All-suture fixation of syndesmotic injuries: a case series.

BACKGROUND: To retrospectively evaluate the clinical outcomes of patients treated for syndesmotic injuries with an all-suture construct technique and compare their patient reported outcome scores with historically published outcomes of syndesmotic injuries fixed with suspensory suture buttons. METHODS: This was a retrospective case series of patients treated at a Level 1 Trauma Center from May 1, 2018, to June 30, 2022. Ten patients aged 18 and older with unstable syndesmotic injuries treated with all-suture repair. Patients were excluded if they were treated with trans-osseous screws, had previous failed syndesmotic fixation, or suspensory suture button fixation. Patient-reported outcomes including Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, and complications were recorded. RESULTS: In the patients with 6 weeks or more of radiographic follow-up (N = 9), there was no evidence of nonunion, loss of fixation, hardware complication, or whitling of the fibula by the suture. At final follow-up average VAS pain scores were 1.5 out of 10 (range 0-4; SD 1.2), AOFAS ankle and hindfoot scores averaged 89.6 out of 100 (range 86-100; SD 6.1). The pain subscale of the AOFAS score averaged 37.5 out of 40 (range 35-40; SD 2.5). The functional subscale of the AOFAS score averaged 46 out of 50 (range 44-50; SD 3.0). Stiffness was reported in one patient at their follow-up visits, which resolved with continued physical therapy. There were no superficial or deep infections. CONCLUSIONS: In conclusion, this case series presents the first clinical outcomes of an all-suture fixation technique for treatment of unstable syndesmotic ankle injuries. Our results suggest that the all-suture fixation technique results in similar patient reported outcomes when compared with historically reported patient reported outcomes of suspensory suture button fixation, and low rates of complication or hardware failure.

Prospective Multicenter Preliminary Validation of Limb Deformity-modified Scoliosis Instruments in Pediatric Patients With Limb Deformity.

INTRODUCTION: There are few disease-specific patient-reported outcome measures (PROMs) for use in pediatric limb deformity (LD), with authors instead relying on generic PROMs such as the Pediatric Outcomes Data Collection Instrument (PODCI) to assess treatment outcomes from the patient's perspective. The purpose of this study was to perform preliminary validation of 2 disease-specific PROMs in pediatric patients with LD. METHODS: LD modifications were created by substituting the word "limb" for "back" in the Early Onset Scoliosis Questionnaire (EOSQ, ages 10 and younger) and the Scoliosis Research Society (SRS, ages 11 to 18) survey, creating the LD-EOSQ and LD-SRS instruments. Children were preoperatively administered the age-appropriate LD-PROMs (n=34 LD-EOSQ; n=30 LD-SRS) and PODCI questionnaires. LD-PROMs were assessed for construct (convergent and discriminant) validity, floor and ceiling effects, content validity, and minimal clinically important difference. RESULTS: Both LD-EOSQ and LD-SRS demonstrated excellent preliminary convergent validity with similar PODCI domains and discriminant validity with demographic information, deformity data, and LLRS-AIM scores. There were minimal floor or ceiling effects. Content validity was achieved in 100% of LD-EOSQ surveys and more than 80% of LD-SRS surveys. Minimal clinically important difference was 0.4 for LD-EOSQ and 0.3 for LD-SRS. CONCLUSIONS: The LD-EOSQ for patients aged 10 and under and LD-SRS for patients aged 11 to 18 demonstrated preliminary validity and reliability in the pediatric LD population. These measures provide more information specifically related to familial impact in younger children and self-image and mental health in adolescents compared to the PODCI and should be further evaluated for use in these patients. LEVEL OF EVIDENCE: Level II-diagnostic. Prospective cross-sectional cohort design.

Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study.

BACKGROUND: The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families. OBJECTIVE: This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents. METHODS: A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team. RESULTS: A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents' and parents' concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups. CONCLUSIONS: The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies.

A tetrathienopyrrole-based ladder-type donor polymer for high-performance organic near-infrared cavity detectors.

