As part of a large-scale noninvasive fetal ultrasound screen to recover ethylnitrosourea (ENU)-induced mutations causing congenital heart defects in mice, we established a high-throughput ultrasound scanning strategy for interrogating fetal mice in utero utilizing three orthogonal imaging planes defined by the fetus' vertebral column and body axes, structures readily seen by ultrasound. This contrasts with the difficulty of acquiring clinical ultrasound imaging planes which are defined by the fetal heart. By use of the three orthogonal imaging planes for two-dimensional (2D) imaging together with color flow, spectral Doppler, and M-mode imaging, all of the major elements of the heart can be evaluated. In this manner, 10,091 ENU-mutagenized mouse fetuses were ultrasound scanned between embryonic days 12.5 and 19.5, with 324 fetuses found to die prenatally and 425 exhibiting cardiovascular defects. Further analysis by necropsy and histology showed heart defects that included conotruncal anomalies, obstructive lesions, and shunt lesions as well as other complex heart diseases. Ultrasound imaging also identified craniofacial/head defects and body wall closure defects, which necropsy revealed as encephalocele, holoprosencephaly, omphalocele, or gastroschisis. Genome scanning mapped one ENU-induced mutation associated with persistence truncus arteriosus and holoprosencephaly to mouse chromosome 2, while another mutation associated with cardiac defects and omphalocele was mapped to mouse chromosome 17. These studies show the efficacy of this novel ultrasound scanning strategy for noninvasive ultrasound phenotyping to facilitate the recovery of ENU-induced mutations causing congenital heart defects and other extracardiac anomalies.

Background: Social media can influence how students and residents learn about and select graduate medical education programs. COVID-19-related travel restrictions forced residencies to adapt their recruitment strategies. The objective of our investigation was to characterize the prevalence of social media use by orthopaedic surgery residency programs and to examine any change over time before the COVID-19 pandemic and leading up to the 2020 to 2021 virtual interview season. Methods: The Fellowship and Residency Electronic Interactive Database was queried for all orthopaedic surgery residency programs (N = 164). We performed a cross-sectional analysis on the use of Facebook, Twitter, and Instagram by orthopaedic surgery residency programs in May 2019, July 2020, and November 2020. Orthopaedic surgery residency programs were systematically identified on each of the social media platforms. Descriptive statistics were used to facilitate comparisons between the time points. Results: Seventy-six social media accounts were identified in May 2019 compared with 239 in November 2020-a greater than 300% increase in 19 months. The prevalence of residency programs using Facebook increased from 21.3% in May 2019 to 30.5% in July 2020 to 36.0% in November 2020. Similar increases in prevalence were identified for Twitter (15.2%-31.7% then 43.9%) and Instagram (9.1% to 37.2% to 65.9%). In May 2019, we identified 35 programs with Facebook accounts, 26 with Twitter accounts, and 15 with Instagram accounts. By November 2020, this increased to 59 Facebook accounts, 72 Twitter accounts, and 108 Instagram accounts. This corresponds to an expansion in the use of each platform by 69%, 177%, and 620% for Facebook, Twitter, and Instagram, respectively. Conclusions: The use of social media by academic orthopaedic surgery residency programs increased substantially over the study period. The adoption of Instagram seems to be occurring at the fastest rate. Social media may represent a useful tool in resident recruitment, but the platform must be carefully selected and planned to avoid unintended dilemmas. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/ A275).

No abstract

Background Venous thromboembolism (VTE) is a common preventable condition in medical inpatients. Thromboprophylaxis is recommended for inpatients who are not at low risk of VTE, but no specific risk threshold for prophylaxis has been defined. Objective To determine a threshold for prophylaxis based on risk of VTE. Patients/Methods We constructed a decision model with a decision-tree following patients for 3 months after hospitalization, and a lifetime Markov model with 3-month cycles. The model tracked symptomatic deep vein thromboses and pulmonary emboli, bleeding events and heparin-induced thrombocytopenia. Long-term complications included recurrent VTE, post-thrombotic syndrome and pulmonary hypertension. For the base case, we considered medical inpatients aged 66 years, having a life expectancy of 13.5 years, VTE risk of 1.4% and bleeding risk of 2.7%. Patients received enoxaparin 40 mg day for prophylaxis. Results Assuming a willingness-to-pay (WTP) threshold of $100 000/ quality-adjusted life year (QALY), prophylaxis was indicated for an average medical inpatient with a VTE risk of ≥ 1.0% up to 3 months after hospitalization. For the average patient, prophylaxis was not indicated when the bleeding risk was > 8.1%, the patient's age was > 73.4 years or the cost of enoxaparin exceeded $60/dose. If VTE risk was < 0.26% or bleeding risk was > 19%, the risks of prophylaxis outweighed benefits. The prophylaxis threshold was relatively insensitive to low-molecular-weight heparin cost and bleeding risk, but very sensitive to patient age and life expectancy. Conclusions The decision to offer prophylaxis should be personalized based on patient VTE risk, age and life expectancy. At a WTP of $100 000/QALY, prophylaxis is not warranted for most patients with a 3-month VTE risk below 1.0%.