Replacement Program Research Articles

Towards a Techno-Hauntological Aesthetic: Immiscible Time and the Spiritual Imagination in Bodyless (Shishenji, 2019) by Huang Hsin-Chien

Abstract This article discusses and explores acclaimed new media artist Huang Hsin-Chien’s virtual reality (VR) experience Bodyless (Shishenji, 2019). In this film, through the process of the body illusion or the body replacement program, a component specific to VR, viewers embody the soul of a political prisoner deceased during Taiwan’s martial law era. Bodyless juxtaposes Taiwan’s traditional spiritual traditions with references to the Ghost Festival (中元節) and includes a dystopic vision of the future that appears towards the end of the film. This article establishes, through a close reading of several key sequences of the film, the emergence of a techno-hauntological aesthetic. It creates a dialogue between Huang’s dream-like imagery and various interpretation of Bliss Cua Lim’s concepts of immiscible time and heterogeneous space. How does Bodyless visually enact, perform, and develop a techno-hauntological aesthetic? How does the artist explore philosophical concepts related to memory, time, and space by using VR?

Outcomes by Race and Ethnicity Following a Medicare Bundled Payment Program for Joint Replacement

The Comprehensive Care for Joint Replacement (CJR) model, a traditional Medicare bundled payment program for lower-extremity joint replacement, is associated with care for patients outside traditional Medicare. Whether CJR model outcomes have differed by patient race or ethnicity outside of traditional Medicare is unclear. To evaluate outcomes associated with the CJR model among Hispanic patients not enrolled in traditional Medicare. This cohort study used hospitalization data from California's Patient Discharge Dataset for all patients who underwent lower-extremity joint replacement in California between January 1, 2014, and December 31, 2017. In California, 3 metropolitan statistical areas (MSAs) were randomly selected to participate in CJR in April 2016. Hospitals not participating in other Medicare Alternative Payment Models were included in the treated group if they were in these 3 MSAs and in the control group if they were in the remaining 23 MSAs. The data analysis was performed between October 1 and December 31, 2023. Comprehensive Care for Joint Replacement program implementation. The main outcomes were hospital length of stay and home discharge rates by race and ethnicity. Home discharge status included self-care, the use of home health services, and hospice care at home. Event study, difference-in-differences, and triple differences models were used to estimate differential changes in health care service use by race and ethnicity for patients in the treated MSAs compared with the control MSAs before vs after CJR implementation. Of 309 834 hospitalizations (patient mean [SD] age, 68.3 [11.3] years; 60.6% women; 14.8% Hispanic; 72.4% non-Hispanic White), 48.0% were in treated MSAs and 52.0% in control MSAs. The CJR program was associated with an increase in home discharge rates for patients without traditional Medicare coverage; however, the increase differed by patient race and ethnicity. The increase was 0.05 (95% CI, 0.02-0.08) percentage points higher for Hispanic patients with Medicare Advantage and 0.03 (95% CI, 0.01-0.04) percentage points higher for Hispanic patients without Medicare compared with their non-Hispanic White counterparts. This cohort study shows that CJR program outcomes differed by race and ethnicity for patients covered outside traditional Medicare, with home discharge rates increasing more for Hispanic compared with non-Hispanic White patients. These findings suggest the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups.

1090: A service evaluation of the clinical contingencies implemented during a Linac Replacement Programme.

1090: A service evaluation of the clinical contingencies implemented during a Linac Replacement Programme.

Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.

To determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid. We used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. We conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program. The primary outcome was LEJR complications. Secondary outcomes included 90-day readmissions and mortality. We identified hospitals in the US market areas eligible for CJR. We included beneficiaries in the intervention group who received joint replacement at hospitals in markets randomized to participate in CJR. The comparison group included patients who received joint replacement at hospitals in markets who were eligible for CJR but randomized to control. The study included 1,603,555 Medicare beneficiaries (mean age, 74.6 years, 64.3% women, 11.0% dual-eligible). Among participant hospitals, complications decreased between baseline and intervention periods from 11.0% to 10.1% for dual-eligible and 7.0% to 6.4% for non-dual-eligible beneficiaries. Among nonparticipant hospitals, complications decreased from 10.3% to 9.8% for dual-eligible and 6.7% to 6.0% for non-dual-eligible beneficiaries. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (-0.9 percentage points, 95% CI -1.6 to -0.1). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model. There were no differential changes in 90-day readmissions or mortality. Mandatory participation in a bundled payment program was associated with reduced disparities in joint replacement complications for Medicare beneficiaries with low income. To our knowledge, this is the first evidence of reduced socioeconomic disparities in outcomes under value-based payments.

