Postoperative laboratory testing in the era of outpatient total joint arthroplasty: Targeted patient selection and associated cost savings.

Background: With the advent of outpatient total joint arthroplasty (TJA), the days of routinely drawing postoperative labs (complete blood counts [CBCs] and metabolic panels [CMPs/BMPs]) to monitor for complications are behind us. However, there does exist a subset of at-risk patients that may benefit from diligent postoperative monitoring, though the circumstances under which labs should be ordered remains unclear and subject to surgeon discretion. A systematic review of the literature was therefore conducted to evaluate the utility of postoperative laboratory testing, approaches to targeted patient selection and associated cost-savings. Methods: The PubMed, MEDLINE, EBSCOhost, and Google Scholar electronic databases were searched on August 17, 2023, to identify all studies published since January 1, 2000, that evaluated the role of postoperative lab testing in TJA. (PROSPERO study protocol registration: CRD42023437334). Articles were included if a full-text English manuscript was available and the study assessed the utility of routine postoperative labs in TJA. 19 studies were included comprising 34,166 procedures. The mean Methodological index for Nonrandomized Studies score was 18.2 ± 1.5. Results: Abnormal postoperative lab results were common and infrequently required clinical intervention. Among several identified risk factors for patients that may benefit from postoperative laboratory monitoring, preoperative lab values proved excellent discriminators of transfusion requirement and metabolite-associated intervention. Selective testing demonstrated the ability to generate substantial cost-savings. Conclusion: Routine postoperative laboratory testing offers little clinical utility and produces unnecessary expenditures. Preoperative lab values offer the greatest predictive utility for postoperative transfusion requirement and metabolite-associated clinical intervention, with a preoperative hemoglobin threshold of 111.5 g/L offering an area under the curve (AUC) of 0.93 for predicting postoperative transfusion. Further investigations are needed for metabolic panel predictive models and should incorporate preoperative lab values. The refinement of such models can enable targeted patient selection to avoid unnecessary labs and generate substantial cost savings without compromising patient safety.

The impact of EU public procurement regulations on tenders in Spain: a study with adalimumab.

Introduction: Pharmaceutical spending accounts for a significant portion of public healthcare budgets. To manage these costs, EU countries implement various cost-containment policies, including competitive tendering for pharmaceuticals. This study examines the impact of EU public procurement regulations on medication procurement practices. Methods: A search for all published tenders of adalimumab in Spain from 2018 to 2024 in the Spanish Public Sector Procurement Database, a period that coincides with the implementation of European legislation and the emergence of adalimumab biosimilars. All available documentation for each tender was reviewed, including the tender offer, technical specifications, specific administrative clauses, appointments of evaluation commissions, supporting memorandum, and evaluation reports. Results and Discussion: Our findings reveal substantial price reductions following the introduction of adalimumab biosimilars, yet highlight significant variability in tender criteria and practices across different regions. Despite adherence to EU directives, the inconsistent application of economic and non-economic factors and an erratic criteria concerning price undermine the intended balance of quality and cost, complicating procurement processes and potentially affecting the availability of a given treatment for patients.

Effects of public concerns on favorable attitudes to pandemic containment policies: a two-wave panel survey study in Hong Kong.

Regions worldwide experienced uncontrolled COVID-19 outbreaks at different times, leading to increased health concerns yet decreased support for stringent containment measures. We aimed to understand this contradiction by examining the factors influencing attitudes toward COVID-19 containment policies in Hong Kong. Using two waves of panel data collected before and after the 2022 major outbreak N = 1148), we determined that concerns over politicization and economic implications, rather than health concerns, led to a decline in favorable attitudes. The study also revealed that political stance moderated the effect of politicization but not economic concern. Based on these findings, we offer several suggestions for public health institutions to improve public favorability: Institutions should undertake sustained efforts to reduce the politicization of containment policies. Providing economic support measures and detailed explanations to the public can help mitigate concerns. Additionally, institutions should respond more promptly to the public's economic concerns during health crises.

Feline Encounters Down Under: Investigating the Activity of Cats and Native Wildlife at Sydney's North Head.

