The effects of social determinants of health on anterior cruciate ligament injury recovery.

Context: Over 200,000 anterior cruciate ligament (ACL) injuries occur in the United States each year. While many patients choose to pursue ACL reconstruction (ACLR), the impact of social determinants of health (SDOH) on outcomes is unclear. Objective: The purpose of this study was to review and synthesize current literature to determine the impact of SDOH on outcomes following ACL reconstruction. Data sources: A systematic search of PubMed, CINAHL, Medline, PsychINFO, and Scopus was completed. Study selection: Articles reporting outcomes following ACLR were included if they discussed at least one SDOH and provided ACLR failure rates. Study design: Systematic review. Level of evidence: Level I. Results: After screening 712 studies, 13 were found that met inclusion criteria and were analyzed. Studies commonly examined the correlations between race, income, location, education, and insurance on outcomes following ACLR. Three studies found that the ACL revision risk for Black patients compared to White patients ranged from 0.23 to 0.78, while the revision risk for Hispanic patients compared to White patients ranged from 0.7 to 0.83. One study reported finding that the odds ratio of revision for the White patients was 1.32. Another study reported no difference in revision risk based on race. Patients living in urban areas were found to have improved outcomes compared to rural areas (Mean IKDC (Urban 85.3 vs Rural 81.87) and Tegner-Lysholm (Urban 88.26 vs Rural 84.82)). Lower socioeconomic status was correlated with decreased post-operative functional scores (KOOS, Marx and IKDC). Conclusion: Several SDOH such as White race, rural location, and low socioeconomic status may be independently correlated with worse ACLR outcomes in the form of increased revision rates or worse post-operative functional scores. However, further research is needed to better elucidate the degree of impact and interconnectedness of SDOH domains on ACLR patient outcomes.

Co-location analysis of pedestrian accident attributes for Ankara.

Even though accidents with pedestrians are more likely to have a severe or fatal outcome, most research concentrates on the vehicle part of the accidents. To make better policies and infrastructure decisions it is crucial to understand how and why such accidents happen. In this article, 2.588 pedestrian accidents from the year 2018 that resulted in injury or death in the city of Ankara, Türkiye are considered, and different attributes are analyzed co-location-wise. Three types of analysis will be undertaken for these accidents: temporal, natural environment, and pedestrian characteristics. The season of the year, weekend-weekday, and time of day will be explored for the temporal analysis. Visibility (daylight, twilight, and darkness) and rain are the natural surroundings of interest. The analyzed pedestrian characteristics are age group, gender, clothing colour, and nationality. Generally, the accident properties are evenly distributed and mostly the higher co-locations occur with themselves. Three important results stand out in this study. Firstly, the type of precaution appropriate to different time periods of the day should be applied, taking into account the locations that have the strongest co-location with themselves. Secondly, a seasonal approach should be adopted in determining places where pedestrian safety needs to be increased in the city. Lastly, pedestrian safety measures targeting especially both '0-14 and 65 + age groups' and 'foreign citizenship' should be prioritized in the identified locations. The results show that the co-location methodology is a good fit for analyzing pedestrian accidents and a wider use of this methodology for other accident types and in general might be beneficial.

Histological Changes in the Blood Vessels of Ruptured Human Anterior Cruciate Ligaments.

