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BACKGROUND: Control of humeral torsion can present a challenge, especially intraoperatively during closed reduction and fixation of humeral shaft fractures or 2-part surgical neck fractures of the proximal humerus. The objective of this study is to develop and validate an indirect method for the assessment of humeral torsion using an index that is linearly correlated with rotational arm position and can be derived from only a single plain radiographic image of the proximal humerus. METHODS: The Humeral Head Offset Index (HHOI) is calculated as the ratio of the medial and lateral offset of the humeral head measured from the outer cortices of the shaft on a plain radiographic or fluoroscopic image. The relationship of HHOI with humeral torsion was first verified on a sawbone model with radiopaque characteristics under fluoroscopic control. Different degrees of retroversion were simulated through manual rotation of the humerus with a digital protractor in 5° increments until 40° internally rotated and then in 5° increments until 40° externally rotated from the neutral position. The same procedure was subsequently performed digitally on Digitally Reconstructed Radiographs (DRRs) from computed tomography (CT) dataset of the sawbone. Next, the HHOI index was applied to eight randomly selected patients with total humerus CT using the same method. Spearman's rho was calculated for the bivariate analysis of correlation between the simulated degree of retroversion and the HHOI. Strength of correlation was classified according to Koo and Li. Interrater and intrarater reliability of three blinded observers with repetition of measurement after three months were analyzed by assessing the intraclass correlation coefficient (ICC). RESULTS: Both in the sawbone model and in DRRs, we demonstrated a high to very high significant linear correlation between simulated retroversion and the HHOI. ICC values demonstrated excellent interrater reliability and excellent intrarater reliability for measurement of the HHOI. CONCLUSIONS: The HHOI is a new, simple, reliable index that has a linear relationship to the rotation of the humerus and can therefore allow an indirect control of humeral torsion in comparison to the contralateral side.

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This paper presents a real-time and non-contact dual-mode embedded impulse-radio (IR) ultra-wideband (UWB) radar system designed for microwave imaging and vital sign applications. The system is fully customized and composed of three main components, an RF front-end transmission block, an analog signal processing (ASP) block, and a digital processing block, which are integrated in an embedded system. The ASP block enables dual-path receiving for image construction and vital sign detection, while the digital part deals with the inverse scattering and direct current (DC) offset issues. The self-calibration technique is also incorporated into the algorithm to adjust the DC level of each antenna for DC offset compensation. The experimental results demonstrate that the IR-UWB radar, based on the proposed algorithm, successfully detected the 2D image profile of the object as confirmed by numerical derivation. In addition, the radar can wirelessly monitor vital sign behavior such as respiration and heartbeat information.

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During peak height velocity, adjusting training intensity is crucial for optimizing performance and minimizing injury risk. This cross-sectional study compares external and internal intensities in different training tasks (analytical tasks, small-sided games, and training matches) and analyzes their effect on the maturation age of young players. Fifty-five U-15 and U-16 boys from two soccer clubs in southwestern Spain were monitored using inertial movement units and heart rate monitors to report training intensities. Anthropometric data and birthdates were collected to estimate maturation age. The Friedman test and Durbin-Conover post hoc test identified specific differences between groups, and Spearman's rank correlation coefficients assessed variable impacts. Training matches showed significantly higher distance covered, maximum and average speed, and average heart rate compared to small-sided games and analytical tasks. High-intensity actions and sprints were significantly higher (p < 0.0001) during training matches compared to analytical tasks and during small-sided games compared to analytical tasks. Player load per minute was significantly highest (p < 0.05) during training matches, followed by small-sided games, and lowest in analytical tasks. Positive correlations between maturational age and high-intensity actions, accelerations, and decelerations indicated higher intensity (p < 0.05) in more mature players. A negative correlation between player load per minute and maturational age suggested more efficient intensity management in mature players. These findings highlight the importance of considering biological maturation and training task variability in youth athletes' development.

