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Modularization of heavy industrial plants is a standard mode of operation utilized to reduce costs, site congestion, and schedule. The standard module is 6 m wide, 24 to 36 m long, and up to 7.5 m high (20 ft wide, 80 to 120 ft long and 24 ft high) with weights ranging from 50 to 160 tonnes. On-site traditional rigging arrangements are costly to adjust for dimension and center of gravity and have inherent safety risks in handling the rigging. Additionally, the modules are often over-designed because of uncertainties in the load redistribution due to lifting. The aim of this work is to design a new system, improving upon the limitations of the traditional system. To achieve this goal, a thorough understanding of the traditional system is required. In this paper, finite element analysis was used to analyze the load redistribution due to lifting of three module types with different sizes under various extreme loading scenarios. The results show that load redistribution depends primarily on the triangular assembly of the traditional rigging independent of the module type, size and loading. Secondly, an adjustable and functionally very flexible engineered module lift frame was designed to handle the variety of loading and dimensional conditions and reduce module stresses exerted due to lifting. It is comprised of two main running beams, adjustable interconnecting cross braces, sliders for longitudinal flexibility in connection points, and supporting slings to a common upper point. Finite element analysis was used to confirm the module lift frame loading resistance and to determine its limits under a variety of extreme loading scenarios. There are significant improvements in the module load redistribution forces as compared to traditional rigging. Key words: finite element analysis, rigging, module, construction engineering, structural engineering. La modularisation des usines industrielles lourdes represente un mode de fonctionnement normalise utilise pour reduire les couts, la congestion des sites et l'echeancier. Le module normal mesure 6 m de large, de 24 a 36 m de long, et jusqu'a 7,5 m de haut (20 pi de large, de 80 a 120 pi de long et 24 pi de haut) et son poids varie de 50 a 160 tonnes. Les dispositions des greements traditionnels sur le site sont couteuses a ajuster aux dimensions et au centre de gravite et elles presentent des risques de securite inherents lors de la manutention des greements. De plus, les modules sont souvent surdimensionnes en raison des incertitudes dans la redistribution des charges dues au levage. L'objectif de ce travail est de concevoir un nouveau systeme en ameliorant les restrictions du systeme traditionnel. Pour atteindre cet objectif, il faut tres bien connaitre le systeme traditionnel. Dans cet article, une analyse par elements finis a ete utilisee pour analyser la redistribution des charges en raison du levage de trois types de modules de dimensions differentes selon divers scenarios de chargement extremes. Les resultats montrent que la redistribution des charges depend principalement de l'assemblage triangulaire du greement traditionnel, peu importe le type de module, sa dimension et la charge. Deuxiemement, un cadre de levage des modules, ajustable et tres flexible, a ete concu pour accepter les charges et les dimensions variees et reduire les contraintes sur les modules induites durant le levage. Ce cadre comporte deux poutres longitudinales, des traverses de raccord ajustables, des glisseurs pour permettre une flexibilite longitudinale aux points de raccord, ainsi que des elingues de soutien reliees a un point commun vers le haut. L'analyse par elements finis a permis de confirmer la resistance a la charge du cadre de levage de modules et de determiner ses limites sous divers scenarios de chargement extremes. Il y a eu des ameliorations importantes dans les forces de redistribution des charges de modules lorsqu'on les compare a la redistribution des greements traditionnels. [Traduit par la Redaction] Mots-cles: analyse par elements finis, greement, module, genie construction, genie des structures., 1. Introduction Modular construction is an efficient and cost-effective method to construct large industrial plants. The individual modules are constructed off-site in a controlled environment, transported to the site and [...]

Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional structural asymmetry of the spine and trunk affecting 2-4% of adolescents. Standard treatment is observation, bracing, and surgery for small, moderate, and large curves, respectively. Schroth exercises aim to correct posture and reduce curve progression., Purpose: This study aimed to determine the effect of Schroth exercises added to the standard care compared to standard care alone on torso asymmetry in AIS., Methods: In a randomized controlled trial (NCT01610908), 124 participants with AIS (age: 10-18, Cobb: 10°-45°, Risser: ≤3) were randomly assigned to the control (Standard care only) or Schroth (Standard care + Schroth treatment) group. Schroth treatment consisted of 1-hour weekly supervised sessions and 30-45 minutes of daily home exercises for six months. The control group received Schroth exercises in the last six months of the 1-year monitoring period. Markerless 3D surface topography assessed torso asymmetry measured by maximum deviation (MaxDev) and root mean square (RMS). Intention to treat linear mixed effects model analysis was compared to the per protocol analysis., Results: In the intention to treat analysis, the Schroth group (n = 63) had significantly larger decreased RMS (-1.2 mm, 95%CI [-1.5,-0.9]mm, p = 0.012) and MaxDev (-1.9mm, 95%CI [-2.4,-1.5]mm, p = 0.025) measurements compared to controls (n = 57) after six months of intervention. In the per protocol analysis (Schroth n = 39, control n = 36), the Schroth group also had a significantly larger decrease compared to the control in both the RMS (-1.0mm, 95%CI [-1.9, -0.2]mm, p = 0.013) and MaxDev measurements (-2.0mm, 95%CI [-3.3,-0.5]mm, p = 0.037). For the control group, both the intention to treat and per protocol analysis showed no difference in RMS and MaxDev in the last six months of Schroth intervention (p>0.5)., Conclusion: Schroth Exercise treatment added to standard care (observation or bracing) reduced asymmetry measurements in AIS. As expected, a greater effect was observed for participants who followed the prescribed exercise treatment per protocol., Competing Interests: The authors of this manuscript have the following competing interests: Dr. Parent is a Schroth certified therapist. Dr. Schreiber became an International Schroth Scoliosis Therapy (ISST) instructor and opened the Curvy Spine clinic after the data for this project had been collected. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Comprehensive understanding of force plate parameters distinguishing individuals postprimary anterior cruciate ligament reconstruction (ACLR) from healthy controls during countermovement jumps (CMJ) and/or drop jumps (DJ) is lacking. This review addresses this gap by identifying discriminative force plate parameters and examining changes over time in individuals post-ACLR during CMJ and/or DJ., Methods: We conducted a systematic review and meta analyses following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine databases were searched from inception to March 2022. We included cross-sectional papers comparing post-ACLR with healthy controls or longitudinal studies of individuals at least 6 months postprimary ACLR while performing CMJ and/or DJ on force plates. The methodological quality was appraised using the Modified Downs and Black Checklist., Results: Thirty-three studies including 1185 (50.38%) participants post-ACLR, and 1167 (49.62%) healthy controls, were included. Data were categorised into single-leg CMJ, double-leg CMJ, single-leg DJ, and double-leg DJ. Jump height was reduced in both single (mean difference [MD] = -3.13; p  < 0.01; 95% confidence interval [CI]: [-4.12, -2.15]) and double-leg (MD = -4.24; p  < 0.01; 95% CI: [-5.14, -3.34]) CMJs amongst individuals with ACLR. Similarly, concentric impulse and eccentric/concentric impulse asymmetry could distinguish between ACLR (MD = 3.42; p  < 0.01; 95% CI: [2.19, 4.64]) and non-ACLR (MD = 5.82; p  < 0.01; 95% CI: [4.80, 6.80]) individuals. In double-leg DJs, peak vertical ground reaction forces were lower in the involved side (MD = -0.10; p  = 0.03; 95% CI: [-0.18, -0.01]) but higher in the uninvolved side (MD = 0.15; p  < 0.01; 95% CI: [0.10, 0.20]) when compared to controls and demonstrated significant changes between 6 months and 3 years post-ACLR., Conclusion: This study identified discriminative kinetic parameters when comparing individuals with and without ACLR and also monitored neuromuscular function post-ACLR. Due to heterogeneity, a combination of parameters may be required to better identify functional deficits post-ACLR., Level of Evidence: Level III., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background  Graft preparation techniques for the Adams-Berger distal radioulnar joint (DRUJ) reconstruction vary among surgeons with insufficient evidence to support any specific technique. Questions/Purposes  We compared survival with cyclic loading, absolute elongation, elongation rate, and modes of failure of four graft preparation techniques. Methods  Fifteen porcine extensor tendons were divided into three equal groups: tendon only; tendon augmented along its full length with nonlocking 2-0 FiberLoop suture spaced at 6 mm intervals; and tendon with suture at 12 mm intervals. Suture only was also tested. Samples were woven through custom radius- and ulna-simulating jigs mounted on a mechanical testing machine. Samples underwent a staircase cyclic loading protocol and were then inspected visually for the mode of failure. Survival with cyclic loading, absolute elongation, and elongation rate was compared. Results  Average survival with cyclic loading of suture-augmented tendon was significantly higher than tendon only. All tendon groups had significantly higher survival compared with suture only. Absolute elongation was subject to variability due to initial nonlinear elongation behavior of samples. The elongation rate was significantly lower with suture compared with all tendon groups. Modes of failure included rupture of the tendon and/or suture at the simulated graft-bone interface and elongation of the entire construct without rupture. Conclusions  In this biomechanical study, augmentation of porcine tendons with suture spaced at either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase cyclic loading protocol Clinical Relevance  For the Adams-Berger reconstruction, tendon grafts augmented along their entire length by nonabsorbable braided suture are biomechanically superior to tendon alone., Competing Interests: Conflict of Interest The FiberLoop sutures used for this study were donated by Arthrex Inc., (Thieme. All rights reserved.)

