Two-dimensional (2D) multiferroic materials with robust magnetoelectric coupling and controllable topological solitons (such as skyrmions) are promising candidates for advanced information storage and processing. Due to the limitations of experimental techniques, first-principles investigations stand out in answering fundamental questions of 2D multiferroic couplings, thus providing guidance for experimental validation. Herein, we will give a review of recent theoretical progress in the exploration of 2D multiferroic coupling via structural design and molecular engineering approach. Particularly, we will focus on (i) how to design the multiferroic structure in the 2D form; (ii) how to achieve robust magnetoelectric coupling; and (iii) how to electrically control the magnetic skyrmion via multiferroic effects. Finally, we give some perspectives on the remaining challenges and opportunities for predicting 2D multiferroic materials.

Perspective on computational design of two-dimensional materials with robust multiferroic coupling

<h3>Purpose</h3> To create a cut-off point for hyperextension that best discriminates retear and to verify whether this cut-off point can predict retear regardless of other characteristics after primary anterior cruciate ligament (ACL) reconstruction with hamstrings autograft. <h3>Methods</h3> A cohort of patients submitted to primary isolated ACL reconstruction with hamstrings autografts was retrospectively evaluated. Patients were stratified according to the degree of passive knee hyperextension measured in the normal contralateral knee. The following data were collected: patient age and sex, time from injury to surgery, knee hyperextension, KT-1000 and pivot-shift, associated meniscus injury, intra-articular graft size, follow-up time, graft failure, and postoperative Lysholm and subjective International Knee Documentation Committee scores. <h3>Results</h3> Data from 457 patients were evaluated. Median age was 31 years. Thirty-two (7.0%) presented with retear. There was a significant difference in hyperextension between patients with and without retear (<i>P</i> < .001), with the cut-off point established by the receiver operating characteristic curve from 6.5°. Patients with greater hyperextension had a statistically greater frequency of women, longer injury time, greater intra-articular graft diameter, greater postoperative KT-1000, and greater frequency of retear, whereas the subjective International Knee Documentation Committee and Lysholm scores were statistically lower in patients with greater hyperextension. Only hyperextension showed a statistically significant association with re-rupture (<i>P</i> < .001). The odds of retear in patients with hyperextension greater than 6.5 was 14.65 times the odds of patients with hyperextension less than 6.5. <h3>Conclusions</h3> Patients with more than 6.5° of hyperextension are 14.6 times more likely to have a graft rupture than patients with lower hyperextension when submitted to ACL reconstruction with hamstring tendons. Also, they present worse knee stability by the KT-1000 test and worse functional outcomes. Therefore, patients with this degree of hyperextension should not have isolated reconstruction with hamstrings as their first choice. <h3>Level of Evidence</h3> Level III, retrospective comparative prognostic trial. 

The cut-off point to discriminate a higher odds of re-tear is 6.5 degrees of hyperextension in isolated anterior cruciate ligament reconstruction with hamstring autograft.

Two-Dimensional Janus Nanostructures M2AB (M = Si, Ge, Sn, A/B = N, P, As) for Piezoelectric Power Generation

Background: Typically, shoulder range of motion (ROM) measurements are performed in a clinic setting, where physicians, physical therapists (PTs), and occupational therapists make use of a goniometer. Purpose: To determine the accuracy of a smartphone-based ROM software application (app) in assessing active shoulder ROM and compare the measurements with traditional goniometry as measured by a PT. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: This prospective, nonblinded study was conducted at a single institution with adult asymptomatic participants with full active ROM of both shoulders. Participants were enrolled between June 1 and 15, 2021. Each participant self-assessed their active shoulder ROM using the PeerWell smartphone app. A single PT concurrently measured each participant’s active shoulder ROM using a handheld universal goniometer. Bilateral shoulder ROM (forward flexion, abduction [AB], external rotation, internal rotation [IR], and extension) was measured 2 times for each participant. Interrater reliability between the smartphone app and PT measurements as well as intrarater reliability for each method of measurement were assessed using the intraclass correlation coefficient (ICC), and limits of agreement were analyzed for the difference in measurement methods. Results: Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age, 31.4 ± 11.7 years; 73% female). The interrater reliability between the 2 methods was excellent for all movements (ICCs, 0.90-0.96). For all movements except shoulder AB, the mean difference in the measurements between the 2 methods was &lt;1.3°; the mean difference in AB ROM was 2.08°. For all movements except IR, both PTs and the app showed excellent intrarater reliability (ICCs &gt;0.90); for IR, good intrarater reliability (ICC ≥0.75) was observed. Conclusion: The PeerWell smartphone app provided measurements comparable with manual measurements taken by a PT using a goniometer. These data provide evidence that the smartphone app is a reliable and valid tool for measuring shoulder ROM and show promise for measuring and monitoring patient ROM remotely. 

