On the geometrization of matter by exotic smoothness

In this paper we discuss the question how matter may emerge from space. For that purpose we consider the smoothness structure of spacetime as underlying structure for a geometrical model of matter. For a large class of compact 4-manifolds, the elliptic surfaces, one is able to apply the knot surgery of Fintushel and Stern to change the smoothness structure. The influence of this surgery to the Einstein-Hilbert action is discussed. Using the Weierstrass representation, we are able to show that the knotted torus used in knot surgery is represented by a spinor fulfilling the Dirac equation and leading to a mass-less Dirac term in the Einstein-Hilbert action. For sufficient complicated links and knots, there are "connecting tubes" (graph manifolds, torus bundles) which introduce an action term of a gauge field. Both terms are genuinely geometrical and characterized by the mean curvature of the components. We also discuss the gauge group of the theory to be U(1)xSU(2)xSU(3).Comment: 30 pages, 3 figures, svjour style, complete reworking now using Fintushel-Stern knot surgery of elliptic surfaces, discussion of Lorentz metric and global hyperbolicity for exotic 4-manifolds added, final version for publication in Gen. Rel. Grav, small typos errors fixe

Exotic Smoothness and Quantum Gravity

Since the first work on exotic smoothness in physics, it was folklore to assume a direct influence of exotic smoothness to quantum gravity. Thus, the negative result of Duston (arXiv:0911.4068) was a surprise. A closer look into the semi-classical approach uncovered the implicit assumption of a close connection between geometry and smoothness structure. But both structures, geometry and smoothness, are independent of each other. In this paper we calculate the "smoothness structure" part of the path integral in quantum gravity assuming that the "sum over geometries" is already given. For that purpose we use the knot surgery of Fintushel and Stern applied to the class E(n) of elliptic surfaces. We mainly focus our attention to the K3 surfaces E(2). Then we assume that every exotic smoothness structure of the K3 surface can be generated by knot or link surgery a la Fintushel and Stern. The results are applied to the calculation of expectation values. Here we discuss the two observables, volume and Wilson loop, for the construction of an exotic 4-manifold using the knot $5_{2}$ and the Whitehead link $Wh$. By using Mostow rigidity, we obtain a topological contribution to the expectation value of the volume. Furthermore we obtain a justification of area quantization.Comment: 16 pages, 1 Figure, 1 Table subm. Class. Quant. Grav

Measurement properties of the Edmonton Frail Scale in older adults: a systematic review and meta-analysis

Background: Frailty is a clinical condition characterised by heightened vulnerabilities to stressors and negative health consequences. The Edmonton Frail Scale is a prominent multidimensional tool for assessing frailty across various settings. Objectives: This review aimed to synthesise and evaluate the certainty of evidence and the quality of Edmonton Frail Scale in older adults aged 60 and above with respect to its reliability (test–retest, inter-rater) and construct validity (convergent, known-group). Design: Systematic review and meta-analysis. Setting and participants: Older adults across clinical and community settings. Methods: A comprehensive search was conducted across eight databases from inception to 29 January 2024. An updated search in MEDLINE (PubMed) on 10 April 2025 identified no additional eligible articles. COSMIN risk-of-bias checklist was used for quality appraisal, and evidence synthesis followed COSMIN guidelines. Random-effects meta-analysis and univariate logistic regression was used to quantitatively synthesise evidence for reliability and construct validity, respectively. Results: Twenty studies involving 3852 older adults were included. The original Edmonton Frail Scale demonstrated sufficient construct validity across most populations, supported by high certainty of evidence. However, construct validity was inconsistent in acute care populations and in studies using modified Edmonton Frail Scale versions, where content adaptations (e.g., omission of performance-based items) may have affected psychometric performance. Meta-regression revealed that modified versions were significantly less likely to yield positive validity ratings compared to the original Edmonton Frail Scale (OR = 0.29; 95 % CI: 0.09–0.95; p = 0.042). Test–retest and inter-rater reliability were sufficient, though heterogeneity was considerable, and certainty of evidence remained moderate. Conclusion: The Edmonton Frail Scale shows good overall reliability and validity in assessing frailty among older adults, particularly in stable clinical or community settings. However, caution is warranted when using modified versions or applying the tool in acutely ill populations. Future studies should validate Edmonton Frail Scale adaptations and enhance the precision of reliability estimates, especially in underrepresented regions and high-risk subgroups. Registration: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024504735)

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

Objective: To define a minimum Standard Set of outcome measures and case-mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients. Methods: An international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus. Results: The working group reached consensus on a concise set of outcome measures to evaluate patients’ joint pain, physical functioning, health-related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients. Conclusion: We have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value-based health care improvements in the treatment of hip and knee OA