Cats (Felis catus) are widespread across Australia, including within natural and protected areas, and in many areas, cats, including owned domestic cats, are not restricted in where or when they can roam. In Australia, cats have contributed to the decline of many native species and continue to be a problem for governments. North Head, Manly, is home to an endangered population of Long-nosed Bandicoot (Perameles nasuta) and the only mainland breeding colony of Little Penguin (Eudyptula minor) in New South Wales (NSW). Camera traps were installed for a 5-week period across North Head to determine the spatial and temporal distribution of cat activity. As well as capturing instances of cats, the cameras detected native animals such as birds, possums, Long-nosed Bandicoots and other small mammals. An analysis of the camera images showed cats could be found within protected areas of the headland (where cats are prohibited) and along the boundary with the adjacent suburban area of Manly. Cats were mostly detected during the night. There were high occurrences of overlap between cats and Long-nosed Bandicoots (Dhat 0.82), possums (Dhat 0.88) and other small mammals (Dhat 0.67). These findings indicate that cats are active across the Manly headland at the same time as native animals, both within protected areas where cats are prohibited and in adjacent residential areas, and this could have implications for these populations.

Containment Measures and Alcohol Consumption Among Drinking Higher Education Students Before and During the COVID-19 Pandemic: A Multilevel Analysis in 25 Countries.

Hazardous alcohol use tends to be more prominent among higher education students. The COVID-19 pandemic severely altered student life, raising questions on its impact on students' alcohol use patterns. The current study examined cross-country variations in drinking behaviors (weekly drinking and binge drinking), and the extent to which these variations were associated with containment measures implemented during the first wave of the COVID-19 pandemic. Data were obtained from the COVID-19 International Student Well-being Study, covering students in 25 middle- and upper-high income countries. Data on government responses were retrieved from the Oxford COVID-19 Government Response Tracker. Multilevel multinomial logistic regression analyses were performed on weekly drinking (n = 44,212) and binge drinking (n = 32,785). Considerable cross-country variation existed for weekly drinking and binge drinking. In the majority of countries, a self-reported decrease in weekly drinking and a substantial self-reported decrease in binge drinking were observed. Closings of schools were associated with decreases in weekly drinking, while limitations on social gatherings were associated with increases in weekly drinking. The stringency index was associated with reporting decreased binge drinking. The study findings demonstrate a number of small yet significant associations between containment measures and changes in student drinking behaviors. Future studies are required to uncover why some students increased their alcohol consumption, particularly in countries with stricter limitations on social gatherings.

Effectiveness of probabilistic contact tracing in epidemic containment: The role of superspreaders and transmission path reconstruction.

The recent COVID-19 pandemic underscores the significance of early stage nonpharmacological intervention strategies. The widespread use of masks and the systematic implementation of contact tracing strategies provide a potentially equally effective and socially less impactful alternative to more conventional approaches, such as large-scale mobility restrictions. However, manual contact tracing faces strong limitations in accessing the network of contacts, and the scalability of currently implemented protocols for smartphone-based digital contact tracing becomes impractical during the rapid expansion phases of the outbreaks, due to the surge in exposure notifications and associated tests. A substantial improvement in digital contact tracing can be obtained through the integration of probabilistic techniques for risk assessment that can more effectively guide the allocation of diagnostic tests. In this study, we first quantitatively analyze the diagnostic and social costs associated with these containment measures based on contact tracing, employing three state-of-the-art models of SARS-CoV-2 spreading. Our results suggest that probabilistic techniques allow for more effective mitigation at a lower cost. Secondly, our findings reveal a remarkable efficacy of probabilistic contact-tracing techniques in performing backward and multistep tracing and capturing superspreading events.

Adaptive dynamic programming for containment control with robustness analysis to iterative error: A global Nash equilibrium solution.

Global Nash equilibrium is an optimal solution for each player in a graphical game. This paper proposes an iterative adaptive dynamic programming-based algorithm to solve the global Nash equilibrium solution for optimal containment control problem with robustness analysis to the iterative error. The containment control problem is transferred into the graphical game formulation. Sufficient conditions are given to decouple the Hamilton-Jacobi equations, which guarantee the solvability of the global Nash equilibrium solution. The iterative algorithm is designed to obtain the solution without any knowledge of system dynamics. Conditions of iterative error for global stability are given with rigorous proof. Compared with existing works, the design procedures of control gain and coupling strength are separated, which avoids trivial cases in the design procedure. The robustness analysis exactly quantifies the effect of the iterative error caused by various sources in engineering practice. The theoretical results are validated by two numerical examples with marginally stable and unstable dynamics of the leader.