Cartilage tissue engineering aims to generate functional replacements to treat cartilage defects from damage and osteoarthritis. Human bone marrow-derived mesenchymal stem cells (hBM-MSC) are a promising cell source for making cartilage, but current differentiation protocols require the supplementation of growth factors like TGF-β1 or -β3. This can lead to undesirable hypertrophic differentiation of hBM-MSC that progress to bone. We have found previously that exposing engineered human meniscus tissues to physiologically relevant conditions of the knee (mechanical loading and hypoxia; hence, mechano-hypoxia conditioning) increased the gene expression of hyaline cartilage markers, SOX9 and COL2A1 , inhibited hypertrophic marker COL10A1 , and promoted bulk mechanical property development. Adding further to this protocol, we hypothesize that combined mechano-hypoxia conditioning with TGF-β3 growth factor withdrawal will promote stable, non-hypertrophic chondrogenesis of hBM-MSC embedded in an HA-hydrogel. We found that the combined treatment upregulated many cartilage matrix- and development-related markers while suppressing many hypertrophic- and bone development-related markers. Tissue level assessments with biochemical assays, immunofluorescence, and histochemical staining confirmed the gene expression data. Further, mechanical property development in the dynamic compression treatment shows promise toward generating functional engineered cartilage through more optimized and longer culture conditions. In summary, this study introduced a novel protocol to differentiate hBM-MSC into stable, cartilage-forming cells., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Osteoarthritis (OA) primarily affects mechanical load-bearing joints, with the knee being the most common. The prevalence, burden and severity of knee osteoarthritis (KOA) are disproportionately higher in females, but hormonal differences alone do not explain the disproportionate incidence of KOA in females. Mechanical unloading by spaceflight microgravity has been implicated in OA development in cartilaginous tissues. However, the mechanisms and sex-dependent differences in OA-like development are not well explored. In this study, engineered meniscus constructs were generated from healthy human meniscus fibrochondrocytes (MFC) seeded onto type I collagen scaffolds and cultured under normal gravity and simulated microgravity conditions. We report the whole-genome sequences of constructs from 4 female and 4 male donors, along with the evaluation of their phenotypic characteristics. The collected data could be used as valuable resources to further explore the mechanism of KOA development in response to mechanical unloading, and to investigate the molecular basis of the observed sex differences in KOA., (© 2022. The Author(s).)

