How to Prevent Ventilator-Induced Lung Injury in Intraoperative Mechanical Ventilation? A Randomized Prospective Study.

Objective: Intraoperative mechanical ventilation practices can lead to ventilator-induced lung injury (VILI) and postoperative pulmonary complications in healthy lungs. Mechanical power (MP) has been developed as a new concept in reducing the risk of postoperative pulmonary complications as it considers all respiratory mechanics that cause VILI. The most commonly used intraoperative modes are volume control ventilation (VCV) and pressure control ventilation (PCV). In this study, VCV and PCV modes were compared in terms of respiratory mechanics in patients operated in the supine and prone positions. Methods: The patients were divided into 4 groups (80 patients), volume control supine and prone, pressure control supine and prone with 20 patients each. MP, respiratory rate, positive end-expiratory pressure, tidal volume, peak pressure, plato pressure, driving pressure, inspiratory time, height, age, gender, body mass index, and predictive body weight data of the patients included in the groups have been obtained from "electronic data pool" with Structured Query Language queries. Results: The supine and prone MP values of the VCV group were statistically significantly lower than the PCV group (P values were 0.010 and 0.001, respectively). Conclusion: Supine and prone MP values of the VCV group were calculated significantly lower than the PCV group. Intraoperative PCV may be considered disadvantageous regarding the risk of VILI in the supine and prone positions.

Single-Track Magnetic Tape Absolute Position Sensor with Self-Adaptivity.

In this study, we demonstrate a single-track magnetic code tape-based absolute position sensor system. Unlike traditional dual-track systems, our method simplifies manufacturing and avoids crosstalk between tracks, offering higher tolerance to alignment errors. The sensing system employs an array of magnetic field sensing elements that recognize the bit sequence encoded on the tape. This approach allows for accurate position determination even when the number of sensing elements is fewer than the number of bits covered, and without the need for specific spacing between sensing elements and bit length. We demonstrate the system's ability to learn and adapt to various magnetic code patterns, including those that are irregular or have been altered. Our method can identify and localize the sensed magnetic field pattern directly within a self-learned magnetic field map, providing robust performance in diverse conditions. This self-adaptive capability enhances operational safety and reliability, as the system can continue functioning even when the magnetic tape is misaligned or has undergone changes.

Implementation of Sound Direction Detection and Mixed Source Separation in Embedded Systems.

In recent years, embedded system technologies and products for sensor networks and wearable devices used for monitoring people's activities and health have become the focus of the global IT industry. In order to enhance the speech recognition capabilities of wearable devices, this article discusses the implementation of audio positioning and enhancement in embedded systems using embedded algorithms for direction detection and mixed source separation. The two algorithms are implemented using different embedded systems: direction detection developed using TI TMS320C6713 DSK and mixed source separation developed using Raspberry Pi 2. For mixed source separation, in the first experiment, the average signal-to-interference ratio (SIR) at 1 m and 2 m distances was 16.72 and 15.76, respectively. In the second experiment, when evaluated using speech recognition, the algorithm improved speech recognition accuracy to 95%.

Design Method of Freeform Surface Optical Systems with Low Coupling Position Error Sensitivity.

Freeform off-axis reflective systems are significantly more difficult to align and assemble owing to their asymmetric surface shapes and system structures. In this study, a freeform surface system design method with low coupling position error sensitivity (FCPESM) was proposed. First, we established a mathematical model of a reflective system when it was perturbed by coupling position errors and used the clustering-microelement method to establish the coupling error sensitivity evaluation function. The evaluation function was then applied to the design process of a freeform surface off-axis three-mirror optical system. The results showed that the FCPESM optical design method can significantly relax the assembly tolerance requirements of optical systems on the basis of ensuring image performance. In this study, the reflective system was perturbed by tilt and decenter simultaneously, and the disturbance mechanism of position errors on optical systems was further improved. Through this research, freeform surface systems with both image performance and error sensitivity can be obtained, which makes freeform off-axis reflective systems with better engineering realizability.

Prevalence and Patterns of Positional Dental Anomalies in First Permanent Molars: Insights from a Study in Oradea, Romania.

