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This case report describes an incident of pneumothorax in 4-month old male German Shorthaired Pointer caused by a grass awn. The patient was brought to the Small Animal Clinic of the Faculty of Veterinary Medicine at Trakia University, Stara Zagora, Bulgaria with respiratory distress and anxiety. Tachypnea, cyanotic mucous membranes and tachycardia were observed during physical examination. Abnormal collection of air in the pleural space between the lung and the chest was observed radiographically. A diagnosis of primary spontaneous closed pneumothorax was made based on these findings. Later pathoanatomical findings showed the presence of the grass awn that had penetrated through the skin.

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Background: Basal subarachnoid hemorrhage (SAH) caused by rupture of intracranial aneurysms usually has non-traumatic etiology. However, head injury shortly before death can start legal case, even if aneurysm was found. In such cases, forensic pathologists have to decide on the cause of the rupture and the role of the injury. Case presentation: The article presents a rare case from forensic practice: 43 years old male dies after a head blunt trauma. The death was caused by basal SAH, which was caused by a microaneurysm rapture of the left posterior cerebral artery. The autopsy revealed external damages on the face and focal hemorrhages in soft tissues of the head and back. A detailed analysis of the morphological findings, clinical picture and circumstances was performed. The results showed that it was non-traumatic basal SAH. The cause of aneurism rupture was intracranial hypertension increased by vomiting and unusual body position shortly before the death. Conclusion: Available published articles were studied on the causes of ruptures of pathological cerebral arteries and forensic interpretation in controversial cases. Results suggest that current recommendations should be revised. The hypothesis of the most significant sign indicating unnatural death (localization of the damage in the projection of the brain base) could not be confirmed.

The geometry of 4-string contact interaction of closed string field theory is characterized using machine learning. We obtain Strebel quadratic differentials on 4-punctured spheres as a neural network by performing unsupervised learning with a custom-built loss function. This allows us to solve for local coordinates and compute their associated mapping radii numerically. We also train a neural network distinguishing vertex from Feynman region. As a check, 4-tachyon contact term in the tachyon potential is computed and a good agreement with the results in the literature is observed. We argue that our algorithm is manifestly independent of number of punctures and scaling it to characterize the geometry of $n$-string contact interaction is feasible., Comment: 28+10 pages, 13 figures, 6 tables

INTRODUCTION: Decreasing unnecessary cranial computed tomography (CT) use in pediatric head trauma patients remains important for emergency departments (EDs) across the US. Our study evaluated CT use in children with minor blunt head trauma in 21 community EDs within an integrated health-care system. METHODS: We studied all children younger than 18 years old presenting to 21 community EDs between 2016 through 2018 with acute minor blunt head trauma, defined by an algorithm of ED chief complaints and diagnoses. We excluded patients with traumatic brain injuries diagnosed in the prior year, a CT within 24 hours prior to the ED visit, or an ED Glasgow Coma Scale score of less than 14. RESULTS: Among 39,792 pediatric minor head trauma ED visits, the aggregate CT use proportion across all EDs was 12.9% [95% confidence interval (CI), 12.6–13.3%; facility-level range, 5.4–21.6%]. The 7 facilities that had previously received a clinical decision support system intervention implementing the Pediatric Emergency Care Applied Research Network rules during 2013 through 2014 had an aggregate mean CT ordering rate of 11.2% (95% CI, 10.7–11.7%; facility-level range, 5.4–14.3%) compared to 14.1% (95% CI, 13.6–14.5%; facility-level range, 7.3–21.6%) for the nonintervention facilities. CONCLUSION: CT use for children with minor blunt head trauma in the community EDs of an integrated health-care system was low and stable across facilities from 2016 through 2018. This may be indicative of the safe stewardship of resources in the system, including the absence of financial or medicolegal incentives to scan very low-risk patients as well the availability of resources for close patient follow-up.

Objective. The variability of the design of the arterial circle of the human brain (ACHB) has been studied.Materials and methods. The systematization was carried out and the original classification of the variants of ACHB was compiled. The study was performed on 116 brain preparations of adult people (64 men and 52 women). The causes of death of these people were not associated with diseases or trauma of the brain. Dissection of the vessels ACHB and central arteries was carried out after the injection of contrasting arteries mixture (mascara - gelatin).Results. There are two types of ACHB design, including two subtypes (4 in total). First of all, the variants of the individual-typological variability (VITV) of the circle design were combined depending on the presence or absence of the sign of its closure in the types of construction of the ACHB - closed or open. The type of construction is one of the integral and basic principles of classification. It serves as a criterion for the morphofunctional consistency of the ACHB. The second level of systematization of the VITV structure of ACHB is associated with the allocation in types of two subtypes in each of them. This is based on the presence or absence of symmetry of the ACHB form. This sublevel is a systemic - all variants of AKBM are caused by the presence or absence, or the degree of development (from hypoplasia to hyperplasia) of the arteries forming it. In accordance with the selected types and subtypes of the ACHB, the identified VITV circle was classified.Conclusions. The statistically significant prevalence of closed and asymmetric ACHB among both men and women has been established. The proposed integral classification is based on the basic morphogeometric characteristics of the ACHB. It takes into account the anatomy of both individual arteries and the circle as a whole, without dividing it into the front and back sections and treating the arterial circle as a single entity.

Closed Loop Analysis of Space Systems (CLASS) is a small satellite test system engineered and maintained by the Laboratory for Advanced Space Systems at Illinois (LASSI), which is affiliated with the Department of Aerospace Engineering at the University of Illinois at Urbana-Champaign. CLASS is designed to be modular and user-friendly while providing the capability to perform accurate and reliable closed-loop tests. Commercial and academic CubeSat developers struggle to implement adequate testing procedures because of the relatively short development timeline and the sophisticated and inaccessible nature of space systems test equipment. Hardware-in-the-loop testing offers a convenient “test-as-you-fly, fly-as-you-test” validation and verification option for CubeSats. CLASS features a customizable real-time satellite orbital mechanics and rigid body dynamics simulation programmed to execute on the widely used Raspberry Pi 4 (RPi4). The RPi4 can be successfully interfaced with numerous hardware elements including the satellite’s actual flight computer, sensors, and actuators. In case certain flight hardware components, such as the magnetometers and gyroscopes, are not available for testing, CLASS offers the option of using Arduino boards that are programmed to emulate satellite sensors and actuators. Using CLASS, closed-loop tests on the Attitude Determination and Control System of CAPSat, a LASSI 3U CubeSat, proved to be critical for the validation of a state feedback Earth-pointing controller.

