Healthcare disparities: patients' perspectives on barriers to joint replacement.

OBJECTIVE: Racial and ethnic disparities in arthroplasty utilization are evident, but the reasons are not known. We aimed to identify concerns that may contribute to barriers to arthroplasty from the patient's perspective. METHODS: We identified patients' concerns about arthroplasty by performing a mixed methods study. Themes identified during semi-structured interviews with Black and Hispanic patients with advanced symptomatic hip or knee arthritis were used to develop a questionnaire to quantify and prioritize their concerns. Multiple linear and logistic regression analyses were conducted to determine the association between race/ethnicity and the importance of each theme. Models were adjusted for sex, insurance, education, HOOS, JR/KOOS, JR, and discussion of joint replacement with a doctor. RESULTS: Interviews with eight participants reached saturation and provided five themes used to develop a survey answered by 738 (24%) participants; 75.5% White, 10.3% Black, 8.7% Hispanic, 3.9% Asian/Other. Responses were significantly different between groups (p < 0.05). Themes identified were "Trust in the surgeon" "Recovery", "Cost/Insurance", "Surgical outcome", and "Personal suitability/timing". Compared to Whites, Blacks were two-fold, Hispanics four-fold more likely to rate "Trust in the surgeon" as very/extremely important. Blacks were almost three times and Hispanics over six times more likely to rate "Recovery" as very/extremely important. CONCLUSION: We identified factors of importance to patients that may contribute to barriers to arthroplasty, with marked differences between Blacks, Hispanics, and Whites.

Late embryo mortality in Holstein cows inseminated with Holstein or Limousine frozen semen.

The objective of this study was to compare the late embryo mortality (LEM) rate (losses approximately between 32 and 53 days of gestation) and Pregnancy Specific Protein B (PSPB) and progesterone (P4) concentrations on day 32 post AI in Holstein cows bred with either Holstein or Limousine semen. A sample size of 1082 cows per group diagnosed pregnant between 28- and 35-days post breeding was calculated. The study consisted of evaluating LEM (%) in a cohort of Holstein cows bred with Holstein semen (HO × HO) or Limousine semen (HO × LM), to compare pregnancy loss from 28 to 35 days post breeding to 50-57 days post breeding. A logistic regression model to compare embryo losses was developed considering as main explanatory variable the cohort (HO × HO embryo vs. HO × LM embryo), correcting by lactation number, breeding season, days to breeding and AI technician. HO × HO embryos had greater LEM (15.16%) than HO × LM embryos (9.79%). Cows bred in summertime had higher LEM (15.23%) than cows bred in no-summertime (9.88%). There were no differences among AI technicians. Within summertime there was no difference in LEM (%) between groups within each lactation number; yet, within no-summertime, LEM (%) was higher in HO × HO than HO × LM within each lactation number. Pregnancy SPB optical densities were significantly greater in the HO × HO than in the HO × LM (p = .023) group; yet, the concentration of P4 was not different between groups (p > .05).

Tumors Constitute a Majority of Total Knee Arthroplasty in Patients <21 Years Old: A United States Nationwide Analysis.

BACKGROUND: Total knee arthroplasty (TKA) is rarely performed in patients under 21 years old, but the frequency of utilization of TKA in this population in the United States is not known. The purpose of this study was to evaluate trends in the use of TKA in patients <21 in the United States. Additionally, we aimed to determine the characteristics of these patients and the hospitals in which this procedure is performed. METHODS: We retrospectively reviewed the Kids' Inpatient Database, a national weighted sample of all inpatient hospital admissions in the United States in patients <21 years of age. We used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000 to 2019 and determine a primary diagnosis. Descriptive statistics were calculated using the appropriate sample weights. RESULTS: The total weighted number of TKAs performed in patients <21 years from 2000 to 2019 was 1,535. There were 70.9% of TKAs performed for a primary diagnosis of tumor, and the use of TKA for malignant tumors has increased. In contrast, the use of TKA for inflammatory arthritis/juvenile idiopathic arthritis decreased significantly over the study period. The majority of TKAs were performed in urban teaching hospitals with a large bed size. CONCLUSION: Approximately 1,535 TKAs have been performed in patients <21 years from 2000 to 2019 in the United States. The majority of these procedures were performed for reconstruction after resection of a malignant tumor. The rate of TKA for inflammatory arthritis/juvenile idiopathic arthritis has decreased over the past two decades.

