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Arthroplasty (London, England) Jul 2024Mid-flexion instability has been identified as a cause for dissatisfaction following total knee arthroplasty (TKA). Robotic-assisted surgery using the Mako robot only...
PURPOSE
Mid-flexion instability has been identified as a cause for dissatisfaction following total knee arthroplasty (TKA). Robotic-assisted surgery using the Mako robot only allows for assessment of stability at 10° and 90°. This study aimed to investigate any evidence of mid-flexion instability in Mako-assisted TKA.
METHODS
Data from 72 TKA in 59 patients from 2018 to 2022 were collected. All patients underwent an RA (Mako, Stryker, Fort Lauderdale, FL, USA), single-radius design, cruciate-retaining TKA. Intraoperatively, medial, and lateral pressures were measured at 10°, 45° and 90° of flexion using a pressure sensor (Verasense, OrthoSensor, 59 Inc., Dania Beach, FL, USA). The knee was considered balanced if the difference in pressures between compartments was less than 15 pounds-force (lbf).
RESULTS
There was no significant difference between the pressures measured in the medial compartment at 10°, 45° and 90° of flexion (P = 0.696). A statistically significant difference was found between the pressures measured in the lateral compartment at 10°, 45° and 90° of flexion, with the 10° value being significantly higher (P < 0.001), but this did not exceed the threshold of 15 lbf. None of the patients had a pressure difference of more than 15 lbf when pressures at 45° were compared to that at 10° and 90°, medially or laterally.
CONCLUSION
This study showed no evidence of mid-flexion instability in Mako-assisted TKA, using a single radius, cruciate-retaining prosthesis whilst maintaining the joint height.
LEVEL OF EVIDENCE
Level III retrospective cohort study.
PubMed: 38946011
DOI: 10.1186/s42836-024-00253-3 -
Journal of Dairy Science Jun 2024The primary objective of this cross-sectional observational study was to determine whether bulk tank milk quality, udder health, udder hygiene and milk production...
The primary objective of this cross-sectional observational study was to determine whether bulk tank milk quality, udder health, udder hygiene and milk production outcomes were associated with facility type on organic dairies. A secondary objective was to identify other management-related risk factors associated with bulk tank milk quality, udder health, udder hygiene, and milk production on organic dairy herds in Vermont. We aimed to enroll 40 farms, to compare herds using the 2 most common systems (freestalls, tiestalls) for housing organic dairy cattle in the state with those using a bedded pack during the non-grazing season (typically November-May). Two general styles of bedded packs were observed: cultivated bedded packs and untilled deep bedded packs. Due to the limited number of herds using bedded packs to house lactating dairy cattle in Vermont, we combined untilled and cultivated bedded packs to describe udder hygiene, milk quality, and udder health on these loose-housing systems deeply-bedded with organic material. The study was completed on 21 farms (5 bedded packs, 6 freestalls, 10 tiestalls) before interruption due to the COVID-19 pandemic. Data captured from Dairy Herd Improvement Association records from the test closest to the date of the farm visit included average somatic cell score (SCS), standardized 150-d milk (pounds), % cows with current high SCS (SCS ≥ 4.0), % cows with newly elevated SCS (previous SCS < 4.0 to current ≥ 4.0), and % cows with chronically elevated SCS (SCS ≥ 4.0 last 2 tests). Multivariable linear regression models were used to describe outcomes by facility type, but suffered from limited statistical power due to small group sample sizes. Unconditional comparisons failed to find statistically significant differences between farms grouped by facility type in metrics captured from Dairy Herd Improvement Association test data, bulk tank milk somatic cell count (BTSCC) and aerobic culture data, or udder hygiene scores. A secondary analysis was conducted using univariate linear regression to identify associations between herd management factors and outcomes for all 21 farms combined. Although not all differences found were statistically significant in this secondary analysis combining all farms, numeric differences that may be biologically important are reported showing farms with deeper bedding had a lower BTSCC, lower newly elevated SCS, lower chronically elevated SCS, lower elevated current SCS, lower average SCS, and better udder hygiene metrics. Farms with lower mean udder hygiene scores had numerically lower chronically elevated SCS, lower elevated current SCS, and lower average SCS. We could not reject the null hypothesis that milk quality and udder health outcomes did not differ by facility type, and this does not preclude the existence of biological differences in these outcomes between facility types. The current study provides insight on factors affecting bulk tank milk quality, udder health and hygiene measures on organic dairy farms in Vermont. Bedded packs may be a viable option for confinement housing during the winter non-grazing season for pasture-based herds interested in a loose-housing system in the Northeastern US, but more research such as longitudinal studies with a larger sample size is needed to test this hypothesis.
