Redefining Recovery: Multimodal Analgesics and Tranexamic Acid in Orthopedic Surgery

Introduction As the demand for joint replacements continues to rise, optimizing patient outcomes and enhancing recovery have become paramount goals for orthopedic surgeons. Patients used to have minimal mobility following a Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA) due to pain or the effects of sedation from anesthesia. This would lead to longer hospital stays, more complications, and higher opioid use.1 These surgeries also resulted in levels of blood loss that required transfusion therapy postoperatively.2 In recent years, there has been a paradigm shift in postoperative care for total joint arthroplasty (TJA), marked by significant advancements in the use of multimodal analgesics and tranexamic acid (TXA). The integration of multimodal analgesic approaches, combining various analgesic agents and techniques, has shown promise in effectively managing postoperative pain while minimizing opioid consumption.3 Concurrently, the administration of TXA, an antifibrinolytic agent, has gained widespread recognition for its role in reducing blood loss and transfusion requirements in TJA procedures.

Multigenerational exposures of Daphnia magna to pristine and aged silver nanoparticles:epigenetic changes and phenotypical ageing related effects

Engineered nanoparticles (NPs) undergo physical, chemical, and biological transformation after environmental release, resulting in different properties of the ‘aged’ versus ‘pristine’ forms. While many studies have investigated the ecotoxicological effects of silver (Ag) NPs, the majority focus on ‘pristine’ Ag NPs in simple exposure media, rather than investigating realistic environmental exposure scenarios with transformed NPs. Here, we systematically evaluate the effects of ‘pristine’ and ‘aged’ Ag NPs with different surface coatings on Daphnia magna over four generations, comparing continuous exposure versus parental only exposure to assess recovery potential for three generations. Biological endpoints including survival, growth and reproduction and genetic effects associated with Ag NP exposure were investigated. Parental exposure to ‘pristine’ Ag NPs had an inhibitory effect on reproduction, induced expression of antioxidant stress related genes and reduced survival. Pristine Ag NPs also induced morphological changes including tail losses and lipid accumulation associated with aging phenotypes in the heart, abdomen and abdominal claw. These effects were epigenetic remaining two generations post-maternal exposure (F2 and F3). Exposure to identical Ag NPs (same concentrations) aged for 6 months in environmentally realistic water containing natural organic matter showed considerably reduced toxicological effects in continuously exposed generations and to the recovery generations

Burnout and depression: A cross sectional study among health care workers providing HIV care during the COVID-19 pandemic in Malawi.

Health care workers (HCWs) in eastern Africa experience high levels of burnout and depression, and this may be exacerbated during the COVID-19 pandemic due to anxiety and increased work pressure. We assessed the prevalence of burnout, depression and associated factors among Malawian HCWs who provided HIV care during the COVID-19 pandemic. From April-May 2021, between the second and third COVID-19 waves in Malawi, we randomly selected HCWs from 32 purposively selected PEPFAR/USAID-supported health facilities for a cross-sectional survey. We screened for depression using the World Health Organization Self Report Questionnaire (positive screen: score≥8) and for burnout using the Maslach Burnout Inventory tool, (positive screen: moderate-high Emotional Exhaustion and/or moderate-high Depersonalization, and/or low-moderate Personal Accomplishment scores). Logistic regression models were used to evaluate factors associated with depression and burnout. We enrolled 435 HCWs, median age 32 years (IQR 28-38), 54% male, 34% were clinical cadres and 66% lay cadres. Of those surveyed, 28% screened positive for depression, 29% for burnout and 13% for both. In analyses that controlled for age, district, and residence (rural/urban), we found that screening positive for depression was associated with expecting to be infected with COVID-19 in the next 12 months (aOR 2.7, 95%CI 1.3-5.5), and previously having a COVID-19 infection (aOR 2.58, 95CI 1.4-5.0). Screening positive for burnout was associated with being in the clinical cadre (aOR 1.86; 95% CI: 1.2-3.0) and having a positive depression screen (aOR 3.2; 95% CI: 1.9-5.4). Reports of symptoms consistent with burnout and depression were common among Malawian HCWs providing HIV care but prevalence was not higher than in surveys before the COVID-19 pandemic. Regular screening for burnout and depression should be encouraged, given the potential for adverse HCW health outcomes and reduced work performance. Feasible interventions for burnout and depression among HCWs in our setting need to be introduced urgently

