Prophylactic Antibiotic Choice and Deep Infection in Lower Extremity Endoprosthetic Reconstruction: Comparison of Cefazolin, Cefazolin-Vancomycin, and Alternative Regimens.

INTRODUCTION: Infection is a common mode of failure in lower extremity endoprostheses. The Prophylactic Antibiotic Regimens in Tumor Surgery trial reported that 5 days of cefazolin had no difference in surgical site infection compared with 24 hours of cefazolin. Our purpose was to evaluate infection rates of patients receiving perioperative cefazolin monotherapy, cefazolin-vancomycin dual therapy, or alternative antibiotic regimens. METHODS: A single-center retrospective review was conducted on patients who received lower extremity endoprostheses from 2008 to 2021 with minimum 1-year follow-up. Three prophylactic antibiotic regimen groups were compared: cefazolin monotherapy, cefazolin-vancomycin dual therapy, and alternative regimens. The primary outcome was deep infection, defined by a sinus tract, positive culture, or clinical diagnosis. Secondary outcomes were revision surgery, microorganisms isolated, and superficial wound issues. RESULTS: The overall deep infection rate was 10% (30/294) at the median final follow-up of 3.0 years (IQR 1.7 to 5.4). The deep infection rates in the cefazolin, cefazolin-vancomycin, and alternative regimen groups were 8% (6/72), 10% (18/179), and 14% (6/43), respectively (P = 0.625). Patients not receiving cefazolin had an 18% deep infection rate (6/34) and 21% revision surgery rate (7/34) compared with a 9% deep infection rate (24/260) (P = 0.13) and 12% revision surgery rate (31/260) (P = 0.17) in patients receiving cefazolin. In those not receiving cefazolin, 88% (30/34) were due to a documented penicillin allergy, only two being anaphylaxis. All six patients in the alternative regimen group who developed deep infections did not receive cefazolin secondary to nonanaphylactic penicillin allergy. CONCLUSION: The addition of perioperative vancomycin to cefazolin in lower extremity endoprosthetic reconstructions was not associated with a lower deep infection rate. Patients who did not receive cefazolin trended toward higher rates of deep infection and revision surgery, although not statistically significant. The most common reason for not receiving cefazolin was a nonanaphylactic penicillin allergy, highlighting the continued practice of foregoing cefazolin unnecessarily.

Achievement Goals as Mediators of the Links Between Self-Esteem and Depressive Symptoms From Mid-Adolescence to Early Adulthood.

Numerous studies have sought to determine whether low self-esteem acts as a risk factor for depressive symptoms (i.e., a vulnerability model) or whether depressive symptoms lead to a decrease in self-esteem (i.e., a scar model). Although both models have received some support, very little research has: (a) addressed this question across critical life transitions likely to modify this pattern of associations, such as the transition to adulthood; (b) sought to identify the psychological mechanisms (i.e., mediators) underpinning these associations. The present study was designed to address these two limitations, focusing on the directionality of the associations between depressive symptoms and self-esteem from mid-adolescence to early adulthood while considering the role of motivational factors, namely mastery (intrinsic/extrinsic) and performance (approach/avoidance) goals as conceptualized in achievement goal theory. A sample of 707 Finnish adolescents aged 15-16 (52.1% boys) was surveyed six times up to the age of 25. Results from a cross-lagged panel model (CLPM) revealed that depressed individuals were more likely to have low self-esteem, although self-esteem protected against depressive symptoms between ages 16-17 to 20-21. Moreover, while self-esteem promoted mastery-extrinsic goals which in turn reinforced self-esteem, depressive symptoms promoted performance-avoidance goals which led to more depressive symptoms and lower self-esteem. Overall, these findings highlight (1) the long-lasting negative consequences of depressive symptoms on self-esteem and (2) the crucial role played by academic motivation in explaining the development of depressive symptoms and self-esteem over time. In turn, these results help refine the vulnerability and scar models, and suggest that motivational factors should be considered in prevention and intervention efforts among young populations.

