Survival in Patients With Spinal Metastatic Disease Treated Nonoperatively With Radiotherapy: Are the SORG-ML Algorithms Relevant?

SUMMARY OF BACKGROUND DATA: The SORG-ML algorithms for survival in spinal metastatic disease were developed in patients who underwent surgery and were externally validated for patients managed operatively. OBJECTIVE: To externally validate the SORG-ML algorithms for survival in spinal metastatic disease in patients managed nonoperatively with radiation. STUDY DESIGN: Retrospective cohort. METHODS: The performance of the SORG-ML algorithms was assessed by discrimination [receiver operating curves and area under the receiver operating curve (AUC)], calibration (calibration plots), decision curve analysis, and overall performance (Brier score). The primary outcomes were 90-day and 1-year mortality. RESULTS: Overall, 2074 adult patients underwent radiation for spinal metastatic disease and 29% (n=521) and 59% (n=917) had 90-day and 1-year mortality, respectively. On complete case analysis (n=415), the AUC was 0.76 (95% CI: 0.71-0.80) and 0.78 (95% CI: 0.73-0.83) for 90-day and 1-year mortality with fair calibration and positive net benefit confirmed by the decision curve analysis. With multiple imputation (n=2074), the AUC was 0.85 (95% CI: 0.83-0.87) and 0.87 (95% CI: 0.85-0.89) for 90-day and 1-year mortality with fair calibration and positive net benefit confirmed by the decision curve analysis. CONCLUSION: The SORG-ML algorithms for survival in spinal metastatic disease generalize well to patients managed nonoperatively with radiation.

Does the SORG Machine-learning Algorithm for Extremity Metastases Generalize to a Contemporary Cohort of Patients? Temporal Validation From 2016 to 2020.

BACKGROUND: The ability to predict survival accurately in patients with osseous metastatic disease of the extremities is vital for patient counseling and guiding surgical intervention. We, the Skeletal Oncology Research Group (SORG), previously developed a machine-learning algorithm (MLA) based on data from 1999 to 2016 to predict 90-day and 1-year survival of surgically treated patients with extremity bone metastasis. As treatment regimens for oncology patients continue to evolve, this SORG MLA-driven probability calculator requires temporal reassessment of its accuracy. QUESTION/PURPOSE: Does the SORG-MLA accurately predict 90-day and 1-year survival in patients who receive surgical treatment for a metastatic long-bone lesion in a more recent cohort of patients treated between 2016 and 2020? METHODS: Between 2017 and 2021, we identified 674 patients 18 years and older through the ICD codes for secondary malignant neoplasm of bone and bone marrow and CPT codes for completed pathologic fractures or prophylactic treatment of an impending fracture. We excluded 40% (268 of 674) of patients, including 18% (118) who did not receive surgery; 11% (72) who had metastases in places other than the long bones of the extremities; 3% (23) who received treatment other than intramedullary nailing, endoprosthetic reconstruction, or dynamic hip screw; 3% (23) who underwent revision surgery, 3% (17) in whom there was no tumor, and 2% (15) who were lost to follow-up within 1 year. Temporal validation was performed using data on 406 patients treated surgically for bony metastatic disease of the extremities from 2016 to 2020 at the same two institutions where the MLA was developed. Variables used to predict survival in the SORG algorithm included perioperative laboratory values, tumor characteristics, and general demographics. To assess the models' discrimination, we computed the c-statistic, commonly referred to as the area under the receiver operating characteristic (AUC) curve for binary classification. This value ranged from 0.5 (representing chance-level performance) to 1.0 (indicating excellent discrimination) Generally, an AUC of 0.75 is considered high enough for use in clinical practice. To evaluate the agreement between predicted and observed outcomes, a calibration plot was used, and the calibration slope and intercept were calculated. Perfect calibration would result in a slope of 1 and intercept of 0. For overall performance, the Brier score and null-model Brier score were determined. The Brier score can range from 0 (representing perfect prediction) to 1 (indicating the poorest prediction). Proper interpretation of the Brier score necessitates a comparison with the null-model Brier score, which represents the score for an algorithm that predicts a probability equal to the population prevalence of the outcome for each patient. Finally, a decision curve analysis was conducted to compare the potential net benefit of the algorithm with other decision-support methods, such as treating all or none of the patients. Overall, 90-day and 1-year mortality were lower in the temporal validation cohort than in the development cohort (90 day: 23% versus 28%; p < 0.001, and 1 year: 51% versus 59%; p<0.001). RESULTS: Overall survival of the patients in the validation cohort improved from 28% mortality at the 90-day timepoint in the cohort on which the model was trained to 23%, and 59% mortality at the 1-year timepoint to 51%. The AUC was 0.78 (95% CI 0.72 to 0.82) for 90-day survival and 0.75 (95% CI 0.70 to 0.79) for 1-year survival, indicating the model could distinguish the two outcomes reasonably. For the 90-day model, the calibration slope was 0.71 (95% CI 0.53 to 0.89), and the intercept was -0.66 (95% CI -0.94 to -0.39), suggesting the predicted risks were overly extreme, and that in general, the risk of the observed outcome was overestimated. For the 1-year model, the calibration slope was 0.73 (95% CI 0.56 to 0.91) and the intercept was -0.67 (95% CI -0.90 to -0.43). With respect to overall performance, the model's Brier scores for the 90-day and 1-year models were 0.16 and 0.22. These scores were higher than the Brier scores of internal validation of the development study (0.13 and 0.14) models, indicating the models' performance has declined over time. CONCLUSION: The SORG MLA to predict survival after surgical treatment of extremity metastatic disease showed decreased performance on temporal validation. Moreover, in patients undergoing innovative immunotherapy, the possibility of mortality risk was overestimated in varying severity. Clinicians should be aware of this overestimation and discount the prediction of the SORG MLA according to their own experience with this patient population. Generally, these results show that temporal reassessment of these MLA-driven probability calculators is of paramount importance because the predictive performance may decline over time as treatment regimens evolve. The SORG-MLA is available as a freely accessible internet application at https://sorg-apps.shinyapps.io/extremitymetssurvival/ .Level of Evidence Level III, prognostic study.

