Ultrasonic tool to cut human bone: cutting speed and forces necessary for potential remote robotic arms

Procedural-related musculoskeletal pain is common among orthopaedic surgeons, often caused by the repetitive use of high-force bone-cutting tools. Ultrasonic cutting devices, which can operate with lower force, may help reduce this physical burden. In this study, three practising orthopaedic surgeons each performed two cuts on three fresh cortical bone samples, harvested from excised femoral necks from three patients undergoing hip replacement surgery. The study was conducted using an ultrasonic cutting device in a controlled yet clinically reflective environment. A novel setup captured real-time data on surgeon-related parameters, including vertical cutting force and vertical and horizontal cutting speed. Consistent with previous research, we confirmed that ultrasonic devices enable low force cutting (average 1.91 N). However, our findings revealed significant variability in how each surgeon interacted with the device - including how much force each surgeon applied, and how the device was manoeuvred which can influence device performance, thermal effects, and overall clinical outcomes. Given the critical importance of surgeon-related factors, our results highlight the need to understand how each surgeon interacts with these devices differently. This insight can inform training and device optimisation strategies; help translate bench testing results into effective clinical use and ultimately improve surgical performance and patient outcomes. Additionally, our findings support the potential benefits of integrating ultrasonic devices with robotic platforms to maintain consistent cutting parameters. Future research should investigate optimal cutting parameters, evaluate different blade profiles, assess result generalisability and compare outcomes before and after training or system enhancements.</p

Magnet4Europe Intervention to Improve Clinician and Patient Well-Being: A Quasi-Experimental Study of 56 Hospitals in 6 European Countries

BACKGROUND: Descriptive studies have documented high hospital nurse burnout and turnover but there are few, if any, large-scale evaluations of organizational interventions to improve clinician retention. The Magnet model is an organizational hospital intervention associated with better clinician and patient outcomes but there is insufficient evidence as to whether the Magnet model based on structural empowerment of clinicians results in better outcomes or rewards hospitals with good work environments, and whether the Magnet model can be implemented at scale outside the United States.OBJECTIVE: To evaluate whether Magnet4Europe-a multiyear organizational intervention of European hospitals-could be implemented and would result in improvements in nurse well-being, care quality, and patient safety.DESIGN: Quasi-experimental longitudinal evaluation of 56 European intervention hospitals in 6 countries. Hospital-level implementation of the intervention measured by changes (from baseline to follow-up) in 77 Magnet model intervention targets. Outcome measures (eg, nurse burnout, intent to leave, quality of care, patient safety) were derived from surveys of nurses (4546 nurses at baseline; 3171 at follow-up).FINDINGS: Hospitals that implemented intervention targets during the study period observed reductions in nurse burnout, nurses' intentions to leave their jobs, and unfavorable care quality. Each 10-percentage-point increase in intervention target implementation was associated with 2.7%-point reduction in nurses who intend to leave (β -2.66; 95% CI: -4.74, -0.58, P&lt;0.05). Hospitals which implemented more than 25% of intervention targets observed 6.3%-point reduction in nurse burnout, 7.6%-point reduction in intent to leave, 6.4%-point reduction in unfavorable care quality, and 3.7%-point reduction in unfavorable patient safety. Improvements in hospital percentages of nurses reporting staffing adequacy were associated with reductions in burnout, intentions to leave, unfavorable care quality, and patient safety.CONCLUSION: Successful implementation of Magnet4Europe demonstrates promise for international adoption at scale of Magnet as an organizational intervention for improving clinician well-being, care quality, and patient safety.</p

Nonlocal mechanical behaviour of functionally graded composite nanostructures

The intricate domain of composite structures, particularly functionally graded nanostructures, presents a fascinating area of study with immense potential for scientific and industrial advancements. This book delves into the unique properties and applications of these advanced materials, providing an in-depth understanding of the continuum theories that underpin functionally graded nanostructures. The authors explore both theoretical foundations and practical insights into the modeling and numerical simulations of the mechanical behavior of functionally graded materials and structures.• Provides a thorough exploration of the wide array of modeling techniques and computational methods pivotal for studying functionally graded nanostructures.• Offers unique insights into the behavior of functionally graded materials, allowing for a multi-faceted exploration of their properties and applications.• Covers the influence of material gradation on mechanical performance and the effects of environmental factors like temperature and humidity.• Combines theoretical foundations with practical insights.• Discusses challenges associated with manufacturing and testing these advanced materials. By presenting a detailed and nuanced view of functionally graded nanostructures, this book equips readers in materials engineering and related fields with the knowledge and tools needed to understand the complex interactions and behaviors of these materials under various conditions