Background: Osteoarthritis (OA) primarily affects mechanical load-bearing joints. The knee joint is the most impacted by OA. Knee OA (KOA) occurs in almost all demographic groups, but the prevalence and severity are disproportionately higher in females. The molecular mechanism underlying the pathogenesis and progression of KOA is unknown. The molecular basis of biological sex matters of KOA is not fully understood. Mechanical stimulation plays a vital role in modulating OA-related responses of load-bearing tissues. Mechanical unloading by simulated microgravity (SMG) induced OA-like gene expression in engineered cartilage, while mechanical loading by cyclic hydrostatic pressure (CHP), on the other hand, exerted a pro-chondrogenic effect. This study aimed to evaluate the effects of mechanical loading and unloading via CHP and SMG, respectively, on the OA-related profile changes of engineered meniscus tissues and explore biological sex-related differences. Methods: Tissue-engineered menisci were made from female and male meniscus fibrochondrocytes (MFCs) under static conditions of normal gravity in chondrogenic media and subjected to SMG and CHP culture. Constructs were assayed via histology, immunofluorescence, GAG/DNA assays, RNA sequencing, and testing of mechanical properties. Results: The mRNA expression of ACAN and COL2A1 , was upregulated by CHP but downregulated by SMG. COL10A1 , a marker for chondrocyte hypertrophy, was downregulated by CHP compared to SMG. Furthermore, CHP increased GAG/DNA levels and wet weight in both female and male donors, but only significantly in females. From the transcriptomics, CHP and SMG significantly modulated genes related to the ossification, regulation of ossification, extracellular matrix, and angiogenesis Gene Ontology (GO) terms. A clear difference in fold-change magnitude and direction was seen between the two treatments for many of the genes. Furthermore, differences in fold-change magnitudes were seen between male and female donors within each treatment. SMG and CHP also significantly modulated genes in OA-related KEGG pathways, such as mineral absorption, Wnt signalling pathway, and HIF-1 signalling pathway. Conclusion: Engineered menisci responded to CHP and SMG in a sex-dependent manner. SMG may induce an OA-like profile, while CHP promotes chondrogenesis. The combination of SMG and CHP could serve as a model to study the early molecular events of KOA and potential drug-targetable pathways., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ma, Li, Kunze, Mulet-Sierra, Westover and Adesida.)

Purpose: Our primary objectives were to (1) describe current approaches for kinetic measurements in individuals following anterior cruciate ligament reconstruction (ACLR) and (2) suggest considerations for methodological reporting. Secondarily, we explored the relationship between kinetic measurement system findings and patient-reported outcome measures (PROMs)., Methods: We followed the PRISMA extension for scoping reviews and Arksey and O'Malley's 6-stage framework. Seven electronic databases were systematically searched from inception to June 2020. Original research papers reporting parameters measured by kinetic measurement systems in individuals at least 6-months post primary ACLR were included., Results: In 158 included studies, 7 kinetic measurement systems (force plates, balance platforms, pressure mats, force-measuring treadmills, Wii balance boards, contact mats connected to jump systems, and single-sensor insoles) were identified 4 main movement categories (landing/jumping, standing balance, gait, and other functional tasks). Substantial heterogeneity was noted in the methods used and outcomes assessed; this review highlighted common methodological reporting gaps for essential items related to movement tasks, kinetic system features, justification and operationalization of selected outcome parameters, participant preparation, and testing protocol details. Accordingly, we suggest considerations for methodological reporting in future research. Only 6 studies included PROMs with inconsistency in the reported parameters and/or PROMs., Conclusion: Clear and accurate reporting is vital to facilitate cross-study comparisons and improve the clinical application of kinetic measurement systems after ACLR. Based on the current evidence, we suggest methodological considerations to guide reporting in future research. Future studies are needed to examine potential correlations between kinetic parameters and PROMs., (© 2021. The Author(s).)

Meniscus fibrochondrocytes (MFCs) experience simultaneous hypoxia and mechanical loading in the knee joint. Experimental conditions based on these aspects of the native MFC environment may have promising applications in human meniscus tissue engineering. We hypothesized that in vitro "mechano-hypoxia conditioning" with mechanical loading such as dynamic compression (DC) and cyclic hydrostatic pressure (CHP) would enhance development of human meniscus fibrocartilage extracellular matrix in vitro . MFCs from inner human meniscus surgical discards were pre-cultured on porous type I collagen scaffolds with TGF-β3 supplementation to form baseline tissues with newly formed matrix that were used in a series of experiments. First, baseline tissues were treated with DC or CHP under hypoxia (HYP, 3% O 2 ) for 5 days. DC was the more effective load regime in inducing gene expression changes, and combined HYP/DC enhanced gene expression of fibrocartilage precursors. The individual treatments of DC and HYP regulated thousands of genes, such as chondrogenic markers SOX5/6 , in an overwhelmingly additive rather than synergistic manner. Similar baseline tissues were then treated with a short course of DC (5 vs 60 min, 10-20% vs 30-40% strain) with different pre-culture duration (3 vs 6 weeks). The longer course of loading (60 min) had diminishing returns in regulating mechano-sensitive and inflammatory genes such as c-FOS and PTGS2 , suggesting that as few as 5 min of DC was adequate. There was a dose-effect in gene regulation by higher DC strains, whereas outcomes were inconsistent for different MFC donors in pre-culture durations. A final set of baseline tissues was then cultured for 3 weeks with mechano-hypoxia conditioning to assess mechanical and protein-level outcomes. There were 1.8-5.1-fold gains in the dynamic modulus relative to baseline in HYP/DC, but matrix outcomes were equal or inferior to static controls. Long-term mechano-hypoxia conditioning was effective in suppressing hypertrophic markers (e.g., COL10A1 10-fold suppression vs static/normoxia). Taken together, these results indicate that appropriately applied mechano-hypoxia conditioning can support meniscus fibrocartilage development in vitro and may be useful as a strategy for developing non-hypertrophic articular cartilage using mesenchymal stem cells., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Szojka, Li, Sopcak, Ma, Kunze, Mulet-Sierra, Adeeb, Westover, Jomha and Adesida.)