Organic semiconductors can afford detection at wavelengths beyond commercial silicon photodetectors. However, for each targeted near-infrared wavelength range, this requires individually optimized materials, which adds to the complexity and costs. Moreover, finding molecules with strong absorption beyond 1 µm that perform well in organic photodetectors remains a challenge. In microcavity devices, the detection window can be extended to wavelengths inaccessible for silicon without the need for new materials by adopting an intelligent design. Previous work has demonstrated the applicability of a dithienopyrrole-based donor polymer (PDTPQx) in such a cavity photodetector device, with a photoresponse up to 1200 nm. In this work, the π-conjugated backbone of the polymer is extended, affording higher hole mobility and better donor:acceptor intermixing. This leads to enhanced peak external quantum efficiencies up to 1450 nm. The (thermal noise limited) detectivities achieved with the PTTPQx polymer (1.07 × 1012 to 1.82 × 1010 Jones) are among the very best in the 900-1400 nm wavelength regime.

A one-stop shoulder clinic to save time and resources.

There is now a need more than ever to streamline services. A one-stop shoulder clinic was introduced during the COVID-19 pandemic. A total of 861 patients were seen, saving 794 future appointments. 111 patients had an ultrasound scan and 285 patients had an ultrasound-guided procedure, saving an average waiting time of 134 days. 327 patients had physiotherapy, and the average Oxford Shoulder Score improved by 8.56 at 1 year.

Sneaking in SpyCatcher using cell penetrating peptides forin vivoimaging.

In vivoimaging of protein complexes is a powerful method for understanding the underlying biological function of these key biomolecules. Though the engineering of small, high affinity nanobodies have become more prevalent, the off-rates of these tags may result in incomplete or partial labeling of proteins in live cells. The SpyCatcher003 and SpyTag split protein system allow for irreversible, covalent binding to a short target peptide unlike nanobody-affinity based probes. However, delivering these tags into a cell without disrupting its normal function is a key challenge. Cell penetrating peptides (CPPs) are short peptide sequences that facilitate the transduction of otherwise membrane-impermeable 'cargo' , such as proteins, into cells. Here we report on our efforts to engineer and characterize CPP-SpyCatcher003 fusions as modular imaging probes. We selected three CPPs, CUPID, Pentratin, and pVEC, to engineer fusion protein probes for superresolution microscopy, with the aim to eliminate prior permeabilization treatments that could introduce imaging artifacts. We find that fusing the CPP sequences to SpyCatcher003 resulted in dimer and multimer formation as determined by size exclusion chromatography, dynamic light scattering, and SDS resistant dimers on SDS-PAGE gels. By isolating and labeling the monomeric forms of the engineered protein, we show these constructs retained their ability to bind SpyTag and all three CPP sequences remain membrane active, as assessed by CD spectroscopy in the presence of SDS detergent. Using fluorescence and super resolution Lattice structured illumination microscopy (Lattice SIM) imaging we show that the CPPs did not enhance uptake of SpyCatcher byE. coli,however withCaulobacter crescentuscells, we show that Penetratin, and to a lesser degree CUPID, does enhance uptake. Our results demonstrate the ability of the CPP-SpyCatcher003 to label targets within living cells, providing the groundwork for using split protein systems for targetedin vivoimaging.

APOE and immunity: Research highlights.

INTRODUCTION: At the Alzheimer's Association's APOE and Immunity virtual conference, held in October 2021, leading neuroscience experts shared recent research advances on and inspiring insights into the various roles that both the apolipoprotein E gene (APOE) and facets of immunity play in neurodegenerative diseases, including Alzheimer's disease and other dementias. METHODS: The meeting brought together more than 1200 registered attendees from 62 different countries, representing the realms of academia and industry. RESULTS: During the 4-day meeting, presenters illuminated aspects of the cross-talk between APOE and immunity, with a focus on the roles of microglia, triggering receptor expressed on myeloid cells 2 (TREM2), and components of inflammation (e.g., tumor necrosis factor α [TNFα]). DISCUSSION: This manuscript emphasizes the importance of diversity in current and future research and presents an integrated view of innate immune functions in Alzheimer's disease as well as related promising directions in drug development.

Do number and location of plates impact infection rates after definitive fixation of high energy tibial plateau fractures?

