Total knee arthroplasty (TKA) is among the most performed orthopaedic surgeries in the United States with at least 1,000,000 cases performed per year. Dissatisfaction following TKA has often been ...reported as 20% or more, with a multitude of causes including sociodemographic, preoperative, and postoperative factors. The purpose of this study was to re-examine the rate and causes of dissatisfaction following TKA.
A systematic review of the literature was performed searching databases from 2010 to 2022. Only primary TKA cases were included and all cases of unicompartmental arthroplasty and revisions were excluded. After abstracts were reviewed, 35 articles were selected for a full-length review, which was ultimately reduced to 21 articles for final inclusion.
The average rate of patient dissatisfaction was 10%. Excluding complications, the average rate of dissatisfaction was 7.3%. The most common sociodemographic factors for dissatisfaction were age < 65 years, lower income, and non-White patients. Preoperative factors included lower Kellgren-Lawrence scores, depression/anxiety, and pain catastrophizing. Postoperatively, most dissatisfaction was due to complications, unmet expectations, persistent pain, and stiffness.
Based on our review, the average rate of patient dissatisfaction following TKA is 10%. Improved counseling for known risk factors may have reduced dissatisfaction rates by increasing preoperative patient optimization. Many studies in recent years have demonstrated the issue of poor patient coping skills, such as pain catastrophizing and anxiety/depression as a common cause of dissatisfaction. Ultimately, dissatisfaction following TKA still continues to affect a high portion of patients but less than historical reports of 20%.
The ongoing coronavirus disease 2019 (COVID-19) pandemic has heightened discussion of the use of mobile phone data in outbreak response. Mobile phone data have been proposed to monitor effectiveness ...of non-pharmaceutical interventions, to assess potential drivers of spatiotemporal spread, and to support contact tracing efforts. While these data may be an important part of COVID-19 response, their use must be considered alongside a careful understanding of the behaviors and populations they capture. Here, we review the different applications for mobile phone data in guiding and evaluating COVID-19 response, the relevance of these applications for infectious disease transmission and control, and potential sources and implications of selection bias in mobile phone data. We also discuss best practices and potential pitfalls for directly integrating the collection, analysis, and interpretation of these data into public health decision making.
The Carnegie Curve Harrison, R. Giles
Surveys in geophysics,
03/2013, Letnik:
34, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The Earth’s fair weather atmospheric electric field shows, in clean air, an average daily variation which follows universal time, globally independent of the measurement position. This single diurnal ...cycle variation (maximum around 19UT and minimum around 03UT) is widely known as the Carnegie curve, after the geophysical survey vessel of the Carnegie Institution of Washington on which the original measurement campaigns demonstrating the universal time variation were undertaken. The Carnegie curve’s enduring importance is in providing a reference variation against which atmospheric electricity measurements are still compared; it is believed to originate from regular daily variations in atmospheric electrification associated with the different global disturbed weather regions. Details of the instrumentation, measurement principles and data obtained on the Carnegie’s seventh and final cruise are reviewed here, also deriving new harmonic coefficients allowing calculation of the Carnegie curve for different seasons. The additional harmonic analysis now identifies changes in the phasing of the maximum and minimum in the Carnegie curve, which shows a systematic seasonal variation, linked to the solstices and equinoxes, respectively.
Giant mineral dust particles (>75 μm in diameter) found far from their source have long puzzled scientists. These wind-blown particles affect the atmosphere's radiation balance, clouds, and the ocean ...carbon cycle but are generally ignored in models. Here, we report new observations of individual giant Saharan dust particles of up to 450 μm in diameter sampled in air over the Atlantic Ocean at 2400 and 3500 km from the west African coast. Past research points to fast horizontal transport, turbulence, uplift in convective systems, and electrical levitation of particles as possible explanations for this fascinating phenomenon. We present a critical assessment of these mechanisms and propose several lines of research we deem promising to further advance our understanding and modeling.
This letter responds to the essay “If Not Now, Then When? Taking Disability Seriously in Bioethics,” by Debjani Mukherjee, Preya S. Tarsney, and Kristi L. Kirschner, in the May‐June 2022 issue of the ...Hastings Center Report.
With the increasing number of primary total knee arthroplasties (TKA) being performed annually there is also an expected increase in the number of revision TKA, as well as failed revision TKA with ...stemmed components. A new classification system based upon the location and degree of bone loss in the tibial and or femoral metaphysis and diaphysis is proposed. Type 1 has no bone loss in the metaphysis and diaphysis; Type 2 has a metaphyseal bone loss. Type 3 defects are subdivided into A and B, depending on the extent of the diaphyseal bone loss. Type 4 has extensive bone loss with an expansion of the diaphyseal cortex.
An online survey with digital anteroposterior and lateral radiographs was sent to five arthroplasty surgeons. A total of 55 cases with stemmed femoral and tibial components, considered failures and pending revision, were reviewed. By using the proposed classification system, each femoral and tibial component was scored. Interobserver reliability was determined using the intraclass correlation coefficient for pooled data.
