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Purpose: The purpose of this study was to conduct a systematic review evaluating the reported complications and outcomes of bone-anchored prostheses in digit and partial hand amputees., Methods: A literature review of primary research articles on osseointegration and bone-anchored prostheses for digit and partial amputees was performed. The Medline, Embase, Scopus, and Cochrane Library databases were queried. Inclusion criteria were journal articles that evaluated osseointegration and bone-anchored prostheses in digit and partial hand amputees. The main outcome measures were reported complications and the need for revision surgery. Secondary outcomes included all reported outcome assessments., Results: Fifteen articles were included with publication dates ranging from 1996 to 2022. The sample sizes ranged from single-patient case reports to a 13-patient retrospective study. Overall, 33 men and 16 women were reported with a mean age of 33.6 years (range: 12-68) and a total of 71 amputated digits. The median follow-up was 2.1 years (IQR: 1.1-6.8 years). A total of 24 complications were reported in 14 digits (19.7%). Complications included superficial infection in 6 digits (8.5%), abutment loosening or failure in 5 (7%), fixture aseptic loosening in 4 (5.6%), deep infection in 1 (1.4%), and soft tissue instability in 1 (1.4%). Sixteen revision surgeries or component changes were reported., Conclusions: Bone-anchored prostheses using osseointegrated implants in the hand are associated with favorable outcomes in the limited number of low-quality studies available for review. Superficial infections and implant-related failures were the most frequently reported complications., Type of Study/level of Evidence: Systematic review IV., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U.S. Government., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Is morality the product of multiple domain-specific psychological mechanisms, or one domain-general mechanism? Previous research suggests that morality consists of a range of solutions to the problems of cooperation recurrent in human social life. This theory of 'morality as cooperation' suggests that there are (at least) seven specific moral domains: family values, group loyalty, reciprocity, heroism, deference, fairness and property rights. However, it is unclear how these types of morality are implemented at the neuroanatomical level. The possibilities are that morality is (1) the product of multiple distinct domain-specific adaptations for cooperation, (2) the product of a single domain-general adaptation which learns a range of moral rules, or (3) the product of some combination of domain-specific and domain-general adaptations. To distinguish between these possibilities, we first conducted an anatomical likelihood estimation meta-analysis of previous studies investigating the relationship between these seven moral domains and neuroanatomy. This meta-analysis provided evidence for a combination of specific and general adaptations. Next, we investigated the relationship between the seven types of morality - as measured by the Morality as Cooperation Questionnaire (Relevance) - and grey matter volume in a large neuroimaging (n = 607) sample. No associations between moral values and grey matter volume survived whole-brain exploratory testing. We conclude that whatever combination of mechanisms are responsible for morality, either they are not neuroanatomically localised, or else their localisation is not manifested in grey matter volume. Future research should employ phylogenetically informed a priori predictions, as well as alternative measures of morality and of brain function., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Grapevine downy mildew (GDM), caused by the oomycete Plasmopara viticola , can cause 100% yield loss and vine death under conducive conditions. High resolution multispectral satellite platforms offer the opportunity to track rapidly spreading diseases like GDM over large, heterogeneous fields. Here, we investigate the capacity of PlanetScope (3 m) and SkySat (50 cm) imagery for season-long GDM detection and surveillance. A team of trained scouts rated GDM severity and incidence at a research vineyard in Geneva, NY, USA from June to August of 2020, 2021, and 2022. Satellite imagery acquired within 72 hours of scouting was processed to extract single-band reflectance and vegetation indices (VIs). Random forest models trained on spectral bands and VIs from both image datasets could classify areas of high and low GDM incidence and severity with maximum accuracies of 0.85 (SkySat) and 0.92 (PlanetScope). However, we did not observe significant differences between VIs of high and low damage classes until late July-early August. We identified cloud cover, image co-registration, and low spectral resolution as key challenges to operationalizing satellite-based GDM surveillance. This work establishes the capacity of spaceborne multispectral sensors to detect late-stage GDM and outlines steps towards incorporating satellite remote sensing in grapevine disease surveillance systems.