Quantifying the extent to which animals detect and respond to human presence allows us to identify pressure (disturbance) and inform conservation management objectively; however, obtaining baselines against which to compare human impact is hindered in areas where human activities are already well established. For example, Zakynthos Island (Greece, Mediterranean) receives around 850,000 visitors each summer, while supporting an important loggerhead sea turtle rookery (~300 individuals/season). The coronavirus (COVID-19)-driven absence of tourism in May-June 2020 provided an opportunity to evaluate the distribution dynamics of this population in the absence (2020) vs. presence (2018 and 2019) of visitors using programmed unmanned aerial system (UAS) surveys. Ambient sea temperature transitioned from suboptimal for breeding in May to optimal in late June, with turtle distribution appearing to shift from shallow (to benefit from waters 3-5°C above ambient) to deeper waters in 2018 and 2019, but not 2020. The 2020 data set demonstrated that increased tourism pressure, not temperature, drives turtles offshore. Specifically, >50% of turtles remained within 100 m of shore at densities of 25-50 visitors/km, even when sea temperature rose, with 2018 and 2019 data supporting this trend. Reduced access to warmer, nearshore waters by tourism could delay the onset of nesting and increase the length of the egg maturation period between nesting events (internesting interval) at this site. A coastal refuge zone could be delimited in May-June where touristic infrastructure is minimal, but also where turtles frequently aggregate. In conclusion, sea turtles appear capable of perceiving changes in the level of human pressure at fine spatial and temporal scales and adjusting their distribution accordingly., Competing Interests: The authors have no competing interests to declare., (© 2021 The Authors. Evolutionary Applications published by John Wiley & Sons Ltd.)

Background: The all-inside anterior cruciate ligament reconstruction (ACLR) procedure uses a single hamstring tendon folded twice and secured to itself to form a 4-stranded graft. There are several possible configurations for preparing the graft., Purpose: To investigate the biomechanical properties of a new graft preparation technique in comparison with 2 commonly used configurations., Study Design: Controlled laboratory study., Methods: Five porcine flexor tendons were prepared into the test graft configuration: side-to-side fixation with a backup fixation at the button loop (graft M). The test configuration was compared with the results of a previous study that included grafts with simple interrupted sutures (graft A; n = 5) and end-to-end fixation (graft C; n = 5). All grafts were subjected to the same mechanical testing protocol to determine the mean failure load, stiffness, rate of elongation, and total elongation during both cyclic loading and pull to failure. Differences between groups were evaluated., Results: Graft A had a significantly lower failure load (637 ± 99 N) compared with graft M (883 ± 66 N; P = .002) and graft C (846 ± 26 N; P = .002). Graft A also had significantly lower stiffness (166 ± 12 N/mm) compared with graft M (215 ± 8 N/mm; P < .001) and graft C (212 ± 11 N/mm; P < .001). Graft C had a significantly lower elongation during cyclic loading (3.42 ± 0.24 mm) compared with graft M (4.37 ± 0.74 mm; P = .026) and graft A (4.90 ± 0.88 mm; P = .006). The unsecured fixation was the weakest graft, with the lowest failure load and stiffness. The new side-to-side configuration and end-to-end configuration were equally strong., Conclusion: The new side-to-side configuration was not biomechanically superior to the end-to-end configuration; however, they were both stronger than unsecured fixation., Clinical Relevance: As the all-inside ACLR is gaining popularity, this study provides surgeons with a new method of preparing grafts and evaluates the method with respect to currently used configurations., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Support for this study was received from the Edmonton Civic Employees Charitable Fund. The adjustable button-loop devices used were contributed by Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Castration-resistant prostate cancers (CRPCs) lose sensitivity to androgen-deprivation therapies but frequently remain dependent on oncogenic transcription driven by the androgen receptor (AR) and its splice variants. To discover modulators of AR-variant activity, we used a lysate-based small-molecule microarray assay and identified KI-ARv-03 as an AR-variant complex binder that reduces AR-driven transcription and proliferation in prostate cancer cells. We deduced KI-ARv-03 to be a potent, selective inhibitor of CDK9, an important cofactor for AR, MYC, and other oncogenic transcription factors. Further optimization resulted in KB-0742, an orally bioavailable, selective CDK9 inhibitor with potent anti-tumor activity in CRPC models. In 22Rv1 cells, KB-0742 rapidly downregulates nascent transcription, preferentially depleting short half-life transcripts and AR-driven oncogenic programs. In vivo, oral administration of KB-0742 significantly reduced tumor growth in CRPC, supporting CDK9 inhibition as a promising therapeutic strategy to target AR dependence in CRPC., Competing Interests: Declaration of Interests A.N.K. is a founder