Exponent

About: Exponent is a company organization based out in Menlo Park, California, United States. It is known for research contribution in the topics: Population & Risk assessment. The organization has 1589 authors who have published 2680 publications receiving 88140 citations.

Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients

Abstract: Background: The patient-related risk factors for periprosthetic joint infection and postoperative mortality in elderly patients undergoing total hip arthroplasty are poorly understood. The purpose of this study was to identify the specific patient comorbidities that are associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in U.S. Medicare patients undergoing total hip arthroplasty. Methods: The Medicare 5% sample claims database was used to calculate the relative risk of periprosthetic joint infection and of ninety-day postoperative mortality as a function of preexisting comorbidities in 40,919 patients who underwent primary total hip arthroplasty between 1998 and 2007. The impact of twenty-nine comorbid conditions on periprosthetic joint infection and on postoperative mortality was examined with use of Cox regression, controlling for age, sex, census region, public assistance, and all other baseline comorbidities. The adjusted hazard ratios for all comorbid conditions were evaluated, and the Wald chi-square statistic was used to rank the degree of association of each condition with periprosthetic joint infection and with postoperative mortality. The Bonferroni-Holm method was used to adjust for the multiple comparisons resulting from the number of comorbid conditions analyzed. Results: Comorbid conditions associated with an increased adjusted risk of periprosthetic joint infection (in decreasing order of significance, p < 0.05 for all comparisons) were rheumatologic disease (hazard ratio [HR] = 1.71), obesity (HR = 1.73), coagulopathy (HR = 1.58), and preoperative anemia (HR = 1.36). Comorbid conditions associated with an increased adjusted risk of ninety-day postoperative mortality (in decreasing order of significance, p < 0.05 for all comparisons) were congestive heart failure (HR = 2.11), metastatic cancer (HR = 3.14), psychosis (HR = 1.85), renal disease (HR = 1.98), dementia (HR = 2.04), hemiplegia or paraplegia (HR = 2.62), cerebrovascular disease (HR = 1.40), and chronic pulmonary disease (HR = 1.32). Conclusions: We identified specific patient comorbidities that were independently associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in Medicare patients who had undergone total hip arthroplasty. This information is important when counseling elderly patients regarding the risks of periprosthetic joint infection and mortality following total hip arthroplasty, as well as for risk adjustment of publicly reported total hip arthroplasty outcomes. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

Abstract: Background Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective.

Physical and chemical characteristics of blast furnace, basic oxygen furnace, and electric arc furnace steel industry slags.

Abstract: Approximately 21 million tons of steel industry slag are produced each year in the United States, and many productive commercial uses of slag have been developed (e.g., road bed, fill material). However, because slag contains heavy metals at concentrations that are higher than in most soil, questions have been raised regarding the need to evaluate the potential human health and environmental hazards associated with current applications. To enhance general understanding of the physical and chemical characteristics of this material, slag samples from 58 active mills with blast furnaces, basic oxygen furnaces, and/or electric arc furnaces were examined. This study profiles the major and minor constituents of slag from each furnace type and reports the leachability of metals from slag under neutral and acidic conditions. Particle size distributions and partitioning coefficients (Kd) are also reported. Although concentrations of metals in slag are elevated relative to concentrations in soil, the metals in slag...

Behavior of moment-resisting frame structures subjected to near-fault ground motions

Abstract: Near-fault ground motions impose large demands on structures compared to ‘ordinary’ ground motions. Recordings suggest that near-fault ground motions with ‘forward’ directivity are characterized by a large pulse, which is mostly orientated perpendicular to the fault. This study is intended to provide quantitative knowledge on important response characteristics of elastic and inelastic frame structures subjected to near-fault ground motions. Generic frame models are used to represent MDOF structures. Near-fault ground motions are represented by equivalent pulses, which have a comparable effect on structural response, but whose characteristics are defined by a small number of parameters. The results demonstrate that structures with a period longer than the pulse period respond very differently from structures with a shorter period. For the former, early yielding occurs in higher stories but the high ductility demands migrate to the bottom stories as the ground motion becomes more severe. For the latter, the maximum demand always occurs in the bottom stories. Preliminary regression equations are proposed that relate the parameters of the equivalent pulse to magnitude and distance. The equivalent pulse concept is used to estimate the base shear strength required to limit story ductility demands to specific target values. Copyright © 2004 John Wiley & Sons, Ltd.