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Long-duration spaceflight missions are on the rise. However, recent literature suggests that prolonged and deep-space exposure is likely to introduce increased risks for brain health and consequent detriments to performance and well-being. Given up-to-date evidence, we argue that transcranial magnetic stimulation (TMS) is a promising solution for mitigating behavioral and neurocognitive risks associated with long-duration and deep-space missions. We provide support from recent Earth-based applications of TMS and review several advantages it holds over current treatment approaches. Lastly, we highlight some of the needs in the process of applying such technology to the spaceflight environment.

Purpose: To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP). Methods: A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP. Results: A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment. Conclusions: The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings. Level of Evidence: Level IV, systematic review of Level I to IV studies.

Appropriate management of radial meniscal tears is complex, with continued efforts focused on optimizing diagnostic methods for identification to help dictate treatment, especially as surgical indications for repair have expanded, coupled with improvements in surgical techniques and instrumentation. Currently, no standardized classification system for radial meniscal tears exists, limiting the ability to accurately characterize injury patterns and guide surgical decision-making.

Treatment-resistant depression (TRD) is an epidemic with rising social, economic, and political costs. In a patient whose major depressive episode (MDE) persists through an adequate antidepressant trial, insurance companies often cover alternative treatments which may include repetitive transcranial magnetic stimulation (rTMS). RTMS is an FDA-cleared neuromodulation technique for TRD which is safe, efficacious, noninvasive, and well-tolerated. Recent developments in the optimization of rTMS algorithms and targeting have increased the efficacy of rTMS in treating depression, improved the clinical convenience of these treatments, and decreased the cost of a course of rTMS. In this opinion paper, we make a case for why conventional FDA-cleared rTMS should be considered as a first-line treatment for all adult MDEs. RTMS is compared to other first-line treatments including psychotherapy and SSRIs. These observations suggest that rTMS has similar efficacy, fewer side-effects, lower risk of serious adverse events, comparable compliance, the potential for more rapid relief, and cost-effectiveness. This suggestion, however, would be strengthened by further research with an emphasis on treatment-naive subjects in their first depressive episode, and trials directly contrasting rTMS with SSRIs or psychotherapy. [ABSTRACT FROM AUTHOR]

Adult Basic Education (ABE) in the United States is an important tool for underrepresented and underserved communities to achieve the goal of high school graduation following noncompletion of K-12 education. Largely in urban settings, ABE centers serve millions of students annually, especially historically and contemporarily marginalized groups. ABE provides critical resources and skills to meet the educational needs of diverse peoples seeking to advance their station in life. ABE centers may serve students with potentially traumatic events (PTE), diagnosable trauma, and related poorer outcomes. Alarmingly, a paucity of research exists that examines the presence of PTEs for ABE students, particularly people and womgen of color. In the present research, the Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item measures were used to weigh depression and anxiety scores across the Life Events Checklist for the DSM-5 (LEC-5) trauma types in a sample (N = 170) of predominantly women of color. We examined three respondent groups based on proximity and frequency of PTEs: (1) denied; (2) witnessed/learned about; and (3) experienced. Results indicate that those experiencing higher levels of PTEs (namely, sexual assault, unwanted/uncomfortable sexual experience, and sudden accidental death) also experienced higher ratings of depression and anxiety. More research is indicated, as women of color within ABE settings could benefit from tailored resources for prevention, intervention, and treatment. [ABSTRACT FROM AUTHOR]

