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International audience; Current climate change models for the southeast UK predict changing rainfall patterns, with increased incidence of extreme events. The chalk aquifer in the UK and northern France is susceptible to groundwater-induced flooding under such conditions. In this methodological study we apply a frequency domain analysis approach to the chalk aquifer to derive a transfer function between effective rainfall and groundwater level from 7 years of monitoring data from the North Heath Barn site, near Brighton. The derived transfer function was calibrated and validated against monitoring data and then used to predict groundwater level for rainfall models for high, medium and low emission scenarios from the UKCP09 database. The derived transfer function is most closely comparable to the linear aquifer model, despite evidence for both matrix and fracture or karst water flow in the chalk, with transmissivity and unconfined storativity at the catchment scale of 1548 m2 day−1 and 1.6 × 10−2. The application of the transfer function to UKCP09 rainfall data suggests that groundwater-induced flooding may be about four times more frequent by 2040–2069 compared with 1961–1990 and seven times more frequent by 2070–2099. The model data also suggest an increase in the duration of groundwater minima relative to the reference period. Compared to deterministic modelling which requires detailed knowledge of aquifer heterogeneity and processes, the transfer function approach, although with limitations, is simpler, incorporating these factors into the analysis through frequency and phase coefficients, and thus may have the potential for groundwater risk assessment in other areas. Copyright © 2015 John Wiley & Sons, Ltd.

Optimizing pain control following total knee arthroplasty is of utmost importance to the immediate post-operative course. Various anesthesia modalities are available, but studies comparing multiple anesthesia modalities, patient age, and sex are limited.The purpose of our study was to examine the impact of patient age, gender, and perioperative anesthesia modality on postoperative pain following primary total knee arthroplasty.443 patients who underwent primary total knee arthroplasty by 14 surgeons with some combination of general anesthesia, spinal anesthesia, femoral nerve block, and intrathecal morphine were identified. Anesthesia route and type, length of surgery, post-operative patient-reported pain measures using the Visual Analog Scale, opioid consumption, and length of hospital stay were recorded for each patient and used to compare differences among study groups.No significant differences were noted between anesthesia groups with regards to postoperative pain or length of hospital stay. Patients receiving spinal anesthesia and femoral nerve block without intrathecal morphine were significantly older than other groups. Patients receiving general anesthesia required significantly more daily intravenous morphine equivalents than patients receiving spinal anesthesia. Patients receiving spinal anesthesia with femoral nerve block and intrathecal morphine consumed the least amount of morphine equivalents. When comparing males and females among all groups, females had significantly higher pain ratings between 24-36 and 24-48 hours postoperatively.Although no significant differences were noted on pain scores, patients who received spinal anesthesia with intrathecal morphine and femoral nerve block used less narcotic pain medication than any other group. Females reported significantly higher pain between 24-48 hours post-op compared with males but not significantly greater anesthetic usage.Level III, Therapeutic Study, (Retrospective Comparative study).

Residency programs are continually attempting to predict the performance of both current and potential residents. Previous studies have supported the use of USMLE Steps 1 and 2 as predictors of Orthopaedic In-Training Examination (OITE) and eventual American Board of Orthopaedic Surgery success, while others show no significant correlation. A strong performance on OITE examinations does correlate with strong residency performance, and some believe OITE scores are good predictors of future written board success. The current study was designed to examine potential differences in resident assessment measures and their predictive value for written boards.A retrospective review of resident performance data was performed for the past 10 years. Personalized information was removed by the residency coordinator. USMLE Step 1, USMLE Step 2, Orthopaedic In-Training Examination (from first to fifth years of training), and written orthopaedic specialty board scores were collected. Subsequently, the residents were separated into two groups, those scoring above the 35(th) percentile on written boards and those scoring below. Data were analyzed using correlation and regression analyses to compare and contrast the scores across all tests.A significant difference was seen between the groups in regard to USMLE scores for both Step 1 and 2. Also, a significant difference was found between OITE scores for both the second and fifth years. Positive correlations were found for USMLE Step 1, Step 2, OITE 2 and OITE 5 when compared to performance on written boards. One resident initially failed written boards, but passed on the second attempt This resident consistently scored in the 20(th) and 30(th) percentiles on the in-training examinations.USMLE Step 1 and 2 scores along with OITE scores are helpful in gauging an orthopaedic resident's performance on written boards. Lower USMLE scores along with consistently low OITE scores likely identify residents at risk of failing their written boards. Close monitoring of the annual OITE scores is recommended and may be useful to identify struggling residents. Future work involving multiple institutions is warranted and would ensure applicability of our findings to other orthopedic residency programs.