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Each year, over 300,000 people older than 65 years are hospitalized for hip fractures. Given the notable morbidity and mortality faced by elderly patients in the postinjury period, recommendations have been put forth for integrating palliative and, when needed, hospice care to improve patients' quality of life. Our objective was to (1) understand the proportion of patients discharged to hospice after hip fracture surgery and their 30-day mortality rates and (2) identify the independent predictors of discharge to hospice.We retrospectively queried the American College of Surgeons National Surgical Quality Improvement Program for all hip fracture surgeries between the years of 2016 and 2018. Included cases were stratified into two cohorts: cases involving a discharge to hospice and nonhospice discharge. Variables assessed included patient demographics, comorbidities, perioperative characteristics, and postoperative outcomes. Differences between hospice and nonhospice patients were compared using chi-squared analysis or the Fisher exact test for categorical variables and Student t -tests for continuous variables. A binary logistic regression model was used to assess independent predictors of hospice discharge with 30-day mortality.Overall, 31,531 surgically treated hip fractures were identified, of which only 281 (0.9%) involved a discharge to hospice. Patients discharged to hospice had a 67% 30-day mortality rate in comparison with 5.6% of patients not discharged to hospice ( P0.001). Disseminated cancer, dependent functional status,10% weight loss over 6 months preoperatively, and preoperative cognitive deficit were the strongest predictors of hospice discharge with 30-day mortality after hip fracture surgery.Current hospice utilization in hip fracture patients remains low, but 30-day mortality in these patients is high. An awareness of the associations between patient characteristics and discharge to hospice with 30-day mortality is important for surgeons to consider when discussing postoperative expectations and outcomes with these patients.Level III, retrospective comparative study.

Diabetes is a global menace, and its severity results in various disorders including cardiovascular, retinopathy, neuropathy, and nephropathy. Recently, diabetic conditions are diagnosed through the level of glycated hemoglobin. The level of glycated hemoglobin is determined with enzymatic methodology. Although the system is sensitive, it has various restrictions such as long processing times, expensive equipment required for testing, and complex steps involved in sample preparation. These limitations are a hindrance to faster results. The limitations of the developed methods can be eliminated through biosensors. In this work, an electrochemical platform was fabricated that facilitates the identification of glycated hemoglobin protein in diabetic patients. The working electrode on the integrated circuit was modified with molecularly imprinted polymer decorated with tungsten disulfide nanoparticles to enhance its analytical properties. The analytical properties of the biosensor were studied using electrochemical techniques. The obtained detection limit of the nanoelectronic sensor was 0.01 pM. The calculated sensitivity of the biosensor was observed to be 0.27 μA/pM. Also, the sensor promises to operate in a dynamic working concentration range and provide instant results.

Background and Aims: Laryngoscopy for tracheal intubation produces a hemodynamic stress response like changes in heart rate and blood pressure, intracranial pressure, intra ocular pressure (IOP). Many pharmacological and non-pharmacological methods have been employed to limit these pressor responses. We hypothesize that as lower lifting forces are required to visualize the glottis while using videolaryngoscopes, hence they should have a beneficial influence on hemodynamics and in turn IOP. Methods: After taking written and informed consent, the patients were allocated by computer generated randomization in 2 groups of 40 patients each. Grp VL- patients were intubated using Kings Vision videolaryngoscope Grp DL – patients were intubated using Macintosh laryngoscope. Heart rate, blood pressure and IOP were recorded just before laryngoscopy,(either by Macintosh or Kings Vision videolaryngoscope) and 1 , 3 and 5 minutes after intubation, by independent anaesthesiologists Results: There was a significant difference in IOP, both in left and right eye from the baseline in direct laryngoscopy group at 1 3 and 5 minutes. No significant difference in IOP from baseline levels was noted in videolaryngoscopy (VL) group .In fact a decrease in IOP was noted at 5 min in VL group in the left eye and no significant change happened in IOP of right eye anytime that we measured (1,3 and 5 min) post intubation. Conclusion: With the use of KVVL, lesser hemodynamic changes and lesser variations in IOP were noted, so the above can be better than DL for use in surgeries where sudden increase in IOP can be deleterious.

