Modern Perioperative Pain Management Strategies to Minimize Opioids after Total Knee Arthroplasty.

Total Knee Arthroplasty is associated with significant postoperative pain that can limit functional outcomes and patient satisfaction. In recent years, the standard of care for postoperative pain management has reduced reliance on opioids in favor of multimodal analgesia. These regimens consist of systemic medications such as COX-2 inhibitors, acetaminophen, corticosteroids, and gabapentinoids, as well as regional and local approaches such as peripheral nerve blocks and local infiltrative analgesics. Newer therapies, such as cryoneurolysis, are still being studied but have shown promising results. Additional studies are needed to determine the ideal pain regimen that will optimize pain control and eliminate the need for postoperative opioids.

A Visual Environment for Data Driven Protein Modeling and Validation.

In structural biology, validation and verification of new atomic models are crucial and necessary steps which limit the production of reliable molecular models for publications and databases. An atomic model is the result of meticulous modeling and matching and is evaluated using a variety of metrics that provide clues to improve and refine the model so it fits our understanding of molecules and physical constraints. In cryo electron microscopy (cryo-EM) the validation is also part of an iterative modeling process in which there is a need to judge the quality of the model during the creation phase. A shortcoming is that the process and results of the validation are rarely communicated using visual metaphors. This work presents a visual framework for molecular validation. The framework was developed in close collaboration with domain experts in a participatory design process. Its core is a novel visual representation based on 2D heatmaps that shows all available validation metrics in a linear fashion, presenting a global overview of the atomic model and provide domain experts with interactive analysis tools. Additional information stemming from the underlying data, such as a variety of local quality measures, is used to guide the user's attention toward regions of higher relevance. Linked with the heatmap is a three-dimensional molecular visualization providing the spatial context of the structures and chosen metrics. Additional views of statistical properties of the structure are included in the visual framework. We demonstrate the utility of the framework and its visual guidance with examples from cryo-EM.

Medicaid Patients Undergo Total Joint Arthroplasty at Lower-Volume Hospitals by Lower-Volume Surgeons and Have Poorer Outcomes.

BACKGROUND: Medicaid insurance coverage among patients undergoing total hip arthroplasty (THA) or those undergoing total knee arthroplasty (TKA) has been associated with worse postoperative outcomes compared with patients without Medicaid. Surgeons and hospitals with lower annual total joint arthroplasty (TJA) volume have also been associated with worse outcomes. This study sought to characterize the associations between Medicaid insurance status, surgeon case volume, and hospital case volume and to assess the rates of postoperative complications compared with other payer types. METHODS: The Premier Healthcare Database was queried for all adult patients who underwent primary TJA from 2016 to 2019. Patients were divided on the basis of their insurance status: Medicaid compared with non-Medicaid. The distribution of annual hospital and surgeon case volume was assessed for each cohort. Multivariable analyses were performed accounting for patient demographic characteristics, comorbidities, surgeon volume, and hospital volume to assess the 90-day risk of postoperative complications by insurance status. RESULTS: Overall, 986,230 patients who underwent TJA were identified. Of these, 44,370 (4.5%) had Medicaid. Of the patients undergoing TJA, 46.4% of those with Medicaid were treated by surgeons performing ≤100 TJA cases annually compared with 34.3% of those without Medicaid. Furthermore, a higher percentage of patients with Medicaid underwent TJA at lower-volume hospitals performing ≤500 cases annually, 50.8% compared with 35.5% for patients without Medicaid. After accounting for differences among the 2 cohorts, patients with Medicaid remained at increased risk for postoperative deep vein thrombosis (adjusted odds ratio [OR], 1.16; p = 0.031), pulmonary embolism (adjusted OR, 1.39; p < 0.001), periprosthetic joint infection (adjusted OR, 1.35; p < 0.001), and 90-day readmission (adjusted OR, 1.25; p < 0.001). CONCLUSIONS: Patients with Medicaid were more likely to undergo TJA performed by lower-volume surgeons at lower-volume hospitals and had higher rates of postoperative complications compared with patients without Medicaid. Future research should assess socioeconomic status, insurance, and postoperative outcomes in this vulnerable patient population seeking arthroplasty care. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Genomic diversity and differentiation between island and mainland populations of white-tailed eagles (Haliaeetus albicilla).

