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Aims: Precise implant positioning, tailored to individual spinopelvic biomechanics and phenotype, is paramount for stability in total hip arthroplasty (THA). Despite a few studies on instability prediction, there is a notable gap in research utilizing artificial intelligence (AI). The objective of our pilot study was to evaluate the feasibility of developing an AI algorithm tailored to individual spinopelvic mechanics and patient phenotype for predicting impingement. Methods: This international, multicentre prospective cohort study across two centres encompassed 157 adults undergoing primary robotic arm-assisted THA. Impingement during specific flexion and extension stances was identified using the virtual range of motion (ROM) tool of the robotic software. The primary AI model, the Light Gradient-Boosting Machine (LGBM), used tabular data to predict impingement presence, direction (flexion or extension), and type. A secondary model integrating tabular data with plain anteroposterior pelvis radiographs was evaluated to assess for any potential enhancement in prediction accuracy. Results: We identified nine predictors from an analysis of baseline spinopelvic characteristics and surgical planning parameters. Using fivefold cross-validation, the LGBM achieved 70.2% impingement prediction accuracy. With impingement data, the LGBM estimated direction with 85% accuracy, while the support vector machine (SVM) determined impingement type with 72.9% accuracy. After integrating imaging data with a multilayer perceptron (tabular) and a convolutional neural network (radiograph), the LGBM’s prediction was 68.1%. Both combined and LGBM-only had similar impingement direction prediction rates (around 84.5%). Conclusion: This study is a pioneering effort in leveraging AI for impingement prediction in THA, utilizing a comprehensive, real-world clinical dataset. Our machine-learning algorithm demonstrated promising accuracy in predicting impingement, its type, and direction. While the addition of imaging data to our deep-learning algorithm did not boost accuracy, the potential for refined annotations, such as landmark markings, offers avenues for future enhancement. Prior to clinical integration, external validation and larger-scale testing of this algorithm are essential. Cite this article: Bone Jt Open 2024;5(8):671–680.

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females’ characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes. Cite this article: Bone Jt Open 2024;5(2):94–100.

Several optical microscopy methods are now available for characterizing scientific and industrial processes at sub-micron resolution. However, they are often ill-suited for imaging rapid events. Limited by the trade-off between camera frame-rate and sensitivity, or the need for mechanical scanning, current microscopes are optimized for imaging at hundreds of frames-per-second (fps), well-below what is needed in processes such as neuronal signaling or moving parts in manufacturing lines. Here, we present a scan-less technology that allows sub-micrometric imaging at thousands of fps. It is based on combining a single-pixel camera with parallelized encoded illumination. We use two acousto-optic deflectors (AODs) placed in a Mach–Zehnder interferometer and drive them simultaneously with multiple and unique acoustic frequencies. As a result, orthogonal light stripes are obtained that interfere with the sample plane, forming a two-dimensional array of flickering spots – each with its modulation frequency. The light from the sample is collected with a single photodiode that, after spectrum analysis, allows for image reconstruction at speeds only limited by the AOD’s bandwidth and laser power. We describe the working principle of our approach, characterize its imaging performance as a function of the number of pixels – up to 400 × 400 – and characterize dynamic events at 5000 fps.

Aims: In-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA). Methods: This large-scale, single-institution study included patients of any age undergoing primary TKA (n = 1,375) or UKA (n = 337) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for post anaesthesia care unit (PACU) admission, anaesthesia type, readmission within 30 days, and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge. Results: The median LOS in the RO TKA group was 76 hours (interquartile range (IQR) 54 to 104) versus 82.5 (IQR 58 to 127) in the CO TKA group (p < 0.001) and 54 hours (IQR 34 to 77) in the RO UKA versus 58 (IQR 35 to 81) in the CO UKA (p = 0.031). Discharge dispositions were comparable between the two groups. A higher percentage of patients undergoing CO TKA required PACU admission (8% vs 5.2%; p = 0.040). Conclusion: Our study showed that robotic arm assistance was associated with a shorter LOS in patients undergoing primary UKA and TKA, and no difference in the discharge destinations. Our results suggest that robotic arm assistance could be advantageous in partly addressing the upsurge of knee arthroplasty procedures and the concomitant healthcare burden; however, this needs to be corroborated by long-term cost-effectiveness analyses and data from randomized controlled studies. Cite this article: Bone Jt Open 2023;4(10):791–800.

IntroductionRobotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following RA-UKA for isolated lateral compartment osteoarthritis. The purpose of this study was to assess the short-term clinical and patient reported outcomes of lateral compartment UKA, utilising robotic-arm assistance.MethodsThis was a retrospective study of prospectively collected data of 21 consecutive patients who underwent lateral RA-UKA. The study included 9 (42.9%) males and 12 (57.1%) females with a mean age of 63.4 ± 9.2 years. The Oxford Knee Score (OKS) was measured pre-operatively and at 1-year post-operatively, while range of motion (ROM) and complications were also recorded.ResultsThere was significant improvement of OKS at 1 year's follow up compared with the baseline score (21.8 ± 5.6 vs. 45.2 ± 2.8 respectively; p

The INFN Tier1 data center is currently located in the premises of the Physics Department of the University of Bologna, where CNAF is also located. During 2023 it will be moved to the “Tecnopolo”, the new facility for research, innovation, and technological development in the same city area; the same location is also hosting Leonardo, the pre-exascale supercomputing machine managed by CINECA, co-financed as part of the EuroHPC Joint Undertaking, 4th ranked in the top500 November 2022 list. The construction of the new CNAF data center consists of two phases, corresponding to the computing requirements of LHC: Phase 1 involves an IT power of 3 MW, and Phase 2, starting from 2025, involves an IT power up to 10 MW. The new data center is designed to cope with the computing requirements of the data taking of the HL-LHC experiments, in the time spanning from 2026 to 2040 and will provide, at the same time, computing services for several other INFN experiments and projects, not only belonging to the HEP domain. The co-location with Leonardo opens wider possibilities to integrate HTC and HPC resources and the new CNAF data center will be tightly coupled with it, allowing access from a single entry point to resources located at CNAF and provided by the supercomputer. Data access from both infrastructures will be transparent to users. In this presentation we describe the new data center design, providing a status update on the migration, and we focus on the Leonardo integration showing the results of the preliminary tests to access it from the CNAF access points.

Aims: The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic. Methods: This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery Results: Overall, 88 patients (88%) were happy to continue with their scheduled procedure at the earliest opportunity. Patients with an ASA grade I were most likely to agree to surgery, followed by patients with ASA grades II, then those with grade III (93.3%, 88.7%, and 78.6% willingness, respectively). Patients waitlisted for an injection were least likely to consent to surgery, with just 73.7% agreeing. In all, there was a large increase in the proportion of patient willingness to continue with surgery compared to our initial study during the first wave of the pandemic. Conclusion: As COVID-19 lockdown restrictions are lifted after the second peak of the pandemic, we are seeing greater willingness to continue with scheduled orthopaedic surgery, reinforcing a change in patient perception towards having elective surgery. However, we must continue with strict COVID-19 precautions in order to minimize viral transmission as we increase our elective orthopaedic services going forward.

Aims: We present the development of a day-case total hip arthroplasty (THA) pathway in a UK National Health Service institution in conjunction with an extensive evidence-based summary of the interventions used to achieve successful day-case THA to which the protocol is founded upon. Methods: We performed a prospective audit of day-case THA in our institution as we reinitiate our full capacity elective services. In parallel, we performed a review of the literature reporting complication or readmission rates at ≥ 30-day postoperative following day-case THA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed. Results: Our evaluation and critique of the evidence-based literature identifies day-case THA to be safe, effective, and economical, benefiting both patients and healthcare systems alike. We further validate this with our institutional elective day surgery arthroplasty pathway (EDSAP) and report a small cohort of successful day-case THA cases as an example in the early stages of this practice in our unit. Conclusion: Careful patient selection and education, adequate perioperative considerations, including multimodal analgesia, surgical technique and blood loss management protocols and appropriate postoperative pathways comprising reliable discharge criteria are essential for successful day-case THA.

Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes.Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty.This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice.

