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Three-dimensional (3D) modeling and printing comprise an important tool for orthopaedic surgeons. One area in which 3D modeling has the potential to dramatically improve our understanding of biomechanical kinematics is pathologies of the patellofemoral joint, in particular trochlear dysplasia. We describe a method for creating 3D printed models of the patellofemoral joint, including computed tomography image acquisition, image segmentation, model creation, and 3D printing. The models created can help surgeons understand and plan surgery for recurrent patellar dislocations.

To determine the incidence of ramp lesions and posteromedial tibial plateau (PMTP) bone bruising on magnetic resonance imaging (MRI) in patients with multiligament knee injuries (MLKIs) and an intact anterior cruciate ligament (ACL).A retrospective review of consecutive patients surgically treated for MLKIs at 2 level I trauma centers between January 2001 and March 2021 was performed. Only MLKIs with an intact ACL that received MRI scans within 90 days of the injury were included. All MLKIs were diagnosed on MRI and confirmed with operative reports. Two musculoskeletal radiologists retrospectively rereviewed preoperative MRIs for evidence of medial meniscus ramp lesions (MMRLs) and PMTP bone bruises using previously established classification systems. Intraclass correlation coefficients were used to calculate the reliability between the radiologists. The incidence of MMRLs and PMTP bone bruises was quantified using descriptive statistics.A total of 221 MLKIs were identified, of which 32 (14.5%) had an intact ACL (87.5% male; mean age of 29.9 ± 8.6 years) and were included. The most common MLKI pattern was combined injury to the posterior cruciate ligament and posterolateral corner (n = 27, 84.4%). PMTP bone bruises were observed in 12 of 32 (37.5%) patients. Similarly, MMRLs were diagnosed in 12 of 32 (37.5%) patients. A total of 8 of 12 (66.7%) patients with MMRLs demonstrated evidence PMTP bone bruising.Over one-third of MLKI patients with an intact ACL were diagnosed with MMRLs on MRI in this series. PMTP bone bruising was observed in 66.7% of patients with MMRLs, suggesting that increased vigilance for identifying MMRLs at the time of ligament reconstruction should be practiced in patients with this bone bruising pattern.Level IV, retrospective case series.

Geothermal reservoir characterization, construction, and operations are technology-intensive activities that contribute significantly to the cost of delivering renewable electricity. The technologies involved, such as downhole tools and drilling equipment, are similar to those used in oil and gas exploration and production must often be adapted for use in the corrosive, high-temperature geothermal reservoir environment. Low production volume of geothermal tools presents a major challenge in meeting the industry's technology needs. Production of specialized tools for geothermal subsurface applications is often cost-prohibitive. Reduced inventory of subsurface well construction, characterization, and production tools causes geothermal reservoir development efficiency and sophistication to lag behind that of the oil and gas industry. Advances in additive manufacturing provide opportunities to advance geothermal technology while reducing lead time and costs associated with production of low-volume, complex parts. This paper performs an initial techno-economic analysis comparing the cost of conventional production techniques and additive manufacturing for geothermal downhole applications. An analysis of representative downhole tools is used to create a framework for estimating fabrication costs of subtractive and additive techniques, including post-print machining required to meet final tolerances. The framework is used to explore several manufacturing scenarios and identify the dominant factors driving manufacturing time and cost. The current feasibility of additive manufacturing for geothermal downhole tool applications is assessed and issues for future development to better meet the needs of the geothermal industry are identified.

BACKGROUND: Access to health insurance and curative interventions [surgery/liver directed therapy (LDT)] affects survival for early-stage hepatocellular carcinoma (HCC). The aim of this multi-institutional study of high-volume safety-net hospitals (SNHs) and their tertiary-academic-centers (AC) was to identify the impact of type/lack of insurance on survival disparities across hospitals, particularly SNHs whose mission is to minimize insurance related access to care barriers for vulnerable populations. METHODS: Early-stage HCC patients (2012-2014) from the US Safety-Net Collaborative were propensity-score matched by treatment at SNH/AC. Overall survival (OS) was the primary outcome. Multivariable Cox proportional-hazard analysis was performed accounting for sociodemographic and clinical parameters. RESULTS: Among 925 patients, those with no insurance (NI) had decreased curative surgery, compared to those with government insurance (GI) and private insurance [PI, (PI-SNH:60.5% vs. GI-SNH:33.1% vs. NI-SNH:13.6%, p

BACKGROUND: Widespread HCV treatment for hepatocellular carcinoma (HCC) patients remains limited. Our aim was to evaluate the association of HCV treatment with survival and assess barriers to treatment. METHODS: Patients in the U.S. Safety Net Collaborative with HCV and HCC were included. Primary outcome was overall survival (OS). Secondary outcomes were recurrence-free survival (RFS) and barriers to receiving HCV treatment. RESULTS: Of 941 patients, 57% received care at tertiary referral centers (n=533), 74% did not receive HCV treatment (n=696), 6% underwent resection (n=54), 17% liver transplant (n=163), 50% liver-directed therapy (n=473), and 7% chemotherapy (n=60). HCV treatment was associated with improved OS compared to no HCV treatment (70 vs 21 months, p

We present a comprehensive update of elbow magnetic resonance imaging, detailing the complex anatomy and pathology of the elbow. A variety of pathologies may affect the elbow joint, and many of the symptoms overlap. As such, magnetic resonance imaging of the elbow serves as an invaluable clinical tool for the clinician in the diagnosis and management of patients presenting with elbow pain.