S1. Epigenetic and transcriptional landscape of AICDA (AID) regulatory region in HepG2 cells. S2. Epigenetic and transcriptional landscape of FAS (CD95) regulatory region in many lymphoma and HCC cell lines. S3. TLR4 expression in Oncomine database (Compagno lymphoma). S4. Different human lymphoma gene profiles show high c-JUN, c-MYC, and TLR4. S5. c-Jun disruption in mice prompted lymphoproliferation and skin diseases that were ameliorated by STAT3 inhibition. Table S1. Resource table. Table S2. Oncomine dataset: Basso Lymphoma Table S3. DLBC Lymphoma Clinicopathological table Table S4. Clinicopathological Table Table S5. Transcription factor binding site sequences of mouse AID promoter Supplemental Materials and Methods

Background Acute kidney injury (AKI) following total joint arthroplasty (TJA) is associated with increased morbidity and mortality. Estimated glomerular filtration rate (eGFR) is used as an indicator of renal function. The purpose of this study was (1) to assess each of the five equations that are used in calculating eGFR, and (2) to evaluate which equation may best predict AKI in patients following TJA. Methods The National Surgical Quality Improvement Program (NSQIP) was queried for all 497,261 cases of TJA performed from 2012 to 2019 with complete data. The Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Cockcroft-Gault, Mayo quadratic, and Chronic Kidney Disease Epidemiology Collaboration equations were used to calculate preoperative eGFR. Two cohorts were created based on the development of postoperative AKI and were compared based on demographic and preoperative factors. Multivariate regression analysis was used to assess for independent associations between preoperative eGFR and postoperative renal failure for each equation. The Akaike information criterion (AIC) was used to evaluate predictive ability of the five equations. Results Seven hundred seventy-seven (0.16%) patients experienced AKI after TJA. The Cockcroft-Gault equation yielded the highest mean eGFR (98.6 ± 32.7), while the Re-expressed MDRD II equation yielded the lowest mean eGFR (75.1 ± 28.8). Multivariate regression analysis demonstrated that a decrease in preoperative eGFR was independently associated with an increased risk of developing postoperative AKI in all five equations. The AIC was the lowest in the Mayo equation. Conclusions Preoperative decrease in eGFR was independently associated with increased risk of postoperative AKI in all five equations. The Mayo equation was most predictive of the development of postoperative AKI following TJA. The mayo equation best identified patients with the highest risk of postoperative AKI, which may help providers make decisions on perioperative management in these patients.

⮞ The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ⮞ Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ⮞ Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ⮞ The choice of femoral fixation method should be determined by the patient’s age, comorbidities, and bone quality. ⮞ We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.

Postoperative urinary retention (POUR) is a disruptive complication after modern rapid recovery total joint arthroplasty. This review aims to synthesize the recent literature on POUR in the setting of total joint arthroplasty. The incidence of POUR ranges from 5.5% to 46.3%. The lack of a standardized definition of POUR accounts for some of this variability. Risk factors previously associated with the development of POUR include increasing age, male sex, benign prostatic hyperplasia, use of bupivacaine and intrathecal morphine in spinal anesthesia, glycopyrrolate, and volume of intraoperative intravenous fluid administered. Predictive scoring assessments, such as the International Prostate Symptom Score and a newer predictive nomogram, have not been adequately validated by high-quality studies. The treatment of POUR comprises either intermittent or indwelling urethral catheterization. Higher quality prospective studies are needed to allow for the standardization of all aspects of POUR from its diagnostic criteria to its treatment.