Understanding the limits of binary diffusion for enhanced clay barrier design.

Waste containment and isolation strategies often utilize bentonite as a buffer material due to its swelling capacity, sealing efficiency, low permeability, and limited diffusive transport. However, previous experimental studies of ionic diffusion through bentonite have shown discrepancies with binary diffusion assumptions. Meticulous experiments and complementary analyses reveal that the migration of preexisting ions in the medium enables the differential flux of diffusing anions and cations, while maintaining local electroneutrality in all cases. The separation between the cationic and anionic fronts is electrically tied to the motion of the preexisting ions and reflects the interplay between valence, concentration, and self-diffusion coefficients of the ions involved. Imposing binary diffusion conditions forces the faster anions to diffuse at the same rate as cations. Therefore, effective barriers to mitigate both cation and anion transport should have low surface charge and low excess salts to minimize the preexisting ionic concentration.

A Modeling Study on the Effect of Interstate Mobility Restrictions on the SARS-CoV-2 Pandemic.

Mobility is a crucial element in comprehending the possible expansion of the transmission chain in an epidemic. In the initial phases, strategies for containing cases can be directly linked to population mobility restrictions, especially when only non-pharmaceutical measures are available. During the pandemic of COVID-19 in Brazil, mobility limitation measures were strongly opposed by a large portion of the population. Hypothetically, if the population had supported such measures, the sharp rise in the number of cases could have been suppressed. In this context, computational modeling offers systematic methods for analyzing scenarios about the development of the epidemiological situation taking into account specific conditions. In this study, we examine the impacts of interstate mobility in Brazil. To do so, we develop a metapopulational model that considers both intra and intercompartmental dynamics, utilizing graph theory. We use a parameter estimation technique that allows us to infer the effective reproduction number in each state and estimate the time-varying transmission rate. This makes it possible to investigate scenarios related to mobility and quantify the effect of people moving between states and how certain measures to limit movement might reduce the impact of the pandemic. Our results demonstrate a clear association between the number of cases and mobility, which is heightened when states are closer to each other. This serves as a proof of concept and shows how reducing mobility in more heavily trafficked areas can be more effective.

Cost-consequence analysis of computer vision-based skin prick tests: implications for cost containment in Switzerland.

BACKGROUND: Skin prick tests (SPTs), or intraepidermal tests, are often the first diagnostic approach for people with a suspected allergy. Together with the clinical history, SPTs allow doctors to draw conclusions on allergies based on the sensitization pattern. The purpose of this study is to investigate the potential cost consequences that would accrue to a Swiss University hospital after the adoption of computer vision-based SPTs. METHODS: We conducted a cost-consequence analysis from a hospital's perspective to evaluate the potential cost consequences of using a computer vision-based system to read SPT results. The patient population consisted of individuals who were referred to the allergology department of one of the five university hospitals in Switzerland, Inselspital, whose allergology department averages 100 SPTs a week. We developed an early cost-consequence model comparing two SPT techniques; computer vision-based SPTs conducted with the aid of Nexkin DSPT and standard fully manual SPTs. Probabilistic sensitivity analysis and additional univariate sensitivity analyses were used to account for uncertainty. RESULTS: The difference in average cost between the two alternatives from a hospital's perspective was estimated to be CHF 7 per SPT, in favour of the computer vison-based SPTs. Monte Carlo probabilistic simulation also indicated that SPTs conducted using the computer vision-based system were cost saving compared to standard fully manual SPTs. Sensitivity analyses additionally demonstrated the robustness of the base case result subject to plausible changes in all the input parameters, with parameters representing the costs associated with both SPT techniques having the largest influence on the incremental cost. However, higher sensitization prevalence rates seemed to favour the more accurate standard fully manual SPTs. CONCLUSION: Against the backdrop of rising healthcare costs especially in Switzerland, using computer-aided or (semi) automated diagnostic systems could play an important role in healthcare cost containment efforts. However, results should be taken with caution because of the uncertainty associated with the early nature of our analysis and the specific Swiss context adopted in this study.

Optimizing control efficiency in discrete-time multi-agent systems via event-triggered containment techniques combining disturbance handling and input delay management.