Minimum 7-Year Follow-Up of Vitamin E-Diffused and Highly Cross-Linked Polyethylene Liners in Total Hip Arthroplasty: Findings From a Prospective, International, Multicenter Study of 977 Patients.

BACKGROUND: Vitamin E-diffused highly cross-linked polyethylene (VEPE) acetabular liners for total hip arthroplasty (THA) have shown favorable results in small cohort studies. However, larger studies are warranted to compare its performance to highly cross-linked polyethylene (XLPE) and demonstrate clinical significance in 10-year arthroplasty outcomes. This study compared acetabular liner wear and patient-reported outcome measures (PROMs) between patients treated with VEPE and XLPE liners in a prospective, international, multicenter study with minimum 7-year follow-up. METHODS: A total of 977 patients (17 centers; 8 countries) were enrolled from 2007 to 2012. The centers were randomly assigned to implants. At 1-year, 3-year, 5-year, and 7-year postoperative visits, radiographs, PROMs, and incidence of revision were collected. Acetabular liner wear was calculated using computer-assisted vector analysis of serial radiographs. General health, disease progression, and treatment satisfaction reported by patients were scored using 5 validated surveys and compared using Mann-Whitney U tests. At 7 years, 75.4% of eligible patients submitted data. RESULTS: The mean acetabular liner wear rate was -0.009 mm/y and 0.024 mm/y for the VEPE and XLPE group, respectively (P = .01). There were no statistically significant differences in PROMs. The overall revision incidence was 1.8% (n = 18). The revision incidence in VEPE and XLPE cohorts were 1.92% (n = 10) versus 1.75% (n = 8), respectively. CONCLUSION: We found that VEPE acetabular liners in total hip arthroplasty led to no significant clinical difference in 7-year outcomes as measured by acetabular liner wear rate, PROMs, and revision rate. While VEPE liners showed less wear, the wear rate for both the VEPE and XLPE liners was below the threshold for osteolysis. Therefore, the difference in liner wear may indicate comparative clinical performance at 7 years, as further indicated by the lack of difference in PROMs and the low revision incidence.

Perceptions of Gender Equity by Urologic Subspecialty.