and member of the scientific advisory board of Kronos Bio, Inc. D.B.F., N.B.S., S.K.D., A.R., M.S.P., and A.N.K. are inventors on patent applications related to KI-ARv-03., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: All-inside anterior cruciate ligament reconstruction (ACLR) is an emerging technique used to treat ACL injuries. The all-inside technique uses a 4-stranded graft made from a single tendon that is looped on itself. The 4 strands of the graft must be secured to each other to become a closed-loop structure. Various suture configurations exist to secure the graft to adjustable loop devices, and there is a lack of data to support one technique over another. In addition to the primary sutures used to fasten the graft together, accessory sutures can be tied over the button as secondary fixation., Purpose: To evaluate biomechanical properties of 4-stranded grafts prepared in 5 different configurations., Study Design: Controlled laboratory study., Methods: Porcine flexor tendons (N = 25) were prepared in 5 different configurations (n = 5 tendons per group): simple-interrupted sutures (unsecured fixation), side-to-side fixation with and without secondary fixation, and end-to-end fixation with and without secondary fixation. The grafts were put through the same mechanical testing protocol (cyclic loading, pull to failure) to measure average load at graft failure, average displacement at failure, average stiffness, and average elongation rate. Differences between graft preparation techniques were investigated using 1-way analyses of variance (ANOVAs) with post hoc t tests ( P < .05)., Results: Significant 1-way ANOVAs for each biomechanical property were found. Unsecured fixation was the weakest graft preparation with the lowest stiffness (167 ± 12 N/mm), lowest ultimate failure load (637 ± 99 N), and highest elongation rate (0.0033 ± 0.0007 mm/s). End-to-end fixation without secondary fixation showed the highest ultimate failure load (846 ± 26 N), highest stiffness (212 ± 10 N/mm), and lowest rate of elongation (0.0025 ± 0.0001 mm/s). End-to-end fixation, both with and without secondary fixation, as well as side-to-side fixation with secondary fixation showed significantly higher ultimate failure loads than grafts with unsecured fixation. End-to-end fixation performed better than side-to-side fixation; however, for most variables, the difference was not statistically significant. Secondary fixation did not provide significant improvement., Conclusion: The all-inside ACL graft with simple-interrupted sutures is biomechanically inferior to a graft that has its free ends secured to the adjustable tibial loop. Adding secondary fixation to the tibial button does not significantly change the biomechanical properties. Further clinical studies are required to determine whether these findings translate into differences in clinical outcome., Clinical Relevance: All-inside ACLR is gaining popularity in hamstring ACL reconstructive techniques. These results provide surgeons with guidance on the best graft preparation method when using a single quadrupled hamstring tendon graft., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for this study was received from the Edmonton Civic Employees Charitable Fund. The adjustable-loop buttons used in this study were donated by Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Due to the complexity of articular interconnections and tenuous blood supply to the talus, talus fractures are often associated with complications (e.g., avascular necrosis). Currently, surgically fusing the talus to adjacent bones is widely used as treatment to talus fractures, but this procedure can greatly reduce mobility in the ankle and hindfoot. Alternatively, customized talus implants have shown an overall satisfactory patient feedback but with the limitation of high expenses and time-consuming manufacturing process. In order to circumvent these disadvantages, universal talus implants have been proposed as a potential solution. In our study, we aimed to develop a methodology using Statistical Shape Model (SSM) to simulate the talus, and then evaluate the feasibility of the model to obtain the mean shape needed for universal implant design. In order to achieve this, we registered 98 tali (41 females and 57 males) and used the registered dataset to train our SSM. We used the mean shape derived from the SSM as the basis for our talus implant template, and compared our template with that of previous works. We found that our SSM mean shape talus implant was geometrically similar to implants from other works, which used a different method for the mean shape. This suggests the feasibility of SSM as a method of finding mean shape information for the development of universal implants. A second aim of our study was to investigate if one scalable talus implant can accommodate all patients. In our study, we focused on addressing this from a geometric perspective as there are multiple factors impacting this (e.g., articular surface contact characteristics, implant material properties). Our initial findings are that the first two principal components should be afforded consideration for the geometrical accuracy of talus implant design. Additional factors would need to be further evaluated for their role in informing universal talus implant design., (Copyright © 2020 Liu, Jomha, Adeeb, El-Rich and Westover.)

