Pipeline to Military Orthopaedic Leadership: 20 Years of Race and Gender Diversity Trends Within Military Orthopaedic Surgery Fellowship Training.

Background: The lack of trainees from underrepresented race and gender backgrounds in orthopaedic surgery fellowship training has been well reported in the literature. The purpose of this study was to investigate the demographic trends of federally sponsored military orthopaedic surgery fellows in the Army, Navy, and Air Force. We hypothesize that there has been an increase in women selected for fellowship but that there has been no change in the race demographics of military fellows over the past 2 decades. Methods: A retrospective review of all available demographic data collected by the Army, Air Force, and Navy since the beginning of tracking federally funded fellowship training in orthopaedic surgery was completed (1998-2021). Data were grouped into 4-year periods for analysis to closely mirror the military assignment cycle. Results: Three hundred sixty-two military orthopaedic surgery fellowship board selectees were included in our analysis. The proportion of women fellows increased from 3% (n = 2/69) over 2001 to 2004 to 21% (n = 17/82) during 2017 to 2020 (p < 0.05). Fellows who identified as White comprised 82% (n = 297) of the cohort during the study period. Individuals who identified as Asian were the next highest proportion of fellows at 4% (n = 16), followed by Black (n = 14, 4%) and Hispanic (n = 13, 3%). Individuals who identified as Native Hawaiian/Pacific Islander represented 1% (n = 3), and an additional 6% (n = 20) fellows identified as "other" or "undeclared." Over the 20-year study period, representation of Asian, Black, Native Hawaiian, and Hispanic fellows did not increase (p = 0.79, 0.81, 0.45, 0.34, respectively). Conclusions: Within military orthopaedics, there has been increased representation of women in fellowship training over the past 20 years. However, the proportion of fellows from underrepresented racial and ethnic groups has remained stagnant. One barrier to improving gender and race representation is the currently imprecise and inconsistent collection of demographic information. Importantly, fellowship training has a direct effect on future leadership opportunities within the military orthopaedic surgery community. A more diverse leadership may help to inspire future generations of military orthopaedic surgeons. Level of Evidence: IV.

Incorporating a Fresh Mixed Annual Ryegrass and Berseem Clover Forage Into the Winter Diet of Dairy Cows Resulted in Reduced Milk Yield, but Reduced Nitrogen Excretion and Reduced Methane Yield.

The winter diet of dairy cows in Mediterranean climate regions is usually a total mixed ration with a base of conserved summer crops such as corn silage and alfalfa hay. However, there is increased labor and financial cost related to this kind of feeding, which could be reduced if fresh forages were used in place of some of the conserved forage in the cow diet. The objective of our study was to evaluate the effect of including fresh mixed annual ryegrass and berseem clover into the diet of dairy cows on milk, nitrogen utilization, and methane emission. Twenty-four lactating dairy cows were split into two groups and offered either a diet similar to that usually offered to the cows (CON) or one where a mixture of fresh annual ryegrass and berseem clover was used to partially substitute the corn silage and alfalfa hay in the diet (MIX). Milk yield was recorded automatically, and methane emissions were estimated using the SF6 tracer technique. The MIX diet had lower crude protein concentration (148 vs. 170 g/kg DM) but higher DM digestibility (81.6 vs. 78.6%) than the CON diet. Compared to the cows offered the CON diet, milk yield was reduced when cows were fed the MIX diet (36.4 vs. 31.9 kg/d), but methane emissions (381 vs. 332 g/d) and nitrogen excretion were also reduced (238 vs. 180 g/d). Nitrogen use efficiency was unaffected (30.8%). In addition, milk from cows fed the MIX diet had a fatty acid profile considered to be more beneficial to human health than that of the milk from cows fed the CON diet. Increasing the protein concentration in the MIX diet, either by direct supplementation or increasing the proportion of legume in the mixed herbage, could overcome the reduction on milk and positively affect methane emission and N use efficiency.

Multicentric, prospective observational data show sperm capacitation predicts male fertility, and cohort comparison reveals a high prevalence of impaired capacitation in men questioning their fertility.