Setting the boundaries-an approach to estimate the Loss Gap in dairy cattle.

Dairy production in the UK has undergone substantial restructuring over the last few decades. Farming intensification has led to a reduction in the total numbers of farms and animals, while the average herd size per holding has increased. These ever-changing circumstances have important implications for the health and welfare of dairy cows, as well as the overall business performance of farms. For decision-making in dairy farming, it is essential to understand the underlying causes of the inefficiencies and their relative impact. The investigation of yield gaps regarding dairy cattle has been focused on specific causes. However, in addition to the risk of overestimating the impact of a specific ailment, this approach does not allow understanding of the relative contribution to the total, nor does it allow understanding of how well-described that gap is in terms of underlying causes. Using the English and Welsh dairy sectors as an example, this work estimates the Loss Gap-composed of yield losses and health expenditure - using a benchmarking approach and scenario analysis. The Loss Gap was estimated by comparing the current performance of dairy herds as a baseline with that of scenarios where assumptions were made about the milk production of cows, production costs, market prices, mortality, and expenditure related to health events. A deterministic model was developed, consisting of an enterprise budget, in which the cow was the unit, with milking herd and young stock treated separately. When constraining milk production, the model estimated an annual Loss Gap of £148 to £227 million for the whole sector. The reduction in costs of veterinary services and medicines, alongside herd replacement costs, were important contributors to the estimate with some variation between the scenarios. Milk price had a substantial impact in the estimate, with revenue from milk yield representing more than 30% of the Loss Gap, when milk price was benchmarked against that of the top performing farms. This framework provides the boundaries for understanding the relative burden from specific causes in English and Welsh dairy cattle, ensuring that the sum of the estimated losses due to particular problem does not exceed the losses from all-causes, health or non-health related.

Quantifying cost of disease in livestock: a new metric for the Global Burden of Animal Diseases.

BACKGROUND: Increasing awareness of the environmental and public health impacts of expanding and intensifying animal-based food and farming systems creates discord, with the reliance of much of the world's population on animals for livelihoods and essential nutrition. Increasing the efficiency of food production through improved animal health has been identified as a step towards minimising these negative effects without compromising global food security. The Global Burden of Animal Diseases (GBADs) programme aims to provide data and analytical methods to support positive change in animal health across all livestock and aquaculture animal populations. METHODS: In this study, we present a metric that begins the process of disease burden estimation by converting the physical consequences of disease on animal performance to farm-level costs of disease, and calculates a metric termed the Animal Health Loss Envelope (AHLE) via comparison between the status quo and a disease-free ideal. An example calculation of the AHLE metric for meat production from broiler chickens is provided. FINDINGS: The AHLE presents the direct financial costs of disease at farm-level for all causes by estimating losses and expenditure in a given farming system. The general specification of the model measures productivity change at farm-level and provides an upper bound on productivity change in the absence of disease. On its own, it gives an indication of the scale of total disease cost at farm-level. INTERPRETATION: The AHLE is an essential stepping stone within the GBADs programme because it connects the physical performance of animals in farming systems under different environmental and management conditions and different health states to farm economics. Moving forward, AHLE results will be an important step in calculating the wider monetary consequences of changes in animal health as part of the GBADs programme. FUNDING: Bill & Melinda Gates Foundation, the UK Foreign, Commonwealth and Development Office, EU Horizon 2020 Research and Innovation Programme.

Rationalising development of classification systems describing livestock production systems for disease burden analysis within the Global Burden of Animal Diseases programme.

