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Background: To investigate if combined single-shot adductor canal blockade (ACB) and infiltration between the popliteal artery and capsule of the knee (IPACK) provide better postoperative pain management compared to ACB alone for patients undergoing unilateral total knee arthroplasty (TKA)., Methods: This retrospective cohort study included adult patients who underwent primary, unilateral TKA. Patients were separated into 2 cohorts: single-shot ACB alone (performed with bupivacaine 0.25%) and combined single-shot ACB + IPACK (performed with bupivacaine 0.25%, dexmedetomidine 1 mg/kg, and dexamethasone 4 mg). Patients were propensity-matched 1:1. The primary study outcome was total opioid consumption converted to morphine milligram equivalents (MME) per eight-hour interval and postoperative day. Secondary outcomes included pain scores, length of stay, ambulation distance, return to emergency department, hospital readmission, and 30-day adverse events., Results: One hundred eighty patients were identified, of which propensity matching used 71% to yield 64 patients receiving ACB alone and 64 receiving combined ACB + IPACK. Combined ACB + IPACK had significantly lower total summative MME throughout the entire postoperative stay ( P  = .002) and cumulatively after the first 24 hours ( P < .001). Combined ACB + IPACK also had lower mean pain scores for 0-8 hours ( P  = .005) and 8-16 hours ( P  = .009) postoperatively. There were no significant differences in secondary outcomes., Conclusions: Combined single-shot ACB + IPACK block was associated with lower total narcotic intake and mean pain scores during most of the immediate postoperative period following primary, unilateral TKA compared to ACB alone. Implementing longer-acting, single-shot ACB + IPACK for TKA can balance effective and more selective pain management with early rehabilitation., (© 2023 The Authors.)

First-order plus dead-time (FOPDT) models are broadly used in process control to represent damped dynamic processes with time delays. An explicit condition for parameter- and delay-dependent robust stability of FOPDT systems with varying uncertain parameters and delay is derived in this paper. An internal model control (IMC) approach is proposed to parameterize stabilizing controllers that satisfy the output tracking objective in time-varying FOPDT systems represented by an uncertain first-order dynamic model with a time-varying delay in the control input. The small-gain theorem is used to derive an explicit necessary and sufficient parameter-dependent robust stability condition as a function of the nominal system gain, nominal varying delay, nominal time constant, and the bounds of the parameter uncertainties. An equivalent proportional-integral-derivative (PID) controller is then extracted to facilitate the implementation of the proposed IMC-based robust control. The application of the proposed explicit robust stability condition is studied in the context of air-fuel ratio (AFR) control in lean-burn spark ignition (SI) engines with a large time-varying transport delay in the control loop due to the placement of the universal exhaust gas oxygen (UEGO) sensor downstream the catalytic converter., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 ISA. Published by Elsevier Ltd. All rights reserved.)

