Background: Hydrogenogenic small intestine bacterial overgrowth (SIBO) has been associated with growth stunting and neurodevelopmental deficits in children from low and middle-income countries. However, methanogenic overgrowth has yet to be studied in this population. We sought to determine if increased methane levels on glucose breath tests (GBT) could predict growth and neurodevelopment.
Methods: GBT was performed at 6, 12, and 18 months on Tanzanian infants as part of the Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT) study conducted in rural Tanzania. Area under the methane curve was calculated and averaged over the three tests (CH4 AUC). Neurodevelopment was assessed using the Malawi Developmental Assessment Tool (MDAT).
Results: Univariate and multivariate linear regressions were performed to determine if CH4 AUC predicted growth or neurodevelopment and to determine predictors driving CH4 AUC levels. There was significant seasonal variation in CH4 AUC levels per child birth-month, with the highest levels associated with the spring months (March-May). Multivariable analysis showed no significant association between CH4 AUC and length-for-age Z score at 18 months, MDAT total score, or MDAT component scores. Birth month was a significant predictor of CH4 AUC (F= 66.614, p<.001). However, when analyzing patients with significant methanogenic SIBO (as determined by the top 50% of valid CH4 AUC values), antimicrobial administration had a positive but non-significant association with growth LAZ18 ( p=0.05), and nicotinamide administration revealed a significant association for LAZ18 when controlling for significant descriptive variables ( p=0.005) as compared to antimicrobial and nicotinamide administration in patients with negligible methanogenic SIBO (p=0.08, p=0.53, respectively).
Conclusion: This initial study does support a relationship between methanogenic overgrowth and growth stunting through the positive growth effect in positive SIBO children who received nicotinamide treatment, an effect that was not seen in the children without SIBO. Further study is needed to understand the relationship between methanogenic overgrowth and environmental enteric dysfunction and/or gastrointestinal symptomatology.

Analyses of Methanogenic Small Intestine Overgrowth Effects on Growth in Tanzanian Children

Cerebral palsy (CP) is the leading cause of childhood physical disability. Children with CP receive several therapies designed to improve gross motor skills, but further research is needed to understand the impact of these therapies on motor learning and optimal therapeutic dose.
The aim of this study is to compare motor learning and variability between children with CP and typically developing (TD) children. We hypothesize that (1) children with CP and TD children will have differing patterns of motor learning, and (2) children with CP will show greater variability in motor learning compared to TD peers, but this variability will reduce for both groups with training.
The motor task involved a stability platform. Participants were instructed to keep the platform within 5 degrees of its horizontal position. Training consisted of 15, 30 s trials/day for 5 days, pre- and post-testing were 5, 30 s trials/day. Performance was determined by quantifying time the participant maintained the platform within 5 degrees of horizontal and variability by time spent on either side of the 5 degrees.
Mixed-model ANOVA was performed with time (pre-test vs. post-test) as the within-subject variable and group (CP vs. TD) as the between-subject variable. Dependent variables were mean center time and variability. 
TD children improved an average of 6.7 seconds (20.8 s to 27.5 s) from pre-test to post-test. Children with CP improved an average of 11.9 seconds (9.85 to 21.7 s). TD children decreased variability an average of 3.35 seconds (4.58 to 1.23 s). Children with CP decreased variability an average of 6 seconds (10.1 to 4.1 s). 
ANOVA showed significant main effects for time on mean center time (F (1,40) = 26.0, p < 0.001) and group on mean center time (F (1,40) = 20.9, p < 0.001), as well as time on variability (F (1,40) = 1, p < 0.001) and group on variability (F (1,40) = 1, p < 0.001). 
Both groups showed motor learning with five days of balance training. Children with CP showed greater variability in their balance performance than TD children. 
While TD children achieved almost maximum performance with training, children with CP may need more training to achieve this same performance. Alternatively, children with CP may reach maximum motor learning potential after a certain dose, therefore requiring other therapeutic interventions. Participant recruitment and data collection is ongoing. 


