Universal logic with encoded spin qubits in silicon.

Quantum computation features known examples of hardware acceleration for certain problems, but is challenging to realize because of its susceptibility to small errors from noise or imperfect control. The principles of fault tolerance may enable computational acceleration with imperfect hardware, but they place strict requirements on the character and correlation of errors1. For many qubit technologies2-21, some challenges to achieving fault tolerance can be traced to correlated errors arising from the need to control qubits by injecting microwave energy matching qubit resonances. Here we demonstrate an alternative approach to quantum computation that uses energy-degenerate encoded qubit states controlled by nearest-neighbour contact interactions that partially swap the spin states of electrons with those of their neighbours. Calibrated sequences of such partial swaps, implemented using only voltage pulses, allow universal quantum control while bypassing microwave-associated correlated error sources1,22-28. We use an array of six 28Si/SiGe quantum dots, built using a platform that is capable of extending in two dimensions following processes used in conventional microelectronics29. We quantify the operational fidelity of universal control of two encoded qubits using interleaved randomized benchmarking30, finding a fidelity of 96.3% ± 0.7% for encoded controlled NOT operations and 99.3% ± 0.5% for encoded SWAP. The quantum coherence offered by enriched silicon5-9,16,18,20,22,27,29,31-37, the all-electrical and low-crosstalk-control of partial swap operations1,22-28 and the configurable insensitivity of our encoding to certain error sources28,33,34,38 all combine to offer a strong pathway towards scalable fault tolerance and computational advantage.

Single fibre enables acoustic fabrics via nanometre-scale vibrations.

Fabrics, by virtue of their composition and structure, have traditionally been used as acoustic absorbers1,2. Here, inspired by the auditory system3, we introduce a fabric that operates as a sensitive audible microphone while retaining the traditional qualities of fabrics, such as machine washability and draping. The fabric medium is composed of high-Young's modulus textile yarns in the weft of a cotton warp, converting tenuous 10-7-atmosphere pressure waves at audible frequencies into lower-order mechanical vibration modes. Woven into the fabric is a thermally drawn composite piezoelectric fibre that conforms to the fabric and converts the mechanical vibrations into electrical signals. Key to the fibre sensitivity is an elastomeric cladding that concentrates the mechanical stress in a piezocomposite layer with a high piezoelectric charge coefficient of approximately 46 picocoulombs per newton, a result of the thermal drawing process. Concurrent measurements of electric output and spatial vibration patterns in response to audible acoustic excitation reveal that fabric vibrational modes with nanometre amplitude displacement are the source of the electrical output of the fibre. With the fibre subsuming less than 0.1% of the fabric by volume, a single fibre draw enables tens of square metres of fabric microphone. Three different applications exemplify the usefulness of this study: a woven shirt with dual acoustic fibres measures the precise direction of an acoustic impulse, bidirectional communications are established between two fabrics working as sound emitters and receivers, and a shirt auscultates cardiac sound signals.

Prostate biopsy sepsis prevention: external validation of an alcohol needle washing protocol.

PURPOSE: Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is associated with a 1-8% risk of post-biopsy sepsis (PBS). A recent study described an isopropyl alcohol needle washing protocol that significantly decreased PBS rates. The current study examined the efficacy of this technique in our clinic population. MATERIALS AND METHODS: Data were reviewed for 1250 consecutive patients undergoing TRUS-Bx at the Charlie Norwood VA Medical Center from January 2017 to January 2023. Needle washing was adopted in February 2021. Complications occurring within 30 days after TRUS-Bx were recorded. RESULTS: There were 912 patients in group 1 (without needle washing) and 338 in group 2 (with needle washing). Groups had equivalent demographic features, and men of African descent comprised 70% of patients. Standard 12 core biopsies were done in 83% and 82% in groups 1 and 2, respectively (p = 0.788). Total complication rates were 4% and 2% in groups 1 and 2, respectively (p = 0.077). There were 13 sepsis events in group 1 (1.4%) and none in group 2 (p = 0.027). Clavien-Dindo Grade I-III complications occurred in 25 (2.7%) and 7 (2.1%) patients in groups 1 and 2, respectively (p = 0.505). Standard antibiotic prophylaxis (PO fluoroquinolone and IM gentamicin) was given in 80% and 86% of patients in groups 1 and 2, respectively (p = 0.030). Subset analysis limited to patients who received standard prophylaxis showed a significant difference in sepsis rates (1.5% vs 0%; p = 0.036). CONCLUSIONS: Adoption of isopropyl alcohol needle washing was associated with a significant decrease in PBS events.