BACKGROUND: Anterior cruciate ligament (ACL) rupture is a commonly encountered sports injury worldwide. ACL rupture is known to have poor healing capacity, hypothesized to be due to low vascularity. ACL reconstruction surgery with ligament removal and tendon graft became essential for the higher grades of ACL tears. However, ACL-reconstructed patients faced post-traumatic osteoarthritis 10-15 years after surgery. In the recent past, the tibial remnant of ACL was shown to have intrinsic healing potential. Blood vessel density and the location of blood vessels of ACL remnants have critical implications in the newly upcoming remnant-preservation ACL reconstruction surgeries that showed better healing response. This study was performed to characterize the histological features of ruptured ACL remnants in terms of blood vessels to assess the healing potential and their utility in novel surgical techniques. METHODS: This was a descriptive cross-sectional study in which the tibial remnant of 24 ruptured ACL samples was evaluated for blood vessel density (per sq. mm), luminal area (sq. µm), and location of blood vessels using hematoxylin and eosin (H&E) staining with ImageJ software (U. S. National Institutes of Health, Bethesda, Maryland, USA). The blood vessel density and location of blood vessels were compared among various groups based on the duration of injury and number of injuries. RESULTS: Twenty-three male and one female adult patients with a mean duration of injury of 7.54 ± 5.63 months (range: 2-24 months) were included in the study. They were divided into three groups based on duration of injury: group I (2-5 months; n = 10), group II (6-8 months; n = 8), and group III (9-24 months; n = 6). The median blood vessel density (blood vessels per sq. mm) was 5.50 (3.30, 10.23) per sq. mm. There was no correlation of blood vessel density observed with duration of injury. All groups showed similar results statistically. More patients in earlier duration of injury showed very high range (10.1-40 per sq. mm) of blood vessels compared to the patients of later duration. Immature and intermediary blood vessels were identified denoting angiogenesis. Location of blood vessels varied in the groups based on duration of injury. There was no significant difference in blood vessel density and location of blood vessels between patients with single injury and those with multiple injuries. CONCLUSION: The present study demonstrates the presence of healing potential of ruptured anterior cruciate ligaments in terms of blood vessel density, luminal area, and location of blood vessels. Future studies looking into the functional outcome would enhance the understanding of utility of novel remnant-preservation surgeries in place of standard graft reconstruction surgeries.

An experimental investigation of the effect of barrier trench on vibration propagation on a laboratory scale model.

Vibration waves caused by construction or mining operations may cause damage to nearby structures or sensitive machinery and equipment. Some measures are implemented to eliminate or reduce this negative environmental effect of vibration. The barrier trench, one of these methods, aims to reduce the vibration by creating a suitable barrier between the structure and the vibration source on the ground. In this study, the effect of trench depth and distance from the source on vibration waves was simulated with a designed laboratory-scale test set-up to determine the effective parameters in barrier trench use. In addition, the effects of the superimposition of the source vibration wave with the reflected and refracted vibration waves from the trench, which has not been previously discussed in the literature, were also investigated. A laboratory scale gypsum-plaster block with dimensions of 200 cm × 90 cm x 70 cm was prepared and a Schmidt hammer was used as the impact energy source to generate vibration throughout the gypsum block. A trench barrier was opened at different depths on the test block and 588 vibration recordings were taken by the vibration monitor in different locations of the designed set-up. Statistical analyses were performed using vibration measurement results, trench source distance, and trench depths. As a result, vibration estimation equations depending on trench depth and the distance between the vibration source point and the trench were developed and how the presence of trench affects vibration propagation is revealed. It was found that vibrations increase due to the superposition of the source and reflected waves in front of the barrier trench. As the barrier depth increases, it is understood that the vibrations emanating from the near-surface vibration energy source are better blocked by the barrier. Thus, this study provides fundamental information on designing barrier trenches to avoid adverse effects of vibrations.

The Patterns of Failure and Prognostic Impact of Tumor Location in Patients Undergoing Reirradiation for Glioblastoma.

Introduction  RTOG 1205 is the only randomized study to evaluate the safety and efficacy of reirradiation (reRT) in recurrent glioblastoma (GBM). While this study showed that reRT was safe and improves progression-free survival (PFS), an improved approach to reRT is still needed. In this study, we report on patterns of failure and outcomes in a cohort of patients with recurrent GBM who underwent reRT. We hypothesize that patients at high risk of leptomeningeal spread (LMS) are not good candidates for reRT due to the risk of treatment-related toxicity without clinical benefit. Methods In this retrospective study, patients with recurrent GBM who underwent reRT at a single institution from 2015-2023 were included. Sociodemographic, treatment, and outcomes data were collected via chart review. Time to progression was defined as the time from the start of reRT to progression per the Response Assessment in Neuro-Oncology (RANO) criteria. Overall survival (OS) was defined as the time from the start of reRT to death. PFS and OS were estimated using the Kaplan-Meier method. Results Thirteen patients with recurrent GBM who underwent reRT were identified. The median age at diagnosis was 58 years. Six patients (46.2%) had tumors that were O6-methylguanine-DNA methyltransferase (MGMT) methylated, four (30.8%) were MGMT unmethylated, and three (23.11%) had unknown MGMT status. Eight patients underwent repeat resection after recurrence and before reRT. Most patients (n=7) received 35 Gy in 10 fractions with concurrent bevacizumab, while other patients were treated with 25-40 Gy in 5-15 fractions with grade 1 or less acute toxicity. Three patients were treated with tumor-treating fields. The median follow-up was five months. Median PFS was three months [95% confidence interval (95% CI): one to four months] and median OS was five months (95% CI, 1-8 months) as compared to 7.1 months and 10.1 months, respectively, on RTOG 1205. Five patients developed LMS after reRT, one patient died before progression, and the remaining seven patients all developed progression within one centimeter of the recurrent tumor. Of the patients who developed LMS, all had tumors abutting the ventricles and three underwent resection 2-17 months before reRT. Conclusion Patterns of failure suggest a potential treatment selection approach for patients with recurrent GBM, in which patients at high risk of LMS (tumor abutting ventricles with or without recent surgery) should not undergo reRT, while patients at low risk of LMS are good candidates for reRT. Furthermore, reRT could be administered with reduced margins given that all non-LMS recurrences were within 1cm of the original tumor. Additional studies are needed to validate this approach.

