Enhanced visible light driven photodegradation of rifampicin and Cr(VI) reduction activity of ultra-thin ZnO nanosheets/CuCo2S4QDs: A mechanistic insights, degradation pathway and toxicity assessment.

In this study, we focused on fabrication of porous ultra-thin ZnO nanosheet (PUNs)/CuCo2S4 quantum dots (CCS QDs) for visible light-driven photodegradation of rifampicin (RIF) and Cr(VI) reduction. The morphology, structural, optical and textural properties of fabricated photocatalyst were critically analyzed with different analytical and spectroscopic techniques. An exceptionally high RIF degradation (99.97%) and maximum hexavalent Cr(VI) reduction (96.17%) under visible light was achieved at 10 wt% CCS QDs loaded ZnO, which is 213% and 517% greater than bare ZnO PUNs. This enhancement attributed to the improved visible light absorption, interfacial synergistic effect, and high surface-rich active sites. Extremely high generation of ●OH attributed to the spin-orbit coupling in ZnO PUNs@CCS QDs and the existence of oxygen vacancies. Besides, the ZnOPUNs@CCS QDs, forming Z-scheme heterojunctions, enhanced the separation of photogenerated charge carriers. We investigated the influencing factors such as pH, inorganic ions, catalyst dosage and drug dosage on the degradation process. More impressively, a stable performance of ZnO PUNs@CCS QDs obtained even after six consecutive degradation (85.9%) and Cr(VI) reduction (67.7%) cycles. Furthermore, the toxicity of intermediates produced during the photodegradation process were assessed using ECOSAR program. This work provides a new strategy for ZnO-based photocatalysis as a promising candidate for the treatment of various contaminants present in water bodies.

Assessment of Dialysis Adequacy Using Small Solute Clearance Indices among Twice versus Thrice Weekly Maintenance Hemodialysis Patients in a Tertiary Care Hospital of Bangladesh.

This observational study was carried out in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020. A total of 179 patients were included in this study according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients were underwent detail history taking, thorough physical examination and relevant investigations. Data collection was conducted through a structured questionnaire. Collected data were analyzed using the statistical software SPSS 23.0. Mean age ±SD of the study patients was 47.06±14.1 with a majority in age group 41-50 years. Male predominance was observed with a male: female ratio of 2.19:1 and 68.7% male patients. Level of pre-dialysis, post-dialysis urea in the study population was 123.77±26.86mg/dl, 50.27±15.70mg/dl respectively and mean ±SD of Urea Reduction Ratio (URR) in hemodialysis (target >65.0%) was 67.2±1.9. Most of the 8 hours (two times) per week hemolysis patients could not achieve the target value of dialysis adequacy parameters. On the other hand, maximum people in 12 hours (three times) per week hemodialysis group achieved the target value of dialysis adequacy parameters. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.

Assessment of anthropogenic-causing-agents act on waterbirds-diversity in the vicinity of Tarbela Dam, Indus River, Pakistan

Abstract Birds are among the best bio-indicators, which can guide us to recognize some of the main conservation concerns in ecosystems. Anthropogenic impacts such as deforestation, habitat degradation, modification of landscapes, and decreased quality of habitats are major threats to bird diversity. The present study was designed to detect anthropogenic causative agents that act on waterbird diversity in Tarbella Dam, Indus River, Pakistan. Waterbird censuses were carried out from March 2019 to February 2020 in multiple areas around the dam. A total of 2990 waterbirds representing 63 species were recorded. We detected the highest waterbird richness and diversity at Pehure whereas the highest density was recorded at Kabbal. Human activity impacts seemed to be the main factor determining the waterbird communities as waterbirds were negatively correlated with the greatest anthropogenic impacts. Waterbirds seem to respond rapidly to human disturbance.