RESEARCH QUESTIONS: Can a previously defined relationship between sperm capacitation and the probability of a man generating pregnancy within three cycles, prospectively predict male fertility in diverse clinical settings? A second study asked, what is the prevalence of impaired sperm fertilizing ability in men questioning their fertility (MQF), and does this relate to traditional semen analysis metrics? DESIGN: In the multicentric, prospective observational study, data (n = 128; six clinics) were analysed to test a published relationship between the percentage of fertilization-competent, capacitated spermatozoa (Cap-Score) and probability of generating pregnancy (PGP) within three cycles of intrauterine insemination. Logistic regression of total pregnancy outcomes (n = 252) assessed fit. In the cohort comparison, Cap-Scores of MQF (n = 2155; 22 clinics) were compared with those of 76 fertile men. RESULTS: New outcomes (n = 128) were rank-ordered by Cap-Score and divided into quintiles (25-26 per group); chi-squared testing revealed no difference between predicted and observed pregnancies (P = 0.809). Total outcomes (n = 252; 128 new + 124 previous) were pooled and the model recalculated, yielding an improved fit (P < 0.001). Applying the Akaike information criterion found that the optimal model used Cap-Score alone. Cap-Scores were performed on 2155 men (with semen analysis data available for 1948). To compare fertilizing ability, men were binned by PGP (≤19%, 20-29%, 30-39%, 40-49%, 50-59%, ≥60%). Distributions of PGP and the corresponding Cap-Scores were significantly lower in MQF versus fertile men (P < 0.001). Notably, 64% of MQF with normal volume, concentration and motility (757/1183) had PGP of 39% or less (Cap-Scores ≤31), versus 25% of fertile men. CONCLUSIONS: Sperm capacitation prospectively predicted male fertility. Impaired capacitation affects many MQF with normal semen analysis results, informing diagnosis versus idiopathic infertility.

The Equipment Used in the SF6 Technique to Estimate Methane Emissions Has No Major Effect on Dairy Cow Behavior.

The natural behavior of animals can be disrupted by the techniques and materials of research methodologies. This study aimed to evaluate the effect of the equipment used in the SF6 tracer technique to estimate enteric methane emissions on the behavior of lactating dairy cows. The cows (n = 24) were allocated to one of two diets: CONTROL and experimental diet (MIX). Behavior was assessed through video recordings between milking times during four phases: 3 days before fitting the cows with the SF6 equipment (PRE), first 2 days after the cows were fitted with the SF6 equipment (ADAP), 3 days during methane emission measurements (MEAS), and 2 days after the SF6 equipment removal (POST). The behaviors recorded included eating, ruminating or idling, resting, and others. Affiliative or agonistic and discomfort behaviors (scratching or pushing the equipment) were also recorded. Lying time was recorded over 14 days using dataloggers fitted to the cows' leg. Milk production and feed intake were recorded daily. MIX cows ruminated more than CONTROL cows (P = 0.05). The cows ruminated more at MEAS than in any other phase (P < 0.01). Time spent idling gradually decreased from PRE to MEAS for MIX cows (P < 0.01). The cows were lying down longer in MEAS than in ADAP and POST (P < 0.01). The time spent lying with the head down was shorter during PRE and ADAP than during POST (P < 0.05). No difference was observed in the occurrence of discomfort or agonistic behaviors (P > 0.05). Affiliative behaviors occurred more often in ADAP than in MEAS (P < 0.05). There was no difference between phases in daily lying time, number of lying bouts per day, or mean bout duration (P > 0.05). Milk production was not influenced by the SF6 equipment (P > 0.05). Dry matter intake was higher for CONTROL cows (P < 0.01), and it decreased from PRE to MEAS (P < 0.01). However, milk yield did not differ between cows wearing the SF6 equipment and those without it (P > 0.05). We conclude that the SF6 equipment had a minimal effect on dairy cow behavior.

