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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]

Regional anesthesia is a valuable component of multimodal pain control in total shoulder arthroplasty (TSA), and multiple interscalene block anesthetic options exist, including nonliposomal interscalene bupivacaine (NLIB) and liposomal interscalene bupivacaine (LIB). The purpose of this study was to compare pain control and opioid consumption within 48 hours postoperation in those undergoing TSA with either LIB or NLIB. This was a retrospective cohort study at a single academic medical center including consecutive patients undergoing inpatient (>23-hour hospitalization) primary anatomic or reverse TSA from 2016 to 2020 who received either LIB or an NLIB for perioperative pain control. Perioperative patient outcomes were collected including pain levels and opioid usage, as well as 30- and 90-day emergency department (ED) visits or readmissions. The primary outcome was postoperative pain and opioid use. Overall, 489 patients were included in this study (316 LIB and 173 NLIB). Pain scores at 3, 6, 12, and 48 hours postoperatively were not statistically significantly different (P >.05 for all). However, the LIB group had improved pain scores at 24 and 36 hours postoperation (P <.05 all). There was no difference in the incidence of severe postoperative pain, defined as a 9 or 10 numeric rating scale–11 score, between the 2 anesthesia groups after adjusting for preoperative pain and baseline opioid use (odds ratio 1.25, 95% confidence interval 0.57-2.74; P =.57). Overall, 99 of 316 patients receiving LIB (31.3%) did not require any postoperative opioids compared with 38 of 173 receiving NLIB (22.0%); however, this difference was not statistically significant after adjusting for prior opioid use and preoperative pain (P =.33). No statistically significant differences in postoperative total morphine equivalents or mean daily morphine equivalents consumed between the groups were found during their hospital stays (P >.05 for both). Finally, no significant differences were found in 30- and 90-day ED visits or readmission rates (all P >.05). LIB and NLIB demonstrated differences in patient-reported pain scores at 24 and 36 hours postoperation, although these did not reach clinical significance. There were no statistically significant differences in opioid consumption during the hospital stay, including opioid use, total morphine equivalents, and daily mean morphine equivalents consumed during the hospital stay. Additionally, no differences were observed in 30- and 90-day ED visits or readmission rates. [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.