High intraoperative accuracy and low complication rate of computer-assisted navigation of the glenoid in total shoulder arthroplasty.

BACKGROUND: Preoperative planning software with intraoperative guidance technology is increasingly being used to manage complex glenoid deformity in anatomic total shoulder arthroplasty (TSA) and reverse TSA. The aim of this study was to review the intraoperative efficacy and complications of computer-assisted navigation (CAN) surgery for the treatment of glenoid deformity in TSA. METHODS: We performed a retrospective review of all TSAs implanted using a single computer navigation shoulder system. All patients underwent preoperative planning with computed tomography-based preoperative planning software. The starting point on the glenoid and the final version and inclination of the central post (cage) of the glenoid component were reviewed on the intraoperative navigation guidance report and compared with these parameters on the preoperative plan for each patient. The intraoperative accuracy of CAN for glenoid positioning was determined by the deviation of the starting point and final position of the central cage drill in the glenoid compared with the preoperative plan. Data regarding intraoperative complications and the number of times the navigation system was abandoned intraoperatively were collected. RESULTS: A total of 16,723 anatomic TSAs and reverse TSAs performed worldwide with the aforementioned navigation system were included in this review. In 16,368 cases (98%), every step of the navigation procedure was completed without abandoning use of the system intraoperatively. There was minimal deviation in the intraoperative execution of the preoperative plan with respect to version (0.6° ± 1.96°), inclination (0.2° ± 2.04°), and the starting point on the glenoid face (1.90 ± 1.2 mm). In this cohort, 9 coracoid fractures (0.05%) were reported. CONCLUSION AND DISCUSSION: This study demonstrates the safety and efficacy of CAN for glenoid implantation in TSA. Future studies should focus on assessing the impact of CAN on the longevity and survival of glenoid components and improving the cost-effectiveness of this technology.

Two-year clinical outcomes and complication rates in anatomic and reverse shoulder arthroplasty implanted with Exactech GPS intraoperative navigation.

INTRODUCTION: We compared the 2-year clinical outcomes of both anatomic and reverse total shoulder arthroplasty (ATSA and RTSA) using intraoperative navigation compared to traditional positioning techniques. We also examined the effect of glenoid implant retroversion on clinical outcomes. HYPOTHESIS: In both ATSA and RTSA, computer navigation would be associated with equal or better outcomes with fewer complications. Final glenoid version and degree of correction would not show outcome differences. MATERIAL AND METHODS: A total of 216 ATSAs and 533 RTSAs were performed using preoperative planning and intraoperative navigation with a minimum of 2-year follow-up. Matched cohorts (2:1) for age, gender, and follow-up for cases without intraoperative navigation were compared using all standard shoulder arthroplasty clinical outcome metrics. Two subanalyses were performed on navigated cases comparing glenoids positioned greater or less than 10° of retroversion and glenoids corrected more or less than 15°. RESULTS: For ASTA, no statistical differences were found between the navigated and non-navigated cohorts for postoperative complications, glenoid implant loosening, or revision rate. No significant differences were seen in any of the ATSA outcome metrics besides higher internal and external rotation in the navigated cohort. For RTSA, the navigated cohort showed an ARR of 1.7% (95% CI 0%, 3.4%) for postoperative complications and 0.7% (95% CI 0.1%, 1.2%) for dislocations. No difference was found in the revision rate, glenoid implant loosening, acromial stress fracture rates, or scapular notching. Navigated RTSA patients demonstrated significant improvements over non-navigated patients in internal rotation, external rotation, maximum lifting weight, the Simple Shoulder Test (SST), Constant, and Shoulder Arthroplasty Smart (SAS) scores. For the navigated subcohorts, ATSA cases with a higher degree of final retroversion showed significant improvement in pain, Constant, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), SST, University of California-Los Angeles shoulder score (UCLA), and Shoulder Pain and Disability Index (SPADI) scores. No significant differences were found in the RTSA subcohort. Higher degrees of version correction showed improvement in external rotation, SST, and Constant scores for ATSA and forward elevation, internal rotation, pain, SST, Constant, ASES, UCLA, SPADI, and SAS scores for RTSA. CONCLUSION: The use of intraoperative navigation shoulder arthroplasty is safe, produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications. The effect of final implant position above or below 10° of glenoid retroversion and correction more or less than 15° does not negatively impact outcomes.

A Variational Quantum Linear Solver Application to Discrete Finite-Element Methods.