Reassessing the environmental context of the Aitape Skull - The oldest tsunami victim in the world?

There is increasing recognition of the long-lasting effects of tsunamis on human populations. This is particularly notable along tectonically active coastlines with repeated inundations occurring over thousands of years. Given the often high death tolls reported from historical events though it is remarkable that so few human skeletal remains have been found in the numerous palaeotsunami deposits studied to date. The 1929 discovery of the Aitape Skull in northern Papua New Guinea and its inferred late Pleistocene age played an important role in discussions about the origins of humans in Australasia for over 25 years until it was more reliably radiocarbon dated to around 6000 years old. However, no similar attention has been given to reassessing the deposit in which it was found-a coastal mangrove swamp inundated by water from a shallow sea. With the benefit of knowledge gained from studies of the 1998 tsunami in the same area, we conclude that the skull was laid down in a tsunami deposit and as such may represent the oldest known tsunami victim in the world. These findings raise the question of whether other coastal archaeological sites with human skeletal remains would benefit from a re-assessment of their geological context.

Modafinil Increases Awake EEG Activation and Improves Performance in Obstructive Sleep Apnea during Continuous Positive Airway Pressure Withdrawal.

OBJECTIVES: We examined the changes in waking electroencephalography (EEG) biomarkers with modafinil during continuous positive airway pressure (CPAP) withdrawal in patients with obstructive sleep apnea (OSA) to investigate neurophysiological evidence for potential neurocognitive improvements. DESIGN: Randomized double-blind placebo-controlled crossover study. CPAP was used for the first night and then withdrawn for 2 subsequent nights. Each morning after the 2 CPAP withdrawal nights, patients received either 200 mg modafinil or placebo. After a 5-w washout, the procedure repeated with the crossover drug. SETTINGS: University teaching hospital. PARTICIPANTS: Stable CPAP users (n = 23 men with OSA). MEASUREMENT AND RESULTS: Karolinska Drowsiness Test (KDT) (awake EEG measurement with eyes open and closed), Psychomotor Vigilance Task (PVT), and driving simulator Performance were assessed bihourly during the 3 testing days following CPAP treatment and CPAP withdrawal nights. Compared to placebo, modafinil significantly increased awake EEG activation (faster EEG frequency) with increased alpha/delta (A/D) ratio (P < 0.0001) and fast ratio = (alpha+beta)/(delta+theta) (P < 0.0001) across the 2 days of CPAP withdrawal. The A/D ratio significantly correlated with the driving simulator response time (P = 0.015), steering variation (P = 0.002), and PVT reaction time (P = 0.006). In contrast, individual EEG band power of alpha, beta, theta, and delta did not correlate with any neurocognitive performance. CONCLUSIONS: Modafinil administration during continuous positive airway pressure (CPAP) withdrawal increased awake EEG activation, which correlated to improved performance. This study provides supporting neurophysiological evidence that modafinil is a potential short-term treatment option during acute CPAP withdrawal.

Adolescent sleep patterns and night-time technology use: results of the Australian Broadcasting Corporation's Big Sleep Survey.

INTRODUCTION: Electronic devices in the bedroom are broadly linked with poor sleep in adolescents. This study investigated whether there is a dose-response relationship between use of electronic devices (computers, cellphones, televisions and radios) in bed prior to sleep and adolescent sleep patterns. METHODS: Adolescents aged 11-17 yrs (n = 1,184; 67.6% female) completed an Australia-wide internet survey that examined sleep patterns, sleepiness, sleep disorders, the presence of electronic devices in the bedroom and frequency of use in bed at night. RESULTS: Over 70% of adolescents reported 2 or more electronic devices in their bedroom at night. Use of devices in bed a few nights per week or more was 46.8% cellphone, 38.5% computer, 23.2% TV, and 15.8% radio. Device use had dose-dependent associations with later sleep onset on weekdays (highest-dose computer adjOR  = 3.75: 99% CI  = 2.17-6.46; cellphone 2.29: 1.22-4.30) and weekends (computer 3.68: 2.14-6.32; cellphone 3.24: 1.70-6.19; TV 2.32: 1.30-4.14), and later waking on weekdays (computer 2.08: 1.25-3.44; TV 2.31: 1.33-4.02) and weekends (computer 1.99: 1.21-3.26; cellphone 2.33: 1.33-4.08; TV 2.04: 1.18-3.55). Only 'almost every night' computer use (: 2.43: 1.45-4.08) was associated with short weekday sleep duration, and only 'almost every night' cellphone use (2.23: 1.26-3.94) was associated with wake lag (waking later on weekends). CONCLUSIONS: Use of computers, cell-phones and televisions at higher doses was associated with delayed sleep/wake schedules and wake lag, potentially impairing health and educational outcomes.

