Hydrodynamic coupling melts acoustically levitated crystalline rafts.

Going beyond the manipulation of individual particles, first steps have recently been undertaken with acoustic levitation in air to investigate the collective dynamical properties of many-body systems self-assembled within the levitation plane. However, these assemblies have been limited to two-dimensional, close-packed rafts where forces due to scattered sound pull particles into direct frictional contact. Here, we overcome this restriction using particles small enough that the viscosity of air establishes a repulsive streaming flow at close range. By tuning the particle size relative to the characteristic length scale for viscous streaming, we control the interplay between attractive and repulsive forces and show how particles can be assembled into monolayer lattices with tunable spacing. While the strength of the levitating sound field does not affect the particles' steady-state separation, it controls the emergence of spontaneous excitations that can drive particle rearrangements in an effectively dissipationless, underdamped environment. Under the action of these excitations, a quiescent particle lattice transitions from a predominantly crystalline structure to a two-dimensional liquid-like state. We find that this transition is characterized by dynamic heterogeneity and intermittency, involving cooperative particle movements that remove the timescale associated with caging for the crystalline lattice. These results shed light on the nature of athermal excitations and instabilities that can arise from strong hydrodynamic coupling among interacting particles.

Stress-activated friction in sheared suspensions probed with piezoelectric nanoparticles.

A hallmark of concentrated suspensions is non-Newtonian behavior, whereby the viscosity increases dramatically once a characteristic shear rate or stress is exceeded. Such strong shear thickening is thought to originate from a network of frictional particle-particle contact forces, which forms under sufficiently large stress, evolves dynamically, and adapts to changing loads. While there is much evidence from simulations for the emergence of this network during shear thickening, experimental confirmation has been difficult. Here, we use suspensions of piezoelectric nanoparticles and exploit the strong local stress focusing within the network to activate charge generation. This charging can then be detected in the measured ac conductance and serve as a signature of frictional contact formation. The direct link between stress-activated frictional particle interactions and piezoelectric suspension response is further demonstrated by tracking the emergence of structural memory in the contact network under oscillatory shear and by showing how stress-activated friction can drive mechano-transduction of chemical reactions with nonlinear reaction kinetics. Taken together, this makes the ac conductance of piezoelectric suspensions a sensitive in-situ reporter of the micromechanics associated with frictional interactions.

Acoustic manipulation of multi-body structures and dynamics.

Sound can exert forces on objects of any material and shape. This has made the contactless manipulation of objects by intense ultrasound a fascinating area of research with wide-ranging applications. While much is understood for acoustic forcing of individual objects, sound-mediated interactions among multiple objects at close range gives rise to a rich set of structures and dynamics that are less explored and have been emerging as a frontier for research. We introduce the basic mechanisms giving rise to sound-mediated interactions among rigid as well as deformable particles, focusing on the regime where the particles' size and spacing are much smaller than the sound wavelength. The interplay of secondary acoustic scattering, Bjerknes forces, and micro-streaming is discussed and the role of particle shape is highlighted. Furthermore, we present recent advances in characterizing non-conservative and non-pairwise additive contributions to the particle interactions, along with instabilities and active fluctuations. These excitations emerge at sufficiently strong sound energy density and can act as an effective temperature in otherwise athermal systems.

Circulating tumor DNA analysis of the phase III VOYAGER trial: KIT mutational landscape and outcomes in patients with advanced gastrointestinal stromal tumor treated with avapritinib or regorafenib.