Intracellular TAS2Rs act as a gatekeeper for the excretion of harmful substances via ABCB1 in keratinocytes.

Bitter taste receptors (TAS2Rs) are not only expressed in the oral cavity but also in skin. Extraoral TAS2Rs are thought to be involved in non-taste perception and tissue-specific functions. Keratinocytes that express TAS2Rs in the skin provide a first-line defense against external threats. However, the functional roles of these receptors in host defense remain unclear. Here, we demonstrated the sensory role of intracellularly located TAS2Rs against toxic substances in keratinocytes. Although many G protein-coupled receptors elicit signals from the surface, TAS2Rs were found to localize intracellularly, possibly to the ER, in human keratinocytes and HaCaT cells. TAS2R38, one of the TAS2R members, activated the Gα12/13/RhoA/ROCK/p38 MAP kinase/NF-κB pathway upon stimulation by phenylthiocarbamide (PTC), an agonist for this receptor, leading to the production of ABC transporters, such as ABCB1, in these cells. Notably, treatment with bitter compounds, such as PTC and saccharin, induced the upregulation of ABCB1 in HaCaT cells. Mechanistically, intracellular TAS2R38 and its downstream signaling Gα12/13/RhoA/ROCK/p38 MAP kinase/NF-κB pathway were identified to be responsible for the above effect. Pretreatment with PTC prevented the accumulation of rhodamine 123 because of its excretion via ABCB1. Furthermore, pretreatment with PTC or saccharin counteracted the effect of the toxic compound, diphenhydramine, and pretreated HaCaT cells were found to proliferate faster than untreated cells. This anti-toxic effect was suppressed by treatment with verapamil, an ABCB1 inhibitor, indicating that enhanced ABCB1 helps clear toxic substances. Altogether, harmless activators of TAS2Rs may be promising drugs that enhance the excretion of toxic substances from the human skin.

Influence of different mining locations on deformation characteristics of overlying strata on gently anti-dip high-steep mining slope.

High-steep gently inclined mining slopes, prevalent globally, often suffer significant deformation, leading to landslides due to numerous goafs. This research investigates the critical role of goaf location in controlling deformation, failure mechanisms, and disaster evolution, vital for safe mining practices. Through field investigations and model generalization in Guizhou, a physical model test method was used to study three positions of goafs: under the shoulder and foot of the slope, under the slope shoulder, and within the slope. Findings highlight the stronger influence of the goaf's mutual position with the slope shoulder on slope and overburden deformation and failure compared to the slope toe. Deformation and failure modes evolve from collapse toppling to collapse slip and collapse settlement as the goaf shifts from the near slope surface to inside of the slope. Statistical analysis of fracture distribution in the goaf's overlying strata reveals damage increase with larger goafs, following a Gaussian distribution, with concentrated damage in the middle. The study identifies the maximum damage area, influenced by the horizontal distance between the goaf center and slope shoulder. These insights advance understanding of overburden rock deformation in gently inclined high-steep mining slopes.

Epidemiological Study of Track-and-Field Meets On-Field Medical Care.

