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Introduction Approximately 10% of reproductive-age females are affected by endometriosis, and of those, ~50% suffer from deep dyspareunia (DD). A portion of those with DD do not respond to medical and surgical treatments and therefore alternative management strategies are required. Objective We conducted a pilot randomized controlled trial (RCT) to assess the acceptability of a silicone buffer (Ohnut) for the management of endometriosis-associated DD. Methods This was a 1:1 waitlist-controlled pilot randomized control trial of a buffer that fits over the penis/penetrating object to limit the depth of penetration. Individuals with a surgical diagnosis of endometriosis aged 19-49 were recruited from a prospective data registry at a tertiary endometriosis centre who had a clinic visit between January 2018 and December 2020. Inclusion criteria were female-assigned at birth, DD score ≥ 4/10 (patient participants), and sexually active with a monogamous partner who consented to participate (partner participants). Exclusion criteria were superficial dyspareunia ≥ 4/10, prior use of a silicone buffer, intense anxiety around sexual activity, GAD-7≥15, and PHQ-9≥15. Participants were not blinded. The trial was 10 weeks. Over the first 4 weeks, participants (both intervention and control groups) continued their normal sexual activities and used a diary to record DD severity (0-10) during each penetrative vaginal sexual encounter. Over the following 6 weeks, the intervention group used the buffer during intercourse, while the control group continued normal sexual activities. Both groups continued to record DD severity until the conclusion of the study period. The intervention group then completed an acceptability questionnaire, of which an acceptability index score was calculated (0-1; 1 indicates more acceptability). Results Recruitment and data collection occurred between June and December 2021. 31 couples enrolled in the study and 17 couples completed primary data collection (control N=7; intervention N=10). All patient participants identified as cis-gender and the majority identified as heterosexual (94.1%) and white (94.1%). The mean buffer acceptability score for intervention was 0.78±0.06 for the patients (N=9) and for their partners (N=8) was 0.78±0.07. All of the patients and partners found that it was somewhat easy or very easy to handle the buffer. Five (55.5%) patients and five (62.5%) partners had somewhat more or much more sexual satisfaction when using the buffer compared to vaginal sex without using the buffer, two (22.2%) patients and three (37.5%) partners were neutral and 2 (22.2%) participants had less sexual satisfaction. The mean DD score from weeks 1-4 (i.e. normal sexual activities) for the control group was 4.5±2.0 and for the intervention group was 5.1±2.0. The mean DD score from weeks 5-10 (i.e. intervention period) was 4.2±2.1 for the control group and 2.4±2.0 for the intervention group that used the silicone buffer. No important adverse events were reported. Conclusions The Ohnut was acceptable among participants with endometriosis-associated DD and their partners. This pilot RCT suggested a reduction in the mean DD scores with the use of the buffer which should be substantiated in a definitive RCT. Disclosure Yes, this is sponsored by industry/sponsor: OhNut Wearable - provided a discount on the silicon buffer used in the trial; ISSWSH Grant. Clarification: No industry support in study design or execution.

Introduction Among individuals with endometriosis, approximately 50% experience deep dyspareunia. There is a validated test to evaluate superficial dyspareunia (tampon test); however, no such test exists for deep dyspareunia. Thus, we conducted a pilot study to evaluate the use of a vaginal insert for self-assessment of deep dyspareunia. Objective To report test-retest reliability and validity of using a vaginal insert for self-assessment of deep dyspareunia in individuals with endometriosis. Methods This was a prospective cohort study embedded within a pilot RCT. Individuals with a surgical diagnosis of endometriosis aged 19-49, who had a clinic visit between January 2018 and December 2020 were recruited from a prospective data registry at a tertiary endometriosis and pelvic pain centre. Inclusion criteria were assigned female at birth, sexually active or not sexually active due to pain, monogamous partner who consents to participate, and deep dyspareunia score ≥ 4/10. Exclusion criteria were superficial dyspareunia ≥ 4/10, prior use of the intervention under investigation in the RCT, intense fear or anxiety around sexual activity, and severe levels of anxiety or depression on validated screening measures. Participants used the vaginal insert to self-assess tenderness at two time points, one week apart, using a numeric rating scale (0-10) at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac. Participants also used a daily diary to record deep dyspareunia severity (0-10) during intercourse over a four-week period. Test-retest reliability was evaluated by correlating tenderness scores between the two time points. Validity was assessed by correlating the vaginal insert tenderness scores with deep dyspareunia scores. Results Nineteen participants completed the study. The average age was 34 ± 7 years, and the majority of participants identified as female (n=18; 94.7%), heterosexual (n=17; 89.5%) and white (n=17;89.5%). Intraclass correlation coefficients for each site showed good test-retest reliability: left pelvic floor 0.79 (p = 0.001), right pelvic floor 0.82 (p < 0.001), bladder 0.54 (p = 0.07), cervix-uterus was 0.89 (p < 0.001), and the cul-de-sac 0.77 (p = 0.003). The strongest correlation between tenderness using the vaginal insert and deep dyspareunia scores was at the cervix-uterus (r=0.35); however, no statistically significant correlations were identified at any of the pelvic sites. Conclusions We found a strong correlation of tenderness scores between assessment dates (test-retest reliability), indicating that the vaginal insert may be a reliable method of assessing deep dyspareunia. A future study with larger sample size will be needed to study the correlations between tenderness assessed with the vaginal insert and prospective deep dyspareunia scores for evaluation of validity. Self-assessment of deep dyspareunia using a vaginal insert shows promise, and may support trauma-informed practice and the collection of ecologically valid data. Disclosure Yes, this is sponsored by industry/sponsor: OhNut Wearable - provided a discount on the silicon buffer used in the trial; ISSWSH Grant. Clarification: No industry support in study design or execution.