BACKGROUND: The current treatment paradigm of imatinib-resistant metastatic gastrointestinal stromal tumor (GIST) does not incorporate KIT/PDGFRA genotypes in therapeutic drug sequencing, except for PDGFRA exon 18-mutant GIST that is indicated for avapritinib treatment. Here, circulating tumor DNA (ctDNA) sequencing was used to analyze plasma samples prospectively collected in the phase III VOYAGER trial to understand how the KIT/PDGFRA mutational landscape contributes to tyrosine kinase inhibitor (TKI) resistance and to determine its clinical validity and utility. PATIENTS AND METHODS: VOYAGER (N = 476) compared avapritinib with regorafenib in patients with KIT/PDGFRA-mutant GIST previously treated with imatinib and one or two additional TKIs (NCT03465722). KIT/PDGFRA ctDNA mutation profiling of plasma samples at baseline and end of treatment was assessed with 74-gene Guardant360® CDx. Molecular subgroups were determined and correlated with outcomes. RESULTS: A total of 386/476 patients with KIT/PDGFRA-mutant tumors underwent baseline (pre-trial treatment) ctDNA analysis; 196 received avapritinib and 190 received regorafenib. KIT and PDGFRA mutations were detected in 75.1% and 5.4%, respectively. KIT resistance mutations were found in the activation loop (A-loop; 80.4%) and ATP-binding pocket (ATP-BP; 40.8%); 23.4% had both. An average of 2.6 KIT mutations were detected per patient; 17.2% showed 4-14 different KIT resistance mutations. Of all pathogenic KIT variants, 28.0% were novel, including alterations in exons/codons previously unreported. PDGFRA mutations showed similar patterns. ctDNA-detected KIT ATP-BP mutations negatively prognosticated avapritinib activity, with a median progression-free survival (mPFS) of 1.9 versus 5.6 months for regorafenib. mPFS for regorafenib did not vary regardless of the presence or absence of ATP-BP/A-loop mutants and was greater than mPFS with avapritinib in this population. Secondary KIT ATP-BP pocket mutation variants, particularly V654A, were enriched upon disease progression with avapritinib. CONCLUSIONS: ctDNA sequencing efficiently detects KIT/PDGFRA mutations and prognosticates outcomes in patients with TKI-resistant GIST treated with avapritinib. ctDNA analysis can be used to monitor disease progression and provide more personalized treatment.

Dynamic-bond-induced sticky friction tailors non-Newtonian rheology.

Frictional network formation has become a new paradigm for understanding the non-Newtonian shear-thickening behavior of dense suspensions. Recent studies have exclusively focused on interparticle friction that instantaneously vanishes when applied shear is ceased. Herein, we investigate a friction that emerges from dynamic chemical bridging of functionalized particle surfaces sheared into close proximity. This enables tailoring of both friction magnitude and the time release of the frictional coupling. The experiments use dense suspensions of thiol-functionalized particles suspended in ditopic polymers endcapped with benzalcyanoacetamide Michael-acceptors. The subsequent room temperature, catalyst-free dynamic thia-Michael reactions can form bridging interactions between the particles with dynamic covalent bonds that linger after formation and release in the absence of shear. This chemical friction mimics physical friction but is stickier, leading to tunable rheopexy. The effect of sticky friction on dense suspension rheology is explored by varying the electronic nature of the benzalcyanoacetamide moiety, the molecular weight of the ditopic polymers, the amount of a competitive bonding compound, and temperature. These results demonstrate how dynamic-bond-induced sticky friction can be used to systematically control the time dependence of the non-Newtonian suspension rheology.

What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis?