The Glasgow Outcome Scale, Pediatric Revision (GOSE-P) is an assessment of "global outcome" designed as a developmentally appropriate version of the Glasgow Outcome Scale-Extended for use in clinical trials of children with traumatic brain injury (TBI). Initial testing describes validity across a wide age and injury severity spectrum, yet the GOSE-P's utility for monitoring children with milder injuries is less clear. We examined the level of agreement between the GOSE-P and the Health and Behavior Inventory (HBI), a TBI-related symptom checklist used to assess children with mild TBI for clinical and research purposes. Participants included children and adolescents 3-16 years of age (n = 50) who presented to two level 1 trauma centers within 24 h of injury, with a GCS of 13-15, who underwent clinical neuroimaging. Outcome was assessed 2 weeks and 3 months following injury. We examined the severity of TBI-related symptoms across disability categories identified using the GOSE-P, and the level of agreement between the two measures in identifying deficits 2 weeks following injury and improvement from 2 weeks to 3 months. Using the GOSE-P, 62% had deficits at 2 weeks, and 42% improved from 2 weeks to 3 months. Agreement between the GOSE-P and HBI was fair 2 weeks after TBI (k = 0.24-0.33), and poor for identifying subsequent improvement (k = 0.10-0.16). Modest agreement between the GOSE-P and the HBI may reflect restricted participation from diverse causes, including TBI, other bodily injuries, and prescribed activity restrictions, and highlights the need for multi-dimensional outcome batteries.

Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, "What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?" Responses were recorded as ordinal categories (5-10%, >10-50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64-85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1-85.5%) and a specificity of 41.5% (37.7-45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1-3) was poorly sensitive (26.3%, 95% CI 17.7-37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9-99.3%) but poorly specific (12.9%, 95% CI 10.4-15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0-80.0%; specificity 35.3%, 95% CI 31.6-38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.

The study by Ogura et al. investigated the association between the structures of intensive care units (ICUs) affecting patient outcomes. A major limitation of this study is that the types of ICUs had not clearly been defined, and the provided definition had been made subjectively. Making an additional questionnaire or site-visits to completely define the types and to clarify the time-coverage is suggested. It would also be worthwhile to analyze whether the existence and density of “certified intensivists” and their involvement contribute to the outcome to determine whether physician quality affects critically ill patient care.

ResumenIntroducciónLas luxaciones periastragalinas generalmente se producen en jóvenes varones activos, como resultado de un traumatismo de alta energía. Se clasifican en 3 tipos, de acuerdo a la dirección del pie en relación con el astrágalo. El objetivo de este trabajo es presentar un caso de una luxación periastragalina medial cerrada, sin fracturas asociadas.Caso clínicoPaciente de 18 años de edad asistido por el equipo médico de guardia, presenta dolor, tumefacción, deformidad e impotencia funcional del tobillo y pie derechos, muestra pie supinado y en aducción después de accidente deportivo (baloncesto).ResultadosSe obtuvo la reducción bajo manipulación cerrada, y se objetivó correcta estabilidad mediante intensificador de imágenes. Se inmovilizó con bota de yeso almohadillada. El paciente, al tercer mes de seguimiento, vuelve al entrenamiento y regresa a la actividad competitiva al cuarto mes. Al año de seguimiento presenta una puntuación de 98 de la escala AOFAS.ConclusiónEn la resolución de este caso se priorizó la rápida reducción de la luxación y la evaluación de la estabilidad con el intensificador de imágenes. Luego del período de inmovilización se hizo hincapié en la rehabilitación fisiocinética, permitiendo al paciente regresar a la competición al cuarto mes de la lesión.AbstractIntroductionPeritalar dislocations usually occur in young active males as a result of high energy trauma. They are classified into three types according to the direction of the foot relative to the talus. The aim of this paper is to present a case of a medial dislocation peritalar closed without associated fractures.Case reportEighteen year old medical team assisted by guard having pain, swelling, deformity and loss of function of ankle and foot rights, presenting supinado foot and adducted after sports accident (basketball).ResultsClosed reduction under proper handling and stability was obtained was observed by image intensifier. He was immobilized with plaster padded boot. The patient returns to the third month follow-up training and competitive activity returns to the fourth month. Year follow-up presents a score of 98 of the AOFAS scale.ConclusionThe resolution of this case the rapid reduction of dislocation and stability assessment with the image intensifier prioritized. After the period of immobilization he stressed the fisiocinética rehabilitation, allowing the patient to return to competition fourth month of the injury.