Persistence of widespread moderate Spinosad resistance among wild melon fly (Zeugodacus cucurbitae) and oriental fruit fly (Bactrocera dorsalis) populations on the major Hawaiian islands.

Insecticide resistance among invasive tephritid fruit flies poses a great risk to national food security and has the potential to disrupt quarantine and eradication programs, which rely on the efficacy of Spinosad to prevent widespread establishment in North America. During 2022 to 2023 we surveyed the extent of Spinosad resistance of two key species, oriental fruit fly Bactrocera dorsalis, and melon fly Zeugodacus cucurbitae, from 20 sites across five Hawaiian Islands including Kaua'i, O'ahu, Maui, Molokai and the "Big Island" (Hawai'i). We used topical thoracic applications of eight concentrations of Spinosad ranging from 0.028 to 3.6 mg/mL to evaluate the lethal concentration (LC50 and LC99) required to kill wild-caught males. Resistance ratios (RR) were calculated by comparing the LC50 of wild flies to laboratory susceptible lines maintained in colony. Our results identified at least two new sites of concern for melon fly resistance on the Big Island, and at least four sites of concern for oriental fruit fly, all of which were located on the Big Island. At these locations RRs were >5. On O'ahu, melon fly RRs were >10. The persistence of Spinosad resistance is concerning, yet it is a reduction compared to the values reported previously and before changes to Spinosad use recommendations by local extension agents beginning in 2017. For oriental fruit fly, these RR values are the highest levels that have been detected in wild Hawai'i populations. These data suggest that expanded Spinosad reduction and replacement programs are warranted given the ongoing issues with Spinosad resistance in Hawai'i and expansion in the number of species affected. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Participants’ perspectives of being recruited into a randomised trial of a weight loss intervention before colorectal cancer surgery: a qualitative interview study

BackgroundThe period between cancer diagnosis and surgery presents an opportunity for trials to assess the feasibility of behaviour change interventions. However, this can be a worrying time for patients and may hinder recruitment. We describe the perspectives of patients with excess weight awaiting colorectal cancer surgery about their recruitment into a randomised trial of a prehabilitation weight loss intervention.MethodsWe interviewed the first 26 participants from the 8 recruitment sites across England in the ‘CARE’ feasibility trial. Participants were randomised into either usual care (n = 13) or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian (n = 13). The semi-structured interviews occurred shortly after recruitment and the questions focused on participants’ recollections of being recruited into the trial. We analysed data rapidly and then used a mind-mapping technique to develop descriptive themes. Themes were agreed by all co-authors, including a person with lived-experience of colorectal surgery.ResultsParticipants had a mean body mass index (± SD) of 38 kg/m2 (± 6), age of 50 years (± 12), and 42% were female. People who participated in the trial were motivated by the offer of structured weight loss support that could potentially help them improve their surgical outcomes. However, participants also had concerns around the potential unpalatability of the intervention diet and side effects. Positive attitudes of clinicians towards the trial facilitated recruitment but participants were disappointed when they were randomised to usual care due to clinical teams’ overemphasis on the benefits of losing weight.ConclusionsPatients were motivated to take part by the prospect of improved surgical outcomes. However, the strong preference to be allocated to the intervention suggests that balanced communication of equipoise is crucial to minimise disappointment from randomisation to usual care and differential dropout from the trial.Clinical trial registrationISRCTN39207707, Registration date 13/03/2023.

Bundled payments lead to quality improvements in hospitals' skilled nursing facility referral networks.

To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities(SNFs). Retrospective observational study using 2009-2015 inpatient and outpatient claims from a20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare. We ran fixed effect regression models regressing BPCI participation on hospital-SNF referral patterns (number of SNF discharges, number of SNF partners, and SNF referral concentration) and SNF quality (facility inspection survey rating, patient outcome rating, staffing rating, and registered nurse staffing rating). We found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars (95% CI, 0.04-0.26). BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating (95%CI, -0.03 to 0.11), staffing rating (95% CI, -0.07 to 0.04), or registered nurse staffing rating (95% CI, -0.09 to 0.02). BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks.