Association Between Preoperative Anemia and Cognitive Function in a Large Cohort Study of Older Patients Undergoing Elective Surgery.

BACKGROUND: The etiology of anemia has tremendous overlap with the disease states responsible for cognitive decline. We used data from a perioperative database of older adults undergoing elective surgery with anesthesia to (1) examine relationships among preoperative anemia blood markers, preoperative screeners of cognitive function, and chronic disease status; and (2) examine the relationship of these factors with operative outcomes. The primary goal of this study was to investigate the association between preoperative anemia blood markers and cognition measured by a preoperative cognitive screener. Secondary goals were to (1) examine the relationship between preoperative anemia blood markers and chronic disease states (ie, American Society of Anesthesiologists [ASA] and frailty), and (2) investigate the relationship of preoperative anemia blood markers and cognition with operative outcomes (ie, discharge disposition, 1-year mortality, number of surgical complications, length of hospital stay, and length of intensive care unit [ICU] stay). METHODS: Data were collected at the University of Florida Health Shands Presurgical Center and the Perioperative Cognitive Anesthesia Network clinic within the electronic medical record. Patients 65 years of age or older were included if they had a preoperative hemoglobin (Hgb) value and a preoperative screening. Nonparametric methods were used for bivariate analysis. Logistic regression was used for the simultaneous examination of variables associated with nonhome discharge and 1-year mortality. Primary outcomes were discharge disposition and 1-year mortality. Secondary outcomes were number of surgical complications and length of hospital and ICU stay. RESULTS: Of 14,795 patients cognitively assessed, 8643 met the inclusion criteria. Of these, 26.7% were anemic, with 16.8%, 9.5%, and 0.4% having mild, moderate, and severe anemia, respectively. The Spearman correlation coefficient [95% confidence interval, CI] between the Hgb level and the clock drawing time (CDT) was -.15 [-.17 to -.13] (P < .0001) indicating that a lower Hgb level was associated with cognitive vulnerability. Hgb was also negatively correlated with the ASA physical status classification, patient Fried Frailty Index, and hospital and ICU length of stay. In the multivariable model, age, surgical service, ASA and Fried Frailty Index significantly predicted nonhome discharge. Furthermore, age, surgical service, ASA, Fried Frailty Index, and Hgb independently predicted death within 1 year of surgery. The odds of death, adjusted for ASA, Fried Frailty, and covariates, were 2.7 times higher for those in the mild anemic group compared to those who were not anemic (odds ratio [OR], 2.7, 95% CI, [2.1-3.5]). The odds of death, adjusted for ASA, Fried Frailty, and covariates, were 3.6 times higher for those in the moderate/severe anemic group compared to those who were not anemic (OR, 3.6, 95% CI, [2.7-4.9]). CONCLUSIONS: In this first medicine study, we established relationships among anemia, preoperative markers of frailty and cognition, and chronic disease states in a large cohort of older patients undergoing elective surgery in a large tertiary medical center. We found that anemia, cognitive vulnerability, and chronic health disease states predicted death within 1 year of surgery, and that these preoperative factors negatively contribute to surgical outcomes such as time in the ICU, length of hospital stay, nonhome discharge, and 1-year mortality. The World Health Organization (WHO) and many academic medical societies have urged the adoption of patient blood management (PBM) disciplines, yet anemia is not routinely optimized as a preoperative risk factor. Given the well-defined association between preoperative anemia and postoperative morbidity and mortality, performing elective surgery on an untreated anemic patient should be considered substandard care. With established safe and effective treatment regimens, iron deficiency anemia is a modifiable preoperative risk factor that should be addressed before elective surgery.

Family Caregiver Comfort with Telehealth Technologies: Differences by Race and Ethnicity in a Cross-Sectional Survey.