Resumo As aves estão entre os melhores bioindicadores, o que pode nos orientar a reconhecer algumas das principais preocupações de conservação dos ecossistemas. Impactos antrópicos como desmatamento, degradação de habitat, modificação de paisagens e diminuição da qualidade dos habitats são as principais ameaças à diversidade de aves. O presente estudo foi desenhado para detectar agentes causadores antropogênicos que atuam na diversidade de aves aquáticas na Represa de Tarbella, rio Indus, Paquistão. Censos de aves aquáticas foram realizados de março de 2019 a fevereiro de 2020 em várias áreas ao redor da barragem. Um total de 2.990 aves aquáticas representando 63 espécies foi registrado. Detectamos a maior riqueza e diversidade de aves aquáticas em Pehure, enquanto a maior densidade foi registrada em Kabbal. Os impactos da atividade humana parecem ser o principal fator determinante das comunidades de aves aquáticas, uma vez que as aves aquáticas foram negativamente correlacionadas com os maiores impactos antrópicos. As aves aquáticas parecem responder rapidamente às perturbações humanas.

Assessment of anthropogenic-causing-agents act on waterbirds-diversity in the vicinity of Tarbela Dam, Indus River, Pakistan / Avaliação de agentes antropogênicos que agem na diversidade de aves aquáticas nas proximidades da Represa de Tarbela, rio Indus, Paquistão

Abstract Birds are among the best bio-indicators, which can guide us to recognize some of the main conservation concerns in ecosystems. Anthropogenic impacts such as deforestation, habitat degradation, modification of landscapes, and decreased quality of habitats are major threats to bird diversity. The present study was designed to detect anthropogenic causative agents that act on waterbird diversity in Tarbella Dam, Indus River, Pakistan. Waterbird censuses were carried out from March 2019 to February 2020 in multiple areas around the dam. A total of 2990 waterbirds representing 63 species were recorded. We detected the highest waterbird richness and diversity at Pehure whereas the highest density was recorded at Kabbal. Human activity impacts seemed to be the main factor determining the waterbird communities as waterbirds were negatively correlated with the greatest anthropogenic impacts. Waterbirds seem to respond rapidly to human disturbance.

Resumo As aves estão entre os melhores bioindicadores, o que pode nos orientar a reconhecer algumas das principais preocupações de conservação dos ecossistemas. Impactos antrópicos como desmatamento, degradação de habitat, modificação de paisagens e diminuição da qualidade dos habitats são as principais ameaças à diversidade de aves. O presente estudo foi desenhado para detectar agentes causadores antropogênicos que atuam na diversidade de aves aquáticas na Represa de Tarbella, rio Indus, Paquistão. Censos de aves aquáticas foram realizados de março de 2019 a fevereiro de 2020 em várias áreas ao redor da barragem. Um total de 2.990 aves aquáticas representando 63 espécies foi registrado. Detectamos a maior riqueza e diversidade de aves aquáticas em Pehure, enquanto a maior densidade foi registrada em Kabbal. Os impactos da atividade humana parecem ser o principal fator determinante das comunidades de aves aquáticas, uma vez que as aves aquáticas foram negativamente correlacionadas com os maiores impactos antrópicos. As aves aquáticas parecem responder rapidamente às perturbações humanas.

Robust visible light active CoNiO2-BiFeO3-NiS ternary nanocomposite for photo-fenton degradation of rhodamine B and methyl orange: Kinetics, degradation pathway and toxicity assessment.

Sustainable wastewater treatment is crucial to remediate the water pollutants through the development of highly efficient, low-cost and separation free photocatalyst. The aim of this study is to construct a novel CoNiO2-BiFeO3-NiS ternary nanocomposite (NCs) for the efficient degradation of organic pollutants by utilising visible light. The NCs was characterized by various physiochemical techniques, including HR-TEM, SEM, XPS, FT-IR, ESR, EIS, PL, UV-visible DRS, and N2 adsorption and desorption analysis. The photocatalyst exhibits extraordinary degradation efficiency towards MO (99.8%) and RhB (97.8%). The intermediates were determined using GC-MS analysis and the degradation pathway was elucidated. The complete mineralization was further confirmed by TOC analysis. The CoNiO2-BiFeO3-NiS ternary NCs have shown excellent photostability, structural stability and reusability even after six cycles and it is confirmed by XRD and XPS analysis. The kinetic study reveals that the photodegradation of the dyes follows first order reaction. The influence of different pH, dye concentrations and NCs dosages were investigated. The intermediate toxicity was predicted by computational stimulation using ECOSAR software. The NCs shows promising potential for ecological safety which demonstrates its practical application in the treatment of waste water pollutants in large scale.

