Preservation of Microalgae, Lignocellulosic Biomass Blends by Ensiling to Enable Consistent Year-Round Feedstock Supply for Thermochemical Conversion to Biofuels.

Seasonal variation in microalgae productivity is a significant barrier to economical production of algae biofuels and chemicals. Summer production can be 3-5 times higher than in the winter resulting in uneven feedstock supplies at algae biorefineries. A portion of the summer production must be preserved for conversion in the winter in order to maintain a biorefinery running at capacity. Ensiling, a preservation process that utilizes lactic acid fermentation to limit microbial degradation, has been demonstrated to successfully stabilize algae biomass (20% solids) and algae-lignocellulosic blends (40% algae-60% lignocellulosic biomass, dry basis) for over 6 months, resulting in fuel production cost savings with fewer emissions. Preservation of algae as blends could be beneficial to biorefineries that utilize thermochemical approaches to fuel production as co-processing of algae and lignocellulosic biomass has been observed to enhance biocrude yield and improve oil quality. This study conducts a resource assessment of biomass residues in the southern United States to identify materials available during peak algae productivity and in sufficient quantity to meet the algae storage needs of an algae biofuel industry. Eight feedstocks met the quantity threshold but only three, distillers grains, haylage, and yard waste, were also available in season. Storage experiments utilizing both freshwater and marine strains of microalgae - Scenedesmus acutus, Chlorella vulgaris, Chlorella zofingiensis, Nannochloropsis gaditana, and Porphyridium purpureum - and yard waste were conducted for 30 days. Storage losses were less than 10% in all but one case, and the pH of all but one blend was reduced to less than 4.7, indicating that yard waste is a suitable feedstock for blending with algae prior to storage. To better understand whether the benefits to conversion realized by processing blends might be affected by storage, elemental analysis and bomb calorimetry of pre- and post-storage algae-yard waste blends were conducted to characterize changes occurring during storage. Storing algae biomass as blends with lignocellulosic biomass could be an effective method of mitigating seasonal variability in algae biomass production while retaining the synergistic effect of co-processing algae blends in thermochemical conversion.

Trends and Risk Factors in Orthopedic Lawsuits: Analysis of a National Legal Database.

Orthopedic surgeons frequently encounter medical malpractice claims. The purpose of this study was to assess trends and risk factors in lawsuits brought against orthopedic surgeons using a national legal database. A legal research service was used to search publicly available settlement and verdict reports between 1988 and 2013 by terms "orthopaedic or orthopedic" and "malpractice." Temporal trends were evaluated, and logistic regression was used to identify independent risk factors for case outcomes. A total of 1562 publicly reported malpractice cases brought against orthopedic surgeons, proceeding to trial during a 26-year period, were analyzed. The plaintiffs won 462 (30%) cases, with a mean award of $1.4 million. The frequency of litigation and pay-outs for plaintiffs increased 215% and 280%, respectively, between the first and last 5-year periods. The mean payout for plaintiff-favorable verdicts was highest in pediatrics ($2.6 million), followed by spine ($1.7 million) and oncology ($1.6 million). Fracture fixation (363 cases), arthroplasty (290 cases), and spine (231 cases) were the most commonly litigated procedures, while plaintiffs were most successful for fasciotomy (48%), infection-treating procedures (43%), and carpal tunnel release (37%). When analyzing data by state and region, adjusted for population, northeastern states had a higher frequency of lawsuits. Malpractice liability has increased during the past 3 decades while orthopedic surgeons continue to win most of the cases making it to court. As patients search for medical care via publicly available information, it is important for orthopedic surgeons to understand what aspects of their own practice carry different risks of litigation. [Orthopedics. 2019; 42(2):e260-e267.].

Metabolic syndrome and shoulder arthroplasty: epidemiology and peri-operative outcomes.

PURPOSE: Little is known about metabolic syndrome in the peri-operative shoulder surgery setting. We sought to determine the prevalence of metabolic syndrome in patients undergoing shoulder arthroplasty, and to characterize its relationship with in-hospital adverse events, prolonged length of stay, and non-routine disposition. METHODS: Using discharge records from the 2002-2011 Nationwide Inpatient Sample, temporal trends were assessed and multivariable logistic regression modeling was used to measure the association of metabolic syndrome with peri-operative outcomes. RESULTS: The prevalence of metabolic syndrome increased by 257 % from 2002 to 2011 (4.2 to 15.0 %). Metabolic syndrome was associated with increased aggregate morbidity (OR 1.34, 95 % CI 1.30-1.38), including acute renal failure (OR 1.51, 95 % CI 1.41-1.63), surgical site infection (OR 1.41, 95 % CI 1.16-1.71), myocardial infarction (OR 1.32, 95 % CI 1.12-1.55), acute posthemorrhagic anemia (OR 1.30, 95 % CI 1.26-1.34), and pulmonary embolism (OR 1.27, 95 % CI 1.06-1.52). It was also associated with prolonged hospital stay (OR 1.13, 95 % CI 1.10-1.16), non-homebound discharge (OR 1.29, 95 % CI 1.26-1.32), and increased blood transfusion use (OR 1.09, 95 % CI 1.06-1.13). CONCLUSIONS: Metabolic syndrome is increasing rapidly among shoulder arthroplasty patients and is associated with considerable peri-operative morbidity and resource utilization. Greater awareness of metabolic syndrome and its health consequences may contribute to improvements in the peri-operative management of shoulder arthroplasty patients.