PURPOSE: Surgical trauma may confer additional infectious risk after operative fixation for high energy tibial plateau fractures. This study aims to determine the impact of plate number and location on infection rates after these injuries. METHODS: This retrospective cohort study completed at two level one trauma centers included patients who underwent staged fixation for a tibial plateau fracture between 2015 and 2019. Plate number and location (lateral, medial, posteromedial, and anterior quadrants) used in the definitive fixation construct were collected from post-operative radiographs. Deep infection rate was primary the outcome. RESULTS: A total of 244 patients met inclusion criteria. The overall infection rate was 13.9% (34/244). Infection rates increased with each additional quadrant utilized (8.0% one quadrant, 13.0% two quadrants, 27.3% three quadrants, 100% four quadrants; p < 0.001), independent of plate number, fracture severity, operative time, number of incisions, external fixator pin and plate construct overlap, and days in the external fixator on multivariate analysis. CONCLUSIONS: Infection risk increases with each quadrant utilized in the fixation of high energy tibial plateau fractures. Providers should attempt to limit the dissection of soft tissue for hardware placement in the fixation of these injuries to limit infection risk. LEVEL OF EVIDENCE: Level III, retrospective therapeutic study.

Effect of Smoking on Motor Recovery After Cervical American Spinal Injury Association Grade D Traumatic Spinal Cord Injury.

BACKGROUND: Smoking is a known neurotoxin that has been shown to negatively impact neurological function and recovery in multiple animal studies. Patients who smoke have been shown to have decreased rates of motor improvement, fusion, and overall successful outcomes after elective spinal surgery, but the effect of smoking on outcomes after traumatic spinal cord injury (TSCI) has not been demonstrated in prior literature. This study aims to investigate how smoking effects motor recovery after TSCI. METHODS: Using the National Spinal Cord Injury Statistical Center database, patients who underwent surgical management of American Spinal Injury Association grade D cervical TSCI between 2009 and 2016 were included. Patients were grouped by smoking or nonsmoking status. Overall total motor score and change in motor scores at rehabilitation admission, rehabilitation discharge, and 1-year follow-up visits were compared between groups. Multiple linear regression analysis was completed, including any possible confounding demographic or injury variables. RESULTS: A total of 152 patients (121 smokers and 31 nonsmokers) completed their 1-year follow-up interview and physical examination and were included in the study. There were no differences in motor score between groups at rehabilitation admission or discharge. Smokers had worse improvement in motor score at 1 year (7.99 nonsmokers vs 4.61 smokers; P = 0.019 on multivariate analysis) and worse overall total motor score at 1 year (94.0 nonsmokers vs 90.0 smokers; P = 0.018 on multivariate analysis) after controlling for confounders. CONCLUSIONS: These results indicate diminished motor recovery in patients who continue to smoke after TSCI. These patients should be targeted for aggressive smoking cessation and require intervention from providers and peers in order to maximize recovery after injury. CLINICAL RELEVANCE: This study demonstrates that smoking cessation may be beneficial for patients with cervical ASIA grade D spinal cord injury and may be a focus for providers of these patients.

Which Factors Are Considered by Patients When Considering Total Joint Arthroplasty? A Discrete-choice Experiment.

