Surface texture effects on mechanical properties of additively manufactured polylactic acid

Additive manufacturing is favored for its capacity to create intricate geometries and enhance component functionality more efficiently than traditional methods. Applying texture to materials is one of the processes used to add functionality to products, wherein it can improve adhesion and tribological behavior in biomedical applications while also controlling mechanical properties and providing perceptual and aesthetic improvements. In this study, custom black-white images containing vertical lines were prepared and added as textures to the design of tensile test specimens during slicing. Custom textured and untextured tensile test specimens were fabricated using the Fused Deposition Method with polylactic Acid filament to evaluate the effect of texture parameters, such as protrusion offset (0.25, 0.50, 0.75 mm), number of protrusions (3, 6) and infill pattern (rectilinear, line, concentric), on the tensile strength of the specimens. Through the analysis of tensile test results and examination of microscopic and slicing software images, it was found that texturing resulted in a reduction in ultimate tensile strength due to nozzle trajectory deviations and stress concentration. The least detrimental texturing parameters observed in this study were 0.5 mm protrusion offset and 3 protrusions with concentric and line infill patterns, resulting in a reduction in tensile strength of 2.36 and 5.79%, respectively when compared to untextured specimens

Diagnostic Decision-Making Variability Between Novice and Expert Optometrists for Glaucoma: Comparative Analysis to Inform AI System Design

BackgroundWhile expert optometrists tend to rely on a deep understanding of the disease and intuitive pattern recognition, those with less experience may depend more on extensive data, comparisons, and external guidance. Understanding these variations is important for developing artificial intelligence (AI) systems that can effectively support optometrists with varying degrees of experience and minimize decision inconsistencies. ObjectiveThe main objective of this study is to identify and analyze the variations in diagnostic decision-making approaches between novice and expert optometrists. By understanding these variations, we aim to provide guidelines for the development of AI systems that can support optometrists with varying levels of expertise. These guidelines will assist in developing AI systems for glaucoma diagnosis, ultimately enhancing the diagnostic accuracy of optometrists and minimizing inconsistencies in their decisions. MethodsWe conducted in-depth interviews with 14 optometrists using within-subject design, including both novices and experts, focusing on their approaches to glaucoma diagnosis. The responses were coded and analyzed using a mixed method approach incorporating both qualitative and quantitative analysis. Statistical tests such as Mann-Whitney U and chi-square tests were used to find significance in intergroup variations. These findings were further supported by themes extracted through qualitative analysis, which helped to identify decision-making patterns and understand variations in their approaches. ResultsBoth groups showed lower concordance rates with clinical diagnosis, with experts showing almost double (7/35, 20%) concordance rates with limited data in comparison to novices (7/69, 10%), highlighting the impact of experience and data availability on clinical judgment; this rate increased to nearly 40% for both groups (experts: 5/12, 42% and novices: 8/21, 42%) when they had access to complete historical data of the patient. We also found statistically significant intergroup differences between the first visits and subsequent visits with a P value of less than .05 on the Mann-Whitney U test in many assessments. Furthermore, approaches to the exam assessment and decision differed significantly: experts emphasized comprehensive risk assessments and progression analysis, demonstrating cognitive efficiency and intuitive decision-making, while novices relied more on structured, analytical methods and external references. Additionally, significant variations in patient follow-up times were observed, with a P value of <.001 on the chi-square test, showing a stronger influence of experience on follow-up time decisions. ConclusionsThe study highlights significant variations in the decision-making process of novice and expert optometrists in glaucoma diagnosis, with experience playing a key role in accuracy, approach, and management. These findings demonstrate the critical need for AI systems tailored to varying levels of expertise. They also provide insights for the future design of AI systems aimed at enhancing the diagnostic accuracy of optometrists and consistency across different expertise levels, ultimately improving patient outcomes in optometric practice

The Effectiveness of Acupuncture on Myofascial Trigger Points Versus Traditional Chinese Medicine Acupoints for Treating Plantar Fasciitis With Low Back Pain: A Study Protocol for a Randomised Clinical Trial

Ziling Huang,1 Xin Liang,1 Yuheng Luo,1 Zhou Fang,2 Ming Xu,1 Yinqin Xu,1 Shan Cheng,3 Lihong Li1 1Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China; 2Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China; 3Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of ChinaCorrespondence: Lihong Li, Email [email protected]: Plantar fasciitis is a common cause of heel pain, often associated with a higher rate of low back pain. This increased disability rate in low back pain may be correlated with reduced foot and ankle function. While both acupuncture and trigger point dry needling have been reported as potentially effective treatments for plantar fasciitis, the quality of evidence is currently low. Acupuncture at trigger points might be a promising treatment for plantar fasciitis, though there is a lack of evidence supporting its effectiveness. This trial aims to compare the effectiveness of acupuncture at trigger points versus Traditional Chinese Medicine (TCM) acupoints in the treatment of participants with plantar fasciitis and low back pain.Methods: The trial will be a single-centre, parallel two-group, randomised controlled trial with 62 participants allocated in a 1:1 ratio to either the trigger point group or the TCM acupoint group. Patients with plantar fasciitis and low back pain will be enrolled in this trial. Eligible participants will receive acupuncture for 30 minutes per session over 8 total sessions, with a 12-week follow-up period. The primary outcome measure will be the change from baseline in the worst first-step pain intensity in the morning after treatment. Secondary outcomes include changes from baseline in foot and low back pain, foot and low back function, plantar fascia thickness, and participants’ self-reported global improvement. Statistical analysis will be conducted using a two-sided test with a significance level of 0.05 and 95% confidence intervals.Clinical Trial Registration: This trial has been registered at the Chinese Clinical Trial Registry. Registration number: ChiCTR2300067552. Registration date: 1 January 2023.Keywords: acupuncture, trigger point, plantar fasciitis, low back pain, randomised clinical tria

A Tale of Two Conditions: Pediatric Brugada Syndrome Unveiled—Navigating the Challenges of Coexisting Arrhythmia and Fever‐Induced ECG Pattern

ABSTRACT Background Brugada syndrome (BrS) is an inherited channelopathy characterized by right precordial ST‐segment elevation. This study investigates the clinical and genetic characteristics of children with BrS in Hong Kong. Methods A retrospective review was conducted at the only tertiary pediatric cardiology center in Hong Kong from 2002 to 2022, including all pediatric BrS patients under 18 years old. The diagnosis of BrS was established with a type 1 ECG pattern detected spontaneously or induced by flecainide, excluding secondary causes. Results Eight probands of mean age 10 years old were identified. Male dominance was observed (6 boys vs. 2 girls). The mean follow‐up duration was 4.6 years (Median 3.5 years). Patients had type 1 ECG pattern either spontaneously (n = 4) or provoked by flecainide (n = 4). Fever was present in seven patients at the initial presentation, and two patients experienced aborted cardiac arrest and one had symptomatic ventricular tachycardia. All symptomatic patients received implantable cardioverter‐defibrillator placement. Five asymptomatic patients (62.5%) were diagnosed with BrS through ECG during febrile illness, and they remained asymptomatic following conservative management involving strict fever control and medication avoidance. Two patients with mixed phenotype (one with long QT syndrome and another with ectopic atrial tachycardia) required antiarrhythmics and one patient received transcatheter ablation for atrial tachycardia to achieve optimal arrhythmia control. Conclusion Fever plays a significant role in unmasking BrS in children. Asymptomatic children with BrS managed conservatively have a favorable prognosis. Difficult arrhythmia control was found in patients with mixed phenotype

Technological Adjuncts to Streamline Patient Recruitment, Informed Consent, and Data Management Processes in Clinical Research: Observational Study

BackgroundPatient recruitment and data management are laborious, resource-intensive aspects of clinical research that often dictate whether the successful completion of studies is possible. Technological advances present opportunities for streamlining these processes, thus improving completion rates for clinical research studies. ObjectiveThis paper aims to demonstrate how technological adjuncts can enhance clinical research processes via automation and digital integration. MethodsUsing one clinical research study as an example, we highlighted the use of technological adjuncts to automate and streamline research processes across various digital platforms, including a centralized database of electronic medical records (enterprise data warehouse [EDW]); a clinical research data management tool (REDCap [Research Electronic Data Capture]); and a locally managed, Health Insurance Portability and Accountability Act–compliant server. Eligible participants were identified through automated queries in the EDW, after which they received personalized email invitations with digital consent forms. After digital consent, patient data were transferred to a single Health Insurance Portability and Accountability Act–compliant server where each participant was assigned a unique QR code to facilitate data collection and integration. After the research study visit, data obtained were associated with existing electronic medical record data for each participant via a QR code system that collated participant consent, imaging data, and associated clinical data according to a unique examination ID. ResultsOver a 19-month period, automated EDW queries identified 20,988 eligible patients, and 10,582 patients received personalized email invitations. In total, 1000 (9.45%) patients signed consents to participate in the study. Of the consented patients, 549 unique patients completed 779 study visits; some patients consented to the study at more than 1 time period during their pregnancy. ConclusionsTechnological adjuncts in clinical research decrease human labor while increasing participant reach and minimizing disruptions to clinic operations. Automating portions of the clinical research process benefits clinical research efforts by expanding and optimizing participant reach while reducing the limitations of labor and time in completing research studies

Advanced anaplastic thyroid carcinoma with positive expression of PD-L1 response to immune checkpoint inhibitors: A case report