Modafinil improves daytime sleepiness in patients with mild to moderate obstructive sleep apnoea not using standard treatments: a randomised placebo-controlled crossover trial.

INTRODUCTION: Patients with mild to moderate obstructive sleep apnoea (OSA) commonly suffer excessive daytime sleepiness. Continuous positive airway pressure (CPAP) has limited effectiveness in reducing sleepiness in milder OSA. Modafinil is a wake-promoting drug licensed to treat residual sleepiness in CPAP-treated OSA. We hypothesised that modafinil may effectively treat sleepiness in untreated mild to moderate OSA. METHODS: Untreated sleepy men with mild to moderate OSA (age 18-70, apnoea-hypopnoea index (AHI) 5-30/h, Epworth Sleepiness Scale (ESS) ≥10) were randomised to receive 200 mg modafinil or matching placebo daily for 2 weeks before crossing over to the alternative treatment after a minimum 2-week washout. Mixed model analysis of variance was used to compare the changes on modafinil to placebo while classifying all randomised patients as random factors. RESULTS: 32 patients were randomised (mean (SD) AHI 13 (6.4)/h, age 47 (10.7) years, ESS 13.6 (3.3), body mass index 28.2 (3.6) kg/m(2)), 29 of whom (91%) completed the trial. The primary outcome (ESS) improved more on modafinil than placebo (3.6 points, 95% CI 1.3 to 5.8, p=0.003) and the secondary outcome (40-min driving simulator performance) also improved more on modafinil than placebo (steering deviation 4.7 cm, 95% CI 0.8 to 8.5, p=0.018). Psychomotor Vigilance Task reciprocal reaction time improved significantly over placebo (0.15 (1/ms), 95% CI 0.03 to 0.27, p=0.016). Improvements on the Functional Outcomes of Sleep Questionnaire were not significant (5.3 points over placebo, 95% CI -1 to 11.6, p=0.093). CONCLUSIONS: Modafinil significantly improved subjective sleepiness in patients with untreated mild to moderate OSA. The size of this effect is clinically relevant at 3-4 ESS points of improvement compared with only 1-2 points in CPAP clinical trials. Driving simulator performance and reaction time also improved on modafinil. CLINICAL TRIAL REGISTRATION: ACTRN#12608000128392.

Modafinil effects during acute continuous positive airway pressure withdrawal: a randomized crossover double-blind placebo-controlled trial.

RATIONALE: Continuous positive airway pressure (CPAP) use is associated with reduced motor vehicle accidents in patients with obstructive sleep apnea (OSA). However, interruption of CPAP therapy is common and is associated with a decline in daytime function. OBJECTIVES: We hypothesized that the wakefulness promoter, modafinil, would ameliorate this decline. METHODS: Patients were admitted to the laboratory for three consecutive nights. CPAP was used for the first night, followed by a baseline day, and was then withdrawn for the two subsequent nights (nasal airflow monitored). On each of the mornings after the two CPAP withdrawal nights, patients received 200 mg modafinil or placebo (n = 21) in a randomized, double-blind, crossover design. Treatment periods were separated by a 5-week washout. Driving simulator performance, neurocognitive performance, and subjective alertness were measured by the AusEd driving simulator, psychomotor vigilance task, and Karolinska Sleepiness Scale, respectively. MEASUREMENTS AND MAIN RESULTS: During CPAP withdrawal, severe sleep-disordered breathing was evident and administration of modafinil improved simulated driving performance (steering variability, P < 0.0001; mean reaction time, P

The effect of modafinil following acute CPAP withdrawal: a preliminary study.