BACKGROUND: Most epidemiological studies on track-and-field meets have been limited to the Olympics and world championships. These are meets in which only high-performance athletes participate at a certain time of the year. In contrast, epidemiological studies on athletes of various ages and across different seasons may provide health care providers with valuable insights into injury prevention and on-field medical care. The study aims to determine the trends and locations of injuries during track-and-field meets in athletes of various ages and seasons based on on-field medical care records. METHODS: The number and incidence of injuries requiring on-field medical care during or after the event were obtained from 39 track-and-field meets. Injuries were defined as cases that required on-field medical care. The incidence was defined as the number of injuries per 1000 athlete exposures wherein 1 athlete exposure is the athlete's participation in one event. We also recorded the number of injuries at each location and whether transportation to a medical station was required. RESULTS: A total of 191 injuries were reported. This study identified a population with a high incidence of injury (middle- and long-distance events, combined events, and athletes over the age of 19), areas within the stadium where injuries were more likely to occur (finish line and first turn), and a high rate of transport to the medical station (approximately 70%); most of them were transported to wheelchairs. CONCLUSION: The results provide insights into the trends, locations, and transport of injured athletes during track-and-field meets. Professionals will better understand the injuries occurring during track-and-field meets and can improve the efficiency of on-field medical care activities. They will also assist organizers in track-and-field meets to improve the safety of their meet operations.

Evaluation of the clinical application value of artificial intelligence in diagnosing head and neck aneurysms.

OBJECTIVE: To evaluate the performance of a semi-automated artificial intelligence (AI) software program (CerebralDoc® system) in aneurysm detection and morphological measurement. METHODS: In this study, 354 cases of computed tomographic angiography (CTA) were retrospectively collected in our hospital. Among them, 280 cases were diagnosed with aneurysms by either digital subtraction angiography (DSA) and CTA (DSA group, n = 102), or CTA-only (non-DSA group, n = 178). The presence or absence of aneurysms, as well as their location and related morphological features determined by AI were evaluated using DSA and radiologist findings. Besides, post-processing image quality from AI and radiologists were also rated and compared. RESULTS: In the DSA group, AI achieved a sensitivity of 88.24% and an accuracy of 81.97%, whereas radiologists achieved a sensitivity of 95.10% and an accuracy of 84.43%, using DSA results as the gold standard. The AI in the non-DSA group achieved 81.46% sensitivity and 76.29% accuracy, as per the radiologists' findings. The comparison of position consistency results showed better performance under loose criteria than strict criteria. In terms of morphological characteristics, both the DSA and the non-DSA groups agreed well with the diagnostic results for neck width and maximum diameter, demonstrating excellent ICC reliability exceeding 0.80. The AI-generated images exhibited superior quality compared to the standard software for post-processing, while also demonstrating a significantly reduced processing time. CONCLUSIONS: The AI-based aneurysm detection rate demonstrates a commendable performance, while the extracted morphological parameters exhibit a remarkable consistency with those assessed by radiologists, thereby showcasing significant potential for clinical application.

Introducing simulation-based education to Genitourinary Medicine specialty training in the North West of England: A quality improvement project exploring trainee perspectives and impact.

INTRODUCTION: Simulation-based education (SBE) provides enactive experiences for learners. This project explores the utility of SBE in GUM training. METHODS: Phase 1 was a qualitative survey of GUM trainees across the UK exploring their views on SBE. Phase 2 involved roll-out of SBE to new GUM trainees. Feedback was subsequently obtained. RESULTS: Twenty-three participants were surveyed in phase 1. When asked to rate the relevance of SBE to curriculum competencies on a scale of 1 to 5 (1 = not relevant, 5 = highly relevant), the highest ratings (score ≥4) were for proctoscopy (4.1), IUD insertion (4.1), SDI removal (4.1), SDI insertion (4.0), and punch biopsy (4.0). All curriculum items scored ≥3. Eighty-three percent (n = 19) felt SBE will improve clinician confidence and competence. Following introduction of SBE, participants fed back on the relevance of the session. All 5 respondents rated the session ≥4 for addressing their clinical and curriculum goals. All respondents rated the session ≥4 for improving clinician confidence and competence. The session received an overall rating of 5, and respondents similarly rated 5 for more sessions. CONCLUSION: Trainees recognise the value of simulated learning experiences and its role in improving procedural competence and addressing bespoke human factor skills relevant to GUM.

