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Perioperative intra-articular joint injection is a known risk factor for developing prosthetic joint infection (PJI) in the immediate preoperative and postoperative periods for total knee arthroplasty, but is less defined in unicompartmental knee arthroplasty (UKA). The goal of this study was to elucidate the risk of developing PJI after intra-articular corticosteroid injection (IACI) into a post UKA knee.A retrospective review of a nationwide administrative claims database was performed from January 2015 to October 2020. Patients who underwent UKA and had an ipsilateral IACI were identified and matched 2:1 to a control group of primary UKA patients who did not receive IACI. Multivariate logistic analyses were conducted to assess differences in PJI rates at 6 months, 1 year, and 2 years.A total of 47,903 cases were identified, of which 2,656 (5.5%) cases received IACI. The mean time from UKA to IACI was 355 days. The incidence of PJI in the IACI group was 2.7%, compared to 1.3% in the control group. The rate of PJI after IACI was significantly higher than the rate in the control group at 6 months, 1 year, and 2 years (all P.05). The majority of PJI occurred within the first 6 months following IACI (75%).In this study, IACI in a UKA doubled the risk of PJI compared to patients who did not receive an injection. Surgeons should be aware of this increased risk to aid in their decision-making about injecting into a UKA.III, retrospective comparative study.

Early discharge has been a target of cost control efforts, given the growing demand for joint replacement surgery. Select patients are given the choice for same-day discharge (SDD) or overnight stay after shoulder arthroplasty. The COVID-19 pandemic changed patient perspectives regarding hospital visitation and admission. The purpose of this study was to determine if the COVID-19 pandemic impacted the utilization of SDD after shoulder arthroplasty. We hypothesize that patients undergoing shoulder arthroplasty after the start of the COVID-19 pandemic will have higher rates of SDD.A retrospective continuous review was performed on 370 patients who underwent a primary anatomic (total shoulder arthroplasty) or reverse shoulder arthroplasty between August 2019 and December 2020 by a single surgeon. This group of patients represent the 185 arthroplasty cases completed before the COVID-19 pandemic and the first 185 patients after the start of the pandemic. April 1, 2020, was chosen as the cutoff for pre-COVID patients, as this represents the date a statewide ban on elective surgery was declared. All patients were counseled preoperatively regarding SDD and given the choice to stay overnight, unless medically contraindicated. Demographics, medical history, length of stay, 30- and 90-day readmissions, and 90-day emergency room (ER) and urgent care visits were obtained from medical records and compared. Two-tailed studentThe 2 groups were similar in age, body mass index, gender distribution, and Outpatient Arthroplasty Risk Assessment score. During the collection period, there were more anatomic shoulder arthroplasties performed after (54%) than before (44%) the COVID-19 pandemic (Our study suggests that the COVID-19 pandemic has dramatically impacted patient choices for SDD within a single surgeon's practice, with nearly 3 times as many patients electing for SDD. Readmissions and ER visits were similar, indicating that SDD remains a safe alternative for patients after total shoulder arthroplasty and reverse shoulder arthroplasty.Level III; Retrospective Comparative Study.

Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion. Methods A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data. Results Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment. Conclusions The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes.

There is now a significant body of human and animal model data which identify common associations between perturbed development during gestation, disproportionate fetal growth and poor adult cardiovascular and metabolic health. Typically, these studies focus on the impact of poor maternal health on offspring development and well-being. However, a growing evidence base now indicates that sub-optimal paternal factors (such as diet) can also program adult offspring ill-health. While the link between paternal health and offspring well-being is becoming established, attention is being focused on defining the underlying mechanism(s). Here, the father may influence post-fertilization development through two main pathways, the integrity and status of the sperm genome (including epigenome) and through components of the seminal plasma. We have used mouse models of poor-quality diet to study the impact sub-optimal paternal nutrition has on the quality and epigenetic status of the sperm, embryonic development and fetal growth. We have also used our models to study the relative seminal plasma and sperm contributions to adult offspring cardiovascular and metabolic health. Our studies identify a continuum of changes ranging from testicular morphology, sperm epigenetic status, preimplantation embryo development, fetal growth and adult offspring cardio-metabolic ill-health in response to either over or undernutrition. Interestingly, we also observed that these long-term offspring effects appear mediated through specific sperm and seminal plasma specific mechanisms. Our data highlight the significance of a father’s diet at the time of conception for the development and well-being of his offspring.

