Cilјevi ovog istraživanja su bili da se utvrde: (1) razlike u antropometrijskim karakteristikama i agilnosti između različitih funkcionalnih klasa košarkaša u kolicima i (2) povezanost između ...antropometrijskih karakteristika i agilnosti sa funkcionalnom klasifikacijom košarkaša u kolicima. Uzorak ispitanika činilo je 40 košarkaša u kolicima, uzrasta 33.9 ± 11.2 godina. Procenjivane su antropometrijske karakteristike (longitudionalne i cirkularne dimenzije, kožni nabori), a za procenu agilnosti korišćeni su modifikovani T-test i osmica test. Rezultati jednosmerne analize varijanse ukazuju na postojanje značajnih razlika sa veoma velikim efektima između igrača različitih funkcionalnih klasa kod telesne mase, sedeće visine i sedeće dohvatne visine, dok su značajne razlike sa velikim efektima zabeležene kod testova za procenu agilnosti: T-testa i osmice testa. Takođe, rezultati korelacione analize ukazuju na to da postoje značajne umerene pozitivne korelacije sedeće visine i dohvatne visine sa funkcionalnom klasifikacijom.
There are many sources to increase value in an integrated mining–metallurgy context. The optimal strategy for concentration of minerals from the ore is one of these sources. The elements of ...mining-metallurgy operations from resources, infrastructure, mining site, processing, and metallurgy are mutually dependent, and reinforce and interact positively with each other to generate a combined value greater than the sum of their individual contributions. Bioleaching technology is an alternative processing technology for treatment of low-grade sulphide ore, and its application contributes to the achievement of better economic results than the conventional pyrometallurgical technology. This work presents the application of bioleaching technology in laboratory conditions for metal extraction from the polymetallic deposit Tenka in East Serbia, belonging to the company Serbia Zijin Bor Copper Doo (formerly the Mining Smelter Basin Bor Group). Bioleaching of sulphide polymetallic raw material is performed by chemolithoautotrophic microorganisms. Applying the bioleaching technology, the achieved recoveries of metals from the polymetallic ore are as follows: Cu 90%, Au 90%, Ag 80%, Zn 72% and Pb 90%. The calculated values for Net Present Value (NPV) and Internal Rate of Return (IRR) are $ 21.927 million and 12.55%, respectively.
Abstract Background The utilization of hip arthroscopy continues to increase in the United States. The purpose of this study was to examine trends in hip arthroscopy procedures and outcomes. Methods ...We performed a retrospective cohort study using Optum Labs Data Warehouse administrative claims data. The cohort comprised 10,042 privately insured enrollees aged 18-64 years who underwent a hip arthroscopy procedure between 2005 and 2013. Utilization trends were examined using age-, sex- and calendar-year specific hip arthroscopy rates. Outcomes were examined using the survival analysis methods and included subsequent hip arthroscopy and total hip arthroplasty. Results Hip arthroscopy rates increased significantly over time from 3.6 per 100,000 in 2005 to 16.7 per 100,000 in 2013. The overall 2-year cumulative incidence of subsequent hip arthroscopy and total hip arthroplasty were 11% and 10%, respectively. In the subset of patients in whom laterality of the subsequent procedure could be determined, about half of the subsequent hip arthroscopy procedures (46%) and almost all of the THA procedures (94%) were on the same side. Decreasing age was significantly associated with the risk of subsequent arthroscopy (p<0.01), whereas increasing age was significantly associated with the subsequent risk of total hip arthroplasty (p<0.01). The 5-year cumulative incidence of total hip arthroplasty reached as high as 35% among individuals aged 55-64 years. Conclusion The utilization of hip arthroscopy procedures increased dramatically over the last decade in the 18-64 year old privately insured population, with the largest increase in younger age groups. Future studies are warranted to understand the determinants of the large increase in utilization of hip arthroscopy and outcomes.
Abstract Periprosthetic joint infection (PJI) represents substantial clinical and economic burdens. This study evaluated patient and procedure characteristics and resource utilization associated with ...revision arthroplasty for PJI. The Nationwide Inpatient Sample (Q4 2005–2010) was analyzed for 235,857 revision THA (RTHA) and 301,718 revision TKA (RTKA) procedures. PJI was the most common indication for RTKA, and the third most common reason for RTHA. PJI was most commonly associated with major severity of illness (SOI) in RTHA, and with moderate SOI in RTKA. RTHA and RTKA for PJI had the longest length of stay. Costs were higher for RTHA/RTKA for PJI than for any other diagnosis except periprosthetic fracture. Epidemiologic differences exist in the rank, severity and populations for RTHA and RTKA for PJI.
Background
Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and ...differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs.
Questions/purposes
We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay LOS) between revision THA and TKA.
Methods
The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.
Results
Revision TKAs increased by 39% (revision burden, 9.1%–9.6%) and THAs increased by 23% (revision burden, 15.4%–14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common in revision THAs (43%) than in TKAs (37%). Patients who underwent revision THA generally were sicker (> 50% major severity of illness score) than patients who underwent revision TKA (65% moderate severity of illness score). Mean LOS was longer for revision THAs than for TKAs. Mean hospitalization costs were slightly higher for revision THA (USD 24,697 +/− USD 40,489 SD) than revision TKA (USD 23,130 +/− USD 36,643 SD). Periprosthetic joint infection and periprosthetic fracture were associated with the greatest LOS and costs for revision THAs and TKAs.
Conclusions
These data could prove important for healthcare systems to appropriately allocate resources to hip and knee procedures: the revision burden for THA is 52% greater than for TKA, but revision TKAs are increasing at a faster rate. Likewise, the treating clinician should understand that while both revision THAs and TKAs bear significant clinical and economic costs, patients undergoing revision THA tend to be older, sicker, and have greater costs of care.
