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Purpose: Emerging literature suggests caregiver self-efficacy is an important factor related to caregivers' shared reading practices with their children. Reduced shared reading has been documented among families of caregiver(s) with language-based learning disabilities (LBLD). Yet, it remains unclear whether caregivers' history of language and reading difficulties is associated with caregiver self-efficacy. The purpose of this study was to examine whether self-efficacy in language- and reading-related caregiver activities related to caregiver history of language and reading difficulties and shared reading practices. Method: One hundred seventy-six caregivers of children aged 18-60 months completed a custom self-efficacy in language- and reading-related caregiver activities questionnaire, as well as demographic, history of language and reading difficulties (used both as a continuous measure and to dichotomize caregivers with and without LBLD history), and shared reading measures in a one-time survey. Results: Caregivers with a history of LBLD reported an overall lower self-efficacy and a reduced amount of time reading with their children per week than caregivers without LBLD history. Examining caregiver history of language and reading difficulties continuously across the whole group, self-efficacy mediated the relationship between caregiver difficulties and shared reading practices, even when caregiver education was incorporated as an additional mediator in models. Conclusions: Findings indicate that self-efficacy and caregiver education mediate the relationship between caregiver history of language and reading difficulties and shared reading practices. Consideration of self-efficacy by clinicians and educators is warranted when promoting shared reading practices to caregivers of young children. There is a need for future research to examine relationships between self-efficacy and shared reading among caregivers with LBLD of culturally and linguistically diverse backgrounds.

Background: Peripheral nerve blocks (PNBs) may be utilized for postoperative pain control following total hip arthroplasty (THA). The purpose of this study was to evaluate the association between PNBs and postoperative complication rates, healthcare utilization, and opioid consumption following elective THA. Methods: Opioid-naive patients who received PNBs on the same day as undergoing THA for degenerative etiologies were identified from a large national database and matched 1:5 to a control cohort using propensity scoring. Rates of medical complications, inpatient readmissions, and emergency department presentations occurring within 90 days of THA and surgery-related complications occurring within 1 year of THA were compared using odds ratios. Total cost and perioperative opioid consumption in morphine milligram equivalents (MMEs) per day were also evaluated and compared between groups. Results: Propensity score matching resulted in 4748 PNB patients matched to 23,740 control patients. THA patients who received PNBs had lower incidences of deep vein thrombosis (odds ratio [OR] 0.67, P = .004), urinary tract infection (OR 0.76, P < .001), and dislocation (OR 0.51, P < .001). PNBs were also associated with decreased perioperative opioid consumption (38.6 MME/day vs 55.3 MME/day, P < .001). Regarding healthcare utilization, there were no differences between cohorts in rates of inpatient readmission, emergency department presentation, or total cost. Conclusions: PNBs are associated with decreased risk of deep vein thrombosis, urinary tract infection, and dislocation and decreased perioperative opioid consumption following THA. Level of evidence: III, Retrospective review.

Background: Juvenile idiopathic arthritis (JIA) is an inflammatory arthropathy that classically affects children but can cause long-term deformity to the femoral head and hip joint, which may require an arthroplasty procedure. There is a paucity of data surrounding the medical and surgical outcomes of total hip arthroplasty (THA) in patients with JIA compared to a control cohort. Methods: Patients with JIA who underwent THA from 2010 to 2019 were identified in a large national insurance database. A propensity score matching algorithm was used to obtain a control cohort who did not have JIA based upon age, sex, and Elixhauser Comorbidity Index in a 1:10 ratio. Seven hundred sixty-three patients with JIA and 7434 patients without JIA were identified who underwent THA. Ninety-day medical outcomes, 1-year surgical outcomes, and 90-day return to the emergency department and readmission were calculated. Results: Patients with JIA were at increased risk of 90-day transfusion (odds ratio [OR] 1.79; P < .001), pneumonia (OR 2.68; P < .001), urinary tract infection (OR 2.64; P < .001), and wound disruption (OR 2.72; P < .001), as well as 1-year risk of revision THA (OR 2.27; P < .001), periprosthetic joint infection (OR 2.98; P < .001), periprosthetic fracture (OR 2.93; P < .001), aseptic loosening (OR 3.92; P < .001), dislocation (OR 2.61; P = .001), and debridement, antibiotics, and implant retention procedure (OR 2.71; P < .001). Patients with JIA were also at increased risk of 90-day emergency department visit (OR 2.54; P < .001) and readmission (OR 2.59; P < .001). Conclusions: Patients with JIA were at increased risk of early medical and surgical complications following THA. These findings are imperative for surgeons to consider and may warrant tailored perioperative decision-making to avoid the aforementioned medical and surgical complications.