Stream hydrology and water quality are highly interconnected and impacted by climate, land use and geology. We examined this connection using monitoring data from 2000 to 2019 for two streams with contrasting hydrological regimes – intermittent and regulated perennial – in subtropical Queensland, Australia. Our main objective was to quantify the impact of groundwater level changes and flow regulation on spatio‑temporal patterns in hydrology and water quality in the two streams. In intermittently flowing Lockyer Creek, flow was highly dependent on groundwater levels and occurred when the aquifer was recharged to elevations exceeding the upper 90‑percentile value. With 9.4% of the catchment area in irrigated horticulture, flow in Lockyer Creek was also likely to be reduced by drawdown of the aquifer for irrigation, with no flow for 30% to 81% of days over the observation period for stations in Lockyer Creek. In contrast, flow in the mid‑Brisbane River was continuous, regulated by discharge from a large upstream dam. Nutrient and suspended sediment concentrations in Lockyer Creek were generally higher than in the mid‑Brisbane River, likely associated with runoff from agricultural areas adjacent to the stream, while the upstream dam likely reduced the concentration and variability of nutrients and suspended sediment in the mid‑Brisbane River. During periods of baseflow in the mid‑Brisbane River, longitudinal changes in nutrient and suspended sediment concentrations occurred, notably a significant decrease in total and dissolved inorganic nitrogen downstream (p < 0.05), indicating a possible effect of in-stream algal uptake and denitrification. This study highlights the impact of human modifications on stream hydrology and water quality in the face of climate change. The findings can inform decision-making on groundwater irrigation or dam release control for water security.

Although both high-frequency and burst spinal cord stimulation (SCS) have shown improved efficacy and patient satisfaction compared with conventional tonic stimulation, there are limited data directly comparing the two. This study aimed to compare both high-frequency 10,000 Hz and burst SCS in the same patients in terms of pain relief and satisfaction in those with axial back pain with or without leg pain.This prospective, single-blind, randomized controlled trial was conducted at an outpatient pain clinic within an academic medical center. Participants were randomly allocated to one of two groups in which they trialed either burst or high-frequency 10,000 Hz SCS over five days, followed by a 24- to 48-hour washout period with no stimulation, and the alternative therapy over the remaining four days. Visual analog scale (VAS) scores were collected immediately before and after both therapy trials. Secondary end points included percentage change in VAS score and patient preference.Of 25 participants, those receiving burst followed by high-frequency SCS (n = 11) had a mean VAS difference of 4.73 after the first trial period and 2.86 after the second. Of those receiving high-frequency followed by burst SCS (n = 14), mean VAS difference after the first trial period was 4.00 and 1.93 after the second trial period. Four participants were withdrawn owing to lead migration. Both therapies showed statistically significant differences in pre- minus post-VAS scores and percent relief. There were no significant differences in carryover or treatment effects between the two groups. There was a statistically significant association between trial sequence and stimulator type implanted because the first stimulator trialed was more likely to be chosen.There were no observed differences in VAS pain score decrease when comparing burst and high-frequency 10,000 Hz SCS programming therapies. Patient preference followed an order effect, favoring the first programming therapy in the trial sequence.

INTRODUCTION It is uncertain if generic comorbidity indices commonly used in orthopedics accurately predict outcomes after total hip (THA) or knee arthroplasty (TKA). The purpose of this study was to determine the predictive ability of such comorbidity indices for: (1) 30-day mortality; (2) 30-day rate of major and minor complications; (3) discharge disposition; and (4) extended length of stay (LOS). METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent elective THA (n = 202,488) or TKA (n = 230,823) from 2011 to 2019. The American Society of Anesthesiologists (ASA) physical status classification system score, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) were calculated for each patient. Logistic regression models predicting 30-day mortality, discharge disposition, LOS greater than 1 day, and 30-day major and minor complications were fit for each index. RESULTS The ASA classification (C-statistic = 0.773 for THA and TKA) and mCCI (THA: c-statistic = 0.781; TKA: C-statistic = 0.771) were good models for predicting 30-day mortality. However, ASA and mCCI were not predictive of major and minor complications, discharge disposition, or LOS. The ECM and mFI-5 did not reliably predict any outcomes of interest. CONCLUSION ASA and mCCI are good models for predicting 30-day mortality after THA and TKA. However, similar to ECM and mFI-5, these generic comorbidity risk-assessment tools do not adequately predict 30-day postoperative outcomes or in-hospital metrics. This highlights the need for an updated, data-driven approach for standardized comorbidity reporting and risk assessment in arthroplasty.

Dialogue on physician well-being was concerning even prior to onset of the COVID-19 pandemic, which introduced additional unprecedented strain on healthcare workers compounded by increased personal and family stress. This paper describes our process for a rapid needs assessment and creation of a pandemic resiliency and well-being support infrastructure for physicians and healthcare staff at an academic medical center. In March 2020, executive leadership from our health system and physician group created a Resiliency and Support Steering Committee (RSSC) for rapid development of a pandemic needs response for our healthcare providers. RSSC identified key priorities: psychological care, medical care, basic care, and communication. A brief pandemic-focused needs survey was designed and distributed to healthcare professionals and targeted efforts focused on initiatives prioritized by respondents. A shared drive database allowed initiatives and outcomes to be communicated in real time. A wellness webpage was rapidly built and disseminated. Psychological support initiatives included proactive and reactive support. Providers were offered rapid access scheduling for primary medical care. Vetted resources were shared for regional grab-and-go food, grocery delivery, laundry services, and childcare. Additional resources included personal protective equipment (PPE) supply chain information, PPE guideline updates and training and access to scrubs/scrub laundering. Our pandemic support will fold into ongoing wellness initiatives that will be tailored and intentionally communicated. Multimodal and intentional communication processes will continue with a focus on enhancing bidirectional platform functionality. Cultural awareness of the importance of mitigating distress and supporting well-being will be prioritized through partnership with frontline members and leadership.