Comparisons between each individual reviewer demonstrated moderate to strong agreement overall for the reviewers using the classification, with an average correlation coefficient of 0.67 (95% CI 0.57 to 0.77) for all cases, signifying a low variation in the scores of each case. Looking specifically at the femoral components, the ICC was 0.62 (95% CI 0.477 to 0.76), while the ICC for the tibial components was 0.71 (95% CI 0.58 to 0.83).
This classification, which has demonstrated moderate to strong interobserver reliability, can help surgeons determine the degree of anticipated bone loss and approach these complex cases with a preoperative plan based upon the radiographic images. This classification system will also allow standardized communication among surgeons, categorization of procedures for comparative research, and anticipated prognosis.
•This is the first classification of bone defects in failed stemmed components in revision TKA.•This classification provides a standardized categorization for better communication.•Knowing the expected degree of bone can influence the surgical plan.
Sample size calculations are an essential component of the design and evaluation of scientific studies. However, there is a lack of clear guidance for determining the sample size needed for ...phylogenetic studies, which are becoming an essential part of studying pathogen transmission. We introduce a statistical framework for determining the number of true infector-infectee transmission pairs identified by a phylogenetic study, given the size and population coverage of that study. We then show how characteristics of the criteria used to determine linkage and aspects of the study design can influence our ability to correctly identify transmission links, in sometimes counterintuitive ways. We test the overall approach using outbreak simulations and provide guidance for calculating the sensitivity and specificity of the linkage criteria, the key inputs to our approach. The framework is freely available as the R package phylosamp, and is broadly applicable to designing and evaluating a wide array of pathogen phylogenetic studies.
A review article summarizes the existing literature on intraoperative injury to medial collateral ligament (MCL) during total knee arthroplasty (TKA), methods of fixation, repair, and the outcomes ...after these injuries. The options for increasing implant constraint and repair of the MCL injury are discussed with the potential indications for each. There is also a review of risk factors for MCL injury during TKA to help anticipate potential issues preoperatively. The proper use of retractors during total knee replacement is also discussed with a focus on careful protection of the MCL during surgery.
Understanding the level and characteristics of protection from past SARS-CoV-2 infection against subsequent re-infection, symptomatic COVID-19 disease, and severe disease is essential for predicting ...future potential disease burden, for designing policies that restrict travel or access to venues where there is a high risk of transmission, and for informing choices about when to receive vaccine doses. We aimed to systematically synthesise studies to estimate protection from past infection by variant, and where data allow, by time since infection.
In this systematic review and meta-analysis, we identified, reviewed, and extracted from the scientific literature retrospective and prospective cohort studies and test-negative case-control studies published from inception up to Sept 31, 2022, that estimated the reduction in risk of COVID-19 among individuals with a past SARS-CoV-2 infection in comparison to those without a previous infection. We meta-analysed the effectiveness of past infection by outcome (infection, symptomatic disease, and severe disease), variant, and time since infection. We ran a Bayesian meta-regression to estimate the pooled estimates of protection. Risk-of-bias assessment was evaluated using the National Institutes of Health quality-assessment tools. The systematic review was PRISMA compliant and was registered with PROSPERO (number CRD42022303850).
We identified a total of 65 studies from 19 different countries. Our meta-analyses showed that protection from past infection and any symptomatic disease was high for ancestral, alpha, beta, and delta variants, but was substantially lower for the omicron BA.1 variant. Pooled effectiveness against re-infection by the omicron BA.1 variant was 45·3% (95% uncertainty interval UI 17·3–76·1) and 44·0% (26·5–65·0) against omicron BA.1 symptomatic disease. Mean pooled effectiveness was greater than 78% against severe disease (hospitalisation and death) for all variants, including omicron BA.1. Protection from re-infection from ancestral, alpha, and delta variants declined over time but remained at 78·6% (49·8–93·6) at 40 weeks. Protection against re-infection by the omicron BA.1 variant declined more rapidly and was estimated at 36·1% (24·4–51·3) at 40 weeks. On the other hand, protection against severe disease remained high for all variants, with 90·2% (69·7–97·5) for ancestral, alpha, and delta variants, and 88·9% (84·7–90·9) for omicron BA.1 at 40 weeks.
Protection from past infection against re-infection from pre-omicron variants was very high and remained high even after 40 weeks. Protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants. The immunity conferred by past infection should be weighed alongside protection from vaccination when assessing future disease burden from COVID-19, providing guidance on when individuals should be vaccinated, and designing policies that mandate vaccination for workers or restrict access, on the basis of immune status, to settings where the risk of transmission is high, such as travel and high-occupancy indoor settings.
Bill & Melinda Gates Foundation, J Stanton, T Gillespie, and J and E Nordstrom.
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