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Background: The present study investigates the clinical and radiographic outcomes in patients with all 4 major lower extremity joints replaced.Methods: A retrospective review of our institution's database identified 125 patients in whom both hips and both knees were replaced. The mean time between the first and last arthroplasty was 6.6 years. Preoperative diagnoses included osteoarthritis in 80% and rheumatoid arthritis in 20%. The average age at the time of the first arthroplasty was 63.7 years. The mean follow-up for all arthroplasties was 10.5 years (range 2-31 years). Patients were then matched according to age, gender, diagnosis, prosthesis, and follow-up, to patients with single or bilateral total hip or total knee arthroplasty.Results: There were 11 aseptic hip revisions (4.4%) and 3 aseptic knee revisions (1.2%). At final follow-up, 86% of hips and 83% of knees were rated with no or mild pain, 68% of patients rated walking as unlimited, and 98% of patients were able to satisfactorily negotiate stairs. Aseptic survivorship for all joint arthroplasties was 93.8% at 15 years. No statistical differences were noted in pain, function, stair, and walking scores between the matched groups.Conclusion: This report demonstrated excellent clinical, functional, and radiographic outcomes in patients with all 4 major lower extremity joints replaced. Walking aids were needed in 15% of patients, however. At final follow-up, this selected group of patients appears to fare just as well as patients with single or bilateral hip or knee arthroplasty with respect to pain and function. [ABSTRACT FROM AUTHOR]

Although advances have been made in the approach to airway management, intubating critically ill patients in the Emergency Department (ED) can still be perilous. In some cases, poor peripheral perfusion may preclude obtaining a consistent or reliable pulse oximetry waveform, and the intubator will not accurately know when the patient begins to desaturate. We describe a case of a patient requiring intubation in whom we were unable to obtain a consistent pulse oximetry waveform. We utilized a novel technique in which a Biphasic Cuirass Ventilation (BCV) device was applied to maintain oxygenation and ventilation during the performance of rapid sequence intubation (RSI). This technique has the potential to improve the safety of RSI, especially in the critically ill patient. [ABSTRACT FROM AUTHOR]

Abstract: The simulation of gross primary production (GPP) at various spatial and temporal scales remains a major challenge for quantifying the global carbon cycle. We developed a light use efficiency model, called EC-LUE, driven by only four variables: normalized difference vegetation index (NDVI), photosynthetically active radiation (PAR), air temperature, and the Bowen ratio of sensible to latent heat flux. The EC-LUE model may have the most potential to adequately address the spatial and temporal dynamics of GPP because its parameters (i.e., the potential light use efficiency and optimal plant growth temperature) are invariant across the various land cover types. However, the application of the previous EC-LUE model was hampered by poor prediction of Bowen ratio at the large spatial scale. In this study, we substituted the Bowen ratio with the ratio of evapotranspiration (ET) to net radiation, and revised the RS-PM (Remote Sensing-Penman Monteith) model for quantifying ET. Fifty-four eddy covariance towers, including various ecosystem types, were selected to calibrate and validate the revised RS-PM and EC-LUE models. The revised RS-PM model explained 82% and 68% of the observed variations of ET for all the calibration and validation sites, respectively. Using estimated ET as input, the EC-LUE model performed well in calibration and validation sites, explaining 75% and 61% of the observed GPP variation for calibration and validation sites respectively. Global patterns of ET and GPP at a spatial resolution of 0.5° latitude by 0.6° longitude during the years 2000–2003 were determined using the global MERRA dataset (Modern Era Retrospective-Analysis for Research and Applications) and MODIS (Moderate Resolution Imaging Spectroradiometer). The global estimates of ET and GPP agreed well with the other global models from the literature, with the highest ET and GPP over tropical forests and the lowest values in dry and high latitude areas. However, comparisons with observed GPP at eddy flux towers showed significant underestimation of ET and GPP due to lower net radiation of MERRA dataset. Applying a procedure to correct the systematic errors of global meteorological data would improve global estimates of GPP and ET. The revised RS-PM and EC-LUE models will provide the alternative approaches making it possible to map ET and GPP over large areas because (1) the model parameters are invariant across various land cover types and (2) all driving forces of the models may be derived from remote sensing data or existing climate observation networks. [Copyright &y& Elsevier]