Continual near-infrared spectroscopy monitoring in the injured lower limb and acute compartment syndrome: an FDA-IDE trial.

Aims: The aim of this study was to evaluate near-infrared spectroscopy (NIRS) as a continuous, non-invasive monitor for acute compartment syndrome (ACS). Patients and Methods: NIRS sensors were placed on 86 patients with, and 23 without (controls), severe leg injury. NIRS values were recorded for up to 48 hours. Longitudinal data were analyzed using summary and graphical methods, bivariate comparisons, and multivariable multilevel modelling. Results: Mean NIRS values in the anterior, lateral, superficial posterior, and deep posterior compartments were between 72% and 78% in injured legs, between 69% and 72% in uninjured legs, and between 71% and 73% in bilaterally uninjured legs. In patients without ACS, the values were typically > 3% higher in injured compartments. All seven limbs with ACS had at least one compartment where NIRS values were 3% or more below a reference uninjured control compartment. Missing data were encountered in many instances. Conclusion: NIRS oximetry might be used to aid the assessment and management of patients with ACS. Sustained hyperaemia is consistent with the absence of ACS in injured legs. Loss of the hyperaemic differential warrants heightened surveillance. NIRS values in at least one injured compartment(s) were > 3% below the uninjured contralateral compartment(s) in all seven patients with ACS. Additional interventional studies are required to validate the use of NIRS for ACS monitoring. Cite this article: Bone Joint J 2018;100-B:787-97.

Effects of ambient exposure, refrigeration, and icing on Vibrio vulnificus and Vibrio parahaemolyticus abundances in oysters.

Vibrio vulnificus (Vv) and V. parahaemolyticus (Vp) illnesses are typically acquired through the consumption of raw molluscan shellfish, particularly oysters. As Vibrio spp. are naturally-occurring bacteria, one means of mitigation of illness is achieved by limiting post-harvest growth. In this study, effects of ambient air storage, refrigeration, and icing of oysters on Vibrio spp. abundances were examined at two sites in Alabama (AL) [Dog River (DR) and Cedar Point (CP)] and one site in Delaware Bay, New Jersey (NJ). As the United States shellfish program recommendations include testing for total these organisms and gene targets, Vv and total (tlh) and pathogenic (tdh+ and trh+) Vp were enumerated from samples using MPN-real-time-PCR approaches. Mean Vv and Vp abundances in oysters from AL-DR were lowest in immediately iced samples (2.3 and -0.1 log MPN/g, respectively) and highest in the 5h ambient then refrigerated samples (3.4 and 0.5 log MPN/g, respectively). Similarly, in AL-CP Vv and Vp mean levels in oysters were lowest in immediately iced samples (3.6 and 1.2 log MPN/g, respectively) and highest in 5h ambient then refrigerated samples (5.1 and 3.2 log MPN/g, respectively). Mean levels of pathogenic Vp from AL sites were frequently below the limit of detection (<0.3 MPN/g). In NJ, Vv and Vp mean abundances in oysters were highest in samples which were held for 7h in the shade (5.3 and 4.8 log MPN/g, respectively). Mean pathogenic Vp levels in oysters at initial harvest were also highest in oysters 7h in the shade (2.1 and 2.2 log MPN/g for tdh+ and trh+ Vp). Regardless of sampling location, Vibrio spp. levels were generally significantly (p<0.05) greater in oysters exposed to 5h of air storage compared to the initially harvested samples. In addition, the data demonstrated that the use of layered ice resulted in lower Vibrio spp. levels in oysters, compared to those that were refrigerated post-harvest. These results suggest vibriosis risk can be mitigated by shorter storage times and more rapid cooling of oysters, providing data regulatory authorities can use to evaluate Vibrio spp. control plans.

Effects of Intertidal Harvest Practices on Levels of Vibrio parahaemolyticus and Vibrio vulnificus Bacteria in Oysters.

