Energy gap and aromatic molecular rings

The manuscript combines rational density functional theory simulations and experimental data to investigate the electrical properties of eight polycyclic aromatic hydrocarbons (PAHs). The optimized geometries reveal a preference for one-row, two-row and three-row ring distributions. Band structure plots demonstrate an inverse correlation between the number of aromatic rings and band gap size, with a specific order observed across the PAHs. Gas phase simulations support these findings, though differences in values are noted compared to the literature. Introducing a two-row ring distribution concept resolves discrepancies, particularly in azulene. The B3LYP function successfully bridges theoretical and experimental gaps, particularly in large PAHs. The manuscript highlights the potential for designing electronic devices based on different-sized PAHs, emphasizing a multi-ring distribution approach and opening new avenues for practical applications.

Factors Associated With Hearing Outcomes After Stapedotomy in Taiwanese Patients With Clinical Otosclerosis

OBJECTIVE

To examine the clinical factors associated with the effectiveness of stapedotomy in improving hearing sensitivity in Taiwanese patients with otosclerosis.

METHODS

In this retrospective study, we reviewed the medical records of 31 patients (36 ears) with otosclerosis undergoing stapedotomy performed by a single surgeon. Preoperative and postoperative hearing results were analyzed to identify factors associated with hearing outcomes after stapedotomy in the Taiwanese population with clinical otosclerosis.

RESULTS

Compared with preoperative pure tone averages (PTAs), stapedotomy significantly improved postoperative air conduction (AC) thresholds (P < .0001), bone conduction (BC) thresholds (P = .025), and air-bone gaps (ABGs; P < .0001). Postoperative closure of ABGs less than 10 or 20 dB was achieved in 16 (44.4%) and 33 (91.7%) of 36 surgical ears. Improvement in postoperative AC thresholds and ABGs and the size of preoperative ABGs were significantly correlated (r = .650, P < .001 and r = .745, P < .001, respectively). Gender-stratified analysis indicated a stronger correlation between improvement in postoperative AC thresholds and preoperative ABGs in male patients than in female patients (r = .893, P < .001 and r = .476, P = .014, respectively), and in postoperative and preoperative ABGs (r = .933, P < .001 and r = .626, P < .001, respectively). With the more stringent criteria for surgical success, factors including age (≤50 years), type (conductive, BC ≤25 dB), and degree (PTA ≤55 dB) of preoperative hearing loss led to more favorable outcomes.

CONCLUSIONS

We reported evidence supporting a potential gender difference on hearing outcomes after stapedotomy in Taiwanese patients with otosclerosis. Age, type, and degree of preoperative hearing loss may affect the surgical success rate.

Predictive role of global spinopelvic alignment and upper instrumented vertebra level in symptomatic proximal junctional kyphosis in adult spinal deformity

OBJECTIVE

The authors of this study sought to evaluate the predictive role of global sagittal alignment and upper instrumented vertebra (UIV) level in symptomatic proximal junctional kyphosis (PJK) among patients with adult spinal deformity (ASD).

METHODS

Data on ASD patients who had undergone fusion of ≥ 5 vertebrae from 2008 to 2018 and with a minimum follow-up of 1 year were obtained from a prospectively collected multicenter database and evaluated (n = 1312). Radiographs were obtained preoperatively and at 6 weeks, 6 months, 1 year, 2 years, and 3 years postoperatively. The 22-Item Scoliosis Research Society Patient Questionnaire Revised (SRS-22r) scores were collected preoperatively, 1 year postoperatively, and 2 years postoperatively. Symptomatic PJK was defined as a kyphotic increase > 20° in the Cobb angle from the UIV to the UIV+2. At 6 weeks postoperatively, sagittal parameters were evaluated and patients were categorized by global alignment and proportion (GAP) score/category and SRS-Schwab sagittal modifiers. Patients were stratified by UIV level: upper thoracic (UT) UIV ≥ T8 or lower thoracic (LT) UIV ≤ T9.

RESULTS

Patients who developed symptomatic PJK (n = 260) had worse 1-year postoperative SRS-22r mental health (3.70 vs 3.86) and total (3.56 vs 3.67) scores, as well as worse 2-year postoperative self-image (3.45 vs 3.65) and satisfaction (4.03 vs 4.22) scores (all p ≤ 0.04). In the whole study cohort, patients with PJK had less pelvic incidence-lumbar lordosis (PI-LL) mismatch (-0.24° vs 3.29°, p < 0.001) but no difference in their GAP score/category or SRS-Schwab sagittal modifiers compared with the patients without PJK. Regression showed a higher risk of PJK with a pelvic tilt (PT) grade ++ (OR 2.35) and less risk with a PI-LL grade ++ (OR 0.35; both p < 0.01). When specifically analyzing the LT UIV cohort, patients with PJK had a higher GAP score (5.66 vs 4.79), greater PT (23.02° vs 20.90°), and less PI-LL mismatch (1.61° vs 4.45°; all p ≤ 0.02). PJK patients were less likely to be proportioned postoperatively (17.6% vs 30.0%, p = 0.015), and regression demonstrated a greater PJK risk with severe disproportion (OR 1.98) and a PT grade ++ (OR 3.15) but less risk with a PI-LL grade ++ (OR 0.45; all p ≤ 0.01). When specifically evaluating the UT UIV cohort, the PJK patients had less PI-LL mismatch (-2.11° vs 1.45°) but no difference in their GAP score/category. Regression showed a greater PJK risk with a PT grade + (OR 1.58) and a decreased risk with a PI-LL grade ++ (OR 0.21; both p < 0.05).

CONCLUSIONS

Symptomatic PJK leads to worse patient-reported outcomes and is associated with less postoperative PI-LL mismatch and greater postoperative PT. A worse postoperative GAP score and disproportion are only predictive of symptomatic PJK in patients with an LT UIV.

Comparative sensitivity and accuracy of 24 vs. 18 MHz ultrasound probes for the diagnosis of flexor tendon repair integrity

Purpose

To determine whether a 24 MHz transducer significantly improves sensitivity, specificity and accuracy in evaluating flexor tendon repair integrity compared with an 18 MHz transducer.

Methods

One hundred and twelve cadaveric digits were randomised to an intact repair or simulated 'failed' repair, and to a two- or eight-strand repair of a flexor digitorum profundus laceration. A blinded sonologist evaluated specimens in static mode using 18 and 24 MHz transducers. Gaps were remeasured after scanning, and final gap width recorded. McNemar's exact test calculated differences between sensitivity, specificity and accuracy, and chi-squared test to compare sensitivity, specificity and accuracy between number of strands (2 vs. 8) and repair gap (≥4 mm).

Results

The 24 MHz transducer had higher sensitivity (81 vs. 59%), lower specificity (67 vs. 70%) and higher overall accuracy (74 vs. 64%), than the 18 MHz transducer. The difference for sensitivity was significant (P = 0.011), but not differences for specificity and overall accuracy (P > 0.05). Pearson's correlation (r = 0.61) demonstrated a moderate-to-strong positive correlation between measured and true gap sizes. Increased number of suture strands (2 vs. 8) did not impair sensitivity, specificity nor accuracy.

Discussion

Ultrasound may tend to overestimate gap width, and a slight risk that some intact repairs, or those with small, clinically insignificant gaps may undergo surgical exploration that may not be indicated.

Conclusions

A 24 MHz transducer is a more sensitive and accurate transducer for assessing flexor tendon repair integrity and measuring small gaps.