Background Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99.0%. A secondary goal of the study was to complete an independent validation and comparison of the Canadian and NEXUS Head CT rules among the subgroup of patients meeting the inclusion and exclusion criteria. Methods and findings We conducted a prospective observational study of the NEXUS Head CT DI in 4 hospital emergency departments between April 2006 and December 2015. Implementation of the rule requires that patients satisfy 8 criteria to achieve “low-risk” classification. Patients are excluded from “low-risk” classification and assigned “high-risk” status if they fail to meet 1 or more criteria. We examined the instrument’s performance in assigning “high-risk” status to patients requiring neurosurgical intervention among a cohort of 11,770 blunt head injury patients. The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurosurgical intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1%–100.0%]). The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurosurgical intervention (specificity, 24.9% [95% CI: 24.1%–25.7%]). None of the 2,823 low-risk patients required neurosurgical intervention (negative predictive value [NPV], 100.0% [95% CI: 99.9%–100.0%]). The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0%–99.6%]). The instrument assigned low-risk status to 2,815 of 11,003 patients who did not have significant injuries (specificity, 25.6% [95% CI: 24.8%–26.4%]). Significant injuries were absent in 2,815 of the 2,823 patients assigned low-risk status (NPV, 99.7% [95% CI: 99.4%–99.9%]). Of our patients, 7,759 (65.9%) met the inclusion and exclusion criteria of the Canadian Head CT rule, including 111 patients (1.43%) who required neurosurgical intervention and 306 (3.94%) who had significant intracranial injuries. In our study, the Canadian criteria for neurosurgical intervention identified 108 of 111 patients requiring neurosurgical intervention to yield a sensitivity of 97.3% (95% CI: 92.3%–99.4%) and exhibited a specificity of 58.8% (95% CI: 57.7%–59.9%). The NEXUS rule, when applied to this same cohort, identified all 111 patients requiring neurosurgical intervention, yielding a sensitivity of 100% (95% CI: 96.7%–100.0%) with a specificity of 32.6% (95% CI: 31.5%–33.6%). Our study found that the Canadian medium-risk factors identified 301 of 306 patients with significant injuries (sensitivity = 98.4%; 95% CI: 96.2%–99.5%), while the NEXUS rule identified 299 of these patients (sensitivity = 97.7%; 95% CI: 95.3%–99.1%). In our study, the Canadian medium-risk rule exhibited a specificity of 12.3% (95% CI: 11.6%–13.1%), while the NEXUS rule exhibited a specificity of 33.3% (95% CI: 32.3%–34.4%). Limitations of the study may arise from application of the rule by different clinicians in different environments. Clinicians may vary in their interpretation and application of the instrument’s criteria and risk assignment and may also vary in deciding which patients require intervention. The instrument’s specificity is also subject to spectrum bias and may change with variations in the proportion of “low-risk” patients seen in other centers. Conclusions The NEXUS Head CT DI reliably identifies blunt trauma patients who require head CT imaging and could significantly reduce the use of CT imaging., In an observational study of over 11,000 blunt trauma head injury patients, William Mower and colleagues validate a decision instrument to identify patients who require computed tomographic imaging., Author summary Why was this study done? Physicians, afraid of missing brain injuries, liberally obtain computed tomographic (CT) scanning for head injury patients. CT scans reliably detect injuries, but they are expensive and carry a small risk of radiation-induced lethal cancer. We previously developed a decision rule that appears to reliably identify patients with brain injuries, decreasing the need for CT scanning. The decision rule assigns head injury patients to low-risk status, and it is therefore safe to omit imaging if they exhibit all the following 8 criteria: no evidence of skull fracture, no scalp hematoma, no neurological abnormalities, normal alertness, normal behavior, no persistent vomiting, normal blood clotting, and age less than 65 years. Patients who are not identified as low risk are automatically assigned high-risk status. Before our decision guide can be considered reliable, it needs to be validated in a new large group of patients to ensure that it retains high reliability and still decreases the overall rate of CT scanning. What did the researchers do and find? We requested that emergency physicians from 4 emergency departments in the United States record the presence or absence of the 8 specific criteria, and thereby assess risk status, on every blunt head injury patient they selected for CT scanning. 11,770 patients were included in the study, and CT scanning identified brain injuries in 767 patients, including 420 patients who required neurosurgical treatment for their injuries. The decision rule assigned high-risk status in all 420 of the patients who required special treatment for their injuries (sensitivity = 100.0%) and in 759 of the patients who had injuries evident on their CT scans (sensitivity = 99.0%). Low-risk status was assigned to 2,815 patients who had neither brain injury on CT nor required neurosurgical care. What do these findings mean? Our decision guide reliably identified patients who required neurosurgical treatment of their injuries, as well as those who had brain injuries evident on CT scan. The decision guide correctly identified nearly one-quarter of all patients as being at low risk for injury and safe to exclude from scanning. Clinical use of our decision guide will allow physicians to reliably identify patients with serious brain injuries, while simultaneously decreasing the number of patients who require CT scanning.

Background and purposeThe effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period.Materials and methodsSeventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis.ResultsThe mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory.ConclusionsOur findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.

OBJECTIVES: To determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. METHODS: We included all AHT cases in the Netherlands in the period 2005-2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. RESULTS: We identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. CONCLUSIONS: Neuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims. Language: en

Background The mechanical properties of 1–2-year-old pediatric cranial bones and sutures and their influential factors were studied to better understand how the pediatric calvarium reacts to loading. Material/Methods Cranial bone and suture specimens were extracted from seven fresh-frozen human infant cadavers (1.5±0.5 years old). Eight specimens were obtained from each subject: two frontal bones, two parietal bones, two sagittal suture samples, and two coronal suture samples. The specimens were tested in a three-point bend setup at 1.5 mm/s. The mechanical properties, such as ultimate stress, elastic modulus, and ultimate strain, were calculated for each specimen. Results The ultimate stress and elastic modulus of the frontal bone were higher than those of the parietal bone (P0.05). The ultimate stress and elastic modulus of the frontal and parietal bones were higher than those of the sagittal and coronal sutures (P

Purpose To examine the effects of subconcussive impacts resulting from a single season of youth (age range, 8-13 years) football on changes in specific white matter (WM) tracts as detected with diffusion-tensor imaging in the absence of clinically diagnosed concussions. Materials and Methods Head impact data were recorded by using the Head Impact Telemetry system and quantified as the combined-probability risk-weighted cumulative exposure (RWECP). Twenty-five male participants were evaluated for seasonal fractional anisotropy (FA) changes in specific WM tracts: the inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus, and superior longitudinal fasciculus (SLF). Fiber tracts were segmented into a central core and two fiber terminals. The relationship between seasonal FA change in the whole fiber, central core, and the fiber terminals with RWECP was also investigated. Linear regression analysis was conducted to determine the association between RWECP and change in fiber tract FA during the season. Results There were statistically significant linear relationships between RWEcp and decreased FA in the whole (R2 = 0.433; P = .003), core (R2 = 0.3649; P = .007), and terminals (R2 = 0.5666; P < .001) of left IFOF. A trend toward statistical significance (P = .08) in right SLF was observed. A statistically significant correlation between decrease in FA of the right SLF terminal and RWECP was also observed (R2 = 0.2893; P = .028). Conclusion This study found a statistically significant relationship between head impact exposure and change of FA fractional anisotropy value of whole, core, and terminals of left IFOF and right SLF's terminals where WM and gray matter intersect, in the absence of a clinically diagnosed concussion. © RSNA, 2016.