The heterogeneity that exists across the global spectrum of livestock production means that livestock productivity, efficiency, health expenditure and health outcomes vary across production systems. To ensure that burden of disease estimates are specific to the represented livestock population and people reliant upon them, livestock populations need to be systematically classified into different types of production system, reflective of the heterogeneity across production systems. This paper explores the data currently available of livestock production system classifications and animal health through a scoping review as a foundation for the development of a framework that facilitates more specific estimates of livestock disease burdens. A top-down framework to classification is outlined based on a systematic review of existing classification methods and provides a basis for simple grouping of livestock at global scale. The proposed top-down classification framework, which is dominated by commodity focus of production along with intensity of resource use, may have less relevance at the sub-national level in some jurisdictions and will need to be informed and adapted with information on how countries themselves categorize livestock and their production systems. The findings in this study provide a foundation for analysing animal health burdens across a broad level of production systems. The developed framework will fill a major gap in how livestock production and health are currently approached and analysed.

Approximating the global economic (market) value of farmed animals.

Understanding the global economic importance of farmed animals to society is essential as a baseline for decision making about future food systems. We estimated the annual global economic (market) value of live animals and primary production outputs, e.g., meat, eggs, milk, from terrestrial and aquatic farmed animal systems. The results suggest that the total global market value of farmed animals ranges between 1.61 and 3.3 trillion USD (2018) and is expected to be similar in absolute terms to the market value of crop outputs (2.57 trillion USD). The cattle sector dominates the market value of farmed animals. The study highlights the need to consider other values of farmed animals to society, e.g., finance/insurance value and cultural value, in decisions about the sector's future.

School Experiences and Anxiety Trajectories Among Youth with Intellectual Disabilities.

This study investigated how the school experiences and personal characteristics of youth with Intellectual Disabilities (ID) contribute to their longitudinal trajectories of anxiety. To this end, we relied on a sample of 390 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged from 11 to 22 (M = 15.70), and recruited in Canada (n = 140) and Australia (n = 250). Across three yearly time points, all participants completed self-report measures of anxiety, school climate, and victimization. Our results revealed a slight normative decrease in anxiety over time and showed that experiences of school victimization were associated with higher levels of anxiety (initially and momentarily) and increases in victimization were accompanied by increases in anxiety over time. Perceptions of attending a school that fosters security and promotes learning also tended to be accompanied by lower levels of anxiety (initially and momentarily). Momentary increases in perceptions of attending a school that fosters positive peer interactions were associated with momentary decreases in anxiety, whereas momentary increases in perceptions of attending a school characterized by positive teacher-student relationships and an equitable treatment of all students both led to small momentary increases in anxiety once all other components of student school experiences were considered. The theoretical and practical implications of these results are discussed.

Intramedullary Nailing of Forearm Fractures.

The primary goal in operative fixation of forearm fractures is to restore length, rotational stability, and maintenance of the radial bow. Plate osteosynthesis is well regarded as the gold standard of treatment though often necessitates soft tissue injury, periosteal stripping, and risk of refracture after hardware removal. While intramedullary nails have been utilized for forearm fixation since the early 1900s, technological advancements including locked intramedullary nails have lead to improved outcomes in intramedullary nail forearm fixation. In select patients, intramedullary nail fixation is an appropriate treatment option. For example, patients with mangled extremities, comminuted or segmental fractures, or soft tissue injury may benefit from this approach as it allows for smaller incisions and limits further soft tissue compromise.

Undergraduate students' motivational profiles before and during the COVID-19 pandemic: The role of educational climate and trait self-control.

BACKGROUND: Universities faced important and sudden changes following the lockdown measures imposed during the COVID-19 pandemic. Traditional educational practices were disrupted as campuses were closed while distance learning was hastily adopted. AIMS: This study documents the evolution of university students' autonomous and controlled motivation for their studies following campus closures by relying on a person-centred perspective. More specifically, it examines motivation profiles and their temporal stability across two time points taken before and during the pandemic, while also considering the role of educational climate, trait self-control and control variables (sex and age) as predictors of profile membership. SAMPLE: A total of 1940 university students participated in this study by responding to online questionnaires at two time points, before (Time 1) and after (Time 2) the pandemic. METHODS: We relied on latent profile and latent transition analyses to estimate motivation profiles, their temporal stability and their predictors. RESULTS: A four-profile solution (Self-Determined, Moderately Motivated, Extrinsically Motivated, Amotivated) was selected and replicated at both time points. We observed a low degree of variability in profile membership over time, especially for the Amotivated profile. A need-supportive educational climate and trait self-control consistently predicted a greater likelihood of membership into more adaptative profiles (Self-Determined, Moderately Motivated). CONCLUSIONS: The COVID-19 pandemic did not drastically change the motivational profiles of university students. Nevertheless, educational climate and self-control appeared to 'protect' students against the endorsement of more problematic motivation profiles both before and during the pandemic, making them important targets for intervention.

