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Label-free biosensors provide an important platform for detecting chemical and biological substances without needing extra labeling agents. Unlike surface-based techniques such as surface plasmon resonance (SPR), interference, and ellipsometry, surface-enhanced Raman spectroscopy (SERS) possesses the advantage of monitoring analytes both on surfaces and in solutions. Increasing the SERS enhancement is crucial to preparing high-quality substrates without quickly losing their stability, sensitivity, and repeatability. However, fabrication methods based on wet chemistry, nanoimprint lithography, spark discharge, and laser ablation have drawbacks of waste of time, complicated processes, or nonreproducibility in surface topography. This study reports the preparation of recyclable TiO[sub.2]/Ag nanoparticle (AgNP) substrates by using simple arc ion plating and direct-current (dc) magnetron sputtering technologies. The deposited anatase-phased TiO[sub.2] ensured the photocatalytic degradation of analytes. By measuring the Raman spectra of rhodamine 6G (R6G) in titrated concentrations, a limit of detection (LOD) of 10[sup.−8] M and a SERS enhancement factor (EF) of 1.01 × 10[sup.9] were attained. Self-cleaning was performed via UV irradiation, and recyclability was achieved after at least five cycles of detection and degradation. The proposed TiO[sub.2]/AgNP substrates have the potential to serve as eco-friendly SERS enhancers for label-free detection of various chemical and biological substances.

ObjectiveTo evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).DesignSystematic review.Eligibility criteriaRandomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.ResultsModerate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.ConclusionLow level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

Tibial stress fractures are a common overuse injury resulting from the accumulation of bone microdamage due to repeated loading. Researchers and wearable device developers have sought to understand or predict stress fracture risks, and other injury risks, by monitoring the ground reaction force (GRF, the force between the foot and ground), or GRF correlates (e.g., tibial shock) captured via wearable sensors. Increases in GRF metrics are typically assumed to reflect increases in loading on internal biological structures (e.g., bones). The purpose of this study was to evaluate this assumption for running by testing if increases in GRF metrics were strongly correlated with increases in tibial compression force over a range of speeds and slopes. Ten healthy individuals performed running trials while we collected GRFs and kinematics. We assessed if commonly-used vertical GRF metrics (impact peak, loading rate, active peak, impulse) were strongly correlated with tibial load metrics (peak force, impulse). On average, increases in GRF metrics were not strongly correlated with increases in tibial load metrics. For instance, correlating GRF impact peak and loading rate with peak tibial load resulted in r = -0.29±0.37 and r = -0.20±0.35 (inter-subject mean and standard deviation), respectively. We observed high inter-subject variability in correlations, though most coefficients were negligible, weak or moderate. Seventy-six of the 80 subject-specific correlation coefficients computed indicated that higher GRF metrics were not strongly correlated with higher tibial forces. These results demonstrate that commonly-used GRF metrics can mislead our understanding of loading on internal structures, such as the tibia. Increases in GRF metrics should not be assumed to be an indicator of increases in tibial bone load or overuse injury risk during running. This has important implications for sports, wearable devices, and research on running-related injuries, affecting >50 scientific publications per year from 2015-2017.

The aim of this study was to compare male vs. female athletes in strength and power performance relative to body mass (BM) and lean body mass (LBM) and to investigate the relationships between muscle architecture and strength in both genders. Sixteen men (age = 26.4 ± 5.0 years; body mass = 88.9 ± 16.6 kg; height = 177.6 ± 9.3 cm) and fourteen women (age = 25.1 ± 3.2 years; body mass = 58.1 ± 9.1 kg; height = 161.7 ± 4.8 cm) were tested for body composition and muscle thickness (MT) of vastus lateralis muscle (VT), pectoralis major (PEC), and trapezius (TRAP). In addition, participants were tested for lower body power at countermovement jump (CMJP) and upper-body power at bench press throw (BPT). Participants were also assessed for one repetition maximum (1RM) at bench press (1RMBP), deadlift (1RMDE), and squat (1RMSQ). Significantly greater (p < 0.01) MT of the VL, PEC and TRAP muscles and LBM were detected in men compared to women. Significantly greater (p < 0.05) 1RMBP and BPT adjusted for LBM were detected in men than in women. No significant gender differences after adjusting for LBM were detected for 1RMSQ (p = 0.945); 1RMDE (p = 0.472) and CMJP (p = 0.656). Significantly greater (p < 0.05) results in all performance assessments adjusted for MT of the specific muscles, were detected in males compared to females. Superior performances adjusted for MT and LBM in men compared to women, may be related to gender differences in muscle morphology and LBM distribution, respectively.