Integrative Medicine Approaches: Bridging the Gap Between Conventional and Renal Complementary Therapies

The global incidence of renal disorders is on the rise, demanding the implementation of novel and comprehensive strategies for patient care. The present study demonstrates the significance of renal health, offering a comprehensive comprehension of renal physiology and the escalating load of renal illnesses. The relevance of controlling renal illnesses is underscored by a thorough examination of conventional treatments, which encompass pharmaceutical interventions, dialysis, and transplantation. Subsequently, the story redirects its attention towards complementary therapies, classifying them into several categories, such as herbal medicine, acupuncture, dietary supplements, and mind-body activities, among various others. This paper presents a comprehensive examination of the available information, providing a critical study of the effectiveness and safety of alternative therapies in renal care. This study focuses on the central idea of integrative medicine, distinguished by its patient-centered and holistic approach and its seamless integration of conventional and complementary therapies. This study examines several integrative care models, using case studies to illustrate successful integrative approaches that have enhanced patient outcomes. The review thoroughly examines the current body of literature on integrative renal care, including meta-analyses, systematic reviews, and notable research discoveries. This study highlights the need for further research to address knowledge gaps and explore areas that require additional examination. These findings emphasize the importance of future research endeavors in this crucial sector. In addition, the paper thoroughly examines the safety issues and regulatory factors pertaining to complementary therapies, underscoring the importance of making educated decisions and maintaining diligent monitoring to safeguard patients' well-being. Integrating patient perspectives, experiences, and shared decision-making is essential to the integrated healthcare process, promoting a collaborative and patient-centered approach. The study culminates by providing a concise overview of the primary discoveries and delineating the ramifications of implementing therapeutic procedures. This statement underscores the considerable potential of integrative medicine in augmenting renal care, ultimately leading to enhanced patient outcomes and an improved overall quality of life for persons with renal diseases. Also, this literature review provides a thorough and knowledgeable examination of the incorporation of conventional and complementary therapies in the context of renal health. It gives valuable perspectives for healthcare practitioners, researchers, and policymakers interested in enhancing care strategies for individuals with renal conditions.

Tuning Gaps and Schottky Contacts of Graphene/Phosphorene Heterostructures by Vertical Electric Field and Strain

We present a comprehensive study of the structural and electronic properties of a graphene/phosphorene (G/P) heterostructure in the framework of density functional theory, including van der Waals interaction in the exchange-correlation functional. While the G(4 × 1)/P(3 × 1) superlattice usually used in the literature is subject to a strain as high as about 7%, the in-plane strain could be drastically reduced to under 1% in the G(4 × 13)/P(3 × 12) heterostructure investigated here. Adapting the lattice constants of the rectangular lattices, the equilibrium configuration in the xy plane of phosphorene relative to the graphene layer is optimized. This results in an equilibrium interlayer distance of 3.5 Å and a binding energy per carbon atom of 37 meV, confirming the presence of weak van der Waals interaction between the graphene and the phosphorene layers. The electronic properties of the heterostructure are evaluated under different values of interlayer distance, strain and applied vertical electric field. We demonstrate that G/P heterostructures form an n-type Schottky contact, which can be transformed into p-type under external perturbations. These findings, together with the possibility to control the gaps and barrier heights, suggest that G/P heterostructures are promising for novel applications in electronics and may open a new avenue for the realization of innovative optoelectronic devices.

80 Hz auditory steady state responses (ASSR) elicited by silent gaps embedded within a broadband noise

Introduction

Although auditory temporal processing plays an important role in speech comprehension, it cannot be measured by pure tone audiometry. Auditory temporal resolution is often assessed by behavioral gaps-in-noise test. To evaluate whether auditory temporal resolution could be objectively assessed, we measured the auditory steady state response (ASSR) elicited by silent gaps embedded within broadband noises at 80 Hz.

Methods

We prepared six sound types as test stimuli. One was a continuous broadband noise without a silent interval as a control stimulus and the others were broadband noises with 80 Hz silent intervals of 0.4, 0.8, 1.6, 3.1, and 6.3 ms.

Results

Significant ASSRs were recorded only when the gap length was longer than the behavioral thresholds and the ASSR amplitude increased as the gap length increased.

Conclusion

Eighty Hertz gap-evoked ASSR appears to reflect the neural activity related to the auditory gap processing and may be used as an objective measure of auditory temporal resolution in humans.

Effects of a gap between the central and surrounding regions with luminance gradients on the feeling of being dazzled

The feeling of being dazzled is evoked by images consisting of an achromatic uniform center, surrounded by regions with luminance gradients. As the perceptual distinctness of the central region has been suggested to contribute to the feeling of being dazzled, we examined the effects of a gap between the central and surrounding regions on the feeling of being dazzled. The stimulus comprised a disk with uniform luminance surrounded by an annulus, of which the luminance was decreased from the inner boundary to the periphery. Three luminance profiles (linear, logistic, and inverse-logistic) of the surrounding luminance ramps were used. The distinctness of the disk decreased in the order of logistic, linear, and inverse-logistic profiles. The luminance of the disk, the maximum luminance of the annulus, and the gap size were also varied. When the luminance continuously transitioned from the disk to the annulus, the feeling of being dazzled was stronger for the inverse-logistic annulus luminance profile, compared with the logistic and linear profiles without a gap; however, it was not different for the three profiles with a gap. Further, the feeling of being dazzled increased when a gap was introduced for the logistic and linear profiles, but not for the inverse-logistic profile. These results suggest that the feeling of being dazzled was reduced by the perceptual indistinctness of the central disk for the logistic and linear annulus luminance profiles, while the gap restored the feeling of being dazzled by making the central disk perceptually distinct.

Arf6 Regulates Endocytosis and Angiogenesis by Promoting Filamentous Actin Assembly

Clathrin-mediated endocytosis (CME) is a process vital to angiogenesis as well as general vascular homeostasis. In pathologies where supraphysiological growth factor signaling underlies disease etiology, such as in diabetic retinopathy and solid tumors, strategies to limit chronic growth factor signaling by way of CME have been shown to have tremendous clinical value. ADP ribosylation factor 6 (Arf6) is a small GTPase that promotes the assembly of actin necessary for CME. In its absence, growth factor signaling is greatly diminished, which has been shown to ameliorate pathological signaling input in diseased vasculature. However, it is less clear if there are bystander effects related to loss of Arf6 on angiogenic behaviors. Our goal was to provide a analysis of Arf6’s function in angiogenic endothelium, focusing on its role in lumenogenesis as well as its relation to actin and CME. We found that Arf6 localized to both filamentous actin and sites of CME in 2-dimensional culture. Loss of Arf6 distorted both apicobasal polarity and reduced the total cellular filamentous actin content, and this may be the primary driver underlying gross dysmorphogenesis during angiogenic sprouting in its absence. Our findings highlight that endothelial Arf6 is a potent mediator of both actin regulation and CME.

Changing racial and ethnic differences for lung transplantation in cystic fibrosis

BACKGROUND

CFTR modulators, especially (elexacaftor/tezacaftor/ivacaftor), have positively impacted the CF population and quickly decreased LTx numbers. However, no study has investigated if this reduction is universal across all races/ethnicities.

METHODS

Using the UNOS Registry, we explored the frequency/proportions of LTx in WNH and NW (Black, non-Hispanic/Hispanic-Latino/Asian-non Hispanic/American Indian-Alaskan Native-non-Hispanic/Native Hawaiian/Other Pacific Islander-non-Hispanic/Multiracial) in children and adults with CF in the US.

RESULTS

Between 1990 and 2019, the annual mean (±SD) number of LTxs for children with CF was 23.2 (±7.7) compared to 5 in 2020 (p < .001) and in 2021 (p < .001). In adults from 1990 to 2019, the mean (±SD) number of LTxs performed was 144.9 (±73.5), which was significantly higher than 2020 (n = 73; p < .001) and 2021 (n = 45; p < .001). Comparing 1990-2019 to post-2019, the proportion of LTxs performed in both children and adults with CF has decreased from 50.5% (696/1378) to 16.4% (9/55) and from 12.1% (4773/39542) to 2.4% (118/5004), respectively. In WNH pediatric patients, the difference in the percentage of all LTx made up by CF patients between the two eras was 41.2% compared to NW patients where the difference was 11%. Similarly in adults, the difference between the two eras was 10.4% in WNH and 2.4% in NW patients.

CONCLUSIONS

The recent reduction in LTx for the CF population has had less impact on the NW population in the US, so the continuation of optimal referrals for this group is needed.

