propagating density gradients of a plasma wakefield may frequency upshift a trailing witness laser pulse, a process known as "photon acceleration." In uniform plasma, the witness laser will eventually dephase because of group delay. We find phase-matching conditions for the pulse using a tailored density profile. An analytic solution for a 1D nonlinear plasma wake with an electron beam driver indicates that, even though the plasma density decreases, the frequency shift reaches no asymptotic limit, i.e., is unlimited provided the wake can be sustained. In fully self-consistent 1D particle-in-cell (PIC) simulations, more than 40 times frequency shifts were demonstrated. In quasi-3D PIC simulations, frequency shifts up to 10 times were observed, limited only by simulation resolution and nonoptimized driver evolution. The pulse energy increases in this process, by a factor of 5, and the pulse is guided and temporally compressed by group velocity dispersion, resulting in the resulting extreme ultraviolet laser pulse having near-relativistic (a_{0}∼0.4) intensity.

Bioreactor analyses of tissue ingrowth, ongrowth and remodelling around implants: An alternative to live animal testing.

Introduction: Preclinical assessment of bone remodelling onto, into or around novel implant technologies is underpinned by a large live animal testing burden. The aim of this study was to explore whether a lab-based bioreactor model could provide similar insight. Method: Twelve ex vivo trabecular bone cylinders were extracted from porcine femora and were implanted with additively manufactured stochastic porous titanium implants. Half were cultured dynamically, in a bioreactor with continuous fluid flow and daily cyclic loading, and half in static well plates. Tissue ongrowth, ingrowth and remodelling around the implants were evaluated with imaging and mechanical testing. Results: For both culture conditions, scanning electron microscopy (SEM) revealed bone ongrowth; widefield, backscatter SEM, micro computed tomography scanning, and histology revealed mineralisation inside the implant pores; and histology revealed woven bone formation and bone resorption around the implant. The imaging evidence of this tissue ongrowth, ingrowth and remodelling around the implant was greater for the dynamically cultured samples, and the mechanical testing revealed that the dynamically cultured samples had approximately three times greater push-through fixation strength (p < 0.05). Discussion: Ex vivo bone models enable the analysis of tissue remodelling onto, into and around porous implants in the lab. While static culture conditions exhibited some characteristics of bony adaptation to implantation, simulating physiological conditions with a bioreactor led to an accelerated response.

From Macro- to Microscale: A combined modelling approach for near-surface wind flow on Mars at sub-dune length-scales.

The processes that initiate and sustain sediment transport which contribute to the modification of aeolian deposits in Mars' low-density atmosphere are still not fully understood despite recent atmospheric modelling. However, detailed microscale wind flow modelling, using Computational Fluid Dynamics at a resolution of <2 m, provides insights into the near-surface processes that cannot be modeled using larger-scale atmospheric modeling. Such Computational Fluid Dynamics simulations cannot by themselves account for regional-scale atmospheric circulations or flow modifications induced by regional km-scale topography, although realistic fine-scale mesoscale atmospheric modeling can. Using the output parameters from mesoscale simulations to inform the input conditions for the Computational Fluid Dynamics microscale simulations provides a practical approach to simulate near-surface wind flow and its relationship to very small-scale topographic features on Mars, particularly in areas which lack in situ rover data. This paper sets out a series of integrated techniques to enable a multi-scale modelling approach for surface airflow to derive surface airflow dynamics at a (dune) landform scale using High Resolution Imaging Science Experiment derived topographic data. The work therefore provides a more informed and realistic Computational Fluid Dynamics microscale modelling method, which will provide more detailed insight into the surface wind forcing of aeolian transport patterns on martian surfaces such as dunes.

Characterization of buried interfaces using Ga Kα hard X-ray photoelectron spectroscopy (HAXPES).

The extension of X-ray photoelectron spectroscopy (XPS) to measure layers and interfaces below the uppermost surface requires higher X-ray energies and electron energy analysers capable of measuring higher electron kinetic energies. This has been enabled at synchrotron radiation facilities and by using lab-based instruments which are now available with sufficient sensitivity for measurements to be performed on reasonable timescales. Here, we detail measurements on buried interfaces using a Ga Kα (9.25 keV) metal jet X-ray source and an EW4000 energy analyser (ScientaOmicron GmbH) in the Henry Royce Institute at the University of Manchester. Development of the technique has required the calculation of relative sensitivity factors (RSFs) to enable quantification analogous to Al Kα XPS, and here we provide further substantiation of the Ga Kα RSF library. Examples of buried interfaces include layers of memory and energy materials below top electrode layers, semiconductor heterostructures, ions implanted in graphite, oxide layers at metallic surfaces, and core-shell nanoparticles. The use of an angle-resolved mode enables depth profiling from the surface into the bulk, and is complemented with surface-sensitive XPS. Inelastic background modelling allows the extraction of information about buried layers at depths up to 20 times the photoelectron inelastic mean free path.

Osseous Migration of a Perforating Gastrointestinal Foreign Body in an Indian Runner Duck (Anas platyrhynchos domesticus).

An Indian runner duck (Anas platyrhynchos domesticus) was presented for a second opinion after a linear, metallic foreign body was identified on radiographic images. The primary veterinarian performed diagnostic imaging while investigating the presenting complaint of the duck's left pelvic limb lameness. The images obtained from a computed tomography scan performed during the second-opinion visit revealed a linear, metallic foreign body with an associated migration tract originating from the ventriculus and terminating in the proximal left femur. Significant osteomyelitis was noted at the proximal left femur associated with the presence of the linear, metallic object. The foreign body and the adhesions associated with its migration were removed in 2, staged, surgical procedures. Although penetrating ventricular foreign bodies have been previously reported, migration through the cortex of a long bone is an unusual presentation. This case demonstrates that perforating, migrating, gastrointestinal foreign bodies can result in lameness refractory to analgesia and ancillary supportive care.

