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Periprosthetic infection after total knee arthroplasty is a devastating complication, and 2-stage exchange is the standard of care in North America. Articulating spacers are effective in treating periprosthetic joint infections, but the optimal articulating spacer construct has yet to be identified. The authors performed a systematic review using MEDLINE, MEDLINE In-Process, EMBASE, BIOSIS, ClinicalTrials.gov , and Cochrane Database of Systematic Reviews. They identified 34 articles meeting inclusion criteria, producing 1016 spacers for comparison. Metal-on-polyethylene spacers had a statistically significant increased interim range of motion compared with other spacers ( P <.003). No statistical differences regarding reinfection rates existed among the 4 types of articulating spacers ( P <.68). Difficulty of reimplantation was similar between groups ( P <.10). There were fewer spacer-specific complications with the metal on polyethylene compared with the other groups ( P <.043) and no spacer fractures. This study answers several clinically relevant questions and provides useful information in guiding clinical decision making in treating periprosthetic infections after total knee arthroplasty. [ Orthopedics. 2017; 40(4):212–220.]

An example of this is in the minimum standard for the distance between beds in a hospital ward. In 1997, that minimum standard was 2.2 metres. If the average hospital bed with its attachments is roughly 1.2 metres wide, then with such close proximity contact between beds is inevitable as I found out in a 1997 flagship PFI hospital earlier this year.

The differential equation describing flow of real fluids through porous media is, in general, nonlinear. For gases, the nonlinearity is particularly strong. In order to obtain analytical solutions to the flow equation for gases, the equation must first be linearized to give it the form of the diffusivity equation. To achieve the desired linearization, two approximate linearizations have been proposed--the use of pseudopressure as the dependent variable, and the use of pseudotime as the independent variable. Empirically it has been observed that use of pseudopressure alone is adequate for drawdown test analysis, while both pseudopressure and pseudotime must be used during buildup. In this study, the pseudopressure-pseudotime linearization is studied using both analytical and numerical methods. The pseudopressure-time linearization is exact for steady-state flow; the pseudopressure-pseudotime linearization is exact for the case of uniform pressure, as long a porosity remains constant. Wellbore storage is shown to be described exactly by the pseudopressure-pseudotime linearization. Drawdown is shown to be dominated at the wellbore by flow very similar to steady-state flow. Buildup is shown to be dominated by storage phenomena, with nearly uniform pressure near the wellbore. For buildup when producing time effects become important, the correct producing pseudotime is shown to be that obtained by dividing the producing time by the initial viscosity-compressibility product. A number of cases are investigated using finite difference solutions to the flow equation. Pseudotime is used successfully to analyze wellbore storage for both drawdown and buildup; high velocity flow; and buildup following constant pressure production. Pseudotime is found to be less successful for extreme formation compressibility. The application of pseudotime is then illustrated with an example well test analysis. The suggested use of both time and pseudotime for drawdown when wellbore storage is present is presented. For buildup, the example well test is analyzed using pseudotime alone.

Spivey and Veech talk about the Navy's Naval Junior Officer Counsel (NJOC), a new avenue enabling junior officers to share ideas, insights and concerns with senior leadership. NJOC is the Navy's first management advisory group. It comprises a core leadership team advised by a board of representatives. These representatives are junior officers from various naval designators and serve as liaisons between NJOC and their respective communities.

In an ideal NHS there would be no need for the separate private sector we have today, but until we reach that ideal, surely it is better to incorporate the resource of that private sector into the NHS rather than allow it to develop separately. At present, the private sector is parasitic on the NHS. It takes doctors and nurses without the burden of training them. It uses the outcomes of research without contributing in anything but a token way with the odd technological spectacular.