Differences in Motor Learning Between Children with Cerebral Palsy and Typically Developing Peers Using a Dynamic Balance Task

Background
In our original study, we utilized clinical next-generation sequencing to identify pathogenic (P) or likely pathogenic (LP) sequence variations that are not associated with a patient's primary indication for testing within a large pediatric cohort. These variations are called secondary findings (SFs). Our cohort was enriched for Black or African-American (AA) children, which comprised 51.8% (8667 subjects) of the total cohort (16713 subjects) at the Center for Applied Genomics at The Children’s Hospital of Philadelphia. The inclusion rate of individuals (adults and pediatrics) with African ancestry in published genome-wide studies is <3% which highlights the unmet need for further genetics research on this population. The strong representation of Black or AA children in our cohort allowed us to present information on the types and frequencies of P/LP SFs primarily affecting Black or AA children and families.

Methods
The original study searched for P/LP variants in disease-causing genes, specifically in 78 American College of Medical Genetics and Genomics (ACMG)-recommended and 93 non-ACMG genes that were defined as SFs in patients of four large pediatric cohorts. The 93 non-ACMG genes were selected after an extensive literature search for relevant genes proposed for addition to the ACMG list. Variants were filtered by P/LP classification as per ACMG/Association for Molecular Pathology (AMP) recommendations, Combined Annotation Dependent Deletion (CADD) vs Mutation Significance Cutoff (MSC) scores, variant type, presence in disease-causing variant databases, and Integrative Genomics Viewer (IGV) visualization for manual variant quality inspection. We divided the patient's P/LP variants into four disease categories: cancer, cardiovascular, metabolic, and miscellaneous. We further divided our patients by self-reported ethnicity.

Results
Black or AA subjects comprised 307/320 (82%) of TTR variants (ACMG), 29/48 (60%) of RYR1 variants (ACMG), and 22/39 (56%) of LDLR variants (ACMG).
Out of 307 Black or AA subjects with P/LP variants in TTR, the most common variant (304) was p.V142I. The other three variants were p.V50M, p.V113M, and p.D119V.
Additionally, Black or AA subjects comprised 335/350 (95%) of G6PD variants (non-ACMG). The most common variant (327) was p.V98M which was excluded from final reports since it has mild clinical manifestations.

Conclusion
These SF data provide valuable insight into common P/LP genetic variations and associated diseases which mainly affect Black or AA children. The implications of identifying most TTR, RYR1, and LDLR gene variants in this underrepresented patient population include: better informed medical management, reproductive planning, and family member genetic testing for Black or AA children and families specifically.

Enrichment of secondary genetic findings of TTR, RYR1, and LDLR in a cohort of 8667 African-American pediatric subjects

INTRODUCTION 
Preoperative anemia is associated with increased postoperative transfusion and complication rates after total knee arthroplasty (TKA). We aimed to create TKA-specific data-driven preoperative hemoglobin strata that quantify the likelihood of 90-day postoperative blood transfusion and evaluate whether these strata are associated with increased risk of 90-day major complications and 2-year prosthetic joint infection (PJI).  

METHODS 
Primary TKA patients from 2013-2022 were identified using a national database. Stratum-specific likelihood ratio (SSLR) analysis defined hemoglobin strata associated with the risk of 90-day blood transfusion. Each stratum was propensity-score matched to the highest identified hemoglobin strata. Unmatched incidence rates and matched risk of 90-day major complications and 2-year PJI between strata were compared.   

