Cost-effectiveness of erosion mitigation to meet water clarity targets in the Manawatu-Whanganui Region of New Zealand.

Soil erosion is a significant environmental issue worldwide. It affects water quality, biodiversity, and land productivity. New Zealand government agencies and regional councils work to mitigate soil erosion through policies, management programmes, and funding for soil conservation projects. Information about cost-effectiveness is crucial for planning, targeting, and implementing erosion mitigation to achieve improvements in sediment-related water quality. While there is a good understanding of the costs of erosion mitigation measures, there is a dearth of literature on their cost-effectiveness in reducing sediment loads and improving water quality at the catchment level. In this study, we estimate the cost-effectiveness of erosion mitigation measures in meeting visual water clarity targets. The analysis utilizes the spatially explicit SedNetNZ erosion process and sediment budget modelling in the Manawatu-Whanganui Region and region-specific mitigation costs. The erosion mitigation measures considered in the analysis include afforestation, bush retirement, riparian retirement, space-planted trees, and gully tree planting. We modelled two scenarios with on-farm erosion mitigation implemented across the region from 2021 to 2100, resulting in a 48% and 60% reduction of total sediment load. We estimate the marginal costs to achieve the visual national bottom line for water clarity, as assessed by the length of waterways that meet the clarity targets. We also estimate the marginal costs of improving average water clarity, which can be linked with non-market valuation studies when conducting a cost-benefit analysis. We find that gully tree planting and space-planted trees are the most cost-effective mitigation measures and that riparian retirement is the least cost-effective. Moreover, cost-effectiveness is highly dependent on current land use and the biophysical features of the landscape. Our estimates can be used in cost-benefit analysis to plan and prioritize soil erosion mitigation at the catchment and regional levels.

Monitoring the susceptibility of Bemisia tabaci Middle East-Asia Minor 1 (Hemiptera: Aleyrodidae) to afidopyropen, cyantraniliprole, dinotefuran, and flupyradifurone in south Florida vegetable fields.

Bemisia tabaci Middle East-Asia Minor 1 (MEAM1) is a significant pest that damages a wide range of high-value vegetable crops in south Florida. This pest has demonstrated the ability to develop resistance to various insecticide groups worldwide. Monitoring the resistance levels of MEAM1 populations and maintaining baseline susceptibility data are crucial for the long-term effectiveness of insecticide management strategies. We conducted serial dilution bioassays on 15 field populations of MEAM1 collected in south Florida to assess their resistance to 4 key insecticides: afidopyropen, cyantraniliprole, dinotefuran, and flupyradifurone. To quantify resistance levels, resistance ratios (RR) were generated by comparing the LC50 values of field populations to those of a known susceptible MEAM1 colony reared in the laboratory. Our findings reveal that all field-collected populations were susceptible to dinotefuran (RR 1-8) and flupyradifurone (RR 2-8). While over 80% of the populations tested were susceptible to afidopyropen (RR 1-9), 2 populations exhibited low (RR 38) and moderate resistance (RR 51), respectively. In contrast, most of the populations (57%) showed low to moderate resistance to cyantraniliprole (RR 21-78), and the remaining populations were susceptible (RR 3-10). The 2 populations with resistance to afidopyropen also exhibited moderate resistance to cyantraniliprole. Further research in this direction can aid in refining insecticide resistance management programs in Florida and other regions where B. tabaci MEAM1 is a major pest. Exploring the implications of these findings will be essential for insecticide use and integrated pest management strategies in south Florida.

Can Artificial Intelligence Accurately Detect Urinary Stones? A Systematic Review.

