"I Feel Like I Have Lost Part Of My Identity" - A Qualitative Study Exploring The Impact Of Chronic Ankle Instability.

Introduction: Lateral ankle sprain is the most common ankle injury and up to 40% of those who sustain a lateral ankle sprain will develop chronic ankle instability (CAI). The aim of this study was to explore the thoughts and expectations of CAI-patients concerning their condition and expectations of care in an orthopedic setting. . Study Design: Qualitative study. Methods: Nine semi-structured one-to-one interviews were conducted with CAI-patients who were referred to an orthopedic setting. Interviews were recorded, transcribed, and analyzed using systematic text condensation with an inductive goal free approach. . Results: Seven themes emerged. The themes were Injury history and symptoms (Lateral ankle sprain during sport, pain and instability), Information from health professional (conflicting information about management and prognosis), Management (mental and physical challenges), Expectation and hope (explanation of symptoms, prognosis and imaging to provide clarification of condition), Activity and participation (restriction in sport and daily life and feelings of uncertainty), Support (support from family/friends) and Identity (low ability to participate in sport and social life result in loss of identity). . Conclusion: The impact of CAI exceeds an experience of pain and instability. Patients experienced loss of identity, having to manage uncertainty regarding their diagnosis and prognosis and had hopes of being able to explain their condition. . Level of Evidence: Not applicable.

Mapping the distribution of electronic states within the 5D4 and 7F6 levels of Tb3+ complexes with optical spectroscopy.

The Tb(III) ion has the most intense luminescence of the trivalent lanthanide(III) ions. In contrast to Eu(III), where the two levels only include a single state, the high number of electronic states in the ground (7F6) and emitting (5D4) levels makes detailed interpretations of the electronic structure-the crystal field-difficult. Here, luminescence emission and excitation spectra of Tb(III) complexes with 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA, [Tb(DOTA)(H2O)]-), ethylenediaminetetraacetic acid (EDTA, [Tb(EDTA)(H2O)3]-) and diethylenetriaminepentaacetic acid (DTPA, [Tb(DTPA)(H2O)]2-) as well as the Tb(III) aqua ion ([Tb(H2O)9]3+) were recorded at room temperature and in frozen solution. Using these data the electronic structure of the 5D4 multiplets of Tb(III) was mapped by considering the transitions to the singly degenerate 7F0 state. A detailed spectroscopic investigation was performed and it was found that the 5D4 multiplet could accurately be described as a single band for [Tb(H2O)9]3+, [Tb(DOTA)(H2O)]- and [Tb(EDTA)(H2O)3]-. In contrast, for [Tb(DTPA)(H2O)]2- two bands were needed. These results demonstrated the ability of describing the electronic structure of the emitting 5D4 multiplet using emission spectra. This offers an avenue for investigating the relationship between molecular structure and luminescent properties in detailed photophysical studies of Tb(III) ion complexes.

Crystal structures of two SmIII complexes with dipicolinate [DPA]2- ligands: comparison of luminescent properties of products obtained at different pH values.

The formation of the two title compounds, Na3[Sm(DPA)3]·14H2O tris-odium tris-(pyridine-2,6-di-carboxyl-ato-κ3 O 2,N,O 6)samarate(III) tetra-deca-hydrate, Na3[Sm(C7H3NO4)3]·14H2O, and catena-poly[[[di-aqua-(6-carb-oxy-pyridine-2-carb-oxyl-ato-κ3 O 2,N,O 6)samarium(III)]-µ-pyridine-2,6-di-carboxyl-ato-κ4 O 2,N,O 6:O 2] tetra-hydrate], {[Sm(C7H3NO4)(C7H4NO4)(H2O)2]·4H2O}n, depends on the pH value adjusted with NaOH solution. In both crystal structures, the coordination spheres of the SmIII cations were found to be best described by a tricapped trigonal prism (TTP), with a more regular O6N3 donor set for Na3[Sm(DPA)3]·14H2O than that of O7N2 for [Sm(DPA)(HDPA)(H2O)2]·4H2O. The supra-molecular features of both crystal structures are dominated by O-H⋯O hydrogen bonds between water mol-ecules and the O atoms of the dipicolinato ligands. Samples were made from solutions at pH = 2, pH = 5, pH = 7, and pH = 10, and the crystals present in each sample were ground to a powder. The powder samples were analyzed with powder X-ray diffraction and luminescence spectroscopy. The splitting of the bands in the luminescence spectra recorded on powders at 77 K was observed to vary with the pH.