Gap-directed chemical lift-off lithographic nanoarchitectonics for arbitrary sub-micrometer patterning

We introduce a unique soft lithographic operation that exploits stamp roof collapse-induced gaps to selectively remove an alkanethiol self-assembled monolayer (SAM) on Au to generate surface patterns that are orders of magnitude smaller than structures on the original elastomer stamp. The smallest achieved feature dimension is 5 nm using a micrometer-scale structured stamp in a chemical lift-off lithography (CLL) process. Molecular patterns retained in the gaps between stamp features and their circumscribed or inscribed circles follow mathematical predictions, and their sizes can be tuned by altering the stamp structure dimensions, including height, pitch, and shape. These generated surface molecular patterns can function as biorecognition arrays or be transferred to the underneath Au layer for metallic structure creation. By combining CLL process with this gap phenomenon, soft material properties that are previously thought as demerits can be used to achieve sub-10 nm features in a straightforward sketch.

Gaps between Activities of Daily Living Performance and Capacity in People with Mild Dementia

Persons with mild dementia can effectively maintain and improve their quality of life (QOL) by regularly performing their daily activities. However, research on activities of daily living (ADL) in this population often fails to distinguish between ADL performance and ADL capability, that is, actual independence in daily lives and potential independence in an ideal setting. This study aimed to identify the potential gaps between ADL performance and capability in individuals with mild dementia. A total of 137 community-dwelling older adults (aged ≥ 65 years) who had been diagnosed with dementia and assessed as 0.5 and 1 on a global clinical dementia rating (CDR). Participants were evaluated for basic ADL (BADL) and instrumental ADL (IADL) using the Hyogo Activities of Daily Living Scale (HADLS). Around 35 individuals who met the inclusion criteria were enrolled in the study. BADL performance and BADL capacity were not significantly different (p = 0.128); however, participants rated IADL capacity significantly higher than IADL performance (p < 0.01). Gaps between performance and capability were observed for IADL but not for BADL. This study distinguishes between ADL performance and capability in individuals with mild dementia and is the first to identify the IADL-specific gap between these two components; pertinent targeted interventions are vital in closing this gap. Environmental adjustments are important to improve QOL of persons with mild dementia.

Influences of Repair Site Tension and Conduit Splinting on Peripheral Nerve Reconstruction

BACKGROUND

We investigated the use of a conduit splinting technique to mitigate tension at the coaptation site of a rodent nerve defect model to determine the optimal reconstruction method for segmental nerve defects.

METHODS

A rat sciatic nerve segmental defect model was created by excising 5mm of the sciatic nerve unilaterally. Four groups of 10 rats were each reconstructed using 1 of 4 techniques: primary repair, repair with conduit splinting, reverse isograft with conduit splinting, and reverse isograft without splinting. Functional outcomes were assessed at 6 weeks by measurement of Sciatic Functional Index (SFI), and sciatic nerves were harvested at the nonsurvival surgery. Histomorphologic measurements were reported as a value normalized to the average measurements of the control side. The primary outcomes were assessment of nerve continuity and the proportion of nerve fibers in the regenerating nerve compared with the uninjured side.

RESULTS

The number of repair site rupture rates was lower when a conduit splint was used-less than half of the primary repairs under tension remained intact at 6 weeks. No difference was seen in axon number, size, and density between primary repairs and those augmented by conduit splints, but worse functional outcomes and more debris were present compared with the intact primary repairs.

CONCLUSIONS

Nerve conduit splinting reduced rupture rates, particularly for nerve repairs associated with a segmental defect. No significant difference was seen in the number of axons among techniques. Primary nerve repair under tension that did not rupture demonstrated superior SFI.

Using Curriculum Mapping as a Tool to Match Student Learning Outcomes and Social Studies Curricula

The interest in program- and colleges of education- level evaluation and alignment of student learning outcomes to course content has been increasing over the past several decades. Curriculum mapping establishes the links between content and expected student learning outcomes. Curriculum map is an overview of what is taking place in the classroom; and it includes evaluation tools and activities. Social Studies Department, Federal Capital Territory (FCT) College of Education Zuba, Abuja, recently completed an accreditation exercise by National Commission for Colleges of Education Abuja, Nigeria. The audit reported that there was no match between the student learning outcomes and Social Studies curricula. The purpose of this paper was to align the Nigeria Certificate in Education (NCE) (Social Studies) minimum standards with student learning outcomes to determine gaps and redundancies. The paper also looked at how virtual education enhances curriculum mapping during COVID-19 pandemic. Minimum standards learning outcomes were modified from existing learning outcomes to better align with college learning outcomes and the Social Studies Core and Elective Competencies. All NCE Social Studies courses were mapped to the Social Studies Core and Elective Competencies and assessed to determine the gaps and redundancies. The study used the documentary research method. The purposeful sampling strategy was used to select the research site. Potential gaps were defined as coverage for each competency in about ≤20% of the courses and potential redundancies was considered as coverage of ≥80% of the courses. The mapping exercise revealed gaps; and no redundancies in course content. The findings of the mapping exercises should be used to improve the content provided to NCE Social Studies students at FCT College of Education Zuba, with the overall objective of enhancing the quality of the education provided to those students and helping them to be better students that are prepared for a successful career in Social Studies.

Notable gaps between patients' and physicians' perspectives on communication and disease management in Japan: multifaceted ad hoc analyses of the global Ulcerative Colitis Narrative Survey for further optimal care

INTRODUCTION

The patient-physician relationship is important in implementing appropriate management strategies. The Ulcerative Colitis (UC) Narrative Global Surveys examined patient and physician views on multiple aspects of living with UC. However, there are many other important undiscovered aspects of UC to consider for patients in Japan.

AIM

The aim of these ad hoc analyses was to identify detailed practical issues for further optimal care.

METHODS

Patient and physician questionnaires covered broad aspects of living with UC and practical care. Results were compared to identify gaps. We conducted multifaceted ad hoc analyses on the responses from Japan.

RESULTS

In Japan, 210 patients with UC and 151 physicians were surveyed. Most (64%) patients felt they would be more successful if they did not have UC. Physicians were more likely to discuss treatment-related topics, including side effects as a proxy for medication satisfaction, than quality of life-related topics. Physicians underestimated the importance to patients of toileting accidents (28% vs 54%) and overestimated the importance of mucosal healing (59% vs 29%). Although 72% of patients felt comfortable raising concerns with their physician, 53% worried about asking too many questions, as they thought they would be seen as a difficult patient, and 66% wished they had talked more about medication fears. The majority (83%) of patients said they were honest with their physician when discussing their experiences with UC, although 45% regretted not telling them more. Some (26%) patients believed, and some (20%) were not sure, that if their symptoms were under control then their UC was not active. More positively, 65% of patients agreed that UC had made them more appreciative of the important things in life.

CONCLUSION

This survey revealed notable gaps between patients' and physicians' perspectives. Consequently, the importance of patient-physician communication remains constant, even in the era of biologics and treat-to-target strategies.

PLAIN LANGUAGE SUMMARY

Overlap and differences in views around communication and management of ulcerative colitis between patients and doctors It is important to discover the different ways that ulcerative colitis (UC) can impact individual patients, and to identify differences in views between people with UC and the doctors treating them, to improve patient care. The UC Narrative is a global survey (containing two questionnaires, one for patients, and one for doctors) that gathers information on how UC impacts patients. The survey aims to identify differences between patients' and doctors' views on communication and disease management.In this analysis, we report the results from 210 patients with UC and 151 doctors who completed the UC Narrative survey in Japan, between November 2017 and January 2018. Most patients (85%) were satisfied with their communication with their doctor. However, doctors underestimated patient satisfaction, as they believed that about 71% of their patients were satisfied with communication. Around two-thirds of patients (65%), and most doctors (82%), wanted more discussion about goals for managing or treating UC. Most patients (83%) said they were honest with their doctor when discussing their experiences with UC, although almost half of patients (45%) said they regretted not telling their doctor more. Three-quarters of doctors (75%) felt that their patients were honest with them. Doctors underestimated the importance of toileting accidents to patients and thought that healing the patients' intestine would be more important to the patients than toileting accidents. Some patients had misconceptions about treatment. For example, only 69% of patients knew that it was not OK to stop taking their UC medications once they felt better. This survey shows that even though treatment options for UC have developed, sufficient communication between patients and doctors is very important for overall patient care.

Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study

Background

Although pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps).

Methods

We included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps.