Divergence in the face of high dispersal capabilities is a documented but poorly understood phenomenon. The white-tailed eagle (Haliaeetus albicilla) has a large geographic dispersal capability and should theoretically be able to maintain genetic homogeneity across its dispersal range. However, following analysis of the genomic variation of white-tailed eagles, from both historical and contemporary samples, clear signatures of ancient biogeographic substructure across Europe and the North-East Atlantic is observed. The greatest genomic differentiation was observed between island (Greenland and Iceland) and mainland (Denmark, Norway and Estonia) populations. The two island populations share a common ancestry from a single mainland population, distinct from the other sampled mainland populations, and despite the potential for high connectivity between Iceland and Greenland they are well separated from each other and are characterized by inbreeding and little variation. Temporal differences also highlight a pattern of regional populations persisting despite the potential for admixture. All sampled populations generally showed a decline in effective population size over time, which may have been shaped by four historical events: (1) Isolation of refugia during the last glacial period 110-115,000 years ago, (2) population divergence following the colonization of the deglaciated areas ~10,000 years ago, (3) human population expansion, which led to the settlement in Iceland ~1100 years ago, and (4) human persecution and exposure to toxic pollutants during the last two centuries.

Evaluation of four methods to identify the homozygotic sex chromosome in small populations.

BACKGROUND: Whole genomes are commonly assembled into a collection of scaffolds and often lack annotations of autosomes, sex chromosomes, and organelle genomes (i.e., mitochondrial and chloroplast). As these chromosome types differ in effective population size and can have highly disparate evolutionary histories, it is imperative to take this information into account when analysing genomic variation. Here we assessed the accuracy of four methods for identifying the homogametic sex chromosome in a small population using two whole genome sequences (WGS) and 133 RAD sequences of white-tailed eagles (Haliaeetus albicilla): i) difference in read depth per scaffold in a male and a female, ii) heterozygosity per scaffold in a male and a female, iii) mapping to the reference genome of a related species (chicken) with annotated sex chromosomes, and iv) analysis of SNP-loadings from a principal components analysis (PCA), based on the low-depth RADseq data. RESULTS: The best performing approach was the reference mapping (method iii), which identified 98.12% of the expected homogametic sex chromosome (Z). Read depth per scaffold (method i) identified 86.41% of the homogametic sex chromosome with few false positives. SNP-loading scores (method iv) identified 78.6% of the Z-chromosome and had a false positive discovery rate of more than 10%. Heterozygosity per scaffold (method ii) did not provide clear results due to a lack of diversity in both the Z and autosomal chromosomes, and potential interference from the heterogametic sex chromosome (W). The evaluation of these methods also revealed 10 Mb of putative PAR and gametologous regions. CONCLUSION: Identification of the homogametic sex chromosome in a small population is best accomplished by reference mapping or examining differences in read depth between sexes.

FluoRender Script: A Case Study of Lingua Franca in Translational Computer Science.

FluoRender is a software program used for the visualization and analysis of 3-D biological image data, particularly from fluorescence microscopy. We examine FluoRender's script system to demonstrate its translation process. In this article, we borrow the concept of lingua franca from linguistics. We designed a connecting language between the source and target domains for translation, thereby augmenting understanding and acceptance. In FluoRender's script system, the lingua franca consists of the mapping between the control of the media player and the computational and interactive subroutines of an analysis workflow. Workflows supporting automatic, semiautomatic, and manual operations were made available and easily accessible to end users. The formalization of the lingua franca as a technique for translational computer science provides guidance for future development.

A Review of Three-Dimensional Medical Image Visualization.

Importance. Medical images are essential for modern medicine and an important research subject in visualization. However, medical experts are often not aware of the many advanced three-dimensional (3D) medical image visualization techniques that could increase their capabilities in data analysis and assist the decision-making process for specific medical problems. Our paper provides a review of 3D visualization techniques for medical images, intending to bridge the gap between medical experts and visualization researchers.Highlights. Fundamental visualization techniques are revisited for various medical imaging modalities, from computational tomography to diffusion tensor imaging, featuring techniques that enhance spatial perception, which is critical for medical practices. The state-of-the-art of medical visualization is reviewed based on a procedure-oriented classification of medical problems for studies of individuals and populations. This paper summarizes free software tools for different modalities of medical images designed for various purposes, including visualization, analysis, and segmentation, and it provides respective Internet links.Conclusions. Visualization techniques are a useful tool for medical experts to tackle specific medical problems in their daily work. Our review provides a quick reference to such techniques given the medical problem and modalities of associated medical images. We summarize fundamental techniques and readily available visualization tools to help medical experts to better understand and utilize medical imaging data. This paper could contribute to the joint effort of the medical and visualization communities to advance precision medicine.