Hypophosphatasia (HPP) is a rare, inherited metabolic disorder caused by deficient tissue-nonspecific alkaline phosphatase activity. This study assessed the impact of treatment with asfotase alfa on patient-reported outcomes (PROs) in adults with pediatric-onset HPP. A longitudinal, telephone-based survey was administered to eligible individuals enrolled in a patient support program. Interviews were conducted at study entry (prior to asfotase alfa initiation) and after 3, 6, and 12 mo. PROs-Patient Health Questionnaire-9 [PHQ-9], Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP], Patient-Reported Outcomes Measurement Information System 29 [PROMIS-29], and Routine Assessment of Patient Index Data 3 [RAPID3]-were assessed at each time point. Appropriate statistical tests were performed to assess score changes. Among 50 enrolled patients (mean age: 46 yr [SD: 15.4]; 80% female; 94% White), 49 were evaluable at 3 mo, 44 at 6 mo, and 29 at 12 mo. By month 3, statistically significant improvements from baseline were detected in PHQ-9 scores (10.6 vs 5.8 [ P <  .0001]), PROMIS-29 domain scores (overall physical function: 38.0 vs 43.0 [ P =  .001]; anxiety: 57.5 vs 51.5 [ P =  .0011]; fatigue: 63.3 vs 55.3 [ P <  .0001]; sleep disturbances: 58.8 vs 54.3 [ P =  .0099]; ability to participate in social roles and activities: 42.6 vs 47.7 [ P =  .0012]; and pain interference: 63.8 vs 58.4 [ P =  .001]), and RAPID3 domain scores (functional status: 2.7 vs 1.1 [ P <  .0001]; pain tolerance: 6.0 vs 3.2 [ P <  .0001]; and global health estimate: 5.1 vs 2.7 [ P <  .0001]). Improvements persisted at month 12. Patients also showed improvements in WPAI:SHP domain scores at month 6 (presenteeism: 39.6% vs 14.1% [ P <  .0001] and work productivity loss: 41.9% vs 14.1% [ P <  .0001]). Treatment with asfotase alfa was associated with improved quality of life across several domains., Competing Interests: K.D. is a clinical trial investigator and consultant for Alexion, AstraZeneca Rare Disease, Kyowa Kirin, and Ultragenyx and collaborates with AM Pharma. S.W.I. has received research grants paid to his institution from Alexion, Amgen, Calcilytix, Radius, Takeda, and Ultragenyx and has served on an advisory board and/or as a consultant for Amgen, Bone Health & Osteoporosis Foundation, Extend Biosciences, and Radius. C.D. collaborates with Alexion, AstraZeneca Rare Disease, Amgen, and Radius and receives grants for research from Radius. A.M. and T.B. are employees of Alexion, AstraZeneca Rare Disease, and own stock/stock options in that company. E.R. collaborates with Alexion, AstraZeneca Rare Disease, Kyowa Kirin, Ultragenyx, and Inozyme. He receives research support from Alexion, AstraZeneca Rare Disease and Ultragenyx. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)

This paper reports on some physicochemical and phytochemical characteristics (i. e. pH, electrical conductivity, colour, moisture content, total phenolic content, sugar profile) and in vitro antioxidant activity of honeys harvested from five legume species, red clover (Trifolium pratense), balansa clover (T. michelianum), Persian clover (T. resupinatum), purple clover (T. purpureum) and sanfoin, also known as holy clover (Onobrychis viciifolia), that were grown in enclosed shade houses to ensure that the honeys' characteristics are reflective of a truly monofloral honey. Glucose and fructose, determined via High-Performance Thin-Layer Chromatography (HPTLC) analysis, were found as the main sugars in all investigated honeys with the ratio of fructose to glucose ranging from 1 : 1.2 to 1 : 1.6. The honeys' pH values ranged from 3.9 to 4.6 which met Codes Alimentarius (CA) requirements. The moisture content was found to be between 17.6 and 22.2 % which in some cases was slightly higher than CA requirements (≤20 %). The honeys' colour values, prior and after filtration, were between 825.5-1149.5 mAU and 532.4-824.8 mAU respectively, illustrating golden yellow to deep yellow hues. The total phenolic content (TPC) of the honeys was determined using a modified Folin-Ciocalteu assay. Their antioxidant activity was captured by the Ferric Reducing-Antioxidant Power (FRAP) assay as well as HPTLC analysis coupled with 2,2-diphenyl-1-picrylhydrazyl (DPPH) derivatisation. The highest total phenolic content was found in red clover honey (45.4 mg GAE/100 g) whereas purple clover honey showed the highest level of activity in the FRAP assay (7.3 mmol Fe 2+ /kg). HPTLC-DPPH analysis of the honeys' organic extracts demonstrated the presence of various bioactive compounds that contribute to their overall antioxidant activity. This study developed a methodology for producing monofloral clover honeys in a space limited, enclosed production system, which allowed to collate important baseline data for these honeys that can serve as the foundation for their potential future development into commercial honeys, including honeys that can be used for medicinal purposes., (© 2024 The Authors. Chemistry & Biodiversity published by Wiley-VHCA AG.)

