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Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present. BACKGROUND Bundled payment initiatives were introduced to reduce costs and improve quality of care. Cemented vs cementless femoral fixation is a modifiable variable that may influence the cost and quality of care. New bundled payment data from the Centers for Medicare and Medicaid Services allowed us to study the influence of femoral fixation strategy on (1) 90-day costs; (2) readmission rates; (3) reoperation rates; (4) length of stay (LOS); and (5) discharge disposition for Medicare patients undergoing total hip arthroplasty. METHODS We retrospectively studied 1671 primary total hip arthroplasty Medicare cases, comparing 359 patients who received cemented femoral fixation to 1312 patients who received cementless fixation. Centers for Medicare and Medicaid Services cost data as well as clinical data were reviewed. Demographic differences were present between the 2 cohorts. Statistical analyses were performed, including multiple regression models to adjust for baseline differences. RESULTS Controlling for cohort differences, cemented patients were significantly more likely to be discharged home compared to cementless patients. PF-00835231 purchase Cemented patients also demonstrated trends toward lower costs, lower readmission rates, and shorter LOS compared to cementless patients. All reoperations within the early postoperative period occurred in patients managed with cementless femoral fixation. CONCLUSION Among Medicare patients, cemented femoral fixation outperformed cementless fixation with respect to discharge disposition and also trended toward superiority with regards to LOS, readmission, cost of care, and reoperation. Cemented femoral fixation remains relevant and useful despite the rising popularity of cementless fixation. BACKGROUND Several recent studies have demonstrated that overlapping surgeries in total hip (THA) and knee (TKA) arthroplasty do not increase the rates of complications, but whether this practice is cost-effective has yet to be addressed in the literature. The purpose of this study is to determine the effect of overlapping surgery on procedural costs and surgical productivity during THA and TKA. METHODS We identified all patients undergoing primary THA or TKA from 2015 to 2018 by 18 surgeons at a single orthopedic specialty hospital. Procedural and personnel costs were calculated for each case using a time-driven activity-based costing algorithm. Overlap of surgical time by at least 30 minutes was used to define an overlapping procedure. We compared costs and outcomes between overlapping and nonoverlapping procedures, standardizing all costs to 8-hour time blocks. A multivariate regression analysis was performed to determine independent effect of overlapping procedures on costs and outcomes. RESULTS Of the 4786 consecutive procedures, 968 (20.2%) overlapped by at least 30 minutes. Although overlapping rooms increased mean operative time by 8.3 minutes (P less then .0001) and operating room personnel costs by $80 per case ( less then .0001), overlapping surgeons could perform significantly more procedures per 8 hours (7.6 vs 6.4; P less then .0001), increasing total 8-hour profit margin by $1215 per procedure. There was no difference in 90-day readmission rate, length of stay, or rates of discharge home between the groups. CONCLUSION Overlapping noncritical portions of procedures in primary THA and TKA appear to be both a safe practice and an effective strategy. Negative symptoms are a core feature of schizophrenia and associated with social and occupational impairment. To encourage treatment development and address the limitations of existing rating instruments in this area across culture, the Brief Negative Symptoms Scale (BNSS) was developed. The authors reviewed studies published since the BNSS was published in 2010 that examined the psychometric properties of the instrument in translation and compared for consistency, psychometric performance and related features. Eleven published cross-cultural validation studies demonstrated the translated versions of the BNSS have strong psychometric properties, similar to the original English version. The internal consistency ranged from 0.88 to 0.98 and the inter-rater reliability ranged from 0.81 to 0.98 for the total score. The BNSS exhibited good convergent validity with existing measures of similar constructs and function, and good discriminant validity relative to other constructs. Recent research also reported that the BNSS is sensitive to drug effects, with effect sizes comparable to established scales. The results of confirmatory factor analyses revealed that the 5-factor structure of negative symptoms in schizophrenia (blunted affect, anhedonia, avolition, asociality, and alogia) crosses cultures. This psychometric evidence suggests that the BNSS is a valid and reliable instrument for assessing pathological mechanism underlying the negative symptoms of schizophrenia across cultures and can be a useful instrument in global clinical trials. V.Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder that emerges in childhood and persists into adulthood in a sizeable portion of afflicted individuals. The persistence of ADHD symptoms elevates the risk of adverse outcomes that result in substantial individual and societal burden. The objective of this study was to delineate neuroanatomical substrates associated with the diversity of adult outcomes of childhood ADHD, which may have considerable value for development of novel interventions that target mechanisms associated with recovery. Structural MRI and diffusion tensor imaging data from 32 young adults who were diagnosed with ADHD combined-type during childhood and 35 group-matched controls were analyzed. Adults with childhood ADHD were divided into 16 remitters and 16 persisters based on DSM-IV criteria. Compared to the controls, ADHD probands showed significantly reduced gray matter (GM) volume in right putamen and white matter (WM) volume in left parieto-insular fiber tracts.
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