RESULTS 
SSLR identified four 90-day blood transfusion hemoglobin strata for males [Strata (g/dL), Likelihood Ratio (5.0-11.4, 8.06; 11.5-11.9, 4.34; 12.0-12.9, 1.70; 13.0-17.0, 0.54)] and females (5.0-10.4, 8.22; 10.5-11.4, 2.84; 11.5-12.4, 1.38; 12.5-17.0, 0.50). Increased 2-year PJI risk was associated with three male strata (12.0-12.9, 11.5-11.9, 5.0-11.4; all p<0.001) and three female strata (11.5-12.4, 10.5-11.4, 5.0-11.4; all p<0.001). Increased 90-day major complication risk was associated with three male strata (12.0-12.9, 11.5-11.9, 5.0-11.4; all p<0.001) and three female strata (11.5-12.4, 10.5-11.4, 5.0-10.4; all p<0.001). 

CONCLUSION 
We identified TKA-specific hemoglobin strata that maximize the likelihood of 90-day blood transfusions and predict the risk of 90-day major complications and 2-year PJI. When using preoperative hemoglobin as a target for anemia optimization, we recommend using these thresholds, noting the increase in complication risk with hemoglobin (g/dL) below 13.0 in males and 12.5 in females.  

Stratum-Specific Preoperative Hemoglobin Intervals Quantify the Likelihood of Blood Transfusion, Major Complications, and Periprosthetic Joint Infection Following Total Knee Arthroplasty

Background
Wound complications are well documented following spine tumor surgery due to risk factors including prior radiation therapy, poor nutritional status, and immunocompromise. Increasing evidence has shown that a multidisciplinary approach to complex oncological spine reconstruction surgery can decrease wound complication rates. The goal of this study is to assess whether plastic surgery wound closure in the setting of spine tumor surgery can lead to a decreased rate of wound complications.

Methods
A retrospective analysis of 157 consecutive patients who underwent spine tumor surgery between October 2012 and October 2022 at a Level 1 Trauma Center was performed. Clinical data regarding pre- and post-operative oncological treatment, surgical management, intra- and post-operative complications, and quality of life surveys were collected. Patients were stratified based on plastic surgery involvement in soft-tissue reconstruction and wound closure. Post-operative complications and outcomes were analyzed between groups. Statistical significance was set at p < 0.05.

Results
130 (82.8%) oncological spine surgeries underwent closure by spine surgeons (SS) and 27 (17.2%) underwent closure by plastic surgeons (PS). The PS group was 33% (N=9) female compared to 38% (N=50) female for the SS group. The PS group was younger compared to SS group (55.3 ± 18.3 vs. 62.5 ± 16.1 years; p=0.035). The PS group had a greater number of levels fused (3.3 ± 4.5 vs. 2.3 ± 2.1; p= 0.049) but a lower number of levels decompressed (1.48 ± 1.5 vs. 2.4 ± 1.2; p<0.001) compared to the SS group.

Patients in the PS group had a longer operative time (362.6 ± 278.3 vs. 225 ± 84.5 minutes; p<0.001), greater blood loss (631.8 ± 576.3 vs. 480.6 ± 454.9 mL; p=0.048), and greater length of stay (57 ± 132 vs. 10 ± 15 days; p<0.001) compared to SS group, which could be attributed to increased complexity of the PS cases. Pre-operative and post-operative Day 3 Albumin (p=0.82), Hematocrit (p=0.095), Glucose (p=0.367) and HA1c (p=0.417) had no effect on wound healing in both surgical groups. The most common coverage performed in the PS group were local paraspinal advancement flaps. The PS group had 0% post-op wound complications, wound infections, or wound-related reoperations, while the SS group had 4% (N=5) wound-related reoperations.


Conclusion
Spine tumor patients are at increased risk for impaired wound healing and post-operative wound complications. A multidisciplinary approach to oncological spine surgery, involving both spine surgeons and plastic surgeons, can improve surgical outcomes and wound healing.