Finite-element methods are industry standards for finding numerical solutions to partial differential equations. However, the application scale remains pivotal to the practical use of these methods, even for modern-day supercomputers. Large, multi-scale applications, for example, can be limited by their requirement of prohibitively large linear system solutions. It is therefore worthwhile to investigate whether near-term quantum algorithms have the potential for offering any kind of advantage over classical linear solvers. In this study, we investigate the recently proposed variational quantum linear solver (VQLS) for discrete solutions to partial differential equations. This method was found to scale polylogarithmically with the linear system size, and the method can be implemented using shallow quantum circuits on noisy intermediate-scale quantum (NISQ) computers. Herein, we utilize the hybrid VQLS to solve both the steady Poisson equation and the time-dependent heat and wave equations.

Patient perspectives on ipilimumab across the melanoma treatment trajectory.

PURPOSE: Ipilimumab was the first FDA-approved agent for advanced melanoma to improve survival and represents a paradigm shift in melanoma and cancer treatment. Its unique toxicity profile and kinetics of treatment response raise novel patient education challenges. We assessed patient perceptions of ipilimumab therapy across the treatment trajectory. METHODS: Four patient cohorts were assessed at different time points relative to treatment initiation: (1) prior to initiation of ipilimumab (n = 10), (2) at weeks 10-12 before restaging studies (n = 11), (3) at week 12 following restaging studies indicating progression of disease (n = 10), and (4) at week 12 following restaging studies indicating either a radiographic response or disease stability (n = 10). Patients participated in a semistructured qualitative interview to assess their experiences with ipilimumab. Quality of life was assessed via the Functional Assessment of Cancer Therapy-General and its Melanoma-specific module. RESULTS: Perceived quality of life was comparable across cohorts, and a majority of the sample understood side effects from ipilimumab and the potential for a delayed treatment response. Patients without progression of disease following restaging studies at week 12 held more positive views regarding ipilimumab compared to patients who had progressed. CONCLUSION: Patients generally regarded ipilimumab positively despite the risk of unique toxicities and potential for delayed therapeutic responses; however, those with progression expressed uncertainty regarding whether taking ipilimumab was worthwhile. Physician communication practices and patient education regarding realistic expectations for therapeutic benefit as well as unique toxicities associated with ipilimumab should be developed so that patients can better understand the possible outcomes from treatment.

Monthly sampling reveals seasonal fine sediment fluctuations and riverine invertebrate community responses.

Managing the impacts of anthropogenically enhanced deposited fine sediment levels in lotic ecosystems requires understanding of how catchment land-use changes have altered the natural sediment regime (erosion, transport, deposition) of rivers. Unfortunately, no existing studies have employed an appropriate sampling frequency over a period encompassing the full range of seasonal flow conditions expected to influence in-stream sediment dynamics. We determined the short-term (monthly) dynamics of deposited fine sediment and invertebrate communities over 12-months in 15 fourth- and fifth-order rivers draining catchments of low, medium and high land-use intensity in Southland, New Zealand to determine when and where fine sediment threatens stream health. We compared the Quorer resuspension method (suspendable inorganic sediment, SIS) and the in-stream visual sediment cover assessment method, and evaluated the effectiveness of four commonly-used invertebrate stream health metrics against their newly developed sediment-specific counterparts. Monthly variability in SIS was substantial across all land-use categories, but became more pronounced as land-use intensity increased. All 15 sites experienced a prolonged period of relatively stable flow which coincided with the largest short-term increase in SIS at 14 of the 15 sites. However, variability in SIS was not mirrored in macroinvertebrate metrics. These findings suggest that controlling inputs of fine sediment to rivers and streams will be most effective when targeted at periods of prolonged stable flow, particularly within high land-use intensity catchments. The resuspension method consistently outperformed visual estimates when considering its relationship with macroinvertebrate metrics, while sediment-specific metrics demonstrated a stronger association with fine sediment than commonly employed metrics e.g. (%EPT). We conclude that restoration/mitigation practices cannot be based solely on short-term, or even long-term, reductions in fine sediment, or on physical measures alone, but should be based on long-term recoveries of sediment-impacted invertebrate communities using concurrent measurements of both biotic and abiotic conditions.

Impacts of increasing levels of salt on intake, digestion, and rumen fermentation with beef cattle consuming low-quality forages.