Objectives: To perform a systematic review on artificial intelligence (AI) performances to detect urinary stones. Methods: A PROSPERO-registered (CRD473152) systematic search of Scopus, Web of Science, Embase, and PubMed databases was performed to identify original research articles pertaining to AI stone detection or measurement, using search terms ("automatic" OR "machine learning" OR "convolutional neural network" OR "artificial intelligence" OR "detection" AND "stone volume"). Risk-of-bias (RoB) assessment was performed according to the Cochrane RoB tool, the Joanna Briggs Institute Checklist for nonrandomized studies, and the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Results: Twelve studies were selected for the final review, including three multicenter and nine single-center retrospective studies. Eleven studies completed at least 50% of the CLAIM checkpoints and only one presented a high RoB. All included studies aimed to detect kidney (5/12, 42%), ureter (2/12, 16%), or urinary (5/12, 42%) stones on noncontrast computed tomography (NCCT), but 42% intended to automate measurement. Stone distinction from vascular calcification interested two studies. All studies used AI machine learning network training and internal validation, but a single one provided an external validation. Trained networks achieved stone detection, with sensitivity, specificity, and accuracy rates ranging from 58.7% to 100%, 68.5% to 100%, and 63% to 99.95%, respectively. Detection Dice score ranged from 83% to 97%. A high correlation between manual and automated stone volume (r = 0.95) was noted. Differentiate distal ureteral stones and phleboliths seemed feasible. Conclusions: AI processes can achieve automated urinary stone detection from NCCT. Further studies should provide urinary stone detection coupled with phlebolith distinction and an external validation, and include anatomical abnormalities and urologic foreign bodies (ureteral stent and nephrostomy tubes) cases.

Temperature and nutrition do not interact to shape the evolution of metabolic rate.

Metabolic cold adaptation, or Krogh's rule, is the controversial hypothesis that predicts a monotonically negative relationship between metabolic rate and environmental temperature for ectotherms living along thermal clines measured at a common temperature. Macrophysiological patterns consistent with Krogh's rule are not always evident in nature, and experimentally evolved responses to temperature have failed to replicate such patterns. Hence, temperature may not be the sole driver of observed variation in metabolic rate. We tested the hypothesis that temperature, as a driver of energy demand, interacts with nutrition, a driver of energy supply, to shape the evolution of metabolic rate to produce a pattern resembling Krogh's rule. To do this, we evolved replicate lines of Drosophila melanogaster at 18, 25 or 28°C on control, low-calorie or low-protein diets. Contrary to our prediction, we observed no effect of nutrition, alone or interacting with temperature, on adult female and male metabolic rates. Moreover, support for Krogh's rule was only in females at lower temperatures. We, therefore, hypothesize that observed variation in metabolic rate along environmental clines arises from the metabolic consequences of environment-specific life-history optimization, rather than because of the direct effect of temperature on metabolic rate. This article is part of the theme issue 'The evolutionary significance of variation in metabolic rates'.

The amount and chemistry of acylsugars affects sweetpotato whitefly (Bemisia tabaci) oviposition and development, and tomato yellow leaf curl virus incidence, in field grown tomato plants.

The objectives of this study were to ascertain the impact of endogenous production of trichome-exuded acylsugars on insects and insect transmitted virus by evaluating tomato lines and their hybrids bred for acylsugar production under field settings on whiteflies and the whitefly-transmitted tomato yellow leaf curl virus. Specifically, we utilized a diverse array of tomato lines and hybrids bred for changes in acylsugar amount or type, grown in three field trials under natural whitefly and virus pressure, to investigate whether the amount of accumulated acylsugars and or the chemical profile of the acylsugars were associated with greater resistance to whiteflies and reduced incidence of tomato yellow leaf curl virus. There was considerable variation in the abundance of whitefly eggs and nymphs and incidence of tomato yellow leaf curl virus across experiments and between entries. Increasing amount of acylsugars accumulated by the tomato entries was associated with a reduction in the abundance of whitefly eggs and nymphs and a reduction in the incidence of tomato yellow leaf curl virus. Additionally, we identified lines with changes in several acylsugar fatty acids that were associated with decreased abundance of whitefly eggs and nymphs and reduced incidence of tomato yellow leaf curl virus. These results inform the utility of acylsugars as a host plant defense system for improving resistance to whiteflies and their transmitted viruses, with potential for reducing insecticides as a control method for whiteflies and provide breeding targets for optimization of existing acylsugar tomato lines to create lines with the most efficacious amount and chemistry of acylsugars.