Aims: Graft infection following anterior cruciate ligament reconstruction (ACLR) may lead to septic arthritis requiring multiple irrigation and debridement procedures, staged revision operations, and prolonged courses of antibiotics. To our knowledge, there are no previous studies reporting on how gentamicin pre-soaking of hamstring grafts influences infection rates following ACLR. We set out to examine this in our study accordingly. Methods: This retrospective study included 2,000 patients (1,156 males and 844 females) who underwent primary ACLR with hamstring autografts between 2007 to 2017. This included 1,063 patients who received pre-soaked saline hamstring grafts for ACLR followed by 937 patients who received pre-soaked gentamicin hamstring grafts for ACLR. All operative procedures were completed by a single surgeon using a standardized surgical technique. Medical notes were reviewed and data relating to the following outcomes recorded: postoperative infection, clinical progress, causative organisms, management received, and outcomes. Results: Superficial wound infection developed in 14 patients (1.31 %) receiving pre-saline soaked hamstring grafts compared to 13 patients (1.38 %) receiving pre-gentamicin soaked hamstring grafts, and this finding was not statistically significant (p = 0.692). All superficial wound infections were treated with oral antibiotics with no further complications. There were no recorded cases of septic arthritis in patients receiving pre-gentamicin soaked grafts compared to nine patients (0.85%) receiving pre-saline soaked grafts, which was statistically significant (p = 0.004). Conclusion: Pre-soaking hamstring autographs in gentamicin does not affect superficial infection rates but does reduce deep intra-articular infection rates compared to pre-soaking hamstring grafts in saline alone. These findings suggest that pre-soaking hamstring autografts in gentamicin provides an effective surgical technique for reducing intra-articular infection rates following ACLR.

A collaboration between different facilities in Casaccia and Frascati ENEA research centers has recently opened the possibility of performing irradiation experiments using different kinds of particles such as protons, neutrons, and electrons. The facilities involved in the project are the TAPIRO fast nuclear research reactor, the TOP-IMPLART proton accelerator (71 MeV), the REX electron accelerator (5 MeV) and the FNG neutron facility (2.5/14 MeV). This suite of plans represents a distributed irradiation facility using different particles and spectra, offering various irradiation capabilities for experiments in many fields, such as: nuclear physics, accelerator physics, aerospace, science material, medicine, detectors, radiation diagnostics, etc. Complete numerical models of all the facilities have been implemented to perform start-to-end simulations before experimental irradiation using beam dynamics and nuclear transport simulation codes. In addition, our distributed irradiation facility makes it possible to recreate an essential part of the Van Allen Belt radiation allowing us to check the FLUKA quantitative calibration regarding this specific simulation, facilitating the disentanglements of the uncertainties. Finally, a comparison of the estimated silicon 1 MeV neutron equivalent fluence (SI1MEVNE) of the radiation damage imparted by the different facilities is presented.

Background: Parents' high academic expectations are positively associated with young children's mathematical abilities. However, minimal attention has been devoted to whether, and how, different ways of conveying the performance targets would result in different outcomes. Aims: The current study investigated whether and how parents' perfectionistic strivings and concerns were associated with young children's mathematical abilities through home mathematical activities, children's approach motivation to learn mathematics, and children's avoidance motivation to learn mathematics. Sample: Participants included 211 kindergarteners in Hong Kong and their parents. Methods: Data were collected through individual child tests and parent questionnaires. Results: Structural equation modelling revealed that parents' perfectionistic strivings had a direct positive link with children's mathematical abilities, an indirect link via approach motivation to learn mathematics, and an indirect link via home mathematical activities, and then approach motivation. Parents' perfectionistic concerns had a direct negative link with children's mathematical abilities, an indirect link via approach motivation to learn mathematics, and an indirect link via avoidance motivation to learn mathematics. Conclusions: Early childhood practitioners are recommended to raise parents' awareness of how to communicate high-performance targets to children in a constructive manner.

Abstract Background Although the linkage between climate change and plague transmission has been proposed in previous studies, the dominant approach has been to address the linkage with traditional statistical methods, while the possible non-linearity, non-stationarity and low frequency domain of the linkage has not been fully considered. We seek to address the above issue by investigating plague transmission in pre-industrial Europe (AD1347–1760) at both continental and country levels. Methods We apply Granger Causality Analysis to identify the casual relationship between climatic variables and plague outbreaks. We then apply Wavelet Analysis to explore the non-linear and non-stationary association between climate change and plague outbreaks. Results Our results show that 5-year lagged temperature and aridity index are the significant determinants of plague outbreaks in pre-industrial Europe. At the multi-decadal time scale, there are more frequent plague outbreaks in a cold and arid climate. The synergy of temperature and aridity index, rather than their individual effect, is more imperative in driving plague outbreaks, which is valid at both the continental and country levels. Conclusions Plague outbreaks come after cold and dry spells. The multi-decadal climate variability is imperative in driving the cycles of plague outbreaks in pre-industrial Europe. The lagged and multi-decadal effect of climate change on plague outbreaks may be attributable to the complexity of ecological, social, or climate systems, through which climate exerts its influence on plague dynamics. These findings may contribute to improve our understanding of the epidemiology of plague and other rodent-borne or flea-borne infectious diseases in human history.