The present study aimed to determine the distribution of Veterans RAND 12-Item Health Survey (VR-12) mental component scores (MCS) of patients undergoing primary total hip arthroplasty (THA) and the thresholds of VR-12 MCS scores that predict higher healthcare utilizations and 1-year patient-reported outcome measures (PROMs).A prospective cohort of 4,194 primary THA patients (January 2016 to December 2019) were included. Multivariable and cubic spline regression models were used to test for associations between preoperative VR-12 MCS and postoperative outcomes, including: 90-day hospital resource utilization (non-home discharge, prolonged length of stay [LOS](i.e.≥3 days), all-cause readmission), attainment of Patient Acceptable Symptom State (PASS) at 1-year postoperative and Substantial Clinical Benefit (SCB) in the Hip Disability Osteoarthritis Outcome Score (HOOS)-pain and HOOS-physical short form (PS).Lower VR-12 MCS was associated with older age, obesity, Black race, women, and smokers (all p0.001). Preoperative VR-12 MCS20 was associated with more than twice the odds of non-home discharge (odds ratio [OR]:2.31) and prolonged LOS (OR:3.46). VR-12 MCS60 was associated with higher odds of achieving PASS (OR:2.00), and SCB in HOOS-JR (OR: 1.16). Starting VR-12 MCS ≤40, there were exponentially higher odds of worse outcomes.Low preoperative VR-12 MCS, specifically less than 40, may predict increased healthcare utilization. Furthermore, preoperative VR-12 MCS60 predicts greater satisfaction at 1-year and higher odds of achieving SCB in HOOS-JR. Quantifiable thresholds for VR-12 MCS may aid in shared-decision making and patient counseling in setting expectations or may guide specific care pathway interventions to address mental health during THA.

Comorbidity indices currently used to estimate negative postoperative outcomes in orthopaedic surgery were originally developed among non-orthopaedic patient populations. While current indices were initially intended to predict short-term mortality, they have since been used for other purposes as well. As the rate of hip and knee arthroplasty steadily rises, understanding the magnitude of the effect of comorbid disease on postoperative outcomes has become increasingly more important. Currently, the ASA classification is the most commonly used comorbidity measure and is systematically recorded by the majority of national arthroplasty registries. Consideration should be given to developing an updated, standardized approach for comorbidity assessment and reporting in orthopaedic surgery, especially within the setting of elective hip and knee arthroplasty. Cite this article: EFORT Open Rev 2021;6:629-640. DOI: 10.1302/2058-5241.6.200124

INTRODUCTION Spinal Cord Stimulation (SCS) is commonly utilized for treatment and management of chronic intractable low back and lower extremity pain. While SCS is an overall low-risk procedure, there are potential life-threatening complications, including surgical site infections such as an epidural abscess. Immunosuppression, a risk factor for epidural abscess, is becoming more common as an increasing number of patients are being treated with biologics for a multitude of autoimmune disorders. One class of commonly utilized biologics is anti-tumor necrosis factor (anti-TNF) alpha. While these drugs can provide tremendous benefit for treatment and management of autoimmune disorders, there is no clear understanding of the degree to which these medications increase a patient's risk for surgical site infection, including those associated with SCS-related procedures. CASE We present a case of an epidural abscess that developed immediately following an SCS trial in a patient with multiple undisclosed risk factors, including the use of an anti-TNF alpha agent to treat ankylosing spondylitis. DISCUSSION For an epidural abscess, early diagnosis is key to preventing devastating complications and the need for surgical intervention. Immunosuppression can be the result of multiple issues including cancer, HIV, and biologic agents such as anti-TNF alpha for the management of autoimmune diseases. There is limited evidence pertaining to the development of epidural abscesses in patients on anti-TNF alpha medications who undergo SCS. Studies focused on infections in patients undergoing SCS trials and permanent implants while on anti-TNF alpha agents could provide recommendations and guidance.

Background: Revision total hip arthroplasty (THA) is a challenging procedure that burdens the healthcare system. Despite being associated with worse outcomes relative to its primary counterpart, postoperative mortality after revision THA remains ill-defined. The present study aimed to (1) establish the overall 30-day mortality rate after revision THA and (2) explore the mortality rate stratified by age, comorbidity burden, and aseptic versus septic failure. Methods: The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent revision THA from 2011 to 2019. A total of 23,501 patients were identified and grouped into mortality ( n = 161) and mortality-free ( n = 23,340) cohorts. Patient demographics, comorbidities, and aseptic/septic failure were evaluated. Results: The overall 30-day mortality was 0.69%. The mortality rate by age group (normalised per 1000 patients) was 0 (18–39 years [Y]), 0.67 (40–49 Y), 1.10 (50–59 Y), 2.58 (60–69 Y), 6.15 (70–79 Y) 19.32 (80–89 Y), and 58.22 (90+Y) ( p 2 ( p Conclusions: 1 in 145 patients will suffer mortality during the 30 days after revision THA. PJI-related revision THA was associated with 1.5-fold increase in 30-day mortality rate compared to its aseptic counterpart. Certain patient determinants and baseline comorbidities, as measured by ASA and CCI scores, were associated with higher 30-day mortality rates. Therefore, it is imperative to identify such risk factors and implement perioperative patient optimisation pathways to mitigate the risk among vulnerable patients.

During the COVID-19 pandemic, social distancing has been employed to decrease the spread of COVID-19, especially within the geriatric population; however, the resulting loneliness and isolation carry their own detrimental effects. Loneliness resulting from the COVID-19 pandemic may also have negative implications on those with chronic musculoskeletal pain.The aim of this review was to identify the role of loneliness specific to the recent COVID-19 pandemic as it relates to the prevalence and severity of chronic pain in the geriatric population and to provide an overview for clinicians.Narrative review.A literature search was conducted using combinations of relevant search terms. Databases included PubMed and relevant grey literature sources. Reference lists of selected articles were also searched for additional relevant literature.Recent literature supports that social isolation and loneliness stemming from the COVID-19 pandemic have negative implications on chronic musculoskeletal pain. Loneliness has been well documented to have deleterious effects on physical and mental health, and it is increasingly linked to worsening debility and pain interference for those with chronic musculoskeletal pain. This has been found to be most prominent in the geriatric population, who are at the greatest risk for social decline and loneliness. Loneliness has also been found to have negative effects on cardiovascular disease, infectious disease, and mental health, as well as cognitive decline.Potential selection bias due to the narrative review design. Some included studies required the use of online questionnaires, which may not be accessible for the geriatric population, those without technology literacy, or low socioeconomic status populations. Future studies should emphasize screening patients for access to technological devices and reliable internet while partnering with community programs focused on digital literacy and resource access.A myriad of deleterious effects stemming from social isolation and loneliness have been documented, of which geriatric populations are especially susceptible. Both early identification of at-risk patients and safe interventions are essential to mitigate loneliness and stop the progression of debility. Further resources and research are necessary to illuminate how best to proceed, both in the setting of the ongoing pandemic and how interventions can be applied to alleviate suffering in those with limited ability to receive hospital or clinic-based care.