Background: Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. Methods: A secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. Results: A total of 340 caregivers were included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.36, 8.02; p = 0.01) of expressing comfort using computers; black caregivers (OR 0.46; 95% CI 0.21, 0.98; p = 0.04) and Hispanic caregivers (OR 0.36; 95% CI 0.17, 0.79; p = 0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64; 95% CI 2.05, 11.69; p = 0.001) of expressing comfort using tablets. Conclusion and Implications: There are identified disparities in the level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies, culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.

Communicating visit information to family caregivers: How does method matter? A national survey.

OBJECTIVES: The clinic visit is a critical point of contact for family caregivers. However, only 37% of family caregivers are able to accompany patients to visits. When they cannot attend, caregivers receive visit information to assist with their caregiving. However, little is known about how method of receiving information from clinic visits is associated with important caregiver outcomes. This study sought to determine whether mode of receiving clinic visit information (speaking with the patient, attending the visit, or using an after-visit summary [AVS]) was associated with changes in caregiver burden, caregiver preparedness, and the positive aspects of caregiving. METHODS: Cross-sectional web-based survey of a national sample of adult family caregivers. Multiple linear regression models determined associations between communication modes and caregivers' burden, preparedness, and positive aspects of caregiving, adjusting for sociodemographic covariates. RESULTS: Respondents (N = 340) were mostly male (58%), White (59%), ranged from 18 to 85 years old, and supported patients with conditions including diabetes, dementia, and cancer. Speaking with patients was associated with increases in positive aspects of caregiving (95% CI = 2.01, 5.42) and an AVS was associated with increases in positive aspects of caregiving (95% CI = 0.4, 3.56) and preparedness for caregiving (95% CI = 0.61, 3.15). Using any method of receiving information from visits was associated with the greatest increase in preparedness, compared to not receiving visit information. We did not observe an association between method of communication and caregiver burden. SIGNIFICANCE OF RESULTS: Method of communicating visit information is associated with improvements in caregiver preparedness and the positive aspects of caregiving, though caregiver burden may be unaffected by information exchange. Given the limitations of current communication methods, future work should explore directionality of the associations we found and identify visit communication strategies with caregivers that optimize caregiver and patient outcomes.

Successful living donor liver transplantation in a patient with hemophilia A and factor VIII inhibitor: A case report with perioperative recommendations.

Liver transplantation in patients with end-stage liver disease and coexisting hemophilia A has been described. Controversy exists over perioperative management of patients with factor VIII inhibitor predisposing patients to hemorrhage. We describe the case of a 58-year-old man with a history of hemophilia A and factor VIII inhibitor, eradicated with rituximab prior to living donor liver transplantation without recurrence of inhibitor. We also provide perioperative management recommendations from our successful multidisciplinary approach.

Family caregiver roles and challenges in assisting patients with cancer treatment decision-making: Analysis of data from a national survey.

BACKGROUND: We aimed to describe the roles and challenges of family caregivers involved in patients' cancer treatment decision-making. METHODS: Family caregiver-reported data were analyzed from a national survey conducted in the United States by CancerCare® (2/2021-7/2021). Four select-all-that-apply caregiver roles were explored: (1) observer (patient as primary decision-maker); (2) primary decision-maker; (3) shared decision-maker with patient and (4) decision delegated to healthcare team. Roles were compared across five treatment decisions: where to get treatment, the treatment plan, second opinions, beginning treatment and stopping treatment. Ten challenges faced by caregivers (e.g., information, cost, treatment understanding) were then examined. χ2 and regression analyses were used to assess associations between roles, decision areas, challenges and caregiver sociodemographics. RESULTS: Of 2703 caregiver respondents, 87.6% reported involvement in patient decisions about cancer treatment, including 1661 who responded to a subsection further detailing their roles and challenges with specific treatment decisions. Amongst these 1661 caregivers, 22.2% reported an observing role, 21.3% a primary decision-making role, 53.9% a shared decision-making role and 18.1% a role delegating decisions to the healthcare team. Most caregivers (60.4%) faced ≥1 challenge, the most frequent being not knowing how treatments would affect the patient's physical condition (24.8%) and quality of life (23.2%). In multivariable models, being Hispanic/Latino/a was the strongest predictor of facing at least one challenge (b = -0.581, Wald = 10.69, p < .01). CONCLUSIONS: Most caregivers were involved in patients' cancer treatment decisions. The major challenge was not understanding how treatments would impact patients' physical health and quality of life. Challenges may be more commonly faced by Hispanic/Latino/a caregivers. PATIENT OR PUBLIC CONTRIBUTION: The CancerCare® survey was developed in partnership with caregiving services and research experts to describe the role of cancer family caregivers in patient decision-making and assess their needs for support. All survey items were reviewed by a CancerCare advisory board that included five professional patient advocates and piloted by a CancerCare social worker and other staff who provide counselling to cancer caregivers.

