Nonunion in Foot and Ankle Arthrodesis Surgery: Review of Risk Factors, Identification of High-risk Patients, and a Guide to Perioperative Testing and Optimization.

Foot and ankle arthrodesis surgery is often associated with high rates of nonunion ranging from 8% to 40%. This complication can result in individual patient burden and system burden in the management of these complex patients. Biologic factors contribute greatly to the development of a nonunion, including patient-related modifiable risk factors, metabolic and endocrine factors, systemic disease, previous surgeries, medications, weight loss treatments, and posttraumatic and postsurgical factors.

Predictive Power of the Fried Phenotype in Assessing Postoperative Outcomes in Patients Undergoing Craniotomy for Tumor Resection.

Background And Objectives: Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor.

Methods: This retrospective cohort analysis included patients with Current Procedural Terminology codes for supratentorial/infratentorial tumor resections and preoperative frailty scores.

Efficient Ground-State Recovery of UV-Photoexcited -Nitrophenol in Aqueous Solution by Direct and Multistep Pathways.

Nitroaromatic compounds are found in brown carbon aerosols emitted to the Earth's atmosphere by biomass burning, and are important organic chromophores for the absorption of solar radiation. Here, transient absorption spectroscopy spanning 100 fs-8 μs is used to explore the pH-dependent photochemical pathways for aqueous solutions of -nitrophenol, chosen as a representative nitroaromatic compound. Broadband ultrafast UV-visible and infrared probes are used to characterize the excited states and intermediate species involved in the multistep photochemistry, and to determine their lifetimes under different pH conditions.

Atlas of pacific sand lance (Ammodytes personatus) benthic habitat - Application of multibeam acoustics and directed sampling to identify viable subtidal substrates.

Defining and delineating species distribution and habitat is critical to informed management and conservation. This process is complicated in marine environments, where detection of marine taxa and characterization of marine habitat is more difficult. Small pelagic fishes and forage fishes are particularly challenging, though insights may be more accessible in species highly dependent on particular habitat.

Competing Nonadiabatic Relaxation Pathways for Near-UV Excited -Nitrophenol in Aqueous Solution.

Nitrophenols are atmospheric pollutants found in brown carbon aerosols produced by biomass burning. Absorption of solar radiation by these nitrophenols contributes to atmospheric radiative forcing, but quantifying this climate impact requires better understanding of their photochemical pathways. Here, the photochemistry of near-UV (λ = 350 nm) excited -nitrophenol in aqueous solution is investigated using transient absorption spectroscopy and time-resolved infrared spectroscopy over the fs to μs time scale to characterize the excited states, intermediates, and photoproducts.

Acute presentation of abusive head trauma.

Child abuse is a major cause of morbidity and mortality in the United States. The leading cause of child physical abuse related deaths is abusive head trauma, formerly known as shaken baby syndrome, making the rapid identification and assessment of these children critical. The clinical presentation of cases of abusive head trauma ranges from neurological complaints, such as seizures, to vague or subtle symptoms, such as vomiting.

An Analysis of the Relationship Between Female Faculty and Female Resident Representation in Neurosurgery Residency Programs.

Background: Promoting minorities within medical specialties has been postulated to be crucial to patient care and recruitment of diverse candidates. This concept has been suspected but not formally studied in the minority of women faculty and trainees in neurosurgery. We aimed to quantitatively investigate the postulated correlation relative to female representation in neurosurgery.

Care irst-nd ater (CareFFuL): an end-of-life home care quality improvement project.

Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able to die at home. The average time to discharge was 6.3 days and 29% died in hospital, as median survival was only 15 days.

Challenges in the distribution of antimicrobial medications in community dispensaries in Accra, Ghana.

Introduction: The dispensation of medicines in some low- and middle-income countries is often carried out by private vendors operating under constrained conditions. The aim of this study was to understand the challenges reported by employees of dispensaries, specifically, chemical and herbal shops and pharmacies in Accra, Ghana. Our objectives were twofold: (1) to assess challenges faced by medicine vendors related to dispensing antimicrobials (antibiotic and antimalarial medications), and (2) to identify opportunities for improving their stewardship of antimicrobials.

The queen bee phenomenon in Canadian surgical subspecialties: An evaluation of gender biases in the resident training environment.

Background: The queen bee phenomenon (QBP) describes the behavioural response that occurs when women achieve success in a male-dominated environment, and in this position of authority, treat their female subordinates more critically. It has been demonstrated in business, academia, the military, and police force. The goal of this study was to determine whether the QBP occurs in surgical specialties.

An uneven distribution of strontium in the coccolithophore revealed by nanoscale X-ray fluorescence tomography.

Coccolithophores are biogeochemically and ecologically important phytoplankton that produce a composite calcium carbonate-based exoskeleton - the coccosphere - comprised of individual platelets, known as coccoliths. Coccoliths are stunning examples of biomineralization; their formation featuring exceptional control over both biomineral chemistry and shape. Understanding how coccoliths are formed requires information about minor element distribution and chemical environment.

