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Migration of Primary Total Knee Replacement from Inpatient to Outpatient Facilities in the US (2019–2022): Trends, Demographics, and Comorbidities
No full textPrimary total knee arthroplasty (TKA) has shifted from inpatient to outpatient facilities in the United States, driven by surgical advances, the 2018 Center for Medicare & Medicaid Services inpatient-only list change, and COVID-19 pressures. Limited national data and unclear patient profiles in outpatient facilities versus hospitals prompt this study. Outpatient TKA patients are often younger and have fewer comorbidities, but safety debates persist. Using a national database, we examined (1) trends in knee arthroplasty settings, (2) demographic differences, and (3) comorbidity variations to inform patient selection, outcomes, and policy.
We conducted a retrospective analysis using two national databases from 2019 to 2022. Adult patients undergoing elective, unilateral, primary TKA were identified using validated coding algorithms. We analyzed temporal trends in procedure location and compared demographic and comorbidity profiles between patients treated in hospitals versus outpatient facilities.
A total of 50% of the volume of primary TKA migrated to outpatient centers from 2019 to 2022. The proportion of hospital-based TKAs declined from 64 to 14%, while Ambulatory Surgical Center (ASC) based procedures rose from 36 to 86%. The ASC patients were younger (67.2 versus 67.6 years, P < 0.01), more likely to be White (78.6 versus 77.6%, P < 0.01), and more likely to have commercial insurance (P < 0.01). Hospital-based patients had significantly higher rates of nearly all comorbidities than those in outpatient facilities.
There has been a dramatic national migration of TKA procedures from inpatient hospitals to ASCs over the last four years. Patients selected for ASC-based TKA tend to be healthier and demographically distinct. These findings underscore the need for careful patient selection and ongoing evaluation of outcomes to ensure safety and equity in the delivery of outpatient TKA
Large intracerebral hemorrhage in the setting of vitamin K prophylaxis refusal
No full textVitamin K is a vital component of prophylactic treatment in newborns, as deficiency leads to inadequate synthesis of coagulation factors. Vitamin K deficiency bleeding (VKDB) can lead to gastrointestinal, mucocutaneous, or intracranial hemorrhage. Unfortunately, the rise in vaccine hesitancy has been paralleled by a rise in refusal of vitamin K prophylaxis at birth. Case report Here, we present the case of a 2-month-old who presented to the emergency department with a large ICH due to a lack of vitamin K prophylaxis. The patient presented to the emergency room (ER) unresponsive with a blown pupil. Computed tomography (CT) scan showed a large intraparenchymal hemorrhage with substantial midline shift. The patient's coagulation studies resulted with INR > 15, PTT > 200, and TEG > 69; he had not received vitamin K prophylaxis at birth. Vitamin K was given, and aggressive transfusion protocol was started in the ER. He was closely monitored in the pediatric intensive care unit (PICU) and safely taken for decompressive hemicraniectomy once coagulopathy was reversed. Post-operatively, he remained paralyzed on the oscillator for ventilatory support due to transfusion-related acute lung injury (TRALI). He was eventually able to be weaned from paralysis, sedation, and respiratory support and was discharged to home with outpatient follow-up and rehabilitation. He has since undergone cranioplasty, and at 6 months follow-up, he continues to progress, is appropriately alert, and moves all extremities grossly symmetrically.
Newborns who do not receive vitamin K at birth remain at risk for intracranial hemorrhage. In this case, it was vital to reverse coagulopathy before taking the patient for decompressive surgery. Teamwork amongst the emergency room, critical care, anesthesia, and neurosurgical teams was crucial to safely manage this patient's large intracranial hemorrhage
Mapping melanoma mortality hot spots: A geographic spatial analysis of socioeconomic and provider disparities (vol 93, pg 477, 2025)
No full text8 - Tumors of the Posterior Segment
No full textSpecific sonographic features can help differentiate intraocular tumors and establish accurate diagnosis with adjunction to ophthalmoscopy. Furthermore, the detection and differentiation provide precise measurements essentials in planning treatments. In addition to imaging the tissues easily seen by clinical methods, it can image the extraocular extension of an intraocular tumor, which is hidden from clinical visualization
The Birt-Hogg-Dubé syndrome gene folliculin (FLCN), operates as a negative regulator of human hair follicle growth ex vivo
No full textHematoma expansion in intracerebral hemorrhage retrospective chart review: Who are the super-expanders?