Anaplastic thyroid carcinoma (ATC) is one rare type of thyroid carcinoma without standard systemic treatment for advanced disease. Recent evidence has demonstrated promising efficacy of immune checkpoint inhibitors, particularly those targeting programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1), in a variety of solid tumors. However, there have been no research of immune checkpoint inhibitors plus chemotherapy in ATC. Here, we present the case of a 37-year-old man with metastatic ATC with positive PD-L1 expression, who achieved long-term remission of 34 months after later-line treatment with zimberelimab (a PD-1 inhibitor) and nab-paclitaxel, followed by single-agent zimberelimab maintenance therapy. After three cycles of the combination treatment, the thyroid lesion and the liver metastases shrank dramatically, leading to the best overall response of partial remission. PD-L1 expression may serve as a potential biomarker for tumor response to immune checkpoint inhibitors in ATC. Our review highlights the need for further studies investigating the role of PD-L1 status as biomarker to predict the prognosis of immunotherapy in the treatment of ATC

The Pareto effect in tipping social networks: from minority to majority

How do social networks tip? A popular theory is that a small minority can trigger population-wide social change. This aligns with the Pareto principle, a semi-quantitative law which suggests that, in many systems, 80 % of effects arise from 20 % of the causes. In the context of the transition to net-zero emissions, this vital 20 % can be a critical instigator of social tipping, a process which can rapidly change social norms. In this work, we asked whether the Pareto effect can be observed in social systems by conducting a literature review, placing a focus on social norm diffusion and complex contagion via social networks. By analysing simulation and empirical results of social tipping events across disciplines and a large parametric space, we identified consistent patterns across studies and key factors which help or hinder social tipping. We show evidence supporting a tipping point near 25 % of the total population within our compiled dataset. Near this critical mass, we observe a high likelihood for a social tipping event, where a large majority quickly adopts new norms. Our findings illustrate slight variations between modelling and empirical results, with average tipping points at 24 % and 27 %, respectively. Additionally, we show a range of critical masses where social tipping is possible; these values lie between 10 % and 43 %. These results indicate the potential, but not the inevitability, of rapid social change in certain susceptible populations and contexts. Finally, we provide practical guidance for facilitating difficult norm changes by (1) leveraging trusted community structures and building critical mass in clustered networks (particularly in the 10 %–43 % threshold range), (2) adapting strategies based on norm type and context, and (3) targeting groups with moderate preferences and network positions – avoiding reliance on highly central or well-connected individuals – to enable endogenous spread.</p

The impact of cultural origin on the psychiatric expertise in Switzerland: a focus on sexual violence illustrated by two criminal cases

Cultural biases and integration in novel socio-geographic contexts are relevant factors for the understanding of dynamics beneath sexual violence, and possibly play a role in modifying responsibility and perpetrators treatment. Here we offer a conceptual analysis of the relevant literature and two case study. Cultural factors influence power dynamics and individual values, impacting the occurrence of sexual violence; the understanding of “coercion” varies across cultures, and cultural legitimization may ensue. The consequences of sexual assault also differ, with shame prevailing in socio-centric societies and guilt in ego-centric societies. Rape and gender-based violence is influenced by masculinity and femininity concepts, the former identified with power. Dominance, rather than sexual gratification, can lead to sexual violence, which could also be a “male backlash” against gender equality. Biological theories link sexual violence to genetic factors; a psychodynamic perspective suggests an unconscious social reproduction of masculine culture and delves into possible explanations for violent behavior. Acculturation strategies and acculturative stress are explored, with a focus on Berry’s strategies and on Camilleri’s model of identity in intercultural situations. The impact of cultural factors on responsibility is discussed, highlighting variability in criminal laws and attitudes towards cultural offenses in different countries. The analysis of two criminal cases accused of rape, revealed common and diverging elements. Both individuals come from favorable socio-economic backgrounds, and lacked of prior or present psychiatric diagnoses. Integration difficulties, psychosexual attitudes, and the improper application of cultural codes played a crucial role. In conclusion, anthropological and ethnopsychiatric knowledge should be integrate into forensic assessments. Early detection of non-acculturation elements is need to prevent criminal behaviors, and a diagnostic instrument as a validated rating scale should be implemented

The potential of wetlands and barrier islands as a coastal defense in mitigating the storm surge

A critical aspect of coastal protection is the role of barrier islands and wetlands in mitigating storm surges. However, the level of protection offered by these natural features can vary based on their geographical characteristics and the storms they face. This study focuses on quantifying the attenuation capacity of the Apalachicola Bay barrier island and coastal wetland system using a novel approach that delineates watersheds to calculate localized water elevation attenuation rates, incorporating spatially varying bed roughness and complex channel-marsh networks. We simulated storm surge dynamics using the ADvanced CIRCulation (ADCIRC) model under multiple configurations, including entire barrier island presence, selective island removal, the absence of all islands, and scenarios with and without marsh vegetation. The study introduces an attenuation rate function based on the prediction factor that improves surge attenuation modeling by integrating real-world scenarios with idealized theoretical functions. Additionally, we derive a theoretical maximum attenuation rate curve to calculate the highest achievable rate of storm surge reduction in Apalachicola Bay, providing a benchmark for the landscape’s full attenuation potential. The findings of this study underscore the importance of integrating wetlands and barrier islands into coastal protection strategies. Insights from this study can guide restoration efforts, particularly in the context of barrier islands and marshlands, to enhance resilience against increasing storm surge threats