BACKGROUND: Conventional radiographs and clinical reassessment are considered guides in managing clinically suspected scaphoid fractures. This is a unique study as it assessed the value of conventional radiographs and clinical reassessment in a cohort of patients, all of whom underwent additional imaging, regardless of the outcome of conventional radiographs and clinical reassessment. QUESTIONS/PURPOSES: (1) What is the diagnostic performance of conventional radiographs in patients with a clinically suspected scaphoid fracture compared with high-resolution peripheral quantitative CT (HR-pQCT)? (2) What is the diagnostic performance of clinical reassessment in patients with a clinically suspected scaphoid fracture compared with HR-pQCT? (3) What is the diagnostic performance of conventional radiographs and clinical reassessment combined compared with HR-pQCT? METHODS: Between December 2017 and October 2018, 162 patients with a clinically suspected scaphoid fracture presented to the emergency department (ED). Forty-six patients were excluded and another 25 were not willing or able to participate, which resulted in 91 included patients. All patients underwent conventional radiography in the ED and clinical reassessment 7 to 14 days later, together with CT and HR-pQCT. The diagnostic performance characteristics and accuracy of conventional radiographs and clinical reassessment were compared with those of HR-pQCT for the diagnosis of fractures since this was proven to be superior to CT scaphoid fracture detection. The cohort included 45 men and 46 women with a median (IQR) age of 52 years (29 to 67). Twenty-four patients with a median age of 44 years (35 to 65) were diagnosed with a scaphoid fracture on HR-pQCT. RESULTS: When compared with HR-pQCT, conventional radiographs alone had a sensitivity of 67% (95% CI 45% to 84%), specificity of 85% (95% CI 74% to 93%), positive predictive value (PPV) of 62% (95% CI 46% to 75%), negative predictive value (NPV) of 88% (95% CI 80% to 93%), and a positive and negative likelihood ratio (LR) of 4.5 (95% CI 2.4 to 8.5) and 0.4 (95% CI 0.2 to 0.7), respectively. Compared with HR-pQCT, clinical reassessment alone resulted in a sensitivity of 58% (95% CI 37% to 78%), specificity of 42% (95% CI 30% to 54%), PPV of 26% (95% CI 19% to 35%), NPV of 74% (95% CI 62% to 83%), as well as a positive and negative LR of 1.0 (95% CI 0.7 to 1.5) and 1.0 (95% CI 0.6 to 1.7), respectively. Combining clinical examination with conventional radiography produced a sensitivity of 50% (95% CI 29% to 71%), specificity of 91% (95% CI 82% to 97%), PPV of 67% (95% CI 46% to 83%), NPV of 84% (95% CI 77% to 88%), as well as a positive and negative LR of 5.6 (95% CI 2.4 to 13.2) and 0.6 (95% CI 0.4 to 0.8), respectively. CONCLUSION: The accuracy of conventional radiographs (80% compared with HR-pQCT) and clinical reassessment (46% compared with HR-pQCT) indicate that the value of clinical reassessment is limited in diagnosing scaphoid fractures and cannot be considered directive in managing scaphoid fractures. The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures. LEVEL OF EVIDENCE: Level II, diagnostic study.

Scale of Emotional Development - Short: reliability and validity in adults with intellectual disability.

BACKGROUND: Intellectual disability (ID) is often associated with delays in emotional development (ED). The Scale of Emotional Development - Short (SED-S) was developed to assess the level of ED and to adapt treatment and care accordingly. METHODS: In a sample of 724 adults from five study sites in three countries, a confirmatory factor analysis with a one-factor model was conducted on the entire dataset as well as in different subgroups. Furthermore, internal consistency was investigated using Cronbach's alpha. RESULTS: The confirmatory factor analysis indicated that a single-factor model fits the SED-S data well. The subgroup analyses revealed good model fit, regardless of the severity of ID and irrespective of sex or the presence of autism spectrum disorder or psychiatric disorders. Internal consistency was excellent for the entire sample (Cronbach's alpha = 0.93) and various subgroups (0.869-0.938). CONCLUSION: The results of this study suggest that the SED-S is psychometrically sound and can be used to assess the level of ED in adults with ID.

Efficient Unitary Designs with a System-Size Independent Number of Non-Clifford Gates.