Diagnosis Dilemma, Culture-Negative Periprosthetic Hip Infection Versus Acute Gouty Arthritis: A Case Report.

CASE: We report the case of acute gouty arthritis mimicking infection in a 59-year-old woman who had an extensive history of periprosthetic joint infection (PJI) and multiple revisions. Initial laboratory testing, examination, and recency bias suggested recurrent PJI, but aspiration revealed an acute gout attack without superimposed infection. The patient's examination and serological markers improved off antibiotics, and she subsequently avoided an unnecessary revision surgery. CONCLUSION: Although rare, acute gouty arthritis should be considered in every patient, and complete workup should be performed, regardless of infectious or rheumatologic history.

Clinical and Physician Factors Associated With Failed Operative Vaginal Delivery.

OBJECTIVE: To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births. METHODS: This was a retrospective cohort study of individuals with NTSV live births with an attempted operative vaginal delivery by a physician between 2016 and 2020 in California. The primary outcome was cesarean birth after failed operative vaginal delivery, identified using linked diagnosis codes, birth certificates, and physician licensing board data stratified by device type (vacuum or forceps). Clinical and physician-level exposures were selected a priori, defined using validated indices, and compared between successful and failed operative vaginal delivery attempts. Physician experience with operative vaginal delivery was estimated by calculating the number of operative vaginal delivery attempts made per physician during the study period. Multivariable mixed effects Poisson regression models with robust standard errors were used to estimate risk ratios of failed operative vaginal delivery for each exposure, adjusted for potential confounders. RESULTS: Of 47,973 eligible operative vaginal delivery attempts, 93.2% used vacuum and 6.8% used forceps. Of all operative vaginal delivery attempts, 1,820 (3.8%) failed; the success rate was 97.3% for vacuum attempts and 82.4% for forceps attempts. Failed operative vaginal deliveries were more likely with older patient age, higher body mass index, obstructed labor, and neonatal birth weight more than 4,000 g. Between 2016 and 2020, physicians who attempted more operative vaginal deliveries were less likely to fail. When vacuum attempts were successful, physicians who conducted them had a median of 45 vacuum attempts during the study period, compared with 27 attempts when vacuum attempts were unsuccessful (adjusted risk ratio [aRR] 0.95, 95% CI 0.93-0.96). When forceps attempts were successful, physicians who conducted them had a median of 19 forceps attempts, compared with 11 attempts when forceps attempts were unsuccessful (aRR 0.76, 95% CI 0.64-0.91). CONCLUSION: In this large, contemporary cohort with NTSV births, several clinical factors were associated with operative vaginal delivery failure. Physician experience was associated with operative vaginal delivery success, more notably for forceps attempts. These results may provide guidance for physician training in maintenance of operative vaginal delivery skills.

Jellybean Quantum Dots in Silicon for Qubit Coupling and On-Chip Quantum Chemistry.

The small size and excellent integrability of silicon metal-oxide-semiconductor (SiMOS) quantum dot spin qubits make them an attractive system for mass-manufacturable, scaled-up quantum processors. Furthermore, classical control electronics can be integrated on-chip, in-between the qubits, if an architecture with sparse arrays of qubits is chosen. In such an architecture qubits are either transported across the chip via shuttling or coupled via mediating quantum systems over short-to-intermediate distances. This paper investigates the charge and spin characteristics of an elongated quantum dot-a so-called jellybean quantum dot-for the prospects of acting as a qubit-qubit coupler. Charge transport, charge sensing, and magneto-spectroscopy measurements are performed on a SiMOS quantum dot device at mK temperature and compared to Hartree-Fock multi-electron simulations. At low electron occupancies where disorder effects and strong electron-electron interaction dominate over the electrostatic confinement potential, the data reveals the formation of three coupled dots, akin to a tunable, artificial molecule. One dot is formed centrally under the gate and two are formed at the edges. At high electron occupancies, these dots merge into one large dot with well-defined spin states, verifying that jellybean dots have the potential to be used as qubit couplers in future quantum computing architectures.