Background and Aims The Extra-Uterine Environment for Neonatal Development (EXTEND) aims to avoid the complications of prematurity, such as NEC. Our goal was to determine if bowel development occurs normally in EXTEND-supported lambs, with specific emphasis on markers of immaturity associated with NEC. Methods We compared terminal ileum from 17 pre-term lambs supported on EXTEND for 2- 4 weeks to bowel from age-matched fetal lambs that developed in utero. We evaluated morphology, markers of epithelial integrity and maturation, enteric nervous system structure, and bowel motility. Results EXTEND-supported lamb ileum had normal villus height, crypt depth, density of mucin-containing goblet cells, and enteric neuron density. Expression patterns for I-FABP, activated caspase-3 and EGFR were normal in bowel epithelium. Transmural resistance assessed in Ussing chambers was normal. Bowel motility was also normal as assessed by ex vivo organ bath and video imaging. However, Peyer’s patch organization did not occur normally in EXTEND ileum, resulting in fewer circulating B cells in experimental animals. Conclusion EXTEND supports normal ileal epithelial and enteric nervous system maturation in pre-term lambs. The classic morphologic changes and cellular expression profiles associated with NEC are not seen. However, immune development within the EXTEND supported lamb bowel does not progress normally.

A culture collection of 41 bacteria isolated from the rhizosphere of cultivated barley ( Hordeum vulgare subsp. vulgare ) is available at the Division of Plant Sciences, University of Dundee (UK). The data include information on plant growth-promoting genes implicated in nitrogen fixation, HCN channels, phosphate solubilization, and linked whole-genome sequences.

Determination of the appropriate post-discharge disposition after total hip (THA) and knee (TKA) arthroplasty is a challenging multidisciplinary decision. Algorithms used to guide this decision have been administered both preoperatively and postoperatively. The purpose of this study was to simultaneously evaluate the predictive ability of 2 such tools-the preoperatively administered Predicting Location after Arthroplasty Nomogram (PLAN) and the postoperatively administered Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" basic mobility tools-in accurately determining discharge disposition after elective THA and TKA.The study included 11,672 patients who underwent THA (n = 4,923) or TKA (n = 6,749) at a single large hospital system from December 2016 through March 2020. PLAN and "6-Clicks" basic mobility scores were recorded for all patients. Regression models and receiver operator characteristic curves were constructed to evaluate the tools' prediction concordance with the actual discharge disposition (home compared with a facility).PLAN scores had a concordance index of 0.723 for the THA cohort and 0.738 for the TKA cohort. The first "6-Clicks" mobility score (recorded within the first 48 hours postoperatively) had a concordance index of 0.813 for the THA cohort and 0.790 for the TKA cohort. When PLAN and first "6-Clicks" mobility scores were used together, a concordance index of 0.836 was observed for the THA cohort and 0.836 for the TKA cohort. When the PLAN and "6-Clicks" agreed on home discharge, higher rates of discharge to home (98.0% for THA and 97.7% for TKA) and lower readmission rates (5.1% for THA and 7.0% for TKA) were observed, compared with when the tools disagreed.PLAN and "6-Clicks" basic mobility scores were good-to-excellent predictors of discharge disposition after primary total joint arthroplasty, suggesting that both preoperative and postoperative variables influence discharge disposition. We recommend that preoperative variables be collected and used to generate a tentative plan for discharge, and the final decision on discharge disposition be augmented by early postoperative evaluation.The determination of post-discharge needs after THA and TKA remains a complex clinical decision. This study shows how simultaneously exploring the predictive ability of preoperative and postoperative assessment tools on discharge disposition after total joint arthroplasty may be a useful aid in a value-driven health-care model.

Patient satisfaction is indicative of the quality of care in the value-driven healthcare model. The Patient Acceptable Symptom State (PASS) is a dichotomous outcome tool measuring the highest level of symptom beyond which a patient considers him/herself well. The purpose of the present study was to identify combined preoperative phenotypes of PROMs associated with not achieving PASS at 1 year following total hip arthroplasty (THA) and to associate such phenotypes with hospital utilization parameters.A prospective institutional cohort of 4,034 patients who underwent primary THA for osteoarthritis (OA) with 1-year follow-up was included. Preoperative scores on Hip Disability and Osteoarthritis Outcome Score (HOOS)-pain, HOOS physical short form-(PS), and Veteran's Rand-12 (VR-12) mental component summary-(MCS) were used to develop phenotypes. Associations between preoperative 'phenotype' and 1-year PASS, discharge disposition, prolonged length of stay, 90-day readmission, and 1-year reoperation were evaluated using multivariate regression.10.6% (427/4,043) reported their state as 'not satisfactory' at 1 year. The phenotypes were the only preoperative factors to demonstrate the increased likelihood of 1-year dissatisfaction. Only phenotypes with lower than average preoperative MCS demonstrated this association. Low scores in all presently measured PROMs (Pain-PS-MCS-) was associated with double the odds of 1-year dissatisfaction (P.001), 2.43 times the odds of nonhome discharge and 2.2 times the odds of prolonged LOS.Patients with lower preoperative scores across multiple PROMs have increased odds of dissatisfaction after THA; and assessing pain, function, and MCS concomitantly (as phenotypes) may support identifying patients at risk for not achieving a satisfactory outcome.

