Orthopaedists Versus Radiologists: A Prospective Comparison of Radiographic Interpretation Between Orthopaedists and Radiologists at a Level I Trauma Center.

The purpose of this investigation was to evaluate the difference in response time, accuracy of radiographic interpretation, and frequency of changes in clinical management necessary after inaccurate reads when comparing orthopaedic and radiology providers. Data including provider response time, accuracy of radiographic interpretation and the frequency of changes in clinical management necessary after imaging reads was collected over a continuous two-month period at a Level I Trauma center. A total of 188 orthopedic injuries involving imaging were included. Orthopedic providers responded 203.2 minutes sooner than radiology providers. Accuracy of radiographic interpretation of the orthopaedic and radiology providers was 100% and 91%, respectively. Frequency of changes in clinical management after inaccurate interpretation of imaging by the orthopaedic and radiology provider was 0% and 7.6%, respectively. Based on our study, orthopaedic providers are significantly faster, more accurate, and make fewer mistakes affecting patient care while interpreting images of orthopaedic injuries than our radiology colleagues. (Journal of Surgical Orthopaedic Advances 30(2):093-096, 2021).

SWITCH-China: A Systems Approach to Decarbonizing China's Power System.

We present an integrated model, SWITCH-China, of the Chinese power sector with which to analyze the economic and technological implications of a medium to long-term decarbonization scenario while accounting for very-short-term renewable variability. On the basis of the model and assumptions used, we find that the announced 2030 carbon peak can be achieved with a carbon price of ∼$40/tCO2. Current trends in renewable energy price reductions alone are insufficient to replace coal; however, an 80% carbon emission reduction by 2050 is achievable in the Intergovernmental Panel on Climate Change Target Scenario with an optimal electricity mix in 2050 including nuclear (14%), wind (23%), solar (27%), hydro (6%), gas (1%), coal (3%), and carbon capture and sequestration coal energy (26%). The co-benefits of carbon-price strategy would offset 22% to 42% of the increased electricity costs if the true cost of coal and the social cost of carbon are incorporated. In such a scenario, aggressive attention to research and both technological and financial innovation mechanisms are crucial to enabling the transition at a reasonable cost, along with strong carbon policies.

The influence of race and ethnicity on complications and mortality after orthopedic surgery: a systematic review of the literature.

BACKGROUND: The decision to perform orthopedic surgery requires substantial discretion and judgment. Similar conditions have been associated with health care disparities in other fields, but the extent of racial and ethnic disparities in orthopedics is unknown. OBJECTIVE: To evaluate the quality of extant orthopedic literature on health care disparities. RESEARCH DESIGN: This study is a systematic review. SUBJECTS: Eligible studies reported complications and/or mortality stratified by minority group after orthopedic surgery in an American population. MEASURES: Queries of PubMed, Embase, Scopus, and Web of Science were performed. Included papers were abstracted regarding complication and/or mortality rates for whites and minority populations, statistical findings, and whether a health care disparity was reported. Statistical associations between study characteristics and the identification of disparities were evaluated using the χ test. RESULTS: The literature search returned 2604 studies, of which 33 met inclusion criteria. All but 3 works dealt with spine surgery or joint replacement. Twenty-one publications (64%) documented health care disparities. Forty-four percent of efforts investigating outcomes for Hispanics and 36% of works documenting results for non-whites recorded a disparity. Investigations reporting on African Americans were significantly more likely to identify health care inequalities (77%) as compared with non-white (P=0.02) cohorts. CONCLUSIONS: Patients from racial and ethnic minority populations seem to be at increased risk of complications and/or mortality following spine surgical or joint replacement procedures. There is insufficient evidence to support generalization to the entire orthopedic field. Studies specific to African American patients identify health care disparities at a significantly higher rate than those utilizing non-white cohorts.

The Influence of Musculoskeletal Conditions, Behavioral Health Diagnoses, and Demographic Factors on Injury-Related Outcome in a High-Demand Population.