Introduction: To date, many prognostic models have been proposed to predict the outcome of patients withtraumatic brain injuries. External validation of these models in different populations is of great importancefor their generalization. The present study was designed, aiming to determine the value of CRASH prognosticmodel in prediction of 14-day mortality (14-DM) and 6-month unfavorable outcome (6-MUO) of patients withtraumatic brain injury. Methods: In the present prospective diagnostic test study, calibration and discriminationof CRASH model were evaluated in head trauma patients referred to the emergency department. Variablesrequired for calculating CRASH expected risks (ER), and observed 14-DM and 6-MUO were gathered. Then ERof 14-DM and 6-MUO were calculated. The patients were followed for 6 months and their 14-DM and 6-MUOwere recorded. Finally, the correlation of CRASH ER and the observed outcome of the patients was evaluated.The data were analyzed using STATA version 11.0. Results: In this study, 323 patients with the mean age of 34.0´s 19.4 years were evaluated (87.3% male). Calibration of the basic and CT models in prediction of 14-day and6-month outcome were in the desirable range (P Ç 0.05). Area under the curve in the basic model for predictionof 14-DM and 6-MUO were 0.92 (95% CI: 0.89–0.96) and 0.92 (95% CI: 0.90–0.95), respectively. In addition,area under the curve in the CT model for prediction of 14-DM and 6-MUO were 0.93 (95% CI: 0.91–0.97) and0.93 (95% CI: 0.91–0.96), respectively. There was no significant difference between the discriminations of thetwo models in prediction of 14-DM (p Æ 0.11) and 6-MUO (p Æ 0.1). Conclusion: The results of the presentstudy showed that CRASH prediction model has proper discrimination and calibration in predicting 14-DMand6-MUO of head trauma patients. Since there was no difference between the values of the basic and CT models,using the basic model is recommended to simplify the risk calculations.

INTRODUCTION Galeazzi fracture associated with ipsilateral posterior elbow dislocation and radial head fracture is a rare pattern of injury. Few reports exist that describes this injury pattern and its treatment. We describe a case report of simultaneous occurrence of Galeazzi fracture and ipsilateral dislocation of elbow. PRESENTATION OF CASE A 58 year-old female presented with Galeazzi fracture and posterior elbow dislocation associated with radial head fracture of left upper extremity. This was managed with closed reduction of the elbow, open reduction and internal fixation of the radial shaft fracture and K-wire stabilisation of the unstable distal radioulnar joint. Prophylactic fasciotomy was performed. At 10 months follow-up, the outcome was favourable with the American shoulder and elbow surgeon score of 92 and the disabilities of the arm, shoulder and hand score of 18. DISCUSSION The presumed mechanism of the injury was a forceful axial loading of a hyperpronated forearm and extended elbow. Our literature review shows that this pattern of injury occurs as a result of high energy trauma in young individuals, and successful outcome can be achieved by addressing each component of this complex injury individually. CONCLUSION Simultaneous occurrence of elbow dislocation and Galeazzi fracture seems to be the result of extreme axial force and unique position of upper extremity at the time of impact. Individualised approach to each component of this injury can result in favourable outcome.

Importance Increased use of computed tomography (CT) in children is concerning owing to the cancer risk from ionizing radiation, particularly in children younger than 2 years. A guardian report that a child is acting abnormally is a risk factor for clinically important traumatic brain injury (ciTBI) and may be a driving factor for CT use in the emergency department. Objective To determine the prevalence of ciTBIs and TBIs in children younger than 2 years with minor blunt head trauma and a guardian report of acting abnormally with (1) no other findings or (2) other concerning findings for TBI. Design, Setting, and Participants Secondary analysis of a large, prospective, multicenter cohort study that included 43 399 children younger than 18 years with minor blunt head trauma evaluated in 25 emergency departments. The study was conducted on data obtained between June 2004 and September 2006. Data analysis was performed between August 21, 2014, and March 9, 2015. Exposures A guardian report that the child was acting abnormally after minor blunt head trauma. Main Outcomes and Measures The prevalence of ciTBI (defined as death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights in association with TBI on CT imaging) and TBI on CT imaging in children with a guardian report of acting abnormally with (1) no other findings and (2) other concerning findings for TBI. Results Of 43 399 children in the cohort study, a total of 1297 children had reports of acting abnormally, of whom 411 (31.7%) had this report as their only finding. Reported as percentage (95% CI), 1 of 411 (0.2% [0-1.3%]) had a ciTBI, and 4 TBIs were noted on the CT scans in 185 children who underwent imaging (2.2% [0.6%-5.4%]). In children with reports of acting abnormally and other concerning findings for TBI, 29 of 886 (3.3% [2.2%-4.7%]) had ciTBIs and 66 of 674 (9.8% [7.7%-12.3%]) had TBIs on CT. Conclusions and Relevance Clinically important TBIs are very uncommon, and TBIs noted on CT are uncommon in children younger than 2 years with minor blunt head trauma and guardian reports of the child acting abnormally with no other clinical findings suspicious for TBI. Computed tomographic scans are generally not indicated in these children although observation in the emergency department may be warranted.

No abstract available. Article truncated after 150 words. Gilbert Hospital and Florence Hospital at Anthem, two medical centers owned by parent company New Vision Health LLC, will close according to the Arizona Republic (1). Gilbert Hospital's emergency room will stay open until 1 p.m. Saturday and the Florence ER will close 8 a.m. Monday. Anyone receiving care was to be transferred or discharged, according to company spokesman Alex Stevenson. The two hospitals and the parent company have been plagued with financial troubles. Creditors filed for involuntary Chapter 11 bankruptcy protection this spring, the second time they had faced bankruptcy in four years. A Maricopa County Superior Court judge on June 7 appointed a receiver, who concluded that the financial problems "were simply too significant to overcome." Bankruptcy court documents show the two medical centers owe creditors at least $13.1 million in unpaid loans. Both hospitals were operating under terminated leases because they could not pay rent, according to …

Primary objective: The purpose of this study was to assess the relationship between sex and traumatic brain injury (TBI) mortality.Methods and procedures: A total of 20 465 persons with TBI were identified from a Colorado population-based surveillance system for 1994–1998. Case fatality ratios were calculated to identify sex differences for selected risk factors. Unconditional logistic regression was used to determine the relationship between TBI mortality and sex controlling for risk factors.Main outcomes and results: Adjusting for age, race, metropolitan residence and penetrating injury, the estimated odds of TBI mortality for males compared to females was 1.21 (95% CI 1.10, 1.34) for pre-hospital fatalities and 1.19 (95% CI 1.05, 1.37) for hospital fatalities.Conclusion: Results indicate differences in TBI mortality comparing males and females. Future studies are warranted to identify if behaviour and physiological responses are associated with TBI outcomes among males and females.