Honey bee nutritional health depends on nectar and pollen, which provide the main source of carbohydrates, proteins and lipids to individual bees. During malnutrition, insect metabolism accesses fat body reserves. However, this process in bees and its repercussions at the colony level are poorly understood. Using untargeted lipidomics and gene expression analysis, we examined the effects of different feeding treatments (starvation, sugar feeding and sugar + pollen feeding) on bees and correlated them with colony health indicators. We found that nutritional stress led to an increase in unsaturated triacylglycerols and diacylglycerols, as well as a decrease in free fatty acids in the bee fat body. Here, we hypothesise that stored lipids are made available through a process where unsaturations change lipid's structure. Increased gene expression of three lipid desaturases in response to malnutrition supports this hypothesis, as these desaturases may be involved in releasing fatty acyl chains for lipolysis. Although nutritional stress was evident in starving and sugar-fed bees at the colony and physiological level, only starved colonies presented long-term effects in honey production., (© 2023 The Authors. Insect Molecular Biology published by John Wiley & Sons Ltd on behalf of Royal Entomological Society.)

Background: Intramedullary implants are an increasingly common method for fixation of metacarpal fractures. Numerous techniques for instrumentation have been described with varied consideration for the risk of extensor tendon injury. The current cadaveric study evaluates the prevalence and degree of extensor tendon injury and compares percutaneous approaches with different drilling techniques., Methods: Ninety-six metacarpals (thumbs excluded) from 24 fresh-frozen cadaveric upper extremities were used to compare 2 percutaneous approaches and 2 drilling techniques. This resulted in 4 subgroups available for comparison: oscillate to bone (OB), forward to bone (FB), oscillating through the skin (OS), and forward through the skin (FS). After instrumentation, the extensor tendons were dissected and disruption was characterized. The main outcome measures were tendon "hit rate" and relative extensor tendon defect width., Results: Tendon hit rate was significantly higher in the long finger (LF), that is, 79.2%, compared with other metacarpals: index finger, 20.8%; ring finger, 12.5%; and small finger 25%. The mean relative tendon disruption was significantly less in the OB group (16.05%) compared with the other groups: FB (31.84%), FS (31.50%), and OS (29.85%)., Conclusion: Retrograde intramedullary screw fixation of metacarpal fractures can be performed using percutaneous approaches without a significant disruption of the extensor mechanism. Instrumentation through a longitudinal stab incision down to the metacarpal head and the use of drill oscillation minimize injury to the extensor tendons. The LF extensor tendon is most at risk with retrograde intramedullary implant placement., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Health care clinicians, educators, and students who plan and implement quality improvement (QI) projects must know reporting guidelines for successful project planning and publication. We aimed to identify QI guidelines, which authors can locate, and highlight how best to use them for manuscript preparation. We also address guidelines for educational QI projects. Because of the increasing number of Doctor of Nursing Practice projects generated, these students and their mentors must be familiar with commonly used guidelines for reporting QI projects to facilitate peer review, demonstrate quality and rigor of work, reduce revisions, and potentially accelerate a paper's acceptance for publication., Competing Interests: CONFLICTS OF INTEREST None to report., (Copyright © 2023 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: Virtual mock interviews were offered to students to improve job interviewing skills. This educational quality improvement project aimed to use virtual mock interviews to increase student preparedness and confidence, and reduce anxiety related to professional interviews., Method: Health professions students ( n = 19) participated in the mock interviews conducted and recorded through a web-based meeting. Students received the recorded interview to watch before follow-up. Students completed pre- and postquestionnaires that addressed students' preparedness, confidence, and anxiety related to interviewing., Results: Participants' confidence and preparedness improved significantly in their virtual interviews ( p < .001), and their anxiety decreased significantly after the virtual interviews ( p < .001). After watching the interviews, students' reported eye contact needed improvement and answers included too many "uhms.", Conclusion: Students benefited from the virtual mock interviews. Mock virtual job interviews may have a positive effect on successful job acquisition in health professions. [ J Nurs Educ . 2023;62(8):479-482.] .