Tooth position anomalies, influenced by both genetic and environmental factors, can significantly impact oral health and play a critical role in establishing proper occlusion. The aim of this study was to identify the most prevalent tooth position anomalies in first permanent molars among Romanian patients and to evaluate additional variables as well. This retrospective study utilized digital study models to identify all existing tooth position anomalies. The study included patients aged 12 to 40 years with complete permanent dentition. Axial changes (buccal tilting, oral tilting, mesial tilting, and distal tilting) as well as rotational changes (mesio-buccal rotation and disto-buccal rotation) were investigated. After applying the exclusion criteria, 103 patients remained in the study. Our findings revealed a notable prevalence of positional anomalies, with disto-buccal rotations being most common in upper molars (tooth 1.6-22.3%, tooth 2.6-31.1%) and oral tilting predominating in lower molars (tooth 3.6-6.8%, tooth 4.6-14.6%). Interestingly, neither gender nor malocclusion type significantly influenced the occurrence of tooth position anomalies. Symmetrical patterns in positional changes were observed, with patients having tooth position anomalies at 1.6 significantly more frequently associated with anomalies at 2.6. Similarly, anomalies at 3.6 were significantly more frequently associated with anomalies at 4.6. Additionally, for molars 2.6 and 3.6 on the left side, the differences were statistically significant, with patients having anomalies at 2.6 significantly more frequently associated with anomalies at 3.6. This pattern was not observed for the molars situated on the right side of the dental arches. While this study provides insights into positional anomalies in first permanent molars among the Romanian population, its retrospective design and focus on a specific demographic may limit generalizability. In conclusion, the study underscores the significant prevalence of positional anomalies in first permanent molars among adolescents and adults in Oradea, Romania. Early detection and targeted interventions are crucial to address these anomalies and improve orthodontic outcomes. Comprehensive assessment and treatment planning are essential to achieve optimal dental harmony and function. Further research is needed to elucidate the underlying factors contributing to these positional changes and their long-term impact on oral health and occlusal stability.

What to take up from the patient's talk? The clinician's responses to the patient's self-disclosure of their subjective experience in the psychiatric intake interview.

During psychiatric diagnostic interviews, the clinician's question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new agenda question concerning a medical or factual theme; 2) the clinician presents a follow-up question that selects a topic from the patient's self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient's telling; 3) the clinician provides an expert interpretation of the patient's self-disclosure of his or her subjective experience from the clinician's expert perspective; 4) the clinician gives advice that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a formulation that focusses on the core of their patient's self-disclosure of his or her subjective experience from the patient's perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient's agency and the clinician's more conscious patient-centred orientation in the psychiatric assessment procedure.

Omnidirectional image super-resolution via position attention network.

For convenient transmission, omnidirectional images (ODIs) usually follow the equirectangular projection (ERP) format and are low-resolution. To provide better immersive experience, omnidirectional image super resolution (ODISR) is essential. However, ERP ODIs suffer from serious geometric distortion and pixel stretching across latitudes, generating massive redundant information at high latitudes. This characteristic poses a huge challenge for the traditional SR methods, which can only obtain the suboptimal ODISR performance. To address this issue, we propose a novel position attention network (PAN) for ODISR in this paper. Specifically, a two-branch structure is introduced, in which the basic enhancement branch (BE) serves to achieve coarse deep feature enhancement for extracted shallow features. Meanwhile, the position attention enhancement branch (PAE) builds a positional attention mechanism to dynamically adjust the contribution of features at different latitudes in the ERP representation according to their positions and stretching degrees, which achieves the enhancement for the differentiated information, suppresses the redundant information, and modulate the deep features with spatial distortion. Subsequently, the features of two branches are fused effectively to achieve the further refinement and adapt the distortion characteristic of ODIs. After that, we exploit a long-term memory module (LM), promoting information interactions and fusions between the branches to enhance the perception of the distortion, aggregating the prior hierarchical features to keep the long-term memory and boosting the ODISR performance. Extensive results demonstrate the state-of-the-art performance and the high efficiency of our PAN in ODISR.

A Gaze into the Eyebrow Standards of Asian Versus Caucasian Women.

