Safety of overlapping inpatient orthopaedic surgery: A multicenter study

BackgroundAlthough overlapping surgery is used to maximize efficiency, more empirical data are needed to guide patient safety. We conducted a retrospective cohort study to evaluate the safety of overlapping inpatient orthopaedic surgery, as judged by the occurrence of perioperative complications.MethodsAll inpatient orthopaedic surgical procedures performed at 5 academic institutions from January 1, 2015, to December 31, 2015, were included. Overlapping surgery was defined as 2 skin incisions open simultaneously for 1 surgeon. In comparing patients who underwent overlapping surgery with those who underwent non-overlapping surgery, the primary outcome was the occurrence of a perioperative complication within 30 days of the surgical procedure, and secondary outcomes included all-cause 30-day readmission, length of stay, and mortality. To determine if there was an association between overlapping surgery and a perioperative complication, we tested for non-inferiority of overlapping surgery, assuming a null hypothesis of an increased risk of 50%. We used an inverse probability of treatment weighted regression model adjusted for institution, procedure type, demographic characteristics (age, sex, race, comorbidities), admission type, admission severity of illness, and clustering by surgeon.ResultsAmong 14,135 cases, the frequency of overlapping surgery was 40%. The frequencies of perioperative complications were 1% in the overlapping surgery group and 2% in the non-overlapping surgery group. The overlapping surgery group was non-inferior to the non-overlapping surgery group (odds ratio [OR], 0.61 [90% confidence interval (CI), 0.45 to 0.83]; p < 0.001), with reduced odds of perioperative complications (OR, 0.61 [95% CI, 0.43 to 0.88]; p = 0.009). For secondary outcomes, there was a significantly lower chance of all-cause 30-day readmission in the overlapping surgery group (OR, 0.67 [95% CI, 0.52 to 0.87]; p = 0.003) and shorter length of stay (e, 0.94 [95% CI, 0.89 to 0.99]; p = 0.012). There was no difference in mortality.ConclusionsOur results suggest that overlapping inpatient orthopaedic surgery does not introduce additional perioperative risk for the complications that we evaluated. The suitability of this practice should be determined by individual surgeons on a case-by-case basis with appropriate informed consent.Level of evidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence

Dicliny in Bouteloua (Poaceae: Chloridoideae): Implications for the Evolution of Dioecy

The New World grass genus Bouteloua (Chloridoideae: Cynodonteae) comprises 57 species, 13 of which produce unisexual spikelets and hence are diclinous. Andromonoecy, gynodioecy, monoecy, trimonoecy, and dioecy all occur in the genus, and ten species are known to express more than one of these breeding systems. Employing a phylogenetic estimate based on parsimony analysis of DNA sequences from the ITS (nrDNA) and trnL–F (cpDNA) regions representing 35 species of Bouteloua, including ten of 13 diclinous species, we used parsimony character state reconstructions to investigate the evolution of unisexual spikelets and breeding systems. Our specific goals were to estimate (1) the ancestral condition in the genus, (2) the number of times spikelet unisexuality has arisen and/or been lost, and (3) the evolutionary pathways leading to dioecy and the other breeding systems. Although a number of related genera are diclinous, the reconstructions suggest that the common ancestor of Bouteloua probably was not diclinous. Spikelet unisexuality appears to have evolved two to seven times in the genus, but precisely how many times is uncertain; zero to four reversals to hermaphroditism are inferred. The reconstructions show andromonoecy arising from monoecy, and gynodioecy arising from monocliny. Neither andromonoecy nor gynodioecy are implicated in the origin of monoecy or dioecy. Monoecy is shown to evolve from monocliny and dioecy, and dioecy from monocliny and monoecy. Polyploidy and arid environments are possible factors in the evolution and variability of breeding systems in Bouteloua

Cystic Fibrosis Airway Epithelia Fail to Kill Bacteria Because of Abnormal Airway Surface Fluid