National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

Running is associated with a higher risk of overuse injury than other forms of aerobic exercise such as walking, swimming and cycling. An accurate description of the proportion of running injuries per anatomical location and where possible, per specific pathology, for both genders is required. The aim of this review was to determine the proportion of lower limb running injuries by anatomical location and by specific pathology in male and female runners (≥800m - ≤ marathon). The preferred reporting items for systematic reviews and meta-analyses guidelines were followed for this review. A literature search was performed with no restriction on publication year in Web of Science, Scopus, Sport-Discus, PubMed, and CINAHL up to July 2017. Retrospective, cross-sectional, prospective and randomised-controlled studies which surveyed injury data in runners were included. 36 studies were included to report the overall proportion of injury per anatomical location. The overall proportion of injury by specific pathology was reported from 11 studies. The knee (28%), ankle-foot (26%) and shank (16%) accounted for the highest proportion of injury in male and female runners, although the proportion of knee injury was greater in women (40% 31%). Relative to women, men had a greater proportion of ankle-foot (26% 19%) and shank (21% 16%) injuries. Patellofemoral pain syndrome (PFPS; 17%), Achilles tendinopathy (AT; 10%) and medial tibial stress syndrome (MTS; 8%) accounted for the highest proportion of specific pathologies recorded overall. There was insufficient data to sub-divide specific pathology between genders. The predominate injury in female runners is to the knee. Male runners have a more even distribution of injury between the knee, shank and ankle-foot complex. There are several methodological issues, which limit the interpretation of epidemiological data in running injury.

This study investigated strontium (Sr[sup.2+]) adsorption by Taiwan Zhi-Shin bentonite (cation exchange capacity (CEC): 80–86 meq 100 g[sup.−1]) using Sr(NO[sub.3])[sub.2]-simulated nuclear waste. Kinetic analysis revealed pseudo-second-order adsorption kinetics, achieving 95% Sr[sup.2+] removal within 5 min at pH 9. Isothermal studies showed a maximum capacity of 0.28 mmol g[sup.−1] (56 meq 100 g[sup.−1]) at 15 mmol L[sup.−1] Sr[sup.2+], accounting for 65–70% CEC and fitting the Freundlich model. Cation exchange was the dominant mechanism (84% contribution), driven by Sr[sup.2+] displacing interlayer Ca[sup.2+]. Alkaline conditions (pH > 9) enhanced adsorption through improved surface charge and electrostatic attraction. Thermodynamic studies demonstrated temperature-dependent behavior: increasing temperature reduced adsorption at 0.01 mM Sr[sup.2+] but increased efficiency at 10 mM. Na[sup.+] addition suppressed adsorption, aligning with cation exchange mechanisms. Molecular dynamics simulations identified hydrated Ca[sup.2+]-Sr[sup.2+] water bridges interacting with bentonite via hydrogen-bonding networks. The material exhibits rapid kinetics (5 min equilibrium), alkaline pH optimization, and resistance to ion interference, making it suitable for emergency Sr[sup.2+] treatment. It shows promise as a cost-effective and good performing adsorbent for radioactive waste solutions.

Purpose of Review The standard of care for lunotriquetral ligament injuries is evolving. An understanding of the mechanics of the lunotriquetral ligament and its role in carpal kinematics is critical when deciding how to treat these injuries. Treatment for these injuries varies from nonoperative to wrist arthroscopy with thermal capsulodesis and/or repair to reconstruction or limited arthrodesis. This article provides a review of the anatomy, pathomechanics, evaluation, and ultimately treatment of lunotriquetral ligament injuries. Recent Findings Although lunotriquetral ligament injuries can occur in isolation, injuries to the lunotriquetral ligament are often viewed as a component of other injury patterns to the intrinsic and extrinsic ligaments of the wrist. Static volar intercalated segment instability typically occurs when the dorsal radiocarpal ligament is also compromised. If nonoperative treatment fails, arthroscopy is the gold standard for diagnosis even with improving imaging modalities. Recently, authors have proposed employing the technique of ulnar-shortening osteotomy in those with ulnar negative variance and the absence of an impaction lesion. Other newer techniques included bone-ligament-bone reconstruction for chronic, static instability. Summary LT injuries rarely occur in isolation. Most injuries involving the lunotriquetral ligament can be treated nonoperatively. Those individuals with persistent pain should be treated with a diagnostic wrist arthroscopy. Primary repairs are indicated in those with an acute, complete tear. In chronic, static instability, ligament reconstruction has been shown to improve wrist function and decrease pain.

Exercise-related lower leg pain (ERLLP) is one of the most prevalent running-related injuries, however little is known about injured runners’ mechanics during outdoor running. Establishing biomechanical alterations among ERLLP runners would help guide clinical interventions. Therefore, we sought to a) identify defining biomechanical features among ERLLP runners compared to healthy runners during outdoor running, and b) identify biomechanical thresholds to generate objective gait-training recommendations. Thirty-two ERLLP (13 M, age: 21 ± 5 years, BMI: 22.69 ± 2.25 kg/m2) and 32 healthy runners (13 M, age: 23 ± 6 years, BMI: 22.33 ± 3.20 kg/m2) were assessed using wearable sensors during one week of typical outdoor training. Step-by-step data were extracted to assess kinetic, kinematic, and spatiotemporal measures. Preliminary feature extraction analyses were conducted to determine key biomechanical differences between healthy and ERLLP groups. Analyses of covariance (ANCOVA) and variability assessments were used compare groups on the identified features. Participants were split into 3 pace bands, and mean differences across groups were calculated to establish biomechanical thresholds. Contact time was the key differentiating feature for ERRLP runners. ANCOVA assessments reflected that the ERLLP group had increased contact time (Mean Difference [95% Confidence Interval] = 8 ms [6.9,9.1], p < .001), and approximate entropy analyses reflected greater contact time variability. Contact time differences were dependent upon running pace, with larger between-group differences being exhibited at faster paces. In all, ERLLP runners demonstrated longer contact time than healthy runners during outdoor training. Clinicians should consider contact time when assessing and treating these ERLLP runner patients.