BACKGROUND: Eyebrow position affects perceived facial expression and youthfulness, and its modification is a key component of facial rejuvenation. OBJECTIVE: This investigation aimed to assess the preferred vertical eyebrow position, apex location, and eyebrow shape in Caucasian and Asian individuals and to analyze gaze patterns during aesthetic judgment using eye-tracking technology. MATERIALS AND METHODS: The study included 76 Asian and Caucasian volunteers with no medical background. Eye movements were captured with a Tobii Pro Nano eye-tracker. Participants viewed AI-generated images of Caucasian and Asian females with varied eyebrow positions (ratios 1:1.3 to 1:2.5), shapes (angles 8° to 20°), and apex positions. Aesthetic preferences were rated on a 5-point Likert scale. Eye-tracking metrics and aesthetic ratings were statistically analyzed using ANOVA and bivariate correlations. RESULTS: Both genders across ethnicities preferred a moderate eyebrow position ratio of 1:1.6. For eyebrow shapes, a 12° angle received the highest ratings, while extremes were less favored, indicating a preference for moderately curved eyebrows. The most appealing apex position was above the lateral canthus for Asians, and halfway between the lateral limbus and lateral canthus for Caucasians. Eye-tracking revealed longer fixations on unattractive features, suggesting more complex cognitive processing, while attractive features were processed more efficiently. CONCLUSION: The study revealed that aesthetic preferences for eyebrow features are influenced by both ethnic background and gender, with a general preference toward moderately curved eyebrows and subtle variations in preferred positions. These findings suggest a need for culturally sensitive approaches in facial aesthetic procedures and highlight the potential of eye-tracking technology to enhance surgical planning. Surgeons are advised to adopt a conservative, patient-centered approach when modifying eyebrow features, considering individual and cultural aesthetics to maximize patient satisfaction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of Whole-Body Vibration Therapy in Weight-Bearing and Non-Weight Bearing Positions for Upper and Lower Extremities on Balance and Cervical Joint Position Sense in Children With Cerebral Palsy.

INTRODUCTION: Cerebral palsy (CP) is a complex pathological entity that affects muscular control, coordination, proprioception, fine and gross motor abilities, position, stability, and, in some cases, cognition. This study aimed to compare the effects of whole-body vibration therapy (WBVT) in weight bearing and non-weight bearing positions for the upper and lower extremities on balance and cervical joint position sense in children with spastic CP. METHODS: A randomized controlled trial was carried out on 60 hemiplegic children with spastic CP aged 5-15 years. Following randomization, all participants were allocated into six equal-sized groups based on the application of WBVT for upper extremities, lower extremities, or both simultaneously in either weight-bearing or non-weight-bearing positions. Pediatric balance scale (PBS) and laser tracker system were used to assess functional balance and cervical joint position sense. RESULTS: One-way analysis of variance for Inter-group analysis showed a statistically significant difference among all groups in PBS and cervical joint position sense (p<0.05). CONCLUSION: WBVT was found to be beneficial in improving balance and cervical joint position sense in both weight-bearing and non-weight-bearing positions for the upper and lower extremities in children with cerebral palsy. However, the simultaneous application of WBVT in weight-bearing positions for both upper and lower extremities showed the most significant improvements in improving both balance and cervical joint position sense, indicating the most efficacious position of this treatment approach in children with cerebral palsy.

Retractable congestive heart failure due to sinus valsalva rupture with coexisting gerbode defect: a rare case report.

Sinus of Valsalva aneurysm (SoVA) is a rare disease with less than 1% prevalence in the population. Most cases are asymptomatic, however, significant clinical manifestations are possible due to fistula formation and sudden rupture resulting in cardiac shunt. Eventually it may develop into progressive heart failure with high morbidity. We report the case of a 33 year old female patient who presented with shortness of breath, ascites, and recurring hospitalisation. The cardiac examination revealed sinus tachycardia along with loud and continuous murmurs on the left parasternal border. Several standard diagnostic procedures could not be performed due to malignant arrhythmia in supine position. Echocardiography examination revealed SoV rupture with a gerbode defect, which was the underlying cause of severe retractable heart failure.

[Effects of"Grain for Green "on the Spatial Distribution of Soil Carbon and Nitrogen in Purple Hilly Area of China].

In order to remedy the lack of research on the effect of "Grain for Green" on soil carbon （C） and nitrogen （N） distribution on slope soil in purple hilly areas of Sichuan Basin, China, a study was conducted on a long-term observation site established in the Wanan small watershed of Yanting Agro-ecological Experimental Station of Purple Soil, Chinese Academy of Sciences. The morphology, content, and storage of C and N in soil at different slope positions of farmland and the artificial forests in rehabilitated land with a history of approximately 30 years were compared. Our results showed that "Grain for Green" significantly increased soil organic carbon （SOC） content and SOC stock in all soil layers. The SOC stock of the surface layer （0-20 cm） increased by 25.86 t·hm-2, and the annual SOC stocks ratio was 0.89 t·hm-2. Soil total nitrogen （TN） content increased slightly but only in the 0-20 cm soil layer. Compared with those in sloping farmland, the differences in available C and N nutrients such as soil nitrate N （NO3--N）, ammonia N （NH4+-N）, and dissolved organic C （DOC） in the whole soil profile （0-70 cm） were basically not significant （P > 0.05）. In addition, our research also found that slope position had significant effects on the contents of TN, SOC, NO3--N, NH4+-N, and DOC in farmland soil （P< 0.05）. The variation trend of soil NO3--N, NH4+-N, and DOC contents along the slope was as follows： upper slope < middle slope < lower slope, whereas the soil TN and SOC contents were highest in the lower slope, followed by the upper slope and middle slope. The position of the slope had a significant impact only on DOC content in forest soil, which increased along the slope. This research indicated that when evaluating the impact of land use changes on soil C and N stocks in the purple soil hilly region, the influence of topographic factors cannot be ignored.

