Biomechanical analysis of cadaveric wrists before and after MOTEC wrist arthroplasty using a hexapod robot.

This study compares wrist motion, biomechanical behaviour and radiographic parameters before and after total wrist arthroplasty using a fourth-generation spherical articulation prosthesis. A total of 10 cadaveric specimens were assessed using a hexapod Stewart platform robot. After arthroplasty, there were significant increases in both stiffness and phase angle of wrist motion across all planes of motion assessed.

Facet deflection and strain are dependent on axial compression and distraction in C5-C7 spinal segments under constrained flexion.

Background: Facet fractures are frequently associated with clinically observed cervical facet dislocations (CFDs); however, to date there has only been one experimental study, using functional spinal units (FSUs), which has systematically produced CFD with concomitant facet fracture. The role of axial compression and distraction on the mechanical response of the cervical facets under intervertebral motions associated with CFD in FSUs has previously been shown. The same has not been demonstrated in multi-segment lower cervical spine specimens under flexion loading (postulated to be the local injury vector associated with CFD).

Microbial patterns and culture utility in orbital cellulitis.

Purpose: To determine the prevalence and types of pathogens found in children with orbital cellulitis and to evaluate the utility of nonoperative cultures.

Methods: This was a retrospective cohort study of children with imaging-confirmed orbital cellulitis over a period of 8 years. Outcomes included prevalence and types of organisms, polymicrobial infection, mixed aerobic-anaerobic infection, effect of age, and culture utility.

Sensation Seeking and Adolescent Drinking: Do Protective Behavioral Strategies Lower Risk?

Using a cross-sectional design, we examined protective behavioral strategies (PBS) as a moderator of the relationship between sensation seeking and hazardous drinking and alcohol-related consequences among high school seniors ( = 212). Hierarchical regression analyses indicated sensation seeking was a significant predictor of binge drinking (β = .65, < .

Clinical Reasoning: A 12-Month-Old Male Child With Staring Episodes, Ataxia, and Right-sided Weakness.

, or raccoon roundworm, is a rare cause of eosinophilic meningoencephalitis with historically poor clinical outcomes. Symptoms of neural larval migrans begin approximately 2-4 weeks after ingestion with fatigue, nausea, fever, and lethargy and then rapidly progress to weakness, incoordination, ataxia, seizures, altered mental status, and finally coma. Only 31 other cases of CNS neural larval migrans have been reported, with more than 25% being lethal.

A 7-Year-Old With Persistent Fever and Cough.

A previously healthy, fully immunized 7-year-old girl presented with a 7-week history of daily fevers and a worsening cough with persistently elevated inflammatory markers. Before admission, she had an unrevealing outpatient workup by infectious disease, rheumatology, pulmonology, and otorhinolaryngology for her fever and other symptoms. Multiple courses of antibiotics had no effect, but brief courses of steroids seemed to modestly alleviate her symptoms.

Factors Associated With Penicillin Allergy Labels in Electronic Health Records of Children in 2 Large US Pediatric Primary Care Networks.

Importance: Penicillin allergy labels influence clinical decision-making, yet most children who are labeled do not have type 1 hypersensitivity allergic reactions and instead have a history of predictable adverse reactions or unspecified illness symptoms while receiving penicillin for viral infections. Studies describing penicillin allergy labeling in the pediatric outpatient setting are lacking.

Objective: To describe the epidemiology and factors associated with penicillin allergy labels across 2 large US pediatric primary care networks.

Chair design for older immobile people: Comparison of pressure mapping and manual handling outcomes.

The number of older adults unable to transfer or ambulate independently is increasing. High support chairs enable people experiencing loss of mobility to be mobile, but current chair designs are associated with global functional loss and pressure ulcers. This pilot study compared the functionality of a traditional design high support chair to a new design of motorised high support chair: 1) a motion laboratory study compared joint angles and pressure at the hip, knee, ankle, elbow and spine when pushing each chair, and 2) a pressure mapping study compared the interface pressure when older people with limited mobility used the chairs.

MRI Findings of Infectious Sacroiliitis in Children: Are There Age-Dependent Differences?

The purpose of this study was to investigate the prevalence of various MRI findings of infectious sacroiliitis in children and with respect to age. This institutional review board-approved, HIPAA-compliant retrospective study included children with infectious sacroiliitis who underwent MRI examination between December 1, 2002, and September 30, 2018. Two radiologists blinded to the clinical outcome reviewed each MRI examination to determine the presence or absence of periarticular marrow edema, erosions, capsular bulge, extracapsular edema, and soft-tissue abscess.

Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study.

Background: Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection.

Methods: We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours.