Assessment of early morning serum cortisol levels in adult male patients with alcohol-related disorders.

BACKGROUND: Alcohol-related disorders are a major health problem among Indian male professionals because of the unique nature of socioeconomic and demographic conditions. Various studies have highlighted the association between alcohol-related disorders and hypothalamic-pituitary-adrenal (HPA) axis dysfunction, but the evidence accrued so far is inconclusive. In our study, we have assessed early morning serum total cortisol concentration among Indian adult male population affected with alcohol-related disorder. METHODS: A case-based cross-sectional study in which all consecutive patients admitted in the psychiatry ward of a tertiary care hospital with diagnosis of 'alcohol-related disorders', who were meeting all the inclusion criteria, and who had none of the exclusion criteria were part of the study. Diseased controls and healthy controls were chosen by applying strict inclusion and exclusion criteria. Serum early morning (0400 h) total cortisol levels were estimated using automated quantitative enzyme-linked fluorescent assay technique. RESULTS: 98 psychiatric patients and 50 healthy controls were evaluated. Out of these 98 patients 66 patients were diagnosed cases of alcohol-related disorder. Morning serum total cortisol levels in patients with alcohol-related disorders was found to be significantly different from healthy controls. CONCLUSION: Our study suggests that alcohol-related disorders are associated with chronic changes in HPA axis and significant alteration of early morning serum total cortisol levels were demonstrated in this group of patients.

Physicochemical features, functional characteristics, and health benefits of cottonseed oil: a review / Benefícios à saúde humana e características físico-químicas e funcionais do óleo de semente de algodão: uma revisão

Vegetable oils have their specific physicochemical properties due to which they are playing vital role in human nutritional diet for health benefits. Cottonseed oil is obtained from various species of cotton seeds that are famous to be grown mainly for their fiber quality. The most prominently used specie is Gossypium hirsutum. It is obvious that the seeds of different variety of cotton vary as grown in diverse agroclimatic conditions with respect to oil, fats and protein contents. Cottonseed oil is routinely used for cooking and food manufacturing products. Cottonseed oil obtained after proper extraction/processing steps from crude state to refined oil in a variety of ways. Cotton crop is considered for their dual-use purpose, for fiber quality and oil production to promote health benefits in the world. Keeping in view the above facts, this review clearly demonstrated an overview about physicochemical and functional properties of cottonseed oil to promote health benefits associated with the use of this oil. The overall characteristics and all concerned health benefits of CSO will further improve their usefulness is a compact way. We have summarized a brief multi-dimensional features of CSO in all aspects up to the best of our knowledge for the end researchers who can further research in the respective aspect.

Os óleos vegetais têm propriedades físico-químicas específicas que desempenham um papel vital na dieta nutricional humana em benefício à saúde. O óleo de semente de algodão, utilizado rotineiramente no preparo e na fabricação de alimentos, é obtido através de várias espécies de sementes de algodão, famosas pela alta qualidade de sua fibra., cuja espécie mais utilizada é Gossypium hirsutum. As sementes variam, em relação ao teor do óleo, da gordura e das proteínas, de acordo com o cultivo e as diversas condições agroclimáticas. O óleo de algodão é obtido após etapas adequadas de extração das sementes e processamento do estado bruto ao refinado. Assim, a presente revisão demonstra, de maneira geral, as propriedades físico-químicas e funcionais do óleo de semente de algodão e seus benefícios à saúde humana, resumindo suas características multidimensionais. As características gerais e todos os benefícios do composto podem melhorar ainda mais se utilizadas de forma compacta, auxiliando futuros pesquisadores.

Assessment of anthropogenic-causing-agents act on waterbirds-diversity in the vicinity of Tarbela Dam, Indus River, Pakistan.