Implementation of a self-management approach (ETMI) for low back pain in a public healthcare system

Importance: self-management is recommended first-line care for chronic low back pain (CLBP). However, implementation of structured self-management models in large public health maintenance organizations (HMO) remains scarce.Objective: to determine the feasibility of implementing the enhanced transtheoretical model intervention (ETMI) in a public HMO in Israel and to compare outcomes of patients who received ETMI-guided vs usual physiotherapy care.Design, setting, and participants: in this cohort study, all physiotherapists in 13 outpatient physiotherapy clinics in a public HMO were trained in ETMI in 2022. Data were extracted for all eligible patients aged 18 years and older with CLBP who attended an associated physiotherapy center between January 1, 2022, and July 31, 2023.Exposure: ETMI is a self-management approach focused on reassurance, addressing unhelpful beliefs, and encouraging recreational physical activity, delivered without passive treatments or prescribed exercises. ETMI trains physiotherapists to guide patients in managing their pain independently, helping them avoid future reliance on medical services, medication, or imaging when pain recurs.Main outcomes and measures: implementation outcomes were reach (physiotherapist uptake of ETMI), adoption (number of patients who received ETMI), and fidelity. Clinical outcomes were patient-reported function (0-100), pain (0-10) and fear-avoidance beliefs (0-100), assessed at baseline and discharge.Results: a total of 128 physiotherapists (mean [SD] age, 37.5 [9.3] years; 63 [49.2%] female) were invited to attend ETMI training, 109 (85.1%) attended, and 70 (64.0%) delivered the intervention at least once. Fidelity to ETMI-guided care was good. Of 4193 patients (mean [SD] age, 56.3 [16.7] years; 2454 [58.5%] female), 711 (17.0%) received ETMI-guided care. A total of 1624 patients (39.0%) had complete data and were included in the analysis. Compared with usual care, ETMI was associated with greater improvement in function scores (mean [SD] change, 12.0 [13.7] vs 15.7 [14.1]; adjusted mean difference (aMD), 3.3; 95% CI, 1.5 to 5.1), and fear-avoidance scores (-4.4 [22.7] vs -8.9 [23.8]; aMD, -4.3; 95% CI, -1.7 to -7.0) with no differences observed for pain scores (-1.7 [2.4] vs -2.0 [2.4]; aMD, -0.0; 95% CI, -0.3 to 0.3). ETMI patients had fewer sessions (mean [SD], 5.0 [4.2] vs 6.3 [4.5]; aMD, 1.3; 95% CI, 0.6 to 1.8; P &lt; .001).Conclusions and relevance: in this cohort study, the implementation of ETMI was feasible and associated with better patient outcomes in fewer treatment sessions than usual care, although its reach was limited

Venture capital and regional path creation: the medical industry in the Yangtze river delta

Path creation is a key concept in evolutionary economic geography. However, although venture capital has been identified in path creation studies, there is still no comprehensive understanding of its role. This study aims to identify the mechanisms through which venture capital supports local industrial paths. To address this, the thesis takes the rapidly developing medical industry in the Yangtze River Delta over the past two decades as its research object, using a mixed-methods analytical approach. Quantitative models are used to answer “when,” “where,” and “what” questions, while qualitative analysis addresses “why” and “how.” The study uses clinical trials innovatively as an indicator of innovation capacity in medical enterprises, thereby filling a gap in medical industry research. Qualitative research includes 28 interviews with venture capital firms, government entities and startups. The findings are as follows:Firstly, venture capital in the Yangtze River Delta’s medical industry shows uneven characteristics that evolve in tandem with regional innovation activities. Macro-institutional reforms under socio-landscape pressures have created three opportunity spaces for regional medical industry development. Different regional policy responses have led to further differentiation in entrepreneurial ecosystems that ultimately shape local venture capital landscapes. Secondly, through propensity score matching and regression analysis, the thesis confirms that venture capital has supported the development of enterprise clinical trials, and validates this at the regional level. Results show that the impact of venture capital incurs time lags and spatial heterogeneity, with geographic distance, syndication and government venture capital promoting innovation to varying degrees. Thirdly, qualitative findings show that venture capital alleviates regional financing constraints by increasing financial capital supply and facilitating the integration of local knowledge resources by promoting talent mobility within and beyond the region. Meanwhile, venture capital engages in corporate governance to improve the institutional legitimacy of technologies through social networks involving the government. By capturing regional niche markets, it builds diversified, place-based industrial portfolios, helping to restructure regional market resources. In this process, the selection effect of venture capital reflects its inherent path dependence, exacerbating regional development imbalances. Finally, qualitative research also shows that geographic distance constrains enterprise activities through trust-building and information asymmetry. Syndication fosters a complementarity between information and resources among actors, mitigating the effect of geographic distance through risk-sharing. Government venture capital displays a local bias, balancing market orientation and different objectives, thus to some extent contributing to local path creation