Spinal Versus General Anesthesia in Contemporary Revision Total Hip Arthroplasties.

BACKGROUND: Spinal anesthesia is increasingly used in complex patient populations including revision total hip arthroplasties (THAs). This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a large institutional series of revision THAs. METHODS: We retrospectively identified 4,767 revision THAs (4,533 patients) from 2001 to 2016 using our institutional total joint registry. Of these cases, 86% had general and 14% had spinal anesthesia. Demographics between groups were similar with mean age of 66 years, 52% women, and mean body mass index of 29. Complications including all-cause rerevisions and reoperations were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that accounted for patient and surgical factors. The mean follow-up was 7 years. RESULTS: Patients treated with spinal anesthesia required fewer postoperative oral morphine equivalents (P < .001) and had lower numeric pain rating scale scores (P < .001). Spinal anesthesia had a decreased LOS (4.2 versus 4.8 days; P = .007), fewer cases of altered mental status (odds ratio (OR) 3.1, P = .001), fewer blood transfusions (OR 2.3, P < .001), fewer intensive care unit admissions (OR 2.3, P < .001), fewer rerevisions (OR 1.6, P = .04), and fewer reoperations (OR 1.5, P = .02). CONCLUSION: Spinal anesthesia was associated with lower oral morphine equivalent use and reduced LOS in this large cohort of revision THAs. Furthermore, spinal anesthesia was associated with fewer cases of altered mental status, transfusion, intensive care unit admission, rerevision, and reoperation after accounting for numerous patient and operative factors. LEVEL OF EVIDENCE: Level III, Retrospective Comparative Study.

Sida Golden Mosaic Virus, an Emerging Pathogen of Snap Bean (Phaseolus vulgaris L.) in the Southeastern United States.

Sida golden mosaic virus (SiGMV) was first detected from snap bean (Phaseolus vulgaris L.) in Florida in 2006 and recently in Georgia in 2018. Since 2018, it has caused significant economic losses to snap bean growers in Georgia. This study, using a SiGMV isolate field-collected from prickly sida (Sida spinosa L.), examined the putative host range, vector-mediated transmission, and SiGMV-modulated effects on host-vector interactions. In addition, this study analyzed the phylogenetic relationships of SiGMV with other begomoviruses reported from Sida spp. Host range studies confirmed that SiGMV can infect seasonal crops and perennial weed species such as snap bean, hollyhock (Alcea rosea L.), marsh mallow (Althaea officinalis L.), okra (Abelmoschus esculentus (L.) Moench), country mallow (Sida cordifolia L.), prickly sida (S. spinosa), and tobacco (Nicotiana tabacum L.). The incidence of infection ranged from 70 to 100%. SiGMV-induced symptoms and virus accumulation varied between hosts. The vector, Bemisia tabaci Gennadius, was able to complete its life cycle on all plant species, irrespective of SiGMV infection status. However, SiGMV infection in prickly sida and country mallow positively increased the fitness of whiteflies, whereas SiGMV infection in okra negatively influenced whitefly fitness. Whiteflies efficiently back-transmitted SiGMV from infected prickly sida, hollyhock, marsh mallow, and okra to snap bean, and the incidence of infection ranged from 27 to 80%. Complete DNA-A sequence from this study shared 97% identity with SiGMV sequences reported from Florida and it was determined to be closely related with sida viruses reported from the New World. These results suggest that SiGMV, a New World begomovirus, has a broad host range that would allow its establishment in the farmscapes/landscapes of the southeastern United States and is an emerging threat to snap bean and possibly other crops.

Spinal Versus General Anesthesia in Contemporary Revision Total Knee Arthroplasties.