BACKGROUND: TKA and THA are major surgical procedures, and they are associated with the potential for serious, even life-threatening complications. Patients must weigh the risks of these complications against the benefits of surgery. However, little is known about the relative importance patients place on the potential complications of surgery compared with any potential benefit the procedures may achieve. Furthermore, patient preferences may often be discordant with surgeon preferences regarding the treatment decision-making process. A discrete-choice experiment (DCE) is a quantitative survey technique designed to elicit patient preferences by presenting patients with two or more hypothetical scenarios. Each scenario is composed of several attributes or factors, and the relative extent to which respondents prioritize these attributes can be quantified to assess preferences when making a decision, such as whether to pursue lower extremity arthroplasty. QUESTIONS/PURPOSES: In this DCE, we asked: (1) Which patient-related factors (such as pain and functional level) and surgery-related factors (such as the risk of infection, revision, or death) are influential in patients' decisions about whether to undergo lower extremity arthroplasty? (2) Which of these factors do patients emphasize the most when making this decision? METHODS: A DCE was designed with the following attributes: pain; physical function; return to work; and infection risks, reoperation, implant failure leading to premature revision, deep vein thrombosis, and mortality. From October 2021 to March 2022, we recruited all new patients to two arthroplasty surgeons' clinics who were older than 18 years and scheduled for a consultation for knee- or hip-related complaints who had no previous history of a primary TKA or THA. A total of 56% (292 of 517) of new patients met the inclusion criteria and were approached with the opportunity to complete the DCE. Among the cohort, 51% (150 of 292) of patients completed the DCE. Patients were administered the DCE, which consisted of 10 hypothetical scenarios that had the patient decide between a surgical and nonsurgical outcome, each consisting of varying levels of eight attributes (such as infection, reoperation, and ability to return to work). A subsequent demographic questionnaire followed this assessment. To answer our first research question about the patient-related and surgery-related factors that most influence patients' decisions to undergo lower extremity arthroplasty, we used a conditional logit regression to control for potentially confounding attributes from within the DCE and determine which variables shifted a patient's determination to pursue surgery. To answer our second question, about which of these factors received the greatest priority by patients, we compared the relevant importance of each factor, as determined by each factor's beta coefficient, against each other influential factor. A larger absolute value of beta coefficient reflects a relatively higher degree of importance placed on a variable compared with other variables within our study. Of the respondents, 57% (85 of 150) were women, and the mean age at the time of participation was 64 ± 10 years. Most respondents (95% [143 of 150]) were White. Regarding surgery, 38% (57 of 150) were considering THA, 59% (88 of 150) were considering TKA, and 3% (5 of 150) were considering both. Among the cohort, 49% (74 of 150) of patients reported their average pain level as severe, or 7 to 10 on a scale from 0 to 10, and 47% (71 of 150) reported having 50% of full physical function. RESULTS: Variables that were influential to respondents when deciding on lower extremity total joint arthroplasty were improvement from severe pain to minimal pain (ß coefficient: -0.59 [95% CI -0.72 to -0.46]; p < 0.01), improvement in physical function level from 50% to 100% (ß: -0.80 [95% CI -0.9 to -0.7]; p < 0.01), ability to return to work versus inability to return (ß: -0.38 [95% CI -0.48 to -0.28]; p < 0.01), and the surgery-related factor of risk of infection (ß: -0.22 [95% CI -0.30 to -0.14]; p < 0.01). Improvement in physical function from 50% to 100% was the most important for patients making this decision because it had the largest absolute coefficient value of -0.80. To improve physical function from 50% to 100% and reduce pain from severe to minimal because of total joint arthroplasty, patients were willing to accept a hypothetical absolute (and not merely an incrementally increased) 37% and 27% risk of infection, respectively. When we stratified our analysis by respondents' preoperative pain levels, we identified that only patients with severe pain at the time of their appointment found the risk of infection influential in their decision-making process (ß: -0.27 [95% CI -0.37 to -0.17]; p = 0.01) and were willing to accept a 24% risk of infection to improve their physical functioning from 50% to 100%. CONCLUSION: Our study revealed that patients consider pain alleviation, physical function improvement, and infection risk to be the most important attributes when considering total joint arthroplasty. Patients with severe baseline pain demonstrated a willingness to take on a hypothetically high infection risk as a tradeoff for improved physical function or pain relief. Because patients seemed to prioritize postoperative physical function so highly in our study, it is especially important that surgeons customize their presentations about the likelihood an individual patient will achieve a substantial functional improvement as part of any office visit where arthroplasty is discussed. Future studies should focus on quantitatively assessing patients' understanding of surgical risks after a surgical consultation, especially in patients who may be the most risk tolerant. CLINICAL RELEVANCE: Surgeons should be aware that patients with the most limited physical function and the highest baseline pain levels are more willing to accept the more potentially life-threatening and devastating risks that accompany total joint arthroplasty, specifically infection. The degree to which patients seemed to undervalue the harms of infection (based on our knowledge and perception of those harms) suggests that surgeons need to take particular care in explaining the degree to which a prosthetic joint infection can harm or kill patients who develop one.

