Patient selection for bilateral total knee replacement needs improvement

ScienceDaily (Sep. 28, 2012) ? Because there are more risks with having a total knee replacement in both legs at the same time than having a knee replacement in one leg, doctors in recent years have been selecting younger and healthier patients for the bilateral procedure. Now a new study by researchers at Hospital for Special Surgery has revealed that although patients are younger and healthier than those undergoing only one-sided surgery, they are becoming sicker and some complication rates have risen.

"Although we are selecting younger people, we can't ignore the fact that the population in general is getting sicker," said Stavros Memtsoudis, M.D., Ph.D., director of Critical Care Services at Hospital for Special Surgery (HSS) in New York City, who led the study. "Many of the complications that we studied didn't decrease over time as you would expect with younger patients and better health care, and some of the complications even increased." The study is published online ahead of print in the journal Clinical Orthopaedics and Related Research.

Rising levels of obesity appear to be driving the complication rates, as well as the increase in the utilization of total knee replacements. Obesity puts extra stress on joints and bones and can cause premature osteoarthritis.

To conduct their research into trends regarding bilateral total knee replacements, researchers at HSS turned to the Nationwide Inpatient Survey, sponsored by the Agency for Healthcare Research and Quality (AHRQ). This is the largest inpatient database available in the United States that includes information on patients of all ages. It collects data from about 20% of all hospitalizations in the U.S. The study investigators identified 258,524 bilateral total knee replacements performed between 1999 and 2008. The number of annual bilateral procedures increased by 75%. In 1999, bilateral procedures accounted for 3.7% of all knee replacement operations and in 2008, they accounted for 6% of the operations.

The average age of patients undergoing bilateral knee replacement decreased by 2.5 years from 1999 to 2008. As the years marched on, patients presented with higher rates of comorbidities, including renal failure, neurologic disease, liver disease, diabetes, and chronic obstructive pulmonary disease. Obesity increased by 131% during the study period. The only comorbidity that decreased was congestive heart failure.

Over the time period studied, the researchers identified a 3% increase in pneumonia, a 6% increase in pulmonary embolism, and a 3% increase in nonmyocardial infarction cardiac complications.

"The take home message of this paper is that we are fighting an uphill battle, because people are getting sicker, despite us attempting to limit risk by choosing younger people to do these procedures in," said Dr. Memtsoudis. "We have to start thinking of other interventions other than patient selection that we can implement in order to reduce these complications."

On a positive note, the investigators also found that absolute in-hospital mortality rates decreased at an average rate of 10% per year. The researchers attribute this decrease to advances in medicine and increased use of telemetry and observation in the last 10 to 15 years. "With advances in medicine and monitoring, we have been able to counteract this extreme event of mortality. If you get a complication and it is not recognized, you may die from it," said Dr. Memtsoudis. "If you observe people more thoroughly, you may not be able to prevent the complication, but you may be able to prevent a mortal event resulting from it."

The researchers also identified a cost shifting landscape. Patients stayed in the hospital an average of five days after their procedure in 1999 and an average of four days in 2008, but the proportion of discharges to a home or customary residence without home health care decreased at an average rate of 5.5% per year.

"Before this study, we were under the assumption that patient complications were steadily decreasing after bilateral knee arthroplasty, because of better patient selection and improvements in medical care," said Dr. Memtsoudis. "Now we understand that the picture is more complex. Patients being selected for the procedure may be getting younger, but they are not getting healthier and maybe that is why we don't see a drastic drop in complications."

Before embarking on a bilateral knee replacement, he said, patients should "critically look at themselves and talk to their physicians about how their health status plays into the choice of surgery."

More work is needed to identify ways to prevent complications in patients undergoing bilateral knee replacement and a recent conference sponsored by the Hospital for Special Surgery is aiming to do just that. The Consensus Conference on the Creation of Guidelines for Bilateral Knee Arthroplasty involved 40 experts from 16 institutions. The guidelines coming out of this conference, which are expected to be published within the next six months, address issues such as determining the appropriate workup and management for a patient undergoing bilateral knee replacement, and how long doctors should wait between procedures if a patient undergoes two operations.