AbstractDespite an increased understanding of the cellular and molecular biology of the CFTR Cl− channel, it is not known how defective Cl− transport across airway epithelia causes chronic bacterial infections in cystic fibrosis (CF) airways. Here, we show that common CF pathogens were killed when added to the apical surface of normal airway epithelia. In contrast, these bacteria multiplied on CF epithelia. We found that bactericidal activity was present in airway surface fluid of both normal and CF epithelia. However, because bacterial killing required a low NaCl concentration and because CF surface fluid has a high NaCl concentration, CF epithelia failed to kill bacteria. This defect was corrected by reducing the NaCl concentration on CF epithelia. These data explain how the loss of CFTR Cl− channels may lead to lung disease and suggest new approaches to therapy

Wildlife at Airports

Collisions between aircraft and wildlife (wildlife strikes) are common occurrences across the developed world. Wildlife strikes are not only numerous, but also costly. Estimates suggest that wildlife strikes cost the civil aviation industry in the U.S. up to $625 million annually, and nearly 500 people have been killed in wildlife strikes worldwide. Most wildlife strikes occur in the airport environment: 72 percent of all strikes occur when the aircraft is ≤500 ft (152 m) above ground level, and 41 percent of strikes occur when the aircraft is on the ground during landing or takeoff. Thus, management efforts to reduce wildlife hazards are focused at the airport. There are many techniques used to reduce wildlife hazards at airports, and these usually work best when used in an integrative fashion. Here, we discuss the available data on wildlife strikes with aircraft, summarize legal considerations, explain why wildlife are attracted to airports and how to identify important wildlife attractants, describe commonly-used tools and techniques for reducing wildlife hazards at airports, and explain how airports can enlist the help of professional wildlife biologists to manage wildlife hazards. Effective management of wildlife to reduce strikes, like all types of wildlife damage management, is based on principles from wildlife ecology, physiology, and behavior. Airport biologists should consider how these disciplines interact in the airport context, particularly with an understanding of regulatory guidance, non-wildlife related airport safety priorities, and strike data. This “marriage” of wildlife ecology with aspects of airport operations will aid in discerning how and why animals respond to various mitigation methods (at both the individual and population levels), why and under what conditions some management tools and techniques work better than others, and allow airport biologists to more intelligently direct management efforts

Cladistic Parsimony Analysis of Internal Transcribed Spacer Region (nrDNA) Sequences of Bouteloua and Relatives (Gramineae: Chloridoideae)

Chloridoideae) employing cladistic parsimony analysis of nuclear ribosomal internal transcribed spacer region (ITS1 + 5.8S + ITS2) DNA sequences. Included were Aegopogon (2 of 4 species), Bouteloua (34 of 42), Buchloë (1 of 1), Buchlomimus (1 of 1), Cathestecum (2 of 4), Cyclostachya (1 of 1), Griffithsochloa (1 of 1), Hilaria (1 of 7), Opizia (2 of 2), Pentarrhaphis (2 of 3), Pleuraphis (2 of 3), Pringleochloa (1 of 1), Soderstromia (1 of 1), and five outgroup genera/species for a total of I8 genera, 56 species, and ten varieties. In all, the ITS region of 72 plants was sequenced and analyzed utilizing PAUP. Aegopogon, the Hilaria-Pleuraphis clade, and Tragus (an outgroup representative) formed a tetratomy with a clade containing the remaining ingroup taxa. Neither Bouteloua nor its two subgenera, Bouteloua and Chondrosium, were found to be monophyletic. Bouteloua chondrosioides was sister to Opizia. Bouteloua rigidiseta formed a clade with Buchlomimus and Pringleochloa. Bouteloua eludens formed a clade with Buchloë, Cathestecum, Griffithsochloa, Pentarrhaphis, and Soderstromia. Bouteloua annua and B. aristidoides (subg. Bouteloua) formed a clade with B. eriopoda, B. eriostachya, B. hirsuta, and B. pectinata (subg. Chondrosium). Bouteloua juncea, which has been included in the B. curtipendula complex, was not a member of that clade. No new circumscriptions were proposed, although recognition of Bouteloua in the broad sense, with Chondrosium reduced to synonymy, was advocated. The findings suggested homoplasy in morphological, anatomical, and breeding system traits