Evaluating trends and drivers of baseline patient-reported outcome measures (PROMs) is critical to understanding when patients and providers elect to undergo surgery. We aimed to assess the following: (1) 5-year trends in baseline PROMs pre-THA (total hip arthroplasty) stratified by patient determinants; (2) patient factor associated with poor preoperative hip pain/function; (3) phenotypes of combined pain/function PROMs at baseline; and (4) intersurgeon variability in PROM thresholds at surgery.A prospective cohort of 6,902 primary THAs was enrolled (January 2016 to December 2020). Patient/surgeon details and PROMs were collected at point of care preoperatively. Outcomes included trends (5 years; 20 quarters) in Hip disability and Osteoarthritis Outcome Score (HOOS)-Pain and HOOS-PS (Physical Function Short-Form), stratified by patient demographics. Patients were further classified into phenotype categories of above or equal to median pain/function (P+PS+); below median pain/function (P-PS-); above or equal to median pain but below median function (P+PS-); and below median pain but above or equal to median function (P-PS+).Baseline HOOS-Pain was consistent across the study period (P-trend = .166), while HOOS-PS demonstrated increasing function (P-trend = .015). Such trends were appreciable in males, females, and White (P-trend.001, each) but not Black patients (P-trend = .67). Higher odds ratio (OR) of low baseline HOOS-Pain and HOOS-PS were detected among females (HOOS-Pain: OR 1.75, 95% confidence interval [CI] 1.55-1.98, P.001; HOOS-PS: OR 1.56, 95% CI 1.38-1.77, P.001), Black patients (HOOS-Pain: OR 1.64, 95% CI 1.35-2.82, P.001; HOOS-PS: OR 1.59, 95% CI 1.34-1.89, P.001), and smokers (HOOS-Pain: OR 1.56, 95% CI 1.29-1.89, P.001; HOOS-PS: OR 1.52, 95% CI 1.25-1.85, P.001). The P-PS- cohort (32.4%) had lowest age (65.2 ± 11.1 years), highest body mass index (31.6 ± 6.9 kg/mIn contrast to the general population, Black patients have consistently received THA at lower functional levels throughout the 5-year period. Females, smokers, and Black patients were more likely to have poorer pain and function at THA. PROMs assessment as combined pain-function phenotypes may provide a more comprehensive interpretation of patient status preoperatively.

Holocene glacial chronostratigraphies in glaciated valleys spread throughout the Himalayan-Tibetan orogen, including the Himalaya, Tibet, Pamir, and Tian Shan, are developed using a landsystems approach, detailed geomorphic mapping, and new and published Be-10 surface exposure dating. New studies in the Kulti valley of Lahul and the Parkachik valley of the Nun Kun massif of the Himalaya of northern India define three glacier advances at similar to 14.7, 12.2, 0.5 ka, in addition to one historically dated late 19th Century advance in the Kulti valley, and one Late Holocene advance at similar to 0.2 ka in the Parkachik valley. Three major climatic groups (subdivided into five climatic zones) are defined across the orogen using Cluster Analysis (CA) and Principal Component Analysis (PCA) to identify glaciated regions with comparable climatic characteristics to evaluate the timing, and extent of Holocene glacier advances across these regions. Our regional analyses across the Himalayan-Tibetan orogen suggest at least one Lateglacial (similar to 15.3-11.8 ka) and five Himalayan-Tibetan Holocene glacial stages (HTHS) at similar to 11.5-9.5, similar to 8.8-7.7, similar to 7.0-3.2, similar to 2.3-1.0, and

Introduction Deep dyspareunia negatively impacts people living with endometriosis and their sexual relationships. We are conducting a pilot study to assess the acceptability of 1) a silicone buffer (brand: OhNut) worn by the penetrating partner during intercourse to manage deep dyspareunia and 2) a vaginal insert for self-assessment of deep dyspareunia. The study is ongoing, and recruitment of participants is complete. Objective To report recruitment outcomes for the ongoing study including response rate, consent rate, and percent screen failed by category. Methods The recommended sample size was 24 couples; given potential dropout and uncertainty about the variance in acceptability, we aimed to recruit 40 couples. Potential patient participants were people with a surgical diagnosis of endometriosis at a tertiary care centre in Western Canada, who attended a clinic appointment between January 1, 2018, and December 31, 2020, and had previously consented to be contacted for research. We telephoned potential participants twice and then contacted them by email twice. Phone screenings were conducted for inclusion criteria in the following order: age 19-49, sexually active with a monogamous partner, superficial dyspareunia Results 2317 new patients attended a clinic appointment within the recruitment time frame, including 864 potentially eligible participants. The response rate was 45% (368 responses). Of respondents, 8% consented to participate, 65% were interested but did not meet inclusion/ exclusion criteria, and 27% declined participation. Of those who did not meet eligibility criteria, 8% had high superficial dyspareunia, 52% reported no or low deep dyspareunia, 21% had no monogamous sexual partner, 4% had a partner who declined participation, 5% did not have penetrative sex, 8% scored ≧ 15 on the GAD-7 or reported high anxiety around sexual activity, 0.4% had a PHQ-9 score ≧ 15, and 2% had previously used the silicone buffer. The recruitment rate was around 5 participants per month of active recruitment. Conclusions Recruitment barriers in this pilot trial included no or low deep dyspareunia (likely related to previous treatment at the tertiary care centre, prior to recruitment); no monogamous partner; concurrent superficial dyspareunia; and high anxiety scores. Thus a future definitive trial should consider including subjects earlier in the treatment pathway, those who are unpartnered, and individuals who are experiencing concomitant superficial dyspareunia or anxiety. Disclosure Yes, this is sponsored by industry/sponsor: OhNut Wearable - provided a discount on the silicon buffer used in the trial; ISSWSH Grant Clarification No industry support in study design or execution

