No abstract

BackgroundMost patients have favorable outcomes after primary total knee arthroplasty (TKA). Well-validated methods to predict the risk of poor outcomes have not been developed or implemented. Several patients have annual clinic visits despite well-funcitoning TKA, as a routine practice, to detect early failure requiring revision surgery. It is not known whether assessment of pain and function can be used as a predictive tool for early failure and revision to guide practice. Our objective was to determine whether pain and function can predict revision after TKA.MethodsWe retrospectively studied data from a large prospectively gathered TKA registry to examine changes in outcome scores for primary TKAs undergoing revision compared to those not requiring revision to determine the factors that are predictive for revision.ResultsOf the 1,012 patients, 721 had had a single-sided primary TKA and had American Knee Society (AKS) Scores for three or more visits. 46 patients underwent revision, 23 acutely (fracture, traumatic component failure or acute infection) and 23 for latent causes (late implant loosening, progressive osteolysis, or pain and indolent infection). Mean age was 70 years for the non-revision patients, and 64 years for those revised. Both AKS Clinical and AKS Function Scores for non-revised patients were higher than in revision patients, higher in acute revision compared to latent revision patients. Significant predictors of revision surgery were preoperative, 3- and 15-month postoperative AKS Clinical Scores and 3-month AKS Function Scores. At 15-month post-TKA, a patient with a low calculated probability of revision, 32 % or less, was unlikely to require revision surgery with a negative predictive value of 99 %.ConclusionTime dependent interval evaluation post-TKA with the AKS outcome scores may provide the ability to assign risk of revision to patients at the 15-month follow-up visit. If these findings can be replicated using a patient-reported measure, a virtual follow-up with patient-reported outcomes and X-ray review may be an alternative to clinic visit for patients doing well.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1669-y) contains supplementary material, which is available to authorized users.

A summative evaluation was conducted to determine the benefit and change resulting from a unique Internationalizing Extension Training Program (IETP). The program consisted of two introductory sessions, a ten-day onsite learning experience in Costa Rica and a follow-up reflection and planning session. Program participants included four extension agents, four county commissioners, four graduate students, one state extension specialist, and two program coordinators. The purpose of this evaluation was to determine how participants have changed behavior in their professional life, and; to determine change in attitudes toward international issues and internationalizing extension. In general, participants found the experience to enhance their world-view and influenced many of them to stay internationally engaged at some level. Commissioners also commented that by participating in the IETP, they realized the impact that Cooperative Extension has in Florida and the United States. As a result, they have supported increased funding for local extension and its services. Graduate students gained an understanding of ways to implement international components into their future careers and the importance of international professional involvement. Participants felt strongly that the IETP was very valuable as extension continues to change and adapt to the needs of local citizens, respond to the changing state demographics, and be a part of the national participation in international affairs.

Throughout Virginia there are a multitude of social, environmental, and economic challenges facing farmers and communities. In 2010 and 2011, an interdisciplinary team of faculty, practitioners, and graduate students collaborated to address these challenges through the creation of the Virginia Farm to Table Plan. As part of the plan, the team completed a comprehensive food system assessment. Comprehensive food system assessments use qualitative and quantitative methodologies to analyze the systematic nature of a local, state, or regional food system to address the interactions of food with social, environmental, and economic concerns. The overall purpose of this article is to present the results of an online survey of Virginia agrifood system stakeholders that investigated their priorities for strengthening Virginia's local and regional food systems. A total of 1,134 Virginia respondents completed the online survey.

No abstract