Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A single-center, multi-surgeon retrospective chart review of two hundred and sixty consecutive patients who underwent primary total knee arthroplasty was performed. The mean length of stay was 3.0 days. Among the different variables studied, increasing comorbidities, lack of adequate assistance at home, and bilateral surgery were the only multivariable significant predictors of longer length of stay. The study was adequately powered for statistical analyses and the concordance index of the multivariable logistic regression model was 0.815.

Percent body fat more associated with perioperative risks after total joint arthroplasty than body mass index

Copyright © 2014 Elsevier Inc. All rights reserved.Understanding the impact of obesity on elective total joint arthroplasty (TJA) remains critical. Perioperative outcomes were reviewed in 316 patients undergoing primary TJA. Higher percent body fat (PBF) was associated with postoperative blood transfusion, increased hospital length of stay (LOS) >3 days, and discharge to an extended care facility while no significant differences existed for BMI. Additionally, PBF of 43.5 was associated with a 2.4× greater likelihood of blood transfusion, PBF of 36.5 with a 1.9× greater likelihood for LOS >3 days, and PBF of 36.0 with a 1.4× greater likelihood for discharge to an extended care facility. PBF may be a more effective measure than BMI to use in screening for perioperative risks and acute outcomes associated with obese total joint patients.

Characterization of porous, dexamethasone-releasing polyurethane coatings for glucose sensors

© 2014 Acta Materialia Inc.Commercially available implantable needle-type glucose sensors for diabetes management are robust analytically but can be unreliable clinically primarily due to tissue-sensor interactions. Here, we present the physical, drug release and bioactivity characterization of tubular, porous dexamethasone (Dex)-releasing polyurethane coatings designed to attenuate local inflammation at the tissue-sensor interface. Porous polyurethane coatings were produced by the salt-leaching/gas-foaming method. Scanning electron microscopy and micro-computed tomography (micro-CT) showed controlled porosity and coating thickness. In vitro drug release from coatings monitored over 2 weeks presented an initial fast release followed by a slower release. Total release from coatings was highly dependent on initial drug loading amount. Functional in vitro testing of glucose sensors deployed with porous coatings against glucose standards demonstrated that highly porous coatings minimally affected signal strength and response rate. Bioactivity of the released drug was determined by monitoring Dex-mediated, dose-dependent apoptosis of human peripheral blood derived monocytes in culture. Acute animal studies were used to determine the appropriate Dex payload for the implanted porous coatings. Pilot short-term animal studies showed that Dex released from porous coatings implanted in rat subcutis attenuated the initial inflammatory response to sensor implantation. These results suggest that deploying sensors with the porous, Dex-releasing coatings is a promising strategy to improve glucose sensor performance.

Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series.

BACKGROUND: Development of hip adductor, tensor fascia lata, and rectus femoris muscle contractures following total hip arthroplasties are quite common, with some patients failing to improve despite treatment with a variety of non-operative modalities. The purpose of the present study was to describe the use of and patient outcomes of botulinum toxin injections as an adjunctive treatment for muscle tightness following total hip arthroplasty. METHODS: Ten patients (14 hips) who had hip adductor, abductor, and/or flexor muscle contractures following total arthroplasty and had been refractory to physical therapeutic efforts were treated with injection of botulinum toxin A. Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks. RESULTS: At a mean final follow-up of 20 months, all 14 hips had increased range in the affected arc of motion, with a mean improvement of 23 degrees (range, 10 to 45 degrees). Additionally all hips had an improvement in hip scores, with a significant increase in mean score from 74 points (range, 57 to 91 points) prior to injection to a mean of 96 points (range, 93 to 98) at final follow-up. There were no serious treatment-related adverse events. CONCLUSION: Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty.

BACKGROUND: Dislocation remains a difficult problem in total hip arthroplasty. Large-diameter femoral heads may lower the incidence of dislocation by enhancing the jump distance and decreasing impingement, but their performance against small-diameter heads has not been assessed. This study compared the mid-term radiographic and functional outcomes of two matched cohorts of patients undergoing total hip arthroplasty who had a high pre-operative risk for dislocation and who received either small-diameter (26- or 28-millimeters) or large-diameter (≥36-millimeters) femoral heads. METHODS: All patients who received large-diameter heads (≥36-millimeter) between 2002 and 2005, and who had pre-operative risk factors for dislocation, were identified in the institution's joint registry. Forty-one patients (52 hips) who received large-diameter heads were identified, and these patients were matched to 48 patients (52 hips) in the registry who received small-diameter femoral heads. RESULTS: At mean final follow-up of 62 months (range, 49 to 101 months), both groups achieved excellent functional outcomes as measured by Harris Hip scores, with slightly better final scores in the large-diameter group (90 vs. 83 points). No patient showed any radiographic signs of loosening. No patient dislocated in the large-diameter femoral head group; the smaller-diameter group had a greater rate of dislocation (3.8%, 2 out of 52). CONCLUSIONS: Large-diameter femoral head articulations may reduce dislocation rates in patients who have a high pre-operative risk for dislocation while providing the same functional improvements and safety as small-diameter bearings.

Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty?

BACKGROUND: The purpose of this study was to evaluate whether compliance and rehabilitative efforts were predictors of early clinical outcome of total hip resurfacing arthroplasty. METHODS: A cross-sectional survey was utilized to collect information from 147 resurfacing patients, who were operated on by a single surgeon, regarding their level of commitment to rehabilitation following surgery. Patients were followed for a mean of 52 months (range, 24 to 90 months). Clinical outcomes and functional capabilities were assessed utilizing the Harris hip objective rating system, the SF-12 Health Survey, and an eleven-point satisfaction score. A linear regression analysis was used to determine whether there was any correlation between the rehabilitation commitment scores and any of the outcome measures, and a multivariate regression model was used to control for potentially confounding factors. RESULTS: Overall, an increased level of commitment to rehabilitation was positively correlated with each of the following outcome measures: SF-12 Mental Component Score, SF-12 Physical Component Score, Harris Hip score, and satisfaction scores. These correlations remained statistically significant in the multivariate regression model. CONCLUSIONS: Patients who were more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.

Determinación de arsénico total e inorgánico en carnes y víceras de camélidos (Lamma glama) autóctonos de la provincia de Jujuy, Argentina

p.105-109

Contenidos de fósforo total en suelos con características vérticas de la Provincia de Entre Ríos

p.53-58

Minimizing total weighted completion time in a proportionate flow shop

We study the special case of the m machine flow shop problem in which the processing time of each operation of job j is equal to pj; this variant of the flow shop problem is known as the proportionate flow shop problem. We show that for any number of machines and for any regular performance criterion we can restrict our search for an optimal schedule to permutation schedules. Moreover, we show that the problem of minimizing total weighted completion time is solvable in O(n2) time. © 1998 John Wiley & Sons, Ltd.

Birth-death processes with an instantaneous reflection barrier

A new structure with the special property that an instantaneous reflection barrier is imposed on the ordinary birth-death processes is considered. An easy-checking criterion for the existence of such Markov processes is first obtained. The uniqueness criterion is then established. In the nonunique case, all the honest processes are explicitly constructed. Ergodicity properties for these processes are investigated. It is proved that honest processes are always ergodic without necessarily imposing any extra conditions. Equilibrium distributions for all these ergodic processes are established. Several examples are provided to illustrate our results.

A fully polynomial approximation scheme for the single machine weighted total tardiness problem with a common due date

We develop a fully polynomial-time approximation scheme (FPTAS) for minimizing the weighted total tardiness on a single machine, provided that all due dates are equal. The FPTAS is obtained by converting an especially designed pseudopolynomial dynamic programming algorithm.

An algorithm for total variation inpainting based on nonlinear multi-grid methods

Image inpainting refers to restoring a damaged image with missing information. The total variation (TV) inpainting model is one such method that simultaneously fills in the regions with available information from their surroundings and eliminates noises. The method works well with small narrow inpainting domains. However there remains an urgent need to develop fast iterative solvers, as the underlying problem sizes are large. In addition one needs to tackle the imbalance of results between inpainting and denoising. When the inpainting regions are thick and large, the procedure of inpainting works quite slowly and usually requires a significant number of iterations and leads inevitably to oversmoothing in the outside of the inpainting domain. To overcome these difficulties, we propose a solution for TV inpainting method based on the nonlinear multi-grid algorithm.

A reconfigurable component model using reflection

Providing a method of transparent communication and interoperation between distributed software is a requirement for many organisations and several standard and non-standard infrastructures exist for this purpose. Component models do more than just provide a plumbing mechanism for distributed applications, they provide a more controlled interoperation between components. There are very few component models however that have support for advanced dynamic reconfigurability. This paper describes a component model which provides controlled and constrained transparent communication and inter-operation between components in the form of a hierarchical component model. At the same time, the model contains support for advanced run-time reconfigurability of components. The process and benefits of designing a system using the presented model are discussed. A way in which reflective techniques and component frameworks can work together to produce dynamic adaptable systems is explained.

Two simple constant ratio approximation algorithms for minimizing the total weighted completion time on a single machine with a fixed non-availability interval

In this note, we consider the scheduling problem of minimizing the sum of the weighted completion times on a single machine with one non-availability interval on the machine under the non-resumable scenario. Together with a recent 2-approximation algorithm designed by Kacem [I. Kacem, Approximation algorithm for the weighted flow-time minimization on a single machine with a fixed non-availability interval, Computers & Industrial Engineering 54 (2008) 401–410], this paper is the first successful attempt to develop a constant ratio approximation algorithm for this problem. We present two approaches to designing such an algorithm. Our best algorithm guarantees a worst-case performance ratio of 2+ε. © 2008 Elsevier B.V. All rights reserved.

Legal method and legal reflection: experiential learning in the law school

The two main themes of the conference centre around teaching experiences in legal education and theme and international and European perspectives in legal education.