Contemporary self-reflective practices: A large-scale survey.

Although self-reflection is a topic that appears in Human-Computer Interaction, the empirical data on the subject can often be dated, fragmented and focused on particular use cases. Our work sought to capture data that would help us better understand the current use of technologies to support self-reflection in the broader population. We did this through a large-scale online survey with a representative sample of internet users in the United Kingdom (N = 998) and a smaller series of follow-up interviews (N = 20). We found that, regardless of recent stress, those with high scores on a scale that measured self-reflection maintained a wider variety of self-reflective activities in recent months. Men reported more access and use of technology for self-reflective activity than women, but women's self-reflection scores were usually higher. We noted that high self-reflectors appear more spontaneous and experimental, using heuristics to mitigate common barriers or adapt their practice to stressors. These individuals appear to favour analogue objects to facilitate reflective practice, utilising technology in more strategic and selective ways.

The impact of paleoclimatic changes on body size evolution in marine fishes.

Body size is an important species trait, correlating with life span, fecundity, and other ecological factors. Over Earth's geological history, climate shifts have occurred, potentially shaping body size evolution in many clades. General rules attempting to summarize body size evolution include Bergmann's rule, which states that species reach larger sizes in cooler environments and smaller sizes in warmer environments, and Cope's rule, which poses that lineages tend to increase in size over evolutionary time. Tetraodontiform fishes (including pufferfishes, boxfishes, and ocean sunfishes) provide an extraordinary clade to test these rules in ectotherms owing to their exemplary fossil record and the great disparity in body size observed among extant and fossil species. We examined Bergmann's and Cope's rules in this group by combining phylogenomic data (1,103 exon loci from 185 extant species) with 210 anatomical characters coded from both fossil and extant species. We aggregated data layers on paleoclimate and body size from the species examined, and inferred a set of time-calibrated phylogenies using tip-dating approaches for downstream comparative analyses of body size evolution by implementing models that incorporate paleoclimatic information. We found strong support for a temperature-driven model in which increasing body size over time is correlated with decreasing oceanic temperatures. On average, extant tetraodontiforms are two to three times larger than their fossil counterparts, which otherwise evolved during periods of warmer ocean temperatures. These results provide strong support for both Bergmann's and Cope's rules, trends that are less studied in marine fishes compared to terrestrial vertebrates and marine invertebrates.

Molecular-Level Control over Ionic Conduction and Ionic Current Direction by Designing Macrocycle-Based Ionomers.

Poor ionic conductivity of the catalyst-binding, sub-micrometer-thick ionomer layers in energy conversion and storage devices is a huge challenge. However, ionomers are rarely designed keeping in mind the specific issues associated with nanoconfinement. Here, we designed nature-inspired ionomers (calix-2) having hollow, macrocyclic, calix[4]arene-based repeat units with precise, sub-nanometer diameter. In ≤100 nm-thick films, the in-plane proton conductivity of calix-2 was up to 8 times higher than the current benchmark ionomer Nafion at 85% relative humidity (RH), while it was 1-2 orders of magnitude higher than Nafion at 20-25% RH. Confocal laser scanning microscopy and other synthetic techniques allowed us to demonstrate the role of macrocyclic cavities in boosting the proton conductivity. The systematic self-assembly of calix-2 chains into ellipsoids in thin films was evidenced from atomic force microscopy and grazing incidence small-angle X-ray scattering measurements. Moreover, the likelihood of alignment and stacking of macrocyclic units, the presence of one-dimensional water wires across this macrocycle stacks, and thus the formation of long-range proton conduction pathways were suggested by atomistic simulations. We not only did see an unprecedented improvement in thin-film proton conductivity but also saw an improvement in proton conductivity of bulk membranes when calix-2 was added to the Nafion matrices. Nafion-calix-2 composite membranes also took advantage of the asymmetric charge distribution across calix[4]arene repeat units collectively and exhibited voltage-gating behavior. The inclusion of molecular macrocyclic cavities into the ionomer chemical structure can thus emerge as a promising design concept for highly efficient ion-conducting and ion-permselective materials for sustainable energy applications.