Background: Use of gene expression profiling (GEP) is considered standard of care, in deciding use of adjuvant chemotherapy in patients with LN negative breast cancer. However, there are limited data for the use of GEP in LN+ disease. Both Mammaprint™ and Oncotype Dx 21 gene recurrence score™ (RS) have been evaluated in LN+ disease, the data are not as robust as in the LN- population. Based on data from the RXPONDER trial and the MINDACT trial, the NCCN has recently recommended the use of Oncotype Dx to help decide the utility and benefit of adjuvant chemotherapy after resection in LN- , Hormone receptor Positive (HR+), HER2 negative (HER2-) breast cancer patients. Because of the potential major impact of these data on patient management and healthcare utilization, we decided to explore the uptake and implementation of this testing at a large community cancer center in order to assess and report real world data pertaining to this novel standard of care. Methods: Database search of the Electronic Medical Records used at Ironwood Cancer Center, revealed 2455 newly diagnosed patients with early stage breast cancer during the period from 1/1/2018 till 6/1/2021. HIPAA deidentified data was extracted with inclusion criteria of newly diagnosed women with LN+ (1-3 nodes), HR+, and Her2- which yielded 403 patients. Demographics & treatment data: Characteristics included menopausal status (Premenopausal 23%, Post Menopausal 77%), Surgery type (mastectomy 44%, breast conservation surgery 56%), size of primary tumor (0-1 cm 16 %, 1-2 cm 28%, 2-5 cm 43%, and > 5 cm 13%), LNs resected (Range 0-37, Median 4), # of LNs +(1-60%, 2-25%, 3-15%), and Tumor Grade (Grade 1-23%, 2-56%, 3-21%). GEP was performed in 62% of the patients. 49% received adjuvant chemotherapy (61% anthracycline based, 39% non anthracycline based). Of the patients tested, 41% received adjuvant chemotherapy. Adjuvant antihormonal therapy included aromatase inhibitors in 86% and Tamoxifen in 14%. 81% of the pre-menopausal patients received complete ovarian suppression. Results: Logistical Regression analysis in a non linear fashion, R2 data and Chi-square analysis was used to test the statistical significance of the observed relationship with respect to the expected relationship. The data was divided into 6 monthly intervals to allow comparison of the uptake of the test and impact on adjuvant chemotherapy decision making. There was a significant increase in GEP profile testing percentages when these intervals were compared across the years (R2 =0.69). Increase in GEP profiling was associated with lower utilization of adjuvant chemotherapy (R2= 0.84). There was a non-significant decline in the use of adjuvant chemotherapy (Chi2 NS, p value 0.22). Menopausal status, grade/size of tumor did not meet the statistical significance for the likelihood of utilization of the test. Currently multivariate analysis is being performed to examine the interplay between the numerous clinical factors on which the data was collected. This analysis will allow us to decide if we can longitudinally explore recurrence rates in each of these subsets. Conclusion: GEP has seen a significant uptake to help with adjuvant chemotherapy decision making in LN + (1-3) patients in the community cancer center setting over the last 4 years. These real world data also showed that increased testing was associated with decreased chemotherapy use which has translated to lowering health care resources and minimizing patient morbidity. Recommendations from the expert guidelines and clinical trial data have helped accelerate the use of this technology in the decision making to undergo adjuvant chemotherapy in the LN+, HR+, HER2- patients with breast cancer. Citation Format: Nisha Rao Kalmadi, Andrew Brown, Manas Sharma, Mikhail Shtivelband, Joshua Rifkind, Sujith Kalmadi, Rajesh Bagai, Emily Ho, Patricia Clark, Christopher Kellogg, Parvinderjit Khanuja. Impact of gene expression profile testing for lymph node positive (LN+) , hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer (BC) patients on the use of adjuvant chemotherapy in a large community cancer center [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-18.

