Frontal knee alignment influences the vertical orientation of the femoral neck in standing position

Aims The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. Methods Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck. Results The cohort included 147 patients who underwent knee realignment-surgery. The mean age was 51.5 years (SD 11). Overall, 106 patients underwent a valgisation-osteotomy, while 41 underwent varisation osteotomy. There was a significant association between the orientation of the knee and the coronal neck-orientation. In the varus group, the median orientation of the femoral neck was 46.5° (interquartile range (IQR) 49.7° to 50.0°), while in the valgus group, the orientation was 52.0° (IQR 46.5° to 56.7°; p < 0.001). Linear regression analysis revealed that HKA demonstrated a direct influence on the coronal neck-orientation ( β = 0.5 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002). Linear regression also showed that realignment surgery was associated with a significant influence on the change in the coronal femoral neck orientation ( β = 5.6 (95% CI 1.5 to 9.8); p = 0.008). Conclusion Varus or valgus knee alignment is associated with either a more horizontal or a more vertical femoral neck orientation in standing position, respectively. Subsequently, osteotomies around the knee alter the vertical orientation of the femoral neck. These aspects are of importance when planning osteotomies around the knee in order to appreciate the effects on the adjacent hip joint. The concept may be of even more relevance in dysplastic hips. Cite this article: Bone Jt Open 2021;2(12):1057–1061.

The developing kidney actively negotiates geometric packing conflicts to avoid defects

The physiological functions of several organs rely on branched tubular networks, but little is known about conflicts in development between building enough tubules for adequate function and geometric constraints imposed by organ size. We show that the mouse embryonic kidney epithelium negotiates a physical packing conflict between tubule tip duplication and limited area at the organ surface. Imaging, computational, and soft material modeling of tubule 'families' identifies six geometric packing phases, including two defective ones. Experiments in kidney explants show that a retrograde tension on tubule families is necessary and sufficient for them to avoid defects by switching to a vertical orientation that increases packing density. These results reveal developmental contingencies in response to physical limitations, and create a framework for classifying kidney defects.

Forced Convection of Non-Newtonian Nanofluid Flow over a Backward Facing Step with Simultaneous Effects of Using Double Rotating Cylinders and Inclined Magnetic Field

The forced convection of non-Newtonian nanofluid for a backward-facing flow system was analyzed under the combined use of magnetic field and double rotating cylinders by using finite element method. The power law nanofluid type was used with different solid volume fractions of alumina at 20 nm in diameter. The effects of the Re number (100≤Re≤300), rotational Re number (−2500≤Rew≤3000), Ha number (0≤Ha≤50), and magnetic field inclination (0≤γ≤90) on the convective heat transfer and flow features were numerically assessed. The non-Newtonian fluid power law index was taken between 0.8 and 1.2 while particle volume fractions up to 4% were considered. The presence of the rotating double cylinders made the flow field complicated where multiple recirculation regions were established near the step region. The impacts of the first (closer to the step) and second cylinders on the heat transfer behavior were different depending upon the direction of rotation. As the first cylinder rotated in the clockwise direction, the enhancement in the average heat transfer of 20% was achieved while it deteriorated by approximately 2% for counter-clockwise directional rotation. However, for the second cylinder, both the rotational direction resulted in heat transfer augmentation while the amounts were 14% and 18% at the highest speeds. Large vortices on the upper and lower channel walls behind the step were suppressed with magnetic field effects. The average Nu number generally increased with the higher strengths of the magnetic field and inclination. Up to 30% increment with strength was obtained while this amount was 44% with vertical orientation. Significant impacts of power law fluid index on the local and average Nu number were seen for an index of n = 1.2 as compared to the fluid with n = 0.8 and n = 1 while an average Nu number of 2.75 times was obtained for the flow system for fluid with n = 1.2 as compared to case for fluid with the n value of 0.8. Further improvements in the local and average heat transfer were achieved with using nanoparticles while at the highest particle amount, the enhancements of the average Nu number were 34%, 36% and 36.6% for the fluid with n values of 0.8, 1 and 1.2, respectively.

