3D preoperative planning for humeral head selection in total shoulder arthroplasty.

BACKGROUND: Recreation of glenohumeral biomechanics and humeral anatomy has been shown to improve outcomes in shoulder arthroplasty. Recent research has focused on utilizing simulation software and intraoperative instrumentation to improve glenoid implant selection and positioning, but no study had evaluated the reliability of new features in 3D preoperative planning software for humeral planning in total shoulder arthroplasty. MATERIALS AND METHODS: Preoperative plans were created for 26 patients using three different simulation software programs: an independent preoperative planning simulation (IPPS) software (OrthoVis) and two automated manufacturers preoperative simulation systems: ArthrexVIP™ (AMPS I) and Tornier Blueprint™ 3D Planning (AMPS II). Preoperative plans were compared for reliability and consistency among different software systems based on available variables including humeral head diameter (HD) and head height (HH). RESULTS: The measured HD was consistent between the three systems with a maximum mean difference of 0.2 mm for HD among IPPS, AMPS I, and AMPS II (p = 0.964). There was a significant difference in measured humeral HH with 1.7 mm difference between IPPS and AMPS II (p ≤ 0.001). The strongest correlation when comparing humeral head measurements (diameter or height) obtained from all systems was seen between IPPS and AMPS I for humeral HD (r = 0.8; p ≤ 0.001). CONCLUSION: There was a high level of consistency between independent and manufacturer preoperative planning software for humeral head measurements. These preoperative planning systems can improve efficiency and workflow during surgery by guiding surgeons on implant size selection to optimally reconstruct the glenohumeral kinematics, in order to improve patient outcomes. LEVEL OF EVIDENCE: Level III, study of nonconsecutive patients and without a universally applied "gold" standard study of diagnostic test.

The effects of anticipated funding changes on maternal and child health projects: a case study of uncertainty.

A questionnaire survey of Title V special projects--Maternal and Infant Care (M&I), Comprehensive Care for Children and Youth (C&Y), Neonatal Intensive Care and Children's Dental Care--indicated that the anticipated change from federal project grants to state formula grants caused anxiety among project directors, low morale and high turnover in project staff, difficulty in filling staff positions, and anticipation of service reductions. These effects were much more prevalent and severe in projects which could realistically be expected to suffer budget cuts as a result of the shift in funding method. Despite the widespread anxiety, low morale and adverse effects reported by program directors, there was no reduction in the number of patients served, the scope of services offered, or the number of staff employed.

Application of inverse filtering for detecting laryngeal pathology.

Inverse filtering analysis was performed on acoustic speech samples of the vowel sound "ah" produced by ten selected patients and ten normal adults. The inverse filter output signal is the residue obtained by automatically extracting the effects of the supraglottal structure from the acoustic speech signal. For normal speakers, the residue consists of a series of rather sharp periodic spikes having low amplitude noise between periods. For pathological voices, the residue consists of lower amplitude, less sharp spikes having higher amplitude noise between periods. Comparisons between the acoustic speech waveforms and the residue signals illustrate the superiority of the residue signal for detecting irregularity, and thus suggests the feasibility of applying inverse filtering as an aid to laryngeal diagnostics.