Revolutionizing Cardiac Care: A Comprehensive Narrative Review of Cardiac Rehabilitation and the Evolution of Cardiovascular Medicine.

Cardiovascular disease (CVD) stands as a global health crisis, with its complex web of conditions, including coronary artery disease, heart failure, hypertension, and stroke, continuing to exact a heavy toll on individuals and healthcare systems worldwide. Despite substantial advances in medical technology and pharmaceutical interventions, CVD remains a formidable adversary, necessitating innovative prevention, management, and rehabilitation approaches. In tracing the historical trajectory of CVD, the narrative reveals the antiquated practices of early 20th-century medicine, marked by extended bed rest as the primary modality for heart-related conditions. It underscores the critical juncture when exercise was first recognized as a therapeutic tool for cardiac health, setting the stage for the evolution of cardiac rehabilitation (CR). CR programs have transcended their initial focus on exercise, expanding to encompass dietary guidance, psychosocial support, and comprehensive risk factor modification. These holistic interventions enhance physical recovery and address the psychosocial and lifestyle aspects of CVD management, ultimately improving patients' overall well-being. CR programs increasingly leverage advanced technologies and personalized strategies to tailor interventions to individual patient needs, ultimately enhancing outcomes and reducing the burden of CVD. In conclusion, this narrative review illuminates the transformative journey of cardiac care, with a particular spotlight on the indispensable role of CR in reshaping the landscape of cardiovascular medicine. By evolving from historical practices to comprehensive, patient-centered interventions, CR has made significant strides in improving the prognosis, quality of life, and holistic well-being of individuals grappling with the complexities of CVD. Understanding this historical context and the contemporary advancements is paramount for healthcare professionals and policymakers as they navigate the intricate terrain of cardiovascular medicine and endeavor to mitigate the impact of this pervasive disease.

The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management.

The complex and mutually influential connection between diabetes mellitus and chronic kidney disease (CKD) is a significant focal point in the current healthcare landscape. Diabetes, a medical condition characterized by elevated blood glucose levels resulting from impaired insulin action or secretion, has become a significant global epidemic. It poses considerable challenges to healthcare systems and affects millions of individuals worldwide. Concurrently, CKD, characterized by the gradual decline of kidney function, has become a persistent health challenge. This narrative review explores the complex relationship between these two conditions, shedding light on their significant implications for public health, clinical practice, and biomedical research. The correlation between diabetes and kidney disease is not merely coincidental. Diabetes is recognized as a significant risk factor for CKD, as individuals with diabetes are considerably more vulnerable to developing renal complications. Diabetic nephropathy, a distinct type of kidney disease closely associated with diabetes, is a significant factor in developing end-stage renal disease. It is imperative to implement efficient diabetes management strategies to regulate blood sugar levels and prevent potential kidney damage. On the other hand, kidney disease may contribute to the development of diabetes. The kidneys regulate glucose levels by filtering the blood and selectively reabsorbing glucose as necessary. In compromised kidney function, such as CKD, impaired glucose metabolism can give rise to insulin resistance and diabetes. As a result, the management of kidney disease plays a dual role in both preserving renal function and preventing diabetes in individuals who are at risk. The coexistence of diabetes and kidney disease in a patient presents complex clinical challenges. Achieving effective management requires a meticulous balance between glycemic control and preservation of renal function. Failing to maintain this delicate equilibrium can lead to cardiovascular complications and subsequent hospitalizations. This comprehensive narrative review aims to thoroughly examine the pathophysiological mechanisms that connect diabetes and kidney disease. It will provide insights into the clinical manifestations and diagnostic methods, explore various approaches to managing the condition, discuss the crucial role of nutrition, delve into pharmacological interventions, emphasize the importance of patient education and self-care, and shed light on emerging research areas. In addition to impacting individual health outcomes, this reciprocal relationship has significant implications for healthcare systems, socioeconomic landscapes, and public health policy. Comprehending this complex interaction is crucial for making well-informed clinical judgments, improving patient care, and developing a more efficient public health approach to address the interconnected issues of diabetes and kidney disease.

Global Optimization of Dinitrogen Clusters Bound to Monolayer and Bilayer Graphene: A Swarm Intelligence Approach.