Anisotropic spin-orbit torque generation in epitaxial SrIrO3 by symmetry design.

Spin-orbit coupling (SOC), the interaction between the electron spin and the orbital angular momentum, can unlock rich phenomena at interfaces, in particular interconverting spin and charge currents. Conventional heavy metals have been extensively explored due to their strong SOC of conduction electrons. However, spin-orbit effects in classes of materials such as epitaxial 5d-electron transition-metal complex oxides, which also host strong SOC, remain largely unreported. In addition to strong SOC, these complex oxides can also provide the additional tuning knob of epitaxy to control the electronic structure and the engineering of spin-to-charge conversion by crystalline symmetry. Here, we demonstrate room-temperature generation of spin-orbit torque on a ferromagnet with extremely high efficiency via the spin-Hall effect in epitaxial metastable perovskite SrIrO3 We first predict a large intrinsic spin-Hall conductivity in orthorhombic bulk SrIrO3 arising from the Berry curvature in the electronic band structure. By manipulating the intricate interplay between SOC and crystalline symmetry, we control the spin-Hall torque ratio by engineering the tilt of the corner-sharing oxygen octahedra in perovskite SrIrO3 through epitaxial strain. This allows the presence of an anisotropic spin-Hall effect due to a characteristic structural anisotropy in SrIrO3 with orthorhombic symmetry. Our experimental findings demonstrate the heteroepitaxial symmetry design approach to engineer spin-orbit effects. We therefore anticipate that these epitaxial 5d transition-metal oxide thin films can be an ideal building block for low-power spintronics.

Satisfaction With the Process vs Outcome of Care in Total Hip and Knee Arthroplasty.

BACKGROUND: Patient satisfaction, with both process of care and outcome of care, is critical for measuring the quality and value of elective procedures such as arthroplasty. The purpose of this study is to evaluate the correlation between early postoperative satisfaction with the process of care and 2-year satisfaction with the outcome of care after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: We retrospectively analyzed data from institutional arthroplasty registries. Satisfaction with the outcome of care was measured on a scale of 0-100 by a previously validated questionnaire administered 2 years postoperatively. Patient satisfaction with the process of care was measured by the Press Ganey (PG) inpatient survey, also scored 0-100. We examined the correlation between these 2 measures of satisfaction in patients who underwent primary THA or TKA. RESULTS: In total, 721 TKA patients and 760 THA patients underwent surgery and completed both the PG survey and 2-year satisfaction questionnaire. The mean age was 65.1 years with a mean body mass index of 28.8 and 56% were female. The mean PG survey score for the entire cohort was 95.6. The mean 2-year satisfaction score was 90.3. The Spearman correlation coefficient between the PG survey and the 2-year satisfaction survey was 0.23 for TKA patients (P < .001) and 0.13 for THA patients (P < .001). CONCLUSION: We found a weak correlation between the measurement of satisfaction with the process of care surrounding hip and knee arthroplasty using the PG survey and measurement of satisfaction with the outcome of care after arthroplasty using a validated 2-year satisfaction instrument.

Dairy cow trade-off preference for 2 different lying qualities: Lying surface and lying space.