A Primary Care–Based Weight Navigation Program

Evidence-based weight management treatments (WMTs) are underused; strategies are needed to increase WMT use and patients' weight loss. To evaluate the association of a primary care-based weight navigation program (WNP) with WMT use and weight loss. This cohort study comprised a retrospective evaluation of a quality improvement program conducted from October 1, 2020, to September 30, 2021. Data analysis was performed from August 2, 2022, to March 7, 2024. Adults with obesity and 1 or more weight-related condition from intervention and control sites in a large academic health system in the Midwestern US were propensity matched on sociodemographic and clinical factors. WNP, in which American Board of Obesity Medicine-certified primary care physicians offered weight-focused visits and guided patients' selection of preference-sensitive WMTs. Primary outcomes were feasibility measures, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss, percentage of patients achieving 5% or more and 10% or more weight loss, referral to WMTs, and number of antiobesity medication prescriptions at 12 months. Of 264 patients, 181 (68.6%) were female and mean (SD) age was 49.5 (13.0) years; there were no significant differences in demographic characteristics between WNP patients (n = 132) and matched controls (n = 132). Of 1159 WNP-eligible patients, 219 (18.9%) were referred to the WNP and 132 (11.4%) completed a visit. In a difference-in-differences analysis, WNP patients lost 4.9 kg more than matched controls (95% CI, 2.11-7.76; P < .001), had 4.4% greater weight loss (95% CI, 2.2%-6.4%; P < .001), and were more likely to achieve 5% or more weight loss (odds ratio [OR], 2.90; 95% CI, 1.54-5.58); average marginal effects, 21.2%; 95% CI, 8.8%-33.6%) and 10% or more weight loss (OR, 7.19; 95% CI, 2.55-25.9; average marginal effects, 17.4%; 95% CI, 8.7%-26.2%). Patients in the WNP group were referred at higher rates to WMTs, including bariatric surgery (18.9% vs 9.1%; P = .02), a low-calorie meal replacement program (16.7% vs 3.8%; P < .001), and a Mediterranean-style diet and activity program (10.6% vs 1.5%; P = .002). There were no between-group differences in antiobesity medication prescribing. The findings of this cohort study suggest that WNP is feasible and associated with greater WMT use and weight loss than matched controls. The WNP warrants evaluation in a large-scale trial.

Force and wear prediction model of disc cutter under compression shear failure mode based on dense core–cavity expansion theory (U-713)

Calculating disc cutter wear and predicting wear life are long-standing issues affecting the efficiency and cost of tunnel boring machines (TBMs). During the TBM excavation process, the wear of the disc cutter is a comprehensive outcome of the interaction between the tool and rock. Studying the mechanisms of tool rock breaking and wear can assist in developing a more precise model for predicting cutter wear. Therefore, based on the rock-breaking and wear mechanisms of a cutter, this study developed a model for predicting the cutter wear rate and life. The model is based on the theory of dense core–cavity expansion combined with the motion state of a cutter. First, the TBM excavation process and rock-breaking mechanism of a cutter were analyzed in detail. A cutting force model under the compression shear failure mode based on the dense core–cavity expansion theory was established. Based on the force model, a prediction model for the wear rate and life of the disc cutter was established, considering the working characteristics and wear mechanism. Furthermore, the impact of penetration on the prediction model was investigated. In addition, to demonstrate the practicality of the method, this study conducted a comprehensive examination using engineering examples. The results showed that the average difference in the cutter average wear rate using the developed model was less than 3% compared with the actual engineering result. In addition, the average difference in the wear life rate was less than 5%. Finally, the developed prediction method was compared with other models. The wear rate fitting accuracy was improved by 4.91–10.85% and the wear life fitting accuracy was improved by 5.11–12.19% by the developed method. This improvement confirms the reasonableness and reliability of the method. This method can estimate the wear rate and lifespan of a cutter more accurately and reliably than other methods, providing a practical tool to TBM engineers to make informed decisions and optimize tool replacement programs.

Fix‐it voucher program aims to improve road safety, ease student stress

Improving campus safety can have wide‐ranging benefits for the community at large. That was the ethos behind the new Fix‐a‐Falcon Bulb Replacement Program at the Solano Community College Department of Public Safety, which allows students to use vouchers to deal with vehicle bulb replacement‐related safety violations.