Birds are among the best bio-indicators, which can guide us to recognize some of the main conservation concerns in ecosystems. Anthropogenic impacts such as deforestation, habitat degradation, modification of landscapes, and decreased quality of habitats are major threats to bird diversity. The present study was designed to detect anthropogenic causative agents that act on waterbird diversity in Tarbella Dam, Indus River, Pakistan. Waterbird censuses were carried out from March 2019 to February 2020 in multiple areas around the dam. A total of 2990 waterbirds representing 63 species were recorded. We detected the highest waterbird richness and diversity at Pehure whereas the highest density was recorded at Kabbal. Human activity impacts seemed to be the main factor determining the waterbird communities as waterbirds were negatively correlated with the greatest anthropogenic impacts. Waterbirds seem to respond rapidly to human disturbance.

Physicochemical features, functional characteristics, and health benefits of cottonseed oil: a review.

Vegetable oils have their specific physicochemical properties due to which they are playing vital role in human nutritional diet for health benefits. Cottonseed oil is obtained from various species of cotton seeds that are famous to be grown mainly for their fiber quality. The most prominently used specie is Gossypium hirsutum. It is obvious that the seeds of different variety of cotton vary as grown in diverse agroclimatic conditions with respect to oil, fats and protein contents. Cottonseed oil is routinely used for cooking and food manufacturing products. Cottonseed oil obtained after proper extraction/processing steps from crude state to refined oil in a variety of ways. Cotton crop is considered for their dual-use purpose, for fiber quality and oil production to promote health benefits in the world. Keeping in view the above facts, this review clearly demonstrated an overview about physicochemical and functional properties of cottonseed oil to promote health benefits associated with the use of this oil. The overall characteristics and all concerned health benefits of CSO will further improve their usefulness is a compact way. We have summarized a brief multi-dimensional features of CSO in all aspects up to the best of our knowledge for the end researchers who can further research in the respective aspect.

COVID-19: lessons learnt and priorities in trauma and orthopaedic surgery.

The COVID-19 pandemic is the most serious health crisis of our time. Global public measures have been enacted to try to prevent healthcare systems from being overwhelmed. The trauma and orthopaedic (T&O) community has overcome challenges in order to continue to deliver acute trauma care to patients and plan for challenges ahead. This review explores the lessons learnt, the priorities and the controversies that the T&O community has faced during the crisis. Historically, the experience of major incidents in T&O has focused on mass casualty events. The current pandemic requires a different approach to resource management in order to create a long-term, system-sustaining model of care alongside a move towards resource balancing and facilitation. Significant limitations in theatre access, anaesthetists and bed capacity have necessitated adaptation. Strategic changes to trauma networks and risk mitigation allowed for ongoing surgical treatment of trauma. Outpatient care was reformed with the uptake of technology. The return to elective surgery requires careful planning, restructuring of elective pathways and risk management. Despite the hope that mass vaccination will lift the pressure on bed capacity and on bleak economic forecasts, the orthopaedic community must readjust its focus to meet the challenge of huge backlogs in elective caseloads before looking to the future with a robust strategy of integrated resilient pathways. The pandemic will provide the impetus for research that defines essential interventions and facilitates the implementation of strategies to overcome current barriers and to prepare for future crises.

The global landscape of availability, accessibility and affordability of essential diagnostics and therapeutics for the management of HER2-positive breast cancer: The ONCOLLEGE-001 survey.