Outcomes and Spine Oncology Surgery With and Without Plastic Surgery Reconstruction

Background
The purpose of this research is to test the clinical validity of a computerized version of the Trail Making Test (TMT) in an acute rehabilitation center for predicting concurrent inpatient disability. The TMT is a widely used neuropsychological assessment that has been shown to predict brain damage. Despite its value and efficacy in testing cognitive function, the TMT is limited to patients who have intact manual dexterity because it requires using a pen. Individuals with conditions that limit manual use (e.g. bone fracture, paralysis, burns, etc.) cannot take the test. Although there are adapted TMTs to include these populations, not many of these tests still involve visual interaction. Assessment of executive function using the Computer-Assisted TMT (CTMT) has already shown to be feasible in rehabilitation patients with intact manual dexterity. This study tested the Computer-Assisted TMT (CTMT) in rehabilitation patients who lack motor hand use.
Methods
This cross-sectional study was conducted in an acute rehabilitation hospital setting with patients (n = 37) who lack hand usability with either hand. Because patients with brain illness may have slower speech, the CTMT scores were corrected for maximal oral speech rate. Participants were tested in their hospital rooms over two sessions of the CTMT to evaluate test-retest reliability. Test-retest reliability was evaluated with Pearson correlation.
Results
50 patients were approached to be in the study, and 37 of them consented to participate. Out of the 37 participants, 33 participants were able to complete one round of testing and 17 participants were able to complete both rounds of testing. Time for CTMT completion was corrected by the maximal speech production rate (diadochokinesis or DDK). Since DDK rate has shown to be modulated by age, we also corrected people 47 years and older by a factor of 0.9316, which is based on previous research. The CMT versions had excellent test-retest reliability (r = 0.93 for CTMT-A, r = 0.83 for CTMT-B, and r =0.92 for CTMT-3).
Conclusion
The results of this study could help to determine if the CTMT can reliably predict concurrent physical disability and inform new forms of cognitive rehabilitation.


The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

Background: Depression is a public health concern affecting the well-being and development of adolescents. Despite evidence-based guidelines promoting routine depression screening, many youths remain unidentified and untreated. Quality improvement (QI) initiatives may enhance depression screening practices. This retrospective chart review assesses a QI initiative's impact on depression screening rates among 12 to 18-year-old patients at four pediatric clinics in urban Nebraska from 2018 to 2022. The study evaluates trends in positive depression screens and the effectiveness of targeted interventions to increase adolescent depression screening. 
Methods: Electronic health record data was used to calculate adolescent depression screening rates and the percentage of positive depression screens. The screening rate equaled the total number of completed adolescent depression screens divided by the total number of well child exams for 12 through 18-year-old patients. The percentage of positive depression screens was the percentage of all adolescents who were screened and were positive on the Patient Health Questionnaire-4 (PHQ-4). The QI initiative comprised a “Lunch and Learn" session to raise provider awareness about the importance of depression screening. Additional interventions involved creating supportive materials for managing positive screenings, integrating depression screening into well-child exam rooming, and posting educational materials in the clinic's computer system for easy access by patients and providers. The impact of the initiative on depression screening rates was analyzed annually over five years. 
Results: The data revealed variations in depression screening rates and stability in the percentage of positive depression screens over the five-year study period. In 2018, the screening rate at well- child exams was 25.9%, with 8.1% of patients positive for depression. In 2019, the screening rate decreased to 21.6%, while the percentage of positive screenings increased to 13.1%. Following the initiation and continuation of the QI initiative in 2019, screening rates notably increased, reaching 37.2% with 11.7% positive patients in 2020. Screening rates further improved to 48.4% and 88.6% in 2021 and 2022, respectively, while the percentage of positive screenings remained relatively stable at 11.2% and 10.1%. 
Conclusion: The QI initiative positively impacted depression screening rates among adolescent patients at the four pediatric clinics, empowering healthcare providers to recognize and support adolescents facing depression. Continuous screening practice improvement efforts are crucial for early identification and intervention. The initiative offers a promising approach to enhance adolescent mental health care. 


Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

Background
Bone autograft is a mainstay in the surgical treatment of fracture nonunion. A traditional donor site for autologous bone graft harvest is the anterior or posterior iliac crest. A bone grafting technique that has gained favor over the past decade has been the Reamer/Irrigator/Aspirator (RIA) system (Synthes,Inc, West Chester, PA). Both techniques come with complications including donor site pain and iatrogenic fracture. The purpose of this study is to compare complications between autogenous bone graft harvest using the RIA system with subsequent prophylactic retrograde intramedullary nailing (rIMN) and the more common posterior iliac crest bone graft (PICBG) technique, as reported in the literature.

Methods
A single center retrospective cohort study was conducted to evaluate all patients who underwent prophylactic retrograde intramedullary nailing after bone graft harvest of the femur using the RIA device between January 2017 and September 2022 by a single surgeon. All patients were over the age of 18 and treated at the institution. All operations performed during January 2017 and September 2022 were manually reviewed from the surgeon daily schedule to identify pertinent procedures. Data collection was performed using the digitized medical records from the institution’s EMR (EPIC). 

Results
Thirty-six patients who underwent retrograde Reamer-Irrigator-Aspirator (RIA) with prophylactic intramedullary nailing were evaluated in this study. Of the 36 patients, two reported harvest site pain (5%). Three patients (8%) had an osteoporosis diagnosis, eleven (30.5%) had an osteomyelitis diagnosis, and four (11%) received prophylactic nailing for cancer. No subjects demonstrated a femoral neck fracture following prophylactic retrograde intramedullary nailing.

Conclusion
RIA with Prophylactic Intramedullary Nailing is a favorable option for bone graft harvest and prophylactic fixation. It has a lower harvest site morbidity, measured by harvest site pain, as compared to anterior or posterior iliac crest bone graft technique.

Retrograde Reamer-Irrigator-Aspirator (RIA) with Prophylactic Intramedullary Nailing vs Posterior Iliac Crest for Bone Grafting

Small-for-gestational-age (SGA) children may be at risk for earlier puberty and adverse long-term health sequalae. This study investigates associations between SGA and age at menarche using secondary data analysis of 992 female children in a U.S. birth cohort of primarily non-marital births. SGA was defined as <10th percentile of weight for gestational age within the sample. We estimated unadjusted and adjusted Ordinary Least Squares (OLS) models of associations between SGA and age at menarche in years, as well as unadjusted and adjusted logistic regression models of associations between SGA and menarche before age 11. SGA was associated with slightly earlier menarche, but the difference was not statistically significant even when adjusting for maternal sociodemographic characteristics and when further adjusting for prenatal smoking and maternal pre-pregnancy overweight and obesity. Similarly, SGA was not significantly associated with the odds of menarche before age 11 in unadjusted or adjusted models. Maternal non-Hispanic Black race-ethnicity, Hispanic ethnicity, and pre-pregnancy obesity all had independent associations with earlier age at menarche and menarche before age 11. Therefore, it appears that inherited maternal risk factors play more direct roles.

SGA and age at menarche in a diverse population-based U.S. sample

Background 

Increased preoperative shoulder dislocations are associated with recurrent instability and greater glenoid bone loss. Initial instability events and subsequent episodes can result in 6.8% and 20% increased glenoid bone loss respectively. Glenoid bone loss increases the risk of instability recurrence and poor outcomes following shoulder stabilization surgery. Low socioeconomic status (SES) indicators, such as high Area Deprivation Index (ADI) and non-commercial insurance status, correlate with emergency room visits and delays to orthopaedic care. This study assesses the correlation between ADI, insurance status, and preoperative glenoid bone loss. We hypothesized higher national ADI and non-commercial insurance would correlate with greater levels of radiographic glenoid bone loss. 