BACKGROUND: Interest in spinal anesthesia utilization in revision total knee arthroplasties (TKAs) is rising. This study investigated the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a single institution series of revision TKAs. METHODS: We identified 3,711 revision TKAs (3,495 patients) from 2001 to 2016 using our institutional total joint registry. There were 66% who had general anesthesia and 34% who had spinal anesthesia. Mean age, sex, and BMI were similar between groups at 67 years, 53% women, and 32, respectively. Data were analyzed using inverse probability of treatment weighted models based on propensity scores that accounted for patient and operative factors. Mean follow-up was 6 years (range, 2 to 17). RESULTS: Patients treated with spinal anesthesia required fewer postoperative oral morphine equivalents (OMEs) (P < .0001) and had lower numeric pain rating scale scores (P < .001). Spinal anesthesia was associated with shorter LOS (4.0 versus 4.6 days; P < .0001), less cases of altered mental status (AMS; Odds Ratio (OR) 2.0, P = .004), less intensive care unit (ICU) admissions (OR 1.6, P = .02), fewer re-revisions (OR 1.7, P < .001), and less reoperations (OR 1.4, P < .001). There was no difference in the incidence of VTE (P = .82), 30-day readmissions (P = .06), or 90-day readmissions (P = .18) between anesthetic techniques. CONCLUSION: We found that spinal anesthesia for revision TKAs was associated with significantly lower pain scores, reduced OME requirements, and decreased LOS. Furthermore, spinal anesthesia was associated with fewer cases of AMS, ICU admissions, and re-revisions even after accounting for numerous patient and operative factors. LEVEL OF EVIDENCE: Level III, Retrospective Comparative Study.

Evidence of the association between the Q2 mitochondrial group of Bemisia tabaci MED species (Hemiptera: Aleyrodidae) and low competitive displacement capability.

The whitefly, Bemisia tabaci (Gennadius), is one of the most serious agricultural pests worldwide. Bemisia tabaci is a cryptic species complex of more than 40 species among which the invasive MEAM1 and MED species are the most widespread and economically important. Both MEAM1 and MED present intraspecific genetic variability and some haplotypes are reported to be more invasive than others. MED can be further deconstructed into different genetic groups, including MED-Q1 and MED-Q2. However, distinct biological phenotypes discerning the different MED mitochondrial haplotypes are yet to be characterized. Competitive displacement and life-history trials were carried out between MED-Q2 and MEAM1 populations collected in Florida, USA. In addition, a phylogenetic analysis was carried out including populations from previous whitefly competitive displacement studies for identification and comparison of the MED mitochondrial groups. In contrast to other studies with MED-Q1, the MED-Q2 population from Florida is less likely to displace MEAM1 on pepper. In addition, both pepper and watermelon were a more favorable host to MEAM1 compared to MED-Q2 according to the life history trials.

Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project - Phase III Outcomes.

BACKGROUND: Our institution initiated the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies (OASIS) project in 2017 to improve the quality and efficiency for hip and knee arthroplasties. Phase III of this project aimed to: 1) increase same-day discharge (SDD) of primary total joint arthroplasties (TJAs) to 20%; 2) maintain or improve 30-day readmission rates; and 3) realize cost savings and revenue increases. METHODS: All primary TJAs performed between 2021 and 2022 represented our study cohort, with those in 2019 (prepandemic) establishing the baseline cohort. A multidisciplinary team met weekly to track project tactics and metrics through the entire episode of care from preoperative surgical visit through 30 days postoperatively. RESULTS: The SDD rate increased from 4% at baseline to 37%, with mean lengths of stay (LOS) decreasing from 1.5 to 0.9 days for all primary TJAs. The 30-day readmission rate decreased to 1.2 from 1.3%. Composite changes in surgical volume and cost reductions equaled $5 million. CONCLUSION: Application of a multidisciplinary team with health systems engineering tools and methods allowed SDD to increase from 4 to 37% with a mean LOS <1 day, resulting in a $5 million incremental gain in profit at a major academic medical center. Importantly, patient safety was not compromised as 30-day readmission rates remained stable. LEVEL OF EVIDENCE: III Therapeutic.

Potential of UV-C for management of two-spotted spider mites and thrips in Florida strawberry.