Results

Compared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010).

Conclusion

CPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.

Theoretical Model of Bending Moment for Straight Mortise-and-Tenon Joints with Wooden Pegs Involving a Gap

The stress mechanism of a straight mortise-and-tenon joint with wooden pegs in traditional residential wooden structures was analyzed, and a theoretical moment-rotation model of the joint was derived. To verify the model, three full-scale joint specimens were fabricated and subjected to low-cycle reversed loading tests. All specimens showed tensile cracking parallel to the grain at the top or bottom of the tenon neck. The theoretical calculation results are consistent with the experimental results. The results of the parametric analysis based on the theoretical model show the following: the rotational stiffness and bending moment of the joint increase as the beam width increases; as the beam height increases, the moment increases, but the initial stiffness of the joint is only slightly impacted; as the column diameter increases, the initial stiffness and moment increase, and the free rotation of the joint decreases; as the gap between the mortise and tenon increases, the initial stiffness and moment decrease; as the sliding friction coefficient increases, both the rotational stiffness and moment of the joint increase, and the increase is greater after the joint yields than before.

Comparison of 4 Different 4-Strand Core Suturing Techniques for Flexor Tendon Laceration: An Ex Vivo Biomechanical Study

BACKGROUND

Forces applied to the repaired flexor tendon should not exceed its yield force during early postoperative rehabilitation to prevent gapping and rupture. We aimed to biomechanically compare the tensile strengths and the 2-mm gapping of 4 different 4-strand core suturing techniques for flexor tendon repair.

METHODS

Fifty-six goat deep digital flexor tendons were repaired with the 4-strand double-modified Kessler, the 4-strand augmented Becker, the 4-strand Savage, and the 4-strand modified Tang techniques. All tendons were repaired with 4-0 polyester for core suture and 5-0 polyester for continuous epitendinous running suture. The specimens were subjected to static linear tensile testing by applying a single linear load-to-failure pull. After the linear load testing, the yield load, the ultimate strength of the repaired tendons, and the force exerted to yield a 2-mm gap were measured.

RESULTS

All peripheral sutures ruptured near the yield point. All core suture techniques were similar regarding the yield force. The augmented Becker 4-strand technique had the greatest ultimate strength (98.7 [82-125.3] N). The modified double Kessler technique was the weakest in resisting a 2-mm gap formation. The 4-strand modified Tang repair had the shortest (11.3 [7-15] minutes), while the 4-strand augmented Becker had the longest operative time (29 [23-33] minutes).

CONCLUSIONS

All 4 techniques demonstrated similar yield force, with differences in operative time, ultimate strength, and resistance to gapping. Future clinical studies can further elucidate their appropriateness for early active motion protocols.

Kinetics and Connectivity Properties of Parvalbumin- and Somatostatin-Positive Inhibition in Layer 2/3 Medial Entorhinal Cortex

Parvalbumin-positive (Pvalb⁺) and somatostatin-positive (Sst⁺) cells are the two largest subgroups of inhibitory interneurons. Studies in visual cortex indicate that synaptic connections between Pvalb⁺ cells are common while connections between Sst⁺ interneurons have not been observed. The inhibitory connectivity and kinetics of these two interneuron subpopulations, however, have not been characterized in medial entorhinal cortex (mEC). Using fluorescence-guided paired recordings in mouse brain slices from interneurons and excitatory cells in layer 2/3 mEC, we found that, unlike neocortical measures, Sst⁺ cells inhibit each other, albeit with a lower probability than Pvalb⁺ cells (18% vs 36% for unidirectional connections). Gap junction connections were also more frequent between Pvalb⁺ cells than between Sst⁺ cells. Pvalb⁺ cells inhibited each other with larger conductances, smaller decay time constants, and shorter delays. Similarly, synaptic connections between Pvalb⁺ and excitatory cells were more likely and expressed faster decay times and shorter delays than those between Sst⁺ and excitatory cells. Inhibitory cells exhibited smaller synaptic decay time constants between interneurons than on their excitatory targets. Inhibition between interneurons also depressed faster, and to a greater extent. Finally, inhibition onto layer 2 pyramidal and stellate cells originating from Pvalb⁺ interneurons were very similar, with no significant differences in connection likelihood, inhibitory amplitude, and decay time. A model of short-term depression fitted to the data indicates that recovery time constants for refilling the available pool are in the range of 50-150 ms and that the fraction of the available pool released on each spike is in the range 0.2-0.5.

Early Sternal Bone Healing after Thermoreactive Nitinol Flexigrip Sternal Closure

PURPOSE

Thermoreactive nitinol Flexigrip has been developed to ensure better fixation than conventional wire closure. To verify the advantage of Flexigrip over the conventional wiring, we compared early sternal bone healing on computed tomography (CT).

METHODS

A prospective cohort study enrolled the first consecutive 80 patients with wiring and the second consecutive 44 patients undergoing Flexigrip sternal closure. The primary endpoint was sternal healing evaluated quantitatively using a 6-point scale and measured gaps/offsets of the sternal halves at 6 levels on CT scans on the 14th postoperative day. Secondary endpoints included pain scores and sternal complications 1 month after surgery.

RESULTS

Compared with the patients of wiring, those who received Flexigrips showed higher 6-point scores at most sternum levels, less frequent gaps (52% vs 70%, p = 0.04), lower offsets (3.3 ± 0.9 mm vs 4.3 ± 0.7 mm, p <0.001) at the manubrium, and less frequent gaps (25% vs 43%, p = 0.04) and offsets (2.3% vs 24%, p = 0.002) at the middle of sternum. The pain scores and sternal complication rates were similar between both groups.

CONCLUSION

CT evaluation 2 weeks after surgery revealed that Flexigrip sternal closure showed less gaps and offsets of the sternal halves, suggesting faster sternal bone union when compared to the wiring.

Publication Trends on Mitophagy in the World and China: A 16-Year Bibliometric Analysis

In the past 16 years, research on mitophagy has increasingly expanded to a wider range of subjects. Therefore, comprehensively analyzing the relevant progress and development trends on mitophagy research requires specific methods. To assess the hotspots, directions, and quality of results in this field worldwide, we used multiple tools to examine research progress and growing trends in research on the matter during the last 16 years (from 2005 to 2020). We also compared the quantity and quality of the literature records on mitophagy published by research institutions in China and other developed countries, reviewed China’s contribution, and examined the gap between China and these developed countries. According to the results of our bibliometric analysis, the United States and its research institutes published the most papers. We identified cell biology as the most commonly researched subject on mitophagy and AUTOPHAGY as the most popular journal for research on mitophagy. We also listed the most cited documents from around the world and China. With gradually increased funding, China is progressively becoming prominent in the field of mitophagy; nevertheless, the gap between her and major countries in the world must be closed.

Evaluation of Newly Introduced Bioactive Materials in Terms of Cavity Floor Adaptation: OCT Study

OBJECTIVE

The aim of the present study was to evaluate the adaptation of newly introduced bioactive restorative materials to the cavity floor using cross-polarization optical coherence tomography (CP-OCT).

MATERIALS AND METHODS

Round class V cavities were prepared on the proximal surfaces of sixty non-carious human anterior teeth (0.5 mm depth × 4 mm diameter), which were divided into groups according to the restorative material (n = 15). In the VF group, Vertise flow composite (Kerr, Orange, CA, USA) was used, in the BF group, Beautifil II composite (Shofu, Koyoto, Japan) was used, and in the AB group, ACTIVA BioACTIVE composite (Pulpdent, Watertown, NY, USA) was used. Cavities were restored using the bulk filling technique and cured according to the manufacturers' instructions. Then, the specimens were immersed in a contrasting agent, and image acquisitions were taken by CP-OCT to calculate the adaptation percentage by using an image analysis software.

RESULTS

B-scans showed a diffuse bright band of white pixels at the tooth-resin interface that was interpreted as a micro-gap present between the cavity floor and restorative material. The Kruskal-Wallis test showed a statistically significant difference between all tested groups with the AB group representing the least gap formation, followed by the BF group, and then the VF group, which demonstrated the highest gap formation.