Daytime symptoms resulting from obstructive sleep apnea (OSA) include impaired neurobehavioural performance and increased sleepiness. Continuous positive airway pressure (CPAP) reduces these symptoms. However, even compliant users may temporarily withdraw from CPAP treatment resulting in an immediate return of OSA. It has been hypothesised that these treatment "holidays" may be associated with neurobehavioural decline. Acute administration of a wakefulness promoter during such treatment "holidays" may help maintain neurobehavioural functioning. We examined the effects of 200 mg modafinil on neurobehavioural performance in a placebo-controlled crossover trial including N = 12 OSA patients acutely removed from CPAP. Sleep-wake activity was assessed for four consecutive days on CPAP and one night off CPAP using actigraphy. During the night off, CPAP patients wore a single channel nasal airflow diagnostic device. On the morning after CPAP withdrawal, patients reported to the laboratory and were administered either modafinil (200 mg) or placebo. At 2 h post-administration, patients completed a single simulated drive of approximately 30 min with simultaneous administration of a divided attention task (STISIMtrade mark), critical flicker fusion (CFF) test and subjective sleepiness scales. After a 14-day washout, participants repeated the protocol. CPAP withdrawal was associated with a worsening of sleep efficiency and the movement and fragmentation index (MFI), compared to the on-CPAP nights (all p < or = 0.02). Modafinil did not result in a superior driving simulator performance or CFF responses the morning after CPAP withdrawal but did result in better subjective sleepiness (both p < or = 0.04) compared to placebo. These data do not support the use of modafinil for the maintenance of daytime functioning in patients with OSA who are acutely withdrawn from CPAP.

Carbon chains and the (5,5) single-walled nanotube: structure and energetics versus length.

Reliable thermochemistry is computed for infinite stretches of pure-carbon materials including acetylenic and cumulenic carbon chains, graphene sheet, and single-walled carbon nanotubes (SWCNTs) by connection to the properties of finite size molecules that grow into the infinitely long systems. Using ab initio G3 theory, the infinite cumulenic chain (:C[double bond]C[double bond]C[double bond]C:) is found to be 1.9+/-0.4 kcal/mol per carbon less stable in free energy at room temperature than the acetylenic chain (.C[triple bond]C-C[triple bond]C.) which is 24.0 kcal/mol less stable than graphite. The difference between carbon-carbon triple, double, and single bond lengths (1.257, 1.279, and 1.333 A, respectively) in infinite chains is evident but much less than with small hydrocarbon molecules. These results are used to evaluate the efficacy of similar calculations with the less rigorous PM3 semiempirical method on the (5,5) SWCNT, which is too large to be studied with high-level ab initio methods. The equilibrium electronic energy change for C(g)-->C[infinite (5,5) SWCNT] is -166.7 kcal/mol, while the corresponding free energy change at room temperature is -153.3 kcal/mol (6.7 kcal/mol less stable than graphite). A threefold alternation (6.866, 6.866, and 6.823 A) in the ring diameter of the equilibrium structure of infinitely long (5,5) SWCNT is apparent, although the stability of this structure over the constant diameter structure is small compared to the zero point energy of the nanotube. In general, different (n,m) SWCNTs have different infinite tube energetics, as well as very different energetic trends that vary significantly with length, diameter, and capping.

Controlling the passage of light through metal microchannels by nanocoatings of phospholipids.

The flow of polarized light through a metal film with an array of microchannels is controlled by the phase of an optically active, phospholipid nanocoating, even though the coating does not cover the open area of the microchannels. The molecular details of the assembly (DPPC phospholipid monolayer/bilayer on a hexadecanethiol monolayer on a copper- or nickel-coated microarray) were determined using the infrared, surface-plasmon-mediated, extraordinary transmission of the metal microarrays. Infrared absorption spectra with greatly enhanced absorptions by comparison to literature were recorded and used as a diagnostic for the phase, composition, and molecular geometry of these nanocoatings. This approach presents new tools for nanoscale construction in constricted microspaces, which may ultimately be useful with individual microchannels.