OBJECTIVES: To evaluate how urologists in various subspecialties view the climate for female urologists, comparing perceptions of gender inequity based on characteristics including gender, subspecialty training, faculty status, parental status, and years in practice. Despite growth in female representation in urology, gender inequalities in career opportunities and compensation continue to exist. METHODS: An IRB approved survey was sent out to the following list-serves: Society of Urological Oncology (SUO), Society of Endourology (ENDO), Genitourinary Reconstructive Surgeons (GURS), Society of Pediatric Urology (SPU), Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), and American Urogynecologic Society (AUGS). A validated study, the Culture Conducive to Women's Academic Success (CCWAS) was used, and scores analyzed using Wilcoxon Rank-Sum and Kruskal-Wallace tests. RESULTS: There were 430 survey responses (35.3% female, 64.7% male). There was a statistically significant difference in CCWAS score for gender, parental status, and society. On multiple regression analysis controlling for gender, parental status and society were not statistically significant. Years in practice and practice type were not significant. Male urologists perceived practice culture toward women as more equitable than their female colleagues, (median [interquartile range] CCWAS score, 203.5 [184.25, 225.0] vs 162.5 [130.75, 188.0]; P < .0001). This discrepancy in perception between genders was consistent across all subcategories; equal access, work-life balance, freedom of gender bias, and leadership support. CONCLUSIONS: This study suggests that there are gender-based differences in how gender inequities are perceived and experienced in urology. Acknowledgment of these differences is the first step in identifying opportunities for improvement.

Linking Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form and PROMIS Physical Function.

INTRODUCTION: Linking scores on patient-reported outcome measures can enable data aggregation for research, clinical care, and quality. We aimed to link scores on the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) and the Patient-reported Outcomes Measurement Information System Physical Function (PROMIS PF). METHODS: A retrospective study was conducted from 2017 to 2020 evaluating patients with hip osteoarthritis who received routine clinical care from an orthopaedic surgeon. Our sample included 3,382 unique patients with 7,369 pairs of HOOS-PS and PROMIS PF measures completed at a single nonsurgical, preoperative, or postoperative time point. We included one randomly selected time point of scores for each patient in our linking analysis sample. We compared the accuracy of linking using four methods, including equipercentile and item response theory-based approaches. RESULTS: PROMIS PF and HOOS-PS scores were strongly correlated ( r = -0.827 for raw HOOS-PS scores and r = 0.820 for summary HOOS-PS scores). The assumptions were met for equipercentile and item response theory approaches to linking. We selected the item response theory-based Stocking-Lord approach as the optimal crosswalk and estimated item parameters for the HOOS-PS items on the PROMIS metric. A sensitivity analysis demonstrated overall robustness of the crosswalk estimates in nonsurgical, preoperative, and postoperative patients. CONCLUSION: These crosswalks can be used to convert scores between HOOS-PS and PROMIS PF metric at the group level, which can be valuable for data aggregation. Conversion of individual patient-level data is not recommended secondary to increased risk of error.

Natural language processing for prediction of readmission in posterior lumbar fusion patients: which free-text notes have the most utility?

BACKGROUND CONTEXT: The increasing volume of free-text notes available in electronic health records has created an opportunity for natural language processing (NLP) algorithms to mine this unstructured data in order to detect and predict adverse outcomes. Given the volume and diversity of documentation available in spine surgery, it remains unclear which types of documentation offer the greatest value for prediction of adverse outcomes. STUDY DESIGN/SETTING: Retrospective review of medical records at two academic and three community hospitals. PURPOSE: The purpose of this study was to conduct an exploratory analysis in order to examine the utility of free-text notes generated during the index hospitalization for lumbar spine fusion for prediction of 90-day unplanned readmission. PATIENT SAMPLE: Adult patients 18 years or older undergoing lumbar spine fusion for lumbar spondylolisthesis or lumbar spinal stenosis between January 1, 2016 and December 31, 2020. OUTCOME MEASURES: The primary outcome was inpatient admission within 90-days of discharge from the index hospitalization. METHODS: The predictive performance of NLP algorithms developed by using discharge summary notes, operative notes, nursing notes, physical therapy notes, case management notes, medical doctor (MD) (resident or attending), and allied practice professional (APP) (nurse practitioner or physician assistant) notes were assessed by discrimination, calibration, overall performance. RESULTS: Overall, 708 patients were included in the study and 83 (11.7%) had 90-day inpatient readmission. In the independent testing set of patients (n=141) not used for model development, the area under the receiver operating curve of NLP algorithms for prediction of 90-day readmission using discharge summary notes, operative notes, nursing notes, physical therapy notes, case management notes, MD/APP notes was 0.70, 0.57, 0.57, 0.60, 0.60, and 0.49 respectively. CONCLUSION: In this exploratory analysis, discharge summary, physical therapy, and case management notes had the most utility and daily MD/APP progress notes had the least utility for prediction of 90-day inpatient readmission in lumbar fusion patients among the free-text documentation generated during the index hospitalization.