No full textHematoma expansion in intracerebral hemorrhage (ICH) is a predictor of poor outcome and remains an important therapeutic target. Little is known about the incidence and clinical characteristics of patients with severe hematoma expansion, who we hereafter label as super-expanders.
We retrospectively reviewed baseline clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a > 33 % increase in hematoma volume or a > 6 ml increase in absolute hematoma volume between the baseline and 24-hour follow-up brain CT. Severe hematoma expansion was defined as a > 50 % increase in ICH volume associated with a decrease in the Glasgow Coma Scale of at least four points. We used Random Forest (RF) to generate importance plots searching for the determinants of super-expanders in ICH. In addition, a multivariable logistic regression model was done to examine independent factors associated with super-expanders.
We analyzed 417 cases. Hematoma expansion, defined conventionally, occurred in 97/417 (23 %) patients of which 15/417 (4 %) were super-expanders. In the univariate analysis, super-expanders were more likely to have a lobar hemorrhage, spot sign, and increased in-hospital mortality. Using the RF analysis, age, platelet count, and presence of a spot sign emerged as important determinants of super-expansion. In a multivariable model, only spot sign was an independent predictor for super-expansion [Age (OR = 1.43, 95 % CI=0.61–3.37), spot sign (OR = 6.25, 95 % CI=2.30–17.00), lobar location (OR = 4.63, 95 % CI= 0.92–23.42)].
We describe a low incidence of 4 % of severe hematoma expansion in ICH. There were no definitive clinical or radiological characteristics that differentiated super-expanders. Identifying such characteristics may allow for patient risk stratification. We encourage further investigations into the early identification of super-expanders, who arguably have the most to benefit from aggressive interventions.
•"Super-expander" hematomas comprised only 4 % (15/417) of intracranial hemorrhages, making them uncommon but clinically relevant.•CTA spot sign was the only independent predictor and potential early risk stratifier of super-expansion, with an odds ratio (OR) of 6.25•Super-expanders were more likely to have lobar hemorrhages, a spot sign, and higher in-hospital mortality.•Age, platelet count, and spot sign were important variables per Random Forest, but only spot sign was signficant per multivariable analysis
Structure–Property Relationships in 6FCDA-Based Fluorinated Copolyimide Membranes for Energy-Efficient Light Olefin/Paraffin Separation
No full textOlefin/paraffin separations, particularly through cryogenic distillation, are highly energy- and cost-intensive processes in the petrochemical industry, consuming ~0.15 Quads annually. To reduce this burden, alternative technologies such as membrane- and adsorption-based separations have gained attention for their potential to improve efficiency and lower operational costs. Among these, membrane-based gas separation is especially promising due to its reduced energy use, operational simplicity, scalability, and lower environmental impact. This study focuses on membrane-based separation of propylene (C3H6) from propane (C3H8), a challenging yet industrially critical process due to the similar physicochemical properties of the two gases. Despite extensive research, achieving adequate C3H6/C3H8 selectivity and long-term stability remains difficult. The objective of this work was to design, synthesize, and process a new class of fluorinated copolyimide membranes capable of combining high thermal and chemical stability with desirable permeability, selectivity, and processability. Six 6FCDA-based fluorinated copolyimides were synthesized and characterized to investigate how fluorine content and segmental rigidity influence gas transport and sorption behavior. The effects of temperature and pressure on C3H6/C3H8 sorption and separation were evaluated to assess membrane performance under realistic operating conditions and to clarify the structure–property relationships governing transport. Overall, the results demonstrate that 6FCDA-based fluorinated copolyimides offer scalable, thermally robust membrane platforms with tunable performance, showing strong potential for next-generation, energy-efficient olefin/paraffin separations.</p
Provenance of pottery from the Florida Keys: A geochemical pilot study
No full text•First LA-ICP-MS for south Florida ceramics.•Ancestral ceramics made in the Florida Keys, not the mainland.•Ceramic technology shared throughout south Florida.•Hyperlocal traditions of craft production in Ancestral south Florida.