Phase-Variation of Pyelonephritis-Associated Pili in \u3ci\u3eEscherichia coli\u3c/i\u3e: Evidence for Transcriptional Regulation

The regulation of pyelonephritis-associated pill (pap) pflin gene transcription has been examined using two operons (pap-17 and pap-21) isolated from the pyelonephritogenic Escherichia coli strain C1212. DNA sequence analysis and E.coli minicell analysis were used to map two genes (papB and papl) within the pilin regulatory regions of both pap-17 and pap-21, and the protein products of these genes were identified. Pilin transcription, initiated at the papBA promoter, was monitored by constructing single copy operon fusions with lacZYA in E.coli K-12. Inocula- tion of E.coli (pap\u27-lac) strains onto solid M9 minimal medium containing glycerol and the Lac indicator X-gal (M9-Glycerol) yielded both Lac\u27 and Lac- colony phenotypes. The Lac\u27 (\u27phase on\u27) and Lac- (\u27phase off\u27) phenotypes were heritable since reinoculation of M9-Glycerol with bacteria picked from Lac\u27 colonies gave rise to a much higher fraction of Lac\u27 colonies than reinoculation of M9-Glycerol with bacteria picked from Lac- colonies. Measurement of phase transition rates for E.coli (pap17\u27-lac) inoculated onto M9-Gly- cerol showed that the Lac - -Lac+ transition frequency (1.57 x 10-4/cell/generation) was reduced 35-fold when cells were inoculated onto minimal medium containing glucose (M9-Glucose). However, the Lac+-Lac- transition frequency obtained using M9-Glycerol (2.60 x 10-2/cell/generation) was 1.4-fold lower compared to results obtained with M9-Glucose. In contrast, lowering the incubation temperature of E.coli (pap17\u27-lac) cultures from 37°C to 23\u27C caused all cells to shift to the Lac- state. Together, our results strongly indicate that pap pfli phase-variation is transcriptionally regulated and show that phase-variation is responsive to changes in the bacterial environment

Prediction of implant failure risk due to periprosthetic femoral fracture after primary elective total hip arthroplasty: a simplified and validated model based on 154,519 total hip arthroplasties from the Swedish Arthroplasty Register

While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA). We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm. The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small ( 52 mm) femoral heads increased both revision and reoperation risks. This is the first study to develop machine-learning models to forecast the risk of PPFF necessitating secondary surgery. Future studies are required to externally validate our algorithm and assess its applicability in clinical practice. [Abstract copyright: © 2025 Alagha et al.

Systematic review of injuries and chronic musculoskeletal pain among high-speed boat operators

Introduction: High-speed boat operators constitute a population at risk of work-related injuries and disabilities. This review aimed to summarize the available knowledge on workplace-related injuries and chronic musculoskeletal pain among high-speed boat operators. Materials and Methods: In this systematic review, we searched Medline, Embase, Scopus, and the Cochrane Library Database for studies, published AQ9 from 1980 to 2022, on occupational health and hazards onboard high-speed boats. Studies and reports were eligible for inclusion if they evaluated, compared, used, or described harms associated with impact exposure onboard high-speed boats. Studies on recreational injuries and operators of unplanned boats were excluded. The primary outcome of interest was the incidence of acute injuries. The secondary outcome measures comprised the presence of chronic musculoskeletal disorders, pain medication use, and days off work. Results: Of the 163 search results, 5 (2 prospective longitudinal and 3 cross-sectional cohort studies) were included in this systematic review. A total of 804 cases with 3,312 injuries sustained during 3,467 person-years onboard high-speed boats were included in the synthesis of the results. The pooled incidence rate was 1.0 per person-year. The most common injuries were related to the lower back (26%), followed by neck (16%) and head (12%) injuries. The pooled prevalence of chronic pain was 74% (95% CI: 73–75%) and 60% (95% CI: 59–62%) of the cohort consumed analgesics. Conclusions: Despite very limited data, this review found evidence that high-speed boat operators have a higher rate of injuries and a higher prevalence of chronic pain than other naval service operators and the general workforce. Given the low certainty of these findings, further prospective research is required to verify the injury incidence and chronic pain prevalence among high-speed boat operators. Review registration: PROSPERO: CRD4202235892

Higher order Josephson effects

Gaussian linking of superconducting loops containing Josephson junctions with enclosed magnetic fields give rise to interference shifts in the phase that modulates the current carried through the loop, proportional to the magnitude of the enclosed flux. We generalize these results to higher order linking of a superconducting loop with several magnetic solenoids, and show there may be interference shifts proportional to the product of two or more fluxes.Comment: 8 pages, 2 figure

Life and living in advanced age: a cohort study in New Zealand - Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

The number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand