An evaluation of a novel method for the MRI-based assessment of Caton-Deschamps index in the Knee.

INTRODUCTION: The radiographical assessment of patella height has historically been performed using X-Ray. The aim of this study was to evaluate a new method for the assessment of patella height using MRI and to assess the correlation with the X-Ray based assessment. MATERIALS AND METHODS: 159 patients who had both lateral radiographs and MRI images were included. Parameters measured included traditional radiographical CDI, MRI-based CDI, and TT-TG distance. On the basis of the TT-TG, the patients were divided into 2 groups. Two different methods were used to assess CDI using MRI: using a single slice image, and an alternative technique using two different cross-sectional images. The correlation of the two measurement methods was assessed using Pearson's correlation coefficient. The intraclass correlation coefficient (ICC) was determined from the measurements of the two investigators. RESULTS: The average TT-TG distance was 11.6 mm (± 4.6). In patients with a TT-TG < 15 mm, both measurement methods showed comparable correlation with measurements on X-Ray. In patients with a TT-TG of > 15 the the new cross-sectional imaging method showed higher correlation with traditional X-Ray assessment compared to CDI assessment using the traditional single slice method (r = 0.594, p < 0.001 vs. r = 0.302, p = 0.055). CONCLUSIONS: The assessment of CDI on MRI using a cross-sectional imaging method has a better correlation with traditional X-Ray assessment of CDI than single-slice assessment. This is particularly true in patients with elevated TT-TG and as such should be preferentially used in the assessment of Patellar height in this cohort.

Assessment of the Quality and Readability of Information Provided by ChatGPT in Relation to the Use of Platelet-Rich Plasma Therapy for Osteoarthritis.

Objective: This study aimed to evaluate the quality and readability of information generated by ChatGPT versions 3.5 and 4 concerning platelet-rich plasma (PRP) therapy in the management of knee osteoarthritis (OA), exploring whether large language models (LLMs) could play a significant role in patient education. Design: A total of 23 common patient queries regarding the role of PRP therapy in knee OA management were presented to ChatGPT versions 3.5 and 4. The quality of the responses was assessed using the DISCERN criteria, and readability was evaluated using six established assessment tools. Results: Both ChatGPT versions 3.5 and 4 produced moderate quality information. The quality of information provided by ChatGPT version 4 was significantly better than version 3.5, with mean DISCERN scores of 48.74 and 44.59, respectively. Both models scored highly with respect to response relevance and had a consistent emphasis on the importance of shared decision making. However, both versions produced content significantly above the recommended 8th grade reading level for patient education materials (PEMs), with mean reading grade levels (RGLs) of 17.18 for ChatGPT version 3.5 and 16.36 for ChatGPT version 4, indicating a potential barrier to their utility in patient education. Conclusions: While ChatGPT versions 3.5 and 4 both demonstrated the capability to generate information of moderate quality regarding the role of PRP therapy for knee OA, the readability of the content remains a significant barrier to widespread usage, exceeding the recommended reading levels for PEMs. Although ChatGPT version 4 showed improvements in quality and source citation, future iterations must focus on producing more accessible content to serve as a viable resource in patient education. Collaboration between healthcare providers, patient organizations, and AI developers is crucial to ensure the generation of high quality, peer reviewed, and easily understandable information that supports informed healthcare decisions.

Assessment of Quality and Readability of Information Provided by ChatGPT in Relation to Anterior Cruciate Ligament Injury.

The aim of our study was to evaluate the potential role of Artificial Intelligence tools like ChatGPT in patient education. To do this, we assessed both the quality and readability of information provided by ChatGPT 3.5 and 4 in relation to Anterior Cruciate Ligament (ACL) injury and treatment. ChatGPT 3.5 and 4 were used to answer common patient queries relating to ACL injuries and treatment. The quality of the information was assessed using the DISCERN criteria. Readability was assessed with the use of seven readability formulae: the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Raygor Estimate, the SMOG, the Fry, the FORCAST, and the Gunning Fog. The mean reading grade level (RGL) was compared with the recommended 8th-grade reading level, the mean RGL among adults in America. The perceived quality and mean RGL of answers given by both ChatGPT 3.5 and 4 was also compared. Both ChatGPT 3.5 and 4 yielded DISCERN scores suggesting "good" quality of information, with ChatGPT 4 slightly outperforming 3.5. However, readability levels for both versions significantly exceeded the average 8th-grade reading level for American patients. ChatGPT 3.5 had a mean RGL of 18.08, while the mean RGL of ChatGPT 4 was 17.9, exceeding the average American reading grade level by 10.08 grade levels and 9.09 grade levels, respectively. While ChatGPT can provide both reliable and good quality information on ACL injuries and treatment options, the readability of the content may limit its utility. Additionally, the consistent lack of source citation represents a significant area of concern for patients and clinicians alike. If AI is to play a role in patient education, it must reliably produce information which is accurate, easily comprehensible, and clearly sourced.