Diagnostic Features for Human Categorisation of Adult and Child Faces

Knowing how humans differentiate children from adults has useful implications in many areas of both forensic and cognitive psychology. Yet, how we extract age from faces has been surprisingly underexplored in both disciplines. Here, we used a novel data-driven experimental technique to objectively measure the facial features human observers use to categorise child and adult faces. Relying on more than 35,000 trials, we used a reverse correlation technique that enabled us to reveal how specific features which are known to be important in face-perception – position, spatial-frequency (SF), and orientation – are associated with accurate child and adult discrimination. This showed that human observers relied on evidence in the nasal bone and eyebrow area for accurate adult categorisation, while they relied on the eye and jawline area to accurately categorise child faces. For orientation structure, only facial information of vertical orientation was linked to face-adult categorisation, while features of horizontal and, to a lesser extent oblique orientations, were more diagnostic of a child face. Finally, we found that SF diagnosticity showed a U-shaped pattern for face-age categorisation, with information in low and high SFs being diagnostic of child faces, and mid SFs being diagnostic of adult faces. Through this first characterisation of the facial features of face-age categorisation, we show that important information found in psychophysical studies of face-perception in general (i.e., the eye area, horizontals, and mid-level SFs) is crucial to the practical context of face-age categorisation, and present data-driven procedures through which face-age classification training could be implemented for real-world challenges.

Fabrication, Tensile Properties, and Photodecomposition of Basalt Fiber-Reinforced Cellulose Acetate Matrix Composites

Cellulose acetate (CA) is widely used as an alternative to conventional plastics because of the minor environmental impact of its decomposition cycle. This study synthesized five-layer environmentally friendly composites from CA bioplastic and basalt fibers (BFs) to produce a high-strength marine-biodegradable polymer. Maleic anhydride-grafted polypropylene (PP-g-MAH) was mixed with CA as a surface-active agent (SAA) to understand the effect of surface treatment on the mechanical properties of the composite. Tensile tests and scanning electron microscopy were conducted to observe the fracture surfaces. The ultimate tensile strength (UTS) of the BF/CA composite increased by approximately a factor of 4 after adding 11 vol.% unidirectional BF. When the SAA was added, the UTS of the composite with 11 vol.% BF was multiplied by a factor of about 7, which indicates that the surface treatment has a significant positive effect on the mechanical properties. However, the improvement is not apparent when the added BFs are in a plain weave with a vertical orientation. A photodecomposition experiment was then conducted by adding TiO2. Observing the UTS changes of the CA and BF/CA composites, the effect of the photocatalyst on the decomposition of the materials was explored.

The Impact of an Anchoring Layer on the Formation of Tethered Bilayer Lipid Membranes on Silver Substrates

Tethered bilayer lipid membranes (tBLMs) have been known as stable and versatile experimental platforms for protein–membrane interaction studies. In this work, the assembly of functional tBLMs on silver substrates and the effect of the molecular chain-length of backfiller molecules on their properties were investigated. The following backfillers 3-mercapto-1-propanol (3M1P), 4-mercapto-1-butanol (4M1B), 6-mercapto-1-hexanol (6M1H), and 9-mercapto-1-nonanol (9M1N) mixed with the molecular anchor WC14 (20-tetradecyloxy-3,6,9,12,15,18,22 heptaoxahexatricontane-1-thiol) were used to form self-assembled monolayers (SAMs) on silver, which influenced a fusion of multilamellar vesicles and the formation of tBLMs. Spectroscopic analysis by SERS and RAIRS has shown that by using different-length backfiller molecules, it is possible to control WC14 anchor molecules orientation on the surface. An introduction of increasingly longer surface backfillers in the mixed SAM may be related to the increasing SAMs molecular order and more vertical orientation of WC14 at both the hydrophilic ethylenoxide segment and the hydrophobic lipid bilayer anchoring alkane chains. Since no clustering of WC14 alkane chains, which is deleterious for tBLM integrity, was observed on dry samples, the suitability of mixed-component SAMs for subsequent tBLM formation was further interrogated by electrochemical impedance spectroscopy (EIS). EIS showed the arrangement of well-insulating tBLMs if 3M1P was used as a backfiller. An increase in the length of the backfiller led to increased defectiveness of tBLMs. Despite variable defectiveness, all tBLMs responded to the pore-forming cholesterol-dependent cytolysin, vaginolysin in a manner consistent with the functional reconstitution of the toxin into phospholipid bilayer. This experiment demonstrates the biological relevance of tBLMs assembled on silver surfaces and indicates their utility as biosensing elements for the detection of pore-forming toxins in liquid samples.