Clinical Outcomes of Surgical Repair for Partial Distal Biceps Tendon Tears.

PURPOSE: The purpose of this study was to describe the outcomes of patients treated with surgical repair of partial tears of the distal biceps tendon. METHODS: The study was a retrospective review of repairs of partial tears of the distal biceps tendon performed by multiple surgeons from January 1, 2015 to October 15, 2020. Inclusion criteria consisted of preoperative magnetic resonance imaging indicative of distal biceps pathology without a complete tear and surgical treatment with intraoperative confirmation of a partial tear. The presence of preceding trauma, duration of symptoms, and postoperative complications were documented. Patients were contacted for outcome assessment using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Reported Elbow Evaluation outcome measures. Clinical outcomes were obtained from 56 of 74 (76%) eligible patients with an average follow-up of 46 months (range: 15-85 months). RESULTS: After surgery, the median QuickDASH was 2.3 (interquartile range, 0-9.7), and the median Patient-Reported Elbow Evaluation score was 1 (interquartile range, 0-12). Postoperative QuickDASH scores were significantly lower than the preoperative scores. Known traumas preceding the symptoms and duration of symptoms before surgery were not significantly associated with the outcome. Of all eligible patients, 30 complications were reported in 25 (34%) patients and included 2 reruptures, 2 cases of heterotopic ossification, 1 deep infection, 1 case of implant irritation, 21 neuropraxias, and 3 hematomas. Five (7%) patients underwent 6 reoperations including 1 revision for a rerupture, 1 irrigation and debridement, 2 heterotopic ossification excisions, 1 hematoma evacuation, and 1 implant removal. CONCLUSIONS: The results suggest that the repair of partial distal biceps tendon tears is a viable treatment option with significant improvement in QuickDASH. There was no significant relationship between the postoperative outcome and duration of symptoms or known traumas preceding the symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Biomechanical Evaluation of 2 Common Approaches for Total Elbow Arthroplasty: Triceps Tongue Compared With Triceps Reflecting.

PURPOSE: We hypothesize that the triceps tongue approach will be equivalent in strength to the triceps reflecting approach in load to failure following a cyclic preload. METHODS: Seven paired fresh-frozen cadaveric arms were dissected using the triceps reflecting approach or triceps tongue approach to the posterior elbow. The triceps was then repaired in each specimen, and the elbows were placed in a testing jig. Elbows were preloaded in a cyclic fashion at 5 lbs (2.3 kgf) for 200 cycles in flexion/extension, followed by load to failure. The stiffness and ultimate failure strength for each specimen were determined. We defined ultimate failure as gapping in the suture construct of 4 mm or suture breakage. RESULTS: One of the triceps tongue specimens was excluded due to a testing error, resulting in 6 elbows in this group. There were no tendon repair failures during the cyclic preload. The median ultimate failure of the reflecting group occurred at 65 pounds, compared to 115 pounds in the tongue group. This was significantly different. The reflecting approach consistently failed along the entire bone-tendon interface. The tongue approach failed at the proximal repair site in 4 of 6 specimens, while the longitudinal aspect of the tendon repair remained intact. CONCLUSIONS: Following a cyclic preload of 5 lbs for 200 cycles, the triceps tongue repair is stronger than triceps reflecting in ultimate failure. The mode of failure of triceps tongue repair may be superior to that of triceps reflecting. CLINICAL RELEVANCE: This study may help guide surgeons when choosing a "triceps off" approach to total elbow arthroplasty.

Short-Term Patient Outcomes after Placement of an Internal Joint Stabilizer for Terrible Triad Injuries: A Multicenter Study.

