Effect of cube texture on local softening of friction stir welded joints for nanostructured AA2024 processed by accumulative roll bonding

Copyright © 2023 The Authors. The current research provides an insight into the correlation between the crystallographic textures, microstructure, and hardness of friction stir welded joints in nanostructured AA2024 alloys processed through accumulative roll bonding (ARB). Utilizing varying rotational speeds (250, 500, 750, and 1000 rpm) at a constant traverse tool (150 mm/min) during friction stir welding (FSW), microstructural analyses reveal distinct grain structures and texture components in the nugget zone. The fully recrystallized Cube {001}⟨100⟩ texture-oriented grains appear at the rotational speed of 750 rpm. The hardness profiles of ARB-processed strips after FSW at different rotational speeds show local softening in the nugget zones. There might be a hypothesis concerning the dissolution of stable and metastable precipitates based on generated heat input, providing insights into the mechanisms influencing hardness variations. Notably, the examination of Cube {001}⟨100⟩ texture and its correlation with local softening adds a valuable dimension to the understanding of microstructural changes in FSW of nanostructured AA2024 alloys processed by accumulative roll bonding process

Prevalence and determinants of diabetes and prediabetes in southwestern Iran: the Khuzestan comprehensive health study (KCHS)

Background: The Middle East and North Africa (MENA) is postulated to have the highest increase in the prevalence of diabetes by 2030; however, studies on the epidemiology of diabetes are rather limited across the region, including in Iran. Methods: This study was conducted between 2016 and 2018 among Iranian adults aged 20 to 65 years residing in Khuzestan province, southwestern Iran. Diabetes was defined as the fasting blood glucose (FBG) level of 126 mg/dl or higher, and/or taking antidiabetic medications, and/or self-declared diabetes. Prediabetes was defined as FBG 100 to 125 mg/dl. Multinomial logistic regression models were used to examine the association of multiple risk factors that attained significance on the outcome. Results: Overall, 30,498 participants were recruited; the mean (±SD) age was 41.6 (±11.9) years. The prevalence of prediabetes and diabetes were 30.8 and 15.3, respectively. We found a similar prevalence of diabetes in both sexes, although it was higher among illiterates, urban residents, married people, and smokers. Participants aged 50�65 and those with Body Mass Index (BMI) 30 kg/m2 or higher were more likely to be affected by diabetes RR: 20.5 (18.1,23.3) and 3.2 (3.0,3.6). Hypertension RR: 5.1 (4.7,5.5), waist circumference (WC) equal or more than 90 cm RR: 3.6 (3.3,3.9), and family history RR: 2.3 (2.2,2.5) were also significantly associated with diabetes. For prediabetes, the main risk factors were age 50 to 65 years RR: 2.6 (2.4,2.8), BMI 30 kg/m2 or higher RR: 1.9 (1.8,2.0), hypertension and WC of 90 cm or higher RR: 1.7 (1.6,1.8). The adjusted relative risks for all variables were higher in females than males, with the exception of family history for both conditions and waist circumference for prediabetes. Conclusions: Prediabetes and diabetes are prevalent in southwestern Iran. The major determinants are older age, obesity, and the presence of hypertension. Further interventions are required to escalate diabetes prevention and diagnosis in high-risk areas across Iran. © 2021, The Author(s)

Accelerating the Evolution of Nonhuman Primate Neuroimaging

Nonhuman primate neuroimaging is on the cusp of a transformation, much in the same way its human counterpart was in 2010, when the Human Connectome Project was launched to accelerate progress. Inspired by an open data-sharing initiative, the global community recently met and, in this article, breaks through obstacles to define its ambitions

Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Background Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with disability and premature death. Up-to-date estimates of the burden of rheumatoid arthritis are required for health-care planning, resource allocation, and prevention. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we provide updated estimates of the prevalence of rheumatoid arthritis and its associated deaths and disability-adjusted life-years (DALYs) by age, sex, year, and location, with forecasted prevalence to 2050. Methods Rheumatoid arthritis prevalence was estimated in 204 countries and territories from 1990 to 2020 using Bayesian meta-regression models and data from population-based studies and medical claims data (98 prevalence and 25 incidence studies). Mortality was estimated from vital registration data with the Cause of Death Ensemble model (CODEm). Years of life lost (YLL) were calculated with use of standard GBD lifetables, and years lived with disability (YLDs) were estimated from prevalence, a meta-analysed distribution of rheumatoid arthritis severity, and disability weights. DALYs were calculated by summing YLLs and YLDs. Smoking was the only risk factor analysed. Rheumatoid arthritis prevalence was forecast to 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates. Findings In 2020, an estimated 17·6 million (95% uncertainty interval 15·8–20·3) people had rheumatoid arthritis worldwide. The age-standardised global prevalence rate was 208·8 cases (186·8–241·1) per 100 000 population, representing a 14·1% (12·7–15·4) increase since 1990. Prevalence was higher in females (age-standardised female-to-male prevalence ratio 2·45 [2·40–2·47]). The age-standardised death rate was 0·47 (0·41–0·54) per 100 000 population (38 300 global deaths [33 500–44 000]), a 23·8% (17·5–29·3) decrease from 1990 to 2020. The 2020 DALY count was 3 060 000 (2 320 000–3 860 000), with an age-standardised DALY rate of 36·4 (27·6–45·9) per 100 000 population. YLDs accounted for 76·4% (68·3–81·0) of DALYs. Smoking risk attribution for rheumatoid arthritis DALYs was 7·1% (3·6–10·3). We forecast that 31·7 million (25·8–39·0) individuals will be living with rheumatoid arthritis worldwide by 2050. Interpretation Rheumatoid arthritis mortality has decreased globally over the past three decades. Global age-standardised prevalence rate and YLDs have increased over the same period, and the number of cases is projected to continue to increase to the year 2050. Improved access to early diagnosis and treatment of rheumatoid arthritis globally is required to reduce the future burden of the disease. Funding Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill & Melinda Gates Foundation

Innate arthroscopic skills in medical students and variation in learning curves.

BACKGROUND: Technical skill is an essential domain of surgical competence, and arthroscopic surgery requires a particularly challenging subset of technical skills. The innate ability to acquire arthroscopic skills is not fully understood. The aim of this study was to investigate the innate arthroscopic skills and learning curve patterns of medical students. METHODS: Tests of two arthroscopic tasks (one shoulder and one knee task designed to represent core skills required for arthroscopic training) were conducted in a surgical skills laboratory. The performance of twenty medical students with no previous arthroscopic surgery experience was assessed as they performed thirty repetitions of each task. The primary outcome measure for each repetition was success or failure in performing the task. An individual was deemed "competent" at the conclusion of the testing if he or she achieved stabilization of the learning curve (success on all subsequent repetitions) within twenty repetitions of the task. The secondary outcome measures were objective assessments of technical dexterity (time taken to complete the task, total length of the path traveled by the subject's hands, and number of hand movements) measured with use of a validated motion analysis system. RESULTS: The performance on each task varied among the students. Seven students were unable to achieve competence in the shoulder task and four were unable to achieve competence in the knee task. Motion analysis demonstrated that students who achieved task competence had better objective technical dexterity and thus better innate arthroscopic ability. The total path length and the number of hand movements differed significantly between the students who did and did not become competent at the shoulder task (p < 0.05, Mann-Whitney U test). The difference in path length was also significant for students performing the knee task (p < 0.05). CONCLUSIONS: Variation in innate arthroscopic skill exists among future surgeons, with some individuals being unable to achieve competence in basic arthroscopic tasks despite sustained practice

Early patient-reported outcomes from primary hip and knee arthroplasty have improved over the past seven years: An analysis of the NHS PROMs dataset