Optimization of the electron beam dump for a GeV-class laser electron accelerator.

The advances of laser-driven electron acceleration offer the promise of great reductions in the size of high-energy electron accelerator facilities. Accordingly, it is desirable to design compact radiation shielding for such facilities. A key component of radiation shielding is the high-energy electron beam dump. In an effort to optimize the electron beam dump design, different material combinations have been simulated with the FLUKA Monte Carlo code in the range of 1-40 GeV. The studied beam dump configurations consist of alternating layers of high-Z material (lead or iron) and low-Z material (high-density concrete or borated polyethylene) in either three-layer or five-layer structures. The designs of various beam dump configuration have been compared and it has been found that the iron and concrete stacking in a three-layer structure with a thick iron layer results in the lowest dose at 1, 10, and 40 GeV. The performance of the beam dump exhibits a strong dependence on the selected materials, the stacking method, the beam dump thickness, as well as the electron energy. This parametric study provides general insights that can be used for compact shielding design of future electron accelerator facilities.

External validation of the Dutch prediction model for prehospital triage of trauma patients in South West region of England, United Kingdom.

IMPORTANCE: This paper investigates the use of a major trauma prediction model in the UK setting. We demonstrate that application of this model could reduce the number of patients with major trauma being incorrectly sent to non-specialist hospitals. However, more research is needed to reduce over-triage and unnecessary transfer to Major Trauma Centres. OBJECTIVE: To externally validate the Dutch prediction model for identifying major trauma in a large unselected prehospital population of injured patients in England. DESIGN: External validation using a retrospective cohort of injured patients who ambulance crews transported to hospitals. SETTING: South West region of England. PARTICIPANTS: All patients ≥16 years with a suspected injury and transported by ambulance in the year from February 1, 2017. EXCLUSION CRITERIA: 1) Patients aged ≤15 years; 2) Non-ambulance attendance at hospital with injuries; 3) Death at the scene and; 4) Patients conveyed by helicopter. This study had a census sample of cases available to us over a one year period. INTERVENTIONS OR EXPOSURES: Tested the accuracy of the prediction model in terms of discrimination, calibration, clinical usefulness, sensitivity and specificity and under- and over triage rates compared to usual triage practices in the South West region. MAIN OUTCOME MEASURE: Major trauma defined as an Injury Severity Score>15. RESULTS: A total of 68799 adult patients were included in the external validation cohort. The median age of patients was 72 (i.q.r. 46-84); 55.5% were female; and 524 (0.8%) had an Injury Severity Score>15. The model achieved good discrimination with a C-Statistic 0.75 (95% CI, 0.73 - 0.78). The maximal specificity of 50% and sensitivity of 83% suggests the model could improve undertriage rates at the expense of increased overtriage rates compared with routine trauma triage methods used in the South West, England. CONCLUSIONS AND RELEVANCE: The Dutch prediction model for identifying major trauma could lower the undertriage rate to 17%, however it would increase the overtriage rate to 50% in this United Kingdom cohort. Further prospective research is needed to determine whether the model can be practically implemented by paramedics and is cost-effective.

Simple Smart Implants: Simultaneous Monitoring of Loosening and Temperature in Orthopaedics With an Embedded Ultrasound Transducer.

Implant failure can have devastating consequences on patient outcomes following joint replacement. Time to diagnosis affects subsequent treatment success, but current diagnostics do not give early warning and lack accuracy. This research proposes an embedded ultrasound system to monitor implant fixation and temperature - a potential indicator of infection. Requiring only two implanted components: a piezoelectric transducer and a coil, pulse-echo responses are elicited via a three-coil inductive link. This passive system avoids the need for batteries, energy harvesters, and microprocessors, resulting in minimal changes to existing implant architecture. Proof-of-concept was demonstrated in vitro for a titanium plate cemented into synthetic bone, using a small embedded coil with 10 mm diameter. Gross loosening - simulated by completely debonding the implant-cement interface - was detectable with 95% confidence at up to 12 mm implantation depth. Temperature was calibrated with root mean square error of 0.19°C at 5 mm, with measurements accurate to ±1°C with 95% confidence up to 6 mm implantation depth. These data demonstrate that with only a transducer and coil implanted, it is possible to measure fixation and temperature simultaneously. This simple smart implant approach minimises the need to modify well-established implant designs, and hence could enable mass-market adoption.

Observations of pressure anisotropy effects within semi-collisional magnetized plasma bubbles.

Magnetized plasma interactions are ubiquitous in astrophysical and laboratory plasmas. Various physical effects have been shown to be important within colliding plasma flows influenced by opposing magnetic fields, however, experimental verification of the mechanisms within the interaction region has remained elusive. Here we discuss a laser-plasma experiment whereby experimental results verify that Biermann battery generated magnetic fields are advected by Nernst flows and anisotropic pressure effects dominate these flows in a reconnection region. These fields are mapped using time-resolved proton probing in multiple directions. Various experimental, modelling and analytical techniques demonstrate the importance of anisotropic pressure in semi-collisional, high-ß plasmas, causing a reduction in the magnitude of the reconnecting fields when compared to resistive processes. Anisotropic pressure dynamics are crucial in collisionless plasmas, but are often neglected in collisional plasmas. We show pressure anisotropy to be essential in maintaining the interaction layer, redistributing magnetic fields even for semi-collisional, high energy density physics (HEDP) regimes.