PURPOSE: The purpose of this study was to assess the functional and patient-reported outcomes after the use of the internal joint stabilizer (IJS) for unstable terrible triad injuries. Specifically, we sought to determine our complication rate and the impact of complications on patient outcomes. METHODS: We identified all patients who had an IJS placed as a supplemental fixation for a terrible triad injury at two urban, level 1 academic medical centers. We reviewed these patients' charts for demographic information, complication profiles, postoperative range of motion (ROM), and pain-level data. We also collected the QuickDASH and Patient-Rated Elbow Evaluation (PREE) scores. Descriptive statistics were reported. Final visit data were compared between patients who returned to the OR for a complication and those who did not. RESULTS: From 2018 to 2020, 29 patients had an IJS placed for a terrible triad injury. The median final follow-up was 6.3 months after surgery (IQR: 6.2 months). There were 38 complications in 19 patients (65.5%) that required 12 patients to return to the OR (41.3%) for procedures beyond simple IJS removal. There were no significant differences in the ROM between patients who returned to the OR for a complication and those who did not. QuickDASH and PREE scores were greater (indicating more disability) in patients who had a complication that required a secondary surgical procedure. CONCLUSIONS: Patients who receive an IJS incur a high rate of complications. When patients sustain complications that require secondary surgeries, their ultimate functional outcome scores worsen. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Using a Contemporary Portable Metabolic Gas Exchange System for Assessing Energy Expenditure: A Validity and Reliability Study.

There are several methods available to assess energy expenditure, all associated with inherent pros and cons that must be adequately considered for use in specific environments and populations. A requirement of all methods is that they must be valid and reliable in their capability to accurately measure oxygen consumption (VO2) and carbon dioxide production (VCO2). The purpose of this study was to evaluate the reliability and validity of the mobile CO2/O2 Breath and Respiration Analyzer (COBRA) relative to a criterion system (Parvomedics TrueOne 2400®, PARVO) with additional measurements to compare the COBRA to a portable system (Vyaire Medical, Oxycon Mobile®, OXY). Fourteen volunteers with a mean of 24 years old, body weight of 76 kg, and a VO2peak of 3.8 L∙min-1 performed four repeated trials of progressive exercises. Simultaneous steady-state measurements of VO2, VCO2, and minute ventilation (VE) by the COBRA/PARVO and OXY systems were conducted at rest, while walking (23-36% VO2peak), jogging (49-67% VO2peak), and running (60-76% VO2peak). Data collection was randomized by the order of system tested (COBRA/PARVO and OXY) and was standardized to maintain work intensity (rest to run) progression across study trials and days (two trials/day over two days). Systematic bias was examined to assess the accuracy of the COBRA to PARVO and OXY to PARVO across work intensities. Intra- and inter-unit variability were assessed with interclass correlation coefficients (ICC) and a 95% limit of agreement intervals. The COBRA and PARVO produced similar measures for VO2 (Bias ± SD, 0.01 ± 0.13 L·min-1; 95% LoA, (-0.24, 0.27 L·min-1); R2 = 0.982), VCO2 (0.06 ± 0.13 L·min-1; (-0.19, 0.31 L·min-1); R2 = 0.982), VE (2.07 ± 2.76 L·min-1; (-3.35, 7.49 L·min-1); R2 = 0.991) across work intensities. There was a linear bias across both the COBRA and OXY with increased work intensity. The coefficient of variation for the COBRA ranged from 7 to 9% across measures for VO2, VCO2, and VE. COBRA was reliable across measurements for VO2 (ICC = 0.825; 0.951), VCO2 (ICC = 0.785; 0.876), and VE (ICC = 0.857; 0.945) for intra-unit reliability, respectively. The COBRA is an accurate and reliable mobile system for measuring gas exchange at rest and across a range of work intensities.

Modulation of red blood cell oxygen affinity with a novel allosteric modifier of hemoglobin is additive to the Bohr effect.