Perceval-S over time. Clinical outcomes after ten years of usage

BackgroundPerceval-S has become a reliable and commonly used option in surgical aortic valve replacement (AVR) since its first implantation in humans 15 years ago. Despite the fact that this aortic valve has been proven efficient enough in the short and mid-term period, there is still lack of evidence for the long-term outcomes.Materials and methodsThis is an observational retrospective study in a high-volume cardiovascular center. Pertinent data were collected for all the patients in whom Perceval-S was implanted from 2013 to 2020.ResultsThe total number of patients was 205 with a mean age 76.4 years. Mean survival time was 5.5 years (SE = 0.26). The overall survival probability of patients undergoing aortic valve replacement with Perceval-S at 6 months was 91.0% (Standard Error SE = 2.0%), at one year 88.4% (SE = 2.3%) and at 5-years 64.8% (SE = 4.4%). A detrimental cardiac event leading to death was the probable cause of death in 35 patients (55.6%). The initiation of Transcatheter Aortic Valve Replacement (TAVR) program in our center in 2017 was associated with a decline in the number of very high-risk patients treated with sutureless bioprosthesis. This fact is demonstrated by the significant shift towards lower surgical risk cases, as median Euroscore II was reduced from 5,550 in 2016 to 3,390 in 2020. Mini sternotomy was implemented in 79,5% of cases favoring less invasive approach. Low incidence of reinterventions, patient prosthesis mismatch and structural valve degeneration was detected.ConclusionsThe survival rate after aortic valve replacement with implantation of Perceval-S is satisfactory in the long-term follow-up. Cases of bioprosthesis dysfunction were limited. Mini sternotomy was used in the majority of cases. TAVR initiation program impacted on the proportion of patients treated with Perceval-S with reduction of high-risk patients submitted to surgery.

Opportunities for improving your medical equipment asset base

The surplus of medical equipment procured by the NHS during the Covid‐19 pandemic provides the veterinary sector with an opportunity to significantly improve the medical equipment they use on a daily basis. This article outlines how building a strategic replacement programme in practice is the first step to actively managing an asset base of medical devices, and explains that there are now good opportunities to improve the veterinary medical equipment asset bases with significantly lower investment.

Factors Influencing Customer Participation in a Program to Replace Lead Pipes for Drinking Water.

Many public water systems are struggling to locate and replace lead pipes that distribute drinking water across the United States. This study investigates factors associated with customer participation in a voluntary lead service line (LSL) inspection and replacement program. It also uses quasi-experimental and experimental methods to evaluate the causal impacts of two grant programs that subsidized homeowner replacement costs on LSL program participation. LSLs were more prevalent in areas with a higher concentration of older housing stock, Black and Hispanic residents, renters, and lower property values. Owner-occupied and higher valued properties were more likely to participate in the LSL program. Results from the two grant program evaluations suggest that subsidies for low-income homeowners to cover LSL replacement costs can significantly boost participation, but only when the programs are well publicized and easy to access. Even then, there was still significant non-participation among properties with confirmed LSLs.

THE SPILLOVER EFFECTS OF COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL: A STUDY FROM CALIFORNIA

Abstract In 2016, Medicare implemented the Comprehensive Care for Joint Replacement (CJR) program to test whether paying hospitals a bundled payment for 90 days of an episode of care for lower extremity joint replacement (LEJR), the most common surgery for Medicare beneficiaries, can improve care coordination and quality in traditional Medicare (TM). Unlike most Medicare alternative payment models, CJR participation was randomly assigned across Metropolitan Statistical Areas (MSAs). Hospitals in selected MSAs were required to participate in the program, while hospitals in other MSAs were paid in the usual fee-for-service manner. Taking advantage of this random assignment, we examined CJR’s direct effects on TM patients and spillover effects on Medicare Advantage (MA) and non-Medicare patients in California. Using California’s Patient Discharge Data (PDD) from 2014 to 2017and event study and difference-in-differences models, we studied changes in adjusted length of stay and home discharge rates before and after program implementation in hospitals in treated versus control MSAs. We found that the CJR program affected not only TM patients, but also untargeted MA and non-Medicare patients. Both TM and non-Medicare patients in treated hospitals experienced shortened length of stay (-3.9% &amp; -1.3%, p&amp;lt;0.05) and increased likelihood of discharge home (3.4%, 2.3%, p&amp;lt; 0.001) relative to those in untreated hospitals after program implementation. MA patients experienced an increase in not only home discharge rates (4.7%, p&amp;lt; 0.001) but also length of stay (2.5%, p&amp;lt; 0.01). Programs designed to affect Medicare costs have the potential to affect the care of patients not covered by the program.

