Search Results (66)

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research. Full article

Background/Objectives: Meniscal root tears, particularly those of the posterolateral root, are frequently associated with anterior cruciate ligament (ACL) injuries and significantly alter load distribution and knee stability. Surgical repair of the posterolateral meniscal root (PLMR) aims to restore normal biomechanics; however, postoperative rehabilitation strategies remain heterogeneous. The objective of this systematic review was to describe and analyze postoperative weight-bearing (WB) and range-of-motion (ROM) protocols following concomitant PLMR repair and anterior cruciate ligament reconstruction (ACLR), integrating both clinical and biomechanical perspectives. Methods: This systematic review followed PRISMA guidelines and analyzed biomechanical and clinical studies assessing postoperative WB and ROM management following PLMR repair combined with ACLR. Results: Eleven studies were included, describing heterogeneous postoperative rehabilitation protocols for WB and ROM following posterolateral meniscal root repair with ACLR. Biomechanical data consistently showed that root section increased tibial internal rotation and contact pressure on the lateral tibial plateau, whereas repair restored near-native load sharing. Clinically, most authors recommended non-weight-bearing or toe-touch loading for 4–6 weeks and flexion limited to 0–90° during early rehabilitation. Gradual progression to full loading and motion between 8 and 12 weeks was the most consistent strategy. Conclusions: Although the current evidence is limited and mainly based on low-level studies, available data suggest that a cautious and progressive rehabilitation protocol after PLMR repair with ACLR early controlled motion and delayed full loading may optimize repair healing while protecting graft integrity. Full article

TLS 1.3 is a crucial protocol for securing modern internet communications. To facilitate a smooth transition to post-quantum security, hybrid key exchange, which combines classical key exchange algorithms with post-quantum key encapsulation mechanisms (KEMs), is proposed to enhance the security of the current TLS 1.3 handshake. However, existing drafts and implementations of hybrid key exchange for TLS 1.3 primarily rely on CCA-secure KEMs (i.e., secure against chosen-ciphertext attacks) based on the Fujisaki-Okamoto (FO) transform. The re-encryption step in their decapsulation algorithms not only introduces additional performance overhead but also raises the risk of side-channel attacks. Although Huguenin-Dumittan and Vaudenay (Eurocrypt 2022) and Zhou et al. (Asiacrypt 2024) demonstrated that the weaker CPA-secure KEMs (i.e., secure against chosen-plaintext attacks) suffice for constructing a secure TLS 1.3 handshake, their analyses were limited to single-KEM settings and did not consider the hybrid key exchange scenario. This work challenges the necessity of CCA security by proving that CPA-secure KEMs are sufficient for the TLS 1.3 handshake even in the hybrid key exchange setting. We provide the first formal security proofs for this claim, covering both the classical random oracle model (ROM) and the quantum random oracle model (QROM), thereby ensuring security against quantum adversaries. To validate the practical benefits, we conduct an extensive performance evaluation based on the latest OpenSSL implementation. Our results show that using CPA-secure KEMs yields up to 44.8% performance improvement at the key exchange layer and up to approximately 9% acceleration for the full TLS 1.3 handshake. Beyond performance gains, this approach reduces the codebase’s attack surface by eliminating the re-encryption step, thereby mitigating a class of side-channel vulnerabilities. Our work positions CPA-secure KEMs as a secure, efficient, and practical alternative for standardizing and deploying post-quantum TLS 1.3 even with hybrid key exchange. Full article