Locating the global minimum of a potential energy surface is an arduous task. The complexity of the potential energy surface increases as the number of degrees of freedom of the system increases. The highly rugged nature of the potential energy surface makes the minimization of the total energy of the molecular clusters a difficult optimization problem. A solution to this conundrum is the use of metaheuristic techniques that efficiently track down the global minima through a trade-off between exploration and exploitation. Herein, we use the swarm intelligence technique, particle swarm optimization to locate the global minima geometries of N2 clusters of size 2-10, in free and adsorbed states. We have investigated the structures and energetics of bare N2 clusters, followed by N2 clusters adsorbed on graphene and intercalated between the layers in bilayer graphene. The noncovalent interactions between dinitrogen molecules are modeled using the Buckingham potential as well as the electrostatic point charge model, while those of the N2 molecules with the carbon atoms of graphene are modeled using the improved Lennard-Jones potential. The interactions of the carbon atoms belonging to different layers in a bilayer are modeled using the Lennard-Jones potential. The bare cluster geometries and intermolecular interaction energies obtained using particle swarm optimization are found to be the same as reported in the literature, validating the use of particle swarm optimization for studying molecular clusters. The N2 molecules are found to adsorb as a monolayer on top of the graphene sheet and intercalate themselves right in the middle of the two sheets of bilayer graphene. Our study establishes that particle swarm optimization is a feasible global optimization technique for performing the optimization of high-dimensional molecular clusters, both in pristine and in confined forms.

Elucidation of Noble Gas Cluster Configurations Bound on Graphdiyne: A Metaheuristic Approach.

Graphynes are a class of all-carbon two-dimensional membranes that have been intensely researched for various membrane-based technologies on account of their unique pore architectures. Herein, we report an investigation of the mechanism and energetics of adsorption of noble gases (He, Ne and Ar) on graphdiyne (GDY), the most popular form of graphynes. Two global optimization techniques, namely particle swarm optimization (PSO) and differential evolution are employed to predict the putative global minima configurations of rare gas clusters in the size range 1-30 when adsorbed on GDY. We use the 12-6 Lennard-Jones potential to represent the pairwise non-covalent interactions between various interacting atoms. Initially, the gas atoms adsorb as monolayers on GDY at the centers of the triangular pores until all the triangular pores are filled. This is followed by a second layer formation on top of the hexagonal pore centers or on top of the C-C bonds. The findings from the empirical approach are further validated by performing density functional theory calculations on the predicted adsorbed cluster configurations. We have also looked into the adsorption of noble gas clusters on bilayer GDY systems and have found that the intercalation of gas atoms within the bilayers is feasible. Our study suggests that the stochastic nature of the swarm intelligence technique, PSO can assist in an effective search of the potential energy surfaces for the global minima, eventually enabling large-scale simulations.

Real-World Evidence Study on the Long-Term Safety of Everolimus in Patients With Tuberous Sclerosis Complex: Final Analysis Results.

The TuberOus SClerosis registry to increase disease Awareness (TOSCA) Post-Authorization Safety Study (PASS) was a non-interventional, multicenter, safety substudy that assessed the long-term safety of everolimus in patients with tuberous sclerosis complex (TSC) receiving everolimus for its licensed indications in the European Union (EU). This substudy also aimed to address TSC-associated neuropsychiatric disorders (TAND), sexual development, and male infertility. Eligible patients were enrolled from 39 sites across 11 countries in the EU. Outcomes of interest included the incidence of adverse events (AEs), serious adverse events (SAEs), treatment-related AEs (TRAEs), AEs leading to everolimus discontinuation, AEs of special interest (AESIs), the observed relationship between everolimus blood levels and incidence of AESIs, TAND, and reproductive clinical features. Herein, we present the final analysis results from this substudy (data cutoff date: 22 January 2020). At data cutoff, 179 patients were enrolled (female, 59.2%; age ≥18 years, 65.9%), of which the majority completed the study (76%). Overall, 121 patients (67.6%) had AEs regardless of causality. The most frequent TRAEs (≥5%) were stomatitis (7.8%), aphthous ulcer (6.7%), and hypercholesterolemia (6.1%). The most common treatment-related SAEs (>1%) were pneumonia (3.4%), influenza, pyelonephritis, aphthous ulcer, stomatitis, dyslipidemia, and hypercholesterolemia (1.1% each). Ten patients (5.6%) reported AEs leading to everolimus discontinuation. The common psychiatric disorders (N = 179) were autism spectrum disorder (21.8%), anxiety disorder (12.8%), "other" psychiatric disorders (8.9%), attention-deficit hyperactivity disorder, and depressive disorder (7.8% each). Of 179 patients, 88 (49.2%) had ≥1 behavioral problem. Of these (n = 88), the most common (>20%) were sleep difficulties (47.7%), anxiety (43.2%), mood swings (37.5%), depression mood (35.2%), impulsivity (30.7%), severe aggression (23.9%), and overactivity (22.7%). Of 179 patients, four (2.2%) reported abnormal puberty onset, and three (1.7%) reported other reproductive disorders. Of 106 females, 23 (21.7%) reported menstrual cycle disorders and 10 (9.4%) reported amenorrhea. Available data did not show delays in sexual maturation or an association between sexual development and infertility. The results demonstrate that everolimus has a manageable long-term safety profile in the TSC treatment setting. No new safety signals emerged. This substudy also contributed to the mapping of TAND and reproductive clinical features in patients with TSC.