In this paper, Zinc Indium Sulphide (ZnIn2S4) marigold like Microsphere are synthesized at 80 °C in aqueous solution by using Zinc sulphate ZnSO4, Indium sulphate In2(SO4)3 and Thioacetamide C2H5NS (TTA). We have characterized the nanopowder of the zinc Indium sulphide, by using various techniques, like UV–Vis spectrophotometer, Field emission scanning electron microscopy (FSEM), X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). The variation of optical properties in Zinc Indium sulphide by using UV–visible spectroscopy, to find the energy band gap (2.31 eV). The hexagonal phase was confirmed from the X-ray diffraction pattern of ZnIn2S4. We have used a simple route to synthesize the Zinc Indium Sulphide, which involves, no templates, no organic solvents or surfactants, and at low temperature (80 °C). Our synthesized Zinc Indium Sulphide have got promising applications in a wide range of areas like solar energy conversion, electrical nanodevices, photocatalysis, optical devices, and electrical devices, etc.

The pandemic corona virus disease 2019 (COVID-19) has rapidly spread to most countries worldwide. Since the year 2019, the world has been facing a global health crisis. Therefore, an automated detection of lung infections is very necessary to tackle COVID-19. For this reason, we develop a framework to automatically segment COVID-19 CT images using K-means Clustering and use them to train proposed Convolutional Neural Network to classify COVID-19 from the normal CT images. Rapid growth in deep learning has led to a series of breakthroughs for image analysis, thereby reducing time of radiologists in the diagnosis of COVID-19. Our framework is evaluated upon 349 positive and 397 negative CT scans to detect COVID-19 & help in taking appropriate diagnostic decisions. To evaluate the performance of our proposed approach, we compared our results with pre-trained models such as VGG19, Inception V3 and ResNet50.

Measuring people's self identity as a feminist and if it translates into actions.

PurposeSupply chain integration (SCI) and flexibility (SCF) are recognised as crucial business practices and capability in the global competitive market. However, limited research has paid attention to study the relationship between SCI, SCF and their impact on supply chain performance (SCP). Therefore, the purpose of this paper is to establish a relationship between integration, flexibility and performance.Design/methodology/approachThe structural equation modelling technique was used to analyse the 187 data collected from Indian organisations through the survey methodology.FindingsFindings indicate that external integration contributes significantly to realise SCF and SCP. Sourcing and logistics flexibility also help to improve the SCP. The mediation analysis showed that the association of customer and supplier integration with SCP is partially and fully mediated by logistics flexibility, respectively. This study suggests that integration influences the SCP when the firm has a strong association with downstream partners and enough capability for logistics flexibility.Research limitations/implicationsThe study has collected cross-sectional data to analyse the relationship between SCI, SCF and SCP. However, as integration requires an effort of the years, longitudinal data and industry-specific studies may provide comprehensive views to validate the results of this study.Originality/valueBuilding on relational view theory and dynamic capability theory, the study has proposed the SCP assessment framework based on the relationship between SCI and SCF.

Synergism between obesity and virus infection promotes the development of B-cell lymphoma. In this study, we tested whether obesity-associated endotoxin release induced activation-induced cytidine deaminase (AID). TLR4 activation in turn caused c-JUN–dependent and STAT3-dependent translocations of MYC loci to suppress transactivation of CD95/FAS. We used viral nucleocapside Core transgenic (Tg) mice fed alcohol Western diet to determine whether oncogenesis arising from obesity and chronic virus infection occurred through TLR4-c-JUN-STAT3 pathways. Our results showed B cell–specific, c-Jun and/or Stat3 disruption reduced the incidence of splenomegaly in these mice. AID-dependent t(8;14) translocation was observed between the Ig promoter and MYC loci. Comparison with human B cells showed MYC-immunoglobulin (Ig) translocations after virus infection with lipopolysaccharide stimulation. Accordingly, human patients with lymphoma with virus infections and obesity showed a 40% incidence of MYC-Ig translocations. Thus, obesity and virus infection promote AID-mediated translocation between the Ig promoter and MYC through the TLR4-c-JUN axis, resulting in lymphoproliferation. Taken together, preventative treatment targeting either c-JUN and/or STAT3 may be effective strategies to prevent tumor development. Implications: Obesity increases gut-derived endotoxin which induces Toll-like receptor–mediated MYC-Ig translocation via c-JUN-STAT3, leading to lymphoproliferation.