Background/Objectives: Studies have demonstrated significant morbidity and mortality associated with airway management, especially when provided outside of the operative setting. The goal of this study was to compare baseline measurements of airway management procedures between anesthesia providers (CRNAs and anesthesiologists) and respiratory therapists using high-fidelity manikins. Methods: This prospective study assessed anesthesia providers and respiratory therapists performing direct laryngoscopy (DL), video laryngoscopy (VL), and LMA placement. The same Laerdal SimMan high-fidelity manikin (Laerdal, Stavanger, Norway) was used in all assessments, with the detection of end-tidal “carbon dioxide” serving as evidence of success for each procedure. Each procedure was performed twice, once under “Healthy Patient” SimMan settings, and once under the “Limited Cervical Range of Motion (ROM)” (DL), “Pharyngeal Obstruction” (VL), and “Full Tongue Edema” (LMA) settings, respectively, to simulate a moderately difficult airway. The order in which the techniques were performed was randomized for each participant. Completion time and number of attempts were recorded for each procedure and compared between the groups. Results: Sixty-two providers (30 anesthesia providers and 32 respiratory therapists) were enrolled. There were no significant differences in average time to completion for any procedure, except respiratory therapists took longer than anesthesia providers in VL with simulated pharyngeal obstruction (p = 0.0004). There were no differences in number of attempts needed for successful completion. Conclusions: This study demonstrates that while completion times for DL and LMA placement were similar amongst provider groups, average time to completion of VL for respiratory therapists was longer under difficult simulated settings. These results reflect potential areas of improvement for other provider groups that may have airway privileges at their respective institutions. Full article

Objectives: This systematic review aimed to examine hip rotator range of motion (ROM) and strength values across athletic, injured, and non-active populations, and to determine how these values differ when measured at different hip flexion angles. Methods: A systematic literature search was conducted in accordance with PRISMA guidelines across six electronic databases (PubMed, Scopus, Web of Science, SPORTDiscus, CINAHL, and Medline) from inception to June 2025. Eligible studies included observational, cross-sectional, case-control, or randomized controlled trial (RCT) studies that quantitatively assessed hip IR/ER ROM and/or strength in defined population groups (athletic, injured, or non-active). Two reviewers independently screened titles, abstracts, and full texts, extracted data on study design, population characteristics, measurement methods, and outcome variables, and assessed risk of bias using an established tool. Discrepancies were resolved by a third reviewer. Results: 11 studies met the inclusion criteria, including 1276 participants across athletic, injured, and non-active populations. Hip rotator ROM was measured in nine studies and strength in three, with varying testing angles (0° and/or 90° hip flexion). Overall, athletes showed greater ROM at 0° compared to injured and non-active groups, but had reduced ROM at 90° relative to non-active participants. Non-active individuals had the lowest ROM at 0°. Strength findings, though limited, indicated higher values at 90° than at 0°. Conclusions: Hip rotator ROM and strength vary across populations and testing angles, with ROM generally lower and strength higher at 90° of hip flexion. Due to methodological inconsistencies, findings should be interpreted as directional evidence, reinforcing the need for standardized assessment protocols in future research. Full article

Digital twins (DTs) offer significant promise for condition-based maintenance of floating offshore wind turbines (FOWTs); however, existing solutions typically compromise either on physical rigor or real-time computational performance. This paper presents a real-time DT framework that resolves this trade-off by embedding a hydro-elastic reduced-order model (ROM) that accurately captures structural dynamics and fluid–structure interaction. Integrated in a cloud-ready Internet of Things architecture, the ROM reconstructs full-field displacements, von Mises stresses, and fatigue metrics with near real-time responsiveness. Validation on the 5 MW OC4-DeepCWind semi-submersible platform shows that the ROM reproduces finite-element (FEM) displacements and stresses with relative errors below 1%. A three-hour load case is solved in 0.69 min for displacements and 3.81 min for stresses on a consumer-grade NVIDIA RTX 4070 Ti GPU—over two orders of magnitude faster than the full FEM model—while one million fatigue stress histories (1000 hotspots × 1000 operating scenarios) are processed in 37 min. This efficiency enables continuous structural monitoring, rapid *what-if* assessments and timely decision-making for targeted inspections and adaptive control. By effectively combining physics-based reduced-order modeling with high-throughput computation, the proposed framework overcomes key barriers to DT deployment: computational overhead, physical fidelity and scalability. Although demonstrated on a steel platform, the approach is readily extensible to composite structures and multi-turbine arrays, providing a robust foundation for cost-effective and reliable deep-water wind-energy operations. Full article