Low socioeconomic status and neighborhood context has been linked to poor health care outcomes after total knee arthroplasty (TKA). The area deprivation index (ADI) addresses this relationship by ranking neighborhoods by socioeconomic disadvantage. We examined the following relationships of the ADI among TKA recipients: (1) patient demographics, (2) lengths of stay (LOS), (3) nonhome discharges, and (4) 90-day readmissions, emergency department visits, and reoperations.We reviewed a consecutive series of primary TKAs from 2018 through 2020 at a tertiary health care system. A total of 3928 patients who had complete ADI data were included. A plurality of patients (14.9%) were categorized within ADI 31-40, below the national median ADI of 47. Associations between the national ADI decile and 90-day postoperative health care utilization metrics were evaluated using multivariate regressions (adjusted for patient demographics and comorbidities).The 91-100 ADI cohort was disproportionately African American, female, younger, and smokers. Compared with ADI 31-40 (reference), the ADI 61-70 cohort was associated with higher odds of LOS ≥3 days (odds ratio [OR] = 1.6 [1.08-2.36], P = .019) and nonhome discharges (OR = 1.73 [1.08-2.75], P = .021). The ADI 91-100 cohort was associated with the highest odds of prolonged LOS (OR = 2.27; [1.47-3.49], P.001), nonhome discharges (OR = 3.49 [2.11-5.78], P.001), and all-cause readmissions (OR: 1.79, [1.02-3.14], P = .044). No significant associations were found between the ADI and 90-day emergency department visits or reoperations (P.05).A higher ADI was associated with prolonged LOS, nonhome discharge status, and 90-day readmissions after TKA. This index highlights potential areas of intervention for assessing health care outcomes.

Value-driven healthcare models prioritize patient-perceived benefits to quantify the quality of care through patient-reported outcome measures (PROMs). The Patient Acceptable Symptom State (PASS) is the highest level of symptom beyond which a patient considers his/her condition satisfactory. We identified preoperative phenotypes of PROMs associated with not achieving PASS at 1 year following total knee arthroplasty (TKA) and explored the relationships between such phenotypes with hospital utilization parameters.A prospective institutional cohort of 5,274 primary TKAs for osteoarthritis from 2016 to 2019 with 1-year follow-up were included. Preoperative scores on Knee Disability and Osteoarthritis Outcome Score (KOOS) Pain, KOOS-Physical function Short form (PS), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were used to develop patient phenotypes. Associations between preoperative "phenotype" and 1-year PASS, discharge disposition, length of stay, 90-day readmission, and 1-year reoperation were evaluated using multivariate regression.In total, 16.3% (n = 862) of patients reported their state as "not acceptable" at 1 year. A combination of low scores in each of the presently examined PROMs was associated with the highest odds of 1-year dissatisfaction (odds ratio 2.18, 95% confidence interval 1.74-2.74). The PROM phenotypes were the greatest drivers compared to sociodemographic variables in predicting satisfaction. Combinations of low scores in VR-12 MCS and KOOS-PS were significantly associated with both non-home discharge status and prolonged length of stay.Patients with combined lower preoperative scores across multiple PROMs (KOOS-Pain41.7, KOOS-PS51.5, and VR-12 MCS52.8) have increased odds of dissatisfaction after TKA. Measuring pain, function, and mental health concurrently as phenotypes may help identify TKA patients at risk for not achieving a satisfactory outcome at 1 year.

It is uncertain if generic comorbidity indices commonly used in orthopedics accurately predict outcomes after total hip (THA) or knee arthroplasty (TKA). The purpose of this study was to determine the predictive ability of such comorbidity indices for: (1) 30-day mortality; (2) 30-day rate of major and minor complications; (3) discharge disposition; and (4) extended length of stay (LOS).The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent elective THA (n = 202,488) or TKA (n = 230,823) from 2011 to 2019. The American Society of Anesthesiologists (ASA) physical status classification system score, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) were calculated for each patient. Logistic regression models predicting 30-day mortality, discharge disposition, LOS greater than 1 day, and 30-day major and minor complications were fit for each index.The ASA classification (C-statistic = 0.773 for THA and TKA) and mCCI (THA: c-statistic = 0.781; TKA: C-statistic = 0.771) were good models for predicting 30-day mortality. However, ASA and mCCI were not predictive of major and minor complications, discharge disposition, or LOS. The ECM and mFI-5 did not reliably predict any outcomes of interest.ASA and mCCI are good models for predicting 30-day mortality after THA and TKA. However, similar to ECM and mFI-5, these generic comorbidity risk-assessment tools do not adequately predict 30-day postoperative outcomes or in-hospital metrics. This highlights the need for an updated, data-driven approach for standardized comorbidity reporting and risk assessment in arthroplasty.

Rockwall slope erosion is an important component of alpine landscape evolution, yet the role of climate and tectonics in driving this erosion remains unclear. We define the distribution and magnitude of periglacial rockwall slope erosion across 12 catchments in Himachal Pradesh and Jammu and Kashmir in the Himalaya of northern India using cosmogenic 10Be concentrations in sediment from medial moraines. Beryllium‐10 concentrations range from 0.5 ± 0.04 × 104 to 260.0 ± 12.5 × 104 at/g SiO2, which yield erosion rates between 7.6 ± 1.0 and 0.02 ± 0.004 mm/a. Between ∼0.02 and ∼8 m of rockwall slope erosion would be possible in this setting across a single millennium, and >2 km when extrapolated for the Quaternary period. This erosion affects catchment sediment flux and glacier dynamics, and helps to establish the pace of topographic change at the headwaters of catchments. We combine rockwall erosion records from the Himalaya of Himachal Pradesh, Jammu and Kashmir, and Uttarakhand in India and Baltistan in Pakistan to create a regional erosion data set. Rockwall slope erosion rates progressively decrease with distance north from the Main Central Thrust and into the interior of the orogen. The distribution and magnitude of this erosion is most closely associated with records of Himalayan denudation and rock uplift, where the highest rates of change are recorded in the Greater Himalaya sequences. This suggests that tectonically driven uplift, rather than climate, is a first order control on patterns of rockwall slope erosion in the northwestern Himalaya. Precipitation and temperature would therefore come as secondary controls., Key Points: Rates of periglacial rockwall slope erosion are defined for the northwestern Himalaya using cosmogenic 10Be concentrations in sediment from medial moraines. Tectonically driven uplift offers a first‐order control on patterns of rockwall slope erosion. Precipitation and temperature play secondary roles in this erosion., National Geographic Society http://dx.doi.org/10.13039/100006363, Geological Society of America http://dx.doi.org/10.13039/100005720, University of Cincinnati, Graduate Student Governance Association, PRIME Laboratories, Purdue University