Lying down is an important behavior for cows, contributing to their health and welfare. With dairy cows being housed for increasingly longer periods, if not year-round, it is important to ensure that dairy cow lying comfort is not compromised when they are housed. The aim of this study was to assess cow preference for 2 different qualities of lying area that appear to be important to cows-surface type and an open lying space-to better understand how to optimize lying comfort for cows when housed. Twenty-four Holstein dairy cows were used during the study, which took place in Scotland from July to November 2018. The study consisted of 6 experimental periods, each lasting a total of 21 d. Cows were tested 4 at a time and individually housed in their own test pen. Each pen had 3 lying surfaces: sand, mattress, and straw (2.4 m × 2.4 m each) with a freestall in the middle of each, which could be removed. Cows were given access to one surface at a time (training period) with a freestall for 2 d, and then given a choice of all 3 surfaces for 2 d. When given the choice with freestalls in position, cows spent, on average, the largest amount of their lying time on straw (46.6 ± 7.8%) followed by mattress (44.3 ± 12.4%). Freestalls were then removed and the training and choice phase was repeated on the following day, with cows, on average, spending the most time lying on straw (64.4 ± 7.2%). Finally, a freestall was refitted onto each cow's most preferred surface and the cows were given a choice between lying on their most preferred surface with a freestall (P1 + freestall) or on their second or third preferred surface without a freestall (P2 + open and P3 + open, respectively) for 3 d. During this final trade-off stage, of the 19 cows for which data were available, 14 cows chose to give up the opportunity to lie down on their most preferred surface to have more space on P2 + open and P3 + open, 3 cows chose to lie down on P1 + freestall, and 2 cows made no clear choice. Overall, cows spent the largest amount of their total lying time on their second most preferred surface as an open lying space (65.7 ± 6.9%) compared with their preferred surface with a freestall (20.5 ± 5.9%) and their third preferred surface as an open lying space (13.8 ± 3.7%). The results indicate that when lying down, these dairy cows value an open lying space more than the lying surface.

Use of Total Hip Arthroplasty in Patients Under 21 Years Old: A US Population Analysis.

BACKGROUND: The purpose of this study is to evaluate trends in the use of total hip arthroplasty (THA) in the United States in patients under 21 years of age. Specifically, we examined the frequency of THA in this patient population over the past 2 decades, the epidemiologic characteristics of patients under 21 who underwent THA, and the characteristics of the hospitals where these procedures were performed. METHODS: We retrospectively reviewed the Kids' Inpatient Database, an inpatient US national weighted sample of hospital admissions in patients under 21 from approximately 4200 hospitals in 46 states. We queried the database using Current Procedural Terminology codes for elective and non-elective primary THA for the years 2000-2016. We utilized the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes to determine primary diagnoses. RESULTS: The weighted total number of THAs performed in patients under 21 in the Kids' Inpatient Database increased from 347 in 2000 to 551 in 2016. The most common diagnoses were osteonecrosis, osteoarthritis, and inflammatory arthritis. The frequency of THA for osteonecrosis increased from 24% in 2000 to 38% in 2016, while the frequency of THA for inflammatory arthritis decreased from 27% in 2000 to 4% in 2016. CONCLUSION: The number of THAs in patients under 21 in the United States has increased over the past 2 decades and these procedures are increasingly performed in urban teaching hospitals. The decrease in THA for inflammatory arthritis in this population likely reflects improvements in medical management during the study period.

Field survey to evaluate space allowances for dairy cows in Great Britain.

Housing conditions can affect health of cows by increasing exposure to biological, chemical, and physical hazards, resulting in increased disease. A report in 2014 indicated that 99% of UK dairy cows are housed during winter months and that an increasing number of farms are committing to year-round indoor-housing management systems. Current literature does not provide a clear understanding of the relationship between cow health, welfare, and production, and the housing environment. Loafing space, in this case defined as non-feed, non-lying, and non-high traffic areas of the housed environment, is considered an important component of housing for dairy cows; however, the scientific literature associated with this subject is sparse internationally. The aim of this research was to explore current housing of dairy cows across Great Britain, with specific focus on understanding the practices and variability associated with space allowance. A secondary aim was to explore farmer opinions and knowledge on the value of living space. A single researcher visited 53 randomly selected farms, from a representative sample group, once during the winter housing period 2017-18. Data collection consisted of 3 elements: collation of basic farm details, precise measurement of adult dairy cow accommodation, and a questionnaire to capture farmer opinions on space allowances. Statistical analysis was undertaken to assess variation among farms in total space, loafing space, and living space per cow. A new metric, termed "living space," was defined to describe the additional space availability for dairy cows above that deemed to be a baseline requirement. Large variability was identified between farms in total space available per cow, with a range from 5.4 to 12.7 m2 [mean = 8.3 m2, median = 8.2 m2, interquartile range (IQR) = 1.9 m2]. The mean living space was 2.5 m2, with a range of 0.5 m2 to 6.4 m2 (median = 2.4 m2, IQR = 1.6 to 3.2 m2). Responses from a farmer questionnaire on importance of loafing space revealed that farmers felt it was essential for cow welfare, over half of farmers scoring this ≥8 on a 0 to 10 scale. Farmers were categorized into 4 latent classes based on their attitudes toward the importance of loafing space. In a linear model to predict the "living space" provided on each farm, geographical location and latent class of farmer attitude were covariates significantly associated with the amount of space provided. This study is the first worldwide to quantify variability in loafing and living spaces for dairy herds; further research is required to evaluate the extent to which variation in quantity and quality of space influences cow health, welfare, and productivity, as well as farm economics and emissions.