Background: Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is not without potential complications. Purpose: To evaluate the reported incidence of complications and adverse events after isolated MMPR repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed, and Scopus databases with the following search terms combined with Boolean operators: "meniscus,""root," and "repair." Inclusion criteria consisted of level 1 to 4 human clinical studies in English or English-language translation reporting complications and adverse events after isolated posterior medial meniscus root repairs. The overall incidence of specific complications was estimated from the pooled sample of the included studies. Results: Eleven studies with a total pooled sample of 442 patients were identified. The mean patient age was 58.1 years, while the mean final follow-up time was 37.2 months (range, 12-84.8 months). The overall incidence of complications was 9.7% (n = 43/442), with the most commonly reported complication being progressive degenerative changes within the knee (10.4%; n = 25/240; n = 5 studies). A total of 1.25% (n = 3/240) of patients who experienced degenerative changes required conversion to total knee arthroplasty. Repair failures were reported in 3.1% (n = 10/327; n = 8 studies) of patients. Conclusion: Repairing MMPR tears is critical in preventing accelerated progression of knee osteoarthritis in patients without significant knee osteoarthritis preoperatively. While this repair is still recommended and necessary in appropriate patients, this review found that the incidence of complications after isolated posterior medial meniscus root repair was 9.7%, primarily involving the presence of progressive degeneration, while repair failure was reported in 3% of patients. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT). Methods: A literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status. Results: Sixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full‐thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT. Conclusions: Conflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

The popularity of fractal analysis studies is increasing in various fields. However, the literature has neglected the fractal analysis of fly ash (FA)-teff straw ash (TSA)-based geopolymer mortars. This fact inspires us to develop fractal analysis formulations for FA-TSA-based geopolymer mortars that are effective and suitable for characterising several solid specimens. In this study, cube counting, triangulation, power spectrum and partitioning algorithms are proposed to predict the random surfaces of FA-TSA-based geopolymer mortars. The study demonstrates that the partitioning algorithm exhibits the highest fractal dimension values of greater than 2.72 for all the specimens, but yields the lowest coefficients of determination ranging from 0.55 to 0.80. The cube counting, triangulation and power spectrum algorithms achieve coefficients of determination greater than 0.84 in predicting the logarithmic data points. The study also reveals that an increment in the coefficient of determination does not necessarily correspond to higher fractal dimension values. These findings on fractal analysis of FA-TSA-based geopolymer mortars are expected to drive the development of more surface properties of civil engineering materials apart from the conventional roughness parameters. Our current achievements and findings will hopefully pave the way for future studies on the surface properties of other civil engineering materials.

The rapid expansion and use of digital data in the era of generative Artificial Intelligence raises significant challenges in legal compliance and ethical data handling. The DataLawCompanion (DLC) emerges as a pivotal tool, blending advanced Large Language Models like ChatGPT-4 with expert legal insights to democratize understanding of data protection laws. This paper explores DLC’s role in simplifying complex legal frameworks for diverse stakeholders through a mixed-method approach, leveraging primary data from East African Data Protection Acts and comprehensive online research. Our findings underscore DLC’s effectiveness in enhancing legal comprehension and compliance in the digital era.

Grossberg’s adaptive resonance theory (ART) provides a framework for understanding possible interactions between mental imagery and visual perception. Our purpose was to integrate, within ART, the phenomenological notion of mental image vividness and thus investigate the possible biasing effects of individual differences on visual processing. Using a Vernier acuity task, we tested whether indirect estimation of relative V1 size (small, medium, large) and self-reported vividness, in three subgroups of 53 observers, could predict significant effects of priming, interference, or more extreme Perky effects (negative and positive), which could be induced by imagery, impacting acuity performance. The results showed that small V1 was correlated with priming and/or negative Perky effects independently of vividness; medium V1 was related to interference at low vividness but priming at high vividness; and large V1 was related to positive Perky effects at high vividness but negative Perky effects at low vividness. Our interpretation of ART and related modeling based on ARTSCAN contributes to expanding Grossberg’s comprehensive understanding of how and why individually experienced vividness may drive the differential use of the dorsal and ventral complementary visual processing pathways, resulting in the observed effects of imagery on concurrent perception.