Background: Osteomyelitis is a condition that disproportionately affects those with sickle cell anemia (SCA). Despite the frequency of osteomyelitis in this population, there are reports of increasing life expectancy and rates of Staphylococcus aureus infections, which contrasts the belief that Salmonella is the most common organism identified. The purpose of this systematic review is to determine the most commonly identified organism and identify whether age is associated with the development of Salmonella osteomyelitis in homozygous sickle cell patients., Methods: A search of PubMed, EMBASE Cochrane and databases was performed for studies of all levels of evidence pertaining to osteomyelitis in SCA. Reasons for exclusion included non-English language, case reports, literature reviews, isolated septic arthritis without bony involvement and isolated oral-facial bony involvement., Results: The most common pathogen cultured was nontyphoid Salmonella , which occurred in 117 of 192 (60.9%) of cases identified. This was followed by S. aureus 41 of 192 (21.8%) and other enteric bacteria 14 of 192 (7.2%). Subgroup analysis demonstrated differences at the age of initial presentation with Salmonella cohort at 6.8 years and S. aureus cohort at 22.1 years ( P = 0.0001). On geographic analysis, African countries had an older average age of diagnosis at 13.1 years with decreased rates of Salmonella infections and increased rates of infections from other organisms compared with the US, Middle East and Europe., Conclusions: This systematic review suggests that Salmonella is most commonly identified in patients with SCA (HbSS phenotype) especially those <12 years old presenting with acute osteomyelitis. Sub-Saharan African countries had later ages of diagnosis compared with the US, Middle East and Europe with bacterial profiles that favors a diagnosis of chronic osteomyelitis and missed acute initial presentation. Therefore, age of presentation is likely a surrogate for geographic and socioeconomic factors such as availability of medical screening and treatment., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To compare the exposure of the coronoid process, anteromedial facet, and anterior band of the medial collateral ligament using the flexor carpi ulnaris (FCU)-splitting approach with the Taylor-Scham approach modified with an ulnar nerve transposition., Methods: Thirty approaches were performed on 15 fresh cadavers using a randomized cross-over design and standardized incision. Access to key anatomic landmarks was assessed, and a calibrated digital image was taken from the surgeon's best perspective of each approach. Images were analyzed using ImageJ (National Institutes of Health) software to calculate the area of osseous exposure., Results: All key anatomic landmarks were visualized using both approaches. The average area of exposure for the Taylor-Scham was 19.5 cm 2 compared with 13.6 cm 2 for the FCU-splitting ( P < 0.0001). The distal extent of the FCU-splitting approach is limited by the ulnar nerve and its branches to the humeral head of the FCU., Conclusion: The Taylor-Scham approach provides a more extensile exposure of the anteromedial coronoid and proximal ulna than the FCU-splitting approach while avoiding cross-tensioning of the ulnar nerve., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Honey bees provide essential environmental services, pollinating both agricultural and natural ecosystems that are crucial for human health. However, these pollination services are under threat by outbreaks of the bacterial honey bee disease American foulbrood (AFB). Caused by the bacterium, Paenibacillus larvae, AFB kills honey bee larvae, converting the biomass to a foul smelling, spore-laden mass. Due to the bacterium's tough endospores, which are easily spread and extremely persistent, AFB management requires the destruction of infected colonies in many countries. AFB detection remains a significant problem for beekeepers: diagnosis is often slow, relying on beekeepers visually identifying symptoms in the colony and molecular confirmation. Delayed detection can result in large outbreaks during high-density beekeeping pollination events, jeopardising livelihoods and food security. In an effort to improve diagnostics, we investigated volatile compounds associated with AFB-diseased brood in vitro and in beehive air. Using Solid Phase Microextraction and Gas Chromatography Mass-Spectrometry, we identified 40 compounds as volatile biomarkers for AFB