UNLABELLED: Vibrio parahaemolyticus and Vibrio vulnificus can grow rapidly in shellfish subjected to ambient air conditions, such as during intertidal exposure. In this study, levels of total and pathogenic (tdh(+) and/or trh(+)) V. parahaemolyticus and total V. vulnificus were determined in oysters collected from two study locations where intertidal harvest practices are common. Samples were collected directly off intertidal flats, after exposure (ambient air [Washington State] or refrigerated [New Jersey]), and after reimmersion by natural tidal cycles. Samples were processed using a most-probable-number (MPN) real-time PCR method for total and pathogenic V. parahaemolyticus or V. vulnificus In Washington State, the mean levels of V. parahaemolyticus increased 1.38 log MPN/g following intertidal exposure and dropped 1.41 log MPN/g after reimmersion for 1 day, but the levels were dependent upon the container type utilized. Pathogenic V. parahaemolyticus levels followed a similar trend. However, V. vulnificus levels increased 0.10 log MPN/g during intertidal exposure in Washington but decreased by >1 log MPN/g after reimmersion. In New Jersey, initial levels of all vibrios studied were not significantly altered during the refrigerated sorting and containerizing process. However, there was an increase in levels after the first day of reimmersion by 0.79, 0.72, 0.92, and 0.71 log MPN/g for total, tdh(+) and trh(+) V. parahaemolyticus, and V. vulnificus, respectively. The levels of all targets decreased to those similar to background after a second day of reimmersion. These data indicate that the intertidal harvest and handling practices for oysters that were studied in Washington and New Jersey do not increase the risk of illness from V. parahaemolyticus or V. vulnificus IMPORTANCE: Vibrio parahaemolyticus and Vibrio vulnificus are the leading causes of seafood-associated infectious morbidity and mortality in the United States. Vibrio spp. can grow rapidly in shellfish subjected to ambient air conditions, such as during periods of intertidal exposure. When oysters are submersed with the incoming tide, the vibrios can be purged. However, data on the rates of increase and purging during intertidal harvest are scarce, which limits the accuracy of risk assessments. The objective of this study was to help fill these data gaps by determining the levels of total and pathogenic (tdh(+) and/or trh(+)) V. parahaemolyticus and V. vulnificus in oysters from two locations where intertidal harvest practices are common, using the current industry practices. The data generated provide insight into the responses of Vibrio spp. to relevant practices of the industry and public health, which can be incorporated into risk management decisions.

Difference in hip prosthesis femoral offset affects hip abductor strength and gait characteristics during obstacle crossing.

The purpose of this article is to determine if individuals with high rather than low femoral offset of a total hip arthroplasty achieve improved hip abductor muscle strength and thus improved their ability to step over an obstacle safely. These outcomes will help surgeons decide whether increasing the femoral offset helps a patient's physical function.

A biomechanical comparison between the single-axis and multi-axis total knee arthroplasty systems for the stand-to-sit movement.

BACKGROUND: Compared to the design of a traditional multi-axis total knee arthroplasty, the single-axis arthroplasty studied has a fixed flexion/extension center of rotation in the femoral component. The influence of this characteristic on functional daily activity, i.e., stand-to-sit, is not well understood. The purpose of this study was to investigate the effect of different arthroplasty designs on knee kinematic and lower limb muscular activation for the stand-to-sit movement. METHODS: Sixteen unilateral, posterior-stabilized knee arthroplasty participants (8 single-axis and 8 multi-axis) with excellent Knee Society scores performed 4 trials of the stand-to-sit test. Three-dimensional video analysis of whole body and joint kinematics and electromyography analysis of quadriceps and hamstrings were conducted. One-way ANOVAs were used for statistical analyses (alpha=0.05). FINDINGS: The multi-axis group showed some functional adaptations while sitting down. The single-axis group exhibited less arthroplasty limb quadriceps electromyography and hamstring co-activation electromyography than the multi-axis group. For the arthroplasty limb, single-axis demonstrated less abduction angular displacement and reached peak abduction earlier than the multi-axis arthroplasty limb. The estimated effect size for this study was 0.196. INTERPRETATION: The single-axis design requires less eccentric knee extensor muscle activation and exhibits greater medio-lateral stability than the multi-axis designs. Findings from this study could provide useful information to orthopedic knee surgeons and rehabilitative specialists.

Interfacing the PACS and the HIS: results of a 5-year implementation.

An interface was created between the Department of Defense's hospital information system (HIS) and its two picture archiving and communication system (PACS)-based radiology information systems (RISs). The HIS is called the Composite Healthcare Computer System (CHCS), and the RISs are called the Medical Diagnostic Imaging System (MDIS) and the Digital Imaging Network (DIN)-PACS. Extensive mapping between dissimilar data protocols was required to translate data from the HIS into both RISs. The CHCS uses a Health Level 7 (HL7) protocol, whereas the MDIS uses the American College of Radiology-National Electrical Manufacturers Association 2.0 protocol and the DIN-PACS uses the Digital Imaging and Communications in Medicine (DICOM) 3.0 protocol. An interface engine was required to change some data formats, as well as to address some nonstandard HL7 data being output from the CHCS. In addition, there are differences in terminology between fields and segments in all three protocols. This interface is in use at 20 military facilities throughout the world. The interface reduces the amount of manual entry into more than one automated system to the smallest level possible. Data mapping during installation saved time, improved productivity, and increased user acceptance during PACS implementation. It also resulted in more standardized database entries in both the HIS (CHCS) and the RIS (PACS).