The multiligament knee injury is devastating and potentially limb threatening. Preoperative magnetic resonance imaging for the evaluation of the multiligament knee injury is an invaluable clinical tool, and when the radiologist is familiar with how certain injury patterns influence management, optimal outcomes can be achieved. We provide a detailed description of the relationship between salient imaging features of the multiligament knee injury, focusing on the preoperative magnetic resonance imaging, and their influence on clinical decision-making.

Using comment streams on Seeking Alpha articles, we examine whether interacting on social media increases or moderates the extremeness of investors’ opinions. Unlike some findings from political science that show social media increases extremeness of opinions, we find that interaction on Seeking Alpha moderates extremeness. Comments become less extreme over the sequence of comments for a given article, as well as within individual comment sub-threads, and over a single user’s comments for a given article. Extremeness reduction is stronger when the article itself is more moderate, and when more users are self-identified (i.e., not anonymous). Results also suggest that the extremeness reduction triggered by Seeking Alpha interaction has capital market implications. Differences of opinion captured by stock-based measures, abnormal volume and turnover, decrease significantly after the release of Seeking Alpha articles with comments. Our results provide the first evidence of the effect of social media interaction on the updating of individuals’ opinions.

Summary Background Intraoperative instrument recounts are performed to avoid retained foreign surgical items. These additional counts, however, beget risks of their own, including prolonged operative times, exposure to radiation, and increased cost. Our study aimed to identify factors that increase the likelihood of instrument recounts during plastic surgery procedures, and use our findings to guide potential solutions for preventing unnecessary recounts across all surgical fields. Study design This is a retrospective review of all plastic surgical cases in the main operating setting at New York University Langone Medical Center (NYULMC) between March 2014 and February 2015. Results Of 1285 plastic surgery cases, 35 (2.7%) reported a missing instrument necessitating a recount. Of all subspecialties within plastic surgery, only microsurgery conferred an increased risk of a recount event. We identified multiple factors that increased the odds of a recount event, including increased operative time, number of surgical sites, and intraoperative instrument handoffs. Conclusion Instrument recounts, although designed to prevent inadvertently retained surgical items, present inherent risks of their own. In a large retrospective review of plastic surgery cases at our medical center, we identified many factors that increased the likelihood of an instrument recount. On the basis of our findings and prior literature, we recommend limiting the number of staff handling instrument, the number of handoffs, and a heightened awareness by surgeons and perioperative staff of specific procedures and factors that increase the risk of a miscount event.

BACKGROUND: Racial/ethnic and socioeconomic disparities are assumed to negatively affect treatment and outcomes for hepatocellular carcinoma (HCC). Our aim was to investigate the interaction of racial/ethnic and socioeconomic factors with stage of disease and type of treatment facility in receipt of treatment and overall survival (OS) of patients with HCC. METHODS: All patients with primary HCC in the US Safety-Net Collaborative database (2012–2014) were included. Patients were categorized into “safety-net” or “tertiary referral center” based on where they received treatment. Socioeconomic factors were determined at the zip-code level and included median income and percent of adults who graduated from high-school. Primary outcomes were receipt of treatment and OS. RESULTS: On MV Cox regression, neither race/ethnicity, median income, nor care provided at a SNH were associated with decreased OS (all p > 0.05). Independent predictors of decreased OS included lack of insurance (HR 1.34), less educational attainment (HR 1.59) higher MELD score (HR 1.07), higher stage at diagnosis (II:HR 1.34, III:HR 2.87, IV:HR 3.23), and not receiving treatment (HR 3.94) (all p < 0.05). Factors associated with not receiving treatment included history of alcohol abuse (OR 0.682), increasing MELD (OR 0.874), higher stage at diagnosis (III: OR 0.234, IV: OR 0.210) and care at a safety net facility (OR 0.424) There were no racial/ethnic or socioeconomic disparities in receipt of treatment. CONCLUSIONS: There is no intrinsic or direct association of race/ethnicity, socioeconomic status, or being treated at select safety-net hospitals with worse outcomes. Poor liver function, no insurance, and advanced stage of presentation are the main determinants of not receiving treatment and decreased survival.