AIM OF THE STUDY: Barriers in access to essential care are key determinants of disparities in cancer survival. Breast cancer (BC) is the most common cancer and lead cause of mortality among women, 60 % occurring in low- and middle-income countries (LMs). A quarter of BC are characterized by an over-expression of the epidermal growth factor receptor 2 (HER2). Valuable strategies to diagnose and manage patients with HER2-positive BC have been determined and some considered essential health interventions. ONCOLLEGE-001 is a global survey of availability, accessibility, and affordability of essential HER2 diagnostics and therapeutics. METHOD: A self-administered questionnaire was shared electronically to oncologists, identified from oncology networks. Data were analyzed using descriptive statistics, per income areas and geographic regions. RESULTS: We received 191 responses (84 % response rate). The majority of the responders were from LMs (n = 153) and were physician providers. Immunohistochemistry was the most common HER2 diagnostics available (n = 185). A third of the responders from low/lower-middle and a half of upper-middle income countries had HER2 testing only in the private sector. Trastuzumab was not available for 8 %: when available, 15%-21% reported accessibility only as out-of-pocket expenditure; when not reimbursed, only 10 % of the providers could significantly offer this intervention. Availability of trastuzumab biosimilars was reported in more than a half of the responders (n = 107). CONCLUSION: Stark disparities are reported, with high out-of-pocket expenses for HER2 testing and significant financial barriers to access trastuzumab treatments. Policy solutions are urgently warranted for the selection, prioritization, and reimbursement of essential health interventions, to result in improved population health. POLICY SUMMARY STATEMENT: the inclusion of essential services for cancer management should be assured and financed in the benefit packages of healthcare to all. Prioritizing high-value health interventions, including medicines and medical devices, is critical to deliver impactful programs on population health.

COPD burden on sexual well-being.

BACKGROUND: Sexual function is often affected in patients suffering from chronic diseases especially chronic obstructive pulmonary disease (COPD). However, the effect of COPD on sexual satisfaction is underappreciated in clinical practice. The aim of this study is to evaluate the impact of COPD on patient's sexuality and the explanatory variables of sexual dissatisfaction. METHODS: Questionnaires were emailed to participants and they submitted their responses on the Santé Respiratoire France website. Data about sexual well-being (Arizona Sexual Experience Scale, ASEX), Quality of life (VQ11), anxiety, depression (Hospitalized anxiety and depression, HAD) and self-declared COPD grade were collected. RESULTS: Seven hundred and fifty one subjects were included and were characterized as follows: women-51%, mean age-61 years, in a couple-62% and 70%-retired. Every grade of COPD was represented. Out of 751 participants, 301 participants (40%) had no sexual activity and 450 (60%) had sexual activity. From the 450 participants, 60% needed to change their sexual life because of their disease (rhythm, frequency and position). Subjects often used medications to improve sexual performance (43% used short-acting bronchodilator and 13% -specific erectile dysfunction drugs). ASEX questionnaire confirmed patients' dissatisfaction (diminution of sexual appetite for 68% and sexual desire for 60%) because of breathlessness and fatigue. Eighty one percent of the responders had an altered quality of life (VQ11 mean score 35) and frequent suspected anxiety or depression (HAD mean score 10.8). Ninety percent declared that sexual dysfunction had never been discussed by their doctors, while 36% of patients would have preferred to undergo a specialized consultation. CONCLUSION: Sexual dysfunction is frequent among COPD patients and leads to an altered well-being, however being a cultural taboo, it remains frequently neglected. Sexual guidance should be a part of patient's consultations improve quality of sexual life.

EMA-amplicon-based sequencing informs risk assessment analysis of water treatment systems.

Illumina amplicon-based sequencing was coupled with ethidium monoazide bromide (EMA) pre-treatment to monitor the total viable bacterial community and subsequently identify and prioritise the target organisms for the health risk assessment of the untreated rainwater and rainwater treated using large-volume batch solar reactor prototypes installed in an informal settlement and rural farming community. Taxonomic assignments indicated that Legionella and Pseudomonas were the most frequently detected genera containing opportunistic bacterial pathogens in the untreated and treated rainwater at both sites. Additionally, Mycobacterium, Clostridium sensu stricto and Escherichia/Shigella displayed high (≥80%) detection frequencies in the untreated and/or treated rainwater samples at one or both sites. Numerous exposure scenarios (e.g. drinking, cleaning) were subsequently investigated and the health risk of using untreated and solar reactor treated rainwater in developing countries was quantified based on the presence of L. pneumophila, P. aeruginosa and E. coli. The solar reactor prototypes were able to reduce the health risk associated with E. coli and P. aeruginosa to below the 1 × 10-4 annual benchmark limit for all the non-potable uses of rainwater within the target communities (exception of showering for E. coli). However, the risk associated with intentional drinking of untreated or treated rainwater exceeded the benchmark limit (E. coli and P. aeruginosa). Additionally, while the solar reactor treatment reduced the risk associated with garden hosing and showering based on the presence of L. pneumophila, the risk estimates for both activities still exceeded the annual benchmark limit. The large-volume batch solar reactor prototypes were thus able to reduce the risk posed by the target bacteria for non-potable activities rainwater is commonly used for in water scarce regions of sub-Saharan Africa. This study highlights the need to assess water treatment systems in field trials using QMRA.