Development of machine learning algorithms to predict achievement of minimal clinically important difference for the KOOS-PS following total knee arthroplasty.

As cost-effective measures become increasingly implemented in the US healthcare system, changes in patient-reported outcome measure (PROM) scores can be utilized to indicate patient satisfaction following procedures including total knee arthroplasty (TKA). The primary aim of this study was to develop and evaluate machine learning algorithms to predict achievement of the minimal clinically important difference (MCID) for the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) at 1-year following TKA. A retrospective review of primary TKA patients between 2016 and 2018 was performed. Variables considered for prediction included demographics and preoperative PROMs. The KOOS-PS MCID was calculated via a distribution-based method. Five machine learning algorithms were developed and tested by discrimination, calibration, Brier score, and decision curve analysis. Among the 744 patients who met the inclusion criteria, 385 (72.8%) patients achieved the MCID. The elastic-net penalized logistic regression model was selected as the best performing model (c-statistic 0.77, calibration intercept -0.02, calibration slope 1.15, and Brier score 0.14). The most important variables for MCID achievement were preoperative KOOS-PS score, preoperative VAS Pain, preoperative opioid use, preoperative PROMIS global mental health score, age, and sex. Algorithms were incorporated into an open-access digital application available at https://sorg-apps.shinyapps.io/tka_koos_mcid/. This study is the first to predict the probability of achieving the KOOS-PS MCID following TKA using a machine learning-based approach. The results were used to develop a clinical decision aid based on commonly collected predictive variables to preoperatively predict an individual patient's likelihood of attaining an acceptable outcome following TKA.

Different Designs of Proximal Femoral Stems for Total Hip Arthroplasty: Mid-Term Clinical and Patient-Reported Functional Outcomes.

INTRODUCTION: A comprehensive comparison of the performance of different femoral stem geometries in total hip arthroplasty (THA) is yet to be described. The primary aim of this study was to evaluate objective and subjective outcome measures in primary THA with different femoral implant styles. METHODS: Stems were classified into the following five classes: cemented, conical, fit and fill, modular, and wedge. The objective outcomes of interest were the length of inpatient hospital stay (LOS), 90-day readmission rate, one-year revision rate, and two-year mortality rate. Preoperative and postoperative patient-reported outcome measures (PROMs), including hip disability and osteoarthritis outcome score (HOOS) - physical function shortform (HOOS-PS), patient-reported outcomes measurement information system physical function short form 10a (PROMIS PF-10a), and patient-reported outcomes measurement information system - short form - mental 10a (PROMIS M-10a) were recorded and compared between different classes. RESULTS: Patients with a wedge stem had a significantly lower LOS versus every other stem group, while patients with a cemented stem had the highest LOS, approximately twofold that of the wedge stem group. Accounting for potential confounders, the conical and fit and fill groups had a significantly higher two-year mortality rate than the wedge stem group. Fit and fill stems conferred a slight risk of revision THA at one-year compared to wedge stems. There was no significant difference in the rates of failure to achieve the minimal clinically important difference (MCID) for the PROMs. CONCLUSION: Placement of wedge stems resulted in a significantly lower LOS compared to every other stem class and a lower mortality rate than the conical, fit and fill, and modular stems. As for the 90-day readmission, one-year revision, and the rates of failure to achieve the MCID for general or hip-specific PROMs, stem design had no meaningful effect.

Can the Knee Outcome and Osteoarthritis Score (KOOS) Function Subscale Be Linked to the PROMIS Physical Function to Crosswalk Equivalent Scores?

