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INTRODUCTION Prosthetic services performed annually number in the millions; this number is only expected to grow in the future (Fortington, 2014). Lifetime costs of clinical services for lower-limb amputees when adjusted for inflation is projected to be between $300K and $1.5M in 2010 dollars (Blough, 2010). However, the incidence and etiology of prosthetic services utilization is poorly understood. This is especially critical during the first 90 days post-delivery of an initial lower-limb prosthesis, as prevailing Medicare reimbursement policy dictates limits on the reimbursement for certain services provided during this time period (CMS, 2016). The first step in understanding the clinical and financial ramifications of such a policy is to examine the taxonomy behind clinical encounters during this period (Etter, 2015). Therefore, the aim of this study was to quantify and categorize clinical encounters by incidence and etiology during the first 90 days post-delivery of an initial prosthesis. METHOD A retrospective chart review was performed within a centralized database of 16 prosthetic clinics and 28 individual providers spanning five states in the Northeastern United States. De-identified data were extracted using OPIE Software and a standardized extraction template. Inclusion criteria were: (1) received their first transtibial or transfemoral prosthesis, and (2) had at least two follow-ups within 90 days post-delivery. Exclusions were: (1) prior experience managing a prosthesis, (2) charts were incomplete, (3) patient was younger than 18 years of age, or (4) a medical event interrupted normal care during the first 90 days. Only those encounters within 90 days following delivery of the initial prosthesis were included in the analysis. The note for each individual clinical encounter was read with an interest in extracting the etiology, as well whether the encounter was scheduled or unscheduled based on pre-determined criteria. Following data collection, a random audit was performed to validate the data set. Table 1 reports a breakdown of participant demographics. RESULTS A total of 537 unique patients were identified, with 109 meeting the inclusion criteria. Of the 438 clinical encounters, 282 were scheduled and 156 were unscheduled. Chi-squared testing showed that comfort (P < 0.05) and mechanical failure (P < 0.001) yielded statistical significance in scheduled versus unscheduled visits. Step-wise regression analysis demonstrated that both gender and K-Level were important predictors of unscheduled visits. Table 2 displays selected etiologies and their incidence. DISCUSSION Comfort (24.5%), alignment issues (17.5%), self-management (15.7%), and mechanical failure (7%) made up the majority of total clinical encounters. If only looking at the unscheduled clinical encounters, we see that comfort (28.2%), mechanical failure (16.6%), alignment problems (21.7%), and self-management (25.6%) issues make up 92.3% of the reasons a prosthetist was sought out. This study supports that comfort is the most common reason for a patient to visit his or her prosthetist (Legro, 1998). CONCLUSION Taxonomy of clinical encounters provides a basis for informing reimbursement policy, workforce planning, and advocacy. [ABSTRACT FROM AUTHOR]

In this Letter, a method for the broadband measurement of complex permittivity using a quasi-optical technique is presented. After calibration of the quasi-optical system, the material under test is inserted into the system and S-parameters are measured from 220 to 330 GHz using a vector network analyser. An extraction method is then applied to calculate the complex permittivity. The permittivity measurements are validated by comparing with a well-established extraction method and the comparison shows good agreement. [ABSTRACT FROM AUTHOR]

We present an analysis of the caustic-crossing binary microlensing event OGLE-2017-BLG-0039. Thanks to the very long duration of the event, with a time scale tE ∼ 130 days, the microlens parallax is measured precisely despite its low value of . Analysis of the well-resolved caustic crossings during the source star’s entrance and exit of the caustic yields an angular Einstein radius of mas. The measured and indicate that the lens is a binary composed of two stars with masses and ∼0.15 M⊙, and is located at a distance of ∼6 kpc. From the color and brightness of the lens estimated from its determined mass and distance, it is expected that ∼2/3 of the I-band blended flux comes from the lens. Therefore, the event is a rare case of a bright lens event for which high-resolution follow-up observations can confirm its nature. [ABSTRACT FROM AUTHOR]