Fingerprinting Organofluorine Molecules via Position-Specific Isotope Analysis.

Organofluorine substances are found in a wide range of materials and solvents commonly used in industry and homes, as well as pharmaceuticals and pesticides. In the environment, organofluorine molecules are now recognized as an important class of anthropogenic pollutants. Fingerprinting organofluorine compounds via their carbon isotope ratios (13C/12C) is crucial for correlating molecules with their source. Here we apply a 19F nuclear magnetic resonance spectroscopy (NMR) technique to obtain the first position-specific carbon isotope ratios for a diverse set of organofluorine molecules. In contrast to traditional isotope ratio mass spectrometry, the 19F NMR method provides 13C/12C isotope ratios at each carbon position where a C-F bond is present, and does not require fragmentation or combustion to CO2, overcoming challenges posed by the robust C-F covalent bonds. The method was validated with 2,2,2-trifluoroethanol, and applied to analyze heptafluorobutanoic acid, 5-fluorouracil and fipronil. Results reveal distinct intramolecular carbon isotope distributions, enabling differentiation of chemically identical molecules. Notably, the NMR method accurately analyzes carbon isotopes within target molecules despite impurities. Potential applications include the detection of counterfeit products and drugs, and ultimately pollution tracking in the environment.

Investigation on drag reduction on rotating blade surfaces with microtextures.

To enhance the aerodynamic performance of aero engine blades, simulations and experiments regarding microtextures to reduce the flow loss on the blade surfaces were carried out. First, based on the axisymmetric characteristics of the impeller, a new simulation method was proposed to determine the aerodynamic parameters of the blade model through the comparison of flow field characteristics and simulation results. Second, the placement position and geometrical parameters (height, width, and spacing) of microtextures with lower energy loss were determined by our simulation of microtextures on the blade surface, and the drag reduction mechanism was analyzed. Triangular ribs with a height of 0.2 mm, a width of 0.3 mm, and a spacing of 0.2 mm exhibited the best drag reduction, reducing the energy loss coefficient and drag by 1.45% and 1.31% for a single blade, respectively. Finally, the blades with the optimal microtexture parameters were tested in the wind tunnel. The experimental results showed that the microtexture decreased energy loss by 3.7% for a single blade under 57° angle of attack and 136.24 m/s, which was favorable regarding the drag reduction performance of the impeller with 45 blades.

Improved automatic segmentation of brain metastasis gross tumor volume in computed tomography images for radiotherapy: a position attention module for U-Net architecture.

Background: Brain metastases present significant challenges in radiotherapy due to the need for precise tumor delineation. Traditional methods often lack the efficiency and accuracy required for optimal treatment planning. This paper proposes an improved U-Net model that uses a position attention module (PAM) for automated segmentation of gross tumor volumes (GTVs) in computed tomography (CT) simulation images of patients with brain metastases to improve the efficiency and accuracy of radiotherapy planning and segmentation. Methods: We retrospectively collected CT simulation imaging datasets of patients with brain metastases from two centers, which were designated as the training and external validation datasets. The U-Net architecture was enhanced by incorporating a PAM into the transition layer, which improved the automated segmentation capability of the U-Net model. With cross-entropy loss employed as the loss function, the samples from the training dataset underwent training. The model's segmentation performance on the external validation dataset was assessed using metrics including the Dice similarity coefficient (DSC), intersection over union (IoU), accuracy, sensitivity, specificity, Matthews correlation coefficient (MCC), and Hausdorff distance (HD). Results: The proposed automated segmentation model demonstrated promising performance on the external validation dataset, achieving a DSC of 0.753±0.172. In terms of evaluation metrics (including the DSC, IoU, accuracy, sensitivity, MCC, and HD), the model outperformed the standard U-Net, which had a DSC of 0.691±0.142. The proposed model produced segmentation results that were closer to the ground truth and could reveal more detailed features of brain metastases. Conclusions: The PAM-improved U-Net model offers considerable advantages in the automated segmentation of the GTV in CT simulation images for patients with brain metastases. Its superior performance in comparison with the standard U-Net model supports its potential for streamlining and improving the accuracy of radiotherapy. With its ability to produce segmentation results consistent with the ground truth, the proposed model holds promise for clinical adoption and provides a reference for radiation oncologists to make more informed GTV segmentation decisions.