PubMed: 38908690
DOI: 10.3168/jds.2023-24576 -
Emergency Medicine Journal : EMJ Jun 2024Reductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is...
Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017.
BACKGROUND
Reductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is known about the relationship of these reductions with healthcare inequalities; therefore, we investigated whether areas with greater reductions in local government funding had greater increases in socioeconomic inequalities in emergency admissions.
METHODS
We examined inequalities between English local authority districts (LADs) using a fixed-effects linear regression to estimate the association between LAD expenditure reductions, their level of deprivation using the Index of Multiple Deprivation (IMD) and average rates of (all and avoidable) emergency admissions for the years 2010-2017. We also examined changes in inequalities in emergency admissions using the Absolute Gradient Index (AGI), which is the modelled gap between the most and least deprived neighbourhoods in an area.
RESULTS
LADs within the most deprived IMD quintile had larger pounds per capita expenditure reductions, higher rates of all and avoidable emergency admissions, and greater between-neighbourhood inequalities in admissions. However, expenditure reductions were only associated with increasing average rates of all and avoidable emergency admissions and inequalities between neighbourhoods in local authorities in England's three least deprived IMD quintiles. For a LAD in the least deprived IMD quintile, a yearly reduction of £100 per capita in total expenditure was associated with a yearly increase of 47 (95% CI 22 to 73) avoidable admissions, 142 (95% CI 70 to 213) all-cause emergency admissions and a yearly increase in inequalities between neighbourhoods of 48 (95% CI 14 to 81) avoidable and 140 (95% CI 60 to 220) all-cause emergency admissions. In 2017, a LAD average population was ~170 000.
CONCLUSION
Austerity policies implemented in 2010 impacted less deprived local authorities, where emergency admissions and inequalities between neighbourhoods increased, while in the most deprived areas, emergency admissions were unchanged, remaining high and persistent.
Topics: Humans; England; Hospitalization; Emergency Service, Hospital; Healthcare Disparities; Socioeconomic Factors; Local Government; Health Expenditures; Male; Female
PubMed: 38871481
DOI: 10.1136/emermed-2022-212845 -
Radiology Case Reports Aug 2024Actinomycosis is a rare chronic suppurative granulomatous disease. Surgical biopsy is often performed in patients with chest actinomycosis because malignancy is...
Actinomycosis is a rare chronic suppurative granulomatous disease. Surgical biopsy is often performed in patients with chest actinomycosis because malignancy is suspected in most cases. A 62-year-old man presented to our hospital with fever and exertional dyspnea that had persisted for several months. Contrast-enhanced computed tomography showed an irregularly shaped mass with contrast enhancement in the anterior mediastinum and consolidation in the left upper lung lobe contiguous with this mass, as well as multiple nodules in both lungs. The pulmonary artery trunk was stenotic and surrounded by the mass, and the right heart system was enlarged. Thoracoscopic biopsy was performed but failed to yield a diagnosis. Contrast-enhanced computed tomography after one month revealed an increased mass and worsening right heart strain. F-FDG (fluorodeoxyglucose) positron emission tomography/computed tomography and contrast-enhanced magnetic resonance imaging also suggested a malignant tumor, and an open chest biopsy was performed. No malignant cells were identified and actinomycetes were detected by histopathology and bacterial culture. The patient was treated with antibiotics, following which his contrast-enhanced computed tomography findings and general condition improved.