Introduction: In recent years, Artificial Intelligence (AI) has seen substantial progress in its utilization, with Chat Generated Pre-Trained Transformer (ChatGPT) emerging as a popular language model. The purpose of this study was to test the accuracy and reliability of ChatGPT's responses to frequently asked questions (FAQ) pertaining to reverse shoulder arthroplasty (RSA)., Methods: The ten most common FAQs were queried from institution patient education websites. These ten questions were then input into the chatbot during a single session without additional contextual information. The responses were then critically analyzed by two orthopedic surgeons for clarity, accuracy, and the quality of evidence-based information using The Journal of the American Medical Association (JAMA) Benchmark criteria and the DISCERN score. The readability of the responses was analyzed using the Flesch-Kincaid Grade Level., Results: In response to the ten questions, the average DISCERN score was 44 (range 38-51). Seven responses were classified as fair and three were poor. The JAMA Benchmark criteria score was 0 for all responses. Furthermore, the average Flesch-Kincaid Grade Level was 14.35, which correlates to a college graduate reading level., Conclusion: Overall, ChatGPT was able to provide fair responses to common patient questions. However, the responses were all written at a college graduate reading level and lacked reliable citations. The readability greatly limits its utility. Thus, adequate patient education should be done by orthopedic surgeons. This study underscores the need for patient education resources that are reliable, accessible, and comprehensible., Level of Evidence: IV., Competing Interests: Declaration of Competing Interest ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Amniotic-derived products have been used for decades in various medical subspecialties and have proven to be a safe method of allograft tissue transplantation. These products have shown promising preclinical and early clinical results in the treatment of tendon/ligament injuries, cartilage defects, and osteoarthritis. The therapeutic benefits of amniotic-derived products are likely due to intrinsic properties, such as their structure as an extracellular matrix and concentration of growth factors, as well as anti-inflammatory, antifibrotic, and antimicrobial molecules. We performed a narrative review, evaluating the pre-clinical and clinical use of amniotic-derived products in musculoskeletal injuries such as osteoarthritis, Achilles tendinopathy, plantar fasciitis, lateral epicondylitis, chronic stenosing tenosynovitis, and nerve, cartilage and tendon repair or reconstruction, along with fracture healing treatment. In vitro and pre-clinical studies using amniotic-derived products for orthopedic treatments have shown promising results and provide the foundation for further human trials to be conducted. With the rise of commercially available biologics, incorporating amniotic products into orthopedic practice is becoming more accessible, while further studies investigating long-term outcomes and potential adverse events are necessary., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: To assess the patient-reported outcomes measures (PROMs), functional knee measures, and incidence of complications in patients aged 50 and older undergoing anterior cruciate ligament reconstruction (ACLR)., Methods: A literature search was conducted across PubMed, Embase, and Scopus databases, spanning from their inception to November 2023, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria consisted of clinical studies reporting PROMs, measures of knee stability, and complication rates, following ACLR in patients aged ≥ 50 with minimum 2 year follow-up. The Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess study quality. Primary outcome measures consisted of changes PROMs and complication rates following ACLR., Results: A total of 17 studies, consisting of 1,163 patients undergoing ACLR were identified. Autografts were utilized in 90.3% of patients, compared to 9.7% of patients treated using allografts. At minimum 24-month follow-up, the mean International Knee Documentation Score (IKDC) ranged from 67.4 to 92.96, while mean Lysholm scores ranged from 84.4 to 94.8, and mean Tegner scores ranged from 0.3 to 5.4. The mean side to side difference at final follow-up ranged from 1.2 to 2.4mm while the rates of recurrent instability ranged from 0 to 18%. Complications and revisions ranged from 0% to 40.4% and 0% to 37.5% of cases, with the highest rates observed in studies noting a high incidence of intraoperative cartilage lesions., Conclusion: Anterior cruciate ligament reconstruction in patients above the age of 50 results in favorable IKDC, Lysholm and Tegner activity scores and improvements in functional knee measures. However, a wide range of reoperation and complications are reported, attributed to varying levels of chondral injury and osteoarthritis which warrant consideration when discussing expectations in patients 50 and above undergoing ACLR., Level of Evidence: IV, Systematic Review of Level II-IV studies., (Copyright © 2024. Published by Elsevier Inc.)