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The above story is reprinted from materials provided by Hospital for Special Surgery, via EurekAlert!, a service of AAAS.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Stavros G. Memtsoudis, Carlos B. Mantilla, Javad Parvizi, Ottokar Stundner, Madhu Mazumdar. Have Bilateral Total Knee Arthroplasties Become Safer?: A Population-Based Trend Analysis. Clinical Orthopaedics and Related Research?, 2012; DOI: 10.1007/s11999-012-2608-9

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/aTlkoVATYFQ/120929140401.htm

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Fire damages Vallejo mayor's law office

Vallejo Mayor Osby Davis watched as firefighters battled a?two-alarm fire at his downtown law office early this morning in Vallejo,?according to a Vallejo police lieutenant.

Vallejo fire Battalion Chief Paige Meyer said the fire started at?about 1:30 a.m. at the law office located at 410 Tuolumne St., just across?the street from the Solano County Superior Court, and that fire officials are?investigating it as arson.

The fire was 50 percent involved when firefighters arrived at the?scene. The fire damaged a waiting room and an office area before it was fully?extinguished at about 1:45 a.m., Meyer said.

Fire inspectors are on scene this morning and a full investigation?is underway, Meyer said.

Copyright ? 2012 by Bay City News, Inc. -- Republication, Rebroadcast or any other Reuse without the express written consent of Bay City News, Inc. is prohibited.

Source: http://www.sfgate.com/news/baycitynews/article/Arson-suspected-in-Vallejo-mayor-s-law-office-fire-3904850.php

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US Dollar Trades Lower Against Euro Following Profit Taking on ...

The US dollar traded lower against most other major currencies following bullish forex news that caused prices to rise to the point where traders began profit taking by selling the greenback, erasing its earlier gains. In September 26 Asian trading, the EUR/USD reached 1.2906, a 0.05% increase. The currency pair breached the 1.2000 mark and reached a low of 1.2847 as trading in the European sessions opened.

The dollar strengthened to profit taking levels following the release of July US composite housing data showing that home prices continued to increase during the period, an indicator that the housing market is on track to recover. The Standard & Poor/ Case-Shiller Home Price Indices rose by a higher-than-expected 1.2% in July on a year-to-year basis compared with the same period last year. Analysts had expected that the Index would rise by 1% during the period. On a month-to-month basis, the Index increased 4% in July, the sixth month in a row it had increased. However, the monthly data failed to meet analysts? expectations, since they had anticipated it would increase by nine percent. The S&P/Case-Shiller Indices are considered the leading measure of the country?s residential housing market as it monitors the value of house prices nationwide as well as in 20 metropolitan areas.

The markets shrugged off criticisms of US monetary policy made by Federal Reserve governor Charles Plosser, president of the Federal Reserve Bank of Philadelphia. Plosser said that quantitative easing, which is intended to lower interest rates in order to stimulate borrowing by increasing the financial system?s liquidity, would not work in its stated aim of increasing job creation and investment simply because businesses and households would rather pay down existing debt rather than taking on new debt. However, traders continued to take profit on the green buck.

?

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Adding to traders? bullishness on the dollar was positive forex news on US consumer confidence. The monthly Consumer Confidence Survey conducted by The Conference Board rebounded to 70.3 in September after declining to 61.3 in August, its highest reading since the 71.6 recorded in February 2012. The Index also outpaced analysts? expectations of a 63.0 reading. The other sub-indices also reported increases, with the Present Situation Index increasing to 50.2 in September from 46.5 in the previous month while the Expectations Index grew to 83.7 during the period from 71.1.

Meanwhile, the euro found support following positive forex news that Germany?s Finance Minister Wolfgang Schauble had supported moves to defend the single currency. Speaking to reporters during his visit to Helsinki, Schauble called for European policymakers to do everything in their power to defend the euro.