BACKGROUND: Major pests of Florida strawberry (two-spotted spider mites, Tetranychus urticae Koch; chilli thrips, Scirtothrips dorsalis Hood; and western flower thrips, Frankliniella occidentalis Pergande) are difficult to manage using only conventional chemical control. Previous research has demonstrated high mortality of T. urticae eggs after exposure to ultraviolet B (UV-B) light. Additionally, ultraviolet C (UV-C) light has been shown to suppress powdery mildew in strawberry at doses between 85 and 200 J m-2 with no damage to the plant. Therefore, UV-C may also have the potential to be used as an integrated pest management tool for arthropod pests of strawberry. The objectives of this study were to: (i) determine the effect of UV-C on T. urticae, S. dorsalis, and F. occidentalis natural populations in open-field strawberry; and (ii) determine the effect of UV-C on T. urticae egg hatch after application in open-field strawberry. Field studies were conducted during the 2019-2020 and 2020-2021 strawberry seasons in Florida, USA. Four treatments were compared: (i) foliar application of spinetoram in response to natural pest pressure; (ii) application of UV-C 200 J m-2 twice a week; (iii) application of UV-C 350 J m-2 twice a week; and (iv) a non-treated control. RESULTS: In the field trials, suppression of T. urticae was observed at 350 J m-2 in 2020-2021. In the other field trials, no effect was observed due to low natural infestations. No negative impact on yield was observed from UV-C applications. CONCLUSION: UV-C shows promise as a component of an integrated pest management program for T. urticae in strawberry. © 2022 Society of Chemical Industry.

Spinal versus general anaesthesia in contemporary primary total knee arthroplasties.

AIMS: Spinal anaesthesia has seen increased use in contemporary primary total knee arthroplasties (TKAs). However, controversy exists about the benefits of spinal in comparison to general anaesthesia in primary TKAs. This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anaesthesia in primary TKAs from a single, high-volume academic centre. METHODS: We retrospectively identified 17,690 primary TKAs (13,297 patients) from 2001 to 2016 using our institutional total joint registry, where 52% had general anaesthesia and 48% had spinal anaesthesia. Baseline characteristics were similar between cohorts with a mean age of 68 years (SD 10), 58% female (n = 7,669), and mean BMI of 32 kg/m2 (SD 7). Pain was evaluated using oral morphine equivalents (OMEs) and numerical pain rating scale (NPRS) data. Complications including 30- and 90-day readmissions were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that included many patient and surgical factors. Mean follow-up was seven years (2 to 18). RESULTS: Patients treated with spinal anaesthesia required fewer postoperative OMEs (p < 0.001) and had lower NPRS scores (p < 0.001). Spinal anaesthesia also had fewer cases of altered mental status (AMS; odds ratio (OR) 1.3; p = 0.044), as well as 30-day (OR 1.4; p < 0.001) and 90-day readmissions (OR 1.5; p < 0.001). General anaesthesia was associated with increased risk of any revision (OR 1.2; p = 0.021) and any reoperation (1.3; p < 0.001). CONCLUSION: In the largest single institutional report to date, we found that spinal anaesthesia was associated with significantly lower OME use, lower risk of AMS, and lower overall 30- and 90-day readmissions following primary TKAs. Additionally, spinal anaesthesia was associated with reduced risk of any revision and any reoperation after accounting for numerous patient and operative factors. When possible and safe, spinal anaesthesia should be considered in primary TKAs.Cite this article: Bone Joint J 2022;104-B(11):1209-1214.

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties.