Collaborative case-based learning with programmatic team-based assessment: a novel methodology for developing advanced skills in early-years medical students.

BACKGROUND: Imperial College London launched a new, spiral undergraduate medical curriculum in September 2019. Clinical & Scientific Integrative cases (CSI) is an innovative, flagship module, which uses pioneering methodology to provide early-years learning that [1] is patient-centred, [2] integrates clinical and scientific curriculum content, [3] develops advanced team-work skills and [4] provides engaging, student-driven learning. These aims are designed to produce medical graduates equipped to excel in a modern healthcare environment. METHODS: CSI has adopted a novel educational approach which utilises contemporary digital resources to deliver a collaborative case-based learning (CBL) component, paired with a team-based learning (TBL) component that incorporates both learning and programmatic assessment. This paper serves to explore how first-year students experienced CSI in relation to its key aims, drawing upon quantitative and qualitative data from feedback surveys from CSI's inaugural year. It provides a description and analysis of the module's design, delivery, successes and challenges. RESULTS: Our findings indicate that CSI has been extremely well-received and that the majority of students agree that it met its aims. Survey outputs indicate success in integrating multiple elements of the curriculum, developing an early holistic approach towards patients, expediting the development of important team-working skills, and delivering authentic and challenging clinical problems, which our students found highly relevant. Challenges have included supporting students to adapt to a student-driven, deep learning approach. CONCLUSIONS: First-year students appear to have adopted a patient-centred outlook, the ability to integrate knowledge from across the curriculum, an appreciation for other team members and the self-efficacy to collaboratively tackle challenging, authentic clinical problems. Ultimately, CSI's innovative design is attractive and pertinent to the needs of modern medical students and ultimately, future doctors.

An anisotropic dressed pairwise potential model for the adsorption of noble gases on boron nitride sheets.

Development of empirical potentials with accurate parameterization is indispensable while modeling large-scale systems. Herein, we report accurate parameterization of an anisotropic dressed pairwise potential model (PPM) for probing the adsorption of noble gases, He, Ne, Ar and Kr on boron nitride sheets. For the noble gas binding on B48N48H24, we carried out a least-squares fit analysis of the dispersion and dispersionless contributions of the interaction potential separately. The transferability of the parameters for a range of molecular model systems of boron nitride is further established. The dressed PPM is then used in conjunction with a global optimization technique, namely particle swarm optimization (PSO) to assess the possibility of performing large-scale simulations with the PPM-PSO methodology. The results obtained for the adsorption of 2-5 noble gases on BN sheets establish the proof-of-concept, encouraging the pursuit of large-scale simulations using the PPM-PSO approach.

Progressive pseudorheumatoid dysplasia misdiagnosed as juvenile idiopathic arthritis: a case report.

BACKGROUND: Progressive pseudorheumatoid dysplasia is a rare, autosomal recessively inherited, noninflammatory musculoskeletal disorder caused by mutations occurring in the WNT1-inducible signaling pathway protein 3 gene. Joint cartilage is the primary site of involvement, leading to arthralgia, joint stiffness, contractures, enlargement of the epiphyses and metaphysis of the hand joints, spinal abnormalities, short stature, early osteoarthritis, and osteoporosis. Juvenile idiopathic arthritis is the most common chronic rheumatic disease in childhood and has unknown etiology. Clinical features of progressive pseudorheumatoid dysplasia resemble those of juvenile idiopathic arthritis. Patients with progressive pseudorheumatoid dysplasia are usually misdiagnosed as having juvenile idiopathic arthritis. CASE PRESENTATION: A 13-year-old Yemeni female presented to the rheumatology clinic with a history of joint pains, bone pains, and bone deformity for 7 years. Weight and height were below the third percentiles. There was no tender swelling of metacarpophalangeal and interphalangeal joints, and she presented with scoliosis. Radiographs of the hands revealed the widening of the epiphyses. Progressive pseudorheumatoid dysplasia was suspected, and genetic testing for WNT1-inducible signaling pathway protein 1, 2, and 3 was requested with these findings. A homozygous, likely pathogenic variant was identified in the WNT1-inducible signaling pathway protein 3 gene, which confirmed our diagnosis. CONCLUSION: Progressive pseudorheumatoid dysplasia is a rare form of spondyloepimetaphyseal dysplasia and is clinically misdiagnosed as juvenile idiopathic arthritis. It is crucial to consider progressive pseudorheumatoid dysplasia, especially in patients with standard inflammatory markers who are being followed up for juvenile idiopathic arthritis and not improving with antirheumatic intervention.

