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Background: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices., Methods: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined., Results: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10-15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70-6.47); proportion with definite RHD was 3.23% (95% CI, 2.61-3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2-77.8), specificity was 78.1% (95% CI, 76.4-79.8)., Conclusions: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.

Purpose: To assess the relationship between donor and recipient factors and corneal allograft rejection in eyes that underwent penetrating keratoplasty in the Cornea Donor Study., Methods: Overall, 1090 subjects undergoing corneal transplantation for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 5 years. Associations of baseline recipient and donor factors with the occurrence of a probable or definite rejection event were assessed in univariate and multivariate proportional hazards models., Results: Eyes with pseudophakic or aphakic corneal edema (n = 369) were more likely to experience a rejection event than eyes with Fuchs dystrophy (n = 676) [34% ± 6% vs. 22% ± 4%; hazard ratio = 1.56; 95% confidence interval (CI), 1.21-2.03]. Among eyes with Fuchs dystrophy, a higher probability of a rejection event was observed in phakic posttransplant eyes compared with those that underwent cataract extraction with or without intraocular lens implantation during penetrating keratoplasty (29% vs. 19%; hazard ratio = 0.54; 95% CI, 0.36-0.82). Female recipients had a higher probability of a rejection event than male recipients (29% vs. 21%; hazard ratio = 1.42; 95% CI, 1.08-1.87) after controlling for the effect of preoperative diagnosis and lens status. Donor age and donor recipient ABO compatibility were not associated with rejection., Conclusions: There was a substantially higher graft rejection rate in eyes with pseudophakic or aphakic corneal edema compared to that in eyes with Fuchs dystrophy. Female recipients were more likely to have a rejection event than male recipients. Graft rejection was not associated with donor age.

Purpose: The purpose of this study was to develop a modified version of a 3-min all-out cycling test (3MT) using equipment readily available to cyclists and to identify exercise intensity domains using the average power output over the last 30 s of the 3MT (end-test power (EP))., Methods: Sixteen competitive cyclists (V(O2peak) = 60.3 +/- 8.3 mL.kg.min) completed three laboratory visits using their own bicycles and a power-measuring rear wheel. In visit 1, subjects performed an incremental load test to volitional termination on an electronically braked trainer (100 + 25 W every 4 min). Power output at lactate threshold was determined by absolute 4 mmol.L (OBLA-PO) and 1 mmol.L over exercise baseline (LT-PO). Power output at ventilatory threshold (VT-PO) was computed on the basis of the V-slope method. Power output at V(O2peak) (V(O2peak)-PO) was the mean power observed during the stage at which peak O2 consumption was recorded. In visits 2 and 3, subjects performed the 3MT using a progressive resistance trainer with Visit 2 as a familiarization trial. During Visit 3, EP was recorded., Results: EP (273 +/- 52 W) was significantly greater than VT-PO, OBLA-PO, and LT-PO (232 +/- 64, 235 +/- 54, and 208 +/- 45 W, respectively) but significantly less than V(O2peak)-PO (288 +/- 56 W). EP was correlated with V(O2peak)-PO (r = 0.97), VT-PO (r = 0.87), OBLA-PO (r = 0.85), and LT-PO (r = 0.79) with regression estimates through the origin made using 105%, 86%, 86%, and 76% of EP, respectively. Demarcations for moderate- to heavy-intensity (LT-PO at 76% EP) and heavy- to severe-intensity (100% EP) domains may be estimated., Conclusion: The 3MT can be used to define exercise intensity in competitive cyclists using readily available equipment.

Heterotopic ossification is a benign, ectopic bone growth that develops in muscle and other soft tissue. The exact cause is poorly understood, but it is a rarely serious complication of soft tissue trauma. Its most common form, myositis ossifications traumatica, occurs as a secondary complication of direct muscle injury. However, other forms are less common and can result from specific pathologic conditions, such as spinal cord trauma and metabolic disorders. In patients who have had spinal cord injury and subsequent paraplegia, heterotopic ossification often results in ankylosis of the hip and a loss in range of motion. Ectopic ossification occurs below the injury site, and, although the specific muscle groups can vary, it usually involves those for which the origin and insertion involve the anterior pelvis and proximal femur. In dried bone, heterotopic ossification can appear as a smooth, irregularly shaped benign tumor of mature bone, extending from the surface but not invading the cortical bone. These tumors range in size from a few millimeters to several centimeters. Because heterotopic ossification is often associated with specific types of injuries, it has a unique anthropological use in forensic cases.