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The authentication of wireless devices through physical layer attributes has attracted a fair amount of attention recently. Recent work in this area has examined various features extracted from the wireless signal to either identify a uniqueness in the channel between the transmitter-receiver pair or more robustly identify certain transmitter behaviors unique to certain devices originating from imperfect hardware manufacturing processes. In particular, the carrier frequency offset (CFO), induced due to the local oscillator mismatch between the transmitter and receiver pair, has exhibited good detection capabilities in stationary and low-mobility transmission scenarios. It is still unclear, however, how the CFO detection capability would hold up in more dynamic time-varying channels where there is a higher mobility. This paper experimentally demonstrates the identification accuracy of CFO for wireless devices in time-varying channels. To this end, a software-defined radio (SDR) testbed is deployed to collect CFO values in real environments, where real transmission and reception are conducted in a vehicular setup. The collected CFO values are used to train machine-learning (ML) classifiers to be used for device identification. While CFO exhibits good detection performance (97% accuracy) for low-mobility scenarios, it is found that higher mobility (35 miles/h) degrades (72% accuracy) the effectiveness of CFO in distinguishing between legitimate and non-legitimate transmitters. This is due to the impact of the time-varying channel on the quality of the exchanged pilot signals used for CFO detection at the receivers.

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While interest in using wearable sensors to measure infant leg movement is increasing, attention should be paid to the characteristics of the sensors. Specifically, offset error in the measurement of gravitational acceleration (g) is common among commercially available sensors. In this brief report, we demonstrate how we measured the offset and other errors in three different off-the-shelf wearable sensors available to professionals and how they affected a threshold-based movement detection algorithm for the quantification of infant leg movement. We describe how to calibrate and correct for these offsets and how conducting this improves the reproducibility of results across sensors.

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In the realm of computer vision, object detection holds significant importance and has demonstrated commendable performance across various scenarios. However, it typically requires favorable visibility conditions within the scene. Therefore, it is imperative to explore methodologies for conducting object detection under low-visibility circumstances. With its balanced combination of speed and accuracy, the state-of-the-art YOLOv8 framework has been recognized as one of the top algorithms for object detection, demonstrating outstanding performance results across a range of standard datasets. Nonetheless, current YOLO-series detection algorithms still face a significant challenge in detecting objects under low-light conditions. This is primarily due to the significant degradation in performance when detectors trained on illuminated data are applied to low-light datasets with limited visibility. To tackle this problem, we suggest a new model named Grouping Offset and Isolated GiraffeDet Target Detection-YOLO based on the YOLOv8 architecture. The proposed model demonstrates exceptional performance under low-light conditions. We employ the repGFPN feature pyramid network in the design of the feature fusion layer neck to enhance hierarchical fusion and deepen the integration of low-light information. Furthermore, we refine the repGFPN feature fusion layer by introducing a sampling map offset to address its limitations in terms of weight and efficiency, thereby better adapting it to real-time applications in low-light environments and emphasizing the potential features of such scenes. Additionally, we utilize group convolution to isolate interference information from detected object edges, resulting in improved detection performance and model efficiency. Experimental results demonstrate that our GOI-YOLO reduces the parameter count by 11% compared to YOLOv8 while decreasing computational requirements by 28%. This optimization significantly enhances real-time performance while achieving a competitive increase of 2.1% in Map50 and 0.6% in Map95 on the ExDark dataset.