Characteristics of the National Applicant Pool for Clinical Informatics Fellowships (2016-2017)

We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented minority groups

The Lantern, 2013-2014

• Strikes • Pietro di Venezia • To the Lover of Small Things • Jim\u27s Big Day • Akademiks • Redamancy • A Love Poem for Arctia Caja • Mother River • The Lyrics to Your Song • Nerves • Gemini Season • White Interface • The Last Time I Played with Dolls • The Mechanic • My Goldfish • Put Down Your Hammer • Strip • Hollywood • Identity • The Grey Zone • Sophia • When I Became a Poet • Unbroken • The Veteran Aeronaut • I Have Running Water but They had the Stars • Not A Nigga • Mother, Adam, Eve • From Fragile Seeds: A Palindrome • Conspiring, The Spires • Finally Working Out What Goes Where (God, For Example, is in His Kingdom) • Identity Crisis • Affection • Patience • An Enchanting Lost Cause • False Starts • Soggy Rice, Lukewarm Water • The Glow • Heat • 9-14 • Filigree • Diane Arbus • Touched • Dying Alive • Just Another Drunkard on the Train • Dinner • The French Legionnaire • Conspiracy and Theory • 1249am • Colored Pencils • Sea Glass • Roundtrip • The Muse Heard Music • Lacrimosa • The Allegory of the Maze • The Stars on Stuart Road • To Isabella • For Want of a Potato Chip • Termite Nests • Saving a Rose • Today and Yesterday • A Foggy New York • Cat; Wurtzburg • Embrace • Faces • Geisha • Pacis Leo • Patterns • Te-Whanganui-a-Tara (The Dock)https://digitalcommons.ursinus.edu/lantern/1180/thumbnail.jp

The Effects of Compressibility on the Performance and Modal Structures of a Sweeping Jet Emitted from Various Scales of a Fluidic Oscillator

Investigations of fluidic oscillators, or sweeping jet actuators, have primarily been conducted within the incompressible flow regime, which limits the accuracy of estimating fluidic oscillator performance for compressible flows. The objective of this study was to evaluate the effects of gas compressibility on the performance of a fluidic oscillator. A commonly used fluidic oscillator geometry (the Bray geometry) was scaled to five different sizes, 3D printed, and tested over a range of air flow rates. High-speed Schlieren images captured the sweeping jet exiting the fluidic oscillators, and custom MATLAB algorithms were used to calculate the oscillation frequencies and angles. A spectral proper orthogonal decomposition (SPOD) method was used to identify and compare the mode structures within the flow fields. All the results were compared using dimensionless parameters to observe performance trends. The results showed that the oscillation frequencies were directly proportional to the flow rate, while the oscillation angles were inversely proportional to the flow rate, regardless of scale size. The angular velocities were not proportional to the flow rate or scale size and exhibited maxima within the evaluated ranges. For all scale sizes, the mode structures were symmetric across the centerlines of the fluidic oscillators and extended further beyond the fluidic oscillators at higher flow rates. These results enable the prediction of fluidic oscillator performance, which can significantly improve the design process for an application where a fluidic oscillator may be used, such as aerospace applications, power generation, heat exchangers, or medical devices

The Effects of Compressibility on the Performance and Modal Structures of a Sweeping Jet Emitted from Various Scales of a Fluidic Oscillator