Many quantum information protocols require the implementation of random unitaries. Because it takes exponential resources to produce Haar-random unitaries drawn from the full n-qubit group, one often resorts to t-designs. Unitary t-designs mimic the Haar-measure up to t-th moments. It is known that Clifford operations can implement at most 3-designs. In this work, we quantify the non-Clifford resources required to break this barrier. We find that it suffices to inject O ( t 4 log 2 ( t ) log ( 1 / ε ) ) many non-Clifford gates into a polynomial-depth random Clifford circuit to obtain an ε -approximate t-design. Strikingly, the number of non-Clifford gates required is independent of the system size - asymptotically, the density of non-Clifford gates is allowed to tend to zero. We also derive novel bounds on the convergence time of random Clifford circuits to the t-th moment of the uniform distribution on the Clifford group. Our proofs exploit a recently developed variant of Schur-Weyl duality for the Clifford group, as well as bounds on restricted spectral gaps of averaging operators.

Tuning the mechanical impedance of disordered networks for impact mitigation.

Disordered-Network Mechanical Materials (DNMM), comprised of random arrangements of bonds and nodes, have emerged as mechanical metamaterials with the potential for achieving fine control over their mechanical properties. Recent computational studies have demonstrated this control whereby an extremely high degree of mechanical tunability can be achieved in disordered networks via a selective bond removal process called pruning. In this study, we experimentally demonstrate how pruning of a disordered network alters its macroscopic dynamic mechanical response and its capacity to mitigate impact. Impact studies with velocities ranging from 0.1 m s-1 to 1.5 m s-1 were performed, using a mechanical impactor and a drop tower, on 3D printed pruned and unpruned networks comprised of materials spanning a range of stiffness. High-speed videography was used to quantify the changes in Poisson's ratio for each of the network samples. Our results demonstrate that pruning is an efficient way to reduce the transmitted force and impulse from impact in the medium strain rate regime (101 s-1 to 102 s-1). This approach provides an interesting alternative route for designing materials with tailored impact mitigating properties compared to random material removal based on open cell foams.

Direct observation of dynamic shear jamming in dense suspensions.

Liquid-like at rest, dense suspensions of hard particles can undergo striking transformations in behaviour when agitated or sheared. These phenomena include solidification during rapid impact, as well as strong shear thickening characterized by discontinuous, orders-of-magnitude increases in suspension viscosity. Much of this highly non-Newtonian behaviour has recently been interpreted within the framework of a jamming transition. However, although jamming indeed induces solid-like rigidity, even a strongly shear-thickened state still flows and thus cannot be fully jammed. Furthermore, although suspensions are incompressible, the onset of rigidity in the standard jamming scenario requires an increase in particle density. Finally, whereas shear thickening occurs in the steady state, impact-induced solidification is transient. As a result, it has remained unclear how these dense suspension phenomena are related and how they are connected to jamming. Here we resolve this by systematically exploring both the steady-state and transient regimes with the same experimental system. We demonstrate that a fully jammed, solid-like state can be reached without compression and instead purely with shear, as recently proposed for dry granular systems. This state is created by transient shear-jamming fronts, which we track directly. We also show that shear stress, rather than shear rate, is the key control parameter. From these findings we map out a state diagram with particle density and shear stress as variables. We identify discontinuous shear thickening with a marginally jammed regime just below the onset of full, solid-like jamming. This state diagram provides a unifying framework, compatible with prior experimental and simulation results on dense suspensions, that connects steady-state and transient behaviour in terms of a dynamic shear-jamming process.

Ultrathin Porous Hydrocarbon Membranes Templated by Nanoparticle Assemblies.

Porous polymer membranes are widely desired as catalyst supports, sensors, and active layers for separation membranes. We demonstrate that electron beam irradiation of freely suspended gold or Fe3O4 nanoparticle (NP) monolayer sheets followed by wet chemical etching is a high-fidelity strategy to template two-dimensional (2D) porous cross-linked hydrocarbon membranes. This approach, which relies on secondary electrons generated by the NP cores, can further be used to transform three-dimensional (3D) terraced gold NP supercrystals into 3D porous hydrocarbon membranes. We utilize electron tomography to show how the number of NP layers (monolayer to pentalayer) controls attenuation and scattering of the primary e-beam, which in turn determines ligand cross-link density and 3D pore structure. Electron tomography also reveals that many nanopores are vertically continuous because of preferential sintering of NPs. This work demonstrates new routes for the construction of functional nanoporous media.

