Search

Background: This study examined trends in inpatient charges for primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), hemiarthroplasty (HA), and revision total shoulder arthroplasty (revTSA) over the past decade. Methods: The New York Statewide Planning and Research Cooperative System was queried for patients undergoing primary aTSA, rTSA, HA, and revTSA from 2010 to 2020 using International Classification of Diseases procedure codes. The primary outcome measured was total charges per encounter. Secondary outcomes included accommodation and ancillary charges, charges covered by insurance, and facility volume. Ancillary charges were defined as fees for diagnostic and therapeutic services and accommodation charges were defined as fees associated with room and board. Subgroup analysis was performed to assess differences between high- and low-volume centers. Results: During the study period, 46,044 shoulder arthroplasty cases were performed: 18,653 aTSA, 4002 HA, 19,253 rTSA, and 4136 revTSA. An exponential increase in rTSA (2428%) and considerable decrease in HA (83.9%) volumes were observed during this period. Total charges were the highest for rTSA and revTSA and the lowest for aTSA. Subgroup analysis of revTSA by indication revealed that total charges were the highest for periprosthetic fractures. For aTSA, rTSA, and HA, high-volume centers achieved significantly lower total charges compared to low-volume centers. Over the study period, total inpatient charges increased by 57.2%, 38.4%, 102.4%, and 68.4% for aTSA, rTSA, HA, and revTSA, outpacing the inflation rate of 18.7%. Conclusion: Total inpatient charges for all arthroplasty types increased dramatically from 2010 to 2020, outpacing inflation rates, but high-volume centers demonstrated greater success at mitigating charge increases compared to low-volume centers.

Physicians should be prepared for the presentation and treatment of an anaphylactic reaction in a patient who has been exposed to chlorhexidine perioperatively and consider a sustained source of allergic exposure when faced with a refractory response to treatment.

Abstract Background There are more than 7,800 people living with human immunodeficiency virus (HIV) in Victoria, Australia. Crucial in maximising the individual and population level benefits from antiretroviral therapy (ART) is understanding how to achieve patient retention in care and the factors that drive it. This study was an expansion of a 2015 assessment of HIV-care retention in Victoria, which sought out to determine whether the inclusion of a broader range of HIV-healthcare sites would yield more accurate estimates of retention in HIV-care. We aimed to improve our understanding of HIV-care retention in Victoria, Australia, identify people living with HIV (PLHIV) with unknown outcomes, and attempt to re-engage PLHIV in care. Methods A network of 15 HIV-care sites was established in Victoria, Australia across diverse care settings which ranged from low-caseload rural sites to high-caseload metropolitan GP clinics and hospitals. Individuals who had an HIV viral load (VL) performed in both calendar years of 2016 and 2017 were classified as retained in care. Individuals with a VL test in 2016 but not in 2017 were considered to potentially have unknown outcomes as they may have been receiving care elsewhere, have disengaged from care or died. For this group, an intervention of cross-referencing partially de-identified data between healthcare sites, and contact tracing individuals who still had unknown outcomes was performed. Results For 5223 individuals considered to be retained in care across 15 healthcare sites in the study period, 49 had unconfirmed transfers of care to an alternative provider and 79 had unknown outcomes. After the intervention, the number of unconfirmed care transfers was reduced to 17 and unknown outcomes reduced to 51. These changes were largely attributed to people being reclassified as confirmed transfers of care. Retention in care estimates that did not include the patient outcome of confirmed transfer of care ranged from 76.2 to 95.8% and did not alter with the intervention. However, retention in care estimates which considered confirmed transfers and those that re-entered care at a new site as retained in care significantly increased across five of the sites with estimates ranging from 80.9 to 98.3% pre-intervention to 83.3–100% post-intervention. Individuals whose outcomes remained unknown post-intervention were more often men who have sex with men (MSM) when compared to other categories (person who injects drugs (PWID), combined PWID/MSM, men who identify as heterosexual or unknown) (74.5% vs. 53.5%, [p = 0.06]) and receiving ART at their last HIV-care visit (84.3% vs. 67.8% [p = 0.09]). Conclusion This study confirmed high retention in HIV-care and low numbers of people disengaged from HIV-care in Victoria. This was demonstrated across a larger number of sites with varying models of care than a prior assessment in 2015. These data align with national and state targets aiming for 95% of PLHIV retained in HIV-care.

Abstract Background Over 2 billion people suffer from vision impairment or blindness globally, and access to validated visual measurement tools in imperative in accurately describing and managing the burden of eye disease. The present study applies contemporary psychometric validation techniques to the widely used 33-item Indian Visual Function Questionnaire (IND-VFQ-33). Methods We first estimated the polychoric correlation between each pair of items. Next, an unrotated and oblique Promax rotated factor analysis, item response theory (IRT, using a graded response model (GRM)), and differential item functioning (DIF) testing were applied to the IND-VFQ-33. We subsequently propose a validated IND-VFQ-33 questionnaire after psychometric testing, data reduction, and adjustment. Results Exploratory unrotated factor analysis identified two factors; one with a particularly high eigenvalue (18.1) and a second with a lower eigenvalue still above our threshold (1.1). A subsequent oblique Promax factor rotation was undertaken for a 2-factor solution, revealing two moderately correlated factors (+ 0.68) with clinically discrete item loadings onto either Factor 1 (21 items; collectively labelled “daily activities”) or Factor 2 (5 items; collectively labelled “bright lights”). IRT confirmed high item discrimination for all remaining items with good separation between difficulty thresholds. We found significant DIF on depression for six items in Factor 1 (all uniform DIF, except item 21 (non-uniform DIF) with no substantive difference in beta thresholds for any item and no substantive difference in expected individual or sum score, by depression at baseline. For Factor 2, only one item demonstrated significant uniform DIF on gender, similarly without major differences in beta thresholds or expected total score between gender at baseline. Consequently, no further item recalibration or reduction was undertaken after IRT and DIF analysis. Conclusion Applying IRT and DIF validation techniques to the IND-VFQ-33 identified 2 discrete factors with 26 uniquely-loading items, clinically representative of difficulty performing daily activities and experiencing difficulty due to bright lights/glare respectively. The proposed modified scale may be useful in evaluating symptomatic disease progression or response to treatment in an Indian population.