Background: Although extensor mechanism failure following total knee arthroplasty (TKA) is a devastating complication and has been heavily studied in the literature, the impact of extensor mechanism rupture and concomitant repair prior to TKA has not previously been evaluated. The purpose of this investigation was to evaluate how quadriceps and/or patellar tendon repairs prior to TKA would impact medical and surgery-related complications following TKA. Methods: The PearlDiver database was retrospectively reviewed to identify all primary TKA patients from 2010 to 2019. Patients who underwent quadriceps or patellar tendon repair prior to TKA were matched using a propensity score algorithm to a control cohort. We compared medical and surgical complication rates, emergency room visits, readmissions, and 90-day cost of care between the groups. Results: A total of 1197 patients underwent extensor mechanism repair prior to TKA and were matched to 11,970 patients who did not undergo repair prior to TKA. Patients who underwent extensor mechanism repair had higher rates of 90-day medical complications, as well as 1-year surgery-related complications including revision TKA (odds ratio [OR] 6.06; P < .001), lysis of adhesions (OR 2.18; P = .026), aseptic loosening (OR 2.21; P = .018), infection (OR 7.58; P < .001), and fracture (OR 8.53; P < .001). Patients with prior extensor mechanism repair were more likely to return to the emergency department (OR 1.66; P < .001) and become readmitted (OR 4.15; P < .001) within 90 days. Conclusions: Patients with previous extensor mechanism repair exhibited higher medical and surgery-related complications, including lysis of adhesions, following TKA than a control cohort. These findings may suggest that patients may require additional surveillance in the early postoperative period to avoid these disastrous complications following primary TKA.

Self-amplifying mRNA vaccines offer the benefit of driving potent immune responses at low doses, as the mRNA replicates intracellularly. Here, the authors report the preclinical evaluation of a self-amplifying mRNA SARS-CoV-2 vaccine in non-human primates.

Background: Statistical fragility is a quantitative measure of the robustness of the statistical conclusions drawn in a study. Although statistical fragility has been comprehensively evaluated in the arthroplasty literature, the statistical fragility of large-scale randomized trials evaluating venous thromboembolism (VTE) prophylaxis has not been evaluated. The purpose of this study was to determine the utility of applying the fragility index (FI) and the fragility quotient (FQ) analysis to randomized controlled trials (RCTs) evaluating VTE prophylaxis following total joint arthroplasty. Methods: A systematic review was performed by searching multiple databases to identify RCTs that evaluated VTE prophylaxis following total joint arthroplasty from 2000 to 2020. The FI was determined by manipulating each reported dichotomous outcome event until a reversal of significance was appreciated with 2 × 2 contingency tables. The associated FQ was determined by dividing the FI by the sample size. Results: Thirty-two RCTs were ultimately included for analysis. The overall FI incorporating all 32 RCTs was only 7 (interquartile range 3-9), suggesting that the reversal of only 7 events is required to change study significance. The associated FQ was determined to be 0.01. Of the RCTs that reported lost-to-follow-up data, the majority of studies had lost-to-follow-up numbers greater than 7. Conclusions: Our findings suggest that RCTs evaluating VTE prophylaxis following total hip arthroplasty and total knee arthroplasty may lack statistical stability as few outcome events are required to reverse the significance of outcomes. Future randomized trials should consider reporting FI and FQ along with the P value analysis to provide better context to the integrity of statistical stability.