Supporting parent treatment decision-making in relapsed and refractory neuroblastoma: co-design of a web-based intervention

Background: parents of children diagnosed with relapsed or refractory neuroblastoma become involved in making treatment decisions for their child due to an absence of no standard treatment protocol with no clear treatment endpoints. Relapsed and refractory neuroblastoma is a poor-prognosis childhood cancer with varying treatment options available depending on their child’s response to treatment. As a result, parents in partnership with their child’s medical team make repeated treatment decisions over time. Research has shown how this decision-making is influenced by uncertainty of their child’s response to treatments and overall outcome, and parents’ emotional and cognitive adjustments. Having time to research and gather information has also shown to enable and inform parent involvement and responsibility within decision-making. An intervention to support parents can help them navigate these complex decisions aiding their cognitive, emotional, and practical needs to enable and inform their decision-making.Methods: intervention development followed the Medical Research Council Framework for developing complex intervention co-designed with a parent stakeholder group. A review of the literature and analysis of parent interviews informed the intervention. A one-off clinical advisory group was formed to review draft content. Intervention user testing was completed using cognitive think-aloud interviews.Results: a web-based intervention was developed to support and facilitate parent treatment decision-making in relapsed and refractory neuroblastoma. Co-design was iterative with a combination of ten face-to-face and virtual workshops to discuss and develop the website content, design, and layout. User testing was completed with seven parents and findings informed changes which included reformatting web pages, reducing text paragraphs for easier reading, creating additional webpages for ease of navigation of information and providing parent quotes for authenticity. Recommendations for intervention development using co-design are provided based on our experiences of using this approach.Conclusions: this is a disease specific intervention developed to support and facilitate parent treatment decision-making in a specific poor-prognosis childhood cancer. Co-design was essential to ensure the intervention met the needs of this parent population. Further work following the MRC framework will test and evaluate its impact and effectiveness in clinical practice

Bioinspired engineering beyond homeostasis

Biological systems operate through precisely coordinated interactions across multiple spatiotemporal scales, from molecules to cells, tissues, and organs. Pathologies often emerge when this homeostatic multiscale organization fails due to elements across different levels pursuing misaligned objectives, creating top-down and bottom-up cascading effects throughout the biological hierarchy. This perspective article explores how understanding these organizational failures provides valuable insights, besides for investigating fundamental processes in pathophysiology and for developing diagnostic and therapeutic strategies targeting biological organization with complex systems approaches, also for designing bioinspired artificial systems across three domains: biomimetic materials, bioinspired devices, and biomorphic computing models. This plethora of paradigms and possibilities is simplified by highlighting selected pathological mechanisms as case studies of multiscale system breakdown, namely, metabolic alterations, cancer, and neurodegenerative conditions, and how these failure modes of biological cooperation, taken in isolation and looked at in a systematic manner, present localized emergent advantages that might offer inspiration for developing adaptive and self-programmable systems, thereby expanding the pool of nature-inspired approaches beyond homeostasis.</p

University of Southampton co-ordinated written evidence submission to: Supporting people with frailty outside of hospitals

The number of older adults living with multiple long-term conditions (MLTC) and frailty in the UK continues to rise. Care for older adults with MLTC and frailty is often divided between routine care in general practice and community health services with most acute care being provided in hospital settings. However, with further investment in community settings, more people could be cared for closer to home. At the University of Southampton, we have a developing portfolio ofresearch investigating best practice in the proactive and urgent community care for older adults living with MLTCs and frailty

Fantasie Nègre: Four Fantasies for Piano by Florence B. Price

An historic addition to the advanced keyboard repertoire, this edition presents Florence B. Price's Four Fantasies for Piano in their entirety for the first time, honouring the composer's development of the Fantasie Nègre genre into a collective body of works. This critical edition foregrounds Price's original, unrevised manuscripts, most notably in the case of No. 4, and presents Ege's meticulous reconstruction of the incomplete, presumed lost, third Fantasie. It also serves as a performing edition, drawing on Ege's significant performance history with this work to include fingerings, redistributions of notes between hands, and additional dynamic and tempo markings, as well as detailed performance notes. This is a spectacular set of virtuosic pieces that showcases Price's ability to blend African American folk idioms and traditional forms with her own unique musical language