This study investigates the potential of a Rhizophora mangrove forest of moderate cross-shore thickness to attenuate wave heights using an idealized prototype-scale physical model constructed in a 104 m long wave flume. An 18 m long cross-shore transect of an idealized red mangrove forest based on the trunk-prop root system was constructed in the flume. Two cases with forest densities of 0.75 and 0.375 stems/m2 and a third baseline case with no mangroves were considered. LiDAR was used to quantify the projected area per unit height and to estimate the effective diameter of the system. The methodology was accurate to within 2% of the known stem diameters and 10% of the known prop root diameters. Random and regular wave conditions seaward, throughout, and inland of the forest were measured to determine wave height decay rates and drag coefficients for relative water depths ranging 0.36 to 1.44. Wave height decay rates ranged 0.008–0.021 m–1 for the high-density cases and 0.004–0.010 m–1 for the low-density cases and were found to be a function of water depth. Doubling the forest density increased the decay rate by a factor two, consistent with previous studies for other types of emergent vegetation. Drag coefficients ranged 0.4–3.8, and were found to be dependent on the Reynolds number. Uncertainty in the estimates of the drag coefficient due to the measured projected area and measured wave attenuation was quantified and found to have average combined standard deviations of 0.58 and 0.56 for random and regular waves, respectively. Two previous reduced-scale studies of wave attenuation by mangroves compared well with the present study when their Reynolds numbers were re-scaled by λ3/2 where λ is the prototype-to-model geometric scale ratio. Using the combined data sets, an equation is proposed to estimate the drag coefficient for a Rhizophora mangrove forest: CD = 0.6 + 3e04/ReDBH with an uncertainty of 0.69 over the range 5e03 < ReDBH < 1.9e05, where ReDBH is based on the tree diameter at breast height. These results may improve engineering guidance for the use of mangroves and other emergent vegetation in coastal wave attenuation.

Objectives Understanding trends of marijuana use in the USA throughout a period of particularly high adoption of marijuana-legalisation, and understanding demographics most at risk of use, is important in evolving healthcare policy and intervention. This study analyses the demographic-specific changes in the prevalence of marijuana use in the USA between 2005 and 2018.Design, setting and participants A 14-year retrospective cross-sectional analysis of the National Health and Nutrition Examination Survey database, a publicly available biennially collected national survey, weighted to represent the entire US population. A total of 35 212 adults between 18 and 69 years old participated in the seven-cycles of surveys analysed (2005–2018).Primary outcome measured Lifetime use, first use before 18 years old, and past-year use of marijuana.Results The majority of adults reported ever using marijuana. While the overall prevalence of lifetime marijuana use remained stable (p=0.53), past-year use increased significantly between 2005 and 2018 (p

As the market share of electric vehicles increases, the intermittent load on the electricity grid due to charging will increase. This can be counteracted by Vehicle-to-Grid (V2G) which utilises dormant electric vehicles to feed power into the grid, generating income for the vehicle owner while relieving load across the grid. However, increased battery use through V2G can negatively affect battery health. In this work, a computational model of an electric vehicle with battery degradation is used to investigate the relationship of these effects. The analysis was conducted at the top level of detail, only considering the battery pack of the vehicle. The findings of this investigation show that the cost relating to battery degradation is smaller than the potential profit available from Vehicle-to-Grid over a three-year period. However, the benefit does not seem to be enough to justify the upfront investment requirement, and further financial incentives, such as net billing, may be required to make V2G economically viable. Future development within this field is vital for the success of the electric vehicle within the automotive markets, and for the transition to a renewable energy grid.

Older adults experience cognitive deficits that can lead to driving errors and a loss of mobility. Fortunately, some of these deficits can be ameliorated with targeted interventions which improve the speed and accuracy of simultaneous attention to a central and a peripheral stimulus called Speed of Processing training. To date, the mechanisms behind this effective training are unknown. We hypothesized that one potential mechanism underlying this training is a change in distribution of eye movements of different amplitudes. Microsaccades are small amplitude eye movements made when fixating on a stimulus, and are thought to counteract the "visual fading" that occurs when static stimuli are presented. Due to retinal anatomy, larger microsaccadic eye movements are needed to move a peripheral stimulus between receptive fields and counteract visual fading. Alternatively, larger microsaccades may decrease performance due to neural suppression. Because larger microsaccades could aid or hinder peripheral vision, we examine the distribution of microsaccades during stimulus presentation. Our results indicate that there is no statistically significant change in the proportion of large amplitude microsaccades during a Useful Field of View-like task after training in a small sample of older adults. Speed of Processing training does not appear to result in changes in microsaccade amplitude, suggesting that the mechanism underlying Speed of Processing training is unlikely to rely on microsaccades.

There exist a number of areas in the teaching of physiology which potentially lend themselves to a Computer-Based Learning approach. One such area which has been explored at Manchester Metropolitan University (MMU) and elsewhere (Dewhurst, 1993; Kwan, 1993) is the use of multimedia tools to simulate aspects of experiments traditionally performed on animals. The use of real animal specimens (for example, frogs or rats) for dissection and experimentation is both costly and contrary to the ethics of some students.