Expanding the Interpretive Potential of Eye Tracking for the Rorschach: Replication and Extension of the Findings of Ales et al. (2020).

The present study was undertaken to determine if the findings of Ales et al. (2020) could be replicated and extended, especially in light of the replication crisis in psychology and the social sciences. Ales et al.

Race Does Not Affect Rates of Surgical Complications at Military Treatment Facility.

Introduction: Racial minorities have been found to have worse health care outcomes, including perioperative adverse events. We hypothesized that these racial disparities may be mitigated in a military treatment facility, where all patients have a military service connection and are universally insured.

Materials And Methods: This is a single institution retrospective review of American College of Surgeons National Surgical Quality Improvement Program data for all procedures collected from 2017 to 2020.

A novel strategy to increase the therapeutic potency of GBM chemotherapy via altering parenchymal/cerebral spinal fluid clearance rate.

Patients with glioblastoma (GBM) face a poor prognosis with a median survival of less than two years. Escalating the dose of chemotherapy is often impossible due to patient comorbidities; thus, we focused on modulating brain clearance as a mechanism to enhance drug accumulation. Given the recently identified interconnectivity between brain parenchymal fluid and cerebral spinal fluid (CSF), we reasoned enhancing drug concentration in the CSF also increases drug concentration in the parenchyma where a GBM resides.

When to shed? Patterns and drivers of time to first ecdysis in snakes.

Time from birth or hatching to the first shed (postnatal ecdysis) in snakes ranges from about an hour to several weeks depending upon the species. We assessed patterns in time to postnatal ecdysis in 102 snake species for which we could source appropriate information, covering 2.6% of all extant snake species, and related measures to various biological traits.

Influence of prior authorization requirements on provider clinical decision-making.

Objectives: Prior authorization (PA) aims to promote the safe and effective use of medications and to control costs. However, PA-related administrative tasks can contribute to burden on health care providers. This study examines how such tasks affect treatment decisions.

Transforming Psychological Testing With Saccadic Responses: Internal Consistency is High for Rorschach and Facial Expressions.

Psychologists have long been interested in the underlying visual perceptual processes associated with forming responses to certain psychological tests, including the Rorschach Ink Blot Test, which modern users conceptualize as a conceptual problem-solving task. Accordingly, we used eye tracking technology to assess the internal consistency of saccadic responses to both the Rorschach Ink Blot Test and a facial expression task. Internal consistency was highest for eye Fixation Duration (FD) and Saccade Amplitude (SA), and both FD and SA measures in the Rorschach were positively related to the same measures in the facial expression task.

Regularities in vertical saccadic metrics: new insights, and future perspectives.

Introduction: Asymmetries in processing by the healthy brain demonstrate regularities that facilitate the modeling of brain operations. The goal of the present study was to determine asymmetries in saccadic metrics during visual exploration, devoid of confounding clutter in the visual field.

Methods: Twenty healthy adults searched for a small, low-contrast gaze-contingent target on a blank computer screen.

Recognizing Nonaccidental Trauma in a Pediatric Tertiary Hospital: A Quality Improvement Imperative.

Unlabelled: Abusive injuries can go unrecognized or improperly managed by medical providers. This study sought to standardize the nonaccidental trauma (NAT) workup and improve NAT evaluation completion for children <7 months with concerning injuries in the pediatric emergency department (PED) and inpatient settings at an urban, tertiary care children's hospital.

Methods: The quality improvement (QI) team created hospital guidelines for suspected NAT, including age-based recommendations (care bundle).

Conservation Practices for Personal Protective Equipment: A Systematic Review with Focus on Lower-Income Countries.

During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries.

Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial.

Background: Minimization of opiate use is an important focus in the setting of the severe national opioid crisis. This study evaluated the role of liposomal bupivacaine (LB) in decreasing postoperative opioid use before and after implementation of a bariatric enhanced recovery after surgery (ERAS) program.

Methods: We performed an IRB-approved, prospective, double-blind, randomized controlled trial of LB versus plain bupivacaine (PB) in patients undergoing elective, minimally invasive, weight loss surgery at a comprehensive metabolic and bariatric surgery program from November 2017 to December 2019.

Efficacy and Safety of Vibegron for the Treatment of Overactive Bladder in Women: A Subgroup Analysis From the Double-Blind, Randomized, Controlled EMPOWUR Trial.

Importance: The international phase 3 EMPOWUR trial demonstrated efficacy and safety of vibegron, a newer β 3 -adrenergic receptor agonist, in adults with overactive bladder (OAB). Women are disproportionately affected by OAB, especially those with bothersome symptoms, such as urge urinary incontinence (UUI).

Objective: This subgroup analysis from EMPOWUR assessed efficacy and safety of vibegron in women.