The objectives of this study were to evaluate the levels of supplemental salt on low-quality forage intake, water intake, dry matter digestibility, and rumen fermentation. Six ruminally cannulated, Angus crossbred heifers (14 mo of age; 449 kg ± 24 kg BW) were used in a dual 3 × 3 Latin square design. The heifers were housed in individual stalls with two animals assigned to each treatment per period. Salt treatments were mixed into a protein supplement of 50% cracked corn and 50% soybean meal and fed at 0.3% of shrunk BW. Salt treatments consisted of: 1) control, no salt (CON), 2) 0.05% of BW salt (LOW), and 3) 0.1% of BW salt (HIGH). Chopped, low-quality (CP = 7.4%; NDF = 64.2%), grass hay was used as the base ration and was provided daily at 120% of the average daily intake of the previous 3 days. Each period included a 14-day diet adaptation, 6 days of sample collection, 1 day collection of rumen fluid samples for ruminal and microbial profiles. Individual forage dry matter intake, water intake, and dry matter digestibility were measured during the 6-day collection period. Rumen pH, ammonia levels, and VFA concentrations were measured during the 1-day ruminal profile. Rumen DM and liquid fill were determined with a 5-hour post feeding rumen evacuation. Supplemental salt had no influence on forage intake (P = 0.19) expressed on a kg/day basis yet tended to decrease linearly (P = 0.06) with increasing levels of salt when expressed on a grams/kg body weight basis. Dry matter digestibility was not influenced by salt levels (P > 0.05), but DM fill tended to increase linearly with increasing salt levels (P = 0.06). Water intake and liquid fill, however, increased linearly with increasing level of salt (P < 0.01) with an 18.9% increase in water intake and 17.0% increase in liquid fill compared to control animals. Ruminal pH and ammonia levels both decreased linearly with increasing salt (P < 0.01). Acetate concentration and acetate: propionate ratio increased linearly with increasing levels of salt (P < 0.01). In contrast, isobutyrate and butyrate concentrations decreased linearly with increasing levels of salt (P < 0.01). Our research suggests that increasing levels of salt tends to influence dry matter intake, DM fill, liquid kinetics, and rumen fermentation characteristics. Results from this research provides additional information on how salt-limited supplements may impact beef cattle consuming low-quality forage diets.

Transcriptomic analyses of ovarian clear-cell carcinoma with concurrent endometriosis.

Introduction: Endometriosis, a benign inflammatory disease whereby endometrial-like tissue grows outside the uterus, is a risk factor for endometriosis-associated ovarian cancers. In particular, ovarian endometriomas, cystic lesions of deeply invasive endometriosis, are considered the precursor lesion for ovarian clear-cell carcinoma (OCCC). Methods: To explore this transcriptomic landscape, OCCC from women with pathology-proven concurrent endometriosis (n = 4) were compared to benign endometriomas (n = 4) by bulk RNA and small-RNA sequencing. Results: Analysis of protein-coding genes identified 2449 upregulated and 3131 downregulated protein-coding genes (DESeq2, P< 0.05, log2 fold-change > |1|) in OCCC with concurrent endometriosis compared to endometriomas. Gene set enrichment analysis showed upregulation of pathways involved in cell cycle regulation and DNA replication and downregulation of pathways involved in cytokine receptor signaling and matrisome. Comparison of pathway activation scores between the clinical samples and publicly-available datasets for OCCC cell lines revealed significant molecular similarities between OCCC with concurrent endometriosis and OVTOKO, OVISE, RMG1, OVMANA, TOV21G, IGROV1, and JHOC5 cell lines. Analysis of miRNAs revealed 64 upregulated and 61 downregulated mature miRNA molecules (DESeq2, P< 0.05, log2 fold-change > |1|). MiR-10a-5p represented over 21% of the miRNA molecules in OCCC with endometriosis and was significantly upregulated (NGS: log2fold change = 4.37, P = 2.43e-18; QPCR: 8.1-fold change, P< 0.05). Correlation between miR-10a expression level in OCCC cell lines and IC50 (50% inhibitory concentration) of carboplatin in vitro revealed a positive correlation (R2 = 0.93). MiR-10a overexpression in vitro resulted in a significant decrease in proliferation (n = 6; P< 0.05) compared to transfection with a non-targeting control miRNA. Similarly, the cell-cycle analysis revealed a significant shift in cells from S and G2 to G1 (n = 6; P< 0.0001). Bioinformatic analysis predicted that miR-10a-5p target genes that were downregulated in OCCC with endometriosis were involved in receptor signaling pathways, proliferation, and cell cycle progression. MiR-10a overexpression in vitro was correlated with decreased expression of predicted miR-10a target genes critical for proliferation, cell-cycle regulation, and cell survival including [SERPINE1 (3-fold downregulated; P< 0.05), CDK6 (2.4-fold downregulated; P< 0.05), and RAP2A (2-3-fold downregulated; P< 0.05)]. Discussion: These studies in OCCC suggest that miR-10a-5p is an impactful, potentially oncogenic molecule, which warrants further studies.