A skin disease and needs assessment analysis of the displaced Rohingya population in the Kutupalong refugee camp, Bangladesh.

The physical, psychological and financial burden of skin disease in low- to middle-income countries, where access to skincare is limited, is poorly understood. A group that we know very little about in this regard are refugees. There are limited data on the range of skin diseases and skincare needs of this group. To better understand the skincare needs of the displaced Rohingya population residing in the Kutupalong refugee camp, Bangladesh, we collected data on demographics, living conditions and range of dermatoses. In the 380 patients assessed, fungal skin infections, predominantly dermatophytes, were by far the most common skin disease seen (n = 215), followed by dermatitis (n = 81). Skin disease can be the presenting feature in many systemic conditions and may cause significant secondary complications itself. Developing a better understanding of the skincare needs of the refugee population is essential for future healthcare planning for this vulnerable group.

Assessment of predatory bacteria and prey interactions using culture-based methods and EMA-qPCR.

Traditional culture-based enumeration methods were compared with the ethidium monoazide quantitative polymerase chain reaction (EMA-qPCR) technique to assess Bdellovibrio-and-like-organisms (BALOs) predator-prey interactions. Gram-negative [Pseudomonas spp. and Klebsiella pneumoniae (K. pneumoniae)] and Gram-positive [Staphylococcus aureus (S. aureus) and Enterococcus faecium (E. faecium)] organisms were employed as prey cells, while a Bdellovibrio bacteriovorus strain (PF13) was used as the predator. The co-culture experiments were also compared in diluted nutrient broth (DNB) and HEPES buffer. In both media, K. pneumoniae (maximum log reduction of 5.13) and Pseudomonas fluorescens (P. fluorescens) (maximum log reduction of 4.21) were sensitive to predation by B. bacteriovorus PF13 as their cell counts and gene copies were reduced during all the co-culture experiments, while the concentration of B. bacteriovorus PF13 increased. The concentration of B. bacteriovorus PF13 also increased in the presence of S. aureus (HEPES buffer) and E. faecium (DNB), indicating that the predator interacted with these Gram-positive prey in order to survive. Moreover, as no predator plaques were produced in the co-culture experiments with P. aeruginosa (DNB and HEPES buffer), S. aureus (DNB and HEPES buffer) and E. faecium (HEPES buffer), EMA-qPCR proved to be beneficial in monitoring the concentration of B. bacteriovorus. In conclusion, the cell counts and/or EMA-qPCR analysis for the HEPES buffer and DNB assays were successfully employed to monitor the predation of P. fluorescens and K. pneumoniae by B. bacteriovorus, while E. faecium was sensitive to predation in DNB and S. aureus was sensitive to predation in HEPES buffer.

Simulation of H p (10) and effective dose received by the medical staff in interventional radiology procedures.