infections, including 16 compounds previously unreported in honey bee studies. In the field, we detected half of the biomarkers in situ (in beehive air) and demonstrated their sensitivity and accuracy for diagnosing AFB. The most sensitive volatile biomarker, 2,5-dimethylpyrazine, was exclusively detected in AFB-disease larvae and hives, and was detectable in beehives with <10 AFB-symptomatic larvae. These, to our knowledge, previously undescribed biomarkers are prime candidates to be targeted by a portable sensor device for rapid and non-invasive diagnosis of AFB in beehives., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jessica Bikaun reports financial support was provided by Cooperative Research Centre for Honey Bee Products. Julia Grassl reports financial support was provided by The CRC for Honey Bee Products. Julia Grassl and Jessica Bikaun have patent #PCT/AU2020/051048 pending to The CRC for Honey Bee Products., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Previous research has documented shortages of personal care aides who provide Medicaid home and community-based services, but there are few detailed geographic data to determine the areas of greatest need and assess the availability of personal care aides nationwide. Using 2013-17 data from the American Community Survey and the Office of Management and Budget, we analyzed potential need for personal care aide services among adults and the supply of aides across the US. Areas with the highest percentages of adults with self-care disability were mainly in the South, and the gap between the potential need for personal care aide services and the aide supply was greatest in southern states. Within states, there were fewer personal care aides per 1,000 adults with self-care disability in the more rural and most rural areas than in the least rural areas. Wage and benefit increases, improved training and career opportunities, increased flexibility in state Medicaid policies on paid family caregiving, incentives and compensation for travel, and increased data collection and government tracking of workforce data could help boost the supply of personal care aides in rural America.

Objective: Postgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD-trained dentists., Study Design: Individual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD-trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC., Results: Individual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign-trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high-poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC., Conclusion: Federal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity., (© 2022 American Dental Education Association.)

Objective: This study examines the individual, educational, and policy factors that predict dentists pursuing postgraduate dental (PGD) training., Methods: Individual dentist records from the 2017 American Dental Association Masterfile were linked with pre-doctoral training attributes and state-level dental policy factors. Generalized logistic models, adjusted for individual, educational, and policy factors, were used to predict: (1) attending any PGD program, and (2) primary (i.e., advanced general practice, pediatrics, or dental public health, per the Health Resources and Services Administration [HRSA]) versus specialty care., Results: The majority of new PGD residency slots (77%) were in primary care. Women held 56% of primary care slots; men held 62% of specialty slots. Individual characteristics that predicted PGD primary care training included being Black, Hispanic, Asian, or other race; being male or older age reduced the odds. Pre-doctoral school characteristics that predicted PGD primary care training included having a pre-doctoral HRSA grant, affiliation with an academic medical center, and being a historically Black college/university; being a private school or in a small metro area lowered the odds. At the policy level, the strongest predictors of attending PGD primary care training are a residency requirement in the state you currently practice in and federal graduate medical education (GME) investment per residency slot., Conclusion: Pursuing PGD training is variable based on the race/ethnicity/gender of the dentist. Federal investments in pre-doctoral dental education and GME can drive equity, as they significantly increase the odds that dentists will go on to PGD training, as do state licensure requirements., (© 2022 American Dental Education Association.)

