Title: The interaction of caseload and usage in determining outcomes of unicompartmental 1 knee arthroplasty: A meta-analysis 2 Abstract 3Background: Outcomes following UKA are variable and influenced by surgical caseload 4

Purpose of Review The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic. Recent Findings SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting "elective" surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely "elective" procedure, versus an "urgent" procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into "elective" versus "urgent" categories. Summary In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one's peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.

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Study Design: Cross sectional study. Objectives: To analyze posts shared on Instagram referencing spinal fusion for tone, gender, activities of daily living (ADLs), rehabilitation, incision, pain, neurological injury, and content of post. Methods: Public instragram posts, which were isolated and evaluated using the hashtags “#spinefusion” and “#spinalfusion.” All posts were analyzed by the authors for the variables previously listed. In total, 264 posts were included for investigation and analysis of patient perception of spine fusion through social media. Results: Of all included posts, approximately 86% of posts had a positive tone. There was statistical significance between positive tone and activities of daily living (ADLs) ( P = 0.047), as well as negative tone and persistent pain ( P = 0.008). Adequate return to activities of daily living is perceived by patients as a positive outcome after surgery: odds ratio (OR) (95% CI) of 2.11 (1.01-4.39). Persistent post operative pain results negatively on perceived outcomes after surgery OR = 0.38 (0.18-0.78). Conclusions: Reported outcomes after spine fusion has not been evaluated through social media avenues. This analysis of patients sharing their experience on social media after spinal fusion demonstrates that returning to activities of daily living is of the utmost importance to patients. Additionally, post-operative pain is a strong metric utilized by patients with their satisfaction after surgery.

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The impact of the electromagnetic waves (EM) on human neurons (HN) has been under investigation for decades, in efforts to understand the impact of cell phones (radiation) on human health, or radiation absorption by HN for medical diagnosis and treatment. Research issues including the wave frequency, power intensity, reflections and scattering, and penetration depths are of important considerations to be incorporated into the research study. In this study, computer simulation for the EM exposure to HN was studied for the purpose of determining the upper limits of the electric and magnetic field intensities, power consumption, reflections and transmissions, and the change in temperature resulting from the power absorption by human neurons. Both high frequency structural simulators (HFSS) from ANSYS software, and COMSOL multi-physics were used for the simulation of the EM transmissions and reflections, and the temperature profile within the cells, respectively. For the temperature profile estimation, the study considers an electrical source of 0.5 watt input power, 64 MHz. The EM simulation was looking into the uniformity of the fields within the sample cells. The size of the waveguide was set to be appropriate for a small animal model to be conducted in the future. The incident power was fully transmitted throughout the waveguide, and less than 1% reflections were observed from the simulation. The minimum reflected power near the sample under investigation was found to be with negligible reflected field strengths. The temperature profile resulting from the COMSOL simulation was found to be near 0.25 m°K, indicating no change in temperature on the neuro cells under the EM exposure. The paper details the simulation results for the EM response determined by HFSS, and temperature profile simulated by COMSOL.

Diabetic foot ulcers are systemic diseases that affect all blood vessels within the human body. From major blood vessels to microvasculature, hardening, thickening, and narrowing of blood vessels ultimately results to diminished blood flow to end organs. The detrimental effects of peripheral vascular disease are well recognized across medicine, particularly with regards to diabetic foot ulcers. Diabetic foot ulcers (DFU) are common across all fields of medicine, including but not limited to: orthopedics, vascular surgery, podiatry, general internal medicine, and infectious disease. As the population of the United States continues to grow in age and obesity, diabetes and DFU are becoming more and more prevalent in our medical society. Current approaches to diagnosing peripheral vascular disease ultimately result in some degree of invasiveness for the patient. Preliminary lab studies, such as the ankle-brachial index and Doppler ultrasound of peripheral arteries, provide efficient safe screening methods. However, these studies lack quantification of the degree of vascular stenosis and are unable to accurately assess the location of narrowing. In current practice, radiologists are called upon to for angiography of the blood vessels using contrast dye. This provides an additional risk for diabetic patients: a population inherently at risk for renal disease. In this study, we proposed utilizing electromagnetic simulation with boundary conditions set at various layers of human tissues. More specifically, the human foot was analyzed using COMSOL multi-physics software in attempt to visualize, analyze, and quantify the degree of peripheral vascular disease, which plays a pivotal role in the development of diabetic foot ulcers. The simulation was conducted for a patient's foot, with bone, blood vessels, and surrounding fat layers to emulate the anatomy of a diabetic foot. A 2-D scan was obtained to assess and visualize the blood vessel's narrowing, widening, vascular turbulence, or occlusion. The analysis was conducted at two frequencies, 2 GHz and 5 GHz, and compared to one another to assess the accuracy of clinical diagnosis. An electric field was generated throughout the 2D model at 20, 50, and 100 Joules, respectively. The simulation was able to adequately predict and stratify varying degrees of occlusion within peripheral vasculature. This study, though a simulation in nature, shows promise for being able to accurately diagnose the peripheral vasculature using electromagnetic parameters. This feasibility study proved successful for possible future implementation using MEMS/NEMS device systems to be designed to detect EM parameters to serve as a diagnostic tool for the early detection of peripheral vascular disease, and ultimately, diabetic foot ulcers.