Interactive Analysis for Large Volume Data from Fluorescence Microscopy at Cellular Precision.

The main objective for understanding fluorescence microscopy data is to investigate and evaluate the fluorescent signal intensity distributions as well as their spatial relationships across multiple channels. The quantitative analysis of 3D fluorescence microscopy data needs interactive tools for researchers to select and focus on relevant biological structures. We developed an interactive tool based on volume visualization techniques and GPU computing for streamlining rapid data analysis. Our main contribution is the implementation of common data quantification functions on streamed volumes, providing interactive analyses on large data without lengthy preprocessing. Data segmentation and quantification are coupled with brushing and executed at an interactive speed. A large volume is partitioned into data bricks, and only user-selected structures are analyzed to constrain the computational load. We designed a framework to assemble a sequence of GPU programs to handle brick borders and stitch analysis results. Our tool was developed in collaboration with domain experts and has been used to identify cell types. We demonstrate a workflow to analyze cells in vestibular epithelia of transgenic mice.

Fluoride in the SEI Stabilizes the Li Metal Interface in Li-S Batteries with Solvate Electrolytes.

Lithium-sulfur (Li-S) batteries offer high theoretical gravimetric capacities at low cost relative to commercial lithium-ion batteries. However, the solubility of intermediate polysulfides in conventional electrolytes leads to irreversible capacity fade via the polysulfide shuttle effect. Highly concentrated solvate electrolytes reduce polysulfide solubility and improve the reductive stability of the electrolyte against Li metal anodes, but reactivity at the Li/solvate electrolyte interface has not been studied in detail. Here, reactivity between the Li metal anode and a solvate electrolyte (4.2 M LiTFSI in acetonitrile) is investigated as a function of temperature. Though reactivity at the Li/electrolyte interface is minimal at room temperature, we show that reactions between Li and the solvate electrolyte significantly impact the solid electrolyte interphase (SEI) impedance, cyclability, and capacity retention in Li-S cells at elevated temperatures. Addition of a fluoroether cosolvent to the solvate electrolyte results in more fluoride in the SEI which minimizes electrolyte decomposition, reduces SEI impedance, and improves cyclability. A 6 nm AlF3 surface coating is employed at the Li anode to further improve interfacial stability at elevated temperatures. The coating enables moderate cyclability in Li-S cells at elevated temperatures but does not protect against capacity fade over time.

Interactive Visualization of Atmospheric Effects for Celestial Bodies.

We present an atmospheric model tailored for the interactive visualization of planetary surfaces. As the exploration of the solar system is progressing with increasingly accurate missions and instruments, the faithful visualization of planetary environments is gaining increasing interest in space research, mission planning, and science communication and education. Atmospheric effects are crucial in data analysis and to provide contextual information for planetary data. Our model correctly accounts for the non-linear path of the light inside the atmosphere (in Earth's case), the light absorption effects by molecules and dust particles, such as the ozone layer and the Martian dust, and a wavelength-dependent phase function for Mie scattering. The mode focuses on interactivity, versatility, and customization, and a comprehensive set of interactive controls make it possible to adapt its appearance dynamically. We demonstrate our results using Earth and Mars as examples. However, it can be readily adapted for the exploration of other atmospheres found on, for example, of exoplanets. For Earth's atmosphere, we visually compare our results with pictures taken from the International Space Station and against the CIE clear sky model. The Martian atmosphere is reproduced based on available scientific data, feedback from domain experts, and is compared to images taken by the Curiosity rover. The work presented here has been implemented in the OpenSpace system, which enables interactive parameter setting and real-time feedback visualization targeting presentations in a wide range of environments, from immersive dome theaters to virtual reality headsets.

Multielectron, Cation and Anion Redox in Lithium-Rich Iron Sulfide Cathodes.