Introduction. We hypothesized changes in the elasticity in quadriceps and patella tendon before and after total knee arthroplasty would be correlated with a post-operative range of motion after total knee arthroplasty. To prospectively assess the post-operative range of motion after total knee arthroplasty, logistic regression was adopted with elasticity in the quadriceps and patella tendons were measured using shear wave elastography (SWE). Materials and Methods. From March 2021 to June 2021, SWE was performed on 95 patients (86 women; aged 57–85, mean 70.62 ± 5.49 years) preoperatively and 2 days after total knee arthroplasty. Elasticity at quadriceps and patellar tendons were measured with full flexion and extension using SWE. Based on the range of motion after surgery at 56 days, we divided the patients into two groups (Group A > 120 degrees; group B < 120 degrees). Using a logistic regression algorithm, classification between groups was performed. For the input of algorithm, patient information, the elasticity of quadriceps and patella tendons preoperatively and two days after total knee arthroplasty were used. Results. The accuracy of predicting group using only patient information was 62%, whereas using only elasticity was 68%. Furthermore, combining information and elasticity before and after surgery at 2 days, accuracy, sensitivity, specificity was 79%, 92%, 56%. Conclusions. Combined with patient information, elasticity measured by SWE at pre-op and early post-op periods could be effective to predict the performance of postoperative ROM. This algorithm could provide direction for rehabilitation. Full article

Background: The medial (MG) and lateral gastrocnemius (LG) muscles exhibit differential activation patterns during plantar flexion tasks. However, the influence of range of motion (ROM), exercise type (unilateral vs. bilateral), and limb dominance on muscle activity during heel raise exercises (HREs) remains unclear. Methods: Nineteen physically active adults performed unilateral and bilateral HREs under two ankle ROM conditions: neutral (NROM) and full (FROM). Surface electromyography (EMG) was collected from both legs during each condition and normalized to peak values recorded during overground sprinting. Results: MG activity was significantly higher during the FROM than the NROM, in both the dominant leg (F = 11.55, p < 0.01, η² = 0.47) and the non-dominant leg (F = 6.63, p < 0.05, η² = 0.31), and was not affected by exercise type. In contrast, LG activity increased significantly during unilateral versus bilateral HREs, especially in the dominant leg during the FROM (F = 17.47, p < 0.01, η² = 0.52) and in the non-dominant leg (F = 5.44, p < 0.05, η² = 0.25). Activation ratios (MG:LG) differed significantly between dominant and non-dominant legs only in the unilateral FROM (p = 0.03). MG activation during the unilateral FROM was comparable to sprinting values, highlighting its high neuromuscular demand. Conclusion: The MG and LG respond differently to exercise parameters. The MG is primarily influenced by ROM, whereas the LG is sensitive to both exercise type and limb dominance. These findings emphasize the importance of ROM manipulation and unilateral training to target specific gastrocnemius regions. FROM and unilateral execution optimize gastrocnemius activation, with implications for rehabilitation and performance programs targeting calf musculature. Full article

Introduction: Spinal thrust manipulation has been found useful for improving pain and mobility in musculoskeletal conditions of the thoracic spine. This case report highlights the importance of incorporating high-velocity low-amplitude (HVLA) thrust manipulation to the mid-thoracic rib articulations in a patient experiencing thoracic spine pain associated with an acute onset of osteomyelitis at levels T7–T9. Detailed Case Description: A 49-year-old female who was recovering from osteomyelitis of the thoracic spine 4 months prior was referred to physical therapy by her neurosurgeon. Her osteomyelitis infection resulted in a bone-on-bone interaction between T7 and T9, resulting in significant thoracic spine pain. Severe restrictions in active range of motion (AROM) were found in extension and right and left rotation. At initial evaluation, the patient’s pain intensity score was 8/10 (NPRS, 0–10), the disability score was 46/50 (NDI, 0–50), and the patient-specific functional scale score was 3/10 (PSFS, 0–10). Initially, interventions included grades I-IV posterior to anterior (PA) mobilizations of the thoracic spine from levels T2 to T9, mobilization with movement of the thoracic spine for extension and rotation bilaterally, scapular stabilization, and thoracic mobility exercises. Treatment progressed to HVLA thrust manipulation techniques targeting the costotransverse articulations of ribs 2–9. Discussion: Following the initial eight treatment sessions over 4 weeks, minimal improvement was observed for pain (NPRS from 8/10 to 6/10), disability (NDI from 46/50 to 34/50), and thoracic extension AROM (13°). However, during visits 9–16, the addition of HVLA thrust manipulation targeting the costotransverse articulations resulted in significant improvements in pain, disability, and AROM. The patient was subsequently discharged after 16 visits and able to return to a full workday as a teacher without any thoracic pain or ROM restrictions. At the 6-month follow-up, the patient outcomes remained, and she was working with no restrictions. Conclusion: The addition of HVLA thrust manipulation targeting the mid-thoracic rib articulations to a program of non-thrust mobilization and exercise appeared useful for improving pain, disability, and range of motion in a patient recovering from osteomyelitis of the thoracic spine. Full article