BACKGROUND: An increased focus on patient-reported outcome measures (PROMs) has led to a proliferation of these measures in orthopaedic surgery. Mandating a single PROM in clinical and research orthopaedics is not feasible given the breadth of data already collected with older measures and the emergence of psychometrically superior measures. Creating crosswalk tables for scores between measures allows providers to maintain control of measure choice. Furthermore, crosswalk tables permit providers to compare scores collected with older outcome measures with newly collected ones. Given the widespread use of the newer Patient-reported Outcome Measure Information System Physical Function (PROMIS PF) and the established Knee Outcome and Osteoarthritis Score (KOOS), it would be clinically useful to link these two measures. QUESTION/PURPOSE: Can the KOOS Function in Activities of Daily Living (ADL) subscale be robustly linked to the PROMIS PF to create a crosswalk table of equivalent scores that accurately reflects a patient's reported physical function level on both scales? METHODS: We sought to establish a common standardized metric for collected responses to the PROMIS PF and the KOOS ADL to develop equations for converting a PROMIS PF score to a score for the KOOS-ADL subscale and vice versa. To do this, we performed a retrospective, observational study at two academic medical centers and two community hospitals in an urban and suburban healthcare system. Patients 18 years and older who underwent TKA were identified. Between January 2017 and July 2020, we treated 8165 patients with a TKA, 93% of whom had a diagnosis of primary osteoarthritis. Of those, we considered patients who had completed a full KOOS and PROMIS PF 10a on the same date as potentially eligible. Twenty-one percent (1708 of 8165) of patients were excluded because no PROMs were collected at any point, and another 67% (5454 of 8165) were excluded because they completed only one of the required PROMs, leaving 12% (1003 of 8165) for analysis here. PROMs were collected each time they visited the health system before and after their TKAs. Physical function was measured by the PROMIS PF version 1.0 SF 10a and KOOS ADL scale. Analyses to accurately create a crosswalk of equivalent scores between the measures were performed using the equipercentile linking method with both unsmoothed and log linear smoothed score distributions. RESULTS: Crosswalks were created, and adequate validation results supported their validity; we also created tables to allow clinicians and clinician scientists to convert individual patients' scores easily. The mean difference between the observed PROMIS PF scores and the scores converted by the crosswalk from the KOOS-ADL scores was -0.08 ± 4.82. A sensitivity analysis was conducted, confirming the effectiveness of these crosswalks to link the scores of two measures from patients both before and after surgery. CONCLUSION: The PROMIS PF 10a can be robustly linked to the KOOS ADL measure. The developed crosswalk table can be used to convert PROMIS PF scores from KOOS ADL and vice versa. CLINICAL RELEVANCE: The creation of a crosswalk table between the KOOS Function in ADL subscale and PROMIS PF allows clinicians and researchers to easily convert scores between the measures, thus permitting greater choice in PROM selection while preserving comparability between patient cohorts and PROM data collected from older outcome measures. Creating a crosswalk, or concordance table, between the two scales will facilitate this comparison, especially when pooling data for meta-analyses.

Availability and reporting quality of external validations of machine-learning prediction models with orthopedic surgical outcomes: a systematic review.

Background and purpose - External validation of machine learning (ML) prediction models is an essential step before clinical application. We assessed the proportion, performance, and transparent reporting of externally validated ML prediction models in orthopedic surgery, using the Transparent Reporting for Individual Prognosis or Diagnosis (TRIPOD) guidelines.Material and methods - We performed a systematic search using synonyms for every orthopedic specialty, ML, and external validation. The proportion was determined by using 59 ML prediction models with only internal validation in orthopedic surgical outcome published up until June 18, 2020, previously identified by our group. Model performance was evaluated using discrimination, calibration, and decision-curve analysis. The TRIPOD guidelines assessed transparent reporting.Results - We included 18 studies externally validating 10 different ML prediction models of the 59 available ML models after screening 4,682 studies. All external validations identified in this review retained good discrimination. Other key performance measures were provided in only 3 studies, rendering overall performance evaluation difficult. The overall median TRIPOD completeness was 61% (IQR 43-89), with 6 items being reported in less than 4/18 of the studies.Interpretation - Most current predictive ML models are not externally validated. The 18 available external validation studies were characterized by incomplete reporting of performance measures, limiting a transparent examination of model performance. Further prospective studies are needed to validate or refute the myriad of predictive ML models in orthopedics while adhering to existing guidelines. This ensures clinicians can take full advantage of validated and clinically implementable ML decision tools.