CONCLUSIONS

In class V cavities, better adaptation to the cavity floor can be obtained when using ACTIVA BioACTIVE more than Vertise flow and Beautifil II composites. In addition, CP-OCT is considered a non-destructive imaging tool that helps in evaluating the quality of the tooth-restoration interface when bioactive composites are used.

The Impact of Local Economic Growth Target Setting on the Quality of Public Occupational Health: Evidence From Provincial and City Government Work Reports in China

This article uses data from the government work reports of 31 provinces (autonomous regions and municipalities) in China and 21 cities in Guangdong Province of China to perform a fixed effect regression. It was found that economic growth target constraints and economic growth target gaps between countries and provinces, or between provinces and cities have a significant impact on the quality of public occupational health. The non-linear relationship between economic growth target setting and the quality of public occupational health was then discussed in detail, and the reliability of basic conclusions drawn was ensured by robustness and endogeneity tests. The results show that the effect of economic growth target constraints and gaps on the quality of public occupational health shows a “U-shaped” trend at both the provincial and city levels, which initially promotes and, eventually, inhibits. This relationship is closely related to the current economic system reforms, administrative reforms, and social transformation in China. Therefore, in emphasising high-quality economic development, the government should fully consider the actual state of the development of jurisdictions in setting economic goals to improve the quality of public occupational health in an orderly manner.

Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps

We report existing evidence and gaps in neuropathic pain management in Saudi Arabia, the prevalence and patient management stages in diabetic peripheral neuropathy (DPN) and low back pain (LBP) with a neuropathic component. A semi-systematic approach was adopted to identify data on neuropathic pain. A structured search was conducted through MEDLINE, Embase, and BIOSIS databases to identify articles published in English between January 2010 and December 2019. Unstructured search was conducted through various sources including Google Scholar and Saudi Arabia's Ministry of Health website. Studies including populations ≥18 years and neuropathic pain were included; data gaps were supplemented with anecdotal data from local experts. Weighted or simple means were calculated for overall data; synthesized evidence was represented as an evidence gap map. Of 37 articles retrieved from structured search, none were eligible for final analyses. Thirteen articles from unstructured search and two anecdotal data sources were included for final analyses. The majority of articles included were of cross-sectional design (n = 10) in diabetes patients. The mean (range; number of articles) DPN prevalence was estimated as 33.6% (5.6%-65.3%; n = 8). Data on DPN patient management stages were limited; synthesized evidence indicated that 37.2% (0.41%-80.0%; n = 3) of patients had DPN awareness, 17.8% (n = 1) underwent screening, 22.4% (18.4%-65.3%; n = 2) had DPN diagnosis, and 45.1% (0.0%-62.7%; n = 2) received treatment for pain management. Data on LBP with neuropathic component were scarce (prevalence, 41.0% [n = 1]; diagnosis, 54.7% [n = 1]). Data are limited, so more studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in the country.

Influence of Embedded Gap and Overlap Fiber Placement Defects on Interlaminar Properties of High Performance Composites

Automated fiber placement (AFP), once limited to aerospace, is gaining acceptance and offers great potential for marine structures. This paper describes the influence of manufacturing defects, gaps, and overlaps, on the out-of-plane properties of carbon/epoxy composites manufactured by AFP. Apparent interlaminar shear strength measured by short beam shear tests was not affected by the presence of defects. However, the defects do affect delamination propagation. Under Mode I (tension) loading a small crack arrest effect is noted, resulting in higher apparent fracture energies, particularly for specimens manufactured using a caul plate. Under Mode II (in-plane shear) loading there is a more significant effect with increased fracture resistance, as stable propagation for specimens with small gaps changes to arrest with unstable propagation for larger gaps.

Gap Confinement Effect of a Tandem Nanochannel System and Its Application in Salinity Gradient Power Generation

As an important nanofluidic device, an artificial ion nanochannel could selectively transport ions inside its nanoconfinement space and the surface charge of the pore wall. Here, confinement effects were realized by tandem nanochannel units, which kept their cascade gaps less than 500 nm. Within these gaps, ionic conductance was governed by the surface charge density of the channel unit. Cations could be sufficiently selected and enriched within this confined space, which improves the cation transfer number of the system. Therefore, the tandem nanochannel system could greatly improve the diffusion potential and energy conversion efficiency in the salinity gradient power generation process. Poisson-Nernst-Planck equations were introduced to numerically simulate the ionic transport behavior and confirmed the experimental results. Finally, the gap confinement effect was introduced in the porous cellulose acetate membrane tandem nanochannel system, and a high output power density of 4.72 W/m² and energy conversion efficiency of 42.22% were achieved under stacking seven channel units.

Disparities in Cancer-Related Avoidable Mortality by the Level of Area Deprivation in South Korea

Background: This study investigated trends in cancer-related avoidable (preventable and treatable) mortality and its association with area deprivation in Korea. Methods: Cancer-related avoidable mortality rates per 100,000 population between 2015 and 2019 were measured using the Causes of Death Statistics. Area Deprivation Index (ADI) was measured from the Population and Housing Census and information on other independent variables from the Korea Community Health Survey. The gap in avoidable mortality between the more and less deprived groups was expressed as rate ratios (RR) and absolute differences (ADs) with a 95 percent confidence interval (95% CI). The association between avoidable mortality and ADI was investigated through Poisson regression modelling. Results: The more deprived areas had higher avoidable (RR 1.15, 95% CI 1.13–1.17; AD 6.58, 95% CI 5.59–7.57) and preventable (RR 1.19, 95% CI 1.17–1.21; AD 6.22, 95% CI 5.38–7.06) mortality. The overall cancer-related avoidable mortality decreased but the gap between the more and less deprived groups did not decline significantly during the study period. The association between avoidable and preventable mortality and area deprivation remained significant after adjusting for variables, including area levels of smokers and alcohol drinkers. Conclusions: The gap in avoidable mortality signifies the importance of addressing related disparities in cancer.

Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy

A substantial proportion of individuals with newly diagnosed epilepsy report prior seizures, suggesting a missed opportunity for early epilepsy care and management. Consideration of the causes and outcomes of diagnostic delay is needed to address this issue. We aimed to review the literature pertaining to delay to diagnosis of epilepsy, describing the components, characteristics, and risk factors for delay. We undertook a systematic search of the literature for full-length original research papers with a focus on diagnostic delay or seizures before diagnosis, published 1998-2020. Findings were collated, and a narrative review was undertaken. Seventeen papers met the inclusion criteria. Studies utilized two measures of diagnostic delay: seizures before diagnosis and/or a study-defined time between first seizure and presentation/diagnosis. The proportion of patients with diagnostic delay ranged from 16% to 77%; 75% of studies reported 38% or more to be affected. Delays of 1 year or more were reported in 13%-16% of patients. Seizures prior to diagnosis were predominantly nonconvulsive, and usually more than one seizure was reported. Prior seizures were often missed or mistaken for symptoms of other conditions. Key delays in the progression to specialist review and diagnosis were (1) "decision delay" (the patient's decision to seek/not seek medical review), (2) "referral delay" (delay by primary care/emergency physician referring to specialist), and (3) "attendance delay" (delay in attending specialist review). There were few data available relevant to risk factors and virtually none relevant to outcomes of diagnostic delay. This review found that diagnostic delay consists of several components, and progression to diagnosis can stall at several points. There is limited information relating to most aspects of delay apart from prevalence and seizure types. Risk factors and outcomes may differ according to delay characteristics and for each of the key delays, and recommendations for future research include examining each before consideration of interventions is made.

Value-Based Pay-for-Performance Gaps in the Care Delivery Framework for a Large-Scale Health System

Many health systems are engaging in pay-for-performance agreements with payers that focus primarily on improving ambulatory preventive screenings. These also are referred to as gaps in care. Gaps in care are typically measured by the Healthcare Effectiveness Data and Information Set measures of health care quality. To address gaps in care effectively, the physician-led Gaps in Care program at Northwell Health works to improve processes related to measurement, data attribution, patient outreach, and patient engagement. Following a structured framework to address patient gaps in care is a successful strategy for accomplishing complex value-based care delivery.