Background: Unicompartmental knee arthroplasty (UKA) is a common orthopedic procedure with overall good clinical outcomes; however, more recent literature has identified disparities in treatment access and outcomes based on sociodemographic factors. There is a paucity of literature examining whether payor type, including Medicare, Medicaid, and commercial insurance types, impacts early medical complications and rates of reoperation following a UKA. Methods: Patients with Medicare, Medicaid, or commercial payor type who underwent primary medial or lateral UKA between 2010 and 2019 were identified using a large national database. Ninety-day incidence of emergency department visit and 1-year incidence of revision, revision to arthroplasty, reimbursement, and cost of care were evaluated. Propensity score matching was used to control for patient demographic factors and comorbidities as covariates. Results: Medicaid insurance was associated with an increased risk of emergency room visit (odds ratio [OR] 2.77; P < .001), revision surgery (OR 1.85; P < .001), and conversion to total knee arthroplasty (OR 1.50; P = .0292) compared to commercially insured patients. Medicaid insurance was associated with an increased risk of emergency room visit (OR 3.58; P < .001), revision surgery (OR 1.97; P < .001), and conversion to total knee arthroplasty (OR 1.80; P = .003). Medicaid patients were associated with a higher overall cost of care and lower reimbursement than commercial and Medicare patients (P < .001 and P < .001, respectively). Conclusions: These findings demonstrate that payor type is associated with increased rates of reoperation and health-care utilization following UKA despite controlling for covariates. Additional work is required to understand the complex relationship between socioeconomic status and outcomes to ensure appropriate health-care access for all patients and pursue appropriate risk stratification. Level of Evidence: III, retrospective chart review.

Background: Obstructive sleep apnea (OSA) has been shown to increase the risk of complications following total knee arthroplasty (TKA) although prior studies were limited by their ability to stratify OSA patients by disease severity. The objective of this study was to determine the effect size of the use of continuous positive airway pressure (CPAP) on early medical and surgery-related complications following TKA among patients with OSA. Methods: Patients with OSA who underwent primary TKA were identified using the PearlDiver Mariner database. Ninety-day incidences of medical complications and 1-year incidences of surgery-related complications as well as hospital utilization were evaluated for OSA patients who had used CPAP prior to TKA compared to those who did not. Results: CPAP patients were at increased 90-day risk of emergency department presentation (odds ratio [OR] 1.61; P < .0001), hospital admission (OR 1.33; P < .001), ICU admission (OR 1.45, P < .0001), pulmonary embolism (OR 1.68, P < .0001), deep vein thrombosis (OR 1.31, P < .0001), transfusion (OR 1.89, P < .0001), pneumonia (OR 1.63, P < .0001), cerebrovascular accident (OR 1.92, P < .0001), myocardial infarction (OR 1.57, P = .0015), sepsis (OR 1.35, P = .0025), blood loss anemia (OR 1.67, P < .0001), acute kidney injury (OR 1.65, P < .0001), and urinary tract infection (OR 1.99, P < .0001), as well as increased 1-year risk of undergoing revision surgery (OR 1.14, P = .0028), compared to OSA patients not using CPAP. Conclusions: OSA patients on CPAP undergoing TKA have significantly increased complication rates compared to OSA patients not using CPAP. Level of Evidence: III, Retrospective review.

Abstract Purpose Hormone replacement therapy (HRT) causes a significant increase in the risk of venous thrombosis. The risk of medical and surgery‐related complications among women taking HRT following total hip arthroplasty (THA) is poorly understood, and there are currently no guidelines in place regarding venous thromboembolism prophylaxis in this patient population. The purpose of this study was to evaluate the frequency of early medical and surgery‐related complications following THA among women taking HRT. Methods Women aged > 40 years of age who underwent primary THA were identified from a retrospective database review. A control group of non‐HRT users was matched using propensity scoring to HRT users. Rates of 90‐day medical complications and 1‐year surgery‐related complications were compared between cohorts using odds ratios. Postoperative anticoagulation regimens were also compared. Results There were 3,936 patients in the HRT cohort who were matched to 39,360 patients not taking HRT. There were no significant differences in rates of DVT (OR 0.94, p = 0.6601) or PE (OR 0.80, p = 0.4102) between cohorts. Patients on HRT were more likely to sustain a dislocation (OR 1.35, p = 0.0269) or undergo revision surgery (OR 1.23, p = 0.0105). HRT patients were more likely to be prescribed warfarin (OR 1.21, p = 0.0001) or enoxaparin (OR 1.18, p = 0.0022) and less likely to be prescribed rivaroxaban (OR 0.62, p