Intrusion into Granular Media Beyond the Quasistatic Regime.

The drag force exerted on an object intruding into granular media is typically assumed to arise from additive velocity and depth dependent contributions. We test this with intrusion experiments and molecular dynamics simulations at constant speed over four orders of magnitude, well beyond the quasistatic regime. For a vertical cylindrical rod we find velocity dependence only right after impact, followed by a crossover to a common, purely depth-dependent behavior for all intrusion speeds. The crossover is set by the timescale for material, forced to well up at impact, to subsequently settle under gravity. These results challenge current models of granular drag.

The role of solvent molecular weight in shear thickening and shear jamming.

The application of stress can drive a dense suspension into a regime of highly non-Newtonian response, characterized by discontinuous shear thickening (DST) and potentially shear jamming (SJ), due to the formation of a frictionally stabilized contact network. Investigating how the molecular weight of the suspending solvent affects the frictional particle-particle interactions, we report on experiments with suspensions of fumed silica particles in polyethylene glycol (PEG). Focusing on the monomer-to-oligomer limit, with n = 1 to 8 ethylene oxide repeat units, we find that increasing n enhances shear thickening under steady-state shear and even elicits rapidly propagating shear jamming fronts, as assessed by high-speed ultrasound imaging of impact experiments. We associate this behavior with a weakening of the solvation layers surrounding the particles as n is increased, which thereby facilitates the formation of frictional contacts. We argue that for n larger than the monomer-to-oligomer limit the trend reverses and frictional interactions are diminished, as observed in prior experiments. This reversal occurs because the polymeric solvent transitions from being enthalpically bound to entropically bound to the particle surfaces, which strengthens solvation layers.

Auxetic metamaterials from disordered networks.

Recent theoretical work suggests that systematic pruning of disordered networks consisting of nodes connected by springs can lead to materials that exhibit a host of unusual mechanical properties. In particular, global properties such as Poisson's ratio or local responses related to deformation can be precisely altered. Tunable mechanical responses would be useful in areas ranging from impact mitigation to robotics and, more generally, for creation of metamaterials with engineered properties. However, experimental attempts to create auxetic materials based on pruning-based theoretical ideas have not been successful. Here we introduce a more realistic model of the networks, which incorporates angle-bending forces and the appropriate experimental boundary conditions. A sequential pruning strategy of select bonds in this model is then devised and implemented that enables engineering of specific mechanical behaviors upon deformation, both in the linear and in the nonlinear regimes. In particular, it is shown that Poisson's ratio can be tuned to arbitrary values. The model and concepts discussed here are validated by preparing physical realizations of the networks designed in this manner, which are produced by laser cutting 2D sheets and are found to behave as predicted. Furthermore, by relying on optimization algorithms, we exploit the networks' susceptibility to tuning to design networks that possess a distribution of stiffer and more compliant bonds and whose auxetic behavior is even greater than that of homogeneous networks. Taken together, the findings reported here serve to establish that pruned networks represent a promising platform for the creation of unique mechanical metamaterials.

Memory in Nonmonotonic Stress Relaxation of a Granular System.

We demonstrate experimentally that a granular packing of glass spheres is capable of storing memory of multiple strain states in the dynamic process of stress relaxation. Modeling the system as a noninteracting population of relaxing elements, we find that the functional form of the predicted relaxation requires a quantitative correction which grows in severity with each additional memory and is suggestive of interactions between elements. Our findings have implications for the broad class of soft matter systems that display memory and anomalous relaxation.

Shear Thickening and Jamming of Dense Suspensions: The "Roll" of Friction.