Hepatitis A vaccination in a racially and sexually diverse population of gay, bisexual, and other men who have sex with men: Findings from the QVax study.

BACKGROUND: Previous studies found vaccination uptake of vaccine-preventable diseases (VPD) to be associated with race/ethnicity and medical mistrust among key populations, however, few studies examine Hepatitis A vaccination uptake. METHODS: This cross-sectional study used online survey data collected from NJ and NY residents identifying as lesbian, gay, bisexual, transgender, queer (LGBTQ+) from October 2021 through November 2022. RESULTS: This study used a subsample of 222 gay, bisexual, and other cisgender men, 66.7% White, with mean age 41.22 years (SD = 15.23), and 60% fully vaccinated for Hepatitis A. Overall, average group-based medical mistrust scores did not differ among non-vaccinated participants compared to fully or partially vaccinated participants. However, higher group-based medical mistrust scores were associated with non-White identifying participants, and were highest among Hispanic/Latinx (2.68, sd = 0.43) and Black non-Hispanic (2.58, sd = 0.50) participants (p < .001). Vaccination patterns did not differ among fear or vaccine confidence-based items. CONCLUSIONS: Our results contribute to the limited knowledge of differences in Hepatitis A vaccination uptake among men who have sex with men, and support the need for targeted intervention programs that acknowledge the diverse population of LGBTQ + identifying individuals and their associated health behaviors.

The Location of Home Support Services for Older Adults in the Aveiro Region of Portugal.

Home and community-based services are key to an aging society and the aging in place strategies that are preferred by older adults as well as policymakers. But the provision of these kinds of services is often inadequate in territorial terms, raising the question of how to increase their reach and efficiency. This article analyzes the spatial coverage of home support services in the Aveiro Region of Portugal, considering the distribution of their target population and identifying network configurations which would provide these services more efficiently, through a location analysis that minimizes the distance to potential users of these services. This approach showed that, in the Aveiro Region, the spatial coverage of these services is highly uneven and insufficient, considering that the population with difficulties in performing daily tasks exceeds the population benefiting from these services and that the level of coverage differs greatly between territories. It also showed that significant efficiency and equity gains are possible by optimizing the service providers' location at the supra-municipal scale, decreasing the distances to be covered and reducing territorial inequalities.

Subgroup disproportionality analysis of dementia-related adverse events with sacubitril/valsartan across geographical regions.

This study aimed to evaluate the association between sacubitril/valsartan and dementia-related adverse events (AEs) in geographical subpopulations using subgroup disproportionality analysis. Cases from the FDA adverse event reporting system involving patients aged 60 or older with sacubitril/valsartan or angiotensin receptor blockers (ARBs) were analyzed. The adjusted reporting odds ratios (RORs) for dementia-related AEs were calculated for each continent. A total of 61,518 AEs associated with sacubitril/valsartan or ARBs were identified. Among these, 1441 were dementia-related AEs. In Asia, Europe, and Africa, the reporting risk of dementia-related AEs associated with sacubitril/valsartan was lower compared to ARBs (adjusted ROR, 0.57 [95% CI 0.31-1.01]; adjusted ROR, 0.89 [95% CI 0.69-1.14]; adjusted ROR, 0.40 [95% CI 0.27-0.61], respectively). In Latin America and Oceania, the reporting risk of dementia-related AEs associated with sacubitril/valsartan was similar to that associated with ARBs (adjusted ROR, 1.04 [95% CI 0.75-1.44]; adjusted ROR, 1.02 [95% CI 0.31-3.37], respectively). On the contrary, in North America, the reporting risk associated with sacubitril/valsartan was higher compared to ARBs (adjusted ROR, 1.29 [95% CI 1.10-1.53]). Although the ROR value did not meet the criteria for signal detection, the significantly greater than 1 ROR observed in North America suggests that caution may be warranted regarding potential dementia-related adverse events associated with sacubitril/valsartan.

Associations between fatty infiltration of rotator cuff muscles and tear size or location of rotator cuff tendon.