In the present paper, a reduced-order modeling (ROM) approach based on a hybrid neural network is presented in order to calculate wing buffet pressure distributions due to structural eigenmode-based deformations. The accurate prediction of unsteady surface pressure distributions is crucial for assessing aeroelastic stability and preventing structural failure, but full-order simulations are computationally expensive; the proposed ROM provides a fast and efficient alternative with a sufficient level of accuracy. The hybrid ROM is defined by a series connection of a convolutional autoencoder (CNN-AE) and a long short-term memory (LSTM) neural network. As a test case, the NASA Common Research Model (CRM) configuration for the transonic buffet condition is applied. Forced-motion computational fluid dynamics (CFD) simulations are conducted in order to obtain the aerodynamic responses induced by the eigenmode-based deformations. For the unsteady simulations, the triangular adaptive upwind (TAU) solver of the German Aerospace Center (DLR), is used. Based on a selected structural model, symmetric and asymmetric eigenmode-based deformations of the wing structure are implemented and considered for performance evaluation. Comparing the pressure loads modeled by the hybrid ROM and the reference full-order numerical solution, an overall good prediction performance is indicated with mean squared error (MSE) values mostly below $3\%$, reaching local maxima of about $12\%$, due to strong pressure gradients associated with pronounced shock oscillations. Full article

The present review summarizes the effects of manipulating different resistance exercise variables on jumps, sprints, and changes of direction (CODs) in soccer. Regarding jumps, moderate-to-high loads, full range of movement (ROM), non-failure sets, and a moderate training volume are recommended. Different external resistances like constant-load, flywheel, or elastic bands, as well as various movement velocities and select exercises, are equally effective. As for sprints, moderate-to-high loads, constant load or flywheel but not elastic resistances, movements performed at full ROM, non-failure sets, and moderate-to-high training volume might be more effective, while numerous movement velocities and exercises could be chosen. As for CODs, moderate-to-high loads, flywheel more than constant-load resistance, and a moderate-to-high total number of repetitions are recommended, while several movement velocities and exercises could be selected, though ROM needs investigation. The effectiveness of concentric-only vs. eccentric-only training on jumps, sprints, and CODs has not been investigated, while an external focus and inter-set rest > 2 min are theoretically preferable, albeit not proven. Importantly, high movement velocity is not a prerogative of effectiveness, and limited ROM is not associated with sport-specific patterns such as jumps. Practitioners in soccer may manipulate resistance exercise variables depending on the purpose. Full article

Introduction: Meniscus injuries are common among endurance athletes, requiring structured rehabilitation to restore function and facilitate a safe return to sport. Traditional in-person rehabilitation may not always be accessible or feasible for high-performance athletes. Telerehabilitation, incorporating virtual reality, motion tracking, and telemonitoring, offers an innovative approach to guided recovery. However, evidence supporting its effectiveness in elite athletes remains limited. Case presentation: This case report explores the application of an innovative telerehabilitation program for a 49-year-old triathlete recovering from partial meniscectomy following a medial meniscus tear. The program was structured into three progressive phases over 12 weeks, focusing on restoring range of motion (ROM), muscle strength, and functional stability while gradually reintroducing sports-specific activities. Results: By the end of the rehabilitation, the patient achieved full ROM and muscle strength (scoring 5/5 on the Medical Research Council scale for the vastus medialis), along with a pain-free state in both static and dynamic conditions. The integration of telemonitoring devices facilitated detailed monitoring and feedback, enabling personalized adjustments to the rehabilitation protocol. Key milestones included a return to swimming and cycling in Phase 2, reintroduction of running in Phase 3, and a full resumption of triathlon training by week 12. Conclusions: Despite the positive results, the study highlights the need for further research to validate these findings across larger cohorts and establish standardized telerehabilitation protocols for athletes. This case underscores the potential of digital health technologies in enhancing recovery trajectories for high-demand athletes post-meniscus surgery, paving the way for supervised, accelerated, and effective sports reintegration. Full article