Purpose of Review: There have been many attempts to use variations in tibial polyethylene design to better recreate normal knee kinematics in the total knee arthroplasty. The goal of this review is to provide an overview of the various types of tibial inserts that exist and review the theoretical mechanics versus what was demonstrated in vivo., Recent Findings: Many polyethylene inserts have been attempted to re-create normal knee kinematics, but none have been able to successfully do so. Previously the only two types of inserts were posterior stabilized (PS) and cruciate retaining (CR) polyethylene inserts. Both of these have shown excellent long-term survival but neither has demonstrated native kinematics. Initially, it was thought that retention of the posterior cruciate ligament (PCL) would allow for more native kinematics, but fluoroscopic evidence has shown that the PCL alone cannot accomplish this. Newer inserts try to restore femoral roll back and the screw home mechanism. The bicruciate retaining total knee inserts are having the most "normal" kinematics, suggesting the importance of both the ACL and PCL in knee biomechanics. Modern polyethylene inserts show favorable short-term data with bicruciate retaining inserts having the best kinematics; however, long-term studies are still needed to determine if survivorship and patient outcomes remain favorable., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Background: Transfusion carries a risk of transfusion reaction that is often underdiagnosed due to reliance on passive reporting. The study investigated the utility of digital methods to identify potential transfusion reactions, thus allowing real-time intervention for affected patients., Method: The hemovigilance unit monitored 3856 patients receiving 43,515 transfusions under the hemovigilance program. Retrospective comparison data included 298,498 transfusions. Transfusion medicine physicians designed and validated algorithms in the electronic health record that analyze discrete data, such as vital sign changes, to assign a risk score during each transfusion. Dedicated hemovigilance nurses remotely monitor all patients and perform real-time chart reviews prioritized by risk score. When a reaction is suspected, a hemovigilance trained licensed clinician responds to manage the patient and ensure data collection. Board-certified transfusion medicine physicians reviewed data and classified transfusion reactions under various categories according to the Centers for Disease Control hemovigilance definitions., Results: Transfusion medicine physicians diagnosed 564 transfusion reactions (1.3% of transfusions)-a 524% increase compared to the previous passive reporting. The rapid response provider reached the bedside on average at 12.4 min demonstrating logistic feasibility. While febrile reactions were most diagnosed, recognition of transfusion-associated circulatory overload demonstrated the greatest relative increase. Auditing and education programs further enhanced transfusion reaction awareness., Discussion: The model of digitally-enabled expert real-time review of clinical data that prompts rapid response improved recognition of transfusion reactions. This approach could be applied to other patient deterioration events such as early identification of sepsis., (© 2022 AABB.)

Snake bites are an uncommon injury requiring intervention by hand surgeons. While counteracting the effects of snake venom is the initial and urgent concern following a bite, infection caused by retention of a foreign body can present in a delayed fashion and may lead to increased morbidity. Standard radiographs of the injury should be carefully examined for foreign bodies, noting that retained snake teeth are somewhat radiolucent due to less mineralization as compared to bone and can be difficult to visualize. In our subject, a retained rattlesnake fang was found in association with a septic interphalangeal joint despite appropriate radiographic evaluation and thorough surgical irrigation and debridement upon initial presentation. This case report highlights a potential complication of snake bites, the importance of aggressive management, and the importance of increased suspicion for retained foreign bodies. Augmenting plain radiographs with additional imaging modalities, such as ultrasound, dark-field, and phase-contrast imaging, may aid in the diagnosis of retained foreign bodies after snake bites., (Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation., Objective: To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players., Methods: The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol., Results: This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players., Conclusion: The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations., Competing Interests: The authors declare that no competing interests exist.