PubMed: 38860267
DOI: 10.1016/j.radcr.2024.05.001 -
Optics Express Apr 2024Lasers with high spectral purity are indispensable for optical clocks and for the coherent manipulation of atomic and molecular qubits in applications such as quantum...
Lasers with high spectral purity are indispensable for optical clocks and for the coherent manipulation of atomic and molecular qubits in applications such as quantum computing and quantum simulation. While the stabilization of such lasers to a reference can provide a narrow linewidth, the widely used diode lasers exhibit fast phase noise that prevents high-fidelity qubit manipulation. In this paper, we demonstrate a self-injection locked diode laser system that utilizes a high-finesse cavity. This cavity not only provides a stable resonance frequency, it also acts as a low-pass filter for phase noise beyond the cavity linewidth of around 100 kHz, resulting in low phase noise from dc to the injection lock limit. We model the expected laser performance and benchmark it using a single trapped Ca-ion as a spectrum analyzer. We show that the fast phase noise of the laser at relevant Fourier frequencies of 100 kHz to >2 MHz is suppressed to a noise floor of between -110 dBc/Hz and -120 dBc/Hz, an improvement of 20 to 30 dB over state-of-the-art Pound-Drever-Hall-stabilized extended-cavity diode lasers. This strong suppression avoids incoherent (spurious) spin flips during manipulation of optical qubits and improves laser-driven gates when using diode lasers in applications involving quantum logic spectroscopy, quantum simulation, and quantum computation.
PubMed: 38859230
DOI: 10.1364/OE.514247 -
BMC Public Health Jun 2024Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on...
BACKGROUND
Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support.
METHODS
A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed.
RESULTS
We included 57 participants (median age 57, interquartile range (IQR) 50 - 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 - 36), with a median weight loss of 2 pounds (IQR -2 - 6) after BRIDGE.
CONCLUSION
The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures.
Topics: Humans; Pilot Projects; Telemedicine; Female; Male; Middle Aged; Shared Medical Appointments; Patient Education as Topic; Fatty Liver; Aged; Feasibility Studies; Adult; Program Evaluation
PubMed: 38849779
DOI: 10.1186/s12889-024-18865-4 -
North American Spine Society Journal Jun 2024In anterior lumbar interbody fusion (ALIF), the use of integrated screws is attractive to surgeons because of the ease of implantation and no additional profile....
BACKGROUND
In anterior lumbar interbody fusion (ALIF), the use of integrated screws is attractive to surgeons because of the ease of implantation and no additional profile. However, the number and length of screws necessary for safe and stable implantation in various bone densities is not yet fully understood. The current study aims to determine how important both length and number of screws are for stability of ALIFs.
METHODS
Three bone models with densities of 10, 15, and 20 pounds per cubic foot (PCF) were chosen as surrogates. These were instrumented using the Z-Link lumbar interbody system with either 2, 3, or 4 integrated 4.5 × 20 mm screws or 4.5 × 25 mm screws (Zavation, LLC, Flowood, MS). The bone surrogates were tested with loading conditions resulting in spine extension to measure construct stiffness and peak force.
RESULTS
The failure load of the construct was influenced by the length of screws (p=.01) and density of the bone surrogate (p<.01). There was no difference in failure load between using 2 screws and 3 screws (p=.32) or when using four 20 mm screws versus three 25 mm screws (p=.295).
CONCLUSION
In our study, both bone density and length of screws significantly affected the construct's load to failure. In certain cases where a greater number of screws are unable to be implanted, the same stability can potentially be conferred with use of longer screws. Future clinical studies should be performed to test these biomechanical results.
PubMed: 38812953
DOI: 10.1016/j.xnsj.2024.100325 -
Cureus Apr 2024Syphilis is a sexually transmitted disease that impacts multiple organ systems and can mimic various diseases and is an extremely rare cause of proctitis in men who...
