A combined musculoskeletal and finite element model of a foot to predict plantar pressure distribution

In this study, a combined subject-specific numerical and experimental investigation was conducted to explore the plantar pressure of an individual. The research utilized finite element (FE) and musculoskeletal modelling based on computed tomography (CT) images of an ankle-foot complex and three-dimensional gait measurements. Muscle forces were estimated using an individualized multi-body musculoskeletal model in five gait phases. The results of the FE model and gait measurements for the same subject revealed the highest stress concentration of 0.48 MPa in the forefoot, which aligns with previously-reported clinical observations. Additionally, the study found that the encapsulated soft tissue FE model with hyper-elastic properties exhibited higher stresses compared to the model with linear-elastic properties, with maximum ratios of 1.16 and 1.88 MPa in the contact pressure and von-Mises stress, respectively. Furthermore, the numerical simulation demonstrated that the use of an individualized insole caused a reduction of 8.3% in the maximum contact plantar pressure and 14.7% in the maximum von-Mises stress in the encapsulated soft tissue. Overall, the developed model in this investigation holds potential for facilitating further studies on foot pathologies and the improvement of rehabilitation techniques in clinical settings.</p

Bone fixation techniques for managing joint disorders and injuries:A review study

The majority of surgical procedures treating joint disorders require a technique to realize a firm implant-to-tissue and/or a tissue-to-tissue fixation. Fixation methods have direct effects on survival, performance and integration of orthopedic implants This review paper gives an overview of novel fixation techniques that have been evaluated and optimized for orthopaedic joint implants and could be alternatives for traditional implant fixation techniques or inspirations for future design of joint implantation procedures. Method: The articles were selected using the Scopus search engine. Key words referring to traditional fixation methods have been excluded to find potential innovative fixation techniques. In order to review the recent anchorage systems, only articles that been published during the period of 2010–2020 have been included. Results: A total of 57 studies were analyzed. The result revealed that three main fixation principles are being employed: using mechanical interlockings, employing adhesives, and performing tissue-bonding strategies. Conclusion: The development of fixation techniques demonstrates a transformation from the general anchoring tools like K-wires toward application-specific designs. Several new methods have been designed and evaluated, which highlight encouraging results as described in this review. It seems that mechanical fixations provide the strongest anchorage. Employing (bio)-adhesives as fixation tool could revolutionize the field of orthopedic surgery. However, the adhesives must be improved and optimized to meet the requirements of an anchorage system. Long-term fixation might be formed by tissue ingrowth approaches which showed promising results. In most cases further clinical studies are required to explore their outputs in clinical applications

Electronic Health Record-Based Surveillance for Community Transmitted COVID-19 in the Emergency Department

Introduction: SARS-CoV-2, a novel coronavirus, manifests as a respiratory syndrome (COVID-19) and is the cause of an ongoing pandemic. The response to COVID-19 in the United States has been hampered by an overall lack of diagnostic testing capacity. To address uncertainty about ongoing levels of SARS-CoV-2 community transmission early in the pandemic, we aimed to develop a surveillance tool using readily available emergency department (ED) operations data extracted from the electronic health record (EHR). This involved optimizing the identification of acute respiratory infection (ARI)-related encounters and then comparing metrics for these encounters before and after the confirmation of SARS-CoV-2 community transmission.Methods: We performed an observational study using operational EHR data from two Midwest EDs with a combined annual census of over 80,000. Data were collected three weeks before and after the first confirmed case of local SARS-CoV-2 community transmission. To optimize capture of ARI cases, we compared various metrics including chief complaint, discharge diagnoses, and ARI-related orders. Operational metrics for ARI cases, including volume, pathogen identification, and illness severity, were compared between the pre- and post-community transmission timeframes using chi-square tests of independence.Results: Compared to our combined definition of ARI, chief complaint, discharge diagnoses, and isolation orders individually identified less than half of the cases. Respiratory pathogen testing was the top performing individual ARI definition but still only identified 72.2% of cases. From the pre to post periods, we observed significant increases in ED volumes due to ARI and ARI cases without identified pathogen.Conclusion: Certain methods for identifying ARI cases in the ED may be inadequate and multiple criteria should be used to optimize capture. In the absence of widely available SARS-CoV-2 testing, operational metrics for ARI-related encounters, especially the proportion of cases involving negative pathogen testing, are useful indicators for active surveillance of potential COVID-19 related ED visits

Ten cold clubfeet

Background and purpose — Idiopathic clubfeet are commonly treated with serial manipulation and casting, known as the Ponseti method. The use of Plaster of Paris as casting material causes both exothermic and endothermic reactions. The resulting temperature changes can create discomfort for patients. Patients and methods — In 10 patients, we used a digital thermometer with a data logger to measure below-cast temperatures to create a thermal profile of the treatment process. Results — After the anticipated temperature peak, a surprisingly large dip was observed (Tmin = 26 °C) that lasted 12 hours. Interpretation — Evaporation of excess water from a cast might be a cause for discomfort for clubfoot patients and subsequently, their caregivers

Call Me Dr Ishmael: Trends in Electronic Health Record Notes Available at Emergency Department Visits and Admissions

OBJECTIVES: Numerous studies have identified information overload as a key issue for electronic health records (EHRs). This study describes the amount of text data across all notes available to emergency physicians in the EHR, trended over the time since EHR establishment. MATERIALS AND METHODS: We conducted a retrospective analysis of EHR data from a large healthcare system, examining the number of notes and a corresponding number of total words and total tokens across all notes available to physicians during patient encounters in the emergency department (ED). We assessed the change in these metrics over a 17-year period between 2006 and 2023. RESULTS: The study cohort included 730 968 ED visits made by 293 559 unique patients and a total note count of 132 574 964. The median note count for all encounters in 2006 was 5 (IQR 1-16), accounting for 1735 (IQR 447-5521) words. By the last full year of the study period, 2022, the median number of notes had grown to 359 (IQR 84-943), representing 359 (IQR 84-943) words. Note and word counts were higher for admitted patients. DISCUSSION: The volume of notes available for review by providers has increased by over 30-fold in the 17 years since the implementation of the EHR at a large health system. The task of reviewing these notes has become commensurately more difficult. These data point to the critical need for new strategies and tools for filtering, synthesizing, and summarizing information to achieve the promise of the medical record

Bioactive calcium phosphate coatings applied to flexible poly(carbonate urethane) foils

Long-term fixation of orthopaedic implants can be enhanced by tissue ingrowth techniques. As such, the deposition of a bioactive bone-like coating could be considered a promising method to facilitate the integration of implants onto bone tissue. In this study, we identified the optimized osteo-conductive Calcium Phosphate (CaP) coating parameters for deposition on PolyCarbonate-Urethane (PCU) foils. The oxygen plasma surface-activated PCU specimens were suspended in simulated body fluid (SBF) and supersaturated SBFs for 4 h, 8 h, 24 h, or 6 days at a temperature of 20 °C, 37 °C, or 50 °C. This resulted in semi-crystalline CaP coatings on a thin flexible foil via a one-step low-temperature aqueous technique. The deposited CaP coatings demonstrated high stability and remained intact upon bending deformation. According to the in vitro cell assessments, the conducted CaP coatings did not influence cell viability nor cell proliferation compared to the bare PCU substrate. In addition, the deposited CaP coatings enhanced the cell-mediated calcium deposition. All in all, this paper demonstrates a promising method to apply stable bioactive coatings to flexible PCU foils, which can be a promising strategy for the enhanced integration of PCU implants onto bone.</p