The microwave imaging reflectometer (MIR) is the leading diagnostic tool for study of density fluctuations in KSTAR. For last three years since 2014, major components such as the multi-frequency probe beam source, multi-channel detector array, signal processing electronic system, data acquisition system, and optical system have been gradually upgraded. In this paper, the detailed system upgrade with test results in the laboratory and/or plasma is given, and analysis results of a distinctive fluctuation structure referred to as the quasi-coherent mode (QCM) measured by the upgraded MIR system for an L-mode discharge are presented. Cross-coherence analysis with multiple channels shows that the QCM is localized in a core region and appears to be driven by electron temperature gradient for the discharge. [ABSTRACT FROM AUTHOR]

We present an analysis of the binary-lens microlensing event OGLE-2017-BLG-0537. The light curve of the event exhibits two strong caustic-crossing spikes among which the second caustic crossing was resolved by high-cadence surveys. It is found that the lens components with a mass ratio ∼0.5 are separated in projection by , where θE is the angular Einstein radius. Analysis of the caustic-crossing part yields mas and a lens-source relative proper motion of μ = 12.4 ± 1.1 mas yr−1. The measured μ is the third highest value among the events with measured proper motions and is ∼3 times higher than the value of typical Galactic bulge events, making the event a strong candidate for follow-up observations to directly image the lens by separating it from the source. From the angular Einstein radius combined with the microlens parallax, it is estimated that the lens is composed of two main-sequence stars with masses M1 ∼ 0.4 M⊙ and M2 ∼ 0.2 M⊙ located at a distance of DL ∼ 1.2 kpc. However, the physical lens parameters are not very secure due to the weak microlens-parallax signal, thus we cross-check the parameters by conducting a Bayesian analysis based on the measured Einstein radius and event timescale, combined with the blending constraint. From this, we find that the physical parameters estimated from the Bayesian analysis are consistent with those based on the measured microlens parallax. Resolving the lens from the source can be done in about 5 years from high-resolution follow-up observations and this will provide a rare opportunity to test and refine the microlensing model. [ABSTRACT FROM AUTHOR]

Purpose: Although the role of radiosurgery has been well documented in the treatment of malignant spinal tumours, more substantial clinical results are expected for the benign spinal tumours to provide its role as an treatment option. This study is to analyze the clinical results of spinal radiosurgery for benign intradural extramedullary spinal tumours. Methods: Between Feb. 2001 and Feb. 2010, sixty-two patients with neurogenic tumours and meningiomas who underwent image-guided stereotactic radiosurgery were reviewed retrospectively. According to radiological classification, 41 patients with schwannomas, 11 patients with neurofibromatosis and 10 patients of meningioma were classified. The dose prescriptions were determined and selected either single fraction or hypo-fraction schedules on the basis of tumour volume, locations and proximity to spinal cord. The clinical and radiological outcomes were analysed. Results: 80% of patients underwent radiosurgery as a primary treatment. Twelve patients were treated postoperative residual or recurrent spinal tumours using radiosurgery. Mean follow-up period was over 2 years. Median prescribed dose was 13Gy and 15Gy at 80 % isodose line in the treatment of neurogenic tumours and meningiomas respectively. Only 8 patients with giant presacral and intraosseous schannoma, enplaque type and atypically infiltrative growth of spinal meningioma were treated in hypofractionated schedules (ranged from two to five fractions). During follow-up, four patients are required to undergo repeated radiosurgery for the newly developed neurogenic tumours and/or recurrent meningiomas. Two patients of neurofibromatosis with advanced systemic diseases showed rapid malignant tumour progression after treatment. One patient with atypically infiltrative growth pattern of meningioma showed radiation related toxicity during the follow-up periods. Pain was significantly relieved in whom their predominant presenting symptoms were pain (three patients of giant intraosseous schwannoma). Conclusions: Spinal stereotactic radiosurgery provides an effective alternative treatment option for benign spinal tumors in order to achieve safe, effective local tumor control and pain relief. Combined surgery and radiosurgical treatment option can eliminate second operations for residual or recurrent tumours and modify the needs of instrumentation and the extent of surgical decompression. It is recommended to take a special care for the patients with advanced stages of neurofibromatosis and atypical feature of meningioma. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Given the rising number of patients with blindness from macular, optic nerve, and visual pathway disease, there is considerable interest in the potential of electrical stimulation devices to restore vision. Electrical devices for restoration of visual function can be grouped into three categories: (1) visual prostheses whose goal is to bypass damaged areas and directly activate downstream intact portions of the visual pathway; (2) electric field stimulation whose goal is to activate endogenous transcriptional and molecular signaling pathways to promote neuroprotection and neuro-regeneration; and (3) neuromodulation whose stimulation would resuscitate neural circuits vital to coordinating responses to visual input.  In this review, we discuss these three approaches, describe advances made in the different fields, and comment on limitations and potential future directions., Competing Interests: Declaration of competing interest Kimberly Kinga Gokoffski is supported by a K08 grant (1K08EY031797) from the NEI.  Darrin Jason Lee is supported by a K08 grant (1K08MH121757) from the NINDS.  Otherwise, the authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2021. Published by Elsevier Inc.)