DASHMEET KAUR KHANUJA; 2Prof. (Dr.) S.K. ROY

Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise regimens following primary THA. Outcomes were separated into short-term (6 months from surgery, closest to 3 months) and long-term (≥6 months from surgery, closest to 12 months) measures. Meta-analyses were performed when possible and reported in standardized mean differences (SMDs) with 95% confidence intervals (CI). Seven studies (N=398) were included for review. No significant differences were observed with regard to lower extremity strength (p=0.85), aerobic capacity (p=0.98), or short-term quality of life scores (p=0.18). Although patients in supervised physical therapy demonstrated improved short-term self-reported outcomes compared to those performing unsupervised exercises, this was represented by a small effect size (SMD 0.23 [95% CI, 0.02-0.44]; p=0.04). No differences were observed between groups regarding long-term lower extremity strength (p=0.24), physical outcome scores (p=0.37), or quality of life (p=0.14). The routine use of supervised physical therapy may not provide any clinically significant benefit over unsupervised exercises following primary THA. These results suggest that providers should reconsider the routine use of supervised physical therapy after discharge.

Surgery for prosthetic joint infection (PJI) can often lead to significant blood loss, necessitating allogeneic blood transfusion (ABT). The use of ABT is associated with higher rates of morbidity and death in revision total joint arthroplasty, particularly in the treatment of PJI. We compared ABT rates by procedure type among patients treated for PJI. We retrospectively reviewed 143 operative cases of hip and knee PJI performed at our institution between 2016 and 2018. Procedures were categorized as irrigation and debridement (I&D) with modular component exchange (modular component exchange), explantation with I&D and placement of an antibiotic spacer (explantation), I&D with antibiotic spacer exchange (spacer exchange), or antibiotic spacer removal and prosthetic reimplantation (reimplantation). Rates of ABT and the number of units transfused were assessed. Factors associated with ABT were assessed with a multilevel mixed-effects regression model. Of the cases, 77 (54%) required ABT. The highest rates of ABT occurred during explantation (74%) and spacer exchange (72%), followed by reimplantation (36%) and modular component exchange (33%). A lower preoperative hemoglobin level was associated with higher odds of ABT. Explantation, reimplantation, and spacer exchange were associated with greater odds of ABT. Antibiotic spacer exchange and explantation were associated with greater odds of multiple-unit transfusion. Rates of ABT remain high in the surgical treatment of PJI. Antibiotic spacer exchange and explantation procedures had high rates of multiple-unit transfusions, and additional units of blood should be made available. Preoperative anemia should be treated when possible, and further refinement of blood management protocols for prosthetic joint infection is necessary. [ Orthopedics . 2022;45(6):353–359.]

Background: Total joint arthroplasty (TJA) is one of the most common procedures performed in the United States. Outcomes of this elective procedure may be improved via preoperative optimization of modifiable risk factors. Purposes: We sought to summarize the literature on the clinical implications of preoperative risk factors in TJA and to develop recommendations regarding preoperative optimization of these risk factors. Methods: We searched PubMed in August 2019 with an update in September 2020 for English-language, peer-reviewed publications assessing the influence on outcomes in total hip and knee replacement of 7 preoperative risk factors—obesity, malnutrition, hypoalbuminemia, diabetes, anemia, smoking, and opioid use—and recommendations to mitigate them. Results: Sixty-nine studies were identified, including 3 randomized controlled trials, 8 prospective cohort studies, 42 retrospective studies, 6 systematic reviews, 3 narrative reviews, and 7 consensus guidelines. These studies described worse outcomes associated with these 7 risk factors, including increased rates of in-hospital complications, transfusions, periprosthetic joint infections, revisions, and deaths. Recommendations for strategies to screen and address these risk factors are provided. Conclusions: Risk factors can be optimized, with evidence suggesting the following thresholds prior to surgery: a body mass index 2, serum albumin ≥3.5 g/dL, hemoglobin A1C ≤7.5%, hemoglobin >12.0 g/dL in women and >13.0 g/dL in men, and smoking cessation and ≥50% decrease in opioid use by 4 weeks prior to surgery. Surgery should be delayed until these risk factors are adequately optimized.