Design of a Flexible Wasp-Inspired Tissue Transport Mechanism

Tissue transport is a challenge during Minimally Invasive Surgery (MIS) with the current suction-based instruments as the increasing length and miniaturisation of the outer diameter requires a higher pressure. Inspired by the wasp ovipositor, a slender and bendable organ through which eggs can be transported, a flexible transport mechanism for tissue was developed that does not require a pressure gradient. The flexible shaft of the mechanism consists of ring magnets and cables that can translate in a similar manner as the valves in the wasp ovipositor. The designed transport mechanism was able to transport 10wt% gelatine tissue phantoms with the shaft in straight and curved positions and in vertical orientation against gravity. The transport rate can be increased by increasing the rotational velocity of the cam. A rotational velocity of 25 RPM resulted in a transport rate of 0.8 mm/s and increasing the rotation velocity of the cam to 80 RPM increased the transport rate to 2.3 mm/s though the stroke efficiency decreased by increasing the rotational velocity of the cam. The transport performance of the flexible transport mechanism is promising. This means of transportation could in the future be an alternative for tissue transport during MIS.

Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease (Preprint)

BACKGROUND Coproduction of care involves patients and families partnering with their clinicians and care teams, with the premise that each brings their own perspective, knowledge, and expertise, as well as their own values, goals, and preferences to the partnership. Dashboards can display meaningful patient and clinical data to assess how a patient is doing and inform shared decision making. Increasing communication between patients and care teams is particularly important for children with chronic conditions, such as juvenile idiopathic arthritis (JIA), which is the most common, chronic rheumatic condition of childhood, and is associated with increased pain, decreased function, and decreased quality of life. OBJECTIVE We aimed to design a dashboard prototype for use in coproducing care for JIA patients. We evaluated the context use and needs of end users, obtained consensus on the necessary dashboard data elements, and constructed display prototypes to inform meaningful discussions for coproduction. METHODS A human-centered design approach involving parents, patients, clinicians, and care team members was used to develop a dashboard to support coproduction of care in four diverse ambulatory pediatric rheumatology clinics across the United States. We engaged a multidisciplinary team (n=18) of patients/parents, clinicians, nurses, and staff during an in-person kick-off meeting, followed by bi-weekly meetings. We also leveraged advisory panels. Teams mapped workflows and patient journeys, created personas, and developed dashboard sketches. Final necessary dashboard components were determined using Delphi consensus voting. Low-tech dashboard testing was completed during clinic visits, and visual display prototypes were iterated using PDSA methodology. Patients and providers were surveyed about their experiences. RESULTS Teams achieved consensus on what data matters most at point-of-care to support JIA patients, families, and clinicians partnering together to make the best possible decisions for better health. Notable themes included: the right data, in the right place, at the right time; data in once for multiple purposes; patient and family self-management components; and opportunity for education and increased transparency. A final set of 11 dashboard data elements were identified which include patient-reported outcomes, clinical data, and medications. Important design considerations include incorporation of real-time data, clearly labeled graphs, and vertical orientation to facilitate review and discussion. Prototype paper testing with 36 patients/families yielded positive feedback about the dashboard’s usefulness during clinic discussions, helped to talk about what mattered most, and informed healthcare decision making. CONCLUSIONS Our study developed a dashboard prototype that displays patient-reported and clinical data over time, along with medications, that can be used during a clinic visit to support meaningful conversations and shared decision making between JIA patients/families and their clinicians and care teams. CLINICALTRIAL N/A