Background: Fatty infiltration (FI) of rotator cuff muscles in patients with rotator cuff tears is an important imaging factor for determining surgical indications. However, the associations between FI grade and the size or location of adjacent rotator cuff tears are not well-known. This study aimed to primarily determine whether tear size and location, especially for the SSc tendon, are associated with FI of adjacent rotator cuff muscles. The secondary aim was to clarify which patient factors are associated with rotator cuff muscle FI in rotator cuff tear cases. Methods: This study examined 373 shoulders of 348 patients (264 males and 109 females; mean age of 62.8 years) who underwent arthroscopic rotator cuff surgery. The FI grades of the supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSc) muscles were assessed using preoperative magnetic resonance imaging (MRI) using the Goutallier classification modified by Fuchs. According to the preoperative MRI and intraoperative findings, the tear size of the posterior-superior rotator cuff (SSP-ISP) was classified using a modified six-grade scale of the Cofield classification, and that of the SSc tear was classified using a six-grade scale according to the Lafosse classification. Age at surgery, sex, body mass index (BMI), presence of diabetes mellitus (DM) or hyperlipidemia (HL), trauma history, and duration of symptoms were investigated. Results: The FI grades of the SSP, ISP, and SSc were significantly associated with the size of the tears in those muscles (all P < 0.01). Furthermore, the FI grades of the SSP and the ISP were significantly associated with SSc tear size (P < 0.01), and the FI grade of the SSc was significantly associated with SSP-ISP tear size (P < 0.01). Patient age at surgery was significantly associated with FI grade (P < 0.01), with significant progression of the FI grade with advancing age. However, there were no significant associations between the FI grade and sex, BMI, presence of DM or HL, trauma history, and duration of symptoms. Conclusions: The FI grade of each of the rotator cuff muscles is affected by not only the tear severity of the muscle concerned but also by the severity of any tear in the adjacent rotator cuff.

Enhanced drug delivery with nanocarriers: a comprehensive review of recent advances in breast cancer detection and treatment.

Breast cancer (BC) remains a leading cause of morbidity and mortality among women worldwide, with triple-negative breast cancer (TNBC) posing significant treatment challenges due to its aggressive phenotype and resistance to conventional therapies. Recent advancements in nanocarrier technology offer promising solutions for enhancing drug delivery, improving bioavailability, and increasing drug accumulation at tumor sites through targeted approaches. This review delves into the latest innovations in BC detection and treatment, highlighting the role of nanocarriers like polymeric micelles, liposomes, and magnetic nanoparticles in overcoming the limitations of traditional therapies. Additionally, the manuscript discusses the integration of cutting-edge diagnostic tools, such as multiplex PCR-Nested Next-Generation Sequencing (mPCR-NGS) and blood-based biomarkers, which are revolutionizing early detection and molecular profiling of BC. The convergence of these technologies not only enhances therapeutic outcomes but also paves the way for personalized medicine in BC management. This comprehensive review underscores the potential of nanocarriers in transforming BC treatment and emphasizes the critical importance of early detection in improving patient prognosis.

Application of the "3-2-1" body surface localization method in intertrochanteric femoral fractures: a technical note.

In femoral intertrochanteric fractures, poor incision positioning may result in inaccurate intramedullary nail placement direction, which increases the difficulty of reduction and thus the size and number of incisions. Repeated intraoperative fluoroscopy not only increases the radiation exposure of the surgeon but also affects the operative outcomes. This technical note proposes a method of identifying incision positioning preoperatively using the "3-2-1" body surface localization method. This auxiliary positioning technique uses a body surface locator and the lower limb force axis. It can predict the incisions for the needle insertion point, spiral blade, and locking nails, create minimally invasive incisions, avoid incorrect incision position, facilitate accurate intraoperative intramedullary nail placement, reduce the incision size, intraoperative bleeding, and radiation exposure, and improve surgical efficiency and reduction quality.

Strategic placement of volunteer responder system defibrillators.