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INTRODUCTION: Soft tissue management in total hip arthroplasty (THA) includes appropriate restoration and/or alteration of leg length and offset to re-establish natural hip biomechanics. The purpose of this study was to evaluate the effect of leg length and offset-derived variables in a multivariable survival model for dislocation. METHODS: Clinical, surgical, and radiographic data was retrospectively acquired for 12,582 patients undergoing primary THA at a single institution from 1998 to 2018. There were twelve variables derived from preoperative and postoperative radiographs related to leg length and offset that were measured using a validated automated algorithm. These measurements, as well as other modifiable and non-modifiable surgical, clinical, and demographic factors, were used to determine hazard ratios (HR) for dislocation risk. RESULTS: None of the leg length or offset variables conferred significant risk or protective benefit for dislocation risk. By contrast, all other variables included in the multivariable model demonstrated a statistically significant effect on dislocation risk with a minimum effect size of 28% (range 0.72 to 1.54) (sex, surgical approach, acetabular liner type, femoral head size, neurologic disease, spine disease, and prior spine surgery). CONCLUSION: Contrary to traditional teaching and our hypothesis, operative changes in leg length and offset did not demonstrate any clinically or statistically significant effect in this large and well-characterized cohort. This does not imply that these variables are not important in individual cases, but rather suggests the overall impact of leg length and offset changes is relatively minor for dislocation risk compared to other variables that were found to be highly clinically and statistically significant in this population. These results may also suggest that surgeons do a good job of restoring native leg length and offset for patients, which may mitigate their analyzed impact.

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Novel composite 180° pulses are designed for use in nuclear magnetic resonance (NMR) and verified experimentally using solution-state 1H NMR spectroscopy. Rather than being constructed from 180° pulses (as in much recent work), the new composite pulses are constructed from 90° pulses, with the aim of finding sequences that are shorter overall than existing equivalents. The primary (but not exclusive) focus is on composite pulses that are dual compensated - simultaneously broadband with respect to both inhomogeneity of the radiofrequency field and resonance offset - and have antisymmetric phase schemes, such that they can be used to form spin echoes without the introduction of a phase error. In particular, a new antisymmetric dual-compensated refocusing pulse is presented that is constructed from ten 90° pulses, equivalent to just five 180° pulses.

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Hip arthroplasties are cost-effective procedures; however, instability and leg length discrepancy are common complications that can lead to higher revision rates and patient dissatisfaction. Preoperative planning aids surgeons in choosing the right offset and neck length before surgery. Nonetheless, intraoperative measures are still necessary due to the differences dictated by the surgical procedure. Several hip trials might be needed to reach the optimum choice of implants. We have introduced a technique that utilizes the trunnion as a reference point to the hip centre of rotation, matching it with the acetabulum centre of rotation after applying the necessary soft tissue tension. This serves as a proximal reference point. Using the trunnion, as opposed to the trial head, allows for a better assessment of tissue tension within the acetabular void, avoiding constraints imposed by the applied trial head. Additionally, determining the acetabulum's centre of rotation is challenging if obscured by the trial head. Matching the two tibial tuberosities indicates the correct leg length, serving as the distal reference point. Both reference points should be considered together to select the right neck length and offset for optimal tissue tension. This technique has been tested on hip arthroplasty patients over five years. All hip surgeons who used this technique agree that it gives a better representation of the tissue tension, easing the challenges when preparing the acetabulum as well as reducing the need for multiple trials.

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BACKGROUND: Optimal sagittal alignment of the femoral prosthesis is critical to the success of total knee arthroplasty (TKA). While robotic-assisted TKA can improve alignment accuracy, the efficacy of default femoral alignment versus individualized alignment remains under scrutiny. This study aimed to compare the differences in prosthetic alignment, anatomical restoration, and clinical outcomes between individualized femoral sagittal alignment and default sagittal alignment in robotic-assisted TKA. METHODS: In a prospective randomised controlled trial, 113 patients (120 knees) underwent robotic-assisted TKA were divided into two groups: 61 with individualized femoral flexion (individualized alignment group) and 59 with default 3-5° flexion (default alignment group). The individualized alignment was based on the distal femoral sagittal anteverted angle (DFSAA), defined as the angle between the mechanical and distal anatomical axes of the femur. The radiographic and clinical outcomes were compared. RESULTS: Despite similar postoperative femoral flexion angles between groups (P = 0.748), the individualized alignment group exhibited significantly lower incidences of femoral prosthesis extension and higher rates of optimal 0-3° prosthesis flexion (9.8% vs. 27.1%, P = 0.014,78.7% vs. 55.9%, p = 0.008, respectively). The individualized alignment group also demonstrated more favourable changes in sagittal anatomy, with higher maintenance of postoperative anterior femoral offset within 1 mm (54.1% vs. 33.9%, P = 0.026) and posterior condylar offset within 1 mm and 2 mm (44.3% vs. 25.4%, p = 0.031,73.8% vs. 50.8%, p = 0.010, respectively). Although slight improvement in the Hospital for Special Surgery Knee Score (HSS) at three months was observed (P = 0.045), it did not reach a minimal clinically important difference. CONCLUSION: Individualized tailoring of femoral sagittal alignment in robotic-assisted total knee arthroplasty (TKA) enhances prosthetic alignment and anatomical restoration, suggesting potential improvements in postoperative outcomes.