Perceptions of gender equity in pediatric urology.

INTRODUCTION/OBJECTIVE: Women constitute more than 50% of medical students in the United States. However, only 9.9% of practicing urologists are women, with much fewer numbers in high ranking appointments and positions of leadership. With a growing number of women in pediatric urology, we sought to evaluate how pediatric urologists perceive the climate for women physicians and compare perceptions and experiences of gender equity based on characteristics including gender, practice type, parental status, and years in practice. STUDY DESIGN: An IRB approved survey was sent out to the Society of Pediatric Urology (SPU) listserve of active members. We utilized a validated study, the Culture Conducive to Women's Academic Success questionnaire (CCWAS, higher scores indicating better perceived culture toward women). Subcategories (equal access, work-life balance, freedom of gender bias, and leadership support) were also analyzed. A comment section was provided for respondents to include their own experiences. Descriptive statistics were used for demographics and clinical characteristics. Wilcoxon Rank-Sum and Kruskal-Wallace tests were used to compare CCWAS scores between groups. RESULTS: A total of 116 practicing physicians returned completed surveys for analysis (response rate, 116/355 (33%) [ n = 41,35.3%] female [n = 75,64.7%] male). There was a statistically significant difference in total CCWAS score between male and female genders, indicating male physicians perceived the culture of their department toward women more positively than their female counterparts (median [ interquartile range] CCWAS score, 208.0 [189.0-228.0] vs 164.0 [136.0-190.3]; P < 0.0001). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic versus private practice. DISCUSSION: Limitations of our survey include both participation and non-response bias. Those with strong opinions may have been more likely to respond to the survey. Male respondents comprised 64.7% (n = 75) of overall respondents, representing 25% active male SPU members. Whereas the response rate of active female members of the SPU was 70%. The survey was designed to assess gender equity in academia, and may not be as generalizable to the private practice community. Yet, the differences in perceptions and experiences of gender equity of this study have been noted by studies in other specialties, as well as the 2018 AUA Census report, and may provide insight into the presence and perpetuation of unconscious or systemic biases within medicine. CONCLUSION: In this study, male physician perceptions of gender equity were different from those reported by female physicians, suggesting there are gender-based differences in how gender inequities are perceived and experienced.

Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty.

BACKGROUND: Malnutrition is a devastating condition which disproportionally affects the elderly population. Malnutrition furthers the pre-existing elevated risk for osteoarthritis in this population, thus exacerbating joint damage in patients and furthering the need for total joint arthroplasty (TJA). A marker for malnutrition is a low body mass index (BMI). The purpose of this study is to investigate whether low BMI status increased the risk for 2-year mortality or reoperation, 90-day readmission, or extended length of stay (LOS) following TJA. METHODS: A retrospective study was performed using the Partners Arthroplasty Registry which contains data from 2016 to 2019. The registry was queried for primary total hip and primary total knee arthroplasty (TKA) patients that had a minimum of 2-years follow-up data. Demographic, surgical, and clinical outcome variables were obtained from these patients. The association between underweight BMI and objective outcomes of reoperation, 90-day readmission, mortality, and LOS was evaluated by univariate analysis followed by multiple logistic and linear regression analyses. RESULTS: The final cohort used for analysis consisted of 4802 TJA cases. After accounting for potential confounders, underweight BMI was found to be independently associated with increased risk of mortality within 2 years following TJA (odds ratio 8.77) (95% confidence interval 2.14-32.0) and increased LOS of 0.44 days (95% confidence interval 0.02-0.86). CONCLUSION: Our findings demonstrate that TJA patients with an underweight BMI experience an 8 times increased risk of 2-year mortality and an increased LOS of 0.44 days. Orthopedic surgeons should consider nutritional consultation and medical optimization in these high-risk patients prior to surgery.

Obesity Increases Risk of Failure to Achieve the 1-Year PROMIS PF-10a Minimal Clinically Important Difference Following Total Joint Arthroplasty.