Conventional Li-ion cathodes store charge by reversible intercalation of Li coupled to metal cation redox. There has been increasing interest in new materials capable of accommodating more than one Li per transition-metal center, thereby yielding higher charge storage capacities. We demonstrate here that the lithium-rich layered iron sulfide Li2FeS2 as well as a new structural analogue, LiNaFeS2, reversibly store ≥1.5 electrons per formula unit and support extended cycling. Ex situ and operando structural and spectroscopic data indicate that delithiation results in reversible oxidation of Fe2+ concurrent with an increase in the covalency of the Fe-S interactions, followed by reversible anion redox: 2 S2-/(S2)2-. S K-edge spectroscopy unequivocally proves the contribution of the anions to the redox processes. The structural response to the oxidation processes is found to be different in Li2FeS2 in contrast to that in LiNaFeS2, which we suggest is the cause for capacity fade in the early cycles of LiNaFeS2. The materials presented here have the added benefit of avoiding resource-sensitive transition metals such as Co and Ni. In contrast to Li-rich oxide materials that have been the subject of so much recent study and that suffer capacity fade and electrolyte degradation issues, the materials presented here operate within the stable potential window of the electrolyte, permitting a clearer understanding of the underlying processes.

OpenSpace: A System for Astrographics.

Human knowledge about the cosmos is rapidly increasing as instruments and simulations are generating new data supporting the formation of theory and understanding of the vastness and complexity of the universe. OpenSpace is a software system that takes on the mission of providing an integrated view of all these sources of data and supports interactive exploration of the known universe from the millimeter scale showing instruments on spacecrafts to billions of light years when visualizing the early universe. The ambition is to support research in astronomy and space exploration, science communication at museums and in planetariums as well as bringing exploratory astrographics to the class room. There is a multitude of challenges that need to be met in reaching this goal such as the data variety, multiple spatio-temporal scales, collaboration capabilities, etc. Furthermore, the system has to be flexible and modular to enable rapid prototyping and inclusion of new research results or space mission data and thereby shorten the time from discovery to dissemination. To support the different use cases the system has to be hardware agnostic and support a range of platforms and interaction paradigms. In this paper we describe how OpenSpace meets these challenges in an open source effort that is paving the path for the next generation of interactive astrographics.

Ray Tracing Generalized Tube Primitives: Method and Applications.

We present a general high-performance technique for ray tracing generalized tube primitives. Our technique efficiently supports tube primitives with fixed and varying radii, general acyclic graph structures with bifurcations, and correct transparency with interior surface removal. Such tube primitives are widely used in scientific visualization to represent diffusion tensor imaging tractographies, neuron morphologies, and scalar or vector fields of 3D flow. We implement our approach within the OSPRay ray tracing framework, and evaluate it on a range of interactive visualization use cases of fixed- and varying-radius streamlines, pathlines, complex neuron morphologies, and brain tractographies. Our proposed approach provides interactive, high-quality rendering, with low memory overhead.

Independent and Collaborative Visualization Tool Development.

Visualization is thriving as an academic discipline. However, the development of visualization heavily relies on applications in other base sciences. We examine the visualization development process, which includes both collaborative development with domain scientists and independent development by visualization tool developers, and tell the behind-the-scene stories of FluoRender.

The Muskox Lost a Substantial Part of Its Genetic Diversity on Its Long Road to Greenland.

The muskox (Ovibos moschatus) is the largest terrestrial herbivore in the Arctic and plays a vital role in the tundra ecosystem [1-4]. Its range, abundance, and genetic diversity have declined dramatically over the past 30,000 years [5]. Two subspecies are recognized, but little is known about the genetic structure and how this relates to the species history. One unresolved question is how and when the species dispersed into its present range, notably the present strongholds in the Canadian archipelago and Greenland. We used genotyping by sequencing (GBS) data from 116 muskox individuals and genotype likelihood-based methods to infer the genetic diversity and distribution of genetic variation in the species. We identified a basal split separating the two recognized subspecies, in agreement with isolation of the muskox into several refugia in the Nearctic around 21,000 years ago [6], near the last glacial maximum (LGM). In addition, we found evidence of strong, successive founder effects inflicting a progressive loss of genetic diversity as the muskox colonized the insular High Arctic from an unknown Nearctic origin. These have resulted in exceptionally low genetic diversity in the Greenlandic populations, as well as extremely high genetic differentiation among regional populations. Our results highlight the need for further investigations of genetic erosion in Nearctic terrestrial mammals, of which several show similar colonization histories in the High Artic.

