This study demonstrates the safety and efficacy of this engineered bovine pericardial patch as a cardiovascular substitute for surgical repair of both simple and more complex congenital cardiac defects.
Improved biostability and durability with reduced calcification of tissues after the multistep ADAPT(®) tissue treatment suggest improved alternative substitutes to autologous pericardium.
A method for predicting the timing of winter rains is presented, making no assumptions about the functional form of any relationships that may exist. Ideas built on classification and regression trees and machine learning are used to develop robust predictive rules. These methods are applied in a case study to predict the timing of winter rain in five farming towns in the southwest of Western Australia. The variables used to construct the model are mean monthly sea surface temperatures (SSTs) over a 72-cell grid in the Indian Ocean, Perth monthly mean sea level pressure (MSLP), and monthly values of the Southern Oscillation index (SOI). A predictive model is constructed from data over the period 1949–99. This model correctly classifies the onset of the winter rains approximately 80% of the time with SST variables proving to be the most important in deriving the predictions. Further analysis indicates a change point in the mid-1970s, a well-known phenomenon in the region. The prediction rates are significantly worse after 1975. Furthermore, the important region of the Indian Ocean, in terms of SSTs for prediction, moves from the Tropics down toward the Southern Ocean after this date.
BackgroundThe use of local infiltration analgesia in the setting of knee arthroplasty is well established. There are no studies to date which have directly compared differences in infiltration techniques. The purpose of this study is to establish if a difference in patient outcomes exists when the infiltrate is injected into the periarticular tissues or directly into the joint.MethodsOne hundred and forty-two consecutive patients waitlisted for primary total knee arthroplasty were enrolled after primary exclusion criteria were applied. These included the following: allergy to study drugs, inability to receive spinal anaesthesia, and planned bilateral surgery. Patients were divided into two groups, a periarticular infiltration group (group A) and an intraarticular infiltration group (group B). Secondary exclusion criteria of regular opioid use, psychiatric illness, and serious medical comorbidity left a total of 47 patients in group A and 54 patients in group B. Both groups received a combination of 30 mg ketorolac, 500 μg of adrenaline, and 300 mg of ropivacaine, and normal saline. This was either injected into the periarticular tissues during surgery (group A) or intraarticularly after closure of the wound (group B).Primary outcome measures included opioid consumption during the first 24 h postoperatively and over the total admission, and visual analogue scales (VAS) on postoperative day 1 and at discharge. Secondary measures included Oxford Knee Score, knee flexion, length of stay, haemoglobin drop, and transfusion requirement.Ethics approval was granted by the hospital review board. The trial is registered in the Australian New Zealand Clinical Trials Registry, registration ACTRN12615000488505.ResultsNo statistically significant differences in postoperative analgesic use were observed between the two groups. However, there was a trend toward decreased postoperative patient-controlled analgesia use in the periarticular group (mean 53.1 vs 68.3 mg morphine equivalents; p = 0.093), as well as a statistically significant reduction in postoperative visual analogue pain scores. No statistically significant differences were observed for haemoglobin drop, range of motion, or pre- to 6-week postoperative Oxford Score difference.ConclusionsOur study is the first we are aware of to directly compare a periarticular to intraarticular injection technique when using local infiltration analgesia for total knee arthroplasty. Our results show no clear statistically significant benefit with either technique. The periarticular group showed a statistically significant reduction in postoperative VAS pain scores alongside a trend in that group toward reduced overall opioid use.
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