Are Infection Rates Increased After Sterilization of the External Fixator During Staged Internal Fixation of High-Energy Tibial Plateau Fractures?

OBJECTIVES: To compare infection rates after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not. DESIGN: Retrospective cohort study. SETTING: Two academic Level 1 trauma centers. PATIENTS/PARTICIPANTS: Two hundred forty-four patients met inclusion and exclusion criteria between the 2 institutions. INTERVENTION: Prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. 162 patients were in the prepped group, and 82 patients were in the nonprepped group. MAIN OUTCOME MEASUREMENTS: The primary outcome was the rate of deep infection after definitive fixation. Secondary outcome was operative time. RESULTS: There were no significant differences in infection rates between prepped (11.7%) and nonprepped (18.3%) groups ( P = 0.162). Patients in the prepped groups had significantly decreased operative time (168.2 minutes vs. 221.9 minutes, P < 0.001) even after controlling for confounders in regression analysis. CONCLUSIONS: There is no increased risk of infection associated with prepping and maintenance of the external fixator during definitive internal fixation for high-energy tibial plateau fractures. These data suggest that this practice may lead to shorter operative times as well. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Mixed Ionic-Electronic Conduction, a Multifunctional Property in Organic Conductors.

Organic mixed ionic-electronic conductors (OMIECs) have gained recent interest and rapid development due to their versatility in diverse applications ranging from sensing, actuation and computation to energy harvesting/storage, and information transfer. Their multifunctional properties arise from their ability to simultaneously participate in redox reactions as well as modulation of ionic and electronic charge density throughout the bulk of the material. Most importantly, the ability to access charge states with deep modulation through a large extent of its density of states and physical volume of the material enables OMIEC-based devices to display exciting new characteristics and opens up new degrees of freedom in device design. Leveraging the infinite possibilities of the organic synthetic toolbox, this perspective highlights several chemical and structural design approaches to modify OMIECs' properties important in device applications such as electronic and ionic conductivity, color, modulus, etc. Additionally, the ability for OMIECs to respond to external stimuli and transduce signals to myriad types of outputs has accelerated their development in smart systems. This perspective further illustrates how various stimuli such as electrical, chemical, and optical inputs fundamentally change OMIECs' properties dynamically and how these changes can be utilized in device applications.

Evolutionary Dynamics of the OR Gene Repertoire in Teleost Fishes: Evidence of an Association with Changes in Olfactory Epithelium Shape.

Teleost fishes perceive their environment through a range of sensory modalities, among which olfaction often plays an important role. Richness of the olfactory repertoire depends on the diversity of receptors coded by homologous genes classified into four families: OR, TAAR, VR1, and VR2. Herein, we focus on the OR gene repertoire. While independent large contractions of the OR gene repertoire associated with ecological transitions have been found in mammals, little is known about the diversity of the OR gene repertoire and its evolution in teleost fishes, a group that includes more than 34,000 living species. We analyzed genomes of 163 species representing diversity in this large group. We found a large range of variation in the number of functional OR genes, from 15 in the Broad-nose Pipefish Syngnathus typhle and the Ocean Sunfish Mola mola, to 429 in the Zig-zag Eel Mastacembelus armatus. The number of OR genes was higher in species when a multilamellar olfactory rosette was present. Moreover, the number of lamellae was correlated with the richness of the OR gene repertoire. While a slow and balanced birth-and-death process generally drives the evolution of the OR gene repertoire, we inferred several episodes of high rates of gene loss, sometimes followed by large gains in the number of OR genes. These gains coincide with morphological changes of the olfactory organ and suggest a strong functional association between changes in the morphology and the evolution of the OR gene repertoire.

Procedure-Specific Arthroscopic Simulation Using 3-Dimensional Printing.

Surgical simulation offers a solution to the problems of reduced training time and surgical exposure by allowing trainees to develop surgical skills outside of the operating room in a safe, cost-effective environment. We developed a highly detailed, procedure-specific shoulder arthroscopy simulator using 3-dimesional printing with the aim of providing greater access to cost-effective simulation support to trainees.