Effect of puncture position on catheter patency rate during tunnelled dialysis catheter insertion from the right internal jugular vein.

Background: No recommendations have been made regarding the puncture position during tunnelled dialysis catheter (TDC) insertion from right internal jugular vein (RIJV). We investigated the effect of puncture positioning along with other characteristics and clinical factors associated with TDCs to determine their correlation with catheter patency rate. Methods: We retrospectively reviewed TDC insertion procedures performed between January 2018 and December 2020 at a single institution. Patients were monitored for at least 1 year or until TDC removal or replacement. The distance on the post-operative chest radiography were measured to determine the height of puncture position. End points were freedom from catheter dysfunction. Results: Total 949 catheters met the eligibility criteria. Catheter dysfunction occurred in 233 patients and catheter infection in 127 patients. By multivariate analysis, female sex [hazard ratio (HR) =1.497, 95% confidence interval (CI): 1.119-2.002; P=0.007] and split-tip catheter (HR =1.453, 95% CI: 1.087-1.944; P=0.012) were associated with an increased rate of catheter dysfunction. Every 10-year increment in age (HR =1.243, 95% CI: 1.123-1.376; P<0.001) and every 1-cm increase in the height of the catheter insertion site (HR =1.270, 95% CI: 1.096-1.473; P=0.001) were also associated with an increased rate of catheter dysfunction. After classifying the height of puncture position into 3 groups, significant worse patency was observed in the catheter with puncture height more than 4 cm (P=0.025). No immediate complications were observed. Conclusions: TDC insertion at a high puncture site correlates with an increased risk of catheter dysfunction. Puncturing the RIJV close to the clavicle is safe and enhances catheter patency.

Built for movement: Neighborhoods and adolescent physical activity behaviors, and the moderating role of socioeconomic position and gender.

This study examined whether the built environment was associated with physical activity among adolescents in Oslo, Norway, and the role of socioeconomic position and gender as potential moderators of this association. We used data from 897 adolescents who participated in the TACKLE cross-sectional study conducted in 2020. Built environment features (recreational facilities, parks, forest, public transport, traffic calming devices, and schools) were assessed objectively using Geographical Information Systems. Physical activity data included device-measured moderate-to-vigorous physical activity, total physical activity, and self-reported active transportation to school. Using general linear models and logistic regression, we found that most built environment features were unrelated to the participants' device-measured physical activity. Longer distances to school and to traffic calming devices were associated with decreased likelihood of participants reporting active transportation to school. Our moderated regression analysis showed that adolescents with low socioeconomic backgrounds seemed less affected by longer distances to school compared with their high socioeconomic counterparts. Furthermore, boys appeared to be more sensitive to traffic safety relative to girls. Implementing traffic calming devices may enhance active transportation to school and improve traffic safety for Norwegian adolescents.

Supine position popliteal vein puncture under ultrasound guidance is a feasible and effective strategy to establish venous access.

OBJECTIVE: This study aims to introduce the clinical application value of popliteal vein puncture in the supine position under ultrasound guidance and compare this method with popliteal vein puncture in the prone position. METHODS: Endovascular operations for nonthrombotic iliac vein lesions (NIVLs) patients using popliteal vein access were performed during the period from July 2019 to August 2022 at the Zhongshan Hospital (Xiamen), Fudan University and Shanghai Xuhui District Central Hospital. Patients were randomly divided into supine position group and prone position group. All of the patients were punctured under ultrasound guidance. The procedure duration time for popliteal vein puncture, visual analogue score (VAS) scores and postoperative complications were recorded and compared between the two groups. RESULTS: Totally 120 patients were included in this study, in which 60 patients were enrolled in the supine position group, and 60 patients were enrolled in the prone position group. The median procedure time from puncture to iliofemoral venography was 5.97 min (interquartile range 5.78 min -6.03 min) and 28.76min (interquartile range 26.84 min -29.83 min ; p＜0.01）in the supine position and prone position group, respectively. The median time from puncture to access sheath insertion was 5.05 min (interquartile range 4.88 min -5.13 min ) and 5.03 min (interquartile range 4.93 min-5.12 min; p =0.607）in the supine position and prone position group, respectively. The median VAS value was 3 (interquartile range 2-3 ) and 8 (interquartile range 7-9 , p＜0.01）in the supine position and prone position group, respectively. In the supine position group, 1 case of arterial branch injury was observed after operation, and was successfully managed by ultrasound-guided compression. CONCLUSIONS: Popliteal vein puncture in the supine position under ultrasound guidance is safe and significantly reduces the overall operation time without changing position, and relieves the discomfort of patients.