The goal of this paper is to mitigate disturbances and input delays while optimizing controller actuation updates for discrete-time multi-agent systems through the use of an event-triggered confinement control system, especially in resource-constrained scenarios. This approach when combined with event-triggered control techniques, then every follower in the system adjusts its condition at specified times based on an event-triggered condition that is suggested. The containment control system issue in the presence of disturbances and input delays was tackled by using both decentralized and centralized event-triggered control systems. Using matrix theory and the Lyapunov technique, convergence analysis is conducted to show that the proposed strategy stays free of zeno phenomena. Numerical boosts are used to further illustrate the impact of theoretical results.

Total intracorporeal robotic radical hysterectomy with vaginal cerclage without uterine manipulator: A nerve sparing tumor containment technique.

This surgical film describes the steps of a novel minimally invasive surgical technique for the treatment of early-stage cervical cancer that prioritizes tumor containment and minimizes tumor seeding. Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage and without uterine manipulator (TIRRHVC) is a C1 nerve sparing procedure that minimizes tumor seeding by eliminating the use of a uterine manipulator and maximizes tumor containment by placing circumferential sutures distal to the tumor, completely occluding it from the vagina. This surgical film demonstrates the relevant anatomy, dissection techniques and unique steps to accomplish a TIRRHVC, including the use of the robotic third arm for optimal traction and vaginal cerclage for complete circumferential occlusion of the cervical tumor.

Opening a 60-year time capsule: sequences of historical poliovirus cold variants shed a new light on a contemporary strain.

Polioviruses (PVs) are positive strand RNA viruses responsible for poliomyelitis. Many PVs have been isolated and phenotypically characterized in the 1940s-50s for the purpose of identifying attenuated strains that could be used as vaccine strains. Among these historical PVs, only few are genetically characterized. We report here the sequencing of four PV strains stored for more than 60 years in a sealed box. These PVs are cold variants that were selected by Albert Sabin based on their capacity to multiply at relatively low temperatures. Inoculation of permissive cells at 25°C showed that two of the four historical virus stocks still contained infectious particles. Both viruses reached titres that were higher at 25°C than at 37°C, thus demonstrating that they were genuine cold variants. We obtained sequences that span virtually all the genome for three out of the four strains; a short sequence that partly covers the 5' untranslated region was recovered for the last one. Unexpectedly, the genome of one historical cold variant (which derives from PV-3 Glenn) displayed a very high nucleotide identity (above 95%) with that of a PV strain (PV-3 strain WIV14) sampled in China in 2014 and then classified as a highly evolved vaccine-derived PV. Our analyses made this hypothesis very unlikely and strongly suggested that Glenn and WIV14 shared a very recent common ancestor with one another. Some strains used to produce the inactivated polio vaccine were also very close to Glenn and WIV14 in the capsid-encoding region, but they had not been sequenced beyond the capsid. We therefore sequenced one of these strains, Saukett A, which was available in our collection. Saukett A and WIV14 featured an identity higher than 99% at the nucleotide level. This work provides original data on cold variants that were produced and studied decades ago. It also highlights that sequences of historical PV strains could be crucial to reliably characterize contemporary PVs in case of release from a natural reservoir or from a facility, which is of highest importance for the PV eradication program.

An Investigation on the Relationship between Dust Emission and Air Flow as Well as Particle Size with a Novel Containment Two-Chamber Setup.

In the present study with a novel two-chamber setup (TCS) for dustiness investigations, the relationship between pressure differences as well as air velocities and the resulting dust emissions is investigated. The dust emissions of six particle size fractions of acetaminophen at pressure differences between 0 and 12 Pa are examined. The results show that both simulated and measured air velocities increase with increasing pressure difference. Dust emissions decrease significantly with increasing pressure difference and air velocity. Fine particles cause higher dust emissions than coarse particles. A high goodness of fit is obtained with exponential and quadratic functions to describe the relationship between pressure difference and dust emission, indicating that even moderate increases in pressure may lead to a reduction in the emission. Average air velocities within the TCS simulated with Computational Fluid Dynamics are between 0.09 and 0.37 m/s, whereas those measured experimentally are between 0.09 and 0.41 m/s, both ranges corresponding to the recommended values for effective particle separation in containment systems. These results underline the ability of the novel TCS to control pressure and airflow, which is essential for reliable dust emission measurements and thus provide support for further scientific and industrial applications.

High-income ZIP codes in New York City demonstrate higher case rates during off-peak COVID-19 waves.