Interventional radiology and cardiology are widespread employed techniques for diagnosis and treatment of several pathologies because they avoid the majority of the side-effects associated with surgical treatments, but are known to increase the radiation exposure to patient and operators. In recent years many studies treated the exposure of the operators performing cardiological procedures. The aim of this work is to study the exposure condition of the medical staff in some selected interventional radiology procedures. The Monte Carlo simulations have been employed with anthropomorphic mathematical phantoms reproducing the irradiation scenario of the medical staff with two operators and the patient. A personal dosemeter, put on apron, was modelled for comparison with measurements performed in hospitals, done with electronic dosemeters, in a reduced number of interventional radiology practices. Within the limits associated to the use of numerical anthropomorphic models to mimic a complex interventional procedure, the personal dose equivalent, H p (10), was evaluated and normalised to the simulated Kerma-Area Product, KAP, value, indeed the effective dose has been calculated. The H p (10)/KAPvalue of the first operator is about 10 µSv/Gy.cm2, when ceiling shielding is not used. This value is calculated on the trunk and it varies of +/-30% moving the dosemeter to the waist or to the neck. The effective dose, normalised to the KAP value, varies between 0.03 and 0.4 µSv/Gy.cm2. Considering all the unavoidable approximation of this kind of investigations, the comparisons with hospital measurement and literature data showed a good agreement allowing to use of the present results for dosimetric characterisation of interventional radiology procedures.

Revision of an infected total hip arthroplasty: the need for the adjustment of risk in bundled payment models for revision arthroplasty.

AIMS: The aim of this study was to investigate the differences in 30-day outcomes between patients undergoing revision for an infected total hip arthroplasty (THA) compared with an aseptic revision THA. PATIENTS AND METHODS: This was a retrospective review of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, between 2012 and 2017, using Current Procedural Terminology (CPT) codes for patients undergoing a revision THA (27134, 27137, 27138). International Classification of Diseases Ninth Revision/Tenth Revision (ICD-9-CM, ICD-10-CM) diagnosis codes for infection of an implant or device were used to identify patients undergoing an infected revision THA. CPT-27132 coupled with ICD-9-CM/ICD-10-CM codes for infection were used to identify patients undergoing a two-stage revision. A total of 13 556 patients were included; 1606 (11.8%) underwent a revision THA due to infection and there were 11 951 (88.2%) aseptic revisions. RESULTS: Patients undergoing an infected revision had a significantly greater length of stay of more than three days (p < 0.001), higher odds of any 30-day complication (p < 0.001), readmission within 30 days (p < 0.001), 30-day reoperations (p < 0.001), and discharge to a destination other than the patient's home (p < 0.001). CONCLUSION: The findings suggest the need for enhanced risk adjustment based on the indication of revision THA prior to setting prices in bundled payment models of total joint arthroplasty. This risk adjustment should be used to reduce the chance of financial disincentives in clinical practice. Cite this article: Bone Joint J 2019;101-B:547-551.

A microbiological assessment of sterile surgical helmet systems using particle counts and culture plates: recommendations for safe use whilst scrubbing.

BACKGROUND: Infection occurs in 2-4% of arthroplasty cases, and identifying potential sources of infection can help to reduce infection rates. The aim of this study was to identify the impact and potential for the contamination of hands and gowns whilst scrubbing using sterile surgical helmet systems (SSHSs). METHODS: A colony-forming unit (cfu) is a pathogenic particle of 0.5-5 µm. Standard arthroplasty hoods and SSHSs, with and without the fan switched on, were tested for a 3-min exposure (to represent scrubbing time) on three subjects and a mannequin with concurrent particle counts and culture plates. RESULTS: All SSHSs were positive for Gram-positive cocci, with a mean colony count of 410 cfu/m2. Background counts were lower for laminar flow areas [mean 0.7 particles/m3; 95% confidence interval (CI) 0-1.4] than scrub areas (mean 131.5 particles/m3; 95% CI 123.5-137.9; P=0.0003). However, neither grew any bacteria with a 2-min exposure. The background count increased 3.7 times with the fan switched on (total P=0.004, cfu P=0.047), and all helmets had positive cultures (mean 36 cfu/m2). There were no positive cultures with the standard arthroplasty hood or the SSHS with the fan switched off. In laminar flow areas, all cultures were negative and particle counts were low. CONCLUSIONS: Sterile gloves and gowns can be contaminated when scrubbing with the SSHS fan switched on. It is recommended that the fan should remain switched off when scrubbing until the hood and gown are in place, ideally in a laminar flow environment.