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Despite improvements in implant design, surgical techniques and assistive technologies for total knee arthroplasty (TKA), anterior knee pain (AKP) remains frequently reported, even by satisfied patients. This persistent problem calls for better understanding and management of the patellofemoral or anterior compartment during surgery, just as the techniques and strategies deployed to optimize the flexion and extension spaces through personalized alignment, bone cuts and ligament balancing. Assistive technologies such as navigation and robotics provide new tools to manage this 'third space' through precise pre-operative planning and dynamic intra-operative assessment. Such endeavors must start with clear definitions of the 'third space', how it should be measured, what constitutes its 'safe zone', and how it affects outcomes. There are yet no established methods to evaluate the patellofemoral compartment, and no clear thresholds to define over- or under-stuffing. Static assessment using lateral radiographs provides a limited understanding and depends considerably on flexion angle, while dynamic evaluation at multiple flexion angles or using intra-operative computer or robotic-assistance enables a broader perspective and solutions to manage patellar tracking and anterior offset. Future studies should investigate the impact of variations in anterior offset in TKA, define its safe zone, and understand the effects of of thresholds for over- or under-stuffing. Experimental methods such as in-vivo motion analysis and force sensors could elucidate the influence of anterior offset on flexion and extension biomechanics.

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Environmental offsetting has been developed as a mechanism to facilitate the benefits from economic development while avoiding or minimizing environmental harm. This is achieved by compensating for environmental impacts at one location by generating equivalent environmental improvements elsewhere. However, experience with biodiversity and carbon offsetting indicates it can be difficult to ensure the integrity of offsets. Under recent legislation in the catchments of the Great Barrier Reef (GBR), Australia, it is mandatory for water quality emissions from new or expanded point source development to be offset by reducing pollution elsewhere, frequently through reducing non-point source pollution (NPSP). Therefore, informed by experience with biodiversity and carbon offsetting, we summarised sources of uncertainty in NPSP reduction that would influence water quality offset integrity; estimated the maximum potential demand for water quality offsets from sewage treatment plants, the largest point source emitter of total nitrogen (TN) in the GBR catchments, between 2018 and 2050; and discussed the implications of both on the ability of offsetting to counterbalance the impact of economic development in catchments where nitrogen loads have a large influence on the health of important GBR ecosystems. The catchments surrounding the population centres of Cairns and Mackay had both a potentially high future demand for nitrogen water quality offsets and nitrogen loads with a strong influence on the health of the GBR. Consequently, any low integrity water quality offsets in these catchments could jeopardise progress toward the water quality improvements needed to ensure the continued health of the GBR. Water quality offsetting has numerous strengths as a policy instrument however substantial uncertainties remain related to environmental outcomes. Until further research can reduce these uncertainties, water quality offsets that are implemented near increased point source emissions and have a high certainty of effectiveness may provide a balance between scientific rigour and policy workability.