A comparison of the pharmacokinetics and safety of enzalutamide in subjects with hepatic impairment and matched healthy subjects.

WHAT IS KNOWN AND OBJECTIVE: Enzalutamide is an androgen receptor inhibitor approved for treatment of metastatic castration-resistant prostate cancer. Enzalutamide is highly protein bound and eliminated primarily by hepatic metabolism; therefore, it is important to understand whether enzalutamide pharmacokinetics is altered by hepatic impairment. METHODS: Pharmacokinetic data were obtained from two non-randomized, open-label, single-dose, phase 1 studies conducted in patients with mild (Child-Pugh class A, n = 6) or moderate (Child-Pugh class B, n = 8) hepatic impairment (NCT01901133) or severe (Child-Pugh class C, n = 8) hepatic impairment (NCT02138162) and their corresponding matched healthy controls; data from both studies are presented here. Subjects with hepatic impairment had liver cirrhosis (n = 19) or chronic hepatitis (n = 3). All subjects received a single oral dose of 160 mg enzalutamide under fasting conditions, with blood samples collected predose and up to 49 days post-dose. RESULTS AND DISCUSSION: Exposure to enzalutamide active moieties, based on the area under the curve of the sum of enzalutamide and N-desmethyl enzalutamide (an active metabolite with similar potency to enzalutamide), increased by 13%, 18% and 4% in subjects with mild, moderate and severe hepatic impairment, respectively, relative to matched controls. Compared with healthy controls, the mean maximum plasma concentration for enzalutamide active moieties was 24% higher in subjects with mild hepatic impairment and 11% and 41% lower in subjects with moderate and severe hepatic impairment, respectively. Enzalutamide was generally well tolerated, with no clinically significant trends in abnormal laboratory findings, vital signs or electrocardiograms. WHAT IS NEW AND CONCLUSIONS: No major differences in single-dose pharmacokinetics were observed in subjects with hepatic impairment vs. matched healthy controls. Therefore, these studies indicate that no initial dose adjustment is necessary when administering enzalutamide to patients with hepatic impairment.

Producer estimates of prevalence and perceived importance of lameness in dairy herds with tiestalls, freestalls, and automated milking systems.

Lameness is one of the most important welfare and productivity concerns in the dairy industry. Our objectives were to obtain producers' estimates of its prevalence and their perceptions of lameness, and to investigate how producers monitor lameness in tiestall (TS), freestall with milking parlor (FS), and automated milking system (AMS) herds. Forty focal cows per farm in 237 Canadian dairy herds were scored for lameness by trained researchers. On the same day, the producers completed a questionnaire. Mean herd-level prevalence of lameness estimated by producers was 9.0% (±0.9%; ±SE), whereas the researchers observed a mean prevalence of 22.2% (±0.9%). Correlation between producer- and researcher-estimated lameness prevalence was low (r = 0.19) and mean researcher prevalence was 1.6, 1.8, and 4.1 times higher in AMS, FS, and TS farms, respectively. A total of 48% of producers thought lameness was a moderate or major problem in their herds (TS = 34%; AMS =53%; FS = 59%). One third of producers considered lameness the highest ranked health problem they were trying to control, whereas two-thirds of producers (TS = 43%; AMS = 63%; FS = 71%) stated that they had made management changes to deal with lameness in the past 2 yr. Almost all producers (98%) stated they routinely check cows to identify new cases of lameness; however, 40% of producers did not keep records of lameness (AMS = 24%; FS = 23%; TS = 60%). A majority (69%) of producers treated lame cows themselves immediately after detection, whereas 13% relied on hoof-trimmer or veterinarians to plan treatment. Producers are aware of lameness as an issue in dairy herds and almost all monitor lameness as part of their daily routine. However, producers underestimate lameness prevalence, which highlights that lameness detection continues to be difficult in in all housing systems, especially in TS herds. Training to improve detection, record keeping, identification of farm-specific risk factors, and treatment planning for lame cows is likely to help decrease lameness prevalence.