Comparative Accuracy of 1.5T MRI, 3T MRI, and Static Ultrasound in Diagnosis of Small Gaps in Repaired Flexor Tendons: A Cadaveric Study

PURPOSE

We hypothesized that magnetic resonance imaging (MRI) would more accurately diagnose small gaps (<6 mm) after flexor tendon repair than static ultrasound (US) and that suture artifact would negatively impair accuracy.

METHODS

A laceration of the flexor digitorum profundus was created in 160 fresh-frozen cadaveric digits and randomized to either an intact repair (0-mm gap) or repairs using a locked 4-strand suture repair with either 4-0 Prolene, Ethibond, or and gaps of 2, 4,or 6 mm; or no suture in which 2-, 4-, or 6-mm gaps were created without a suture crossing the repair site. We performed 1.5T and 3T MRI and static US studies; gap widths were estimated by radiologists blinded to suture presence and true gap widths.

RESULTS

The 1.5 and 3.0T MRI had a lower mean error than US for gap sizes 0 and 2 mm. All 3 modalities performed similarly for 4- and 6-mm gaps. Documentation of imaging artifact worsened error, and odds of seeing artifacts were 1.72 higher with MRI than with US. Suture did not worsen artifact nor impair accuracy for any of the 3 modalities. When no suture was used, all 3 modalities significantly overestimated the true gap.

CONCLUSIONS

MRI is most accurate for small gaps less than 4 mm. Although all modalities overestimated gap sizes in specimens with a 0-mm gap (intact tendon repair), mean overestimation (<2 mm) was not clinically relevant. Ultrasound overestimated 2-mm gaps (clinically intact repairs), whereas MRIs did not. We recommend MRI for evaluation of gaps after flexor tendon repair. The 1.5T has slightly better sensitivity and specificity for distinguishing clinically intact (gap < 3 mm) from clinically impaired (gap > 3 mm) repairs than the 3T.

CLINICAL RELEVANCE

Accurate diagnosis of intact repairs or small gaps (<3 mm) might prevent unnecessary exploration or allow modification of rehabilitation protocols. Diagnosis of clinically relevant gaps (3-6 mm) may allow for earlier revision surgery before significant tendon retraction and adhesions develop, possibly necessitating a staged reconstruction.

Gap or prehistoric monster? A history of the humanitarian-development nexus at UNICEF

Why has bridging the humanitarian-development divide been such a long-running endeavour, and why have so many frameworks to do so been proposed and picked apart over the years? Rather than contributing yet another 'mind the gap' approach, this paper seeks to articulate why such a lacuna emerged in the first place, and to explore how to exit a debate that has grown increasingly circular. To provide one possible answer to the questions above, the paper draws on the history of UNICEF (United Nations Children's Fund) in working across the 'humanitarian-development' nexus. Suggesting that the gap is more artefact than fact, derived from the institutionalisation of aid, the paper argues that focusing on the challenges and the concepts that inherently transcend humanitarian-development silos may enhance understanding of what it means-and what is needed-to operate at the intersection of humanitarian and development action on behalf of children.

Paediatric tuberculosis - new advances to close persistent gaps

Young children are most vulnerable to develop severe forms of tuberculosis (TB) and are over-represented among TB deaths. Almost all children estimated to have died from TB were never diagnosed or offered TB treatment. Improved access to TB preventive treatment (TPT) requires major upscaling of household contact investigation with allocation of adequate resources. Symptom-based screening is often discouraged in adults for fear of generating drug resistance, if TB cases are missed. However, the situation in vulnerable young children is different, as they present minimal risk of drug resistance generation. Further, the perceived need for additional diagnostic evaluation presents a major barrier to TPT access and underlies general reluctance to consider pragmatic decentralised models of care. Widespread roll-out of Xpert MTB/RIF Ultra® represents an opportunity for improved case detection in young children, but attaining full impact will require the use of non-sputum specimens. The new Fujifilm SILVAMP TB LAM® urine assay demonstrated good diagnostic accuracy in HIV-positive and malnourished children, but further validation is required. Given the limited accuracy of all available tests and the excellent tolerance of TB drugs in children, the global community may have to accept some over-treatment if we want to close the persistent case detection gap in young children.

Comparative Sensitivity and Specificity of Static and Dynamic High-Resolution Ultrasound in Diagnosis of Small Gaps in Repaired Flexor Tendons: A Cadaveric Study

PURPOSE

To compare the sensitivity and specificity of high-resolution static and dynamic ultrasound (US) for diagnosing intact repairs and small, clinically relevant gaps (≥4 mm) in repaired flexor digitorum profundus tendons within zone 2 and, secondarily, to evaluate the effect of suture artifact from 3 commonly used suture types.

METHODS

Eighty-eight fresh-frozen cadaveric digits (thumbs excluded) were randomized to either an intact repair (0-mm gap) or repairs using a locked 4-strand suture repair with either 4-0 Prolene, Ethibond, or FiberWire and gaps of 2, 4, or 6 mm and no suture in which 2-, 4-, or 6-mm gaps were created without a suture crossing the repair site. Gap widths were estimated by a blinded musculoskeletal ultrasonographer in static and dynamic modes.

RESULTS

Both static and dynamic modalities tended to overestimate actual gap sizes. For the suture gaps, both modalities had poor sensitivity (29% static; 42% dynamic) for accurately diagnosing a clinically intact repair (<4 mm), but better specificity (83% static; 75% dynamic) for diagnosing a clinically failed repair (≥4-mm gap). Although suture presence decreased the sensitivity of gap width measurement for both modalities, no differences were seen between suture types.

CONCLUSIONS

Static and dynamic US have poor sensitivity for diagnosing clinically intact repairs (gaps < 4 mm) because they typically overestimate gap size. The ability to diagnose failed repairs (gap ≥ 4 mm), based on greater specificity, is much better, but still suboptimal.

CLINICAL RELEVANCE

Based on a receiver operating characteristic analysis cutoff of 5 mm, if a gap of 5 mm or larger is identified with US when evaluating a zone 2 flexor digitorum profundus tendon repair, a failed repair is likely in about 80% of cases. A gap measurement of less than 5 mm may miss a high percentage of repairs that are clinically failed.

Optical comparison between micro-CT and OCT in imaging of marginal composite adaptation: Observational study

Dental composite is the most used aesthetic restorative biomaterial worldwide. However, it undergoes polymerisation shrinkage that could lead to loss of the interfacial seal between tooth and resin in some circumstances. This demands high-resolution imaging technologies to detect these defects. This study carried out a comparison between microcomputed tomography (micro-CT; Shimadzu, Japan) and swept-source optical coherence tomography (SS-OCT; Santec, Japan) in the detection of marginal adaptation defects at the tooth-resin interface. Unlike in micro-CT, it was possible to outline interfacial gaps along with tooth-resin interfaces with SS-OCT, which was attributed to the Fresnel diffraction of light. This in vitro comparison demonstrates SS-OCT has great potential in dental imaging to effectively assess dental composite adaptation and marginal defects when high resolution is desired in real time. LAY DESCRIPTION: Detection of tooth-colored restoration defects had been assessed by different radiographic methods. However, most of these methods are either invasive or suffer from low-resolution. In this study, a comparison has been carried out between two different high-resolution imaging systems; microcomputed tomography and optical coherence tomography, to explore their potentials in detecting restorations defects. The results showed optical coherence tomography has a great accuracy in locating the underlying defects when the obtained images were validated against confocal laser scanning microscopy images.

Sensitivity of express saccades to the expected value of the target

Express saccades, a distinct fast mode of visually guided saccades, are probably underpinned by a specific pathway that is at least partially different from the one underlying regular saccades. Whether and how this pathway deals with information on the subjective value of a saccade target is unknown. We studied the influence of varying reward expectancies and compared it with the impact of a temporal gap between the disappearance of the fixation dot and the appearance of the target on the visually guided saccades of two rhesus macaques (Macaca mulatta). We found that increasing reward expectancy increased the probability and decreased the reaction time of express saccades. The latter influence was stronger in the later parts of the reaction time distribution of express saccades, satisfactorily captured by a linear shift model of change in the saccadic reaction time distribution. Although different in strength, increasing reward expectancy and inserting a temporal gap resulted in similar effects on saccadic reaction times, suggesting that these two factors summon the same mechanism to facilitate saccadic reaction times.NEW & NOTEWORTHY Express saccades are the fastest visually driven way of shifting gaze to targets of interest. We examined whether the pathway underlying these saccades has access to information on the value of saccade targets. We found that not only regular saccades but also express saccades occur earlier in case of higher expectations of reward. Yet, the sensitivity of express saccades to reward decreases linearly when approaching the earliest possible reaction time.