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Noninvasive detection of surface-enhanced Raman spectroscopy (SERS) signals from deep within tissue represents a common challenge in many biological and clinical applications including disease diagnosis and therapy monitoring. Such signals are typically weak and not readily discernible from often much larger Raman and fluorescence background signals (e.g., from surrounding tissue). Consequently, suboptimal sensitivity in the detection of SERS signals is often achieved in these situations. Similar issues can arise in SERS measurements in other diffusely scattering samples and complex matrices. Here, we propose a novel concept, active SERS, for the efficient retrieval of SERS signals from deep within complex matrices such as biological tissues that mitigates these issues. It relies on applying an external perturbation to the sample to alter the SERS signal from nanoparticles (NPs) deep inside the matrix. A measurement with and without, or before and after, such perturbation then can provide powerful contrasting data enabling an effective elimination of the matrix signals to reveal more clearly the desired SERS signal without the interfering background and associated artifacts. The concept is demonstrated using ultrasound (US) as an external source of perturbation and SERS NPs inserted deep within a heterogeneous tissue phantom mimicking a cluster of NPs accumulated within a small target lesion. The overall SERS signal intensity induced by the applied US perturbation decreased by ∼21% and the SERS signal contrast was considerably improved by eliminating subtraction artifacts present in a conventional measurement performed at a neighboring spatial location in a heterogeneous tissue sample. Although the technique was demonstrated with SERS gold NPs with a standard Raman label, it is envisaged that active SERS NPs (both the nanoscale metal geometry and Raman label) could be specifically designed to deliver an augmented response to the external stimulus to further enhance the achievable SERS signal contrast and yield even greater improvement in detection sensitivity. The method was demonstrated using transmission Raman spectroscopy; however, it is also applicable to other Raman implementations including spatially offset Raman spectroscopy and conventional Raman spectroscopy performed both at depth and at surfaces of complex matrices.

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Background. Accurate timing offset calibration is crucial for time-of-flight (TOF) positron emission tomography (PET) to mitigate image artifacts and improve quantitative accuracy. However, existing methods are often time-consuming, complex, or costly.Objective. This paper presents a method for TOF PET timing offset calibration that eliminates the need for costly equipment, phantoms, short-half-life sources, and precise source positioning.Approach. We estimate channel timing offsets using stationary scans of a68Ge line source, typically used for routine quality control, at a minimum of three non-coplanar positions, with each position scanned for two minutes. The line source positions are accurately determined by applying a simple algorithm to their reconstructed images, allowing precise calculation of arrival time differences. Channel timing offsets are estimated by solving a least squares problem. This method is assessed through analyses of phantoms and patient images using a RAYSOLUTION DigitMI 930 scanner.Main results. The estimated timing offsets ranged from -500 ps to 500 ps across all channels. Calibration with a minimum of three scanned positions was sufficient to correct these offsets, achieving less than a 1% discrepancy across various metrics of the image quality (IQ) phantom compared to 12 positions. This calibration significantly reduced edge artifacts in TOF reconstruction of both phantoms and patients. Furthermore, the IQ phantom displayed a 14% increase in average contrast recovery, a 61% reduction in average background variability across all spheres, and a 90% reduction in average residual error. Consistent with the phantom results, patient data revealed enhancements in maximum standardized uptake values (SUVmax) from 14% to 55% for lesions measuring 6 mm to 14 mm. The calibration also improved lesion-to-background contrast and eliminated artifacts caused by the spillover effect of the kidneys and bladder.Significance. The proposed method is fast, user-friendly, and cost-effective, effectively improving lesion detection and diagnostic accuracy.

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Spatially offset Raman spectroscopy (SORS) is typically used to non-invasively investigate stratified samples that possess features on a millimeter scale, whereas micro-SORS usually deals with micrometer-thick layered samples. However, there are many instances where these boundaries are intertwined, sometimes indicating the possibility of using both techniques as well as circumstances that present mutual exclusion to their applicability. The aim of this study is to establish an application protocol that provides better insight into their suitability for deployment in various scenarios. The differences and similarities between the two approaches are investigated highlighting their strengths and limitations considering both theoretical and practical aspects. Diverse available parameters entail prospects and restrictions of both techniques and give rise to specific instrumental effects, namely, the overlap between the collection and excitation areas, the percentage of collected area for a given spatial offset, and the accuracy in the definition of the spatial offset (spread effect). These aspects are studied and exemplified on mockup samples relevant to the field of cultural heritage. The samples are characterized by high compositional complexity comprising features ranging from micrometer to millimeter scales. The conclusions reached are also relevant to other scientific areas such as biomedical, forensic, or energy harvest.