Frailty and socioeconomic position: A systematic review of observational studies.

BACKGROUND: Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP. METHODS: We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis. RESULTS: We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP. INTERPRETATION: Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.

Radiographic evaluation of anterior tibial translation in the prone position after total knee arthroplasty: comparison of BCS-TKA and PS-TKA.

PURPOSE: The purpose of this study was to evaluate the anterior tibial translation (ATT) in the prone position after total knee arthroplasty (TKA). METHODS: Fifty subjects (50 knees) undergoing bi-cruciate substituting (BCS)-TKA (Journey II: Smith and Nephew) and age-gender matching 50 subjects (50 knees) undergoing posterior stabilizing (PS)-TKA, were included in this study. Approximately, six months after surgery, and when the subjects had recovered their range of knee motion, following the Mae's method, accurate lateral radiographic imaging of the knee was performed with full knee extension in both supine and prone positions. The maximal protrusion length of the femoral posterior component, posterior to the extension line parallel to the tibial shaft from the edge of the posterior tibial plateau, was measured on lateral radiographs. The difference in length between the prone and supine positions was regarded as the prone-ATT. The posterior protrusion length of the femoral component, and the prone-ATT were compared between BCS and PS-TKA. RESULTS: The posterior protrusion length of the femoral component in the supine position was BCS-TKA 4.3 ± 1.9 mm, and PS-TKA 8.7 ± 2.3 mm. The length in the prone position was BCS-TKA 4.8 ± 2.3 mm, and PS-TKA 10.7 ± 2.2 m. Posterior protrusion length of the femoral component was significantly larger in both positions in PS-TKA when compared with BCS-TKA. In PS-TKA, posterior protrusion length of the femoral condyle was significantly larger in the prone position when compared to the supine position. No significant difference was observed in BCS-TKA. Prone-ATT was significantly larger in PS-TKA (2 ± 1.9 mm) when compared to BCS-TKA (0.7 ± 2 mm). CONCLUSION: Even in a position corresponding to daily movement such as the prone position, ATT was significantly larger in PS-TKA, when compared to BCS-TKA.

Challenging trophic position assessments in complex ecosystems: Calculation method, choice of baseline, trophic enrichment factors, season and feeding guild do matter: A case study from Marquesas Islands coral reefs.

Assessments of ecosystem functioning are a fundamental ecological challenge and an essential foundation for ecosystem-based management. Species trophic position (TP) is essential to characterize food web architecture. However, despite the intuitive nature of the concept, empirically estimating TP is a challenging task due to the complexity of trophic interaction networks. Various methods are proposed to assess TPs, including using different sources of organic matter at the base of the food web (the 'baseline'). However, it is often not clear which methodological approach and which baseline choices are the most reliable. Using an ecosystem-wide assessment of a tropical reef (Marquesas Islands, with available data for 70 coral reef invertebrate and fish species), we tested whether different commonly used TP estimation methods yield similar results and, if not, whether it is possible to identify the most reliable method. We found significant differences in TP estimates of up to 1.7 TPs for the same species, depending on the method and the baseline used. When using bulk stable isotope data, the choice of the baseline significantly impacted TP values. Indeed, while nitrogen stable isotope (δ15N) values of macroalgae led to consistent TP estimates, those using phytoplankton generated unrealistically low TP estimates. The use of a conventional enrichment factor (i.e. 3.4‰) or a 'variable' enrichment factor (i.e. according to feeding guilds) also produced clear discrepancies between TP estimates. TPs obtained with δ15N values of source amino acids (compound-specific isotope analysis) were close to those assessed with macroalgae. An opposite seasonal pattern was found, with significantly lower TPs in winter than in summer for most species, with particularly pronounced differences for lower TP species. We use the observed differences to discuss possible drivers of the diverging TP estimates and the potential ecological implications.