In this paper we give a number of arguments why, in approach theory, the notion of compactness which from the intrinsic categorical point of view seems most satisfying is 0-compactness, i.e., measure of compactness equal to zero. It was already known from [R. Lowen, Kuratowski’s measure of noncompactness revisited, Quart. J. Math. Oxford 39 (1988) 235–254] that measure of compactness has good properties and good interpretations for both topological and metric approach spaces. Here, introducing notions of closed and proper mappings in approach theory, which satisfy all the intrinsic categorical axioms put forth in [Clementino et al., A functional approach to topology, in: M.C. Pedicchio, W. Tholen (Eds.) Categorical Foundations Special Topics in Order, Topology, Algebra, and Sheaf Theory, Cambridge University Press, 2003], we prove fundamental results concerning these concepts, also linked to 0-compactness, and we give a Kuratowski–Mrowka-type characterization of 0-compactness.  2005 Elsevier B.V. All rights reserved. MSC: 18B99; 54A05; 54B30; 54C10; 54D30

Background. Aneurysmal bone cyst (ABC) is a benign, expansive, osteolytic lesion that mainly occurs in young people, and involves the skull bones only exceptionally. The origin of ABC is controversial: secondary reactive bone lesion, or primary disease that represents an independent nosological entity. Blunt head trauma was suggested as a possible etiological factor. Case report. A case of a 19-year old man with primary ABC of the right frontal bone was reported. The lesion was totally excised through frontal craniotomy, and the skull bone defect primarily reconstructed with an acrilate cranioplasty. Five years after the surgery, the patient was without signs of local recurrence. Conclusion. Clinical and neuroradiological presentation of the skull ABC was not specific. Pathohistology confirmed the diagnosis. Total excision was the treatment of choice.

Aim. To determine the degree of psychological and endocrinological changes in war veterans with the diagnosis of Chronic Posttraumatic Stress Disorder (PTSD) regarding presence/absence of comorbid mild closed head injury (mCHI) caused by explosive devices. Methods. Two groups of PTSD inpatients, with (n = 37), and without (n = 86) sustained blast trauma followed by mCHI were formed during the psychiatric treatment. Participants were interviewed by experienced clinicians who used the PTSD Interview (PTSD-I). In addition, patients completed the Symptom Checklist-90-Revised (SCL-90-R). Serum levels of ten hormones were assessed: triiodothyronine, thyroxine, thyrotropin-stimulating hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and insulin, by radioimmunoassays and hydrocortisone, growth hormone and testosterone by fluoroimmunoassays. Results. Veterans with comorbid mCHI and PTSD showed significantly higher level of amnesia for traumatic event as well as of somatization on the SCL-90-R. Significant differences of hormone levels were not found. Conclusion. The results didn't support the hypothesis on specific PTSD subgroup characterized by history of mCHI and consecutive postconcussion syndrome. The absence of differences in levels of hormones indicated the dominant role of psychogenic trauma in the etiology of hormone disbalance in chronic PTSD. Amnesia for traumatic event in war veterans with comorbid PTSD and mCHI was easily explained by neurogenic peritraumatic amnesia due to the blast trauma, but it did not affect either quality of intensity or posttraumatic symptoms as well as endocrinological parameters.

Introduction. Constructional apraxia is a disorder characterized by an inability to join the elements into a unity. It has not been studied much in patients with closed head injury (CHI). Methods. Forty-one patients with CHI were examined, of which 11 (26.83%) were with the right-sided, 12 (29.27%) with the left-sided, and 18 (43.90%) with bilateral lesion using the Wechsler Individual Intelligence Test (VITI) - Serbian version, Rey Complex Figure (RCF) test, Trail Making Test - TMT A and B, and the Wisconsin Card Sorting Test (WCST). Results. Intelligence quotient (IQ) was significantly higher in the patients with the right-sided (95.27) and bilateral cerebral lesions (87.56) than in the left-sided (84.42). RCF scores did not show any significant difference regarding the side of the lesion, but was numerically the lowest scores were in patients with bilateral brain damage. Patients with left-sided lesions had the score of 30.63, right-sided of 28.68, and bilateral of 27.39. TMT B showed a significantly lower result in patients with the left-sided (196.50 seconds) and bilateral lesions (192.07 seconds) compared to the right-sided (140.14 seconds). WCST scores were not significantly different regarding the side of the lesion, but the absolute value of the categories was less than expected. Conclusion. Constructional apraxia was more frequently present in the patients with CHI than it was previously considered. The use of sensitive tests can show the presence of the disorder mainly in bilateral, but also in unilateral lesions.

This study investigated the hypothesis that brain damaged patients with memory disorder are poorer at remembering the semantic than the perceptual attributes of information. Eight patients with memory impairment of different etiology and 24 patients with chronic consequences of severe closed-head injury were compared to similarly sized age- and literacy-matched normal control groups on recognition tests for the physical aspect and the semantic identity of words and pictures lists. In order to avoid interpretative problems deriving from different absolute levels of performance, study conditions were manipulated across subjects to obtain comparable accuracy on the perceptual recognition tests in the memory disordered and control groups. The results of the Picture Recognition test were consistent with the hypothesis. Indeed, having more time for the stimulus encoding, the two memory disordered groups performed at the same level as the normal subjects on the perceptual test but significantly lower on the semantic test. Instead, on the Word Recognition test, following study condition manipulation, patients and controls performed similarly on both the perceptual and the semantic tests. These data only partially support the hypothesis of the study; rather they suggest that in memory disordered patients there is a reduction of the advantage, exhibited by normal controls, of retrieving pictures over words (picture superiority effect).