Abstract Periprosthetic joint infection is one of the most challenging complications of total joint arthroplasty. We evaluated the incidence of early-onset (less than 2 years) and late-onset (greater ...than 2 years) periprosthetic joint infection after primary total hip arthroplasty (THA). The Medicare 5% national sample data set (1997-2006) was used to longitudinally follow primary THA patients. Deep infections were identified with the International Classification of Diseases, Ninth Revision, Clinical Modification code 996.66. Kaplan-Meier survivorship curves were compiled with infection as the end point. Cox regression was used to evaluate patient and hospital characteristics. Eight hundred eighty-seven THA infections were identified from 39 929 THA patients. The incidence of infection was 1.63% within 2 years and 0.59% between 2 and 10 years. Comorbidities, sex, procedure duration, and socioeconomic status were found to be significant risk factors. This is the first study to establish the incidence and risk factors associated with early onset and delayed periprosthetic joint infection in the Medicare patient population.
The patient-related risk factors for periprosthetic joint infection and postoperative mortality in elderly patients undergoing total hip arthroplasty are poorly understood. The purpose of this study ...was to identify the specific patient comorbidities that are associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in U.S. Medicare patients undergoing total hip arthroplasty.
The Medicare 5% sample claims database was used to calculate the relative risk of periprosthetic joint infection and of ninety-day postoperative mortality as a function of preexisting comorbidities in 40,919 patients who underwent primary total hip arthroplasty between 1998 and 2007. The impact of twenty-nine comorbid conditions on periprosthetic joint infection and on postoperative mortality was examined with use of Cox regression, controlling for age, sex, census region, public assistance, and all other baseline comorbidities. The adjusted hazard ratios for all comorbid conditions were evaluated, and the Wald chi-square statistic was used to rank the degree of association of each condition with periprosthetic joint infection and with postoperative mortality. The Bonferroni-Holm method was used to adjust for the multiple comparisons resulting from the number of comorbid conditions analyzed.
Comorbid conditions associated with an increased adjusted risk of periprosthetic joint infection (in decreasing order of significance, p < 0.05 for all comparisons) were rheumatologic disease (hazard ratio HR = 1.71), obesity (HR = 1.73), coagulopathy (HR = 1.58), and preoperative anemia (HR = 1.36). Comorbid conditions associated with an increased adjusted risk of ninety-day postoperative mortality (in decreasing order of significance, p < 0.05 for all comparisons) were congestive heart failure (HR = 2.11), metastatic cancer (HR = 3.14), psychosis (HR = 1.85), renal disease (HR = 1.98), dementia (HR = 2.04), hemiplegia or paraplegia (HR = 2.62), cerebrovascular disease (HR = 1.40), and chronic pulmonary disease (HR = 1.32).
We identified specific patient comorbidities that were independently associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in Medicare patients who had undergone total hip arthroplasty. This information is important when counseling elderly patients regarding the risks of periprosthetic joint infection and mortality following total hip arthroplasty, as well as for risk adjustment of publicly reported total hip arthroplasty outcomes.
Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision ...making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed.
Level of Evidence:
Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.
Understanding the causes of failure and the types of revision total hip arthroplasty performed is essential for guiding research, implant design, clinical decision-making, and health-care policy. The ...purpose of the present study was to evaluate the mechanisms of failure and the types of revision total hip arthroplasty procedures performed in the United States with use of newly implemented ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes related specifically to revision total hip arthroplasty in a large, nationally representative population.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze clinical, demographic, and economic data from 51,345 revision total hip arthroplasty procedures performed between October 1, 2005, and December 31, 2006. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, census region, primary payer class, and type of hospital. The cause of failure, the average length of stay, and total charges were also determined for each type of revision arthroplasty procedure.
The most common type of revision total hip arthroplasty procedure performed was all-component revision (41.1%), and the most common causes of revision were instability/dislocation (22.5%), mechanical loosening (19.7%), and infection (14.8%). Revision total hip arthroplasty procedures were most commonly performed in large, urban, nonteaching hospitals for Medicare patients seventy-five to eighty-four years of age. The average length of hospital stay for all types of revision arthroplasties was 6.2 days, and the average total charges were $54,553. However, the average length of stay, average charges, and procedure frequencies varied considerably according to census region, hospital type, and type of revision total hip arthroplasty procedure performed.
Hip instability and mechanical loosening are the most common indications for revision total hip arthroplasty in the United States. As further experience is gained with the new diagnosis and procedure codes specifically related to revision total hip arthroplasty, this information will be valuable in directing future research, implant design, and clinical decision-making.
The current risk of infection in contemporary total knee arthroplasty (TKA) as well as the relative importance of risk factors remains under debate as a result of the rarity of the complication and ...temporal changes in the treatment and prevention of infection. We therefore determined infection incidence and risk factors after TKA in the Medicare population. The Medicare 5% national sample administrative data set was used to identify and longitudinally follow patients undergoing TKA for deep infections and revision surgery between 1997 and 2006. Cox regression was used to evaluate patient and hospital characteristics. In 69,663 patients undergoing elective TKA, 1400 TKA infections were identified. Infection incidence within 2 years was 1.55%. The incidence between 2 and up to 10 years was 0.46%. Women had a lower risk of infection than men. Comorbidities also increased TKA infection risk. Patients receiving public assistance for Medicare premiums were at increased risk for periprosthetic joint infection (PJI). Hospital factors did not predict an increased risk of infection. PJI occurs at a relatively high rate in Medicare patients with the greatest risk of PJI within the first 2 years after surgery; however, approximately one-fourth of all PJIs occur after 2 years.
Level of Evidence:
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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