Modular Femoral Sleeve and Stem Implant Provides Long-term Total Hip Survivorship

Background  

A femoral implant with a modular sleeve and stem has been designed to allow independent and complete metaphyseal-diaphyseal fit and fill as well as independent rotation to accommodate anteversion at the time of THA.     

An implementation model for managing cloud-based longitudinal care plans for children with medical complexity

ObjectiveWe aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC).Materials and MethodsWe conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. During audio-recorded sessions, we asked participants to walk through role-specific scenarios of how they would create, review, and edit an LCP using a cloud-based prototype, which we concurrently developed. Between sessions, we reviewed audio recordings to identify strategies that would mitigate barriers that participants reported relating to 4 processes for managing LCPs: (1) taking ownership, (2) sharing, (3) reviewing, and (4) editing. Analysis informed iterative implementation model revisions.ResultsWe conducted 30 design sessions, with 10 caregivers and 20 providers. Participants emphasized that cloud-based LCPs required a team of owners: the caregiver(s), a caregiver-designated clinician, and a care coordinator. Permission settings would need to include universal accessibility for emergency providers, team-level permission options, and some editing restrictions for caregivers. Notifications to review and edit the LCP should be sent to team members before and after clinic visits and after hospital encounters. Mitigating double documentation barriers would require alignment of data fields between the LCP and electronic health record to maximize interoperability.DiscussionThese findings provide a model for how we may leverage emerging Health Insurance Portability and Accountability Act–compliant cloud computing technologies to support families and providers in comanaging health information for CMC.ConclusionsUtilizing these management strategies when implementing cloud-based LCPs has the potential to improve team-based care across settings.     

Real‐time motion and B0 corrected single voxel spectroscopy using volumetric navigators

In population groups where head pose cannot be assumed to be constant during a magnetic resonance spectroscopy examination or in difficult‐to‐shim regions of the brain, real‐time volume of interest, frequency, and shim optimization may be necessary. We investigate the effect of pose change on the B₀ homogeneity of a (2 cm)³ volume and observe typical first‐order shim changes of 1 μT/m per 1° rotation (chin down to up) in four different volumes of interest in a single volunteer. An echo planar imaging volume navigator was constructed to measure and apply in real‐time within each pulse repetition time: volume of interest positioning, frequency adjustment, and first‐order shim adjustment. This volume navigator is demonstrated in six healthy volunteers and achieved a mean linewidth of 4.4 Hz, similar to that obtained by manual shim adjustment of 4.9 Hz. Furthermore, this linewidth is maintained by the volume navigator at 4.9 Hz in the presence of pose change. By comparison, a mean linewidth of 7.5 Hz was observed, when no correction was applied. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Estimating the sequence complexity of a random oligonucleotide population by using in vitro thermal melting and Cot analyses

Randomly generated oligonucleotide populations have a high potential to serve as pools for selecting non-cross-hybridizing sequences, which are useful for nanoscale self-assembly and biological and biomedical applications, as well as for DNA computing applications. In this study a nonlinear kinetic model was developed for the complexity estimation of large unknown polynucleotide populations and was experimentally verified. The model was implemented to estimate the sequence complexity of the random 20 base-pair population after in vitro renaturation experiments. The kinetic behaviors of the random 20mers were also evaluated with in vitro thermal melting experiments. This study represents a step in realizing the potential of random oligonucleotides for DNA computing and nanoscale self-assembly applications for biology and medicine.     

Cutaneous radiation necrosis as a complication of yttrium-90 synovectomy

Radiation synovectomy is an effective method of treatment of chronic synovitis in patients with conditions such as rheumatoid arthritis, haemophilic synovitis and pigmented villonodular synovitis. This case demonstrates one of the potential complications of this procedure in a 46 year old man treated with bilateral radiation synovectomy for haemophilic synovitis. Cutaneous radiation necrosis is a known but rare complication of this procedure and this case is reported to demonstrate this known complication and to highlight that appropriate technique is required to avoid this.