Man on the Mound: Pictures of a Pitcher in Pain.

Description Atraumatic ball thrower's humerus fracture is an uncommon, and poorly understood injury pattern. The majority of these cases are seen in untrained and younger individuals. A missed diagnosis could severely impact a patient's quality of life, as management is operative in most cases.

A simulation study of extrapolation uncertainty in exposure assessment - Use of pilot study results for site investigation.

Accurate characterization of soil contaminant concentrations is often crucial for assessing risks to human and ecological health. However, fine-scale assessments of large tracts of land can be cost prohibitive due to the number of samples needed. One solution to this problem is to extrapolate sampling results from one area to another unsampled area.

Global patterns and correlates in the emergence of antimicrobial resistance in humans.

Antimicrobial resistance (AMR) is a critical global health threat, and drivers of the emergence of novel strains of antibiotic-resistant bacteria in humans are poorly understood at the global scale. We examined correlates of AMR emergence in humans using global data on the origins of novel strains of AMR bacteria from 2006 to 2017, human and livestock antibiotic use, country economic activity and reporting bias indicators. We found that AMR emergence is positively correlated with antibiotic consumption in humans.

The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study.

The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories.

Improving Adolescent Violent Trauma Outcomes With a Hospital-Based Violence Prevention Initiative.

Background: Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes.

Objective: To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates.

Challenges and recommendations for high quality research using electronic health records.

Harnessing Real World Data is vital to improve health care in the 21st Century. Data from Electronic Health Records (EHRs) are a rich source of patient centred data, including information on the patient's clinical condition, laboratory results, diagnoses and treatments. They thus reflect the true state of health systems.

Behavioral-biological surveillance of emerging infectious diseases among a dynamic cohort in Thailand.

Background: Interactions between humans and animals are the key elements of zoonotic spillover leading to zoonotic disease emergence. Research to understand the high-risk behaviors associated with disease transmission at the human-animal interface is limited, and few consider regional and local contexts.

Objective: This study employed an integrated behavioral-biological surveillance approach for the early detection of novel and known zoonotic viruses in potentially high-risk populations, in an effort to identify risk factors for spillover and to determine potential foci for risk-mitigation measures.

A global repository of novel antimicrobial emergence events.

Despite considerable global surveillance of antimicrobial resistance (AMR), data on the global emergence of new resistance genotypes in bacteria has not been systematically compiled. We conducted a study of English-language scientific literature (2006-2017) and ProMED-mail disease surveillance reports (1994-2017) to identify global events of novel AMR emergence (first clinical reports of unique drug-bacteria resistance combinations). We screened 24,966 abstracts and reports, ultimately identifying 1,757 novel AMR emergence events from 268 peer-reviewed studies and 26 disease surveillance reports (294 total).

Human-animal interactions and bat coronavirus spillover potential among rural residents in Southern China.

Human interaction with animals has been implicated as a primary risk factor for several high impact zoonoses, including many bat-origin viral diseases. However the animal-to-human spillover events that lead to emerging diseases are rarely observed or clinically examined, and the link between specific interactions and spillover risk is poorly understood. To investigate this phenomenon, we conducted biological-behavioral surveillance among rural residents in Yunnan, Guangxi, and Guangdong districts of Southern China, where we have identified a number of SARS-related coronaviruses in bats.

Addendum to Iwai and Hoberman (2014)-Reassessment of Developmental Toxicity of PFHxA in Mice.

This article presents a supplemental data analysis and evaluation of the findings from an oral (gavage) combined developmental and perinatal/postnatal reproduction toxicity study of the ammonium salt of perfluorohexanoic acid (CASRN: 21615-47-4) in Crl: CD-1(ICR) mice. The original study has been cited as supporting a lowest-observed-adverse-effects level of 175 mg/kg/d and no-observed-adverse-effects level of 35 mg/kg/d for developmental effects from perfluorohexanoic acid (PFHxA, CASRN: 307-24-4) in mice. The statistical analysis reported in 2014 was accurate in terms of quantifying statistical significance within phase 2 of the study.

Temporal Trends in Exposure to Organophosphate Flame Retardants in the United States.