Introduction: Our study explores how New York City (NYC) communities of various socioeconomic strata were uniquely impacted by the COVID-19 pandemic. Methods: New York City ZIP codes were stratified into three bins by median income: high-income, middle-income, and low-income. Case, hospitalization, and death rates obtained from NYCHealth were compared for the period between March 2020 and April 2022. Results: COVID-19 transmission rates among high-income populations during off-peak waves were higher than transmission rates among low-income populations. Hospitalization rates among low-income populations were higher during off-peak waves despite a lower transmission rate. Death rates during both off-peak and peak waves were higher for low-income ZIP codes. Discussion: This study presents evidence that while high-income areas had higher transmission rates during off-peak periods, low-income areas suffered greater adverse outcomes in terms of hospitalization and death rates. The importance of this study is that it focuses on the social inequalities that were amplified by the pandemic.

Adaptive fixed-time fuzzy containment control for uncertain nonlinear multiagent systems with unmeasurable states.

This paper addresses the adaptive fixed-time fuzzy containment control for uncertain nonlinear multiagent systems, where the states and nonlinear functions are not feasible for the controller design. To address the issue of unmeasurable states, a state observer is developed, and fuzzy logic systems are utilized to approximate unknown nonlinear functions. Under the framework of fixed-time Lyapunov function theory and cooperative control, an adaptive fixed-time fuzzy containment control protocol is derived via the adaptive backstepping and adding one power integrator method. The derived fixed-time containment controller can confirm that the closed-loop systems are practical fixed-time stable, which implies that all signals in the systems are bounded and all follower agents can converge to the convex hull formed by the leader agents within fixed-time in the presence of unmeasurable states and unknown nonlinear functions . Simulation examples are conducted to test the validity of the present control algorithm.

Quantifying Viable M. tuberculosis Safely Obviating the Need for High Containment Facilities.

Mycobacterium tuberculosis is an infectious pathogen that requires biosafety level-3 laboratory for handling. The risk of transmission is high to laboratory staff, and to manage the organism safely, it is necessary to construct high containment laboratory facilities at great expense. This limits the application of tuberculosis diagnostics to areas where there is insufficient capital to invest in laboratory infrastructure. In this method, we describe a process of inactivating sputum samples by either heat or guanidine thiocyanate (GTC) that renders them safe without affecting the quantification of viable bacteria. This method eliminates the need for level 3 containment laboratory for the tuberculosis molecular bacterial load assay (TB-MBLA) and is applicable in low- and middle-income countries.

Feasibility and early oncologic outcomes of Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC) for the treatment of clinical stage IB cervical cancer: A tumor containment technique.

Introduction: Minimally invasive radical hysterectomy (MIRH) has been reported to have a four-fold increase in recurrence compared to open radical hysterectomy (ORH) for the treatment of early-stage cervical cancer. The cause for the inferior outcomes with MIRH is unclear. However, the use of a uterine manipulator and the lack of tumor containment strategies may contribute to tumor seeding in previous MIRH approaches. Objective: Determine the feasibility and early oncologic outcomes of a novel robotic-assisted surgical technique for the treatment of early-stage cervical cancer, Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC). Methods: Retrospective cohort study. Results: Twenty-six patients between 2018 and 2022 underwent the TIRRHVC procedure after being counseled on the risks and benefits of ORH and TIRRHVC; these 26 patients' demographics, clinical, surgical, and oncologic outcomes were reviewed retrospectively. Seventeen patients (65.4 %) had clinical stage IB1 and 9 (34.6 %) were IB2 cervical cancer according to FIGO 2018 guidelines. Following hysterectomy and lymphadenectomy, 4 patients were upstaged. The average pathologic tumor size was 2.66 cm (0 cm - 5.6 cm); 65 % of tumors were > 2 cm. There were no intraoperative complications. There were 13 postoperative complications, including 10 urinary tract infections. Eleven patients (42.3 %) received adjuvant therapy. The average follow-up period was 2.8 years (IQR 2.3-3.6). Only one patient has recurred at 3.6 years. One patient expired from causes unrelated to gynecologic cancer. The 3-year disease free survival is 95.5 %. Conclusion: These promising early oncologic outcomes are encouraging that TIRRHVC may be a treatment option that offers the benefits of minimally invasive surgery without compromising oncologic outcomes.