In pursuit of accurate interlayer potentials for twisted bilayer graphynes.

Recent explorations of twist in bilayer graphene and the discovery of superconducting phases at certain magic angles have laid the groundwork for a new branch in materials science called twistronics. However, theoretical studies on twisted layered materials are impeded due to the computational expense associated with first-principles calculations. Empirical force field approaches that include anisotropic terms to describe interlayer interactions have come to the fore as excellent alternatives to deal with such a stumbling block. Taking a cue from these formulations, herein, we describe our pursuit of capturing the interlayer interactions in bilayer graphynes with atomistic empirical potentials. The choice of the potentials, namely the improved Lennard-Jones potential and Hod's interlayer potential, is motivated by the objective of bringing out the role of anisotropy explicitly. Empirical parameters for both the potentials are calibrated against dispersion-corrected DFT calculations that are performed to incorporate the stacking, sliding and twisting features of the bilayer configurations. Although the isotropic improved Lennard-Jones potential is able to describe the interlayer stacking of graphynes, it is inadequate to account for the interlayer twist properties. The anisotropic Hod's interlayer potential portrays the interlayer twisting energy profiles of the benchmark DFT calculations with a reasonable accuracy. Our potential formulations can bestow impetus to the research on the homo- and hetero-bilayer structures of graphynes and other two-dimensional materials.

Involvement of mental health professionals in the treatment of tuberous sclerosis complex-associated neuropsychiatric disorders (TAND): results of a multinational European electronic survey.

BACKGROUND: Tuberous sclerosis complex (TSC) is a rare, genetic, multisystem disorder characterized by the growth of hamartomas in several organs, including the brain, kidneys, heart, eyes, and lungs. Even though over 90% of patients will have some form of TSC-associated neuropsychiatric disorder (TAND), there is an apparent lack of involvement of mental health professionals (MHPs) in the care of patients with TSC. The aim of this study was to determine the current level of TAND awareness in the TSC community and to identify possible barriers to effective multidisciplinary collaboration between MHPs and other healthcare providers (HCPs) in TAND management. METHODS: An electronic survey on current TSC and TAND management was conducted, targeting TSC caregivers/families, psychiatrists, neurologists, TSC specialists, and primary care physicians. RESULTS: The invitation to participate in the survey was emailed to 659 HCPs and was disseminated through social media channels of patient advocacy groups. The survey was open for 4 months, with 359 responses collected. The majority of participants were TSC caregivers/families (73.3% of all responses). Of the 96 HCPs who participated, most were neurologists (61.5%) or TSC specialists (28.1%). Only 6 psychiatrists and 4 primary care physicians participated. Approximately half of patients have never had a neuropsychiatric assessment, and it was their caregivers/families who initiated the discussion of TAND with their providers. Almost 70% of TSC caregivers/families believed that psychiatric treatment could improve their quality of life. However, 54% of patients had difficulty obtaining psychiatric assessment. In turn, only 21% of HCPs believed that psychiatric therapy would help and 74% were concerned that their patients would be stigmatized by psychiatric referral. CONCLUSIONS: This study focused on European healthcare systems suggests that current care for mental health issues in patients with TSC is inadequate, despite guideline recommendations for regular neuropsychiatric assessments. This appears to be due to a combination of gaps in diagnosis and surveillance, low frequency of psychiatric referrals, insufficient resources, and stigmatization of mental healthcare. There is a pressing need for further initiatives to study and address the mechanisms underlying the mental health treatment gap. The importance of MHP support must be recognized to optimize TSC management.

A swarm intelligence modeling approach reveals noble gas cluster configurations confined within carbon nanotubes.