Volunteer responder systems (VRS) alert and guide nearby lay rescuers towards the location of an emergency. An application of such a system is to out-of-hospital cardiac arrests, where early cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED) are crucial for improving survival rates. However, many AEDs remain underutilized due to poor location choices, while other areas lack adequate AED coverage. In this paper, we present a comprehensive data-driven algorithmic approach to optimize deployment of (additional) public-access AEDs to be used in a VRS. Alongside a binary integer programming (BIP) formulation, we consider two heuristic methods, namely Greedy and Greedy Randomized Adaptive Search Procedure (GRASP), to solve the gradual Maximal Covering Location (MCLP) problem with partial coverage for AED deployment. We develop realistic gradually decreasing coverage functions for volunteers going on foot, by bike, or by car. A spatial probability distribution of cardiac arrest is estimated using kernel density estimation to be used as input for the models and to evaluate the solutions. We apply our approach to 29 real-world instances (municipalities) in the Netherlands. We show that GRASP can obtain near-optimal solutions for large problem instances in significantly less time than the exact method. The results indicate that relocating existing AEDs improves the weighted average coverage from 36% to 49% across all municipalities, with relative improvements ranging from 1% to 175%. For most municipalities, strategically placing 5 to 10 additional AEDs can already provide substantial improvements.

Auditory objects in working memory include task-irrelevant features.

Object-based attention operates both in perception and visual working memory. While the efficient perception of auditory stimuli also requires the formation of auditory objects, little is known about their role in auditory working memory (AWM). To investigate whether attention to one object feature in AWM leads to the involuntary maintenance of another, task-irrelevant feature, we conducted four experiments. Stimuli were abstract sounds that differed on the dimensions frequency and location, only one of which was task-relevant in each experiment. The first two experiments required a match-nonmatch decision about a probe sound whose irrelevant feature value could either be identical to or differ from the memorized stimulus. Matches on the relevant dimension were detected more accurately when the irrelevant feature matched as well, whereas for nonmatches on the relevant dimension, performance was better for irrelevant feature nonmatches. Signal-detection analysis showed that changes of irrelevant frequency reduced the sensitivity for sound location. Two further experiments used continuous report tasks. When location was the target feature, changes of irrelevant sound frequency had an impact on both recall error and adjustment time. Irrelevant location changes affected adjustment time only. In summary, object-based attention led to a concurrent maintenance of task-irrelevant sound features in AWM.

Effects of Surface Crack Shape on Fracture Behavior of Oil Pipelines Based on the MMC Criterion.

This study employs a hybrid numerical-experimental calibration method based on phenomena to determine the fracture parameters of the Modified Mohr-Coulomb (MMC) model. Using a self-developed VUMAT subroutine and the element deletion technique, the fracture process of a wide plate pipeline is thoroughly analyzed. This study investigates the impact of various crack shapes on the fracture response under tensile loading and the influence of surface crack size on the initiation location of a wide plate. These results demonstrate the calibrated MMC fracture model's accurate prediction of the toughness fracture behavior of X80 pipeline steel. Under equal area conditions of the dangerous section, circular cracks exhibit lower bearing capacity compared to elliptical cracks. Elliptical cracks predominantly propagate in the thickness direction, whereas circular cracks show nearly uniform growth in all directions. Furthermore, when the crack depth is less than half of the wall thickness, the damage accumulation value at the midpoint of the crack front is maximized; conversely, when the crack front is closer to the internal measurement point of the wide plate, the damage accumulation value is maximized.

Octogenarians unable to return home by postoperative-day 30.

BACKGROUND: For older adults undergoing surgery, returning home is instrumental for functional independence. We quantified octogenarians unable to return home by POD-30, assessed geriatric factors in a predictive model, and identified risk factors to inform decision-making and quality improvement. METHODS: This retrospective cohort study examined patients ≥80 years old from the ACS NSQIP Geriatric Surgery Pilot, using sequential logistic regression modelling. The primary outcome was non-home living location at POD-30. RESULTS: Of 4946 patients, 19.8 â€‹% lived in non-home facilities at POD-30. Increased odds of non-home living location were seen in patients with preoperative fall history (OR 2.92, 95%CI 2.06-4.14) and new postoperative pressure ulcer (OR 2.66, 95%CI 1.50-4.71) Other significant geriatric-specific risk factors included mobility aid use, surrogate-signed consent, and postoperative delirium, with odds ratios ranging from 1.42 (1.19-1.68) to 1.97 (1.53-2.53). CONCLUSIONS: These geriatric-specific risk factors highlight the importance of preoperative vulnerability screening and intervention to inform surgical decision-making.