During the past decade, use of organophosphate compounds as flame retardants and plasticizers has increased. Numerous studies investigating biomarkers (i.e.

Growth and final height of children with Gaucher disease: A 15-year follow-up at an Israeli Gaucher center.

Background: It is held that enzyme replacement therapy (ERT) accelerates the growth rate in children with Gaucher disease, but its effect on final height has not been established with certainty. This study presents final heights of Gaucher patients followed up for 15years.

Methods: The study included 41 adults with non-neuronopathic Gaucher disease.

Nail polish as a source of exposure to triphenyl phosphate.

Triphenyl phosphate (TPHP) is primarily used as either a flame retardant or plasticizer, and is listed as an ingredient in nail polishes. However, the concentration of TPHP in nail polish and the extent of human exposure following applications have not been previously studied. We measured TPHP in ten different nail polish samples purchased from department stores and pharmacies in 2013-2014.

Screening-level human health risk assessment of toluene and dibutyl phthalate in nail lacquers.

Toluene and dibutyl phthalate (DBP) are found in many consumer products, including cosmetics, synthetic fragrances, and nail polish. In 2012, the California Environmental Protection Agency evaluated 25 nail products and found that 83% of the products that claimed to be toluene-free contained toluene at concentrations ranging up to 190,000 ppm, and 14% of the products that claimed to be DBP-free contained DBP at concentrations ranging up to 88,000 ppm. We conducted a preliminary, screening-level analysis of the potential toluene and DBP-related health risks to consumers and professionals based on the medium and maximum concentrations of toluene and DBP presented in the 2012 report and evaluated dermal and inhalation exposure to a salon patron, nail technician, and home user.

Outcomes after hip arthroscopy in patients with workers' compensation claims.

Patients with a workers' compensation claim have been shown to have inferior outcomes after various orthopedic procedures. In hip arthroscopy, good to excellent results have been shown in the athletic and prearthritic population in short-term and long-term follow-up. In the current study, the authors' hypothesis was that patients with a workers' compensation claim would have inferior outcomes after hip arthroscopy compared with patients without a workers' compensation claim.

CT characterizing the anatomy of uninjured ankle syndesmosis.

Although it is expert opinion that transsyndesmotic screws are placed obliquely 30° from posterolateral to anteromedial in the transverse plane, this has not been formally studied, and there is inconsistency regarding the congruency of the distal tibiofibular joint. Thirty-eight computed tomography (CT) scans of the lower extremity were used to examine the rotational profile of the axis of the syndesmotic joint in relation to the femoral transepicondylar axis and to describe the congruency of this joint. The axis of the distal tibiofibular joint was 32°±6° externally rotated in relation to the transepicondylar axis.

Application of an antibiotic intramedullary nail in the management of a large metacarpal bone defect.

Contaminated wounds and infected nonunions of the hand are not amenable to primary internal fixation and grafting. Antibiotic-impregnated cement intramedullary nails have been used in the lower extremity in the treatment of these fractures but have not been described in the hand. This technique combines the advantages of local antibiotic delivery with the mechanical stability afforded by an intramedullary nail.

The effect of obesity on early failure after operative syndesmosis injuries.

Objective: The goal of this investigation was to determine if obese patients with syndesmotic injuries have a higher incidence of early postoperative failure compared with nonobese patients.

Design: Retrospective cohort study.

Setting: Level 1 urban trauma center.

Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research.

The DSM-5 formulation presents an opportunity to refine the negative symptom assessments that are crucial for a schizophrenia diagnosis. This review traces the history of negative symptom constructs in neuropsychiatry from their earliest conceptualizations in the 19th century. It presents the relevant literature for distinguishing between different types of negative symptoms.

A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures.

Background: The most commonly cited classification system for lateral condyle fractures (Milch) has not been shown to be predictive of outcome or recommend treatment.

Purpose: To determine whether a classification system and treatment based on fracture displacement and articular congruity correlates with the complication rate after pediatric lateral humeral condyle fractures.

Methods: A retrospective review of all children with lateral condyle fractures treated operatively at one institution from 1996 to 2003 was performed.