A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection

BackgroundShort-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection.MethodsA systematic review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed.ResultsForty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12–7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27–11.36); neurovascular injury (OR 0.31, 95% CI 0.01–7.92); other complications (OR 0.63, 95% CI 0.26–1.53); or stiffness (OR 1.04, 95% CI 0.53–2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814).ConclusionsThere is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.

Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study

BackgroundThe capacity to meet anticipated growth in joint replacement demand requires safe, efficient models of care. While short-stay joint replacement programs are being used internationally, they have not been widely implemented in many countries. Importantly, the critical challenges that need to be addressed ahead of large-scale program implementation remain unclear. This study aimed to investigate stakeholder perspectives on short-stay joint replacement programs, including perceived barriers and enablers to implementation and sustainability, and understand current practices in Australia.MethodsFour key stakeholder groups were invited to participate in this national study: (1) health professionals who provide joint replacement care; (2) hospital administrators involved in joint replacement provision; (3) patients with recent joint replacement; and (4) carers of people with recent joint replacement. Data on perceived feasibility (0 (not at all feasible) − 10 (highly feasible), appeal (0 (not at all appealing) − 10 (highly appealing), current practices, and barriers and enablers were collected using visual analogue scales, multiple response option and open-ended questions, via an online platform. Descriptive analysis and free-text content analysis was undertaken.ResultsData were available from 1,445 participants including 360 health professionals, 20 hospital administrators, 1,034 patients, and 31 carers. Short-stay program implementation was considered moderately feasible by health professionals (median 6, interquartile range (IQR) 3–8) and hospital administrators (median 5, IQR 5–6). Short-stay programs were moderately appealing to patients (median 7, IQR 2–9) but of little appeal to carers (median 3, IQR 1–7). Prominent implementation barriers included perceived limited appropriateness of short-stay programs, inadequate home supports, and issues around reimbursement models or program funding. Not having daily physiotherapy access and concerns about pain and mobility at home were common barriers for patients. Concern about patients’ ability to manage daily activities was the most common barrier for carers. Access to post-discharge services, better funding models, improved staffing, and consistent protocols and national care standards were prominent enablers.ConclusionsThis national study has uniquely captured multiple stakeholder perspectives on short-stay joint replacement programs. The findings can guide future quality improvement and implementation initiatives and the development of resources to best support patients, carers, clinicians, and hospitals.

Is there correlation between flow volume and Kt/V ratio in upper arm arteriovenous fistula in patients end stage renal failure?

Introduction: Chronic kidney disease is irreversible and may result in end-stage renal failure (ESRF). The kidney replacement program is determined by calculating Kt/V ratios, one of the dialysis efficiency indicators in treatment planning in routine dialysis applications in ESRF patients. We aimed to investigate whether there is a correlation between flow rate and Kt/V ratio. Methods: All patients were evaluated by B-mode ultrasonography (US) and color doppler ultrasonography (CDUS). The anastomosis line diameter was measured in the B-mode US. The fistula flow rate was calculated in a spectral examination at the anatomical location where the fistulized flow was best obtained at the anastomosis level. Patients with a fistula flow rate above 300 mL/min in CDUS examinations were considered reasonable flow rates. The fistula flow rate in these patients was compared with the Kt/V ratios. Spearman’s rank correlation coefficient was calculated since the normal distribution condition was not met to determine the relationship between variables. Results: The results of this study showed a high level (r=0.72, P=0.001) of positive and statistically significant correlation between flow rate and Kt/V ratio in upper arm arteriovenous fistula in patients with end stage renal failure. Conclusion: We found a highly positive and statistically significant correlation between fistula flow rate and Kt/V ratio. Low Kt/V ratios have different causes. Low fistula flow should be considered first in low Kt/V values.

Short-Term Effects of Weight-Loss Meal Replacement Programs with Various Macronutrient Distributions on Gut Microbiome and Metabolic Parameters: A Pilot Study.

