Comparative Morbidity of Cubital Tunnel Surgeries: A Prospective Cohort Study.

PURPOSE: Randomized controlled trials have not identified a superior surgical approach to cubital tunnel syndrome surgery. This study evaluates the early morbidity of open in situ decompression and transposition. METHODS: This prospective cohort study enrolled 125 adult patients indicated for cubital tunnel surgery at a tertiary institution. Exclusion criteria included preoperative use of narcotics and concurrent elbow procedures. In situ decompressions (n = 47) and ulnar nerve transpositions (n = 78) were performed. Data were collected by independent clinicians at 3 postoperative intervals: 1 to 3 weeks, 4 to 8 weeks, and longer than 8 weeks. Postoperative data quantified surgical morbidity: visual analog scale (0-10) surgical site pain, narcotic consumption, patient-reported disability (Levine-Katz, Patient-Reported Elbow Evaluation [PREE] scores). Olecranon paresthesia and wound complications (hematoma, drainage, infection) were recorded. RESULTS: No preoperative differences in age, sex, or the presence of pain existed between the surgical groups. Surgical site pain was not significantly different at any time. Following transposition, a significantly greater percentage of patients were using narcotics at 4 to 8 weeks after surgery and the average total morphine equivalents consumed per patient was significantly greater. Both Levine-Katz and PREE scores indicated greater disability at 1 to 3 and 4 to 8 weeks after transposition, but this significant difference resolved by final follow-up. Olecranon paresthesias occurred after both procedures but were significantly less frequent at 4 to 8 weeks and longer than 8 weeks after decompression. Twelve hematomas occurred following transposition (15%) with 1 requiring operative debridement and 5 hematomas resolved with nonsurgical treatment after in situ decompression (11%). CONCLUSIONS: Ulnar nerve transposition imparts greater surgical morbidity than decompression with greater narcotic consumption, more patient-reported disability up to 8 weeks after surgery, and more persistent olecranon paresthesia. However, most differences in surgical morbidity are transient with resolution after 8 weeks following surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Entropy-as-a-Service: Unlocking the Full Potential of Cryptography.

Securing the Internet requires strong cryptography, which depends on the availability of good entropy for generating unpredictable keys and accurate clocks. Attacks abusing weak keys or old inputs portend challenges for the Internet. EaaS is a novel architecture providing entropy and timestamps from a decentralized root of trust, scaling gracefully across diverse geopolitical locales and remaining trustworthy unless much of the collective is compromised.

The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes.

BACKGROUND: The US Department of Agriculture Automated Multiple-Pass Method (AMPM) is used for collecting 24-h dietary recalls in What We Eat In America, the dietary interview component of the National Health and Nutrition Examination Survey. Because the data have important program and policy applications, it is essential that the validity of the method be tested. OBJECTIVE: The accuracy of the AMPM was evaluated by comparing reported energy intake (EI) with total energy expenditure (TEE) by using the doubly labeled water (DLW) technique. DESIGN: The 524 volunteers, aged 30-69 y, included an equal number of men and women recruited from the Washington, DC, area. Each subject was dosed with DLW on the first day of the 2-wk study period; three 24-h recalls were collected during the 2-wk period by using the AMPM. The first recall was conducted in person, and subsequent recalls were over the telephone. RESULTS: Overall, the subjects underreported EI by 11% compared with TEE. Normal-weight subjects [body mass index (in kg/m(2)) < 25] underreported EI by <3%. By using a linear mixed model, 95% CIs were determined for the ratio of EI to TEE. Approximately 78% of men and 74% of women were classified as acceptable energy reporters (within 95% CI of EI:TEE). Both the percentage by which energy was underreported and the percentage of subjects classified as low energy reporters (<95% CI of EI:TEE) were highest for subjects classified as obese (body mass index > 30). CONCLUSIONS: Although the AMPM accurately reported EIs in normal-weight subjects, research is warranted to enhance its accuracy in overweight and obese persons.