BACKGROUND: The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution. METHODS: We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry. Of these cases, 58% had general anesthesia and 42% had spinal anesthesia. The demographic characteristics were similar between groups, with mean age of 64 years, 51% female, and mean body mass index (BMI) of 31 kg/m 2 . Data were analyzed using an inverse probability of treatment weighted model based on a propensity score that accounted for numerous patient and operative factors. The mean follow-up was 6 years. RESULTS: Patients treated with spinal anesthesia had lower Numeric Pain Rating Scale (NPRS) scores (p < 0.001) and required fewer postoperative oral morphine equivalents (OMEs) at all time points evaluated (p < 0.001). Patients treated with spinal anesthesia also had shorter hospital length of stay (p = 0.02), fewer altered mental status events (odds ratio [OR], 0.7; p = 0.02), and fewer intensive care unit (ICU) admissions (OR, 0.7; p = 0.01). There was no difference in the incidence of deep vein thrombosis (p = 0.8), pulmonary embolism (p = 0.4), 30-day readmissions (p = 0.17), 90-day readmissions (p = 0.18), all-cause revisions (p = 0.17), or all-cause reoperations (p = 0.14). CONCLUSIONS: In this large, single-institution study, we found that spinal anesthesia was associated with reduced pain scores and OME use postoperatively. Furthermore, spinal anesthesia resulted in fewer altered mental status events and ICU admissions. These data favor the use of spinal anesthesia in primary THAs. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Arthropod Pest Management in Strawberry.

The strawberry crop endures economic losses due to feeding injury from a number of phytophagous arthropod pests. A number of invasive pests have posed challenges to crop protection techniques in the strawberry cropping system recently. It is increasingly evident that sole reliance on chemical control options is not sustainable. In this review, current challenges and advances in integrated pest management of various strawberry pests are presented. Key pests discussed include thrips, mites, lygus bug, spotted wing drosophila, seed bug, weevils, aphids, whiteflies, and armyworms. Several integrated pest management techniques that include use of intercropping, resistant cultivars, irradiation with gamma rays, use of spectral sensitivity of pests, biological control agents and natural enemies, and biorational pesticides have recently been reported to be useful in managing the various strawberry pests. With the increase in world production of strawberry, several techniques will be necessary to manage the pest complex of strawberry.

Impacts of tracer type, tracer selection, and source dominance on source apportionment with sediment fingerprinting.

Sediment fingerprinting estimates the proportional contribution of fine sediment from distinct catchment sources delivered to downstream receiving environments. Increased attention has focused on assessing the accuracy of source contribution estimates, particularly in relation to tracer selection and statistical un-mixing procedures. However, no studies have systematically tested the impact of source combination or dominance on the accuracy of source estimates. Here, we assess sensitivity to tracer type, selection, and number of sources, and examine how variations in the dominant sediment source affect the accuracy of source apportionments using numerical mixtures. Sources were sampled according to erosion process and land cover from a New Zealand catchment. Topsoil and subsoil (landslide) samples were collected from pasture, harvested pine, kanuka scrub, and native forest, while banks were sampled along the main channel. Samples were analysed for bulk geochemistry, fallout radionuclides, and compound specific stable isotopes (CSSIs). Source apportionment accuracy tended to decrease as source number increased, which reflected decreasing source discrimination. Tracer selection showed variations in accuracy but exhibited no clear pattern overall. Source combination and particularly the dominant source had the largest impact on accuracy, reflecting the level of discrimination for each source. Notably, channel bank was frequently identified as the dominant source when using CSSI tracers. While this partly reflected lower levels of discrimination, the CSSI apportionment was particularly sensitive to the use of post-unmixing corrections routinely applied to derive soil proportional contributions from isotopic proportions. This sensitivity likely related to the low organic carbon content in bank material and the assumption that source apportionments based on isotopic proportions can be corrected using a linear relationship with organic carbon content. These results indicate that the use of CSSI tracers in catchments where erosion sources exhibit large differences in soil organic carbon content may introduce significant unquantified error in source apportionments.

A Target Site Mutation Associated With Diamide Insecticide Resistance in the Diamondback Moth Plutella xylostella (Lepidoptera: Plutellidae) is Widespread in South Georgia and Florida Populations.