Abstract Purpose The aim of this research was to investigate the relationship between socio-economic inequalities and fatal and non-fatal cardiovascular events. Methods A systematic review of recently published cohort studies and a meta-analysis of relative risk (RR) of low compared with high socio-economic status (SES) in relation to cardiovascular incidence and mortality was conducted. Supplementary evaluations were conducted considering different proxies of SES in relation to different types of cardiovascular disease (CVD). Results We identified 17 studies including approximately 26.5 million of participants with more than 900,000 CVD events. We estimated a 50% increased CVD risk for low SES with respect to high SES (RR = 1.49 [95% confidence interval: 1.26, 1.78]). For sex-specific risk, we estimated a 79% increased CVD risk for women of low SES (RR = 1.79 [1.30, 2.46]). In men, the same investigation found a 45% increased CVD risk (RR = 1.45 [1.09, 1.92]). We reported that low education (RR = 1.56 [1.27, 1.91]), increased CVD risk the most, more than low income (RR = 1.38 [1.12, 1.70]). Conclusion Although not statistically significant, women of low SES were at higher CVD risk than men. CVD risk was more relevant to educational inequality than economic inequality.

Abstract There are 56 officially-recognized ethnic groups in China. However, the distinct geographic patterns of various ethnic groups in relation to the physical environment in China have rarely been investigated. Based on the geo-referenced physical environmental parameters of 455 Han, Tu, Hui, Salar, Mongolian, and Tibetan communities in Qinghai, we found that the communities could be statistically demarcated by temperature and aridity threshold according to their ethnicity, implying that the geographic distribution of each ethnic group is mediated by the physical environment. We also observed that the habitat of each ethnic group is ecologically compatible with current subsistence strategies. Tibetans settle in cold and humid high-altitude regions owing to the cultivation of highland barley and the breeding of yak, dzo, Tibetan sheep and Tibetan goat. Mongolians survive by animal husbandry in cold and dry grassland areas. Han and Tu people settle in the Huangshui River Valley, which offers relatively humid climate and flat land for agriculture. Hui and Salar people occupy the Yellow River Valley with its relatively arid environment and grassland vegetation suitable for animal breeding. Our findings offer a new perspective in explaining the geographic patterns and the varieties of ethnic groups in China and elsewhere.

First-generation college students comprise a sizable number of the student population in colleges and universities across the nation. As faculty are tasked with teaching and supporting these students in their courses, it is important to consider the alignment of faculty perspectives and the needs of first-generation students. This study explored the perspectives of 176 post-baccalaureate students and 54 faculty at a large, urban Hispanic-serving university in California, with nearly 77% of the campus population consisting of first-generation students and 65% of Latinx students. Data collection consisted of surveys completed by faculty as well as first-generation and non-first-generation students. Although first-generation and non-first-generation students did not differ significantly in their ratings of faculty's teaching practices, the means were lower for more items among the first-generation students. Findings also indicate that greater alignment is needed between how faculty teach and what first-generation students need to succeed, most notably in the lower ratings of faculty teaching by students versus faculty themselves and the differing themes emerging from qualitative analyses of participants' responses.

Art is a common approach for communicating and educating about science, yet it remains unclear the extent to which science art can benefit varied audiences in varied contexts. To examine this gap, we developed an art exhibit based on the findings of two publications in disease ecology. In study 1, we asked visitors with varying formal science, technology, engineering, and math (STEM) education backgrounds to complete a survey about their interest in science research before and after viewing the exhibit. In study 2, we recruited upper-level ecology undergraduate students to receive one of three treatments: engage with the art exhibit, read the abstracts of the papers, or do neither. Students completed a comprehension quiz immediately after their learning treatment and again 2 weeks later to evaluate retention. Following the exhibit, visitors who did not report a career or major in STEM showed a greater increase in research interest than visitors who did report a career or major in STEM. For the ecology undergraduate students, comprehension quiz scores were higher for students in the abstract group than the art exhibit group, while both groups scored higher than the control group. Retention of information did not significantly differ between the three groups. Overall, these findings suggest that science art exhibits are an effective method for increasing the accessibility of science to broader audiences and that audience identifiers (e.g., level of formal education in STEM) play an important role in audience experience of science communication and science education initiatives.