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Zoe Brown,Michael Perry,Cameron Killen,Daniel Schmitt,Michael Wesolowski,Nicholas M. Brown 대한고관절학회 2022 Hip and Pelvis Vol.34 No.1
Purpose: Histopathologic analysis of femoral head specimens following total hip arthroplasty (THA) is a routine practice that represents a significant use of health care resources. However, it occasionally results in discovery of undiagnosed hematopoietic malignancy and other discrepant diagnoses such as avascular necrosis. The purpose of this study was to determine the rate of discordant and discrepant diagnoses discovered from routine histopathological evaluation of femoral heads following THA and perform a cost analysis of this practice. Materials and Methods: A review of patients undergoing primary THA between 2004-2017 was conducted. A comparison of the surgeon’s preoperative and postoperative diagnosis, and the histopathologic diagnosis was performed. In cases where the clinical and histopathology differed, a review determined whether this resulted in a change in clinical management. Medicare reimbursement and previously published cost data corrected for inflation were utilized for cost calculations. Results: A review of 2,134 procedures was performed. The pathologic diagnosis matched the postoperative diagnosis in 96.0% of cases. Eighty-three cases (4.0%) had a discrepant diagnosis where treatment was not substantially altered. There was one case of discordant diagnosis where lymphoma was diagnosed and subsequently treated. The cost per discrepant diagnosis was $141,880 and per discordant diagnosis was $1,669 when using 100% Medicare reimbursement and Current Procedural Terminology (CPT) code combination 88304+88311. Conclusion: Histopathologic analysis of femoral head specimens in THAs showed an association with high costs given the rarity of discordant diagnoses. Routine use of the practice should be at the discretion of individual hospitals with consideration for cost and utility thresholds.
Daniel R. Schmitt,Cameron Killen,Michael Murphy,Michael Perry,Joseph Romano,Nicholas Brown 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.3
Background: Antibiotic-loaded bone cement (ALBC) is commonly used in total knee arthroplasty (TKA), especially among high-risk patients. While previous studies have reported on the efficacy of ALBC in reducing the rate of periprosthetic joint infection (PJI), its impact on antibiotic resistance has not been determined. The purpose of this study was to investigate antibiotic resistance among organisms causing PJIs after TKA in which ALBC was utilized. Methods: A retrospective review from December 1998 through December 2017 identified 36 PJIs that met inclusion criteria. Patients with culture-negative infection and unknown cement type were excluded. Patient characteristics, infecting organism, and antibiotic susceptibilities were recorded. ABLC included an aminoglycoside in all cases. Results: There was no difference in the type of PJI between the 2 groups. Staphylococcus species was the most commonly isolated, with 9 of 16 cases (56.3%) using non-ALBC and 14 of 20 (65.0%) cases using ALBC. Of those infected with Staphylococcus , there was no significant difference in antibiotic susceptibilities between groups. Overall, there were only 3 cases where the infecting organism was aminoglycoside resistant (standard cement, 1; ALBC, 2). Conclusions: These results suggest that the use of ALBC does not increase the risk of antibiotic resistance or affect the pattern of infection, even as the use of ALBC continues to increase, particularly among high-risk patients.
Ben Magolan,Emilio Baglietto,Cameron Brown,Igor A. Bolotnov,Gretar Tryggvason,Jiacai Lu 한국원자력학회 2017 Nuclear Engineering and Technology Vol.49 No.6
Direct Numerical Simulation (DNS) serves as an irreplaceable tool to probe the complexities of multiphase flow and identify turbulent mechanisms that elude conventional experimental measurement techniques. The insights unlocked via its careful analysis can be used to guide the formulation and development of turbulence models used in multiphase computational fluid dynamics simulations of nuclear reactor applications. Here, we perform statistical analyses of DNS bubbly flow data generated by Bolotnov (Reτ = 400) and LueTryggvason (Reτ = 150), examining single-point statistics of mean and turbulent liquid properties, turbulent kinetic energy budgets, and two-point correlations in space and time. Deformability of the bubble interface is shown to have a dramatic impact on the liquid turbulent stresses and energy budgets. A reduction in temporal and spatial correlations for the streamwise turbulent stress (uu) is also observed at wall-normal distances of y+ = 15, y/δ = 0.5, and y/δ = 1.0. These observations motivate the need for adaptation of length and time scales for bubble-induced turbulence models and serve as guidelines for future analyses of DNS bubbly flow data.
Structure-rheology elucidation of human blood via SPP framework and TEVP modeling
Matthew Armstrong,Jeff Baker,Jesse Trump,Erin Milner,J. Kenneth Wickiser,Kenneth Cameron,Nick Clark,Kaitlyn Schwarting,Thomas Brown,Dorian Bailey,Corey James,Chi Nguyen,Trevor Corrigan 한국유변학회 2021 Korea-Australia rheology journal Vol.33 No.1
Recent work modeling the rheological behavior of human blood indicates that it has all the hallmark features of a complex material, including shear-thinning, viscoelastic behavior, a yield stress, and thixotropy. After decades of modeling steady state blood data, and the development of simple steady state models, like the Casson and Herschel-Bulkley the advancement and evolution of blood modeling to incorporate more thixo-elasto-visco-plastic (TEVP) features to accurately capture transient flow has renewed interest. With recently collected steady state and oscillatory shear flow rheological data from a DHR-3 using human blood, we show modeling efforts with a contemporary thixo-elasto-visco-plastic (TEVP) model. Best fit rheological model parameters are used to determine values for normal, h ealthy blood and corroborate correlations from literature. Series of physical processes (SPP) analysis is incorporated to illustrate how mechanical properties are tied to the transient, evolving microstructure of human blood and physiological parameters. Using LAOS data predictions of the structure parameter, is compared, and correlated with the transient elastic modulus, .