Newly-released positive forex news regarding US home sales is expected to boost the dollar further. According to figures from the Commerce Department, new home sales in August reached 373,000. The figure, while slightly lower than the revised 374,000 figure recorded in July, was the strongest recorded since April 2010, a sign that the US housing market may be on the road to recovery. The increase was attributed to record-low borrowing costs as well as a fall in the supply of foreclosed homes, which is easing the downward pressure on housing prices.

Source: http://blog.fxcc.com/us-dollar-trades-lower-against-euro-following-profit-taking-on-bullish-forex-news/?utm_source=rss&utm_medium=rss&utm_campaign=us-dollar-trades-lower-against-euro-following-profit-taking-on-bullish-forex-news

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CIA off Austin Peay's campus! | Fight Back!

Getting ready for 'CIA Off Campus' protest.

Getting ready for 'CIA Off Campus' protest. (Fight Back! News/Staff)

Clarksville, TN - On Sept. 26, students, including members of Students for a Democratic Society (SDS), joined parents, anti-war veterans and alumni of Austin Peay State University to resist Central Intelligence Agency (CIA) recruitment on campus. Students petitioned the Office of Career Services, which invited the CIA to campus. The protesters were removed by force by the Clarksville Police Department as they questioned the CIA about their activities.

Speakers at the rally included U.S. Army veteran and concerned parent Lara Davis who said, ?The CIA is responsible for or complicit in the killing of U.S. citizens, assassinations, torture, kidnapping, drug trafficking, overthrowing democratically elected governments and propping up military dictatorships and puppet governments.? Protesters surrounding the speakers held signs saying, ?CIA off campus!?, ?CIA, how many kids did you kill today??, ?CIA=Cocaine Importing Agency? and ?Money for education, not for war!?

Another U.S. Army veteran and student, David Jennings said, ?We stand in solidarity with Syrians in their struggle against CIA-trained and funded terrorists that compose the so-called ?Free Syrian Army?.? The rally was part of a nationwide week of actions in solidarity with the anti-war and international solidarity activists raided by the Federal Bureau of Investigation (FBI) and subpoenaed to testify before a grand jury two years ago this week.

After addressing the crowd opposing CIA crimes, protesters marched on the Office of Career Services and delivered a petition with over 125 signatures. The petition urged the university administration to uphold the student code of conduct - specifically that the university not allow any organization that routinely violates international law, commits human rights abuses, and/or operates in contradiction with the high standards outlined in the student code of conduct, to organize or recruit students on the Austin Peay State University campus.

Later, several people from the rally went into the CIA recruitment event and attempted to question the CIA representatives directly about their involvement in torture, assassinations, overthrowing democratically elected governments and other crimes. The CIA offered no response to these questions. Students handed out flyers with a timeline detailing the CIA?s nefarious actions since its establishment. The flyers called for an end to repression of anti-war and international solidarity activists. Then, members of the Clarksville police department forcibly dragged an SDS member out of the room, snatched the flyers out of his hands, and threatened to arrest everyone if they continued to hand out flyers, question the CIA, or otherwise exercise free speech and free assembly in the student union.

Source: http://www.fightbacknews.org/2012/9/28/cia-austin-peay-s-campus

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US, Mexico in food fight over tomatoes: How messy will it get?

American tomato growers, upset at Mexico's growing share of the US market, are taking steps that could lead to new tariffs on Mexican tomatoes. Mexico's ambassador threatened retaliation.?

By Ron Scherer,?Staff writer / September 28, 2012

Tomatoes grow in a hothouse in San Luis de la Paz, Mexico, in February 2012.

Melanie Stetson Freeman/The Christian Science Monitor

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The tomato, one of America?s favorite vegetables, is the focus of a burgeoning cross-border food fight that Mexican officials say could escalate into a broader trade war.

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Mexican exporters currently supply about half the tomatoes consumed in the US. American growers, upset over what they see as a steady incursion of low priced Mexican produce, are trying to quash a deal that has kept the price of Mexican tomatoes low. The move could lead either to new tariffs on Mexican tomatoes or an agreement by the Mexicans to sell their produce at higher prices.

