Background: Fibromyalgia is a disease primarily characterized by chronic widespread pain and associated symptoms of fatigue, mild cognitive impairment, and sleep disturbance. The condition affects 1% to 6% of the general population in the United States and is more commonly diagnosed in women (2:1 ratio). There is evidence to suggest that fibromyalgia patients may be more at risk of postoperative complications. The rate of total knee arthroplasties (TKAs) performed worldwide is escalating and thus it is expected that the proportion of fibromyalgia patients under orthopaedic care will increase accordingly. However, the literature on TKA outcomes in this subpopulation is limited. We assessed whether fibromyalgia patients have a higher likelihood of developing medical complications compared to a matched cohort of non-fibromyalgia patients following TKA. Specifically, we assessed the likelihood of developing (I) any medical complication and (II) specific medical complications. Methods: Using the Medicare Standard Analytical Files of the PearlDiver supercomputer, patients who underwent a TKA between 2005 and 2014 were queried. Propensity score matching was used to match patients with and without fibromyalgia in a 1:1 ratio based on age, sex, and the Charlson Comorbidity Index (CCI). A total cohort of 305,510 patients (female =242,198; male =59,810; and unknown =3,502) with (n=152,755) and without fibromyalgia (n=152,755) was identified. Statistical analyses involved the calculation of odds ratios, 95% confidence intervals (95% CI), and P values (<0.05) were utilized to evaluate the occurrence of any and specific medical complications. Results: Compared to a matched cohort of non-fibromyalgia patients, fibromyalgia patients had increased odds of developing any medical complication following TKA [odds ratio (OR): 1.95, 95% CI: 1.86-2.04, P<0.001]. Furthermore, compared to a matched cohort, these patients had significantly greater odds of
A physically compact, low cost, high performance 3D graphics accelerator is presented. It supports shaded rendering of triangles and antialiased lines into a double-buffered 24-bit true color frame buffer with a 24-bit Z-buffer. Nearly the only chips used besides standard memory parts are 11 ASICs (of four types). Special geometry data reformatting hardware on one ASIC greatly speeds and simplifies the data input pipeline. Floating-point performance is enhanced by another ASIC: a custom graphics microprocessor, with specialized graphics instructions and features. Screen primitive rasterization is carried out in parallel by five drawing ASICs, employing a new partitioning of the back-end rendering task. For typical rendering cases, the only system performance bottleneck is that intrinsically imposed by VRAM.
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