Optical spectroscopy as a tool for studying the solution chemistry of neodymium(III).

In nature, the elements of the inorganic part of the periodic table are found in three forms: metals, ions in salts & minerals, and ions in solution. The ions may be coordinated to simple or complicated ligands. They may form purely electrostatic or partially covalent bonds. A common trend is that the more covalent bonds an element form, the more we know of its physicochemical properties. The rare earths form purely electrostatic bonds, thus, our understanding of the solution chemistry of these elements is limited-yet important. Most rare earth elements used today pass through hydrometallurgical processes that rely on the solution chemistry of these elements, even through the critical applications are in alloys and functional materials. Through developments in optical spectroscopy, total X-ray scattering, and quantum chemical methods we are posed to remedy this situation: we are ready to create predictive structure-property relationships in the field of lanthanide solution chemistry. The scope of this review is to summarise the state-of-the-art for neodymium(III), to go through the structure-property relationships that are in use. In the form of NdFeB magnets, neodymium plays a crucial role in green energy production and electric propulsion. As a 4f3 ion in solution it is also one of the simpler rare earth ions, and the Nd(III) ion has characteristic optical properties that can be exploited as a handle in physicochemical studies. Here, we start with a critical review of the current concepts used to relate structure and electronic energy levels. We follow with our suggested approach of using the methodology from molecular photophysics to relate optical properties and structure, and conclude with selected literature examples.

Shape-color associations in an unrestricted color choice paradigm.

Since Kandinsky's claim for fundamental shape-color associations, several studies have revealed that those tendencies were not generalizable to the entire population and that different associations were more prevalent. Past studies, however, lacked a methodology that allowed participants to freely report their shape-color preferences. Here, we report data from 7,517 Danish individuals, using a free choice full color wheel for five different geometrical shapes. We find significant shape-hue associations for circle-red/yellow, triangle-green/yellow, square-blue, and pentagon/hexagon-magenta. The significant shape-hue associations are also more saturated than non-significant ones for the circle, triangle, and square. At the conceptual level, basic shapes, which show stronger associations, are linked to primary colors, and non-basic shapes to secondary colors. Shape-color associations seem indeed to follow the Berlin-Kay stages of entry into languages. This pattern had previously been described for graphemes and weekday-color associations. The methodology employed in our study can be repeated in different cultural contexts in the future. We also provide another instance of color associations for ordinal concepts that follow the stages of entry into languages.

Change in orthopaedic surgeon behaviour by implementing evidence-based practice.

INTRODUCTION: Orthopaedic practice is not always aligned with new evidence which may result in an evidence-practice gap. Our aim was to present and report the use of a new model for implementation of evidence-based practice using treatment of distal radius fractures (DRF) as an example. METHODS: A new implementation model from the Centre for Evidence-Based Orthopaedics (CEBO) was applied. It comprises four phases: 1) baseline practice is held up against best available evidence, and barriers to change are assessed. 2) A symposium involving all stakeholders discussing best evidence is held, and agreement on a new local guideline is obtained. 3) The new guideline based on the decisions at the symposium is prepared and implemented into daily clinical practice. 4) Changes in clinical practice are recorded. We applied the model on the clinical question of whether to use open reduction and internal fixation with a locked volar plate (VLP) or closed reduction and percutaneous pinning (CRPP) in adults with DRF. RESULTS: Prior to application of the CEBO model, only VLP was used in the department. Based on best evidence, the symposium found that a change in practice was justified. A local guideline stating CRPP as first surgical choice was implemented. If acceptable reduction could not be obtained, the procedure was converted to VLP. A year after implementation of the guideline, the rate of VLP had declined from 100% to 44%. CONCLUSION: It is feasible to change surgeons' practice according to best evidence using the CEBO model. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Life expectancy among patients with pulmonary tuberculosis is less than one-third of life expectancy in the background population in Guinea-Bissau-an observational study.