We defined the timing of surface abandonment for 10 alluvial and debris-flow fans across contrasting climatic settings in the NW Himalaya of northern India using cosmogenic 10Be surface exposure dating. Debris-flow fans in the Garhwal, Kullu, and Lahul-Spiti regions of the monsoon-influenced Greater Himalaya were largely abandoned during the Mid- to Late Holocene. Large alluvial fans and smaller debris-flow fans in the semiarid Ladakh region of the Greater and Tethyan Himalaya have surface ages that extend throughout the last glacial. Regional events of landform abandonment and incision were defined for the monsoon-influenced western Himalaya ranges and the semiarid western Himalaya ranges over the past ~120 k.y. In the monsoon-influenced and semiarid western Himalaya ranges, these regional events were limited to the Holocene and from ca. 40 ka, respectively. The timing of fan surface abandonment and regional landform abandonment events coincided with periods of weakening monsoon strength and cooling, and local and regional glacier advances. Regional incision events from the monsoon-influenced and semiarid western Himalaya regions were recognized across various climatic conditions due to the ubiquitous nature of erosion in mountain settings. This study showed that climate-driven processes and glaciation were important drivers in fan sedimentation, catchment sediment flux, and the topographic evolution of the NW Himalaya during the late Quaternary.

Introduction: Total joint arthroplasty constitutes a major focus of publications within orthopaedics. Because research expands and investigators from around the world contribute, it is important to understand the dynamics of publication. Methods: PubMed was queried for hip and knee arthroplasty-related articles published between 1988 and 2018 within seven orthopaedic journals. A bibliometric analysis was done. The manuscript region of origin was determined by the affiliated country of the last author and used to examine trends in publication. Results: A total of 6,160 publications were included. Forty-eight countries from six continents were identified. The quantity of arthroplasty-related publications increased over the study period (n = 246 in 1988 and n = 1,247 in 2018, P < 0.01). Articles were primarily published by North America (51.9%), Europe (32.5%), and Asia (12.4%). Clinical trials accounted for 45.6% of all publications. Articles from Asia received fewer citations than those from North America, Europe, and Oceania (P < 0.001). Discussion: The volume of publications was five times greater in 2018 than in 1988, yet international articles constitute a marginal proportion of annual publications. Most of the literature (84.4%) originated from North America and Europe. Balanced publication of international research may favor global communication of findings, increasing the spectrum of available evidence applicable worldwide.

Transglutaminases (TGs) are crosslinking enzymes best known for their vascular remodeling in hypertension. They require calcium to form an isopeptide bond, connecting a glutamine to a protein bound lysine residue or a free amine donor such as norepinephrine (NE) or serotonin (5-HT). We discovered that perivascular adipose tissue (PVAT) contains significant amounts of these amines, making PVAT an ideal model in which to test interactions of amines and TGs. We hypothesized that TG2 and FXIII are active in PVAT. Sprague-Dawley rat aortic, superior mesenteric (SMA), and mesenteric resistance artery (MR) PVAT express TG2 and blood coagulation factor XIII (FXIII) mRNA (Figure 1A). Consistent with this, immunohistochemical analyses support that PVATs all express TG2 and FXIII protein. The activity of TG2 and FXIII was investigated in tissue sections using substrate peptides that label active TGs and a catalyzing calcium solution, visualized with TRITC fluorescence (Figure 1B,C). Both TG2 and FXIII are active in rat aortic PVAT, SMAPVAT, and MRPVAT. Western blot analysis determined that the known TG inhibitor cystamine reduced incorporation of experimentally added amine donor 5-(biotinamido)pentylamine (BAP) into MRPVAT by 6.14% of total normalized signal (p

Sample details of local and regional chronological datasets

Steep north-south trending gradients in elevation, slope, relief, rock uplift and precipitation make the NW Himalaya an excellent location to examine the relative roles of climate and tectonics in ...

7 pags., 3 figs. -- 27th International Nuclear Physics Conference (INPC2019), The tetraneutron has attracted the attention of nuclear physicists during the past decades, but there is still no unambiguous confirmation of its existence or nonexistence. A new experiment based on 8 He(p,2p)7H{t+4n} reaction, with direct detection of the four neutrons, has been carried out at RIBF, which can hopefully help to draw a definite conclusion on the tetraneutron system., We acknowledge the support of the RIBF accelerator staff and the BigRIPS team for providing the high-quality beam. Z. H. Yang acknowledges the financial support from the Foreign Postdoctoral Researcher program of RIKEN. T. Aumann acknowledges the support by DFG via SFB 1245. P. Koseoglou acknowledges the support from BMBF (NUSTAR.DA grant No.05P 15RDFN1).