INTRODUCTION: The aims of this study were to determine if increasing body mass index (BMI) is a risk factor for failure to attain the 1-year Patient Reported Outcomes Measurement Information System Physical Function (PROMIS PF-10a) minimal clinically important difference (MCID) following total joint arthroplasty (TJA) and to determine a possible BMI threshold beyond which this risk increases significantly. METHODS: This retrospective study was performed using 3506 TJAs sourced from a regional-based registry. An anchor-based MCID threshold of 7.9 was chosen. PROMIS PF-10a scores were collected at the preoperative and 1-year postoperative timepoints, and the change was used to determine failure to achieve the 1-year MCID. Demographic and surgical variables were also collected. The association between BMI and failure to achieve 1-year PROMIS PF-10 MCID was then evaluated using logistic regression. A BMI threshold was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: Increasing BMI assessed continuously was a significant risk factor for failure to achieve the MCID (P < .001). "Obese Class I" (30-35 kg/m2), "Obese Class II" (35-40 kg/m2), and "Obese Class III" (>40 kg/m2) subgroups compared to "Normal BMI" (<25 kg/m2) were significantly associated (P < .05) with this adverse outcome as well. CONCLUSION: Our study showed that increasing BMI is a risk factor for failure to achieve the 1-year PROMIS PF-10a MCID following TJA. Among our patients, an increase in 1 kg/m2 increased the risk of failure to achieve the MCID by 2%. With these findings, surgeons will be better equipped to preoperatively advise patients with elevated BMIs considering TJA.

Zika Virus Knowledge among Pregnant Women Who Were in Areas with Active Transmission.

We surveyed women in New York, New York, USA, who were in areas with active Zika virus transmission while pregnant. Of 99 women who were US residents, 30 were unaware of the government travel advisory to areas with active Zika virus transmission while pregnant, and 37 were unaware of their pregnancies during travel.

Using a call center to coordinate Zika virus testing-New York City, 2016.

BACKGROUND: After local testing criteria for Zika virus expanded to include asymptomatic pregnant women who traveled to areas with active Zika virus transmission while pregnant, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) experienced a surge in test requests and subsequent testing delays due to factors such as incorrectly completed laboratory requisition forms. The authors describe how DOHMH addressed these issues by establishing the Zika Testing Call Center (ZTCC). METHODS: Using a case study approach, the authors illustrate how DOHMH leveraged protocols, equipment, and other resources used previously during DOHMH&s Ebola emergency response to meet NYC's urgent Zika virus testing needs. To request Zika virus testing, providers call the ZTCC; if patients meet testing criteria, the ZTCC collects data necessary to complete requisition forms and sends the forms back to providers. The ZTCC also provides guidance on specimens needed for Zika virus testing. Providers submit completed requisition forms and appropriate specimens to DOHMH for testing. RESULTS: During March 21 through July 21, 2016, testing for 3,866 patients was coordinated through the ZTCC. CONCLUSION: The ZTCC exemplifies how a health department, using previous emergency response experiences, can quickly address local testing needs for an emerging infectious disease.

Multiplexed method to calibrate and quantitate fluorescence signal for allergen-specific IgE.

Using a microarray platform for allergy diagnosis allows for testing of specific IgE sensitivity to a multitude of allergens, while requiring only small volumes of serum. However, variation of probe immobilization on microarrays hinders the ability to make quantitative, assertive, and statistically relevant conclusions necessary in immunodiagnostics. To address this problem, we have developed a calibrated, inexpensive, multiplexed, and rapid protein microarray method that directly correlates surface probe density to captured labeled secondary antibody in clinical samples. We have identified three major technological advantages of our calibrated fluorescence enhancement (CaFE) technique: (i) a significant increase in fluorescence emission over a broad range of fluorophores on a layered substrate optimized specifically for fluorescence; (ii) a method to perform label-free quantification of the probes in each spot while maintaining fluorescence enhancement for a particular fluorophore; and (iii) a calibrated, quantitative technique that combines fluorescence and label-free modalities to accurately measure probe density and bound target for a variety of antibody-antigen pairs. In this paper, we establish the effectiveness of the CaFE method by presenting the strong linear dependence of the amount of bound protein to the resulting fluorescence signal of secondary antibody for IgG, ß-lactoglobulin, and allergen-specific IgEs to Ara h 1 (peanut major allergen) and Phl p 1 (timothy grass major allergen) in human serum.