Syphilis is a sexually transmitted disease that impacts multiple organ systems and can mimic various diseases and is an extremely rare cause of proctitis in men who have sex with men and transgender females. We present a case of a 49-year-old transgender female with a medical history significant for diabetes mellitus and hyperlipidemia who presented to the emergency department with dull abdominal pain in the left upper and lower quadrants for two days. She had non-bloody, nonbilious emesis, 10-pound weight loss over 1 month, and constipation for 2 weeks. Laboratory results showed a cholestatic pattern. Computed tomography of the abdomen showed rectal wall thickening, multiple enlarged perirectal adenopathy, and mild inflammatory infiltration around the rectum suggesting superimposed proctitis. On colonoscopy, a possible rectal mass or severe proctitis with near complete obstruction was seen with initial pathology concerning for lymphoma or a rare type of colitis. The patient was empirically started on ceftriaxone and doxycycline leading to improvement in inflammation. Special stains requested were positive for Treponema pallidum confirming the diagnosis of syphilitic proctitis and highly suggestive syphilitic hepatitis. Few cases of syphilitic proctitis imitating rectal malignancy and syphilitic hepatitis have been reported. Syphilis requires exclusion as well as confirmation of spirochetes for high-risk populations with special staining. It is important to diagnose syphilis in special populations that are at high risk of contraction.
PubMed: 38807842
DOI: 10.7759/cureus.59222 -
JMIR Research Protocols May 2024Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial... (Observational Study)
Observational Study
BACKGROUND
Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial fibrillation (AFib) in outpatient settings. AFib has been associated with various comorbid diseases that prompt further investigation and screening methodologies for at-risk populations. A simple 30-second sinus rhythm strip from the KardiaMobile ECG (AliveCor) can provide an effective screen for cardiac rhythm abnormalities.
OBJECTIVE
The aim of this study is to demonstrate the feasibility of performing Kardia-enabled ECG recordings routinely in outpatient settings in high-risk populations and its potential use in uncovering previous undiagnosed cases of AFib. Specific aim 1 is to determine the feasibility and accuracy of performing routine cardiac rhythm sampling in patients deemed at high risk for AFib. Specific aim 2 is to determine whether routine rhythm sampling in outpatient clinics with high-risk patients can be used cost-effectively in an outpatient clinic without increasing the time it takes for the patient to be seen by a physician.
METHODS
Participants were recruited across 6 clinic sites across the University of Florida Health Network: University of Florida Health Nephrology, Sleep Center, Ophthalmology, Urology, Neurology, and Pre-Surgical. Participants, aged 18-99 years, who agreed to partake in the study were given a consent form and completed a questionnaire regarding their past medical history and risk factors for cardiovascular disease. Single-lead, 30-second ECGs were taken by the KardiaMobile ECG device. If patients are found to have newly diagnosed AFib, the attending physician is notified, and a 12-lead ECG or standard ECG equivalent will be ordered.
RESULTS
As of March 1, 2024, a total of 2339 participants have been enrolled. Of the data collected thus far, the KardiaMobile rhythm strip reported 381 abnormal readings, which are pending analysis from a cardiologist. A total of 78 readings were labeled as possible AFib, 159 readings were labeled unclassified, and 49 were unreadable. Of note, the average age of participants was 61 (SD 10.25) years, and the average self-reported weight was 194 (SD 14.26) pounds. Additionally, 1572 (67.25%) participants report not regularly seeing a cardiologist. Regarding feasibility, the average length of enrolling a patient into the study was 3:30 (SD 0.5) minutes after informed consent was completed, and medical staff across clinic sites (n=25) reported 9 of 10 level of satisfaction with the impact of the screening on clinic flow.
CONCLUSIONS
Preliminary data show promise regarding the feasibility of using KardiaMobile ECGs for the screening of AFib and prevention of cardiological disease in vulnerable outpatient populations. The use of a single-lead mobile ECG strip can serve as a low-cost, effective AFib screen for implementation across free clinics attempting to provide increased health care accessibility.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/52647.
Topics: Humans; Atrial Fibrillation; Aged; Electrocardiography; Middle Aged; Male; Adult; Female; Aged, 80 and over; Adolescent; Young Adult; Outpatients; Smartphone; Feasibility Studies
PubMed: 38801762
DOI: 10.2196/52647