Gender Compensation Gap for Ophthalmologists in the First Year of Clinical Practice

PURPOSE

To identify the role of gender and other factors in influencing ophthalmologists' compensation.

DESIGN

Cross-sectional study.

PARTICIPANTS

U.S. practicing ophthalmologists.

METHODS

Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables.

MAIN OUTCOME MEASURES

Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus.

RESULTS

Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P = 0.00). The PSM analysis showed an SWB difference of -$27 273.89 (10.3% gap, P = 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (-$27 793.67 [10.5% gap, P = 0.0013]) and clinic days (-$23 597.57 [8.90% gap, P = 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22 261.49, $-18 604.65, and $-16 191.26, respectively; P = 0.017, P = 0.015, P = 0.002, respectively). Gender independently predicted income in all 3 analyses (P < 0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P = 0.03).

CONCLUSIONS

Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.

Achilles Tendon Rupture: Can the Tendon Gap on Ultrasound Scan Predict the Outcome of Functional Rehabilitation Program?

Background and objectives  There is a growing use of functional rehabilitation programs for the treatment of Achilles tendon rupture. Factors such as patient age and level of activity have been used to guide the decision. One of the debated indications is the gap size between the ruptured ends of the tendon. This study aims to define any correlation between the amount of the initial gap between tendon ends and patients outcome treated with the functional rehabilitation program. Method  A prospective case series study of all patients with acute Achilles tendon rupture treated non-surgically with the functional rehabilitation program between 2016 and 2018. The tendon gap was measured with an ultrasound scan on the initial presentation. Patients were followed for a minimum of 12 months and assessed for Achilles Tendon Rupture Score (ATRS), plantarflexion strength, and re-rupture rate.  Results  A total of 56 patients completed one-year follow-up, and 2 patients had re-ruptures. The mean plantar flexion gap was 13.7 mm. The mean ATRS at 12 months was 85.12. There was no statistically significant correlation between the final ATRS and the mean rupture gap. Conclusion  The outcome following non-operative functional rehabilitation treatment of rupture Achilles tendon did not correlate with the size of the tendon gap, and authors recommend that decision on functional rehabilitation should not be based on these criteria.

Is dermis fat arthroplasty better than plain gap arthroplasty? A prospective randomised controlled trial

The aim of the study was to compare interpositional arthroplasty using a dermis fat graft with gap arthroplasty in the management of ankylosis of the temporomandibular joint (TMJ). We organised a prospective randomised study of 22 patients who presented with ankylosis of the TMJ. They were randomised to be treated with either plain gap arthroplasty or dermis fat arthroplasty, and the predictor variable was the method of treatment. The primary outcome variables were mouth opening and pain on jaw exercises. Pain and interincisal opening were measured on day 5, day 14, at the end of one month, and at six months, one year, two years, and three years. There was a significant difference between the two groups on two occasions: postoperative day 5 (p=0.013) and at one year (p=0.018). The mean (SD) scores for mouth-opening were higher in the dermis fat group at all times (41.20 (4.69) mm compared with 39.50 (2.46) mm in gap arthroplasty at two years, and 41.40 (3.60) mm compared with 38.9 (2.02) mm at three years). The visual analogue pain scores were also lower in the dermis fat graft group. The groups showed similar results at the end of three years follow up, with no significant difference in mouth opening. We conclude therefore that the two techniques have similar outcomes in the management of ankylosis of the TMJ.

Intraoperative manipulation for flexion contracture during total knee arthroplasty

BACKGROUND

Joint gap unbalancing during total knee arthroplasty (TKA) induces flexion contracture. Flexion contracture is one of the most serious complications of TKA. When flexion contracture is found during surgery, intraoperative manipulation is often empirically performed. We evaluated the effects of intraoperative manipulation on joint gap and postoperative flexion contracture.

MATERIALS AND METHODS

TKA was performed for 136 knees. Intraoperative manipulation was performed for flexion contracture in 61 knees. Joint gap changes before and after manipulation were measured at six positions from extension to 120° of flexion. Manipulation was not performed for 75 knees. The extension angle was measured radiographically immediately after surgery, at 3 months, and 6 months postoperatively. Extension angles with manipulation and without manipulation were compared.

RESULTS

Joint gap changes (mm) before and after manipulation were 0.1, 0.0, -0.2, -0.3, -0.1, and -0.3 at 0°, 30°, 45°, 60°, 90°, and 120° of flexion, respectively, indicating that manipulation could not change joint gaps significantly. Extension angles (°) with and without manipulation were -4.0 ± 4.6 and -3.8 ± 3.9 immediately after surgery, -5.3 ± 6.7 and -5.5 ± 6.2 at 3 months postoperatively, and -2.7 ± 6.0 and -3.8 ± 5.8 at 6 months postoperatively. No statistically significant difference existed between the values with or without manipulation during all periods.

CONCLUSION

Intraoperative manipulation does not enlarge the gap or resolve postoperative flexion contracture. Developing the new surgical technique is required to achieve perfect balance at TKA.

Gaps present a trade-off between dispersal and establishment that nourishes species diversity

We took advantage of two natural experiments to investigate processes that regulate tree recruitment in gaps. In the first, we examined the recruitment of small and large saplings and trees into 31 gaps resulting from treefalls occurring between 1984 and 2015 in the 2.25-ha core area of a 4-ha tree plot at Cocha Cashu in Perú. In the second, we identified the tallest saplings recruiting into 69 gaps created during a violent wind storm in February 2000. In the established tree plot, we were able to compare the composition of saplings in the disturbance zones of gaps prior to, during, and subsequent to the period of gap formation. Recruitment in gaps was compared with that in "nofall" zones, areas within the plot that had not experienced a treefall at least since the early 1980s. Our results confirmed earlier findings that a consistently high proportion (~60%) of established saplings survived gap formation. Light demanding species, as proxied by mortality rates, recruited under all conditions, but preferentially during periods of gap formation, a pattern that was especially strong among gap pioneers. Similar results were noted, separately, for small and large saplings and trees recruiting at ≥10 cm dbh. One hundred percent of previously untagged trees recruiting into gaps in the first post-disturbance census were gap pioneers, suggesting rapid development. This conclusion was strongly supported in a follow-up survey taken of 69 gaps 19 months after they had been synchronously created in a wind storm. Ten species of gap pioneers, eight of which are not normally present in the advance regeneration, had attained heights of 6-10 m in 19 months. The 10 gap pioneers were dispersed, variously, by primates, bats, birds, and wind and reached maximum frequency in different-sized gaps (range <100 m² to >1,000 m² ). Both gap size and limited dispersal of zoochorous species into gaps serve as filters for establishment, creating a complex mosaic of conditions that enhances species diversity.

How Flat Is the Tibial Osteotomy in Total Knee Arthroplasty?

BACKGROUND

Cementless total knee arthroplasty has been developed to decrease the incidence of failure in younger and more active patients. However, failures are still more common in cementless versus cemented components. It is hypothesized that this is triggered by incomplete bone-tray contact. The present study compares the final contact area of a cementless tray as a function of the initial osteotomy flatness.

METHODS

Eight surgeons prepared 14 cadaveric knees for cementless total knee replacement using standard instrumentation. The topography of each osteotomy was captured with a laser scanner; 3-dimensional computer models of the surfaces were generated. After scanning each tibia, the surgeons implanted cementless tibial trays using a manual impactor. Each tibia was then dissected, embedded in mounting resin, and sectioned. The sectioned blocks were observed under stereomicroscopy to identify points of bone-tray contact which were incorporated into the 3-dimensional models. Maps were then generated illustrating depicting contacting and noncontacting areas.

