Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient Demographics.

Purpose:To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. Methods:We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation. Results:Patients who canceled were significantly older (46.5 years vs 41.5 years, t = 2.432, P = .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, χ2 = 10.85, P = .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, χ2 = 5.35, P = .021), non-English-speaking patients (29.5% vs 11.6%, χ2 = 11.43, P = .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, χ2 = 9.96, P = .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language. Conclusions:Increased age (≥46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation. Level of Evidence:Level III, case-control study

OPTIMIZATION OF THE HOT-ELECTRON BOLOMETER AND A CASCADE QUASIPARTICLE AMPLIFIER FOR SPACE ASTRONOMY

Ultra low noise bolometers are required for space - based astronomical observations. Extremely sensitive detectors are necessary for a deep full-sky survey of distant extragalactic sources in the submillimeter-wave region corresponding to the extraterrestrial background spectrum minimum. A deep full-sky survey is the main goal of the Submillimetron project of the cryogenically cooled telescope on the International Space Station [1,2], project CIRCE (NASA) and other projects. Detection of faint sources involvves wide-band continuum observation using direct detectors (bolometers) that are not restricted by the quantum noise of indirect heterodyne receivers. Theoretical estimations and preliminary experiments show that it is possible to realize the necessary sensitivity of 10-18 - 10-19 W/Hz1/2 with a novel concept of the antenna-coupled microbolometers at temperatures 0.1 K. Additional advantages of such detectors are the possibility to operate with a wide range of background load, easy integration in arrays, and direct possibility of polarization measurements

Incorporating Sociocultural Phenomena into Ecosystem-Service Valuation: The Importance of Critical Pluralism

Ecosystem-services scholarship has largely focused on monetary valuation and the material contributions of ecosystems to human well-being. Increasingly, research is calling for a deeper understanding of how less tangible, nonmaterial values shape management and stakeholder decisions. We propose a framework that characterizes a suite of sociocultural phenomena rooted in key social science disciplines that are currently underrepresented in the ecosystem-services literature. The results from three example studies are presented to demonstrate how the tenets of this conceptual model can be applied in practice. We consider the findings from these studies in light of three priorities for future research: (1) complexities in individual and social functioning, (2) the salience and specificity of the perceived benefits of nature, and (3) distinctions among value concepts. We also pose a series of questions to stimulate reflection on how ecosystem-services research can adopt more pluralistic viewpoints that accommodate different forms of knowledge and its acquisition

From Antenna to Antenna: Lateral Shift of Olfactory Memory Recall by Honeybees

Honeybees, Apis mellifera, readily learn to associate odours with sugar rewards and we show here that recall of the olfactory memory, as demonstrated by the bee extending its proboscis when presented with the trained odour, involves first the right and then the left antenna. At 1–2 hour after training using both antennae, recall is possible mainly when the bee uses its right antenna but by 6 hours after training a lateral shift has occurred and the memory can now be recalled mainly when the left antenna is in use. Long-term memory one day after training is also accessed mainly via the left antenna. This time-dependent shift from right to left antenna is also seen as side biases in responding to odour presented to the bee's left or right side. Hence, not only are the cellular events of memory formation similar in bees and vertebrate species but also the lateralized networks involved may be similar. These findings therefore seem to call for remarkable parallel evolution and suggest that the proper functioning of memory formation in a bilateral animal, either vertebrate or invertebrate, requires lateralization of processing

Population pharmacokinetics of colistin and the relation to survival in critically ill patients infected with colistin susceptible and carbapenem-resistant bacteria

Objectives: The aim was to analyse the population pharmacokinetics of colistin and to explore the relationship between colistin exposure and time to death. Methods: Patients included in the AIDA randomized controlled trial were treated with colistin for severe infections caused by carbapenem-resistant Gram-negative bacteria. All subjects received a 9 million units (MU) loading dose, followed by a 4.5 MU twice daily maintenance dose, with dose reduction if creatinine clearance (CrCL) 2 mg/L in 94% (195/208) and 44% (38/87) of patients with CrCL ≤120 mL/min, and >120 mL/min, respectively. Colistin methanesulfonate sodium (CMS) and colistin clearances were strongly dependent on CrCL. High colistin exposure to MIC ratio was associated with increased hazard of death in the multivariate analysis (adjusted hazard ratio (95% CI): 1.07 (1.03–1.12)). Other significant predictors included SOFA score at baseline (HR 1.24 (1.19–1.30) per score increase), age and Acinetobacter or Pseudomonas as index pathogen. Discussion: The population pharmacokinetic model predicted that >90% of the patients had colistin concentrations

Hyperammonemic Coma—Barking Up the Wrong Tree

Hepatic encephalopathy and myxedema coma share clinical features: coma, ascites, anemia, impaired liver functions, and a “metabolic” electroencephalogram (EEG). Hyperammonemia, a hallmark of hepatic encephalopathy, has also been described in hypothyroidism. Differentiation between the 2 conditions, recognition of their possible coexistence, and the consequent therapeutic implications are of utmost importance. We describe a case of an 82-year-old woman with a history of mild chronic liver disease who presented with hyperammonemic coma unresponsive to conventional therapy. Further investigation disclosed severe hypothyroidism. Thyroid hormone replacement resulted in gain of consciousness and normalization of hyperammonemia. In patients with an elevated ammonia level, altered mental status, and liver disease, who do not have a clear inciting event for liver disease decompensation, overwhelming evidence of hepatic decompensation, or who do not respond to appropriate therapy for hepatic encephalopathy, hypothyroidism should be considered and evaluated