BACKGROUND: The extent to which musculoskeletal injuries and sociodemographic factors impact long-term outcome remains unknown. The purpose of this study was to provide a prognostic analysis of the influence of musculoskeletal conditions, behavioral health diagnoses, and patient-based characteristics on outcomes among a longitudinal cohort. METHODS: This is a longitudinal observational study of the population of an Army brigade deployed to Iraq from 2006 to 2007. The 4087 soldiers who survived the deployment were followed for forty-eight months and were observed for the development of chronic musculoskeletal conditions, behavioral health disorders, and inability to remain in active service as indicated by the findings of the Physical Evaluation Board. The influence of demographic factors, behavioral health conditions, and deployment-related musculoskeletal injuries on the capacity to remain in the military was assessed using Poisson multivariate analysis and receiver operating characteristic curves. RESULTS: The mean age of the cohort was twenty-seven years (range, eighteen to fifty-two years). One hundred and sixty-three soldiers sustained combat-related musculoskeletal trauma, and 587 soldiers had musculoskeletal injuries not related to battle. Three hundred and seventy-four soldiers (9%) were found to be unfit by the Physical Evaluation Board, with 236 soldiers (63%) referred for at least one musculoskeletal condition. Of these 236 soldiers, 116 (49%) also had a behavioral health diagnosis. Multivariate regression analysis revealed that junior enlisted rank (incidence rate ratio, 9.7 [95% confidence interval, 3.1 to 30.3]), senior enlisted rank (incidence rate ratio, 5.6 [95% confidence interval, 1.8 to 17.7]), behavioral health diagnosis (incidence rate ratio, 7.4 [95% confidence interval, 5.6 to 9.6]), age of eighteen to twenty-three years (incidence rate ratio, 1.6 [95% confidence interval, 1.2 to 2.3]), and male sex (incidence rate ratio, 2.5 [95% confidence interval, 1.2 to 5.0]) were significant predictors of referral to the Physical Evaluation Board for a musculoskeletal condition. A prognostic model developed using receiver operating characteristic curves and the risk factors of musculoskeletal injury, presence of a psychiatric condition, and lower rank explained 78% (95% confidence interval, 77% to 80%) of the risk of being found unfit by the Physical Evaluation Board. CONCLUSIONS: Musculoskeletal conditions, psychological diagnoses, and lower rank (socioeconomic status) were identified as potent predictors of inferior outcome in this study. Targeting at-risk patients within populations may improve results. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

End-to-end alignment of nanorods in thin films.

A simple approach to obtain end-to-end assemblies of nanorods over macroscopic distances in thin films is described. Nanorods with aspect ratio of 8-12 can be aligned parallel to the surface in an end-to-end fashion by imposing geometric confinement via block copolymer-based supramolecular assemblies. Successful control over the orientation and location of nanorods requires a balance of particle-particle interactions and entropy associated with geometric confinement from the supramolecular framework, as well as consideration of the kinetics of assembly.

SunShot solar power reduces costs and uncertainty in future low-carbon electricity systems.

The United States Department of Energy's SunShot Initiative has set cost-reduction targets of $1/watt for central-station solar technologies. We use SWITCH, a high-resolution electricity system planning model, to study the implications of achieving these targets for technology deployment and electricity costs in western North America, focusing on scenarios limiting carbon emissions to 80% below 1990 levels by 2050. We find that achieving the SunShot target for solar photovoltaics would allow this technology to provide more than a third of electric power in the region, displacing natural gas in the medium term and reducing the need for nuclear and carbon capture and sequestration (CCS) technologies, which face technological and cost uncertainties, by 2050. We demonstrate that a diverse portfolio of technological options can help integrate high levels of solar generation successfully and cost-effectively. The deployment of GW-scale storage plays a central role in facilitating solar deployment and the availability of flexible loads could increase the solar penetration level further. In the scenarios investigated, achieving the SunShot target can substantially mitigate the cost of implementing a carbon cap, decreasing power costs by up to 14% and saving up to $20 billion ($2010) annually by 2050 relative to scenarios with Reference solar costs.

Temporal changes in combat casualties from afghanistan by nationality: 2006-2010.

This study sought to evaluate temporal changes in combat deaths and improvised explosive device (IED)-related fatalities among three coalition allies in Afghanistan: the United States, Canada, and Great Britain. The website icasualties.org was used to identify American, Canadian, and British soldiers killed in combat in Afghanistan between 2006 and 2010. Population-at-risk was determined as the number of personnel serving within the Afghanistan theater for each coalition nation. Unadjusted incidence rates of combat deaths per deployed personnel, and IED deaths as a portion of total combat deaths, were derived and adjusted comparisons performed to control for confounders. Between 2006 and 2010, 1,673 combat deaths occurred in a population of 721,520 soldiers. Fifty percent of all combat deaths occurred as a result of IED attack. British personnel maintained the highest unadjusted risks of combat-related death, as well as IED-associated mortality. As compared to Americans, Canadian personnel were at a significantly increased risk of combat-related death and IED-related fatality. Among Americans, there was a significant reduction in IED-related deaths between 2010 and 2009. For Canadians, no significant change in IED fatalities as compared to total number of troops, or total combat deaths, was appreciated at any point in the study.