Enhanced infrared absorption spectra of self-assembled alkanethiol monolayers using the extraordinary infrared transmission of metallic arrays of subwavelength apertures.

The surface-plasmon-mediated, extraordinary transmission of metallic arrays of subwavelength apertures has been used as the light source for absorption studies of self-assembled monolayers on metal. Enhanced infrared absorption spectra of a sequence of alkanethiol self-assembled monolayers on copper were recorded for carbon chain lengths varying from 8 to 18 atoms. Transition positions and intensities are presented over a large range of the infrared region. The connection between the vibrational modes of the CH(2) wagging progression and the infinite methylene chain is explored using a traditional coupled oscillator approach and a new cluster perspective.

Improved endometrial assessment using cyclin E and p27.

OBJECTIVE: To evaluate endometrial expression of cyclin E and p27 in fertile and infertile women. DESIGN: Retrospective clinical study. SETTING: University medical center and private practice. PATIENT(S): Thirty-three fertile volunteers, 83 women seeking infertility treatment, and 23 women undergoing mock cycles. INTERVENTION(S): Endometrial biopsy. MAIN OUTCOME MEASURE(S): Cyclin E and p27 immunohistochemistry. RESULT(S): Glandular cyclin E and p27 expression dramatically changed in intensity and subcellular localization throughout the menstrual cycle. In normal control biopsies, glandular cyclin E progressed from the basal to the lateral cytoplasm (midproliferative phase) to the nucleus (days 18 to 19) and was absent in biopsies after day 20. First appearing on days 17 to 19, p27 was found only in the nuclei. Cyclin E was more frequently seen after day 20 in infertility patients. In the hyperstimulated cycles, staining for cycle E in proliferative samples was more intense than in the natural cycles, but p27 staining was unchanged. CONCLUSION(S): Cyclin E and p27 may be clinically useful markers of development in the endometrium. As cell cycle regulators, cyclins reveal underlying biochemical processes driving endometrial progression and may partly represent the means by which estrogen and progesterone regulate this dynamic tissue.

Minimal ovarian hyperstimulation for in vitro fertilization using sequential clomiphene citrate and gonadotropin with or without the addition of a gonadotropin-releasing hormone antagonist.

OBJECTIVE: To compare the results of a minimal-stimulation protocol with those of a standard protocol used for IVF. DESIGN: Retrospective, controlled study. SETTING: University center. PATIENT(S): Fifty-five patients undergoing IVF using a minimal-stimulation protocol with or without adjuvant therapy with a GnRH antagonist. A control group consisted of age- and diagnosis-matched patients undergoing a standard long GnRH agonist (GnRH-a)-gonadotropin stimulation during the same time period. INTERVENTION(S): Clomiphene citrate and gonadotropins, with or without the GnRH antagonist ganirelix. MAIN OUTCOME MEASURE(S): Oocytes recovered and pregnancy rates. RESULT(S): The number of oocytes retrieved was significantly lower for the minimal-stimulation regimen compared with the case of the long GnRH-a protocol (4.8 +/- 2.6 vs. 16.2 +/- 7.5, respectively). The clinical pregnancy rate per transfer, however, was not significantly different between the two regimens (37% vs. 41%, minimal stimulation vs. long GnRH-a protocol, respectively). The addition of ganirelix resulted in at least the same pregnancy outcome as compared with the case of cycles without the antagonist. CONCLUSION(S): Minimal stimulation using clomiphene citrate followed by gonadotropin for IVF results in pregnancy rates equal to the standard long GnRH-a-gonadotropin protocol. The addition of ganirelix resulted in at least similar results with the advantage of eliminating the occurrence of a premature endogenous LH surge.