BACKGROUND: Few studies have assessed life expectancy of patients with tuberculosis (TB) against a comparable background population, particularly in low-income, high-incidence settings. This study aimed to estimate the life expectancy (LE) of patients with TB in the West African country of Guinea-Bissau and compare it with the LE of the background population. METHODS: This study used data from the Bandim TB cohort from 2004-20 as well as census data from the capital of Guinea-Bissau. LE was estimated using a bootstrapped Kaplan-Meier survival analysis for patients with TB and the background population, stratifying by age of entry and various patient subgroups. The analysis was further stratified by diagnosis period and length of schooling (an indicator of socioeconomic status), to assess their influence on LE. A sensitivity analysis was performed assuming death at loss to follow-up. RESULTS: The analysis included 2278 patients and a background population of 169 760 individuals. Overall median LE among 30-year-old patients with TB was 10.7 years (95% CI: 8.7-12.6), compared with 35.8 (95% CI: 35.1-36.5) in the background population. LE was shorter in HIV-infected patients and those who had unsuccessful treatment outcome; however, even among those who were both uninfected with HIV and experienced successful treatment outcome, LE was 20% shorter than in the background population. Longer schooling appeared to decrease mortality. CONCLUSIONS: TB substantially shortens LE. This effect is present even in patients who are uninfected with HIV and who have successful treatment outcome.

Electronic Structure of Neodymium(III) and Europium(III) Resolved in Solution Using High-Resolution Optical Spectroscopy and Population Analysis.

Solution chemistry of the lanthanide(III) ions is unexplored and relevant: extraction and recycling processes exclusively operate in solution, MRI is a solution-phase method, and bioassays are done in solution. However, the molecular structure of the lanthanide(III) ions in solution is poorly described, especially for the near-IR (NIR)-emitting lanthanides, as these are difficult to investigate using optical tools, which has limited the availability of experimental data. Here we report a custom-built spectrometer dedicated to investigation of lanthanide(III) luminescence in the NIR region. Absorption, luminescence excitation, and luminescence spectra of five complexes of europium(III) and neodymium(III) were acquired. The obtained spectra display high spectral resolution and high signal-to-noise ratios. Using the high-quality data, a method for determining the electronic structure for the thermal ground states and emitting states is proposed. It combines Boltzmann distributions with population analysis and uses the experimentally determined relative transition probabilities from both excitation and emission data. The method was tested on the five europium(III) complexes and was used to resolve the electronic structures of the ground state and the emitting state of neodymium(III) in five different solution complexes. This is the first step toward correlating optical spectra with chemical structure in solution for NIR-emitting lanthanide complexes.

Myopathy as a cause of Long COVID fatigue: Evidence from quantitative and single fiber EMG and muscle histopathology.

OBJECTIVE: To describe neurophysiological abnormalities in Long COVID and correlate quantitative electromyography (qEMG) and single fiber EMG (sfEMG) results to clinical scores and histopathology. METHODS: 84 patients with non-improving musculoskeletal Long COVID symptoms were examined with qEMG and sfEMG. Muscle biopsies were taken in a subgroup. RESULTS: Mean motor unit potential (MUP) duration was decreased in ≥ 1 muscles in 52 % of the patients. Mean jitter was increased in 17 % of the patients in tibialis anterior and 25 % in extensor digitorum communis. Increased jitter was seen with or without myopathic qEMG. Low quality of life score correlated with higher jitter values but not with qEMG measures. In addition to our previously published mitochondrial changes, inflammation, and capillary injury, we show now in muscle biopsies damage of terminal nerves and motor endplate with abundant basal lamina material. At the endplate, axons were present but no vesicle containing terminals. The post-synaptic cleft in areas appeared atrophic with short clefts and coarse crests. CONCLUSIONS: Myopathic changes are common in Long COVID. sfEMG abnormality is less common but may correlate with clinical scores. sfEMG changes may be due to motor endplate pathology. SIGNIFICANCE: These findings may indicate a muscle pathophysiology behind fatigue in Long COVID.

Chelating chloride using binuclear lanthanide complexes in water.

Halide recognition by supramolecular receptors and coordination complexes in water is a long-standing challenge. In this work, we report chloride binding in water and in competing media by pre-organised binuclear kinetically inert lanthanide complexes, bridged by flexible -(CH2)2- and -(CH2)3- spacers, forming [Ln2(DO3A)2C-2] and [Ln2(DO3A)2C-3], respectively. These hydrophilic, neutral lanthanide coordination complexes are shown to bind chloride with apparent association constants of up to 105 M-1 in water and in buffered systems. Hydroxide bridging was observed in these complexes at basic pH, which was proven to be overcome by chloride. Thus, these lanthanide complexes show promise towards chloride recognition in biology and beyond. The results described here have clearly identified a new area of anion coordination chemistry that is ripe for detailed exploration.