The DECIDE project: from surveillance data to decision-support for farmers and veterinarians.

Farmers, veterinarians and other animal health managers in the livestock sector are currently missing sufficient information on prevalence and burden of contagious endemic animal diseases. They need adequate tools for risk assessment and prioritization of control measures for these diseases. The DECIDE project develops data-driven decision-support tools, which present (i) robust and early signals of disease emergence and options for diagnostic confirmation; and (ii) options for controlling the disease along with their implications in terms of disease spread, economic burden and animal welfare. DECIDE focuses on respiratory and gastro-intestinal syndromes in the three most important terrestrial livestock species (pigs, poultry, cattle) and on reduced growth and mortality in two of the most important aquaculture species (salmon and trout). For each of these, we (i) identify the stakeholder needs; (ii) determine the burden of disease and costs of control measures; (iii) develop data sharing frameworks based on federated data access and meta-information sharing; (iv) build multivariate and multi-level models for creating early warning systems; and (v) rank interventions based on multiple criteria. Together, all of this forms decision-support tools to be integrated in existing farm management systems wherever possible and to be evaluated in several pilot implementations in farms across Europe. The results of DECIDE lead to improved use of surveillance data and evidence-based decisions on disease control. Improved disease control is essential for a sustainable food chain in Europe with increased animal health and welfare and that protects human health.

Educational contexts that nurture students' psychological needs predict low distress and healthy lifestyle through facilitated self-control.

Psychological distress and unhealthy lifestyle behaviors are highly prevalent among undergraduate students. Importantly, numerous longitudinal studies show that these phenomena rise significantly during the first months of college and remain high thereafter. However, research identifying theory-driven mechanisms to explain these phenomena is lacking. Using two complementary statistical approaches (person- and variable-centered), this study assesses basic psychological needs (BPNs) and self-control as possible explanatory factors underlying the association between student's educational experience and multiple health-related outcomes. A total of 2450 Canadian undergraduates participated in this study study involving two time points (12 months apart; NTime1 = 1783; NTime2 = 1053), of which 386 participated at both measurement occasions. First, results from person-centered analyses (i.e., latent profile and transition analyses) revealed three profiles of need-satisfaction and frustration in students that were replicated at both time points. Need-supportive conditions within college generally predicted membership in the most adaptive profile. In turn, more adaptive profiles predicted higher self-control, lower levels of psychological distress (anxiety, depression), and healthier lifestyle behaviors (physical activity, fruit and vegetable consumption). Second, results from variable-centered analyses (i.e., structural equation modeling) showed that the association between students' BPNs and health-related outcomes was mediated by self-control. In other words, high need satisfaction and low need frustration were associated with higher self-regulatory performance at Time 1, which in turn predicted a more adaptive functioning at Time 2. Overall, these findings help clarify the mechanisms underlying the association between college educational climate and students' health-related functioning. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-04019-5.

Reporting on 16 years of laboratory capacity building while exploring the future of WOAH's Laboratory Twinning Programme.