Incidence and risk factors for lumbar degenerative disc disease in the United States military 1999-2008.

The epidemiology of lumbar degenerative disc disease (DDD) is poorly understood, and the incidence of this disorder has not previously been characterized for a young, physically active population. This study sought to evaluate the incidence of lumbar DDD, and identify risk factors for its development, among individuals serving in the U.S. military over a 10-year period. The Defense Medical Epidemiology Database was queried for the years 1999-2008 using the International Classification of Diseases, Ninth Revision, Clinical Modification code for lumbar disc degeneration (722.52). Overall incidence was determined and multivariate Poisson regression analysis was performed to identify risk factors among demographic characteristics such as age, sex, race, military rank, and branch of service. White race, female sex, Army, Air Force, or Marine service, enlisted positions within the ranks, and age were found to be significant risk factors for the development of lumbar disc degeneration. Increased age appeared to be one of the most important risk factors, with adjusted incidence rates successively increasing for each age group under study. The incidence of lumbar DDD in this young, racially diverse, and physically active population is higher than most other degenerative conditions.

Fabrication and spectroscopic studies on highly luminescent CdSe/CdS nanorod polymer composites.

Highly luminescent nanocomposites were prepared by incorporating CdSe/CdS core/shell nanorods into different polymer matrices. The resulting nanocomposites show high transparency of up to 93%. A photoluminescence quantum efficiency of 70% was obtained, with an optimum combination of nanorod (0.05 wt %) and at a UV-initiator concentration of 0.1 wt % for poly(lauryl methacrylate). Nanorods tend to agglomerate in cellulose triacetate.

Seeded growth of highly luminescent CdSe/CdS nanoheterostructures with rod and tetrapod morphologies.

We have demonstrated that seeded growth of nanocrystals offers a convenient way to design nanoheterostructures with complex shapes and morphologies by changing the crystalline structure of the seed. By using CdSe nanocrystals with wurtzite and zinc blende structure as seeds for growth of CdS nanorods, we synthesized CdSe/CdS heterostructure nanorods and nanotetrapods, respectively. Both of these structures showed excellent luminescent properties, combining high photoluminescence efficiency (approximately 80 and approximately 50% for nanorods and nanotetrapods, correspondingly), giant extinction coefficients (approximately 2 x 10(7) and approximately 1.5 x 10(8) M(-1) cm(-1) at 350 nm for nanorods and nanotetrapods, correspondingly), and efficient energy transfer from the CdS arms into the emitting CdSe core.

Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine.

BACKGROUND: An advanced hemostatic dressing is needed to augment current methods for the control of life-threatening hemorrhage. A systematic approach to the study of dressings is described. We studied the effects of nine hemostatic dressings on blood loss using a model of severe venous hemorrhage and hepatic injury in swine. METHODS: Swine were treated using one of nine hemostatic dressings. Dressings used the following primary active ingredients: microfibrillar collagen, oxidized cellulose, thrombin, fibrinogen, propyl gallate, aluminum sulfate, and fully acetylated poly-N-acetyl glucosamine. Standardized liver injuries were induced, dressings were applied, and resuscitation was initiated. Blood loss, hemostasis, and 60-minute survival were quantified. RESULTS: The American Red Cross hemostatic dressing (fibrinogen and thrombin) reduced (p < 0.01) posttreatment blood loss (366 mL; 95% confidence interval, 175-762 mL) and increased (p < 0.05) the percentage of animals in which hemostasis was attained (73%), compared with gauze controls (2,973 mL; 95% confidence interval, 1,414-6,102 mL and 0%, respectively). No other dressing was effective. The number of vessels lacerated was positively related to pretreatment blood loss and negatively related to hemostasis. CONCLUSION: The hemorrhage model allowed differentiation among topical hemostatic agents for severe hemorrhage. The American Red Cross hemostatic dressing was effective and warrants further development.