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Objective: We evaluated longitudinal rates, risk factors, and costs of superficial and deep incisional surgical-site infection (SSI) 6 months after primary total knee arthroplasty (pTKA) and revision total knee arthroplasty (rTKA). Methods: Patients were identified from January 1, 2016 through March 31, 2018, in the IBM MarketScan administrative claims databases. Kaplan-Meier survival curves evaluated time to SSI over 6 months. Cox proportional hazard models evaluated SSI risk factors. Generalized linear models estimated SSI costs up to 12 months. Results: Of the 26,097 pTKA patients analyzed (mean age, 61.6 years; SD, 9.2; 61.4% female; 60.4% commercial insurance), 0.65% (95% CI, 0.56%–0.75%) presented with a deep incisional SSI and 0.82% (95% CI, 0.71%–0.93%) with a superficial incisional SSI. Also, 3,663 patients who had rTKA (mean age, 60.9 years; SD, 10.1; 60.6% female; 53.0% commercial insurance), 10.44% (95% CI, 9.36%–11.51%) presented with a deep incisional SSI and 2.60% (95% CI, 2.07%–3.13%) presented with a superficial incisional SSI. Infections were associated with male sex and multiple patient comorbidities including chronic pulmonary disease, pulmonary circulatory disorders, fluid and electrolyte disorders, malnutrition, drug abuse, and depression. Adjusted average all-cause incremental commercial cost ranged from $14,298 to $29,176 and from $41,381 to 59,491 for superficial and deep incisional SSI, respectively. Conclusions: SSI occurred most frequently following rTKA and among patients with pulmonary comorbidities and depression. The incremental costs associated with SSI following TKA were substantial.

This chapter looks at the rules relating to legal professional privilege and, in outline, the doctrine of the privilege against self-incrimination. Under these provisions potentially relevant evidence may be excluded at trial. The role of legal professional privilege in protecting defendants in criminal trials is outlined and the absolutist stance of the courts discussed. The chapter outlines the various immunities which are embraced under the privilege against self-incrimination. Summarizing some recent case law, the chapter reflects on the extent to which the privilege may now extend to a broader set of circumstances than the earlier authorities suggested. For example, the privilege may not necessarily be unavailable against the use of compelled questions in an administrative enquiry.

This chapter focuses on the competence and compellability of witnesses in criminal and, in outline, in civil trials. It explains the main criminal law exceptions in relation to competence and universal compellability. It gives details on the complex and controversial position under s80 of the Police and Criminal Evidence Act (PACE) 1984. The chapter outlines the special measures directions (SMDs) available under the Youth Justice and Criminal Evidence Act (YJCAE) 1999 for vulnerable non-defendant witnesses in criminal trials. The more limited measures for vulnerable defendants are outlined, in particular the use of intermediaries. The chapter concludes with an outline of the Criminal Evidence (Witness Anonymity) Act 2008.

This chapter focuses on confessions and on the defendant’s pre-trial silence. It explains how a defendant may be convicted on the evidence of a confession alone. It analyses the definition of a confession as specified in s82(1) of the Police and Criminal Evidence Act 1984 (PACE), and how a confession proffered by the prosecution or by a co-defendant may be excluded by rule under PACE. The chapter also considers the preservation of the common law discretion to exclude confession evidence as well as the procedure for police interrogation of suspects under PACE. It examines recent case law on the significance of lack of access to legal advice of a suspect under interrogation. It concludes with an examination of how the jury at trial may draw an inference of guilt under ss34, 36, and 37 of the Criminal Justice and Public Order Act 1994 (CJPO), sections which have eroded the right to silence. The influence of the Strasbourg jurisprudence in this area is outlined.

This chapter examines a number of procedural matters in criminal trials. It first explains suspect evidence and the erosion of the rules on corroboration under the Criminal Justice and Public Order Act (CJPOA)1994. It then concentrates in some detail on identification evidence concerned with the Turnbull directions and the provisions of Code D Police and Criminal Evidence Act (PACE) 1984. The extent to which the defendant’s lies may constitute evidence of guilt is explained, along with a review of Lucas directions. It continues with a review of the various procedural aspects of examination and cross-examination. The chapter concludes with a discussion of the rules on cross-examination of complainants in sexual cases on their previous sexual history along with the case law under s41 Youth Justice and Criminal Evidence Act (YJCEA)1999.

This chapter, which focuses on hearsay evidence and its relationship to confessions, first considers the rule against hearsay and its application to out-of-court statements of witnesses in civil and criminal cases. It then looks at statements, both oral and written, and gestures, as well as the admissibility of hearsay in criminal proceedings under the Criminal Justice Act (CJA) 2003 and, in outline, in civil proceedings under the Civil Evidence Act (CEA) 1995. The survival of some common law rules on hearsay is discussed. The chapter also explains the legal distinction between first-hand (what X told Y) and multiple hearsay (what X told Y who told Z). It concludes by discussing the landmark decisions under Art 6(3)(d) of the European Convention on Human Rights (ECHR).

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.