Accuracy of a Smartphone Software Application Compared With a Handheld Goniometer for Measuring Shoulder Range of Motion in Asymptomatic Adults

Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination.A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on applications, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by adherence and patient satisfaction, functional outcomes and pain scores, gait analyses and ranges of motion, and measurement and comparison tools.A review of 24 of 25 publications related to smartphone applications used for postoperative recovery in TKA showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies used in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months.Smartphone applications and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of TKA patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings. 

Integrating Smartphone Applications and Wearable Devices for Post-Operative Rehabilitation in Total Knee Arthroplasty: A Critical Review.

Two-dimensional (2D) materials have potential applications in nanoscale sensors and spintronic devices. Herein, motivated by experimental synthesis of a CrI3 monolayer possessing intrinsic magnetism and a Janus MoSSe monolayer with piezoelectricity, we propose a 2D Janus Cr2I3F3 monolayer as a multifunctional material exhibiting both piezoelectricity and ferromagnetism. Using density functional theory calculations, we systematically investigated the structural stability and the electronic, magnetic, and piezoelectric properties of the Janus Cr2I3F3 monolayer. We predicted that a vertical polarization of up to −0.155 × 10−10 C/m is induced in the Cr2I3F3 monolayer due to the breaking of symmetry. The origination mechanism of polarization was demonstrated in terms of a local dipole moment calculated by maximally localized Wannier functions. Meanwhile, it was found that a remarkable piezoelectric response can be produced under a uniaxial strain in the basal plane. The calculated piezoelectric coefficients of the Cr2I3F3 monolayer compare favorably with those of the frequently used bulk piezoelectric materials such as α–quartz and wurtzite AlN. Particularly, the e31 and d31 values of the Cr2I3F3 monolayer are nearly 10 times as large as that of Mo-based transition metal dichalcogenides. We also found that the magnitude of e31 mainly arises from the ionic contribution, while the electronic contribution can be nearly neglected. The considerable piezoelectric response combined with the intrinsic magnetism make the Janus Cr2I3F3 monolayer a potential candidate for novel multifunctional devices integrating both piezoelectric and spintronic applications.

/pdf/large-vertical-piezoelectricity-in-a-janus-cr2i3f3-monolayer-1jat2abx.pdf

Large Vertical Piezoelectricity in a Janus Cr2I3F3 Monolayer

Objectives: Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting. Methods: A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/) Results: Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed. Conclusions: These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.

Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion

Digital technology has emerged as a useful tool for preoperative and postoperative patient engagement and for remote patient monitoring. Smartphones are equipped with motion-sensing technology, and apps can be designed which use these features to create a simple method for measuring range of motion. The purpose of this study was to determine the accuracy of digital technology in assessing knee range of motion using a smartphone app, compared to traditional goniometric measurements in an office setting.Fifty-three (53) patients in a clinical practice were enrolled between October 2019 and March 2020. Three separate measurements were taken during the patient encounter: (1) the surgeon, (2) the app, and (3) the physical therapist. Intraclass correlations were computed to assess the agreement between (1) the surgeon and app and (2) that between the physical therapist and surgeon.When measuring flexion, the correlation between either the surgeon or therapist with the app was good, whereas the comparison between the surgeon and therapist was moderate. All extension measurement comparisons, between the app, surgeon, and therapist, showed moderate correlation. Limits of agreements showed that 80% of the difference between surgeon and app is within 10 degrees for extension and 11 degrees for flexion. Body mass index did not affect the accuracy of the measurements.Digital app measurements were comparable to measurements made by either a surgeon or physical therapist with a manual goniometer in the clinical setting and may be beneficial for measuring and monitoring patients' range of motion remotely. 

Comparison of a Smartphone App to Manual Knee Range of Motion Measurements

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Large Vertical Piezoelectricity in a Janus Cr2I3F3 Monolayer

Accuracy of a Smartphone Software Application Compared With a Handheld Goniometer for Measuring Shoulder Range of Motion in Asymptomatic Adults

Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion

Comparison of a Smartphone App to Manual Knee Range of Motion Measurements