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PURPOSE: To compare clinical and radiographic outcomes of total hip arthroplasty (THA) using standard offset versus high offset short cementless stems. METHODS: We reviewed a consecutive series of 204 primary THAs performed over 5 years using a short cementless collared stem. At a minimum follow-up of 2 years, 6 patients had deceased, 6 were not evaluated radiographically and, 2 were lost to follow-up. This left a final cohort of 190 hips, of which 72 had received a standard offset stem and 118 had received a high offset stem. Outcomes collected included: Oxford hip score (OHS), forgotten joint score (FJS), canal fill ratio (CFR), canal-bone ratio (CBR), stem subsidence (≥ 3 mm), stem misalignment (> 5°), radiolucent lines (≥ 2 mm), cortical hypertrophy, and calcar modifications. RESULTS: There were no significant differences in postoperative clinical and radiographic outcomes between the standard offset and high offset groups, except for incidence of stems in varus (6% vs 17%; p = 0.001). Multivariable analyses revealed that OHS was significantly worse for patients of greater age (ß = 0.1; p = 0.001), higher BMI (ß = 0.2; p = 0.018), or with inflammatory arthropathy (ß = 4.7; p = 0.005); while FJS was significantly worse for patients with higher BMI (ß = - 0.7; p = 0.003); and cortical hypertrophy was significantly associated with CBR (OR > 100; p = 0.008). CONCLUSIONS: There were little to no differences in clinical or radiographic outcomes of THA performed using standard offset versus high offset short cementless stems. Although high offset stems are more frequently aligned in varus, while cortical hypertrophy occurs in wider intramedullary canals.

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PURPOSE: To compare clinical and radiographic outcomes of propensity-matched patients undergoing THA using standard versus high offset stems at five years. METHODS: The authors retrospectively reviewed a consecutive series of primary THAs performed between 01/09/2015-31/12/2017 using a fully-hydroxyapatite coated collared stem, with either a standard (n = 365) or high (n = 110) offset. Outcomes collected included: modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and radiographic measurements including limb length discrepancy (LLD), stem subsidence, and stem radiolucencies. RESULTS: Propensity score matching resulted in 80 hips per group. Preoperatively there were no significant differences in patient demographics, surgical data and radiographic measurements, except the standard offset group had significantly smaller femoral (40.0 ± 7.5 vs 48.4 ± 6.2, p < 0.001), acetabular (92. ± 6.3 vs 94.8 ± 7.3, p = 0.011) and global (132.0 ± 10.3 vs 143.2 ± 8.2, p < 0.001) offsets compared to the high offset group. At a minimum five years follow-up, there were no significant differences in mHHS (93.2 ± 11.0 vs 93.1 ± 10.6, p = 0.553), OHS (45.1 ± 4.1 vs 45.3 ± 4.6, p = 0.623), and FJS (85.1 ± 19.3 vs 82.7 ± 23.0, p = 0.910). There were also no differences in radiographic measurements, including LLD (1.5 ± 4.8 vs 1.1 ± 3.5, p = 0.537), stem subsidence (0% vs 0%, p = 1.000), and stem radiolucencies (severe: 6% vs 1%, p = 0.152). CONCLUSION: The present matched-cohort study found no significant differences between standard versus high offset straight fully-hydroxyapatite coated collared stems for primary THA in terms of clinical and radiographic outcomes at five years. These findings may suggest that uncemented collared high offset stems are not associated with an increased risk of radiolucencies and loosening compared to uncemented collared standard offset stems.

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BACKGROUND: The concept of restoring the femoral offset is well established during hip replacement surgery, but is less well known when treating Garden I or II femoral neck fractures by internal fixation. And yet, the therapeutic aim for these fractures is to restore this native parameter as best possible. The aim of this study was to identify the risk factors for reduction of femoral offset after union of a Garden I or II femoral neck fracture treated by internal fixation. HYPOTHESIS: After internal fixation of a femoral neck fracture, certain factors may contribute to reducing the femoral offset, which itself has been identified as being responsible for altering the patients' quality of life and functional outcomes. MATERIALS AND METHODS: This multicenter study included 193 patients who had a Garden I or II femoral neck fracture treated by cannulated screws or a sliding compression screw-plate. The difference between the femoral offset in the operated hip and that of the contralateral hip was measured in weightbearing patients after the fracture had healed. This difference was the primary outcome measure. Univariate and multivariate analyses were done to look for risk factors contributing to femoral neck shortening. RESULTS: Based on the univariate analysis, being more than 85 years of age, having a Garden I fracture, and cannulated screw fixation were associated with a significantly greater reduction in the femoral offset. In the multivariate analysis, only Garden I fractures were associated with a greater reduction in femoral offset. DISCUSSION: Garden I fractures were associated with a greater reduction in the offset, although there was no evidence that this change was related to early weightbearing. By identifying this risk factor, surgeons can optimize the indications given that the treatment of these fractures is still widely debated and there is still no consensus as to the best method. LEVEL OF EVIDENCE: IV.

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OBJECTIVE: Posterior condylar offset (PCO) and anterior condylar offset (ACO) exert an influence on the sagittal alignment in total knee arthroplasty (TKA). However, there is no common consensus that the variation range of posterior condylar offset (PCO) is associated with patient-reported outcome measures (PROMs) and the optimum variation range of PCO. This study aims to investigate the correlation between PCO and the PROMs of primary TKA for osteoarthritis (OA) and find out the optimal variation range of the PCO. METHODS: In this study, we performed a radiographic analysis of 106 patients (112 knees) with primary TKA. Patients were divided into two cohorts (A and B) according to the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Correlations between the sagittal parameter and WOMAC were investigated using univariate and multivariate analysis. The receiver operating characteristic (ROC) curve was used to establish the cut-off value for the optimal variation range. We then further investigated how different variation range affects the WOMAC subscale score and forgotten-joint-score-12 (FJS-12). RESULTS: Univariate analysis revealed a correlation between the variation range of PCO (p < 0.01), ACO (p < 0.01) and PROMs. Multivariate analysis showed that only PCO was associated with PROMs. In the ROC graph, the cut-off value of the variation range of PCO is 2.85 mm (AUC = 0.66, Youden index = 0.26). The WOMAC functional ability score of the group outside the PCO variation range of 2.85 mm significantly increased compared to the group within the range. CONCLUSION: In this study, PCO variation was significantly associated with clinical outcomes in TKA and the optimal PCO variation range was within 2.85 mm. Maintaining the PCO variation within 2.85 mm could enhance functional recovery and patient satisfaction.

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The Arctic is warming four times faster than the rest of the world, threatening the persistence of many Arctic species. It is uncertain if Arctic wildlife will have sufficient time to adapt to such rapidly warming environments. We used genetic forecasting to measure the risk of maladaptation to warming temperatures and sea ice loss in polar bears (Ursus maritimus) sampled across the Canadian Arctic. We found evidence for local adaptation to sea ice conditions and temperature. Forecasting of genome-environment mismatches for predicted climate scenarios suggested that polar bears in the Canadian high Arctic had the greatest risk of becoming maladapted to climate warming. While Canadian high Arctic bears may be the most likely to become maladapted, all polar bears face potentially negative outcomes to climate change. Given the importance of the sea ice habitat to polar bears, we expect that maladaptation to future warming is already widespread across Canada.

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