PURPOSE: The Bohr effect describes hemoglobin's affinity for oxygen dependent on solution pH. Within pH range 6.0-8.5, hemoglobin's oxygen affinity decreases with decreasing pH. This results in increased oxygen delivery to metabolically active, acidic tissues and improved oxygen uptake in basic regions including lung tissue. Myo-Inositol tripyrophosphate (ITPP) translocates the erythrocyte membrane and allosterically modifies hemoglobin (Hb). We tested the hypothesis that ITPP does not abrogate the Bohr effect. METHODS: Experiments were conducted to determine the effect of increasing concentrations of ITPP on P50 with varying pH. We incubated 10 mL red blood cells at 37 °C for 1 h with ITPP concentrations from 0 to 240 mM. The Clark oxygen electrode (Hemox-Analyzer; TCS Scientific, New Hope, PA) determined oxygen affinity of each sample, in triplicate, using buffers pH 6.8, 7.4, and 7.6. A mixed linear regression model with fixed effects for ITPP concentration and pH was used. RESULTS: Increasing ITPP concentration and decreasing pH increased P50 (p < 0.0001 for ITPP concentration, p < 0.0001 for pH). ITPP modulated increased P50 in normal pH (7.4) and acidic condition pH (6.8); with no effect at alkaline pH (7.6). CONCLUSION: The Bohr effect is conserved, with ITPP augmenting the decreased oxygen affinity seen with tissue acidosis, while not affecting oxygen affinity in conditions similar to a pulmonary microenvironment.

Internal joint stabilizer for varus posteromedial rotatory instability of the elbow.

BACKGROUND: Management of varus posteromedial rotatory instability (VPMRI) of the elbow presents a challenging problem, sometimes requiring supplemental external fixation or ulnohumeral cross-pinning. A relatively new treatment adjunct for posterolateral rotatory instability of the elbow has become available with the development of the internal joint stabilizer (IJS) implant. However, this has not been studied for VPMRI because the implant is thought to be ineffective at treating this instability when placed in the usual manner on the lateral side of the elbow. We hypothesize that modifying the IJS technique to place the implant medially will make it as effective as external fixation at preventing VPMRI. METHODS: Nine whole-arm cadaveric specimens were tested on a rig that allowed for gravity stress of the elbow at 60° of abduction. Intact specimens (INT) were tested to find the baseline stability with all structures intact. Then, O'Driscoll type 2-subtype III coronoid fractures were created with a microsagittal saw, and these same specimens were again tested without any fixation (WAF), with a static lateral external fixator (SLEF), and with a medially placed IJS (MIJS). The method for medial IJS placement is detailed within. RESULTS: The WAF specimens were significantly more unstable than the INT, SLEF, and MIJS groups (P < .001). There was no difference in stability between the INT and the SLEF (P = .59) or MIJS group (P = .21). CONCLUSION: In this cadaveric model, a medially placed IJS was as effective as an SLEF at maintaining elbow stability in a coronoid-deficient elbow. This technique allows for early elbow range of motion, with no external hardware, and may eliminate the complications associated with external fixation or ulnohumeral cross-pinning.

Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis.

BACKGROUND: Limited data are available on the efficacy of cortisone injections for glenohumeral osteoarthritis (GHOA). The amount and longevity of pain relief provided by a single cortisone injection are unclear. Additionally, it remains uncertain how the severity of radiographic GHOA and patient-reported function and pain levels impact the efficacy of an injection. Therefore, we sought to describe the relief provided by a single, image-guided glenohumeral injection in patients with GHOA. We hypothesized that patients with more severe radiographic GHOA and poorer baseline shoulder function would require earlier secondary intervention. METHODS: Patients with symptomatic GHOA who elected to receive a corticosteroid injection for pain relief were prospectively enrolled. A phone interview was conducted to record the baseline Oxford Shoulder Score (OSS) and visual analog scale (VAS) score prior to the injection, as well as the OSS and VAS score at months 1, 2, 3, 4, 6, 9, and 12 after the injection. The endpoint of the study occurred when patients required a second injection, progressed to surgery, or reached month 12. Patients were grouped by their respective baseline OSS (mild vs. moderate or severe) and Samilson-Prieto radiographic classification (mild, moderate, or severe) for analysis. RESULTS: We analyzed 30 shoulders (29 patients). Of the patients, 52% were men. The average age was 66.1 years. No significant difference in overall survival (defined as no additional intervention) was seen between groups based on either the OSS or Samilson-Prieto grade. Additionally, the OSS and VAS score at each follow-up were compared with baseline values. For the entire cohort, a clinically significant difference was seen between baseline and months 1-4 for the OSS and between baseline and months 1-4, 6, 9, and 12 for the VAS score. DISCUSSION: This study aimed to determine the efficacy of corticosteroid injections for GHOA. There were no differences in the need for secondary intervention in this population based on the severity of either the OSS or the Samilson-Prieto radiographic classification. However, patients with more severe shoulder dysfunction based on the OSS did experience statistically significantly greater symptomatic relief than patients with milder dysfunction. Additionally, following a single injection, patients in this cohort experienced statistically and clinically relevant improvements in shoulder function and pain up to 4 months after injection.