This study develops and validates a Reduced Order Model (ROM) integrated with Digital Twin technology for real-time temperature control in the Main Control Room (MCR) of a nuclear power plant. Utilizing Computational Fluid Dynamics (CFD) simulations, we obtained detailed three-dimensional thermal flow distributions under various operating conditions. A ROM was generated using machine learning techniques based on 94 CFD cases, achieving a mean temperature error of 0.35%. The ROM was further validated against two excluded CFD cases, demonstrating high correlation coefficients (R > 0.84) and low error metrics, confirming its accuracy and reliability. Integrating the ROM with the Heating, Ventilating, and Air Conditioning (HVAC) system, we conducted a two-month simulation, showing effective maintenance of MCR temperature within predefined criteria through adaptive HVAC control. This integration significantly enhances operational efficiency and safety by enabling real-time monitoring and control while reducing computational costs and time associated with full-scale CFD analyses. Despite promising results, the study acknowledges limitations related to ROM’s dependency on training data quality and the need for more comprehensive validation under diverse and unforeseen conditions. Future research will focus on expanding the ROM’s applicability, incorporating advanced machine learning methods, and conducting pilot tests in actual nuclear plant environments to further optimize the Digital Twin-based control system. Full article

This study presents the design and validation of a numerical method based on an AI-driven ROM framework for implementing stress virtual sensing. By leveraging Reduced-Order Models (ROMs), the research aims to develop a virtual stress transducer capable of the real-time monitoring of mechanical stresses in mechanical components previously analyzed with high-resolution FEM simulations under a wide range of multiple load scenarios. The ROM is constructed through neural networks trained on Finite Element Method (FEM) outputs from multiple scenarios, resulting in a simplified yet highly accurate model that can be easily implemented digitally. The ANN model achieves a prediction error of ${\mathrm{MAE}}_{\mathrm{test}}=(0.04\pm 0.06) \mathrm{MPa}$ for the instantaneous mechanical stress predictions, evaluated over the entire range of stress values (0 to 5.32 MPa) across the component structure. The virtual sensor is capable of producing a quasi-instantaneous, detailed full stress map of the component in just 0.13 s using the ROM, for any combination of 4-load inputs, compared to the 6 min and 31 s required by the FEM. Thus, the approach significantly reduces computational complexity while maintaining a high degree of precision, enabling efficient real-time monitoring. The proposed method’s effectiveness is demonstrated through rigorous ROM validation, underscoring its potential for stress control. This precise AI-driven procedure opens new horizons for predictive maintenance strategies centered on stress cycle monitoring. Full article

Introduction: This study hypothesized that changes in the elasticity of the quadriceps and patellar tendons before and after the diagnosis of patellar tendinopathy would correlate with the range of motion (ROM) following conservative treatment. We aimed to prospectively assess post-treatment ROM using multinomial logistic regression, incorporating elasticity measurements obtained via shear wave elastography (SWE). Materials and Methods: From March 2023 to April 2024, 95 patients (86 men; aged 20–45 years, mean 25.62 ± 5.49 years) underwent SWE preoperatively and two days post-diagnosis of patellar tendinopathy. Elasticity measurements of the rectus femoris, vastus medialis, vastus lateralis, patellar tendon, and biceps tendon were obtained during full flexion and extension. Based on ROM 56 days post-treatment, patients were categorized into two groups: Group A (ROM > 120 degrees) and Group B (ROM < 120 degrees). A multinomial logistic regression algorithm was employed to classify the groups using patient information and tendon elasticity measurements both at diagnosis and 1-week post-diagnosis. Results: The predictive accuracy using only patient information was 62%, while using only elasticity measurements yielded 68% accuracy. When combining patient information with elasticity measurements taken at diagnosis and two days post-diagnosis, the algorithm achieved an accuracy of 79%, sensitivity of 92%, and specificity of 56%. Conclusions: The combination of patient information and tendon elasticity measurements obtained via SWE at pre-conservative treatment and early post-conservative treatment periods effectively predicts post-treatment ROM. This algorithm can guide rehabilitation strategies for soldiers with patellar tendinopathy. Full article