Emergency Aeromedical Services in Ireland: A Single-Centre Study in 2014.

This retrospective analysis includes patients requiring Emergency Aeromedical Services (EAS) in 2014. The aim of this paper is to evaluate the HEMS service in a single centre and to accurately assess whether certain internationally validated criteria can predict admission rates better than the currently used criteria. Using the American College of Surgeons (ACS) trauma-related dispatch criteria, each case was retrospectively evaluated. Results showed the mean total criteria met were 2.73 (?=0.88) and 1.45 (?=0.82) in admitted and discharged patients respectively. The total criteria met had a significant predictive value on admission rates (p<0.05). Increased admission rates were shown in patients with a high Mechanism of Injury (MOI) (p<0.05). False positive rates of HEMS transfer were higher when applying the current criteria compared to the ACS criteria. ACS total criteria can predict admission in HEMS patients with a higher specificity than currently used guidelines.

An assessment tool to help producers improve cow comfort on their farms.

Effective management and an appropriate environment are essential for dairy cattle health and welfare. Codes of practice provide dairy producers with best practice guidance for the care and handling of their cattle. New Canadian recommendations have been established for the dairy industry. The objectives of this study were to develop an on-farm assessment tool that helps producers assess how well they are meeting their code of practice and that identifies management and environment modifications that could improve dairy cow comfort on their farms. The assessment tool addressed critical areas of dairy cow comfort, including accommodation and housing (stall design, space allowance, stall management, pen management, milking parlor, and transfer alleys), feed and water (body condition scoring, nutrition), and health and welfare (lameness, claw health, and hoof-trimming). Targets of good practices were identified from the requirements and recommendations of the code of practice. Each farm received a score for each target, ranging from 0 (target not reached) to 100 (target reached). One hundred tiestall and 110 freestall farms were surveyed in 3 provinces of Canada (Quebec, Ontario, and Alberta). The duration of the assessment, in 2 visits lasting, on average, 8 and 9h (range between freestall and tiestall farms) and 4 and 4.1h, was beyond the targeted 3 to 4h due mainly to the animal-based measures; strategies to reduce the duration of the assessment were discussed. Standard operating procedures were developed to ensure consistency in measuring and recording data. Periodical checks were conducted by trainers to ensure all 15 assessors remained above target agreement of weighted kappa ≥0.6. Average scores for all critical areas ranged from 25 to 89% for freestall farms and from 48 to 95% for tiestall farms. These scores need to be considered with caution when comparing farms because scores could not always be calculated the same way between housing systems. An evaluation report was provided and discussed with each producer, identifying strengths and areas for improvement that could benefit dairy cow comfort on their farms. The producers were convinced of the effectiveness of our tool for assessing cow comfort (freestall: 86%; tiestall: 95%) and in assisting them to make decisions for improvements (freestall: 83%; tiestall: 93%). Our cow comfort assessment tool served as background material for the Dairy Farmers of Canada animal care assessment program.

Cultivation can increase harvesting pressure on overexploited plant populations.