Particle-based simulations of discontinuous shear thickening (DST) and shear jamming (SJ) suspensions are used to study the role of stress-activated constraints, with an emphasis on resistance to gearlike rolling. Rolling friction decreases the volume fraction required for DST and SJ, in quantitative agreement with real-life suspensions with adhesive surface chemistries and "rough" particle shapes. It sets a distinct structure of the frictional force network compared to only sliding friction, and from a dynamical perspective leads to an increase in the velocity correlation length, in part responsible for the increased viscosity. The physics of rolling friction is thus a key element in achieving a comprehensive understanding of strongly shear-thickening materials.

The Prevalence of Celiac Disease in a Fracture Liaison Service Population.

Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

The impact of emotional development in people with autism spectrum disorder and intellectual developmental disability.

BACKGROUND: Intellectual developmental disabilities (IDDs) and autism spectrum disorders (ASDs) are developmental conditions, which may also be associated with impairments in emotional development (ED). ED can be assessed using the Scale of Emotional Development - Short (SED-S), a five-stage model consisting of eight domains, which allows to study the relationship between ASD and ED in people with IDD. METHODS: In this retrospective study, the level of ED was compared in 327 adults with IDD with [n = 83; mean age 38.3 years; level of IDD: mild (6), moderate (21), severe (45) and profound (11)] and without [n = 244, mean age 36.9 years; level of IDD: mild (67), moderate (73), severe (68) and profound (36)] ASD. The discriminative ability of the SED-S was determined by a regression in a training and a validation sample. RESULTS: The level of ED correlated with the severity of IDD (rs  = -.654) and the presence of ASD (rs  = -.316). People with additional ASD showed lower levels of ED compared with those with IDD only (mean reference ages 7-18 vs 19-36 months). The developmental profiles were equally balanced in ASD and IDD-only. A regression analysis revealed three domains ('Relating-to-Peers', 'Differentiating-Emotions', and 'Regulating-Affect') to be useful for ASD assignment (AUC > 0.70, sensitivity 0.76-0.80, specificity 0.62-0.63). CONCLUSIONS: In people with IDD, additional ASD was associated with delays in ED, which may be considered in diagnostics, treatment and care.

[Implant-associated joint infections]. / Implantatassoziierte Gelenkinfektionen.

Due to the increasing number of endoprosthetic joint replacement operations in older patients as well as in patients with severe primary diseases and comorbidities, the number of revision operations is continuously increasing due to infections. The infection of an endoprosthesis represents a complex clinical picture. This article provides a detailed overview of the treatment of periprosthetic infections with a focus on the diagnostic approach and treatment decision-making. A differentiation is made in periprosthetic infections between infections with a mature or immature biofilm on the surface of the implant. Depending on this, different treatment concepts are available. Highly acute infections represent an orthopedic/surgical emergency in artificial as well as in native joints. Low-grade infections play a role particularly in the area of exchange endoprosthetics. The greatest possible success is achieved only by the interplay of a timely diagnosis, sufficient surgical approach and individualized anti-infective treatment.

[Native joint infections]. / Native Gelenkinfektionen.

Joint infections are a great challenge for the treating physicians. Infection of a native joint can result in the rapid destruction of the joint if treatment is inadequate or delayed and is associated with severe life-threatening diseases, such as sepsis. This article presents a detailed overview of the treatment of joint infections of native joints with a focus on the diagnostic approach and treatment decisions. Infections in native joints are caused either endogenously by hematogenic spreading or are caused by exogenous factors. A relevant proportion of joint infections in native joints occur in connection with iatrogenic measures, such as operations, synovial punctures and joint infiltrations. Fundamentally, acute infections represent an orthopedic surgical emergency, which is associated with the necessity for immediate operative measures. The best possible success can only be achieved by an interaction between early diagnosis, an adequate surgical approach and a tailor-made anti-infectious treatment. This is also the case with periprosthetic infections, which will be dealt with in detail in a second article.