Confinement of atoms and molecules brings forth fascinating properties to chemical systems that are otherwise not known in the bulk. Carbon nanotubes (CNTs) and fullerenes are excellent hosts for probing the confinement effects. Herein, we explore the potential energy surfaces of large noble gas clusters, Ngn (Ng = He, Ne and Ar; n = 10, 20, 30, 40, and 50), in the confines of CNTs of various lengths. Our implementation involves integrating the continuum approximation for CNTs with the well-known swarm intelligence technique, particle swarm optimization (PSO), followed by a deterministic local optimization. Global search techniques such as PSO have been increasingly utilized in recent times to track down minimum energy configurations on highly rugged potential energy surfaces. Aside from the position vectors of the noble gas atoms, we have considered the radius of the CNTs as a design variable. Such an approach enabled us to predict the optimal CNT radii for the encapsulation of each of the clusters. Confined cluster geometries ranging from linear, zig-zag, and double-helical to spiral configurations are obtained on encapsulation, in sharp contrast to their bare cluster geometries. On increasing the CNT length, our approach yielded quasi-linear geometries, suggesting that the length of the CNTs plays a crucial role in determining the stable cluster configurations on confinement.

Quantum Transmission of He Isotopes through Crown Ether-Embedded Graphene Nanomeshes: An Eckart Potential Approach.

The remarkable performance of carbon membranes for the selective passage of various species has led to extensive research in designing smart membranes. The mechanical stability of graphene in conjunction with the excellent host-guest chemistry of crown ethers makes the recently synthesized family of crown ether-embedded graphene nanomeshes promising candidates for sieving applications. Inspired by the excellent control over pore architectures offered by such nanomeshes, we investigate the abilities of crown ether-embedded graphene nanomeshes for noble gas separation by the size-sieving mechanism and for He isotope separation by the quantum sieving mechanism. Unlike the previous studies that employ either a finite-difference approach or a wave packet approach, we employ an analytical Eckart potential approach to calculate the tunneling probabilities. Using tunneling-corrected transition-state theory, we examine the competing nature of the zero-point energy effects and tunneling effects in governing the total quantum transmission of the isotopes. Our analysis of the permeation barriers, diffusion rates, transmission probabilities, permeabilities, and selectivities suggests that crown ether-embedded graphene nanomeshes are a class of promising carbon membranes for He isotope separation.

From workforce intelligence to workforce development: advancing the Eastern Mediterranean pharmaceutical workforce for better health outcomes.

BACKGROUND: The pharmaceutical workforce in the World Health Organization (WHO) Eastern Mediterranean Region plays a key role in improving health outcomes through responsible use of drugs and optimizing effective choice and use. Investment in this workforce's development and planning is fundamental to achieving universal health coverage. AIMS: To provide an overview of the pharmacy workforce capacity trends in the Region and emphasize the importance of workforce intelligence for strategic development. METHODS: A review of the literature and global pharmacy workforce studies conducted by the International Pharmaceutical Federation to identify trends and issues in the Region. RESULTS: The Region has high workforce production capacity compared to other WHO regions but challenges in workforce planning and intelligence strategies persist. Effective workforce planning relies not only on quality intelligence, but also on cross-sectoral coordination and stewardship, and the Pharmaceutical Workforce Development Goals provide countries within the Region with a framework for development. CONCLUSION: There is no workforce development without workforce intelligence.

Selective Permeation through One-Atom-Thick Nanoporous Carbon Membranes: Theory Reveals Excellent Design Strategies!

Research on the permeation of various species through one-atom-thick nanoporous carbon membranes has gained an unprecedented importance in the past decade, thanks to the development of numerous theoretical design strategies for a plethora of applications ranging from gas separation, water desalination, isotope separation, and chiral separation, to DNA sequencing. Although some of the recent experiments have demonstrated successful performance of such carbon membranes in sieving, many of the suggested applications are yet to be realized in experiments. This review aims to draw the attention of the theoretical as well as the experimental researchers working on two-dimensional carbon materials toward the recent theoretical developments probing the permeation of various species such as atoms, ions, small molecules, and biopolymers like DNA through carbon frameworks like graphynes, graphdiyne, graphenylenes, and various forms of nanoporous graphene, including graphene crown ethers. The underlying guiding principles toward the design of carbon-based membranes for nanofiltration are established using estimates of the adsorption energies, barrier heights for permeation, rates of permeation, selectivities, permeances, etc. The crucial roles of tunneling, temperature effects, chemical functionalities, and dynamical aspects of the nanopores are also highlighted, paving the way to a comprehensive description of the theoretical design strategies for tailoring the applicability of novel nanoporous carbon membranes in sieving and related aspects.