An eco-friendly and facile in-situ polymerization method was used to develop template free acid-etched graphitic carbon nitride (TGCN) nanosheets with optimized PANI nanofibers. PANI nanofibers grown on TGCN nanosheets offer large surface area, high porosity and unique charge transfer properties. The rapid agglomeration of TGCN nanosheets throughout electrochemical measurements lowers the specific capacitance due to its reduced shelf life which was overcome by the incorporation of a suitable polymer (PANI) as a spacer. Herein, We report the comparative electrochemical performance of TGCN/PANI nanocomposites as a function of morphology, composition, surface area and pore size study was obtained using X-Ray diffraction (XRD), Field emission scanning electron microscopy (FESEM), Transmission electron microscopy (TEM), X-Ray Photoelectron Spectroscopy (XPS) and Brunauer-Emmett-Teller (BET) N2 adsorption-desorption. Herein, we prepared TGCN/PANI nanocomposites, which are also optimized to act as a highly efficient electrode nanocomposite for high-performance supercapacitor applications. The optimized TGCN/PANI (TCP50) nanocomposite showed a high specific capacitance of 298.31 F/g at a scan rate of 0.02 V s-1 and long cycling stability with low capacitance loss after 5000 cycles as well as low leakage current and self-discharge. At a power density of 400 W/kg, TCP50 electrode exhibits superior energy density of 33.57 Wh/kg.

In this paper, we report the synthesis of zinc indium sulfide (ZnIn

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PurposeThis paper aims to establish a relationship between supply chain integration (SCI) and supply chain flexibility (SCF) to develop a two-dimensional approach, i.e. integrated flexibility.Design/methodology/approachBuilding on a relational view and dynamic capability theory, this paper argues that integrated flexibility is the strategy that enables organisations to achieve different positions and states to create distinctive capability. The article has proposed the conceptual framework that connects different supply chain strategies and practices to improve supply chain performance (SCP) considering the cross-disciplinary approach.FindingsThe conceptual framework around the new perspective, i.e. integrated flexibility, is built to deal with issues related to operations management. The paper suggests examining the mediating effect of SCF between SCI and SCP and the moderating role of knowledge management (KM), data analytics (DA) and quality management (QM) practices on their relationship. Moreover, research direction in terms of propositions and implications are developed to showcase how underlying practices streamline the supply chain and lead to superior SCP.Practical implicationsThe proposed framework discusses the degree of integration and flexibility levels to guide practitioners in designing a supply chain strategy with their partners and answering how much resources need to be extended to achieve flexible operations and realise SCP.Originality/valueAuthors have developed an entirely new integrated flexibility concept that provides a base to sustain in the competitive market. The foundation of integrated flexibility is built on relational view and dynamic capability theory and supported by DA, QM and KM.

A liquid exfoliation method is an indispensable productive approach, inhibited by our breakdown to measure nanosheet concentration, estimation, and thickness. The light scattered by MoS2 nanosheets in liquid solvents, viz., dimethyl sulfoxide (DMSO), N-methyl-2-pyrrolidone, and ethanol results in optical extinction spectra which determines the optoelectronic properties. All samples were characterized by X-ray diffraction, scanning electron microscopy, and UV–Vis spectroscopy for determining their structure, morphology, and optical properties, respectively. The minimum estimated number of layers was found to be 15 in DMSO as solvent. The liquid-phase method can be employed to a wide range of 2D material including MoSe2, WS2, and WSe2.