Methods 

339 Bankart repair patients were identified. Data obtained included demographics, national ADI, insurance status, and glenoid bone loss. National ADI was obtained utilizing the Neighborhood Atlas Website and patients’ home addresses. Patients were excluded for prior ipsilateral shoulder surgery (N=16), lack of viewable imaging (N=97), and low-quality magnetic resonance imaging (MRI)(N=34). Glenoid bone loss was measured using the Best-fit circle method on high-quality MRIs (i.e., Fast imaging employing steady-state acquisition (FIESTA)). Three-dimensional alignment of images provided the best glenoid en face view. Researchers were blinded to ADI and insurance status during radiographic analysis and inter- and intra-observer reliability testing. Glenoid bone loss was compared between insurance types using one-way ANOVAs. Before evaluating the ADI and glenoid bone loss association, a scatterplot was generated to qualitatively assess the nature of the relationship. A curve fitting tool determined a quadratic non-linear regression best characterized the association between ADI and glenoid bone loss. 



Results 

192 patients (23% female; 23.9±7.5 years of age; national ADI=16.7%±16.0%) were included. Patients experienced 9.50±6.59% glenoid bone loss. A significant quadratic association between national ADI and glenoid bone loss (R2=0.483, p<0.001) was observed. Individuals with non-commercial insurance experienced greater glenoid bone loss compared to commercial insurance (commercial=8.80±6.46%, other=12.52±6.36%, p=0.003). Interobserver reliability was .910; intraobserver reliability was .948. 



Conclusion 

Our findings indicate a positive association between area deprivation and MRI-measured glenoid bone loss in patients with anterior shoulder instability. Patients with low SES indicators, such as high ADI and non-commercial insurance, are more likely to have greater glenoid bone loss and could be at risk for increased rates of pre- and postoperative instability. While a correlation between low SES indicators and glenoid bone loss has been demonstrated; the association of SES with surgical complexity and functional outcomes in this context should be explored.

Low Socioeconomic Indicators Correlate with Greater Pre-Operative Glenoid Bone Loss

1. Background
Approximately 1.2 million spine surgeries are performed each year in the US. Of those, an estimated 60-80% are successful, while 20-40% require revision due to a wide range of causes. Additionally, recovery from spine surgery often requires significant rehabilitation and care plan adherence, which can be impacted by biopsychosocial factors. As follows, substance use and other psychiatric comorbidities can worsen spine surgery patient outcomes.
Per the US Department of Health and Human Services, 61.2 million Americans over 12 years old use an illicit substance, and 9.2 million misuse opioids. Furthermore, 46.3 million meet criteria for substance use disorder (SUD), but 94% receive no treatment, and the vast majority are unaware of their SUD. With both SUD and spine surgery numbers increasing, and the likelihood that the former negatively impacts the latter, more research is needed to better understand the effects of perioperative substance use, both illicit and prescription, on the outcomes of spine surgeries to elucidate the significance of this emerging public health threat.
2. Methods
The PubMed database was searched in June 2023 using spine disease, spine surgery, and substance use search terms. Opinion articles, studies on extraspinal surgeries, and ongoing studies were excluded, but review articles were eligible for inclusion. Included studies tracked perioperative substance use and related spine surgery outcomes.
3. Results
Thirteen of nineteen included studies investigated perioperative opioid use and collectively found deleterious postoperative effects of acute, subacute, and chronic opioid use in spine surgery patients. Impacts were consistent across prescription and illicit drugs, even in opioid naïve patients and those receiving low-dose
regimens, though SUD exacerbated effects.
One study investigated opioids and muscle relaxants and showed elevated reoperation risk with both compared to controls (40% and 19%, respectively). A case report series of patients with SUDs also found increased complications and inadequate follow-ups. Postoperative effects of these substances included increased pain, surgical site infection rates, reoperations, healthcare costs, and medical complication rates.
Data on cannabis use remains contradictory. One study demonstrated reduced complications; another, decreased length of hospital stays; others, no effect or increased complications.
4. Conclusion
Substance use diminishes spine surgery success rates and increases medical complications, reoperations, and healthcare costs, whether use is acute or continuous with chronic SUD. As such, enhanced preoperative screening and careful prescribing should be a high priority in these patients, and perioperative patient education may also mitigate risks resulting from postoperative pain management regimens.