Increased map density and transferability of markers are essential for the genetic analysis of fruit quality and stress tolerance in interspecific grapevine populations. We used 1449 GBS and 2000 rhAmpSeq markers to develop a dense map for an interspecific F 2 population (VRS-F 2 ) that was derived by selfing a single F 1 from a Vitis riparia x 'Seyval blanc' cross. The resultant map contained 2519 markers spanning 1131.3 cM and was highly collinear with the Vitis vinifera 'PN40024' genome. Quantitative trait loci (QTL) for berry skin color and flower type were used to validate the map. Four rhAmpSeq transferable markers were identified that can be used in pairs (one pistillate and one hermaphroditic) to predict pistillate and hermaphrodite flower type with ≥99.7% accuracy. Total and individual anthocyanin diglucoside QTL mapped to chromosome 9 near a 5-O-GLUCOSYLTRANSFERASE candidate gene. Malic acid QTL were observed on chromosome 1 and 6 with two MALATE DEHYRDROGENASE CYTOPLASMIC 1 and ALUMINUM-ACTIVATED MALATE TRANSPORTER 2-LIKE ( ALMT ) candidate genes, respectively. Modeling malic acid identified a potential QTL on chromosome 8 with peak position in proximity of another ALMT. A first-ever reported QTL for the grassy smelling volatile (E)-2-hexenal was found on chromosome 2 with a PHOSPHOLIPID HYDROPEROXIDE GLUTATHIONE PEROXIDASE candidate gene near peak markers.

Background: Subtotal cholecystectomy is occasionally the management of choice in the patient with a hostile Calot's triangle but when it is not considered safe to close the cystic duct this often leads to a biliary fistula. In order to reduce this morbidity a novel strategy to seal the cystic duct with cyanoacrylate glue was introduced. The outcome of the two strategies have been compared., Methods: Patients who had a laparoscopic subtotal cholecystectomy where the cystic duct was left open, the Unsecured group, were compared with those where the duct orifice was occluded with cyanoacrylate glue, the Glued group. The outcome of the two strategies have been compared by duration of biliary drainage, whether a leak was shown on ERCP, time to removal of the drain, length of hospital stay, the re-operation and readmission rates., Results: In 78 cases of laparoscopic subtotal cholecystectomy it was considered unsafe to close the cystic duct. 36 patients were managed without closure of the cystic duct, the Unsecured group and bile drainage continued for more than 3 days in 9 cases (25%) compared with 3 of 42 cases (7%) treated with glue, the Glued group (NS). Postoperative ERCP demonstrated a leak more frequently in the Unsecured group ( p  < 0.02). The length of stay was reduced in the Glued group. (0.9 compared with 3.0 days, p  < 0.01)., Conclusion: The results suggest that glue may be a safe option to occlude the cystic duct orifice and reduce hospital stay when this cannot safely be closed at subtotal cholecystectomy.

Background: In 2019, an increase in clotted platelet filter occurrences was noted with the implementation of new leukocyte reduction filters through a volumetric pump., Local Problem: Occluded platelet filters contribute to delays in platelet transfusions, additional nursing workflows, and potential wastage of platelets, leading to staff and patient dissatisfaction., Methods: Direct observation of nursing practice with priming platelet filters identified opportunities for improvement. Education was designed incorporating manufacturer recommendations with results of the observations. Nursing education was disseminated through small group sessions, one-to-one teaching, tip sheets, and an e-learning video., Results: Nursing education interventions resulted in a 170% reduction in the reported monthly filter occlusion rate., Conclusion: Engagement of nurses in quality improvement processes and collaboration across departments led to a sustained decrease in the clotted platelet filters., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The purpose of this study was to examine patient outcomes and the risk of recurrence of mucous cysts affecting the distal interphalangeal (DIP) joint in the absence of osteophytectomy using the described flap technique., Methods: A retrospective review of 143 records of patients who were treated for mucous cysts of the DIP joint by a single surgeon. Inclusion criteria included the absence of an osteophytectomy during treatment using the described dorsally based flap technique and a minimum of 12 months of follow-up., Results: A total of 143 mucous cysts affecting the DIP joint of 131 patients with an average age of 65.3 years were included. The average follow-up was 21.9 months (12 to 139). Postoperative DIP joint extension was less in the surgical digit compared with the same digit of the contralateral hand with a significant change from the preoperative motion (1.5° versus 0.3°; P = 0.05). No significant change in the postoperative flexion of the DIP joint was observed compared with that of the contralateral side (-1.4° versus -0.9°; P = 0.57). Recurrence occurred in 2 patients (1.4%). No infections or wound complications were identified., Conclusions: Using the described technique without an osteophytectomy seemed to be an effective treatment of mucous cysts originating from the DIP joint., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)