Animal health laboratories are an increasingly important part of safeguarding animal and public health due to their role in surveillance and diagnostics of animal diseases, food safety, and in the development and production of medicinal products, vaccines, and diagnostic tools. Despite their importance, the global distribution of veterinary laboratory expertise is uneven, with greater concentration of reference laboratories in wealthier countries. To address this issue, the World Organization for Animal Health (WOAH, founded as OIE) created a Laboratory Twinning Programme in 2006. The paper will briefly review this Programme in the context of an increasingly populated global health security field, based on a literature review and on a combination of public and internal WOAH data and describe the implementation of the Programme in the past 16 years, noting the drivers for project implementation, its links with the global livestock biomass distribution and with the current distribution of veterinary laboratory expertise. There has been broad uptake and diversity in the focus of the twinning projects implemented in WOAH Member Countries. The Laboratory Twinning Programme would benefit from an evaluation that looks at its outcomes and quantifiable impact in beneficiary countries. A case is made for the development of a monitoring and evaluation system tailored to the Programme's specificities.

Late breeding season definitive prebasic molt in males, and late breeding season brood care by females, in central California Wilson's warblers.

I made observations of a central California population of Wilson's Warbler, Cardellina pusilla, after July 1 over 10 breeding seasons. I sighted males in definitive prebasic molt from July 4 (in 2007) to September 1 (in 1999). Most territorial males molted on their breeding territories, and individual molt lasted up to 46 days. Following prebasic molt, territorial males engaged in subdued "post-molt singing," which lasted about 7 days in some males, and which I first heard on August 13 (in 2004) and last heard on September 6 (in 1999). I sighted no female in definitive prebasic molt, or in fresh basic plumage, during the study. Of 13 females sighted ≥ July 21, 11 were in late breeding season uniparental brood care, and I could not rule out late brood care for the other two. Most, and possibly all, females not engaged in late season uniparental brood care apparently vacated their breeding territories before July 21. This departure was much earlier than for resident males, the last of which I sighted on September 10 (in 1999). Early-departing females presumably underwent prebasic molt after July 21 at locations not known. Remaining late-nesting females must have molted much later than resident males and likely later than early-departing females, and at locations unknown. I last sighted two uniparental brood-tending females, still in worn plumage, on August 26 and 29, respectively. Two unique findings of this study are a male/female difference in location of prebasic molt, and a likely dichotomy of prebasic molt timing between females leaving their breeding territories early and those remaining in uniparental brood care. Another finding, post-molt singing in most and possible all territorial males, is a largely unrecognized behavior, but one previously reported in several passerine species. Post-molt singing may reliably indicate completion of prebasic molt.

Should Periodontists Prescribe Postoperative Oral Corticosteroids to Control Pain and Swelling? A Systematic Review.

FOCUSED CLINICAL QUESTION: In generally healthy patients receiving third molar, periodontal, or dental implant surgery, do postoperative oral corticosteroids effectively limit pain and swelling compared with placebo or alternative medications?

Severe maternal and neonatal morbidity after attempted operative vaginal delivery.