We fabricate the thinnest (1.3 μm) and lightest (3.6 g/m2) solar cells yet demonstrated, with weight-specific power exceeding 6 W/g, in order to illustrate the lower limits of substrate thickness and materials use achievable with a new processing paradigm. Our fabrication process uniquely starts with growth of an ultra-thin flexible polymer substrate in vacuum, followed by deposition of electrodes and photoactive layers in situ. With this process sequence, the entire cell—from transparent substrate to active layers to encapsulation—can be fabricated at room temperature without solvents and without breaking vacuum, avoiding exposure to dust and other contaminants, and minimizing damage risk associated with handling of thin substrates. We use in situ vapor-phase growth of smooth, transparent, and flexible parylene-C films to produce ultra-thin, lightweight molecular organic solar cells as thin as 2.3 μm including encapsulation with a second parylene-C film. These parylene-based devices exhibit power conversion efficiencies and fabrication yields comparable to glass-based cells. Flexible solar cells on parylene membranes can be seamlessly adhered to a variety of solid surfaces to provide additive solar power.

This monograph, Working to Limit Restrictive Housing: Efforts in Four Jurisdictions to Make Changes, is related to Reforming Restrictive Housing: The 2018 ASCA-Liman Nationwide Survey of Time-in-Cell, the fourth in a series of ASCA-Liman research projects focused on restrictive housing — or what is popularly known as “solitary confinement” — defined as placement of an individual in a cell for an average of 22 hours or more for 15 days or more. In Working to Limit Restrictive Housing, directors of prison systems in Colorado, Idaho, Ohio, and North Dakota detail how they were limiting and, in Colorado, abolishing the use of restrictive housing. Correctional administrations’ efforts to reduce the numbers of people in restrictive housing are part of a larger picture in which legislatures, courts, and other institutions are seeking to limit holding people in cells 22 hours or more for 15 days or more. These endeavors reflect the national and international consensus that restrictive housing imposes grave harms on individuals confined, on staff, and on the communities to which prisoners return. Once solitary confinement was seen as a solution to a problem. Now prison officials around the United States are finding ways to solve the problem of restrictive housing.

Reforming Restrictive Housing: The 2018 ASCA-Liman Nationwide Survey of Time-in-Cell is the fourth in a series of research projects co-authored by the Association of State Correctional Administrators (ASCA) and the Arthur Liman Center at Yale Law School. These monographs provide a unique, longitudinal, nationwide database. The topic is “restrictive housing,” often termed “solitary confinement,” and defined as separating prisoners from the general population and holding them in cells for an average of 22 hours or more per day for 15 continuous days or more. The 2018 monograph is based on survey responses from 43 prison systems that held 80.6% of the U.S. prison population. They reported that 49,197 individuals—4.5% of the people in their custody—were in restrictive housing. Extrapolating, we estimate that some 61,000 individuals were in isolation in U.S. prisons. This number does not include people in most jails or juvenile, military, or immigration facilities. Two areas of special concern are the impact of mental illness and the length of time individuals spend in restrictive housing. Correctional systems use a variety of definitions for serious mental illness. Using their own descriptions, jurisdictions counted more than 4,000 prisoners identified as seriously mentally ill and in restrictive housing. Within the 36 jurisdictions that reported on the length of time people had been in segregation, most people were held for a year or less. Twenty-five jurisdictions counted more than 3,500 individuals held more than three years. Reforming Restrictive Housing details policy changes tracking the impact of the 2016 American Correctional Association’s (ACA) Restrictive Housing Performance Based Standards. The ACA Standards call for limiting the use of isolation for pregnant women, juveniles, and seriously mentally ill individuals. This monograph also compares the responses of the 40 prison systems that answered the ASCA-Liman surveys in both 2015 and 2017. See ASCA-Liman, Aiming to Reduce Time-in-Cell (Nov. 2016), SSRN No. 2874492. The number in restrictive housing was reported to have decreased from 56,000 in 2015 to 47,000 in 2017. Looking at specific states, in more than two dozen systems, the numbers in segregation decreased. In 11 systems, the numbers went up. A related monograph, Working to Limit Restrictive Housing: Efforts in Four Jurisdictions to Make Changes, details the work of four correctional administrations to limit—and in one state abolish—holding people in cells 22 hours a day for 15 days or more.

L o E he preferred access for hemodialysis is a native autogenous arteriovenous fistula ecause fistulas have lower complication rates nd better longevity compared with prosthetic rafts. However, fistulas are inclined to deelop such complications as aneurysm, pseudoneurysm, venous stenosis, venous hypertenion, thrombosis, hemorrhage, arm edema, steal yndrome, and infection. Pseudoaneurysm in he brachial artery is a rare complication of emodialysis therapy. We report the case of a an who presented with several small brachial rtery pseudoaneurysms because of repeated indvertent needle punctures of the brachial artery uring access of the arteriovenous fistula.