National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database.

BACKGROUND: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated. AIM: To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups. METHODS: We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized. RESULTS: Of the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA. CONLUSION: There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS

Integrated Assessment of Shallow-Aquifer Vulnerability to Multiple Contaminants and Drinking-Water Exposure Pathways in Holliston, Massachusetts

Half of U.S. drinking water comes from aquifers, and very shallow ones (table) are especially vulnerable to anthropogenic contamination. We present the case of Holliston, a Boston, Massachusetts suburb that draws its drinking water from very shallow aquifers, and where metals and solvents have been reported in groundwater. Community concerns focus on water discolored by naturally occurring manganese (Mn), despite reports stating regulatory aesthetic compliance. Epidemiologic studies suggest Mn is a potentially toxic element (PTE) for children exposed by the drinking-water pathway at levels near the regulatory aesthetic level. We designed an integrated, community-based project: five sites were profiled for contaminant releases; service areas for wells were modeled; and the capture zone for one vulnerable well was estimated. Manganese, mercury, and trichloroethylene are among 20 contaminants of interest. Findings show that past and/or current exposures to multiple contaminants in drinking water are plausible, satisfying the criteria for complete exposure pathways. This case questions the adequacy of aquifer protection and monitoring regulations, and highlights the need for integrated assessment of multiple contaminants, associated exposures and health risks. It posits that community-researcher partnerships are essential for understanding and solving complex problems

Early mobilization in the critical care unit: A review of adult and pediatric literature.

Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations

Integrated Assessment of Shallow-Aquifer Vulnerability to Multiple Contaminants and Drinking-Water Exposure Pathways in Holliston, Massachusetts

Half of U.S. drinking water comes from aquifers, and very shallow ones (<20 feet to water table) are especially vulnerable to anthropogenic contamination. We present the case of Holliston, a Boston, Massachusetts suburb that draws its drinking water from very shallow aquifers, and where metals and solvents have been reported in groundwater. Community concerns focus on water discolored by naturally occurring manganese (Mn), despite reports stating regulatory aesthetic compliance. Epidemiologic studies suggest Mn is a potentially toxic element (PTE) for children exposed by the drinking-water pathway at levels near the regulatory aesthetic level. We designed an integrated, community-based project: five sites were profiled for contaminant releases; service areas for wells were modeled; and the capture zone for one vulnerable well was estimated. Manganese, mercury, and trichloroethylene are among 20 contaminants of interest. Findings show that past and/or current exposures to multiple contaminants in drinking water are plausible, satisfying the criteria for complete exposure pathways. This case questions the adequacy of aquifer protection and monitoring regulations, and highlights the need for integrated assessment of multiple contaminants, associated exposures and health risks. It posits that community-researcher partnerships are essential for understanding and solving complex problems

Integrated Assessment of Shallow-Aquifer Vulnerability to Multiple Contaminants and Drinking-Water Exposure Pathways in Holliston, Massachusetts

Half of U.S. drinking water comes from aquifers, and very shallow ones (<20 feet to water table) are especially vulnerable to anthropogenic contamination. We present the case of Holliston, a Boston, Massachusetts suburb that draws its drinking water from very shallow aquifers, and where metals and solvents have been reported in groundwater. Community concerns focus on water discolored by naturally occurring manganese (Mn), despite reports stating regulatory aesthetic compliance. Epidemiologic studies suggest Mn is a potentially toxic element (PTE) for children exposed by the drinking-water pathway at levels near the regulatory aesthetic level. We designed an integrated, community-based project: five sites were profiled for contaminant releases; service areas for wells were modeled; and the capture zone for one vulnerable well was estimated. Manganese, mercury, and trichloroethylene are among 20 contaminants of interest. Findings show that past and/or current exposures to multiple contaminants in drinking water are plausible, satisfying the criteria for complete exposure pathways. This case questions the adequacy of aquifer protection and monitoring regulations, and highlights the need for integrated assessment of multiple contaminants, associated exposures and health risks. It posits that community-researcher partnerships are essential for understanding and solving complex problems