Introducción: Las fracturas mediodiafisarias de clavícula representan hasta el 10% del todas las fracturas del esqueleto. El tratamiento conservador en trazos con leve deformidad y desplazamiento brinda en general buenos resultados con baja incidencia de complicaciones. Sin embargo, ante trazos desplazados, multifragmentarios o con deformidad significativa el tratamiento quirúrgico debe considerarse. Se presenta una serie de casos retrospectiva con el propósito de exponer nuestra experiencia en el tratamiento de fracturas cerradas, desplazadas y mediodiafisarias de clavícula con placas pre-contorneadas con técnica MIPO, descripción de la técnica y resultados funcionales preliminares.Materiales y métodos: Se presenta una serie retrospectiva de 13 pacientes (11 varones [84,6%] y 2 mujeres [15,4%]), media de edad de 31 años, con fracturas diafisarias cerradas desplazadas de clavícula clasificadas tipo 2 B según Robinson (Edinburgo) tratadas mediante reducción y osteosíntesis con placas de osteosíntesis pre-contorneadas con técnica mini invasiva (MIPO) entre abril del 2010 y noviembre de 2013. Seguimiento promedio de 13 meses (rango 11 a 25).Se realizaron controles radiográficos y TAC, valorando la funcionalidad mediante las escalas de Constant – Murley modificada, Quick DASH y dolor por escala visual analógica (VAS).Resultados: En promedio, el tiempo transcurrido hasta la cirugía fue 8 días, el tiempo quirúrgico 35 minutos y 1.28 días postoperatorios de internación, registrándose consolidación clínico-imagenológica en todos los caso en 15.2 semanas de media. La puntuación promedio en escala de Constant – Murley modificada fue 96 puntos, Quick DASH 29.5 y VAS de 0.3. No se registraron complicaciones sistémicas ni cosméticas.Discusión: En la presente serie, la osteosíntesis mini invasiva (MIPO) en fracturas cerradas mediodiafisarias desplazadas de clavícula, representó una técnica reproducible con tiempo quirúrgico reducido y scores funcionales aceptables, sin complicaciones de relevancia.

Letters The HVRN assembles home visiting stakeholders to set a na- tional research agenda, advance that agenda through innova- tion research methods, and translate research findings into policy and practice. 3 The HVRN identified the top 10 priorities for home visiting research with input from nearly 1800 individuals. 4 Now, the HVRN is building the Home Visiting Ap- plied Research Collaborative, a national practice-based re- search network of local home visiting programs to conduct field- initiated studies to address the research agenda’s priorities. We need to learn what works best for which families and under what circumstances and to translate this efficiently to policy and practice. The MIECHV Program’s state-level evalu- ative research, the Mother and Infant Home Visiting Program Evaluation, and the HVRN will substantially “clarify the evi- dence base” 1 related to home visiting investments to maxi- mize outcomes for children, families, and communities. Stake- holders are key participants in these efforts; they are eager to use results to ensure success in the adoption, adaptation, implementation, and sustainability of home visiting as part of the early childhood system of care and as part of efforts to pro- mote the foundations of health by enhancing the capacity of caregivers and communities. 5 Cynthia S. Minkovitz, MD, MPP Kay M. Gonsalves O’Neill, MSPH Anne K. Duggan, ScD Author Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Corresponding Author: Cynthia S. Minkovitz, MD, MPP, Departments of Population, Family and Reproductive Health, and Pediatrics, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4636, Baltimore, MD 21205 (cminkovi@jhsph.edu). Conflict of Interest Disclosures: None reported. Funding/Support: Each of the authors is funded in part through home visiting research supported by grants or subcontracts as part of the Patient Protection and Affordable Care Act. Role of the Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. 1. Shonkoff JP. Changing the narrative for early childhood investment. JAMA Pediatr. 2014;168(2):105-106. 2. Michalpoulos C, Duggan A, Knox V, et al. ACF-OPRE Reports 2011-16: Design Options for the Home Visiting Evaluation: Draft Final Report. Washington, DC: US Dept of Health & Human Services; 2011. 3. Duggan A, Minkovitz CS, Chaffin M, et al. Creating a national home visiting research network. Pediatrics. 2013;132(suppl 2):S82-S89. 4. Home Visiting Research Network. Home visiting research agenda. http://www.hvrn.org/research-agenda.html. Accessed December 30, 2013. 5. Mistry KB, Minkovitz CS, Riley AW, et al. A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health. 2012;102(9):1688-1696. Incorrect Classification in Articles About Traumatic Brain Injuries in Children With Minor Blunt Head Trauma To the Editor We are writing to make readers aware of an ana- lytic error that affected the data reported in 2 of our articles. 1,2 During recent preparation of another manuscript based on the same data, we discovered an error in construction of the final jamapediatrics.com analytic database for the entire cohort (an erroneous SQL [Structured Query Language] join statement) that led to the incorrect classification of the mechanism of injury as moder- ate, rather than severe, for 394 children in our cohort of 42 412 patients. Most of the erroneous classifications were among chil- dren aged 2 years or older. The first article affected by this erroneous classification was titled “Prevalence of Clinically Important Traumatic Brain In- juries in Children With Minor Blunt Head Trauma and Isolated Severe Injury Mechanisms.” 1 We have carefully examined the effects of this error on the entire published analysis. As previ- ously noted, the number of children with severe injury mecha- nism increased by 394, and the number of children with iso- lated severe injury mechanism increased from 3302 to 3630 as a result. These increased numbers led to numerous modifica- tions to data points in the article. However, the most impor- tant data points in the report are only slightly affected. The over- all incidence of severe injury mechanism increases by only a single percentage point in this population (from 14% to 15%) and the rates of clinically important traumatic brain injuries asso- ciated with isolated severe injury mechanism remain low, de- creasing by one-tenth of 1% among older children (from 0.6% to 0.5% for isolated severe mechanism and no other Pediatric Emergency Care Applied Research Network predictors and from 0.3% to 0.2% for isolated severe mechanism and no other pre- dictors in the expanded definition), with no change among younger children from the published report. The second article affected by the erroneous classifica- tion was titled “Cranial Computed Tomography Use Among Children With Minor Blunt Head Trauma: Association With Race/Ethnicity.” 2 Again, an erroneous SQL join statement led to the incorrect classification of the mechanism of injury as moderate, rather than severe, for 394 children in our cohort of 42 412 patients. This led to minor effects on the reported tabular data (Tables 1, 2, and 3), as well as minor differences in reported odds ratios/confidence intervals for association of black non-Hispanic or Hispanic race/ethnicity with cranial com- puted tomography in the emergency department (these data are reported in the abstract and the Results section of the text). We regret these errors but also believe unequivocally that the key findings and conclusions of the published papers firmly stand. The articles have been corrected and correction no- tices published. Nathan Kuppermann, MD, MPH JoAnne E. Natale, MD, PhD Lise E. Nigrovic, MD, MPH Author Affiliations: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento (Kuppermann); Department of Pediatrics, University of California, Davis School of Medicine, Sacramento (Kuppermann, Natale); Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts (Nigrovic). Corresponding Author: Nathan Kuppermann, MD, MPH, Departments of Emergency Medicine and Pediatrics, University of California, Davis Medical Center, 2315 Stockton Blvd, PSSB Bldg, Suite 2100, PSSB 2100, Sacramento, CA 95817 (nkuppermann@ucdavis.edu). Published Online: May 19, 2014. doi:10.1001/jamapediatrics.2014.651. Conflict of Interest Disclosures: None reported. JAMA Pediatrics June 2014 Volume 168, Number 6 Copyright 2014 American Medical Association. All rights reserved.