Objectives: Of the several barriers associated with uptake and adherence to hearing services, cost is the most commonly identified barrier in Canada. This study evaluated health insurance plans for hearing care coverage within Alberta, Canada, and subsequent out-of-pocket expenses that would result if an individual chose to pursue treatment., Methods: An investigation of eight companies that provide supplementary health coverage in Alberta was conducted. Categories of health service coverage included hearing, vision, speech-language pathology (S-LP), physical therapy related (PT-R; including massage therapy and chiropractic therapy) and alternative medicine related (AM-R; including osteopathy, acupuncture and naturopathy). All coverage amounts were corrected to a four-year term for comparison purposes., Results: For a four-year term, the coverage amounts for hearing services were CAD 300-750; for vision services were CAD 0-900; for S-LP services were CAD 0-2,400; for PT-R services were CAD 1,400-10,200; and for AM-R services were CAD 0-10,200 per four-year term. The expected out-of-pocket expense for vision ranged from CAD 0 to CAD 2,766, whereas for hearing, it ranged from CAD 250 to CAD 11,700., Conclusion: A considerable range and discrepancy were reported between hearing care and most paramedical services. In addition, the coverage amounts for hearing care were inconsistent with treatment costs, resulting in considerable out-of-pocket expenses for most consumers. The potential implications of such cost-related barriers on public health are an important consideration as our understanding of the impact of untreated hearing impairment continues to increase., (Copyright © 2019 Longwoods Publishing.)

Objectives: To evaluate the longitudinal changes in periodontal ligament (PDL) stiffness during orthodontic tooth movement using the Advanced System for Implant Stability Testing (ASIST)., Materials and Methods: ASIST measurements of maxillary canines that were actively retracted into an extraction space were collected approximately once per month for 12 adolescent female patients. The ASIST Stability Coefficient (ASC) values, which are directly related to PDL stiffness, were determined for each visit to examine longitudinal changes for individual canines as they were exposed to different forces (approximately 80 and 150 g) during retraction., Results: The pattern of longitudinal changes in ASC was similar for both canines (regardless of the two force levels applied) in individual patients and across patients. All patients showed some decrease in ASC, with an average maximum reduction in stiffness of 73.4 ± 7.7%. Some recovery was observed for most patients; however, none of the patients had the PDL stiffness return to the pre-treatment value at the final measurement appointment which was some time close after space closure was completed. On average, the ASC value at the final measured visit was 48.1 ± 12.2% of the initial value. No measurements are available after removal of orthodontic appliances and during retention., Conclusions: The ASIST was able to detect changes in PDL stiffness during orthodontic treatment, providing some insight into the mechanical changes that occur at the tooth root interface.

Stimulation of a cell with insulin initiates a signal transduction cascade that results in cellular activities that include phosphorylation of the receptor itself. Measurement of the degree of phosphorylation can serve as a marker for receptor activation. Receptor phosphorylation has been measured using Western blot analysis, which is very low throughput and not easily quantifiable. The goal of this project was to develop a cell-based assay to measure receptor phosphorylation in high throughput. This report describes a cell-based assay for insulin receptor phosphorylation that is robust and amenable to high-volume screening in a microwell format.