The Mexican government is threatening retaliation if the US tacks on any new tariffs.

?If Mexico?s interests end up being affected, Mexico will respond,? said Arturo Sarukhan, the Mexican ambassador to the US in a statement. ?When Mexico aims, Mexico hits the target.?

What does this mean for US consumers? Whether the US action results in higher tomato prices is hard to say. In public filings over the issue, large buyers of tomatoes, such as Wal-Mart, worry that any disruption of a stable and predictable supply of tomatoes from Mexico will hinder their ability to provide consistent pricing to the US consumer.

But the US growers say those fears are unfounded, maintaining that the US has the ability to grow enough tomatoes to keep every salad bar stocked at a reasonable price.

?I don?t anticipate consumer prices will be impacted significantly at all,? says Reggie Brown, executive vice president of the Florida Tomato Exchange, which represents growers there.

The Mexican government, meanwhile, is deeply suspicious over the timing of the tomato flap since it involves growers from politically sensitive Florida. Mexico?s minister of the economy, Bruno Ferrari, told Reuters this week it was ?obvious? the request was timed to put political pressure on the White House ahead of the election.

Over the last several months, the Obama administration has become more aggressive in charging importers with dumping. This summer the US charged Chinese companies with unfair trade actions regarding cars and auto parts. The president touted that trade action while campaigning in Ohio, but Mitt Romney called it too little too late. Romney says he would get tough on China regarding trade issues if elected president.

Source: http://rss.csmonitor.com/~r/feeds/csm/~3/krHgBWA-e3c/US-Mexico-in-food-fight-over-tomatoes-How-messy-will-it-get

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"Honey Boo Boo" gets more episodes, 3 holiday specials

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Source: http://news.yahoo.com/honey-boo-boo-gets-more-episodes-3-holiday-222652957.html

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Angry Birds maker hopes Bad Piggies will help it fly again

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Minimizing Market Risks With Forex Demo Account | Free Finance ...

Traders, who have spent a long time in Currency exchange, know there is rather a difference between a live account and a demo one. The performance differences a great deal , not just psychologically but practically also. Another outstanding thing is that, you are not the only one to experience this, as it has been quite a simple task to earn income using a demonstration account. Many players blame their loss on dishonest dealers trying to ?influence ? their trades, and often, flactuating market conditions also. However the reality behind every act is your ?BRAIN?. It is not just the success booster but also the culprit behind your loss after you step in live trading. This is very clear, that we are still left with too much to learn, so let?s dig a little deeper?

The unvarnished reality of Currency exchange Demo Trading

Have you ever felt frightened or your heartbeat got quicker when you start your trial account and place your first trading amount? The answer would be ?No ? for most of us, but the first encounter with live-account may have made you sweat due to anxiousness. This is among the most common experiences that traders customarily face, while switching their virtual money to real one. This is thanks to the fact that, they know, they have placed their real money this time. To some point it?s quite standard. Actually if you are basically provided and prepared for the Forex mind battle, then you've got to have learned about the clear danger of losing your funds in the ever changing markets.

However the simple fact behind the strategy is that we frequently take the steps we shouldn't do. Here, I want to draw your attention to new players who started with demo and suffered large losses lately after jumping to real Foreign exchange market. Losses make them realize the difference between virtual and real trading. Where the traders need to focus on trade and performance, they concentrate on cash. When they start to concentrate on trade, they're going to find it improves on its own in quite a fast pace.

While using a practise account, players are not aware of losing money before making the switch to the particular game. After going live, they forget that the money they're using isn't fake. As the market undergoes changes, it makes the traders become mystified and do something against the market. So , if you're actually thinking to join the trading line, stand by and plan strategy to handle the coming worries.

This text has been authored by Andrew Jaw Weng Keong who is a famous person in the domain of Forex trading market and its environment. For full info on Currency exchange, you may visit at www.liteforex.com home. Go here and learn the strategies of foreign exchange trading.