The body of the ascidian tunicateCorella inflatais relatively transparent. Thus, the circulatory system can be visualized by injecting high molecular weight fluorescein labeled dextran into the heart or the large vessels at the ends of the heart without surgery to remove the body wall. In addition, after staining with neutral red, the movement of blood cells can be easily followed to further characterize the circulatory system. The heart is two gently curved concentric tubes extending across the width of the animal. The inner myocardial tube has a partial constriction approximately in the middle. As in other tunicates, the heart is peristaltic and periodically reverses direction. During the branchial phase blood leaves the anterior end of the heart by two asymmetric vessels that connect to the two sides of the branchial basket. Blood then flows in both transverse directions through a complex system of ducts in the basket into large ventral and dorsal vessels which carry blood back to the visceral organs in the posterior of the animal. During the visceral phase blood leaves the posterior end of the heart in two vessels that repeatedly bifurcate and fan into the stomach and gonads. Blood velocity, determined by following individual cells in video frames, is high and pulsatory near the heart. A double peak in velocity at the maximum may be due to the constriction in the middle of the heart tube. Blood velocity progressively decreases with distance from the heart. In peripheral regions with vessels of small diameter blood cells frequently collide with vessel walls and cell motion is erratic. The estimated volume of blood flow during each directional phase is greater than the total volume of the animal. Circulating blood cells are confined to vessels or ducts in the visible parts of the animal and retention of high molecular weight dextran in the vessels is comparable to that seen in vertebrates. These are characteristics of a closed circulatory system.

The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years) with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes® LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH), the simple shoulder test (SST) and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0–35.5) and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9–12). All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12–17 weeks). Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands.

IntroductionInadequate sample size and power in randomized trials can result in misleading findings. This study demonstrates the effect of sample size in a large clinical trial by evaluating the results of the Study to Prospectively evaluate Reamed Intramedullary Nails in Patients with Tibial fractures (SPRINT) trial as it progressed.MethodsThe SPRINT trial evaluated reamed versus unreamed nailing of the tibia in 1226 patients, and in open and closed fracture subgroups (N = 400 and N = 826, respectively). We analyzed the reoperation rates and relative risk comparing treatment groups at 50, 100, and then increments of 100 patients up to the final sample size. Results at various enrollments were compared with the final SPRINT findings.ResultsIn the final analysis, there was a statistically significant decreased risk of reoperation with reamed nails for closed fractures (relative risk reduction 35%). Results for the first 35 patients enrolled suggested that reamed nails increased the risk of reoperation in closed fractures by 165%. Only after 543 patients with closed fractures were enrolled did the results reflect the final advantage for reamed nails in this subgroup. Similarly, the trend toward an increased risk of reoperation for open fractures (23%) was not seen until 62 patients with open fractures were enrolled.ConclusionsOur findings highlight the risk of conducting a trial with insufficient sample size and power. Such studies are not only at risk of missing true effects but also of giving misleading results.

Derives a new rank condition which guarantees the arbitrary pole assignability of a given system by dynamic compensators of degree at most q. By using this rank condition the authors establish several new sufficiency conditions which ensure the arbitrary pole assignability of a generic system. The authors' proofs also come with a concrete numerical procedure to construct a particular compensator which assigns a given set of closed-loop poles.

The main goal of this work is to present a new class of feedback controller which contains on its structure a polynomial form of the named control error, the proposed controller is applied to a class of sulfate-reducing chemostat in order to control the sulfate concentration, which would be useful for several biotechnological issues, as heavy metal removal in wastewater. The closed-loop behavior of the chemostat is theoretically analyzed and a practical convergence to the selected optimum trajectory is proved. The proposed methodology is applied to an experimentally corroborated kinetic model of a sulfate-reducing bacterium and further numerical experiments show the satisfactory closed-loop performance of the process in comparison with other controllers.

This study focuses on the copyright and related laws of Australia, the Netherlands, the United Kingdom and the United States and the impact of those laws on digital preservation of copyrighted works. It also addresses proposals for legislative reform and efforts to develop non-legislative solutions to the challenges that copyright law presents for digital preservation.

Thirteen intubated, high dependency patients with neurological injuries were studied in order to investigate the short term respiratory effects of neurophysiological facilitation and passive movement on tidal volume (VT), minute ventilation (VE), respiratory rate (VR) and oxygen saturation (SpO2). The subjects were studied under four conditions: no intervention (control) and during periods of neurophysiological facilitation, passive movement and sensory stimulation. All periods were standardised to three minutes duration and all parameters were recorded before and after each intervention. Neurophysiological facilitation produced significant increases (p < 0.01) in VE and SpO2 (p < 0.05) when compared with control values, with an overall mean increase in VE of 14.6%. Similarly, passive movement increased VE (p < 0.01) by an average of 9.8% and also increased SpO2 (p < 0.01). In contrast, sensory stimulation produced significant increases (p < 0.01) in SpO2 with control levels, with no significant change in VT or VE. There was no significant difference in VR with all treatments. This study provides preliminary evidence of improved short term ventilatory function following neurophysiological facilitation, independent of generalised sensory stimulation, which has not been previously examined in the literature, supporting its use in the management of high dependency neurological patients.