Background: Interlocking telescopic rods for the management of osteogenesis imperfecta (OI)-related long bone fractures are a modification of the Sheffield rod. An interlocking pin anchors the obturator at the distal epiphysis, which spares the distal joint, while a T-piece anchors the sleeve at the proximal epiphysis. However, these devices are associated with some problems, including failure to elongate and difficulty with removal. A dual interlocking telescopic rod (D-ITR), in which the sleeve and the obturator are anchored with interlocking pins, was developed to address these problems., Questions/purposes: In this study, we compared the D-ITR with an older version of a single interlocking telescopic rod (S-ITR) based on (1) surgery-free survival and rod survival; (2) cessation of rod elongation and elongated length of the rod; and (3) risk of refracture and complications related to the interlocking telescopic system., Methods: This article compares the D-ITR with the S-ITR using a historically controlled, single-surgeon, retrospective design comparing two implants for the management of fractures in children with OI. Before August 2007, we exclusively used the S-ITR (n = 17 patients, 29 tibiae); from July 2008 until October 2014, we exclusively used the D-ITR (n = 17 patients, 26 tibiae). During the 1-year transition period, we performed five of these procedures (two S-ITR in two patients and three D-ITR in three patients), and implant use was based on availability with our preference being the D-ITR during that time when it was available. The general indications for use of both devices were the same: patients with OI and a tibial fracture who were older than 3 to 4 years of age and whose tibial canals were wide enough to accept an intramedullary rod. Younger patients were treated other ways (generally without surgery) and those with narrower canals with thinner, nonelongating rods or Kirschner wires, as indicated. All patients in both groups were available for followup at a minimum of 2 years (mean ± SD, 9.6 ± 3.0 years in the S-ITR group and 5.3 ± 2.1 years in the D-ITR group) except for one patient in the D-ITR group who died > 1 year after the procedure resulting from reasons unrelated to it. For the between-group comparison, we used only the followup data collected up to the ninth postoperative year in the S-ITR group. The truncated followup period of the S-ITR group was a mean of 5.0 ± 1.6 years. The mean age in the S-ITR group was 7 years (range, 3-12 years) and it was 8 years (range, 3-14 years) in the D-ITR group. There were nine boys and 10 girls in each group. Two orthopaedic surgeons other than the operating surgeon performed chart review to address our three research purposes. Survival analyses were performed using the Kaplan-Meier method. The overall pooled risk of refracture and major complications potentially associated with the interlocking telescopic rod system was compared between the groups., Results: With the numbers available, there were no differences between the D-ITR and the S-ITR in terms of mean surgery-free survival time (5.7 [95% confidence interval {CI}, 4.5-6.9] versus 5.1 [95% CI, 4.1-6.1]; years; p = 0.653) or mean rod survival time (7.4 [95% CI, 6.4-8.4] versus 6.0 [95% CI, 5.1-6.9] years; p = 0.120). With the numbers available, cessation of elongation (4% in the D-ITR group versus 19% in the S-ITR group; p = 0.112) and elongated length (45.3 ± 24.3 mm in the D-ITR group versus 44.2 ± 22.3 mm in the S-ITR group; p = 0.855) also did not differ between the groups. The pooled proportions of refracture or complications after the index surgery were higher in the S-ITR group (25 tibias [81%]) than in the D-ITR group (15 tibias [54%]; p = 0.049). Eight tibias in the S-ITR group had proximal migration of the sleeve compared with no patients in the D-ITR group (p = 0.005)., Conclusions: In patients with OI, the modified D-ITR provides effective tibial stabilization with similar or better results than the S-ITR design. Anchoring the sleeve at the proximal epiphysis with an interlocking pin provides better anchorage and allows easier removal., Level of Evidence: Level III, therapeutic study.