Return to Sport After Operative Fixation of Midshaft Clavicle Fractures in Professional Jockeys.

OBJECTIVE: Clavicle fractures are the most commonly observed fracture sustained in professional horse racing. This study is the first to report on time lost from injury and functional recovery after surgical fixation of midshaft clavicle fractures in professional jockeys. DESIGN: Retrospective cohort study. SETTING: Professional Horse Racing Ireland; Patients (or Participants): Professional Jockeys in Ireland with midshaft clavicular fractures managed with Open Reduction Internal Fixation. Interventions (or Assessment of Risk Factors or Independent Variables): Operative fixation with Open Reduction Internal Fixation. MAIN OUTCOME MEASURES: Assessment of postoperative Quick Disabilities of Arm Shoulder and Hand (QuickDASH) score and Patient Reported Outcome Measures assessing for associated complications and time to return to competition among professional athletes. RESULTS: Between 07/06/2013 and 29/09/2022, 22 patients met the predetermined inclusion criteria. Ninety-five percent of patients returned to competition at their preinjury level, one patient failed to return to competition for reasons unrelated to his injury. The mean time for return to competition was 68.14 days postinjury. Few complications were reported, whereas functional recovery was excellent across the cohort, with an average QuickDASH score of 0.85 (0.0-2.3). CONCLUSIONS: Plate fixation of midshaft clavicle fractures is effective and safe in the setting of professional horse racing. Ninety-five percent of patients can be expected to return within 14 weeks of injury. Patients returning at less than 7 weeks after injury had no adverse outcomes, suggesting a potential role for more aggressive rehabilitation postoperatively and ultimately, a quicker return to competition.

Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland.

AIMS: Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland. METHODS: A retrospective study was conducted. All emergency department presentations between 27 March 2019 to 27 April 2020 and 27 March 2020 to 27 April 2020 were cross-referenced against the National Integrated Medical Imaging System-Picture Archiving Communication System (NIMIS-PACS) radiology system to identify those with radiologically proven skeletal trauma. These patients were grouped according to sex, age, discharge outcome, mechanism of injury, and injury location. RESULTS: A 21% decrease in radiologically proven trauma was observed on comparison with the same time-period last year. Additionally, a 40% reduction in trauma admissions was observed during the COVID-19 lockdown. A 60% reduction in sports-related injuries and road traffic accident-related injuries was noted during the national lockdown. However, a 17% increase was observed in patients sustaining trauma because of domestic accidents. CONCLUSION: Variation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown. As would be expected, a reduction was seen in the number of injuries resulting from outdoor activities. Interestingly, increased rates of domestic injuries were seen during this period which could represent an unintended consequence of the prolonged period of lockdown.Cite this article: Bone Joint Open 2020;1-6:261-266.

Assessing the Attitudes, Awareness, and Behavioral Alterations of Patients Awaiting Total Hip Arthroplasty During the COVID-19 Crisis.

BACKGROUND: COVID-19 has placed a huge burden on healthcare systems which has led to widespread cancellation elective surgical care. Ireland is recovering from the first wave of COVID-19 and as such the expeditious return of elective surgical care is important. This is the first study to examine the attitudes of patients to undergoing total joint arthroplasty during the COVID-19 crisis. METHODS: A prospective qualitative study was undertaken in our institution during the week 13/05/2020-20/05/2020. 65 patients completed a questionnaire assessing attitudes, awareness, and behavioral changes associated with COVID-19, a Charlson Comorbidity Index, modified-Harris Hip Score, and a Short Form-12 score. RESULTS: 86% of patients felt that they were at little to no risk of COVID-19 infection. The majority of patients were happy to proceed with surgery at the current level of COVID-19 related threat (86%). Patients with higher mHHS were more likely to postpone their operation than those with lower mHHS scores. Our cohort had low patient reported outcome measures in both mHHS and SF-12, indicating the significant burden of hip osteoarthritis on both physical and mental health. CONCLUSION: Patients reported a significant disease-related impairment of physical function and subsequent deterioration in mental health as a result of hip osteoarthritis. Patients with worse hip function, as measured by the mHHS are more willing to proceed with surgery than those with superior hip function. This offers a potential mechanism by which to triage patients once elective surgical pathways reopen in the coming months.

Ultrafast Relaxation of Symmetry-Breaking Photo-Induced Atomic Forces.

We present a first-principles method for the calculation of the temperature-dependent relaxation of symmetry-breaking atomic driving forces in photoexcited systems. We calculate the phonon-assisted decay of the photoexcited force on the low-symmetry E_{g} mode following absorption of an ultrafast pulse in Bi, Sb, and As. The force decay lifetimes for Bi and Sb are of the order of 10 fs and in agreement with recent experiments, demonstrating that electron-phonon scattering is the primary mechanism relaxing the symmetry-breaking forces. Calculations for a range of absorbed photon energies suggest that larger amplitude, symmetry-breaking atomic motion may be induced by choosing a pump photon energy which maximizes the product of the initial E_{g} force and its lifetime. The high-symmetry A_{1g} force undergoes a partial decay to a nonzero constant on similar timescales, which has not yet been measured in experiments. The average imaginary part of the electron self-energy over the photoexcited carrier distribution provides a crude indication of the decay rate of symmetry-breaking forces.