It has emerged the gut microbiome is crucially linked to metabolic health and obesity. Macronutrient distribution has been discussed as a key parameter in weight-loss programs, but little is known about its impact on the gut microbiome. We investigated the effects of weight-loss meal replacement programs with different macronutrient ratios on the gut microbiota and metabolic parameters in subjects with overweight and obesity. Three low-calorie meal replacement programs with different ratios of carbohydrates, proteins, and lipids were designed: a balanced diet (Group B, 60:15:30), a high-lipid-low-carbohydrate diet (Group F, 35:20:55), and a protein-enriched diet (Group P, 40:25:35). Sixty overweight or obese participants were provided with the meals twice daily for 3 weeks. In all groups, diet intervention resulted in reduced body weight and BMI. The relative abundance of Bacteroidetes and Firmicutes phyla decreased and increased, respectively, which increased the Firmicutes/Bacteroidetes (F/B) ratio in all subjects, particularly in Groups B and P. Alpha- and beta-diversity were augmented at the phylum level in Group P. In conclusion, short-term interventions with weight-loss meal replacement programs increased butyrate-producing bacteria and the F/B ratio. Moreover, the protein-enriched diet significantly increased alpha- and beta-diversity compared to the balanced diet and the high-lipid-low-carbohydrate diet.

Implementation of preventive maintenance routines and the “zero breakdowns by base condition” methodology in an organization

This work has the general objective of maximizing the availability and reliability of industrial equipment, reducing the frequency and severity of failures. To achieve this objective, two specific strategies will be implemented: preventive maintenance routines and the "Zero Breakdown by Base Condition" methodology. The implementation of preventive maintenance routines consists of establishing a systematic program of inspections, lubrication, adjustments and replacement of components before failures occur. This proactive approach allows you to identify and correct potential equipment problems, preventing them from becoming critical and causing unscheduled interruptions in production. The best maintenance intervals will be studied, taking into account the characteristics and requirements of each equipment, as well as the analysis of data from previous failures. In addition, the "Zero break by base condition" methodology will be implemented. This approach involves continuous monitoring of equipment conditions using data analysis techniques. The objective is to identify abnormal patterns of operation that may indicate the potential for imminent failure. Based on this information, maintenance can be scheduled appropriately and in advance, avoiding unexpected breakdowns. Various monitoring techniques will be explored, such as vibration analysis, thermography and oil analysis, to obtain a comprehensive view of the equipment condition. The study will be carried out in a specific industry, where data will be collected on the availability and reliability of equipment before and after implementing the proposed strategies. Statistical analyzes will be carried out to evaluate the effectiveness of preventive maintenance routines and the "Zero Breakdown by Base Condition" methodology in reducing failures and increasing equipment availability. It is expected that this work will contribute to the development of more efficient and reliable maintenance practices, promoting the improvement of production processes and reducing costs associated with failures and unscheduled stops. Maximizing equipment availability and reliability will have a direct impact on the efficiency and competitiveness of the industry under study.

Did the Comprehensive Care for Joint Replacement Bundled Payment Program Impact Sex Disparities in Total Hip and Knee Arthroplasties?

BackgroundSex disparities have been noted across various aspects of total hip/knee arthroplasty (THA/TKA). Given incentives to standardize care, bundled payment initiatives including the Comprehensive Care for Joint Replacement (CJR) program may reduce disparities. This study aimed to assess the CJR program’s impact on sex disparities in THA/TKA care and outcomes. MethodsThis retrospective cohort study included 259,673 THAs (61.7% women) and 506,311 TKAs (64.0% women) from a large national database (2013 to 2017). Sex disparities were assessed for care and outcomes related to the period (1) before surgery, (2) during hospitalization for THA/TKA, and (3) after discharge. Disparities were reported as women:men ratios. Difference-in-differences analyses estimated the impact of the CJR program on pre-existing sex disparities. ResultsFor both THA and TKA, women were less likely than men to present with a Charlson-Deyo comorbidity index >0 (women:men ratio 0.88 to 0.92), but were more likely to require blood transfusions (women:men ratio 1.48 to 1.79) and be discharged to institutional postacute care (women:men ratio 1.50 to 1.66). Difference-in-differences models demonstrated that the CJR bundled payment program reduced sex disparities in institutional postacute care discharges (THA: −2.28%; 95% confidence interval [CI] −4.20 to −0.35%, P = .02; TKA: −2.07%; 95% CI −3.93 to −0.20%; P = .03) and THA 90-day readmissions (−1.00%, 95% CI −1.88 to −0.13%, P = .02), indicating a differential impact of CJR in women versus men for some outcomes. ConclusionsWhile sex disparities in THA/TKA persist, the CJR program demonstrates potential to impact such differences. Future research should focus on how potential mechanisms could be leveraged to reduce disparities.