Investigations of fluidic oscillators, or sweeping jet actuators, have primarily been conducted within the incompressible flow regime, which limits the accuracy of estimating fluidic oscillator performance for compressible flows. The objective of this study was to evaluate the effects of gas compressibility on the performance of a fluidic oscillator. A commonly used fluidic oscillator geometry (the Bray geometry) was scaled to five different sizes, 3D printed, and tested over a range of air flow rates. High-speed Schlieren images captured the sweeping jet exiting the fluidic oscillators, and custom MATLAB algorithms were used to calculate the oscillation frequencies and angles. A spectral proper orthogonal decomposition (SPOD) method was used to identify and compare the mode structures within the flow fields. All the results were compared using dimensionless parameters to observe performance trends. The results showed that the oscillation frequencies were directly proportional to the flow rate, while the oscillation angles were inversely proportional to the flow rate, regardless of scale size. The angular velocities were not proportional to the flow rate or scale size and exhibited maxima within the evaluated ranges. For all scale sizes, the mode structures were symmetric across the centerlines of the fluidic oscillators and extended further beyond the fluidic oscillators at higher flow rates. These results enable the prediction of fluidic oscillator performance, which can significantly improve the design process for an application where a fluidic oscillator may be used, such as aerospace applications, power generation, heat exchangers, or medical devices

Amyotrophic Lateral Sclerosis Risk, Family Income, and Fish Consumption Estimates of Mercury and Omega-3 PUFAs in the United States

Most amyotrophic lateral sclerosis (ALS) cases are considered sporadic, without a known genetic basis, and lifestyle factors are suspected to play an etiologic role. We previously observed increased risk of ALS associated with high nail mercury levels as an exposure biomarker and thus hypothesized that mercury exposure via fish consumption patterns increases ALS risk. Lifestyle surveys were obtained from ALS patients (n = 165) and n = 330 age- and sex-matched controls without ALS enrolled in New Hampshire, Vermont, or Ohio, USA. We estimated their annual intake of mercury and omega-3 polyunsaturated fatty acid (PUFA) via self-reported seafood consumption habits, including species and frequency. In our multivariable model, family income showed a significant positive association with ALS risk (p = 0.0003, adjusted for age, sex, family history, education, and race). Neither the estimated annual mercury nor omega-3 PUFA intakes via seafood were associated with ALS risk. ALS incidence is associated with socioeconomic status; however, consistent with a prior international study, this relationship is not linked to mercury intake estimated via fish or seafood consumption patterns

Amyotrophic Lateral Sclerosis Risk, Family Income, and Fish Consumption Estimates of Mercury and Omega-3 PUFAs in the United States

Most amyotrophic lateral sclerosis (ALS) cases are considered sporadic, without a known genetic basis, and lifestyle factors are suspected to play an etiologic role. We previously observed increased risk of ALS associated with high nail mercury levels as an exposure biomarker and thus hypothesized that mercury exposure via fish consumption patterns increases ALS risk. Lifestyle surveys were obtained from ALS patients ( n = 165) and n = 330 age- and sex-matched controls without ALS enrolled in New Hampshire, Vermont, or Ohio, USA. We estimated their annual intake of mercury and omega-3 polyunsaturated fatty acid (PUFA) via self-reported seafood consumption habits, including species and frequency. In our multivariable model, family income showed a significant positive association with ALS risk ( p = 0.0003, adjusted for age, sex, family history, education, and race). Neither the estimated annual mercury nor omega-3 PUFA intakes via seafood were associated with ALS risk. ALS incidence is associated with socioeconomic status; however, consistent with a prior international study, this relationship is not linked to mercury intake estimated via fish or seafood consumption patterns

Multigenerational Exposure to Nano‐TiO 2 Induces Ageing as a Stress Response Mitigated by Environmental Interactions

Despite their ubiquity in personal care products, the health implications of titanium dioxide (TiO2) nanomaterials (NMs) are under strenuous investigation for their potential as a carcinogen, whereas other evidence has shown links with premature ageing. Both potential hazards are manifested after chronic exposure. To explore the chronic effects of TiO2 NMs in the environment, a multigenerational study using the model test species Daphnia magna is conducted. Phenotypical characteristics associated with ageing are observed (loss or shortening of tails and lipid accumulation) with increased expression of highly conserved key stress response genes involved in inflammatory responses and oxidative stress. These responses are visible in continuously exposed daphnids over four generations and in daphnids removed from maternal exposure even three generations later. However, exposure to the “aged” variants of these NMs at the same concentrations significantly reduced these effects, and exposure in medium containing natural organic matter is less severe than in salt‐only medium