RESULTS

The mean initial flatness of all specimens was 1.1 ± 0.35 mm. After impaction, 79.4% ± 0.3% of the surface had established bony contact. Of the noncontacting areas, 17.6% were within 0.3 mm of the tray. Only 2.6% of the surface was at distances reported to impede ingrowth. Noncontacting areas were typically located centrally. A trend in decreasing percent contact area with increased flatness tolerance was observed (R² = 0.605).

CONCLUSION

(1) There is an inverse correlation between the flatness of the tibial osteotomy and the percentage of the bony surface in contact with underside of the tibial tray. (2) Almost all tray-tibia contact is generated during implantation through flattening of elevated features on the tibial surface. (3) Gaps between the tray and the tibia are consistently located in the central regions of the osteotomy proximal to the medullary canal.

Influence of Narrow Femoral Implants on Intraoperative Soft Tissue Balance in Posterior-Stabilized Total Knee Arthroplasty

BACKGROUND

Narrow femoral implants were developed to improve fit and prevent overhang in primary total knee arthroplasty (TKA). We compared intraoperative soft tissue balance between standard and narrow implants in posterior-stabilized (PS) TKA.

METHODS

We enrolled 30 consecutive patients with varus osteoarthritis undergoing PS TKA using an image-free navigation system. Standard and narrow femoral trial implants were inserted, and their soft tissue balance was measured. Subgroup analysis, based on the actual implanted femoral implant, was performed to assess the influence of narrow implants on soft tissue balance.

RESULTS

Narrow trial group had significantly larger joint component gaps than standard trial group at all measured flexion angles, except at 60° (P < .05). For the standard implant cohort, narrow trial group had significantly larger joint component gaps than standard trial group at 30°, 120°, and 135° flexion (P < .05). For the narrow implant cohort, narrow trial group had significantly larger joint component gaps than standard trial group at all measured flexion angles, except at 0° and 60° (P < .05). Narrow trial group had significantly larger varus ligament balance than standard trial group at 45° and 60° flexion (P < .05). The varus angles for standard implants were comparable between groups; however, narrow trial group had significantly larger varus angles for narrow implants than standard trial group at 45°, 60°, and 120° flexion (P < .05).

CONCLUSION

The medial-lateral dimension and volume of the femoral component may influence intraoperative soft tissue balance in PS TKA. The effects may be greater when narrow implants are selected to avoid component overhang.

Gap Opening in Twisted Double Bilayer Graphene by Crystal Fields

Crystal fields occur due to a potential difference between chemically different atomic species. In van der Waals heterostructures such fields are naturally present perpendicular to the planes. It has been realized recently that twisted graphene multilayers provide powerful playgrounds to engineer electronic properties by the number of layers, the twist angle, applied electric biases, electronic interactions, and elastic relaxations, but crystal fields have not received the attention they deserve. Here, we show that the band structure of large-angle twisted double bilayer graphene is strongly modified by crystal fields. In particular, we experimentally demonstrate that twisted double bilayer graphene, encapsulated between hBN layers, exhibits an intrinsic band gap. By the application of an external field, the gaps in the individual bilayers can be closed, allowing to determine the crystal fields. We find that crystal fields point from the outer to the inner layers with strengths in the bottom/top bilayer [Formula: see text] = 0.13 V/nm ≈ [Formula: see text] = 0.12 V/nm. We show both by means of first-principles calculations and low energy models that crystal fields open a band gap in the ground state. Our results put forward a physical scenario in which a crystal field effect in carbon substantially impacts the low energy properties of twisted double bilayer graphene, suggesting that such contributions must be taken into account in other regimes to faithfully predict the electronic properties of twisted graphene multilayers.

The Effect of Posterior Tibial Slope on Joint Gap and Range of Knee Motion in Mobile-Bearing Unicompartmental Knee Arthroplasty

BACKGROUND

It is widely known that the posterior tibial slope (PTS) has an influence on the clinical outcome of arthroplasty. However, the influence of PTS on unicompartmental knee arthroplasty (UKA) is still not fully clear. The objective of this study is to reveal the effect PTS has on knee flexion and extension joint gap and the postoperative range of motion in mobile-bearing UKA. Moreover, we investigated an adequate PTS angle in mobile-bearing UKA.

METHODS

Oxford UKA was performed so that the flexion gap would be equal to the extension gap. Correlation between the gap value difference from 90° to 120° of the knee flexion and the PTS was evaluated. Correlation between postoperative range of motion and the PTS was also evaluated to find whether a small degree of PTS would cause knee flexion restriction.

RESULTS

The PTS had a moderate positive correlation with the flexion gap difference. However, the PTS had no correlation with the knee flexion angle both postoperative and 1 year after surgery.

CONCLUSION

It was suggested that the degree of the PTS should not be so large to avoid joint looseness throughout every knee angle. Increasing the degree of the PTS had the potential to dislocate the bearing. Since a small degree of the PTS does not have an influence on the clinical outcome, surgeons should aim to cut the tibia with a posterior slope of less than 7°.

Changes of mediolateral soft tissue gaps in total knee arthroplasty after suturing medial extensor in navigation

PURPOSE

Aim is to investigate the changes of mediolateral soft tissue gaps in total knee arthroplasty (TKA) after suturing medial extensor.

METHODS AND MATERIALS

We compared the differences of medial and lateral gap values that were shown by the computer navigation at 0°, 45°, 90°, and 120° knee flexion during patella in situ and during patella repaired by a towel clip on two constant sites. Fifty consecutive knees (43 patients) scheduled for TKA due to varus knee osteoarthritis, from February 2017 to May 2017, were enrolled in this prospective study.

RESULTS

The medial gaps with patella repaired were significantly lower ( p < 0.05) than the medial gaps with patella in situ at 45°, 90°, and 120° knee flexion. Differences in the medial gap were largest at 90, with the difference of 0.87 mm. Twenty-four of 50 cases (48%) showed medial gap differences of 1 mm or over, and 13 of 50 cases (26%) showed medial gap differences of 2 mm or over. The variation in the medial gap at 90° following patellar repair showed significant association (correlation coefficient = 0.78, p = 0.001) with the difference between medial and lateral gaps (medial gap - lateral gap) at 90° of patella in situ. At 90° knee flexion, when the medial and lateral gap difference in patella in situ was 1 mm or less, 73.5% (25/34) of the cases showed variation in the medial gap of less than 1 mm after patellar repair.

CONCLUSION

During TKA, while measuring the medial gap with patella in situ, overestimation might occur, especially in the position of knee flexion. Thus, reevaluation using towel clips should be considered when the medial and lateral gap difference is 1 mm or larger when patella in situ during evaluation of the medial and lateral gaps at 90° knee flexion.

Impact of task-specific training on saccadic eye movement performance

Prosaccades are saccadic eye movements made reflexively in response to the sudden appearance of visual stimuli, whereas antisaccades are saccades that are directed to a location opposite a stimulus. Bibi and Edelman (Bibi R, Edelman JA. J Neurophysiol 102: 3101-3110, 2009) demonstrated that decreases in reaction time resulting from training prosaccades along one spatial axis (horizontal or vertical) could transfer to prosaccades made along the other axis. To help determine whether visual or motor-related processes underlie this facilitation, in the present study we trained participants to make prosaccades and probed their performance (reaction time, error rate) on antisaccade trials and vice versa. Subjects were probed for the effects of training on saccade performance before, during, and after 12 sessions of training. Training on prosaccades improved performance on both pro- and antisaccade tasks. Antisaccade training, with either a classic step task or a gap task, improved performance on gap prosaccades, though by less than it improved antisaccade performance, but had limited effect on an overlap prosaccade task. Across all subjects, training on one task only rarely had an adverse impact on an untrained task. These findings suggest that the predominant effect of saccade training is to facilitate fixation disengagement and motor preparation processes while having little impact on visual input to the saccadic system.NEW & NOTEWORTHY This is the first systematic examination of whether training of prosaccades and antisaccades is task specific or instead transfers to the other saccade type. It finds that training tends to improve performance of all saccade types tested. These behavioral results provide insight into saccade neurophysiology, suggesting that saccade training enhances processes related to motor excitation and inhibition.