Source: http://freefinancearticles.info/minimizing-market-risks-with-forex-demo-account

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More Illinoisans favor gay marriage now than two ... - Capitol Fax.com

* And here?s another result from the 2012 Paul Simon Public Policy Institute poll?

Which of the following three statements comes closest to your position on the legal rights of gay and lesbian couples in Illinois

    Gay/lesbian couples should be allowed to legally marry 43.6%

Gay/lesbian couples should be allowed to form civil unions 31.8%

There should be no legal recognition of relationships between gay and lesbian couples 20.2%

Other/ Don?t know 4.4%

* Compare those results to how the numbers looked two years ago, in the 2010 Paul Simon Public Policy Institute poll?

Which of the following three statements comes closest to your position on the legal rights of gay and lesbian couples in Illinois?

    Gay and lesbian couples should be allowed to legally marry 33.6%

Gay and lesbian couples should be allowed to form civil unions, which would give them some legal rights 33.9%

There should be no legal recognition of relationships between gay and lesbian couples 26.5%

Other/Don?t know 6.0%

So, the number of people who say gays should be allowed to marry is up ten points in just two years, while those opposing all recognition of gay unions has declined by over 6 points. The most recent poll?s margin of error is 2.77 points, so this is real movement.

That?s pretty amazing.

Source: http://capitolfax.com/2012/09/26/more-illinoisans-favor-gay-marriage-now-than-two-years-ago/

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Ways To Ensure A More Satisfying Home Improvement Endeavor ...

Thinking about doing a home improvement
cheap patrick willis 49ers jersey project? It is vital that you do your homework first before you ever begin. If you undertake any kind of home repair or renovations without the right kind of planning, you?re relying on luck to carry you through, which is never a good idea. This article will help you plan your home improvement project in a way that will be efficient and cost effective .Anyone planning to do a large home renovation certainly will need to hire people to help them complete the project. Before you hire anybody, however, you should do a background check on them to make sure that they can actually do the work that is required. It?s always a good idea to get several estimates from different contractors before choosing one. Contractors that are easy to work with, that offer you the lowest bid, are the ones that you want to find as you sort through the different estimates.

Getting the job done may require hiring many workers. Make sure that the contractor that you choose can do the hiring for you. This is the best way to go about hiring people in that a general contractor can supervise the entire project and get people working so your job is done the right way. Making improvements to the kitchen and bathroom can do a lot for a home, and you don?t necessarily have to rebuild them from the ground up. Before you do any complete and total renovation of a room, consider simple changes that can make large differences. Instead of gutting an entire room, you might want to consider painting it to change its overall appeal. New fixtures in a bathroom can make a big difference! In fact, don?t spend a lot of money and see how everything looks by making simple renovations over a long period of time. As you can see, your bathroom and kitchen can be renovated with very little money and making simple changes over the course of time.The material that you use when renovating or remodeling your home is of the utmost importance in regard to your plans and desires. Using high-quality materials is not always necessary, as you can do many repairs with average materials that do not cost as much. It is not always necessary to go to a home improvement store to get the necessary materials as there are several companies that offer these materials for a lower-cost
cheap jerseys. It is usually easy to find used material stores; it depends on your location.

Most people are shocked at how little the merchandise at these stores cost ? this includes roofing, flooring, and other building materials cheap nfl jerseys. By just looking in your local newspaper or classified ad section, you can find quality materials for far less than those found at mainstream stores. Oftentimes, businesses will purchase too much material for their construction jobs. This gives you the ability to pick it up at a discounted price. Just remember that giving your home a face lift can be uplifting in several areas; like the value of your home and pure comfort. However, if you don?t put enough effort into the planning stage, you may make errors or run into issues you didn?t anticipate. Overall, keep you project intact and do what is necessary to avoid any mishaps that may crop up.

Source: http://articlebro.com/2012/business/ways-to-ensure-a-more-satisfying-home-improvement-endeavor/

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