Effect of buffers and pH in antenna sensitized Eu(III) luminescence.

The photophysics of a europium(III) complex of 1,4,7,10-tetraazacycododecane-1,4,7-triacetic acid-10-(2-methylene)-1-azathioxanthone was investigated in three buffer systems and at three pH values. The buffers-phosphate buffered saline (PBS), 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES), and universal buffer (UB)-had no effect on the europium luminescence, but a lower overall emission intensity was determined in HEPES. It was found that this was due to quenching of the 1-azathioxanthone first excited singlet state by HEPES. The effect of pH on the photophysics of the complex was found to be minimal, and protonation of the pyridine nitrogen was found to be irrelevant. Even so, pH was shown to change the intensity ratio between 1-azathioxanthone fluorescence and europium luminescence. It was concluded that the full photophysics of a potential molecular probe should be investigated to achieve the best possible results in any application.

Tb3+ Photophysics: Mapping Excited State Dynamics of [Tb(H2O)9]3+ Using Molecular Photophysics.

The study of optical transitions in lanthanide(III) ions has evolved separately from molecular photophysics, but the framework still applies to these forbidden transitions. In this study, a detailed photophysical characterization of the [Tb(H2O)9]3+ aqua ion was performed. The luminescence quantum yield (Φlum), excited state lifetime (τobs), radiative (kr ≡ A) and nonradiative (knr) rate constants, and oscillator strength (f) were determined for Tb(CF3SO3)3 in H2O/D2O mixtures in order to map the radiative and nonradiative transition probabilities. It was shown that the intense luminescence observed from Tb3+ compared to other Ln3+ ions is not due to a higher transition probability of emission but rather due to a lack of quenching, quantified by quenching to O-H oscillators in the aqua ion of kq(OH) = 2090 s-1 for terbium and kq(OH) = 8840 s-1 for europium. In addition, the Horrocks method of determining inner-sphere solvent molecules has been revisited, and it was concluded that the Tb3+ is 9-coordinated in aqueous solution.

Electronic Energy Levels and Optical Transitions in Samarium(III) Solvates.

Lanthanide luminescence fascinates with a complicated electronic structure and "forbidden" transitions. By studying the photophysics of lanthanide(III) solvates, a close to ideal average coordination geometry can be used to map both electronic energy levels and transition probabilities. Some lanthanide(III) ions are simpler to study than others, and samarium(III) belongs to the more difficult ones. The 4f5 system has numerous absorption and emission lines in the visible and infrared parts of the spectrum and in this work, the energy levels giving rise to these transitions were mapped, the transition probability between them was calculated, and it was shown that the electronic structures of the samarium(III) solvates in DMSO, MeOH, and water are different.

Invisible strings. The first single crystal of the cTSAP form of [Eu(DOTA)(H2O)]- has an electronic structure similar to one of the reported cSAP forms.

The coordination geometry of lanthanide(III) ions is extremely sensitive to perturbation from the surrounding environment. Changes in the crystal field can be observed as spectral variations in the emission spectra of luminescent lanthanide(III) ions. Europium(III) ions are commonly used to correlate luminescence properties to the crystal field. In solution, kinetically inert complexes as [Ln(DOTA)(H2O)]- can fluctuate and give rise to different diastereomers (H4DOTA = 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid). The [Ln(DOTA)(H2O)]- complex adopts a capped square antiprism (cSAP) geometry but can rotate into a capped twisted square antiprism (cTSAP). The time scale of the solution dynamics in [Ln(DOTA)(H2O)]- is shorter than that of luminescence emission, thus, structural averages are observed in the emission spectra. For the first time, we were able to crystallise both forms of the [Eu(DOTA)(H2O)]- diastereomers. The single crystal structure was combined with single crystal luminescence spectroscopy to reveal the electronic structure of Eu(III) in each form of the complex. The coordination geometry of the crystallized cSAP and cTSAP forms of the complex was compared to ideal coordination polyhedra using a continuous symmetry measure in the AlignIt code. The diastereomers of [Eu(DOTA)(H2O)]- all demonstrate very little deviation from ideal geometries yet nearly identical electronic properties were observed from the two different forms.

What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome.