Direct Measurement of Anharmonic Decay Channels of a Coherent Phonon.

We report channel-resolved measurements of the anharmonic coupling of the coherent A_{1g} phonon in photoexcited bismuth to pairs of high wave vector acoustic phonons. The decay of a coherent phonon can be understood as a parametric resonance process whereby the atomic displacement periodically modulates the frequency of a broad continuum of modes. This coupling drives temporal oscillations in the phonon mean-square displacements at the A_{1g} frequency that are observed across the Brillouin zone by femtosecond x-ray diffuse scattering. We extract anharmonic coupling constants between the A_{1g} and several representative decay channels that are within an order of magnitude of density functional perturbation theory calculations.

First-principles calculation of femtosecond symmetry-breaking atomic forces in photoexcited bismuth.

We present a first-principles method for the calculation of the polarization-dependent atomic forces resulting from optical excitation in a solid. We calculate the induced force driving the E(g) phonon mode in bismuth immediately after absorption of polarized light. When radiation with polarization perpendicular to the c axis is absorbed, the photoexcited charge density breaks the threefold rotational symmetry, leading to an atomic force component perpendicular to the axis. We calculate the initial excited electronic distribution as a function of photon energy and polarization and find the resulting atomic force components parallel and perpendicular to the axis. The magnitude of the calculated force is in excellent agreement with that derived from recent measurements of the amplitude of E(g) atomic motion and the decay time of several femtoseconds for the driving force.

Self-consistent Green's function method for dilute nitride conduction band structure.

We present a self-consistent Green's function (SCGF) approach for the Anderson many-impurity model to calculate the band dispersion and density of states near the conduction band edge in GaN(x)As(1-x) dilute nitride alloys. Two different models of the N states have been studied to investigate the band structure of these materials: (1) the two-band model, which assumes all N states have the same energy, EN; (2) a model which includes a full distribution of N states obtained by allowing for direct interaction between N sites. The density of states, projected onto extended and localised states, calculated by the SCGF two-band model, are in excellent agreement with those previously obtained in supercell calculations and reveal a gap in the density of states just above E(N), in contrast with the results of previous non-self-consistent Green's function calculations. However, including the full distribution of N states in a SCGF calculation removes this gap, in agreement with experiment.

Optical absorption of dilute nitride alloys using self-consistent Green's function method.

We have calculated the optical absorption for InGaNAs and GaNSb using the band anticrossing (BAC) model and a self-consistent Green's function (SCGF) method. In the BAC model, we include the interaction of isolated and pair N levels with the host matrix conduction and valence bands. In the SCGF approach, we include a full distribution of N states, with non-parabolic conduction and light-hole bands, and parabolic heavy-hole and spin-split-off bands. The comparison with experiments shows that the first model accounts for many features of the absorption spectrum in InGaNAs; including the full distribution of N states improves this agreement. Our calculated absorption spectra for GaNSb alloys predict the band edges correctly but show more features than are seen experimentally. This suggests the presence of more disorder in GaNSb alloys in comparison with InGaNAs.

The S.T.A.B. trial-standardized testing of artificial blood: a comparative study of various products that may be used as artificial blood for high fidelity simulation training in the critical care setting.

AIM: In the current climate of medical education, there is an ever-increasing demand for and emphasis on simulation as both a teaching and training tool. The objective of our study was to compare the realism and practicality of a number of artificial blood products that could be used for high-fidelity simulation. METHOD: A literature and internet search was performed and 15 artificial blood products were identified from a variety of sources. One product was excluded due to its potential toxicity risks. Five observers, blinded to the products, performed two assessments on each product using an evaluation tool with 14 predefined criteria including color, consistency, clotting, and staining potential to manikin skin and clothing. Each criterion was rated using a five-point Likert scale. The products were left for 24 hours, both refrigerated and at room temperature, and then reassessed. Statistical analysis was performed to identify the most suitable products, and both inter- and intra-rater variability were examined. RESULTS: Three products scored consistently well with all five assessors, with one product in particular scoring well in almost every criterion. This highest-rated product had a mean rating of 3.6 of 5.0 (95% posterior Interval 3.4-3.7). Inter-rater variability was minor with average ratings varying from 3.0 to 3.4 between the highest and lowest scorer. Intrarater variability was negligible with good agreement between first and second rating as per weighted kappa scores (K = 0.67). CONCLUSION: The most realistic and practical form of artificial blood identified was a commercial product called KD151 Flowing Blood Syrup. It was found to be not only realistic in appearance but practical in terms of storage and stain removal.