This study presents the first use of geochemical analysis to shed light on the provenance of Ancestral Florida pottery from the southeast coast, the Everglades, and the Keys to better understand production and exchange dynamics in a coastal wetland and island zone. The people who once occupied far south Florida during the Ancestral period can be characterized as living within a frontier zone, far from centers of technological innovation. Archaeologists have often conceived of coastal and wetland populations from the logistically more convenient mainland, although this perspective is changing. The use of compositional pottery analysis has proven effective at helping to further elucidate aspects of past lifeways, cultural differentiation, and community interactions not otherwise recognized through typological or technofunctional analyses. We report the results of a pilot study utilizing laser ablation – inductively coupled plasma – mass spectrometry (LA–ICP–MS) on materials from an expansive region with pottery assemblages dominated by plain ware dating to 100–1800 CE. Our results indicate at least two distinct compositional groups with hyperlocal areas of production. A larger and more robust baseline of compositional data on pottery and clay throughout far southern Florida could provide a proxy for the movement of ceramic technology knowledge and the people who held that knowledge
Is the seagrass greener on the other side? Faster growth in Biscayne Bay, Florida’s nurse sharks (Ginglymostoma cirratum) compared to neighboring conspecifics of Bimini, The Bahamas
No full textEffective management of vulnerable species requires a precise understanding of life history. In 2024, Fadool et al. published the first von Bertalanffy growth model for the nurse shark (
Ginglymostoma cirratum
), reporting an asymptotic maximum length
L
∞
of 303.28 cm and a growth coefficient
k
of 0.04 yr
−1
for the population in Bimini, The Bahamas. We investigated whether nurse shark growth varies in nearby Biscayne Bay, Florida, an adjacent site within the western Atlantic region. We used 37 recaptured nurse sharks from Biscayne Bay to generate a comparable growth model, which estimated a significantly smaller
L
∞
of 259.26 cm and a larger
k
of 0.11 yr
−1
than Bimini. Biscayne Bay’s empirical growth rates were significantly higher on average than Bimini and exhibited a significantly steep decrease with increasing shark size not observed in Bimini. Additionally, the minimum linear displacement of 48 recaptured sharks was positively correlated with shark size, suggesting potential site fidelity to a small home range (1.6 ± 2.2 km) that increases with age. Our results indicate that differences in growth can occur over relatively small spatial scales despite environmental and geographic similarities, potentially reflecting genetic differences driven by historic fishing pressure or differences in resource availability. Significant growth rate variation between adjacent shark subpopulations assumed to be ecologically indistinct highlights the importance of sampling across a region’s subpopulations to inform management with more accurate life history data
Social Robots for Pediatric Asthma Education: A Pilot Study
No full textHospital discharge marks a crucial transition point in care, particularly for pediatric asthma patients, where education is essential but often rushed or not delivered properly. To address this challenge, we conducted a pilot study to evaluate the feasibility of using a socially assistive robot to deliver asthma education during pediatric hospital discharge. The system integrates validated educational content into a structured, robot-led dialogue. We evaluated the usability, engagement, and perceived effectiveness of the system. The study involved 11 university students assigned roles simulating a discharge scenario. Results showed that over 78% of participants rated the robot’s usability positively, more than 81% found the interaction engaging, and over 90% expressed a favorable attitude toward the robot. All participants reported satisfaction with the educational experience. These initial findings demonstrate the potential of social robots to enhance discharge education for pediatric asthma, supporting better understanding and preparedness among both patients and caregivers