OpenSpace: Bringing NASA Missions to the Public.

This viewpoint presents OpenSpace, an open-source astrovisualization software project designed to bridge the gap between scientific discoveries and their public dissemination. A wealth of data exists for space missions from NASA and other sources. OpenSpace brings together this data and combines it in a range of immersive settings. Through non-linear storytelling and guided exploration, interactive immersive experiences help the public to engage with advanced space mission data and models, and thus be better informed and educated about NASA missions, the solar system and outer space. We demonstrate this capability by exploring the OSIRIS-Rex mission.

OpenSpace: Changing the Narrative of Public Dissemination in Astronomical Visualization from What to How.

We present the development of an open-source software called OpenSpace that bridges the gap between scientific discoveries and public dissemination and thus paves the way for the next generation of science communication and data exploration. We describe how the platform enables interactive presentations of dynamic and time-varying processes by domain experts to the general public. The concepts are demonstrated through four cases: Image acquisitions of the New Horizons and Rosetta spacecraft, the dissemination of space weather phenomena, and the display of high-resolution planetary images. Each case has been presented at public events with great success. These cases highlight the details of data acquisition, rather than presenting the final results, showing the audience the value of supporting the efforts of the scientific discovery.

FluoRender: joint freehand segmentation and visualization for many-channel fluorescence data analysis.

BACKGROUND: Image segmentation and registration techniques have enabled biologists to place large amounts of volume data from fluorescence microscopy, morphed three-dimensionally, onto a common spatial frame. Existing tools built on volume visualization pipelines for single channel or red-green-blue (RGB) channels have become inadequate for the new challenges of fluorescence microscopy. For a three-dimensional atlas of the insect nervous system, hundreds of volume channels are rendered simultaneously, whereas fluorescence intensity values from each channel need to be preserved for versatile adjustment and analysis. Although several existing tools have incorporated support of multichannel data using various strategies, the lack of a flexible design has made true many-channel visualization and analysis unavailable. The most common practice for many-channel volume data presentation is still converting and rendering pseudosurfaces, which are inaccurate for both qualitative and quantitative evaluations. RESULTS: Here, we present an alternative design strategy that accommodates the visualization and analysis of about 100 volume channels, each of which can be interactively adjusted, selected, and segmented using freehand tools. Our multichannel visualization includes a multilevel streaming pipeline plus a triple-buffer compositing technique. Our method also preserves original fluorescence intensity values on graphics hardware, a crucial feature that allows graphics-processing-unit (GPU)-based processing for interactive data analysis, such as freehand segmentation. We have implemented the design strategies as a thorough restructuring of our original tool, FluoRender. CONCLUSION: The redesign of FluoRender not only maintains the existing multichannel capabilities for a greatly extended number of volume channels, but also enables new analysis functions for many-channel data from emerging biomedical-imaging techniques.

TOD-Tree: Task-Overlapped Direct Send Tree Image Compositing for Hybrid MPI Parallelism and GPUs.

Modern supercomputers have thousands of nodes, each with CPUs and/or GPUs capable of several teraflops. However, the network connecting these nodes is relatively slow, on the order of gigabits per second. For time-critical workloads such as interactive visualization, the bottleneck is no longer computation but communication. In this paper, we present an image compositing algorithm that works on both CPU-only and GPU-accelerated supercomputers and focuses on communication avoidance and overlapping communication with computation at the expense of evenly balancing the workload. The algorithm has three stages: a parallel direct send stage, followed by a tree compositing stage and a gather stage. We compare our algorithm with radix-k and binary-swap from the IceT library in a hybrid OpenMP/MPI setting on the Stampede and Edison supercomputers, show strong scaling results and explain how we generally achieve better performance than these two algorithms. We developed a GPU-based image compositing algorithm where we use CUDA kernels for computation and GPU Direct RDMA for inter-node GPU communication. We tested the algorithm on the Piz Daint GPU-accelerated supercomputer and show that we achieve performance on par with CPUs. Last, we introduce a workflow in which both rendering and compositing are done on the GPU.