Holocene glacial chronostratigraphies are developed for four glaciated valleys at the northwestern end of the Himalayan-Tibetan orogen using geomorphic mapping and cosmogenic 10Be surface exposure dating. The study areas include the Hamtah valley in the Lahul Himalaya, and the Karzok, Lato and upper Stok valleys in Zanskar. Five local glacial stages are dated to ∼10.4, ∼6.1–3.3, ∼2.1–0.9, ∼0.7–0.4, and ∼0.3–0.2 ka based on 49 new moraine boulder ages. Large age dispersions are evident for each of the local glacial stages. This is especially the case for ∼6.1–3.3 and ∼2.1–0.9 ka, which is likely a result of prior and/or incomplete exposures in very young moraine boulders. An additional compilation of 187 published 10Be moraine boulder ages help define seven Himalayan Holocene regional glacial stages (HHs) for the northwestern end of the Himalayan-Tibetan orogen. These HHs date to ∼10.9–9.3, ∼8.2–7.4, ∼6.9–4.3, ∼4.5–2.8, ∼2.7–1.8, ∼1.8–0.9, and

The glacial chronostratigraphy and history of the Lato Massif of Zanskar northern India is defined for the first time using geomorphic mapping and 10Be surface exposure dating. Three local glacial stages, the Lato, Shiyul and Kyambu, are dated to 244–49, 25–15 and 3.4–0.2 ka, respectively. The Lato glacial stage was the most extensive period of glaciation, characterized by expanded ice caps with glaciers advancing to ∼16 km from their present position. Large till deposits are associated with this glacial stage, which represent a time of heightened glacial erosion and localized incision, and increased rates of sediment transfer and deposition. The glacial style transitioned to entrenched valley glaciation during the Shiyul glacial stage. Hummocky moraine complexes reflecting fluctuating glacier margins characterize this glaciation. Glaciers have been confined to the cirques and headwalls of the massif during and since the Kyambu glacial stage. Equilibrium-line altitude (ELA) reconstructions help define the shifts in glaciation over time, with ELA depressions changing from 470 ± 140, 270 ± 80 to 100 ± 30 m for the Lato, Shiyul and Kyambu glacial stages, respectively. The change of glacial style during the latter part of the Quaternary is similar to other regions of the Transhimalaya and Tibet suggesting that this pattern of glaciation may reflect regional climatic forcing. The evolution of the Lato Massif from an isolated alpine plateau to a steeply incised massif over the last several glacial-interglacial cycles may have also influenced the shifts from ice cap to valley glaciation.

Background This study aims to answer the following questions regarding elective total hip arthroplasty (THA): What is (1) the overall 30-day mortality rate; (2) the mortality rate when stratified by age, comorbidities, and preoperative diagnosis; and (3) the distribution of patient demographics, comorbidities, and preoperative diagnoses between the mortality and mortality-free cohorts? Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all patients undergoing elective primary THA (2011-2018). A total of 194,062 patients were categorized based on the incidence of 30-day mortality (mortality: n = 206 vs mortality-free: n = 193,856). Patient demographics, comorbidities, and preoperative diagnosis (osteoarthritis [OA] vs non-OA) were recorded. Age category, American Society of Anesthesiologists (ASA) score, and modified Charlson Comorbidity Index (CCI) scores were normalized per 1000 and stratified by preoperative diagnosis. Results The 30-day mortality rate was 0.11%. The percentage of deaths per age group (normalized per 1000) was 0% (18-29 years), 0% (30-39 years), 0.049% (40-49 years), 0.052%(50-59 years), 0.071% (60-69 years), 0.133% (70-79 years), and 0.352% (80-89 years). The percentage of deaths per ASA score was 0% (ASA I), 0.035% (ASA II), 0.174% (ASA III), and 1.008% (ASA IV). The percentage of deaths per CCI score was 0.09% (CCI = 0), 0.23% (CCI = 1), 0.74% (CCI = 2), 3.21% (CCI = 3), 4.76% (CCI = 4), and 0.57% (CCI ≥ 5). Non-OA diagnoses were significantly more frequent in the mortality cohort (16.0% vs 7.6%; P Conclusion The risk of mortality was highest in patients aged 80-89, patients of ASA class IV, patients with a CCI score of 4, and patients with a non-OA diagnosis. The overall rate of death was higher in the non-OA cohort compared to the OA cohort. Level of Evidence III.

A shift toward a value-driven health-care model has made prospective collection of patient-reported outcome measures (PROMs) inextricably tied to measuring the success of orthopaedic surgery and patient satisfaction. While progress has been made in optimizing the utilization of PROM data, including establishing appropriate PROMs for a procedure and determining the clinical importance of unique tools, if these PROMs are not accurately analyzed and reported, a proportion of patients who do not reach the clinical thresholds may go unnoticed. Furthermore, parameters are unclear for setting a statistically and clinically important PROM threshold along with a minimum period for follow-up data collection.In this forum, we walk through simulated data sets modeling PROMs with the example of total joint arthroplasty. We discuss how the commonly used method of reporting PROMs by mean change can overestimate the treatment effects for the cohort as a whole and fail to capture distinct populations that are below a clinically relevant threshold. We demonstrate that when a study's outcome is PROMs, clinical importance should be reported using clinical thresholds such as the minimum clinically important difference (MCID), the smallest change in the treatment outcome that a patient perceives as beneficial, and the patient acceptable symptom state (PASS), the highest level of symptoms beyond which a patient considers himself or herself well. Finally, we propose a standardized reporting of PROMs that incorporates both the MCID and the PASS, and introduce a "clinical relevance ratio," which relies on a clinically relevant threshold to dichotomize outcomes and reports the number of patients achieving clinical importance at a given time point divided by the total number of patients included in the study. Unlike other common PROM-reporting approaches, the clinical relevance ratio is not skewed by patients who are lost to follow-up with increased time.

Objective Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Methods Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed. Demographic, medical, laboratory, anaesthetic, intraoperative and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analysed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome. Results Average patient age was 43.4±11.4 years, and average body mass index was 48.2±10.3 kg m2-1. A total of 155 patients (77.1%; 95% confidence interval, 71%-83%; p

The present study furthered the concept of simulation-based medical education by applying a personalized active learning component. We tested this novel approach utilizing a noninvasive hemodynamic monitor with the capability to measure and display in real time numerous hemodynamic parameters in the exercising participant. Changes in medical knowledge concerning physiology were examined with a pre-and posttest. Simply by observation of one's own hemodynamic variables, the understanding of complex physiological concepts was significantly enhanced.