Protocol for a multi-site pilot and feasibility randomised controlled trial: Surgery versus PhysiothErapist-leD exercise for traumatic tears of the rotator cuff (the SPeEDy study).

BACKGROUND: Clinically, a distinction is made between types of rotator cuff tear, traumatic and non-traumatic, and this sub-classification currently informs the treatment pathway. It is currently recommended that patients with traumatic rotator cuff tears are fast tracked for surgical opinion. However, there is uncertainty about the most clinically and cost-effective intervention for patients with traumatic rotator cuff tears and further research is required. SPeEDy will assess the feasibility of a fully powered, multi-centre randomised controlled trial (RCT) to test the hypothesis that, compared to surgical repair (and usual post-operative rehabilitation), a programme of physiotherapist-led exercise is not clinically inferior, but is more cost-effective for patients with traumatic rotator cuff tears. METHODS: SPeEDy is a two-arm, multi-centre pilot and feasibility RCT with integrated Quintet Recruitment Intervention (QRI) and further qualitative investigation of patient experience. A total of 76 patients with traumatic rotator cuff tears will be recruited from approximately eight UK NHS hospitals and randomly allocated to either surgical repair and usual post-operative rehabilitation or a programme of physiotherapist-led exercise. The QRI is a mixed-methods approach that includes data collection and analysis of screening logs, audio recordings of recruitment consultations, interviews with patients and clinicians involved in recruitment, and review of study documentation as a basis for developing action plans to address identified difficulties whilst recruitment to the RCT is underway. A further sample of patient participants will be purposively sampled from both intervention groups and interviewed to explore reasons for initial participation, treatment acceptability, reasons for non-completion of treatment, where relevant, and any reasons for treatment crossover. DISCUSSION: Research to date suggests that there is uncertainty regarding the most clinically and cost-effective interventions for patients with traumatic rotator cuff tears. There is a clear need for a high-quality, fully powered, RCT to better inform clinical practice. Prior to this, we first need to undertake a pilot and feasibility RCT to address current uncertainties about recruitment, retention and number of and reasons for treatment crossover. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT04027205 ) - Registered on 19 July 2019. Available via.

More than fantasy: Prosocial daydreams relate to prosocial dispositions and behaviour.

The current studies examined the relationship between the penchant to daydream about helping others and prosocial traits and behaviour. We reasoned that fantasising about prosocial acts should be positively associated with a more prosocial disposition and real behaviour. Across both studies, the findings suggest that people who exhibit prosocial characteristics (e.g., empathic concern, fantasy/fictional empathy, moral reasoning) are more likely to fantasise about prosocial behaviour, and these characteristics are reliably associated with increased helping behaviours. From Study 1, the correlational results showed that people higher in agreeableness exhibited a stronger tendency to engage in prosocial fantasising, and empathy, in part, mediated the relationship. The experimental results from Study 2 conceptually support those from Study 1; when prompted to fantasise about prosocial behaviour, those higher in agreeableness and openness to experience engaged in more helping behaviour, whereas in a control condition, no helping differences emerged. Finding that empathic concern was most consistently related to daydreaming is consistent with the theory in that people are more intrinsically motivated to promote other's welfare at a personal cost when they feel empathy. Engaging in prosocial fantasising may increase empathy, which in turn, may enhance one's prosocial disposition and increase one's helping behaviour.

Regulatory focus and social reconnection following social exclusion.

Promotion- and prevention-focused people are differentially sensitive to situational gains and losses, thus we reasoned that people's state regulatory focus following social exclusion should influence whether a social reconnection opportunity is perceived as safe (i.e., will exclusion persist or abate). To create an exclusion condition, all participants believed that other ostensible participants read their personal essay and chose not to work with them (i.e., all participants were excluded). Following the exclusion, participants rated how much they wanted to work with a new partner whose personality was depicted as a safe or unsafe reconnection opportunity. We expected and found that participants who held a prevention focus were willing to work with the partner, but only when the opportunity was perceived as safe. By comparison, participants who held a promotion focus were willing to work with the partner regardless of the opportunity's safety. The relationship between social reconnection safety and regulatory focus and its effect on social reconnection efforts is discussed.