Captive breeding and cultivation of overharvested species is frequently proposed as a conservation strategy, yet there is little evidence under what conditions, if at all, the strategy is effective. We created a bioeconomic model to investigate the socioeconomic conditions favoring cultivation over wild harvesting and likely impacts on the wild population. We parameterize the model with the case study of illegal xaté palm (Chamaedorea ernesti-augusti) harvesting in Belize and Guatemala. We examine how changes in law enforcement, a price premium for cultivated leaf, land ownership, and alternative income might affect decisions to cultivate and the impact of cultivation on wild populations. We show that those switching to cultivation are largely not wild harvesters because of barriers such as land ownership. We also find that if harvesters do switch to cultivation, they may have a negative effect on the wild population through harvesting of material to set up plantations. We found increasing alternative income reduces harvesting pressure and suggests the provision of alternative livelihoods would more directly reduce pressure on the wild population. Although schemes to encourage cultivation seem an appealing conservation intervention, we urge caution in assuming that people will readily adopt cultivation of wild harvested species or that this would necessarily reduce impacts on wild populations.

Prevalence of and factors associated with hock, knee, and neck injuries on dairy cows in freestall housing in Canada.

Injuries are a widespread problem in the dairy industry. The objective of this study was to determine the prevalence of and explore the animal-based and environmental factors associated with hock, knee, and neck injuries on dairy cows in freestall housing in Ontario and Alberta, Canada. Freestall dairy farms in the provinces of Ontario (n=40) and Alberta (n=50) were visited for cross-sectional data collection. A purposive sample of 40 lactating Holstein cows was selected for detailed observation on each farm. Cows were scored for hock, knee, and neck injuries on a 3- or 4-point scale, combining the attributes of hair loss, broken skin, and swelling and with a higher score indicating a more severe injury. The highest hock and highest knee score were used in the analysis. Animal-based and environmental measures were taken to explore which factors were associated with injury. Overall, the prevalence of cows with at least one hock, knee, and neck injury was 47, 24, and 9%, respectively. Lame cows had a greater odds of hock injury [odds ratio (OR)=1.46] than nonlame cows, whereas cows with fewer days in milk (DIM) had reduced odds of hock injury compared with those >120 DIM (OR=0.47, 0.64, and 0.81 for <50, 50-82, and 83-120 DIM, respectively). The odds of hock injury was lower on sand (OR=0.07) and concrete (OR=0.44) stall bases in comparison to mattresses. Conversely, the odds of knee injury was greater on concrete (OR=3.19) stall bases compared with mattresses. Cows in parity 1 (OR=0.45 and 0.27 for knee and neck injury, respectively) and 2 (OR=0.49 and 0.40 for knee and neck injury, respectively) had lower odds of knee and neck injury compared with cows in parity 4+. Low feed rail heights increased the odds of neck injury (OR=76.71 for rails between 128 and 140 cm and OR=43.82 for rails ≤128 cm). The odds of knee injury was greater on farms where any cows were observed slipping or falling when moving into the holding area for milking (OR=2.69) and lower on farms with rubber flooring in the alley along the feed bunk compared with bare concrete floors (OR=0.19). These results demonstrate that individual animal characteristics, as well as barn design and animal management, are associated with hock, knee, and neck injuries. These data can help to guide investigations into causes and prevention of injuries.

Factors affecting temperature variation and habitat use in free-ranging diamondback terrapins.

Measuring the thermal conditions of aquatic reptiles with temperature dataloggers is a cost-effective way to study their behavior and habitat use. Temperature dataloggers are a particularly useful and informative approach to studying organisms such as the estuarine diamondback terrapin (Malaclemys terrapin) that inhabits a dynamic environment often inaccessible to researchers. We used carapace-mounted dataloggers to measure hourly carapace temperature (Tc) of free-ranging terrapins in South Carolina from October 2007 to 2008 to examine the effects of month, sex, creek site, and tide on Tc and to determine the effects of month, sex, and time of day on terrapin basking frequency. Simultaneous measurements of environmental temperatures (Te; shallow mud, deep mud, water) allowed us to make inferences about terrapin microhabitat use. Terrapin Tc differed significantly among months and creek and between sexes. Terrapin microhabitat use also varied monthly, with shallow mud temperature being the best predictor of Tc November-March and water temperature being the best predictor of Tc April-October. Terrapins basked most frequently in spring and fall and males basked more frequently than females. Our study contributes to a fuller understanding of terrapin thermal biology and provides support for using dataloggers to investigate behavior and habitat use of aquatic ectotherms inhabiting dynamic environments.