Problems in behavioural and emotional outcome are amongst the long-term sequelae of preterm birth. The exact prevalence and associations with perinatal risk factors are unknown. Minimal research has been performed in pre-school aged children, compared to school age. The primary aim of this study was to determine the prevalence of parent-reported behavioural and emotional problems at the age of two in children born at less than 30 weeks' gestational age and/or birth weight less than 1000 g. The secondary aim was to determine whether perinatal factors were associated with the behavioural and emotional outcome. Perinatal characteristics of 144 preterm-born children from the NeoLiFeS cohort were collected retrospectively. Of these children, 101 parents filled out a Childs Behaviour Checklist (CBCL) at the corrected age of two. The results of the CBCL tests were presented as Z-scores, a Z-score of 0 indicating the mean of behavioural scores in the norm population. A Z-score higher than zero indicates less behavioural problems than average, a negative Z-score indicates more problems. Associations between perinatal risk factors and CBCL-scores were analysed using linear regression analyses. Prevalences of clinically relevant CBCL scores were low, 4%, 2% and 5% for total score, internalizing score or externalizing score, respectively. Being part of a twin was associated with higher internalizing Z-scores, indicating less problems in emotional behaviour. Bronchopulmonary dysplasia was associated with lower Z-scores in total and externalizing behaviour. In conclusion, in our cohort generally very few problems in behavioural and emotional outcome were reported at the age of two., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Brachiocephalic arteriovenous fistulas (BCFs) are commonly placed in outpatient settings. The impact of general anesthesia (GA), regional anesthesia (RA), or local anesthesia (LA) on perioperative recovery and fistula maturation/patency after outpatient BCF creations is unknown. We evaluated whether outcomes of outpatient BCF creations vary based on anesthesia modality., Methods: The Vascular Quality Initiative (2011-2018) national database was queried for outpatient BCF creations. Anesthesia modalities included GA, RA, and LA. Perioperative, 3-month, and 1-year outcomes were compared between GA versus RA/LA anesthesia types., Results: Among 3,527 outpatient BCF creations, anesthesia types were GA in 1,043 (29.6%), RA in 1,150 (32.6%), and LA in 1,334 (37.8%). Patients receiving GA were more often younger, obese, Medicaid recipients, without coronary artery disease, and treated in non-office-based settings (P < 0.05 for all). GA compared with RA/LA cohorts were more often admitted postoperatively (5.3% vs. 2.4%, P < 0.001) but had similar rates of thirty-day mortality (0.9 vs. 0.6%, P = 0.39). 3-month access utilization for hemodialysis was lower in GA than in RA/LA cohorts (12.6% vs. 23.6%, P < 0.001). The Kaplan-Meier analysis showed that GA and RA/LA cohorts had similar 1-year primary access occlusion-free survival (43.6% vs. 47.1%, P = 0.24) and endovascular/open reintervention-free survival (57.2% vs. 57.6%, P = 0.98). On multivariable analysis, GA compared with RA/LA use was independently associated with increased postoperative admission (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.08-2.67, P = 0.02) and decreased 3-month access utilization (OR: 0.39, 95% CI: 0.25-0.61, P < 0.001) but had similar 1-year access occlusion (hazard ratio [HR]: 1.09, 95% CI: 0.9-1.32, P = 0.36) and reintervention (HR: 1.02, 95% CI: 0.82-1.26, P = 0.88). On subgroup analysis of the RA/LA cohort, RA compared with LA was associated with increased 3-month access utilization (OR: 1.6, 95% CI: 1.01-2.5; P = 0.04) and 1-year access reintervention (HR: 1.46, 95% CI: 1.12-1.89), but had similar 1-year access occlusion (HR: 1.2, 95% CI: 0.95-1.51, P = 0.13)., Conclusions: Compared with RA/LA use, GA use in patients undergoing outpatient BCF creations was associated with increased hospital admissions, decreased access utilization at 3 months, and similar 1-year access occlusion and reintervention. RA/LA is preferable to expedite recovery and access utilization., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The assessment of the early motor repertoire is a widely used method for assessing the infant's neurological status., Aim: To determine the association between the early motor repertoire and language development., Study Design: Prospective cohort study., Subjects: 22 term children born after normal pregnancy; video recorded for the assessment of the early motor repertoire including their motor optimality score (MOS), according to Prechtl, at 3 and 5months post term., Outcome Measures: At 4years 7months and 10years 5months, we tested the children's language performance by administering three tests for expressive language and two for receptive language., Results: Smooth and fluent movements at 3months of age was associated with better expressive language outcome at both 4years 7months and 10years 5months (betas 0.363 and 0.628). A higher MOS at 5months was associated with better expressive language at both ages (betas 0.486 and 0.628). The item postural patterns at 5months was the only aspect associated with poorer expressive language outcome (beta -0.677)., Conclusion: Predominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development., (Copyright © 2017 Elsevier B.V. All rights reserved.)