BACKGROUND: Operative vaginal delivery is a critical tool in reducing primary cesarean delivery, but declining operative vaginal delivery rates and concerns about provider skill necessitate a clear understanding of risks. These risks are ambiguous because most studies compare outcomes of operative vaginal delivery with that of spontaneous vaginal delivery rather than outcomes of cesarean delivery in the second stage of labor, which is usually the realistic alternative. OBJECTIVE: This study aimed to compare severe maternal and neonatal morbidity by mode of delivery of patients with a prolonged second stage of labor who had a successful operative vaginal delivery, a cesarean delivery after failed operative vaginal delivery, or a cesarean delivery without an operative vaginal delivery attempt. STUDY DESIGN: We used a population-based database to evaluate nulliparous, term, singleton, vertex live births in California between 2007 and 2012 of patients with prolonged second stage of labor. Birth certificates and the International Classification of Diseases, Ninth Revision, Clinical Modification coded diagnoses and procedures were used for ascertainment of exposure, outcome, and demographics. Exposure was mode of delivery of patients who had any operative vaginal delivery attempt vs cesarean delivery without operative vaginal delivery attempt. The outcomes were severe maternal morbidity and severe unexpected newborn morbidity, defined using established indices. Anticipating that the code for prolonged second stage of labor would represent only a fraction of true operative vaginal delivery candidates, a secondary analysis was conducted removing this restriction to explore granular outcomes in a larger cohort with unsuccessful labor. Multivariable logistic regression was used to compare outcomes by mode of delivery adjusted for measured confounders. Sensitivity analyses were done excluding patients with combined vacuum-forceps-assisted delivery and birthweight of >4000 g. RESULTS: A total of 9239 births after prolonged second stage of labor were included, where 6851 (74.1%) were successful operative vaginal deliveries, 301 (3.3%) were failed operative vaginal deliveries, and 2087 (22.6%) were cesarean deliveries without operative vaginal delivery attempts. Of successful operative vaginal deliveries, 6195 (90.4%) were vacuum assisted and 656 (10.6%) were forceps-assisted. Of failed operative vaginal deliveries where operative vaginal delivery type was specified, 83 (47.4%) were vacuum assisted, 38 (21.7%) were forceps-assisted, and 54 (30.9%) were combined vacuum-forceps-assisted. Of note, all 54 combined vacuum-forceps-assisted operative vaginal delivery attempts that we identified failed. The outcomes of patients with failed operative vaginal delivery differed from those with successful operative vaginal delivery, such as higher rates of comorbidities, use of combined operative vaginal delivery, and birthweight of >4000 g. Successful operative vaginal delivery was associated with reduced severe maternal morbidity (adjusted odds ratio, 0.55; 95% confidence interval, 0.39-0.78) without a difference in severe unexpected neonatal morbidity (adjusted odds ratio, 0.99; 95% confidence interval, 0.78-1.26). In contrast, failed operative vaginal delivery was associated with increased severe maternal morbidity (adjusted odds ratio, 2.14; 95% confidence interval, 1.20-3.82) and severe unexpected neonatal morbidity (adjusted odds ratio, 1.78; 95% confidence interval, 1.09-2.86). In addition, findings were similar in the secondary analysis of 260,585 patients with unsuccessful labor. CONCLUSION: In this large cohort of nulliparous, term, singleton, vertex births, successful operative vaginal delivery was associated with a 45% reduction in severe maternal morbidity without differences in severe unexpected neonatal morbidity compared with cesarean delivery after prolonged second stage of labor. Operative vaginal delivery infrequently failed and was associated with a 214% increase in severe maternal morbidity and a 78% increase in severe unexpected neonatal morbidity; furthermore, combined operative vaginal deliveries were major contributors to this, as all combined operative vaginal deliveries failed. Optimization of operative vaginal delivery success rates through means such as improved patient selection, enhanced provider skill, and discussions against combined operative vaginal delivery could reduce maternal and neonatal complications.

Orthodontic Treatment of Periodontally Compromised Teeth After Laser Periodontal Therapy: A Case Report.

Objective: To assess stability of laser periodontal therapy (LPT) results after orthodontic tooth movement. Background: Periodontitis and malocclusion each exhibit high global prevalence. Thus, dentists inevitably face increasing demand for orthodontic treatment in patients with reduced periodontal support. Many of these patients benefit from orthodontic treatment, provided that periodontal inflammation is controlled. Materials and methods: We present a case demonstrating successful orthodontic treatment of periodontally compromised teeth after LPT. A patient with severe attachment and alveolar bone loss received orthodontic treatment 13 months after neodymium-doped: yttrium aluminum garnet LPT (1064 nm). We utilized three laser parameter sets for various purposes during the procedure-ablation of the periodontal pocket epithelium (2.8 W, 20 Hz, 100 µs), clot stabilization (2.8 W, 20 Hz, 550 µs), and photobiomodulation (2.8 W, 20 Hz, 100 µs, noncontact). Results: Treatment resulted in improved radiographic bone levels, clinical parameters consistent with periodontal health, and favorable occlusal relationships. Conclusions: In the presented case, we successfully treated a patient presenting with malocclusion and reduced periodontal support while avoiding the risk and morbidity of conventional periodontal surgery. Controlled clinical research to establish the predictability of the described approach appears warranted.