Abstract Purpose Despite benefits of total knee arthroplasty (TKA) on function and quality of life, obese patients have less improved functional outcomes following TKA compared to their normal weight counterparts. Furthermore, obesity is a risk factor for aseptic loosening and revision surgery following TKA. With known benefits of robotic‐assisted TKA (RaTKA) in precision and patient satisfaction, we aimed to evaluate the differences in patient reported outcome and early complication rates for patients undergoing RaTKA versus conventional TKA among patients of varying BMI groups. Methods This study was a retrospective cohort study of patients who underwent conventional versus RaTKA. Patients were grouped by BMI range ( 40 kg/m2). Patient‐reported outcomes were measured by Oxford Knee Scores and 12‐Item Short Form Survey scores preoperatively, 6‐month, 1‐year, and 2‐year postoperatively. Mixed‐effects linear models were built for each patient‐reported outcome to assess the interaction between type of surgery and BMI while adjusting for known confounders such as demographic variables. Results A total of 350 patients (n = 186 RaTKA, n = 164 conventional TKA) met inclusion criteria. SF‐12 physical scores were significantly higher at 2‐year follow‐up among non‐obese patients compared to obese and morbidly obese patients (p = 0.047). There was no statistically significant interaction between the type of surgery performed (RaTKA versus conventional TKA) and obesity regarding their effects on patient reported outcomes. Conclusions This study demonstrates no differences in functional outcomes among patients undergoing RaTKA compared to conventional TKA. Furthermore, obesity had no significant effect on this association. Level of evidence III.

Introduction:. Coronavirus disease 2019 (COVID-19) infections have strained hospital resources worldwide. As a result, many facilities have suspended elective operations and ambulatory procedures. As the incidence of new cases of COVID-19 decreases, hospitals will need policies and algorithms to facilitate safe and orderly return of normal activities. We describe the recommendations of a task force established in a multi-institutional healthcare system for resumption of elective operative and ambulatory procedures applicable to all hospitals and service lines. Methods:. MedStar Health created a multidisciplinary task force to develop guidelines for resumption of elective surgeries/procedures. The primary focus areas included the establishment of a governance structure at each healthcare facility, prioritization of elective cases, preoperative severe acute respiratory syndrome coronavirus 2 testing, and an assessment of the needs and availability of staff, personal protective equipment, and other essential resources. Results:. Each hospital president was tasked with establishing a local perioperative leadership team answering directly to them and granted the authority to prioritize elective surgery and ambulatory procedures. An elective surgery algorithm was established using a simplified Medically Necessary Time Sensitive score, with multiple steps requiring a “go/no-go” assessment based on local resources. In addition, mandatory preoperative COVID testing policies were developed and operationalized. Conclusions:. Even when the COVID pandemic has passed, hospitals and surgical centers will require COVID screening and testing, case prioritization, and supply chain management to provide care essential to the surgical patient while protecting their safety and that of staff. Our guidelines consider these factors and are applicable to both tertiary academic medical centers and smaller community facilities.

Cerebrosides, including glucosylceramides (GlcCers) and galactosylceramides (GalCers), are important membrane components of animal cells with deficiencies resulting in devastating lysosomal storage disorders. Their quantification is essential for disease diagnosis and a better understanding of disease mechanisms. The simultaneous quantification of GlcCer and GalCer isomers is, however, particularly challenging due to their virtually identical structures. To address this challenge, we developed a new LC/MS-based method using differential ion mobility spectrometry (DMS) capable of rapidly and reproducibly separating and quantifying isomeric cerebrosides in a single run. We show that this LC/ESI/DMS/MS/MS method exhibits robust quantitative performance within an analyte concentration range of 2.8–355 nM. We further report the simultaneous quantification of nine GlcCers (16:0, 18:0, 20:0, 22:0, 23:0, 24:1, 24:0, 25:0, and 26:0) and five GalCers (16:0, 22:0, 23:0, 24:1, and 24:0) molecular species in human plasma, as well as six GalCers (18:0, 22:0, 23:0, 24:1, 24:0 and 25:0) and two GlcCers (24:1 and 24:0) in human cerebrospinal fluid. Our method expands the potential of DMS technology in the field of glycosphingolipid analysis for both biomarker discovery and drug screening by enabling the unambiguous assignment and quantification of cerebroside lipid species in biological samples.