Image compression and chest radiograph interpretation: image perception comparison between uncompressed chest radiographs and chest radiographs stored using 10:1 JPEG compression.

We have assessed the effect of 10:1 lossy (JPEG) compression on six board-certified radiologists' ability to detect three commonly seen abnormalities on chest radiographs. The study radiographs included 150 chest radiographs with one of four diagnoses: normal (n = 101), pulmonary nodule (n = 19), interstitial lung disease (n = 19), and pneumothorax (n = 11). Before compression, these images were printed on laser film and interpreted in a blinded fashion by six radiologists. Following an 8-week interval, the images were reinterpreted on an image display workstation after undergoing 10:1 lossy compression. The results for the compressed images were compared with those of the uncompressed images using receiver operating characteristic (ROC) analyses. For five of six readers, the diagnostic accuracy was higher for the uncompressed images than for the compressed images, but the difference was not significant (P > .1111). Combined readings for the uncompressed images were also more accurate when compared with the compressed images, but this difference was also not significant (P = .1430). The sensitivity, specificity, and accuracy values were 81.5%, 89.2%, and 86.7% for the compressed images, respectively, as compared with 78.9%, 94.5%, and 89.3% for the uncompressed images. There was no correlation between the readers' accuracy and their experience with soft-copy interpretation; the extent of radiographic interpretation experience had no correlation with overall interpretation accuracy. In conclusion, five of six radiologists had a higher diagnostic accuracy when interpreting uncompressed chest radiographs versus the same images modified by 10:1 lossy compression, but this difference was not statistically significant.

Reengineering the picture archiving and communication system (PACS) process for digital imaging networks PACS.

Prior to June 1997, military picture archiving and communications systems (PACS) were planned, procured, and installed with key decisions on the system, equipment, and even funding sources made through a research and development office called Medical Diagnostic Imaging Systems (MDIS). Beginning in June 1997, the Joint Imaging Technology Project Office (JITPO) initiated a collaborative and consultative process for planning and implementing PACS into military treatment facilities through a new Department of Defense (DoD) contract vehicle called digital imaging networks (DIN)-PACS. The JITPO reengineered this process incorporating multiple organizations and politics. The reengineered PACS process administered through the JITPO transformed the decision process and accountability from a single office to a consultative method that increased end-user knowledge, responsibility, and ownership in PACS. The JITPO continues to provide information and services that assist multiple groups and users in rendering PACS planning and implementation decisions. Local site project managers are involved from the outset and this end-user collaboration has made the sometimes difficult transition to PACS an easier and more acceptable process for all involved. Corporately, this process saved DoD sites millions by having PACS plans developed within the government and proposed to vendors second, and then having vendors respond specifically to those plans. The integrity and efficiency of the process have reduced the opportunity for implementing nonstandard systems while sharing resources and reducing wasted government dollars. This presentation will describe the chronology of changes, encountered obstacles, and lessons learned within the reengineering of the PACS process for DIN-PACS.

Acceptance testing of integrated picture archiving and communications systems.

An integrated picture archiving and communication system (PACS) is a large investment in both money and resources. With all of the components and systems contained in the PACS, a methodical set of protocols and procedures must be developed to test all aspects of the PACS within the short time allocated for contract compliance. For the Department of Defense (DoD), acceptance testing (AT) sets the protocols and procedures. Broken down into modules and test procedures that group like components and systems, the AT protocol maximizes the efficiency and thoroughness of testing all aspects of an integrated PACS. A standardized and methodical protocol reduces the probability of functionality or performance limitations being overlooked. The AT protocol allows complete PACS testing within the 30 days allocated by the digital imaging network (DIN)-PACS contract. AT shortcomings identified during the testing phase properly allows for resolution before complete acceptance of the system. This presentation will describe the evolution of the process, the components of the DoD AT protocol, the benefits of the AT process, and its significance to the successful implementation of a PACS. This is a US government work. There are no restrictions on its use.