Another cost of being a young black male: Race, weaponry, and lethal outcomes in assaults.

We examine the effect of the race, age, and gender of victims of assault on the offenders' use of weapons and lethal intent. Evidence from the National Incident Based Reporting System (NIBRS) suggests that offenders are particularly likely to use guns against young black men-a three-way interaction - and to kill black males and young black adults. Black offenders respond more strongly to the victim's race than do white offenders. As a result of these effects, a violent incident between two young black men is about six times more likely to involve a gun than a violent incident between two young white men. We suggest that adversary effects, i.e., an offender's tactical response to the threat posed by adversaries, help explain why violence in black communities tends to be much more serious than violence in white communities.

Impacts of Rumen Degradable or Undegradable Protein Supplementation on Supplement Intake and Performance of Yearling Heifers and Cows Grazing Dryland Pastures.

Angus and Red Angus-based yearling heifers (n = 40) and lactating cows (n = 51) were each used in a complete randomized design and stratified by weight and body condition score to one of two treatments: (1) pressed supplement block containing rumen undegradable protein (RUP) and (2) pressed supplement block containing rumen degradable protein (RDP). Heifer and cow supplement intake displayed (p < 0.01) a treatment × period interaction. The RUP heifers and RDP cows consumed more in Period 2 than Period 1, whereas RDP heifers and RUP cows consumed more in Period 1 than Period 2, respectively. Intake rate demonstrated (p < 0.01) a treatment effect for heifers, with RUP consuming supplement faster than the RDP treatment. Intake rate for cows demonstrated (p < 0.01) a treatment × period interaction with RUP cows in Period 1 having faster intakes than Period 2, and RDP cows having the inverse. Cow intake variation displayed (p < 0.01) a treatment × period interaction with RUP cows having more variation in Period 2, while RDP cows had less variation in intake in Period 2. In conclusion, RDP and RUP impacted intake behavior of cows and heifers but had minimal impacts on performance.

Impacts of Rumen Degradable or Undegradable Protein Supplementation with or without Salt on Nutrient Digestion, and VFA Concentrations.

The objectives of this study were to evaluate the effect of differences in protein type and delivery method on rumen dynamics and nutrient digestion. Cows were allotted to rumen degradable protein (RDP) or rumen undegradable protein (RUP) and self-fed (SF) salt-limited pressed blocks or hand-fed (HF) loose supplement, resulting in four dietary treatments. There was a delivery effect (p = 0.04) on neutral detergent fiber (NDF) intake, as the SF animals consumed more NDF than HF animals. The RDP-SF animals had greater NDF digestibility (p = 0.04) and water intake (p = 0.03) than the three other treatments. Supplement intake displayed a protein type effect (p = 0.03), as RDP-supplemented animals consumed more supplement on a g·kg body weight (BW)-1 d-1 basis than RUP animals. There was an effect of protein type (p = 0.02) and delivery method (p = 0.03) on fluid flow rate, with RUP and HF cows having greater liquid flow rates. Ruminal pH was lower (p < 0.01) in RDP-HF cows than RDP-SF cows at all hours, except 4-h post-feeding. RDP-SF animals had the greatest (p < 0.01) concentrations of ruminal ammonia. Valerate ruminal concentrations were greater (p = 0.04) in RDP supplemented animals compared to RUP supplemented animals. In conclusion, self-fed supplements containing RDP may enhance the use of low-quality forages and increase ruminal ammonia concentrations.

Justice community opioid innovation network (JCOIN): The TCU research hub.

Recognizing the current opioid crisis among justice-involved individuals and the need to intervene at the intersection of justice and community health, the JCOIN TCU hub study explores outcomes associated with a multi-level hybrid implementation approach. The study capitalizes on facilitated collaboration, training, and cross-system data sharing to leverage improvements in criminal justice (CJ) and community behavioral health (CBH) interagency collaboration. The goal is to improve local community public health and safety outcomes for reentering justice-involved individuals who have a history of (or are at risk for) using opioids. The study compares two implementation strategies: one (vertical) in which all units in a community are trained and begin the program simultaneously and another (horizontal) in which one lead-off unit in the community is trained as a prototype of the program, the prototype is tested and refined, and then the lead-off unit helps to train other units within the community. Specific aims are to 1) increase access to and retention in CBH and medications for opioid use disorder services; 2) improve outcomes associated with public health and safety; 3) compare two implementation strategies on systems-level outcomes designed to increase service initiation and receipt of implementation and services; and 4) examine the impact of these strategies on justice-involved individuals' outcomes. The study examines both implementation and implementation-effectiveness, seeking to answer the questions of which implementation strategy is most effective for rapid and sustainable uptake of evidence-based practices and for increasing service linkage and initiation, services retention, and improved opioid-related public health safety outcomes. The study uses a hybrid type 3 study design. The study's primary aim is to compare two implementation strategies and two interventions at two levels (client and system), with a secondary aim to assess client-level outcomes associated with the trial. The study design integrates 2 robust methodologies (stepped wedge and cluster randomized trial), and plans to include 18 research performance sites (communities) located in Texas, New Mexico, and Illinois. The study will contribute to the JCOIN network's effort to establish a national consortium of investigators examining promising strategies to enhance the capabilities and capacity of the justice system to more effectively address the opioid epidemic.