The Challenge of Patient Notification and the Work of Follow-Up Generated by a 2-Step Testing Protocol for Group A Streptococcal Pharyngitis in the Pediatric Emergency Department.

Objective: Current guidelines recommend confirmatory testing for negative rapid antigen detection tests (RADTs) for group A streptococcal pharyngitis in children. We sought to describe the work of follow-up generated by this process and frequency of our inability to notify patients of positive results.

Methods: We retrospectively reviewed laboratory and outreach nurse records of patients who had group A streptococcal pharyngitis testing performed in an academic pediatric emergency department during 2014.

Impact of seductive details on the acquisition and transfer of laparoscopic suturing skills: Emotionally interesting or cognitively taxing?

Background: A common strategy to increase learner engagement is to interweave educational material with interesting but slightly tangential tidbits of information (eg, "war stories" and funny anecdotes), known as seductive details. Our objective was to examine the impact of seductive details on initial acquisition and transfer of basic laparoscopic surgical skills.

Methods: Novices (first- to fourth-year medical students) were randomized into control (N = 47) or seductive details (N = 42) groups.

Frame-of-reference training for simulation-based intraoperative communication assessment.

Background: The purpose of this study was to examine the impact of frame-of-reference (FOR) training on assessments of intraoperative communication skills and identify areas of need to inform curricular efforts.

Methods: Simulation instructors (M.D.

Multicenter Clinical Evaluation of the Novel Alere i Strep A Isothermal Nucleic Acid Amplification Test.

Rapid detection of group A beta-hemolytic streptococcus (GAS) is used routinely to help diagnose and treat pharyngitis. However, available rapid antigen detection tests for GAS have relatively low sensitivity, and backup testing is recommended in children. Newer assays are more sensitive yet require excessive time for practical point-of-care use as well as laboratory personnel.

Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial.

Introduction: Internal herniation is a potential complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Previous studies have shown that closure of mesenteric defects after LRYGB may reduce the incidence of internal herniation. However, controversy remains as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after LRYGB.

Augmented reality telementoring (ART) platform: a randomized controlled trial to assess the efficacy of a new surgical education technology.

Background: Laparoscopic skills training has evolved over recent years. However, conveying a mentor's directions using conventional methods, without realistic on-screen visual cues, can be difficult and confusing. To facilitate laparoscopic skill transference, an augmented reality telementoring (ART) platform was designed to overlay the instruments of a mentor onto the trainee's laparoscopic monitor.

Combustion of 1,5-dinitrobiuret (DNB) in the presence of nitric acid using ReaxFF molecular dynamics simulations.

In this study we have examined the combustion dynamics of 1,5-dinitrobiuret (DNB) and nitric acid using reactive molecular dynamics simulations. Simulations were performed using the ReaxFF force field with parameters that were fitted against quantum mechanical calculations on model compounds/clusters relevant for this particular chemical system. Several different compositions were investigated, at densities of 0.

Evaluation and referral for child maltreatment in pediatric poisoning victims.

Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS.

Methods: Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008.

Synthesis and evaluation of human phosphodiesterases (PDE) 5 inhibitor analogs as trypanosomal PDE inhibitors. Part 2. Tadalafil analogs.

In this Letter we describe our ongoing target repurposing efforts focused on discovery of inhibitors of the essential trypanosomal phosphodiesterase TbrPDEB1. This enzyme has been implicated in virulence of Trypanosoma brucei, the causative agent of human African trypanosomiasis (HAT). We outline the synthesis and biological evaluation of analogs of tadalafil, a human PDE5 inhibitor currently utilized for treatment of erectile dysfunction, and report that these analogs are weak inhibitors of TbrPDEB1.

Effect of formic acid addition on water cluster stability and structure.

Computational chemistry simulations were performed to determine the effect that the addition of a single formic acid molecule has on the structure and stability of protonated water clusters. Previous experimental studies showed that addition of formic acid to protonated pure water results in higher intensities of large-sized clusters when compared to pure water and methanol-water mixed clusters. For larger, protonated clusters, molecular dynamics simulations were performed on H(+)(H(2)O)(n), H(+)(H(2)O)(n)CH(3)OH, and H(+)(H(2)O)(n)CHOOH clusters, 19-28 molecules in size, using a reactive force field (ReaxFF).

Ambulatory monitoring of sleep disorders.

Background: Behavioural and functional activity monitoring has a long history in sleep research. The term "Actigraphy" refers to methods using computerized wristwatch-size devices (generally placed on the wrist, but also on the ankle or trunk) to record the movement it undergoes. Collected data are displayed on a computer and analyzed for change in rhythm parameters that in turn provide an estimate on wake-sleep parameters (such as total sleep time, percent of time spent asleep, total wake time, percent of time spent awake and the number of awakenings).