Introduction Routinely-collected patient-reported outcome measures (PROMs) have been useful to quantify and quality-assess provision of total hip replacement (THR) and total knee replacement (TKR) in the UK for the past decade. This study aimed to explore whether the outcome following primary THR and TKR has improved over the past seven years. Methods Secondary data analysis of 277,430 primary THR and 308,007 primary TKR from the NHS PROMs programme. Outcome measures were: (i) post-operative Oxford hip/knee score (OHS/OKS); (ii) proportion of patients achieving a clinically important improvement in joint function (responders); (iii) quality of life; (iv) patient satisfaction; (v) perceived success; and (vi) complication rates. Outcomes were compared based on year of surgery. Results For primary THR, more recent year of surgery was associated with higher post-operative OHS (0.15 points, 95% confidence interval (CI) 0.14-0.17; p<0.001) and higher EQ-5D utility (0.002, 95% CI 0.001-0.002; p<0.001). The odds of being a responder (OR 1.02, 95% CI 1.01-1.03; p<0.001) and patient satisfaction (OR 1.02, 95% CI 1.01-1.03; p<0.001) increased with year of surgery, whilst the odds of any complication reduced (OR 0.97, 95% CI 0.97-0.98; p<0.001). No trend was found for perceived success (p=0.56). For primary TKR, more recent year of surgery was associated with higher post-operative OKS (0.21 points, 95% CI 0.19-0.22; p<0.001) and higher EQ-5D utility (0.002, 95% CI 0.002-0.003; p<0.001). The odds of being a responder (OR 1.04, 95% CI 1.03-1.04; p<0.001), perceived success (OR 1.02, 95% CI 1.01-1.02; p<0.001) and patient satisfaction (OR 1.02, 95% CI 1.01-1.02; p<0.001) all increased with year of surgery, whilst the odds of any complication reduced (OR 0.97, 95% CI 0.97-0.97; p<0.001). Conclusion Nearly all patient-reported outcomes following primary THR/TKR improved by a small amount over the past seven years. Due to the high proportion of patients achieving good outcomes, PROMs following THR/TKR may need to focus on better discrimination of patients achieving high scores to be able to continue to measure improvement in outcomes

Manipulation under anaesthetic following primary knee arthroplasty is associated with a higher rate of subsequent revision surgery

Aim:&nbsp;To determine the association between manipulation under anaesthetic (MUA) following primary knee arthroplasty and subsequent revision surgery. Methods:&nbsp;Patients undergoing primary knee arthroplasty April 2011 to April 2016 with minimum 1-year follow up to April 2017 were identified from the national hospital episode statistics for England. The first arthroplasty per patient, per side, was included; cases with a record of subsequent infection or periprosthetic fracture were excluded. Patients undergoing MUA within 1-year to the same knee were identified, defining the populations for the MUA and non-MUA cohorts. Mortality adjusted Kaplan-Meier survival analysis (revision arthroplasty), was performed to a maximum of 6-years. A Cox proportional hazards model was used to determine the hazard for revision, adjusting for type of primary arthroplasty, gender, age group, year, comorbidity index, obesity, regional deprivation, rurality, and ethnicity. Results:&nbsp;A total of 309,650 primary arthroplasty cases (309,650 patients) were included. Manipulation under anaesthetic within 1-year was recorded in 6882 patients (2.22%; 95% CI 2.17-2.28) defining the MUA cohort; all others were included in the parallel non-MUA cohort. At 6-years, the mortality-adjusted estimated implant survival rate in the MUA cohort was 91.2% (95% CI 90.0-92.2) in comparison to 98.1% (95% CI 98.0-98.2) in the non-MUA cohort. In the fully adjusted model, this corresponded to an adjusted hazard for revision of 5.03 (hazard ratio [HR]; 95% CI 4.55-5.57). Conclusion:&nbsp;Patients who underwent MUA within 1-year of primary arthroplasty were at a five-fold increased risk of subsequent revision even after excluding cases of infection or fracture. Further investigation of the aetiology of &lsquo;stiffness&rsquo; following primary knee arthroplasty and the optimal treatment options to improve outcomes is justified.</p