Randomized, phase II study of the insulin-like growth factor-1 receptor inhibitor IMC-A12, with or without cetuximab, in patients with cetuximab- or panitumumab-refractory metastatic colorectal cancer.

PURPOSE: To evaluate the safety and efficacy of IMC-A12, a human monoclonal antibody (mAb) that blocks insulin-like growth factor receptor-1 (IGF-1R), as monotherapy or in combination with cetuximab in patients with metastatic refractory anti-epidermal growth factor receptor (EGFR) mAb colorectal cancer. METHODS: A randomized, phase II study was performed in which patients in arm A received IMC-A12 10 mg/kg intravenously (IV) every 2 weeks, while patients in arm B received this same dose of IMC-A12 plus cetuximab 500 mg/m(2) IV every 2 weeks. Subsequently, arm C (same combination treatment as arm B) was added to include patients who had disease control on a prior anti-EGFR mAb and wild-type KRAS tumors. Archived pretreatment tumor tissue was obtained when possible for KRAS, PIK3CA, and BRAF genotyping, and immunohistochemistry was obtained for pAKT as well as IGF-1R. RESULTS: Overall, 64 patients were treated (median age, 61 years; range, 40 to 84 years): 23 patients in arm A, 21 in arm B, and 20 in arm C. No antitumor activity was seen in the 23 patients treated with IMC-A12 monotherapy. Of the 21 patients randomly assigned to IMC-A12 plus cetuximab, one patient (with KRAS wild type) achieved a partial response, with disease control lasting 6.5 months. Arm C (all patients with KRAS wild type), however, showed no additional antitumor activity. Serious adverse events thought possibly related to IMC-A12 included a grade 2 infusion-related reaction (2%; one of 64 patients), thrombocytopenia (2%; one of 64 patients), grade 3 hyperglycemia (2%; one of 64 patients), and grade 1 pyrexia (2%, one of 64 patients). CONCLUSION: IMC-A12 alone or in combination with cetuximab was insufficient to warrant additional study in patients with colorectal cancer refractory to EGFR inhibitors.

Are Blacks and Hispanics Disproportionately Incarcerated Relative to Their Arrests? Racial and Ethnic Disproportionality Between Arrest and Incarceration.

Do large racial and ethnic disparities in prison populations reflect systematic racial and policy discrimination in the criminal justice system, or do they reflect disproportionate involvement of blacks and Hispanics in "serious" or street crime? Our investigation of this question keys off the approach initiated by Alfred Blumstein is his pioneering studies on the topic. While yielding important findings, there are, however, substantial gaps in the empirical literature on the racial disproportionality issue. We attempt to fill those gaps by (1) using both data on prison admission as well as in-stock prison populations, (2) presenting more recent racially and ethnically disaggregated arrest and incarceration data from Pennsylvania for 2003-2007, and (3) including Hispanic offenders in our racial and ethnic disproportionality comparisons. Our results indicate, first, that the representation of blacks, whites, and Hispanics among offenders admitted to state prison and in the prison population corresponds closely to their representation in arrest statistics. Second, using arrests as a marker of violent offending, the overrepresentation of blacks among offenders admitted to state prisons occurs because they commit a disproportionate number of frequently imprisoned (i.e., violent) crimes. Third, for those offenses where there is a within-race difference between arrest and incarceration representation, Hispanics experience the greatest disadvantage. Fourth, failing to account for Hispanics in white and black estimates tends to inflate white proportions and deflate black proportions of arrests, admissions, and prison population estimates, masking the "true" black and white racial disproportionality. We conclude that while there is a need for continued concern with possible racial discrimination in justice system processing, this concern should not distract attention from what arguably is the more important matter-ameliorating the social environmental conditions that foster disproportionate minority (especially black) involvement in violent crime.