Graphynes: indispensable nanoporous architectures in carbon flatland.

Theoretical design and experimental realization of novel nanoporous architectures in carbon membranes has been a success story in recent times. Research on graphynes, an interesting class of materials in carbon flatland, has contributed immensely to this success story. Graphyne frameworks possessing sp and sp2 hybridized carbon atoms offer a variety of uniformly distributed nanoporous architectures for applications ranging from water desalination, gas separation, and energy storage to catalysis. Theory has played a pivotal role in research on graphynes, starting from the prediction of various structural forms to the emergence of their remarkable applications. Herein, we attempt to provide an up-to-date account of research on graphynes, highlighting contributions from numerous theoretical investigations that have led to the current status of graphynes as indispensable materials in carbon flatland. Despite unsolved challenges in large-scale synthesis, the future appears bright for graphynes in present theoretical and experimental research scenarios.

Coevolution between Nuclear-Encoded DNA Replication, Recombination, and Repair Genes and Plastid Genome Complexity.

Disruption of DNA replication, recombination, and repair (DNA-RRR) systems has been hypothesized to cause highly elevated nucleotide substitution rates and genome rearrangements in the plastids of angiosperms, but this theory remains untested. To investigate nuclear-plastid genome (plastome) coevolution in Geraniaceae, four different measures of plastome complexity (rearrangements, repeats, nucleotide insertions/deletions, and substitution rates) were evaluated along with substitution rates of 12 nuclear-encoded, plastid-targeted DNA-RRR genes from 27 Geraniales species. Significant correlations were detected for nonsynonymous (dN) but not synonymous (dS) substitution rates for three DNA-RRR genes (uvrB/C, why1, and gyrA) supporting a role for these genes in accelerated plastid genome evolution in Geraniaceae. Furthermore, correlation between dN of uvrB/C and plastome complexity suggests the presence of nucleotide excision repair system in plastids. Significant correlations were also detected between plastome complexity and 13 of the 90 nuclear-encoded organelle-targeted genes investigated. Comparisons revealed significant acceleration of dN in plastid-targeted genes of Geraniales relative to Brassicales suggesting this correlation may be an artifact of elevated rates in this gene set in Geraniaceae. Correlation between dN of plastid-targeted DNA-RRR genes and plastome complexity supports the hypothesis that the aberrant patterns in angiosperm plastome evolution could be caused by dysfunction in DNA-RRR systems.

Single-incision repair of acute distal biceps ruptures by use of suture anchors.

The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures by use of suture anchors. Sixty consecutive patients underwent distal biceps repair after an acute rupture between January 1997 and January 2001 by use of a limited antecubital incision and suture anchors. Fifty-three patients could be evaluated at a mean follow-up of 38.1 months. A limited transverse incision was made in the antecubital fossa. The retracted biceps tendon end was identified, retrieved, and lightly debrided. Two suture anchors were placed in the radial tuberosity, and the tendon was reapproximated. Final follow-up consisted of physical examination, radiographs, and Andrews-Carson elbow score tabulations. According to the Andrews-Carson scores, there were 46 excellent and 7 good results. In 2 patients, heterotopic ossification developed that resulted in a mild loss of forearm rotation and mild pain. In 1 patient, a temporary radial nerve palsy developed, which resolved completely within 8 weeks. Repair of acute distal biceps tears via a limited antecubital incision and suture anchors is a safe, effective technique.

Helping people assess the health risks from lifestyle choices: comparing a computer decision aid with customized printed alternative.

Decisions about lifestyle play a key role in influencing health. Illnesses such as heart disease result from combinations of factors, making it hard for people to evaluate alternatives (e.g., knowing how much exercise might give similar benefit to eating more fruit and vegetables). Computers can provide customized risk leaflets and interactive displays, which may encourage people to explore potential lifestyle changes by showing the consequences for future health of specific combinations of lifestyle changes. This empirical study invited 24 adult volunteers to use the information from a customized leaflet or interactive display to advise hypothetical patients about lifestyle changes. Advisers used both leaflet and computer for different patients, with order counterbalanced across volunteers. It was found that more combinations of lifestyle factors were explored with the interactive display, especially by the younger volunteers, without this taking more time. Most of the older volunteers preferred interacting with the computer, and rated it as easier to use than the leaflet. It is concluded that easy to use computer interfaces can be devised that help people explore the health consequences of personal decisions about lifestyle, and that people prefer interactive assistance rather than using printed alternatives.