BACKGROUND: The heel fat pad is an important structure of the foot as it functions as a cushion to absorb shock and distribute plantar force during ambulation. Clinical practice guidelines or decision support platforms emphasize that heel fat pad syndrome (HFPS) is a distinct pathology contributing to plantar heel pain. We aimed to identify and synthesize the prevalence, etiology and diagnostic criteria, and conservative management of HFPS. METHODS: A comprehensive search was conducted in May 2021 and updated in April 2022, using MEDLINE, Scopus, Cinahl, EMBASE, Cochrane Library, SPORTDiscus, and PEDro and ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP) for pertinent registrations. We included all study types and designs describing the prevalence; etiology and diagnostic criteria; and non-pharmacological, non-surgical interventions for HFPS. RESULTS: We found a small body of original research for HFPS (n = 7). Many excluded full-text articles were expert-opinion articles or studies of heel fat pad in participants with plantar fasciitis/fasciopathy or unspecified heel pain. HFPS may be the second leading cause of plantar heel pain, based on two studies. A number of differentiating pain characteristics and behaviors may aid in diagnosing HFPS vs. plantar fasciopathy. Thinning heel fat pad confirmed by ultrasonography may provide imaging corroboration. Randomized controlled trials assessing the efficacy of viscoelastic heel cups or arch taping for managing HFPS do not exist. CONCLUSIONS: The research literature for HFPS is sparse and sometimes lacking scientific rigor. We have identified a substantial knowledge gap for this condition, frequent inattention to distinguishing HFPS from plantar fasciopathy when describing plantar heel pain, and an absence of robust clinical trials to support the commonly recommended conservative management of HFPS.

A high-sensitivity rapid acquisition spectrometer for lanthanide(III) luminescence.

Detecting luminescence beyond 750-800 nm becomes problematic as most conventional detectors are less sensitive in this range, and as simple corrections stops being accurate. Lanthanide luminescence occurs in narrow bands across the spectrum from 350-2000 nm. The most emissive lanthanide(III) ions have bands from 450 nm to 850 nm, some with additional bands in the NIR. Investigating NIR bands are hard, but the difficulties already start at 700 nm. In general, the photon flux from lanthanide(III) emitters is not great, and the bands beyond 700 nm are very weak, we therefore decided to build a spectrometer based on cameras for microscopy with single-photon detection capabilities. This was found to allieviate all limitations and to allow for fast and efficient recording of luminescence spectra in the range from 450 to 950 nm. The spectrometer characteristics were investigated and the performance was benchmarked against two commercial spectrometers. We conclude that this spectrometer is ideal for investigating lanthanide luminescence, and all other emitters with emission in the target range.

Long story short: donor set symmetry in [Eu(DOTA)(H2O)]- crystals determines the electronic structure.

Lanthanide complexes of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid DOTA have been studied in great detail due to their use as MRI contrast agents. Since the first report from Desreux in 1980, the Ln[DOTA]- complexes of gadolinium(III) in particular have been thoroughly investigated. The forms of the nine-coordinated [Ln(DOTA)(H2O)]- complexes are well known, and the ligand backbone has been used extensively to create functional MRI contrast agents, luminescent probes, and as a model system for studying the properties of lanthanide(III) ions. In solution, the photophysical properties have been mapped, but as the structures are not known, direct structure-property relationships have not been created. Here, the electronic properties of two Eu[DOTA] compounds (1 and 2) and a Eu[DOTA]-like compound (3) were studied using single-crystal luminescence spectroscopy. The donor set in the three compounds is identical (4N 4O 1O), and using the symmetry deviation value σideal it was shown that the coordination geometry is close to identical. Nevertheless, the electronic properties evaluated using the luminescence spectrum were found to differ significantly between the three compounds. The magnitude of the crystal field splitting was found not to scale with the symmetry of the coordination geometry. It was concluded that the donor set dictates the splitting, yet the structure-property relationships governing the electronic properties of europium(III) ions still elude us.

A europium(III)-based nanooptode for bicarbonate sensing - a multicomponent approach to sensor materials.

Lanthanide luminescence contains detailed chemical information and can be used to report on several chemical analytes. This has been exploited through elaborate synthesis of responsive lanthanide complexes. Here, we report on a less elaborate approach and assemble four different nanooptodes. Europium(III) is used to sense the bicarbonate concentration. The signal from the optode was enhanced 100 times using antenna chromophore and the response was modulated by the addition of lipophilic cations.