Pixee knee+ augmented reality assisted navigation for total knee arthroplasty in an ambulatory surgical center

Total knee arthroplasty (TKA) requires precise alignment for optimal post-operative outcomes and prosthesis longevity. Recently, augmented reality (AR) has emerged as a promising technology in surgical procedures, including TKA. This case series evaluates the feasibility and accuracy of the knee+ augmented reality-assisted navigation (ARAN) system by Pixee Medical in an ambulatory surgical center (ASC) setting. Our study involved 17 consecutive TKA patients performed with the knee+ ARAN system at an ASC from August 2022 to October 2022. Demographic data, including sex, age, ASA score, height, weight, and BMI, were recorded. Postoperative measurements of the mechanical distal femoral angle (MDFA), mechanical distal tibial angle (MDTA), posterior tibial slope (PTS), femoral-tibial angle (FTA), and posterior femoral flexion (PFF) were compared to the ideal intraoperative angles. Outliers were defined as deviations greater than 3° from the planned angles. In this study, 15 out of 17 TKAs utilizing the Pixee knee+ ARAN system were analyzed. All mean post-operative radiographic measurements were within clinically acceptable ranges. The study also found that surgeries using the knee+ system had a slightly longer incision-to-closing time relative to the control group of patients undergoing normal TKA. Our results indicate clinically acceptable accuracy and precision in alignment with the knee+ ARAN system, albeit with a slight increase in surgery duration. This is the first study evaluating the knee+ ARAN system in an ASC setting indicates its suitability for outpatient centers, highlighting its precision, portability, and cost-effectiveness. Larger studies utilizing outcome measures can further assess the system’s advantages and disadvantages

Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation

pre-printObjective: To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived.. Data Source/Study Setting: An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design™, its version of the Patient Centered Medical Home. Study Design: Mixed methods. Data Collection/Extraction Methods: Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semi-structured interviews, focus groups, Centers for Medicare and Medicaid Services database and the Utah All Payers Claims Database. Principal findings: Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Conclusions: Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence

Costs and benefits of folic acid fortification in the United States: economic analysis, regulatory action, and public health

ManuscriptThe United States Food and Drug Administration (FDA) required that as of January 1, 1998, manufacturers of enriched cereal- grain products fortify their products with folic acid to reduce the number of pregnancies affected by a neural tube defect (NTD). Prior to adoption of the regulation in 1996, three economic evaluations projected the net economic benefits or cost savings of folic acid fortification. The expected percentage decline in NTDs in these three studies was between 2.6% and 10.5%. Birth defects surveillance data indicate that since fortification there has been a 20% to 30% decline in births with either spina bifida or anencephaly. We estimate that folic acid fortification is associated with an economic benefit of $425 million per year in the United States and constitutes a major public health success that has resulted from regulatory actio

Half-life of cost-of-illness estimates: the case of Spina Bifida

ManuscriptNeural tube defects, which include spina bifida, are one of the most frequent and important categories of birth defects. Accordingly, there has been considerable interest in studying the impact of spina bifida as a public health problem. This impact can be measured in various ways, including disease-specific mortality, morbidity, functional limitation or disability, and quality of life impairment. Each of these measures captures one component of the total burden of disease. Such measures of impact are important because they allow public health agencies, researchers, and health care providers to understand the effects of preventive or diagnostic interventions, changes in disease incidence or prevalence, and new technologies

For cost-reducing technologies, knowing markets is to change them

Journal ArticleSponsored research from a NSF Foundation/Whitaker Foundation initiative on cost-reducing technologies brought together faculty from engineering, medicine, and social sciences to link economic and policy assessments to engineering design. The technology under development is to be an inexpensive, easy-to-use monitor for self-management of metabolic diseases by patients, with specific application to phenylketonuria (PKU). While the technology remains in development, the experience, including discussions with others in the Whitaker and National Science foundations' program, raised interesting issues about economics, policy, and cost-reducing technologies

The haunted delimitation of subjectivity in the Work of Nicolas Abraham

Kinesin-like calmodulin binding protein (KCBP), a Kinesin-14 family motor protein, is involved in the structural organization of microtubules during mitosis and trichome morphogenesis in plants. The molecular mechanism of microtubule bundling by KCBP remains unknown. KCBP binding to microtubules is regulated by Ca(2+)-binding proteins that recognize its C-terminal regulatory domain. In this work, we have discovered a new function of the regulatory domain. We present a crystal structure of an Arabidopsis KCBP fragment showing that the C-terminal regulatory domain forms a dimerization interface for KCBP. This dimerization site is distinct from the dimerization interface within the N-terminal domain. Side chains of hydrophobic residues of the calmodulin binding helix of the regulatory domain form the C-terminal dimerization interface. Biochemical experiments show that another segment of the regulatory domain located beyond the dimerization interface, its negatively charged coil, is unexpectedly and absolutely required to stabilize the dimers. The strong microtubule bundling properties of KCBP are unaffected by deletion of the C-terminal regulatory domain. The slow minus-end directed motility of KCBP is also unchanged in vitro. Although the C-terminal domain is not essential for microtubule bundling, we suggest that KCBP may use its two independent dimerization interfaces to support different types of bundled microtubule structures in cells. Two distinct dimerization sites may provide a mechanism for microtubule rearrangement in response to Ca(2+) signaling since Ca(2+)- binding proteins can disengage KCBP dimers dependent on its C-terminal dimerization interface