As the process feature size continues to scale down, the susceptibility of logic circuits to radiation induced error has increased. This trend has led to the increase in sensitivity of circuits to multi-node upsets. Previously, work has been done to harden latches against single event upsets (SEU). Currently, there has been a concerted effort to design latches that are tolerant to double node upsets (DNU) and triple node upsets (TNU). In this paper, we first propose a novel DNU tolerant latch design. The latch is designed specifically to provide additional reliability when clock gating is used. Through experimentation, it is shown that the DNU tolerant latch is 11.3 percent more power efficient than existing latch designs suited for clock gating. In addition to the DNU tolerant design, we propose the first TNU tolerant latch. The TNU tolerant latch is shown to provide superior soft error resiliency while incurring a 40 percent overhead compared to DNU tolerant designs.

Lesser tuberosity osteotomy (LTO) and subscapularis peel (Peel) are 2 common techniques used to mobilize the subscapularis tendon during anatomic total shoulder arthroplasty (TSA). The literature is inconclusive over which technique is optimal; thus, controversy exists over which technique should be performed. The purpose of this study was to compare specific functional internal rotation tasks and general outcome scores in TSA patients who received either an LTO or Peel.A retrospective review of 563 patients treated with primary TSA using either an LTO (n = 358) or Peel (n = 205) with a minimum 2-year follow-up was performed. Subjective internal rotation, active internal rotation, and specific questions related to functional internal rotation isolated from the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons functional questionnaires were reviewed. Other outcome scores including visual analog scale pain and function, Single Assessment Numerical Evaluation, SST, American Shoulder and Elbow Surgeons, and revision rates were compared between the 2 groups.The study found no difference in postoperative functional internal rotation and range of motion between LTO and Peel. Patients who received a Peel were shown to have a slightly greater improvement in the ability to perform toileting and a higher average change in SST score that did not reach clinical significance. There was no difference in the percentage of maximal improvement, revision rate, or need for revision between the 2 groups.No difference was found between the LTO and Peel techniques in regard to functional tasks of internal rotation at short-term follow-up.

Aims and methodRecent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.ResultsOver the past 2 years, liaison psychiatry services have been set up in six out of seven health boards in Wales. Staffing levels have increased and the remit of services has broadened.Clinical implicationsMapping has highlighted that liaison psychiatry services in Wales continue to evolve. It will be important to continue to monitor these developments and their effects. Comparison with services in England will provide a useful comparison of service provision. A particular challenge will be to establish and monitor liaison psychiatry standards in Wales.Declaration of interestNone.

The JESD89 test standard defines how terrestrial neutron testing is conducted [1] . The test standard covers a number of different types of radiation used for testing, including protons, neutrons, and alphas, and different types of testing, including life testing and accelerated testing. Broad-spectrum neutron testing is the most common type of accelerated radiation testing for the terrestrial radiation environment. Unlike most test standards, the JESD89 defines the minimum energy for determining the cumulative fluence for the deployed and test environment. Currently, the minimum energy is set at 10 MeV. As the test standard is currently being rewritten, changing the minimum energy to 1 MeV is being explored, because it is believed that the onset to neutron-induced single-event effects (SEEs) is less than 10 MeV. There are three separate problems with lowering the minimum energy: determining whether electronics have a sensitivity to neutron-induced SEEs below 10 MeV, determining whether the test spectra match the terrestrial environment in the 1–10-MeV range, and the measurement error caused by not including the fluence from 1 to 10 MeV. In this paper, we present information on these factors and whether the minimum energy should be lowered to 1 MeV.

In this chapter we introduce logic gates because they are very useful to describe digital hardware such as computer processors. This was observed by Claude Shannon1 in his master thesis in 1937 [28]. We show how such gates are constructed using electronic components, such as transistors, and illustrate how circuits with more complex functionality can be constructed efficiently from such elementary gates.

This book describes how to make combinatorial and sequential circuits from logical gates, to use sequential circuits to model state machines, registers and a full-fledged computer. This computer has a simple assembly language. It is shown how higher level languages can be compiled into this assembly language. The general construction of a computer, including memory management systems is described culminating in a compact description of an ARM processor.

As you may have noticed, programming in assembly can be time-consuming and error-prone, so to make programming easier higher-level languages have been developed. These languages abstract away the details of particular processors and allow for the expression of common operations in a more concise and comprehensible manner. Typical early examples of higher-level programming languages are Fortran, Cobol, Algol 60 and Lisp. These days C/C++, Java and Python are the most popular languages. There are more than 1000 programming languages in existence and this number is quickly growing.

In this chapter, we discuss the representation of numbers and their manipulation by the central component of a processor, namely, the ALU (Arithmetic Logic Unit). We end with a small section on the representation of alphanumeric characters.