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Purpose: Studies demonstrate similar long-term Total Knee Arthroplasty (TKA) outcomes in patients with significant versus minimal preoperative coronal plane deformity. Limited short-term outcomes data, which determine costs of care, exist. Methods: We retrospectively explored the impact of preoperative coronal plane deformity on operative time, length of stay (LOS), and discharge to skilled nursing facility (SNF) in TKA. A total of 3,964 patients undergoing unilateral primary TKA at our institution from 2014 to 2019 were included (1,158 > 10˚ deformity: mean age 67.2 years, 47% male; 2,806 < 10˚ deformity: mean age 67 years, 37.4% male). The degree of coronal plane deformity (mechanical axis deviation on preoperative radiographs) was recorded. Patients with no knee radiographs ≤ 3 years preoperatively were excluded. Statistical analysis included Chi-Square tests, Student’s t-tests, Mann-Whitney U tests, and uni- and multivariable linear and logistic regression analyses. Results: The > 10˚ deformity cohort had a longer time from procedure start to finish (113.56 vs. 110.68 min; p = 0.020), greater deviation from surgeon mean operative time (+ 6.19 vs. + 0.69 min; p < 0.001), and higher proportion of cases requiring > 15 (26.8% vs. 22%;p = 0.001) and > 30 (12.3% vs. 7.8%;p < 0.001) additional minutes over their scheduled times. LOS was similar between cohorts (median 2 days, IQR 1–3). The deformity cohort more likely discharged to SNF (19.9% vs. 15.8%;p = 0.002). For every 1˚ increase in coronal plane deformity, operative time increased by 0.566 min (p = 0.000). The odds of SNF discharge increased with increasing coronal plane deformity (OR 1.029 [1.009,1.050]; p = 0.004). Conclusion: Greater preoperative coronal deformity is associated with increased operative time and odds of discharge to SNF in TKA. [ABSTRACT FROM AUTHOR]

The inconclusive category in forensics reporting is the appropriate response in many cases, but it poses challenges in estimating an “error rate”. We discuss the use of a class of information‐theoretic measures related to cross entropy as an alternative set of metrics that allows for performance evaluation of results presented using multi‐category reporting scales. This paper shows how this class of performance metrics, and in particular the log likelihood ratio cost, which is already in use with likelihood ratio forensic reporting methods and in machine learning communities, can be readily adapted for use with the widely used multiple category conclusions scales. Bayesian credible intervals on these metrics can be estimated using numerical methods. The application of these metrics to published test results is shown. It is demonstrated, using these test results, that reducing the number of categories used in a proficiency test from five or six to three increases the cross entropy, indicating that the higher number of categories was justified, as it they increased the level of agreement with ground truth. [ABSTRACT FROM AUTHOR]

Introduction Fetomaternal Hemorrhage is a condition in which a fetus blood mixes with the patient's during pregnancy due to a disruption in the barrier that keeps the fetus' and patient's blood separate. In this case, the patient visited her OBGYN's office and complained that she had recently noticed decreased fetal movement. Ultrasound revealed negative fetal heart tones. A stillborn fetus was delivered the next day and Kleihauer-Betke test indicated complete fetal exsanguination. Case Description A 24 year old female, G2P1001, presented to her OBGYN's office for routine checkup. At this visit, gestation was noted to be 35 weeks and 2 days. The patient reported that she had not felt the fetus move in the recent days, so an ultrasound was performed which showed no fetal heart movement. She was immediately induced and the fetus was delivered shortly after with a diagnosis of intrauterine fetal demise. It was determined that fetomaternal hemorrhage had occurred. Pathology report showed no obvious causes, but a Kleihauer-Betke test revealed that 300mL of the fetus' blood had mixed with the patient's, indicating complete fetal exsanguination. After careful calculation, the mother was given 8 vials of RhoGAM, which is a significantly larger dose of RhoGAM than the recommended empiric dose (12,000 IU's in our case vs the recommended 1500 IU empiric dose) Discussion This case illustrates an unusually large amount of fetal blood loss into the patient's circulation, but the use of Rhogam was able to prevent the patient from developing anti-D antibodies that would otherwise have affected future pregnancies. [ABSTRACT FROM AUTHOR]

Conventional models of natural transition flows are inadequate because they fail to predict streamwise intensities. One-equation and stress model formulations for the calculation of transitional flows which take the best features of the conventional linear stability model were presented. Theoretically-derived data showed that transitional region fluctuation-induced stresses exhibit laminar and large eddy components.