Perioperative Prescription and Illicit Substance Use Profoundly Impacts Spine Surgery Outcomes

Background
Acute hip fractures are a public health problem that affect primarily older adults. Given the subtleties in different patient indications and classifications such as fracture type, preoperative mobility/functional status, and presence or absence of preexisting/symptomatic arthritis, Chat Generative Pre-trained Transformer (ChatGPT) may be a helpful clinical decision-making tool in the treatment plan to optimize patient outcomes. The purpose of this study was to evaluate the accuracy of ChatGPT-4.0 by comparing its appropriateness scores for acute hip fractures with the American Academy of Orthopedic Surgeons (AAOS) Appropriate Use Criteria (AUC) given various patient scenarios. 

Methods
Using the AUC as the gold standard, a numerical scale was utilized to quantify the appropriateness of 6 different treatments. Quantitative scores ranging from 1-9 were assigned as follows: 7-9 signifies “Appropriate,” 4-6 signifies “May Be Appropriate,” and 1-3 signifies “Rarely Appropriate.” ChatGPT-4.0 was prompted separately and asked to assign an appropriate score for each treatment. To measure any notable errors, AAOS AUC scores were subtracted from the ChatGPT-4.0 scores, and the mean error, mean absolute error, and mean squared error were calculated. Spearman’s rank correlation coefficients and paired t-tests were used to determine statistical significance.

Results
30 patient scenarios were evaluated among 6 different treatment options for a total of 180 paired scores. Spearman’s rank correlation testing found that there was a very strong positive correlation between AAOS and ChatGPT-4.0 scores for Multiple Cannulated Screw Fixation, a strong positive correlation between scores for THA and for Hemiarthroplasty, and a moderate positive correlation for Long Cephalomedullary Nails. There was a non-significant weak positive correlation between scores for Short Cephalomedullary Nails and for Sliding Hip Screw ± Anti-Rotation Screw. Using a paired t-test, there were significant differences between scores for Long Cephalomedullary Nails.

Conclusion
The AAOS AUC is designed to optimize treatment outcomes for acute hip fractures in adults by improving the quality of care, and minimizing short- and long-term mortality. The appropriateness scores for THA, Hemiarthroplasty, Long Cephalomedullary Nails, and Multiple Cannulated Screw Fixation determined by ChatGPT-4.0 were positively correlated with the AUC scores. ChatGPT-4.0 overestimated the appropriateness of THA, Hemiarthroplasty, and Long Cephalomedullary Nails. The scores to treat with Long Cephalomedullary Nails were non-equivalent. Although it demonstrated some utility in recommending the appropriateness of treatment options for acute hip fractures in older adults, clinicians should refrain from fully relying on ChatGPT-4.0. The AI model needs improvement to assist physicians and must be further evaluated.

Underline digital video library

Analyses of Methanogenic Small Intestine Overgrowth Effects on Growth in Tanzanian Children

Differences in Motor Learning Between Children with Cerebral Palsy and Typically Developing Peers Using a Dynamic Balance Task

Enrichment of secondary genetic findings of TTR, RYR1, and LDLR in a cohort of 8667 African-American pediatric subjects

Stratum-Specific Preoperative Hemoglobin Intervals Quantify the Likelihood of Blood Transfusion, Major Complications, and Periprosthetic Joint Infection Following Total Knee Arthroplasty

Outcomes and Spine Oncology Surgery With and Without Plastic Surgery Reconstruction

The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

Retrograde Reamer-Irrigator-Aspirator (RIA) with Prophylactic Intramedullary Nailing vs Posterior Iliac Crest for Bone Grafting

SGA and age at menarche in a diverse population-based U.S. sample

Low Socioeconomic Indicators Correlate with Greater Pre-Operative Glenoid Bone Loss

Perioperative Prescription and Illicit Substance Use Profoundly Impacts Spine Surgery Outcomes

Can Large Language Models Recommend Treatment for Hip Fractures?

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