Understanding the Influence of Single Payer Health Insurance on Socioeconomic Disparities in Total Hip Arthroplasty (THA) Utilization: A Transnational Analysis.

OBJECTIVE: Access to care varies between countries. It is theorized that income-based disparities in access may be reduced in countries with universal health insurance relative to the United States, but data are currently limited. We hypothesized that income-based differences in total hip arthroplasty (THA) utilization and outcomes would be larger in the United States than in Canada. METHODS: We retrospectively compared all patients undergoing THA from 2012 to 2018 in Pennsylvania, the United States, and Ontario, Canada. We compared age-standardized and sex-standardized per-capita THA utilization in the United States and Canada overall and across different income strata, where income strata were defined by neighborhood income quintile. We also examined income-based differences in rates of 1-year revision, 90-day mortality, and 90-day readmission. RESULTS: Overall THA utilization per 10,000 people per year was higher across all income groups in Pennsylvania compared with Ontario (15.1 versus 8.8, P < 0.001 in lowest-income quintile; 21.4 versus 12.6, P < 0.001 in highest-income quintile). Income-based differences in utilization in the highest-income vs lowest-income quintile groups were greater in Ontario (43.2%) than Pennsylvania (41.7%). The adjusted odds for the lowest-income group compared with the highest-income group of 1-year revision were greater in Ontario compared with Pennsylvania (P = 0.03), and risk of 90-day mortality and 90-day readmission was similar between the regions. CONCLUSION: Income-based differences in THA utilization were more notable in Ontario than in Pennsylvania. In addition, patients in low-income communities in Ontario were at equal or greater risk relative to high-income community patients for adverse outcomes compared with patients in Pennsylvania. Income-based disparities in THA utilization and outcomes were smaller in the United States than in Canada, in contrast to what might be expected. LEVEL OF EVIDENCE: III.

QTLs associated with root traits increase yield in upland rice when transferred through marker-assisted selection.

Altering root morphology of rice (Oryza sativa L.) cultivars could improve yields in drought-prone upland ecosystems. Marker-assisted backcross breeding was used to introgress four QTLs for root traits into an upland rice cultivar. The QTLs had previously been identified under experimental conditions in a different genetic background. The introgressed lines and the recurrent parent were grown for 6 years by resource-poor farmers in upland sites in Eastern India and yields recorded. In combination the QTLs significantly increased yield by 1 t ha(-1) under relatively favourable field conditions. In less favourable trials, the QTL effects were not detected due to greater heterogeneity in soil-water availability in very low yielding environments and consequent yield variability. Root studies under controlled conditions showed that lines with the introgressions had longer roots throughout tillering than the recurrent parent (14 cm longer 2 weeks after sowing). Therefore, both improved roots and increased yield can be attributed to the introgression of QTLs. This is the first demonstration that marker-assisted backcross breeding (MABC) to introgress multiple root QTLs identified under controlled conditions is an effective strategy to improve farmers' yields of upland rice. The strategy was used to breed a novel upland rice cultivar that has been released in India as Birsa Vikas Dhan 111.

Development and implementation of a training program to ensure high repeatability of body condition scoring of dairy cows.