Rejuvenation solution as an adjunct cold storage solution maintains physiological haemoglobin oxygen affinity during early-storage period of red blood cells.

BACKGROUND: Red blood cell (RBC) units accumulate morphologic and metabolic lesions during storage before transfusion. Pyruvate-inosine-phosphate-adenine (PIPA) solutions (Rejuvesol, Biomet, Warsaw, IN) can be incubated with RBC units to mitigate storage lesions. This study proposes a PIPA treatment process, termed cold 'rejuvenation', using Rejuvesol as an adjunct additive solution, to prevent biomechanical storage lesions while avoiding the 1 h PIPA incubation required with standard PIPA treatment. We compared the efficacy of cold to standard 'rejuvenation' in improving metabolic lesions that occur during cold storage of RBCs, without altering function. METHODS: Twelve leucoreduced, A-positive RBC units were obtained. Each unit was aliquoted into either control (standard storage), washed (W), standard rejuvenation (SR) or cold rejuvenation (CR) groups, the latter two requiring washing. A volume-adjusted dose of Rejuvesol was instilled into the CR group upon receipt (Day 3). After 15 days of storage, p50, RBC deformability, in-bag haemolysis and mechanical fragility were analysed. 'Any treatment' is defined as W, SR and CR, with comparisons in reference to control. RESULTS: Higher p50s were seen in rejuvenated groups (>30 mmHg vs. <19 mmHg; P < 0·0001). Any treatment significantly increased elongation index (P = 0·034) but did not significantly increase in-bag haemolysis (P = 0·062). Mechanical fragility was not significantly different between groups (P = 0·055) at baseline, but the control (CTL) group was more fragile after 2 h in a cardiac bypass simulation than any treatment (P < 0·0001). CONCLUSIONS: This study demonstrates that rejuvenation (standard or cold) prevents the leftward p50 shift of storage lesions without detrimental effect on RBC deformity, in-bag haemolysis or mechanical fragility.

How challenges and peers contribute to social-emotional learning in outdoor adventure education programs.

INTRODUCTION: Many youth development programs view adolescents' process of grappling with challenges as a major driver of social-emotional learning. Our goal was to understand these processes as experienced and enacted by youth. We focused on the program Outward Bound in the United States because its students experience significant physical and social challenges and it has well-developed staff practices for facilitating learning from challenges. METHODS: Group interviews were conducted with 32 youth (ages 14-18; 50% female), immediately following their completion of Outward Bound expedition courses. Students were asked to provide a detailed narrative account of an episode on course in which they learned from challenges. Grounded theory analyses identified three processes that contributed to learning. RESULTS: First, students, described developing skills for persistence through successfully enduring distress and a process of experimenting with new mindsets that helped them rise above their anxiety and distress. Second, we found that peers provided skillful and responsive on-the-spot support that motivated youth, helped them succeed, and scaffolded students' learning strategies for dealing with physical, social, and emotional challenges. Third, we found that this peer support and scaffolding was animated by a culture of compassion and mutual commitment, which was cultivated by staff and embraced by youth. CONCLUSIONS: These findings from Outward Bound illuminate a learning model that may be useful to other youth programs. This model combines intense challenges with attuned peer support for adolescents' active processes of addressing and learning from challenges. We highlight program structures and staff practices that support these processes.

Interval decline in hemoglobin A is associated with annual clinical event rate in sickle cell anemia patients receiving maintenance apheresis RBC exchange.