This study investigated the basic mechanisms of the impairment of memory for actions to be performed in a group of 16 chronic survivors of severe closed-head injury (CHI). The experimental paradigm allowed discrimination between the deficit in spontaneously remembering the intention at the appropriate moment (prospective component of the task) and the deficit in remembering the specific actions to perform (retrospective component). The experimental procedure also contrasted a condition in which the time expiration was marked by the ringing of a timer (event-based condition) and one in which the time expiration was not marked by any event and the patient had to monitor the passing of time and completely self-activate the recall of the intention (time-based condition). Two other experimental manipulations were concerned with the duration of the delay interval from the examiner's instructions to the time expiration (10 vs. 45 min) and the fact that the three actions to be performed could be functionally related or not. With respect to a group of 16 normal controls, the patients with CHI were impaired in both the prospective and retrospective components of the memory for actions. Although an impairment of episodic memory is a plausible explanation for the poor retrieval of specific actions to perform, it is unlikely that this deficit played a major role in the CHI patients' reduced accuracy in spontaneously recalling the intention when the event occurred or the time expired. Instead, reduced frequency and less strategic utilization of time monitoring and/or self-reminding likely played a significant role in this sense. (JINS, 2004, 10, 679–688.)

We reviewed 42 patients (mean age 37.7+/-14.2 years) with closed fracture dislocations of Lisfranc's joint treated with percutaneous screw fixation. Mean follow-up was 58.4+/-17.3 months. The aim was to compare dislocations in which a perfect anatomical reduction had been reached with dislocations in which reduction was only near anatomical. The mean American Orthopaedic Foot and Ankle Society score for all patients was 81.0+/-13.5. There were no significant differences in outcome scores between patients with perfect anatomical reduction and patients with near anatomical reduction. However, patients with combined fracture dislocations obtained statistically better scores than patients with pure dislocations.

Årsliste 2001 NIVA har undersøkt sigevannavrenningen fra Møretrømoen fyllplass i Grimstad kommune i Aust-Agder i henhold til en forenklet prosedyre for klassifisering av forurensede områder. Arbeidet er basert på intervjuer med naboer og tidligere driftspersonell til fyllingen, samt dagens ansatte i Grimstad kommune. Videre er det foretatt befaring og prøveuttak på stedet. Prøvene er analysert mhp. fysisk-kjemiske forhold, og utvalgte organiske miljøgifter, hydrokarboner og metaller. Innholdet i fyllingen domineres av blandet kommunalt avfall, men det hevdes at industriavfall også skal ha blitt deponert. Fyllingen er lokalisert på en grus/sandavsetning, og har ikke noe system for å hindre sigevannspredning. Fyllingen er kilde til noe spredning av forurensning, men omfanget ser ikke ut til å representere noe betydelig miljøproblem. Det er ingen tydelige økologiske effekter av denne spredningen, men det er indikasjoner på fremmedstoffer i bekken/drikkevannskilden nedstrøms fyllingen. Så lenge lokal bekk og evt også grunnvann blir benyttet som drikkevannskilde vil vi anbefale at det gjøres videre undersøkelser av fyllingens tilstand, muligvis etterfulgt av forurensningsbegrensende tiltak. Alternativt bør drikkevannsuttaket stenges. Fylkesmannen i Aust-Agder, Miljøvernavdelingen

This study was aimed at investigating long-term forgetting in chronic survivors of severe closed-head injury (CHI). For this purpose, performance decay passing from a 30-sec- to a 60-min-delay test in four memory procedures (Free Recall of unrelated stimuli, Free Recall of related stimuli. Cued Recall and y/n Recognition) of 20 CHI and 20 normal controls was analyzed. Comparable 30-sec-delay performance in CHI and control patients were obtained by manipulating exposure times to study material during the learning phase. Results demonstrated accelerated forgetting in CHI patients in the Free Recall of the related list only. This finding was particularly evident in CHI patients suffering from a focal temporal lobe lesion. These data are discussed in light of retrieval and encoding deficits characterizing memory disorders in CHI patients.

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158 Church, St, Ailsa Craig. Today Marg & Leory Walker Research Rome. The steeple was damaged ono 12 September 2021 during a storm. https://ir.lib.uwo.ca/anglican_interiors/1016/thumbnail.jpg

This thesis presents an evaluation of instructional television as used in four courses at Utah State University. The study is divided into four parts: first, student attitudes and reactions; second, faculty attitudes and reactions; third, the costs involved for the individual faculty members concerned, the academic department, the Radio-Television department, and the University as a whole; and fourth, recommendations concerning the future use of instructional television at Utah State University. The four courses involved in this study were basic introductory courses in Political Science, English, Sociology, and Music. The investigator found that student attitudes and reactions varied with each course. The students in Political Science and English were generally uncertain in their attitude toward the use of television, with approximately equal numbers for and against. The students in Sociology and Music were very much in favor of the use of television. The attitudes of the faculty members associated with this project ranged from very negative to very positive. The study indicated that those instructors who were highly motivated and enthusiastic before actually becoming involved with instructional television tended to remain so throughout. Those instructors who were skeptical and hesitant beforehand also retained their attitudes. The third part of this study dealing with costs was divided into six areas for the Political Science and English courses: production costs, recording costs, instructional costs, utilization costs, cost for additional use, and cost per student credit unit for one academic year. In the cases of Sociology and Music only the production, recording and instructional costs were computed. As a result of this study, this researcher recommends the delegation of more authority to the television personnel in order that they may have a voice in the utilization process of the television courses produced. A second recommendation is that of initiating a two-phase in-service training program to assist the classroom teacher in adjusting to his new role, and to train the television teacher in methods of using instructional television. Finally, the need to have available adequate facilities for the utilization processes has become apparent during the course of this study. Television cannot prove to be a satisfactory medium of instruction if it must be satisfied with poor lighting conditions, excessive noise levels, and an undesirable choice of hours during which to offer classes.

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