A body condition score (BCS) in dairy cattle is a subjective assessment of the proportion of body fat that she possesses and is a common measure used in animal welfare assessment. The objectives of our study were to develop and implement a training program to produce highly repeatable BCS by many assessors as part of a cross-Canada epidemiological study on dairy cow comfort and welfare. In preliminary studies, we established that without any proper standard operating procedures (SOP) to describe the practical steps of the process and good standard reference for each score, assessors provided with a BCS chart scored with each other only with substantial agreement within 0.5 points and moderate agreement on exact score (mean weighted kappa coefficient=0.79 and 0.46, respectively). Detailed SOP were developed to assess BCS in 4 locations on a dairy farm. Assessing BCS presented more challenges in some locations (when cows exited the milking parlor, when the assessor was located outside the freestall pen) than others (when cows were headlocked at the feed bunk, when assessor was located inside the freestall pen). Additionally, training material and a training procedure were developed to ensure that future assessors would achieve almost perfect repeatability with the trainer within 0.5 points (weighted kappa coefficient >0.80). Twelve trainees followed this training and their repeatability was assessed using photographs in classroom sessions and live observations on farm over a 1-wk period. Repeatability was maintained above target agreement at periodic checks over the 6 mo of on-farm data collection. Two trainers were used as a reference standard to which all trainees were compared. This study demonstrates that to obtain reliable measures, a training program must include validated procedures to help assessors cope with a variety of farm setups. Regular repeatability checks are essential to ensure that the reference standard is maintained over time and to secure high data quality. This method to develop a training program as well as the training program implemented can be used as a model to successfully train on-farm assessors.

Racial Differences in Patient Satisfaction With the Hospital Experience Undergoing Primary Unilateral Hip and Knee Arthroplasty: A Retrospective Study.

Background: Press Ganey (PG) inpatient survey is widely used to track patient satisfaction with the hospital experience. Our aim was to use the PG survey to determine if there are racial differences in overall hospital experience and perception of nurses and surgeons following hip and knee arthroplasty. Methods: We retrospectively analyzed Black and White patients from hip and knee arthroplasty registries from a single institution between July 2010 and February 2012. The overall assessment score for the hospital experience and perception of the nurse and surgeon questions from the PG inpatient survey were dichotomized as "not completely satisfied" or "completely satisfied". Multivariable logistic regression models were developed to determine the impact of race on the likelihood of being 'completely satisfied' in the hip and knee cohorts. Results: There were 2517 hip and 2114 knee patients who underwent surgery and completed the PG survey, of whom 3.9% were Black and 96.0% were White. Black patients were less likely to be completely satisfied with their hospital experience compared to White patients in the hip (odds ratio 0.62, confidence interval 0.39-1.00, P = .049) and knee (odds ratio 0.52, confidence interval 0.33-0.82, P = .005) cohorts. Black patients were also less likely to be completely satisfied with multiple aspects of care they received from the nurse and surgeon in both cohorts. Conclusions: We found that the PG Survey shows Black patients were less likely to be completely satisfied than White patients with the hospital experience, including their interactions with nurses and surgeons. More work is needed to understand this difference.

Machine learning identification of thresholds to discriminate osteoarthritis and rheumatoid arthritis synovial inflammation.

BACKGROUND: We sought to identify features that distinguish osteoarthritis (OA) and rheumatoid arthritis (RA) hematoxylin and eosin (H&E)-stained synovial tissue samples. METHODS: We compared fourteen pathologist-scored histology features and computer vision-quantified cell density (147 OA and 60 RA patients) in H&E-stained synovial tissue samples from total knee replacement (TKR) explants. A random forest model was trained using disease state (OA vs RA) as a classifier and histology features and/or computer vision-quantified cell density as inputs. RESULTS: Synovium from OA patients had increased mast cells and fibrosis (p < 0.001), while synovium from RA patients exhibited increased lymphocytic inflammation, lining hyperplasia, neutrophils, detritus, plasma cells, binucleate plasma cells, sub-lining giant cells, fibrin (all p < 0.001), Russell bodies (p = 0.019), and synovial lining giant cells (p = 0.003). Fourteen pathologist-scored features allowed for discrimination between OA and RA, producing a micro-averaged area under the receiver operating curve (micro-AUC) of 0.85±0.06. This discriminatory ability was comparable to that of computer vision cell density alone (micro-AUC = 0.87±0.04). Combining the pathologist scores with the cell density metric improved the discriminatory power of the model (micro-AUC = 0.92±0.06). The optimal cell density threshold to distinguish OA from RA synovium was 3400 cells/mm2, which yielded a sensitivity of 0.82 and specificity of 0.82. CONCLUSIONS: H&E-stained images of TKR explant synovium can be correctly classified as OA or RA in 82% of samples. Cell density greater than 3400 cells/mm2 and the presence of mast cells and fibrosis are the most important features for making this distinction.