BACKGROUND: Apheresis red blood cell (RBC) exchange (RCE) is a standard intervention for patients with sickle cell anemia (SCA) who have had previous thromboembolic stroke or intractable chronic pain. Replacing sickling cells with those containing hemoglobin A (HbA) minimizes microvascular pathophysiology that produces clinical crises. Limited data exist regarding the interval changes in HbA between transfusions. We sought to describe the HbA decrement between RCE procedures and its relationship to clinical status. STUDY DESIGN AND METHODS: SCA patients (all hemoglobin SS disease) treated with maintenance RCE (n = 21) over a 15-month period at two neighboring institutions were retrospectively reviewed. Time-normalized daily HbA decrement was calculated to reflect loss of transfused RBCs, and annual events of either emergency department or hospital admissions for SCA complications were noted. Associations between HbA decrement and laboratory measures were calculated using mixed linear regression models and unpaired t test was used to compare HbA decrement between high and low event rate groups. RESULTS: A total of 31 events were recorded, and mean HbA decrement per day was 0.77 ± 0.16%. The mean interval between RCEs was 36 ± 12 days. Patients with more annual events exhibited a significantly greater daily HbA decrement (p = 0.007). No significant association between RBC unit age and HbA decrement or annual event rate was observed. CONCLUSIONS: Patients exhibiting greater daily HbA decrement were more likely to have multiple emergency department visits or admissions for sickling crises. Modulating HbA decrement may merit study as an intermediate metric for interventions to improve outcomes in hemoglobin SS disease.

Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization.

OBJECTIVES: To examine the effect of implementing postcatheterization ultrasound (US) on femoral arterial thrombosis detection rates and factors associated with thrombosis in infants. BACKGROUND: Although femoral arterial thrombosis is an uncommon complication of cardiac catheterization, it can cause limb threatening complications. Previous studies assessing the utility of postprocedure US to detect thrombosis in infants have utilized US as an adjunct to standard clinical detection methods, are small scale, or include small cohorts of infants within older populations. METHODS: We reviewed institutional records of patients 0-12 months undergoing catheterization from 2007 to 2016. Demographics and procedural data were compared between the thrombosis and non-thrombosis group. Pre- and post-US groups were compared for detected thrombosis rate. Using univariate and multivariable analyses, we identified factors associated with thrombosis. RESULTS: In total, 270 patients underwent 509 catheterizations, with 40 (7.9%) documented thromboses. The rate of thrombus detection in patients younger than 6 months increased from 8.3% to 23.4% (P = 0.006) after implementing routine US. On multivariable analysis, lower weight (P < 0.001), larger arterial sheath size (P < 0.001), and longer procedure duration (P = 0.003) were independently associated with higher odds of thrombosis. CONCLUSIONS: Higher rates of femoral arterial thrombosis detection were observed since implementing an US screening program. Further studies are needed to evaluate age-related changes in hemostasis in this population and how advanced screening methods and anticoagulation protocols may help improve short-term and long-term sequelae of femoral arterial thrombosis.

Radiologist performance in the detection of lung cancer using CT.

AIM: To measure the level of radiologists' performance in lung cancer detection, and to explore radiologists' performance in cancer specialised and non-specialised centres. MATERIALS AND METHODS: Thirty radiologists read 60 chest computed tomography (CT) examinations. Thirty cases had surgically or biopsy-proven lung cancer and 30 were cancer-free cases. The cancer cases were validated by four expert radiologists who located the malignant lung nodules. Reader performance was evaluated by calculating sensitivity, location sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC). In addition, sensitivity at fixed specificity (0.794) was computed from each reader's estimated ROC curve. RESULTS: The radiologists had a mean sensitivity of 0.749, sensitivity at fixed specificity of 0.744, location sensitivity of 0.666, specificity of 0.81 and AUC of 0.846. Radiologists in the specialised and non-specialised cancer centres had the following (specialised, non-specialised) pairs of values: sensitivity=(0.80, 0.719); sensitivity for fixed 0.794 specificity=(0.752, 0.740); location sensitivity=(0.712, 0.637); specificity=(0.794, 0.82) and AUC=(0.846, 0.846). CONCLUSION: The efficacy of radiologists was comparable to other studies. Furthermore, AUC outcomes were similar for specialised and non-specialised cancer centre radiologists, suggesting they have similar discriminatory ability and that the higher sensitivity and lower specificity for specialised-centre radiologists can be attributed to them being less conservative in interpreting case images.