Laboratory colonies of diamondback moth (DBM) larvae were established from larvae collected from four sites in Georgia and Florida where diamide, specifically chlorantraniliprole, insecticide resistance was recently documented. Based on dose-response experiments, these colonies exhibited 109- to 4,298-fold resistance to chlorantraniliprole, compared to a commercially available susceptible control colony. Colonies exhibited 50- to 107-fold resistance to another diamide, cyantraniliprole, based on similar dose-response experiments. All colonies were screened for the presence of four known mutations in the ryanodine receptor (RyR), the target of diamide insecticides, previously associated with resistance in Asian DBM populations. One mutation, G4946E, was identified in colonies from all four field sites, but not the susceptible control colony. Three additional RyR target site mutations, E1338D, Q4594L, and I4790M, were not identified in any of the screened samples. The estimated allele frequency of the G4946E mutation in these colonies ranged from 32 to 90%. These data are consistent with recently reported chlorantraniliprole control failures in Georgia and Florida. It is likely that the G4946E mutation is currently an important contributing factor to chlorantraniliprole resistance in Georgia and Florida DBM populations.

Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation.

OBJECTIVE: To compare the relative value of 3 analgesic pathways for total knee arthroplasty (TKA). PATIENTS AND METHODS: Time-driven activity-based costing analyses were performed on 3 common analgesic pathways for patients undergoing TKA: periarticular infiltration (PAI) only, PAI and single-injection adductor canal blockade (SACB), and PAI and continuous adductor canal blockade (CACB). Additionally, adult patients who underwent elective primary TKA from November 1, 2017, to May 1, 2018, were retrospectively identified to analyze analgesic (pain score, opiate use) and hospital outcomes (distance walked, length of stay) after TKA based on analgesic pathway. RESULTS: There was no difference in patient demographic characteristics, specifically complexity (American Society of Anesthesiologists score) or preoperative opiate use, between groups. Compared with PAI, total cost (labor and material) was 1.4-times greater for PAI plus SACB and 2.3-times greater for PAI plus CACB. The addition of SACB to PAI resulted in lower average and maximum pain scores and opiate use on the day of operation compared with PAI alone. Average and maximum pain scores and opiate use between SACB and CACB were not significantly different. Walking distance and hospital length of stay were not significantly different between groups. CONCLUSION: Perioperative care teams should consider the cost and relative value of pain management when selecting the optimal analgesic strategy for TKA. Despite slightly higher relative cost, the combination of SACB with PAI may offer short-term analgesic benefit compared with PAI alone, which could enhance its relative value in TKA.

The effects of shoulder arthroscopy on ultrasound image quality of the interscalene brachial plexus: a pre-procedure vs post-procedure comparative study.

BACKGROUND: Fluid extravasation from the shoulder compartment and subsequent absorption into adjacent soft tissue is a well-documented phenomenon in arthroscopic shoulder surgery. We aimed to determine if a qualitative difference in ultrasound imaging of the interscalene brachial plexus exists in relation to the timing of performing an interscalene nerve block (preoperative or postoperative). METHODS: This single-center, prospective observational study compared pre- and postoperative interscalene brachial plexus ultrasound images of 29 patients undergoing shoulder arthroscopy using a pretest-posttest methodology where individual patients served as their own controls. Three fellowship-trained regional anesthesiologists evaluated image quality and confidence in performing a block for each ultrasound scan using a five-point Likert scale. The association of image quality with age, gender, BMI, duration of surgery, obstructive sleep apnea, and volume of arthroscopic irrigation fluid were analyzed as secondary outcomes. RESULTS: Aggregate preoperative mean scores in quality of ultrasound visualization were higher than postoperative scores (preoperative 4.5 vs postoperative 3.8; p < .001), as was confidence in performing blockade based upon the imaging (preoperative 4.8 vs postoperative 4.2; p < .001). Larger BMI negatively affected visualization of the brachial plexus in the preoperative period (p < 0.05 for both weight categories). Patients with intermediate-high risk or confirmed obstructive sleep apnea had lower aggregate postoperative mean scores compared to the low-risk group for both ultrasound visualization (3.4 vs 4.0; p < .05) and confidence in block performance (3.8 vs 4.4; p < .05). CONCLUSION: Due to the potential reduction of ultrasound visualization of the interscalene brachial plexus after shoulder arthroscopy, we advocate for a preoperative interscalene nerve block when feasible. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03657173 ; September 4, 2018).