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Purpose: This study aimed to compare two different double‐level knee osteotomy (DLO) fixation techniques. The primary outcome reported the radiological coronal plane correction and its accuracy. The secondary outcomes reported the correction outliers, the clinical outcomes, the 5‐year postoperative satisfaction and the complications. Methods: A retrospective review of a single surgeon osteotomy database identified 52 cases of DLO between 2011 and 2019, of which 24 cases met the inclusion criteria. Patients were categorised into two groups: the nail‐plate (NP) group fixed with a magnetic extendable intramedullary tibial nail and femoral conventional plate, and the double‐plate (DP) group fixed with conventional plates (tibia and femur). Radiographic parameters were recorded, including the mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and weight‐bearing line ratio (Mikulicz %). Surgical accuracy was calculated as the difference between the achieved and the planned correction. Outliers were defined as those with a greater than 10% difference from the planned correction. Simple knee value scores and visual analogue scale for pain were recorded preoperatively and postoperatively at 2 and 5 years. Five‐year patient satisfaction was recorded. Results: A total of 24 patients were included: the NP group (n = 12) and the DP group (n = 12). Significant coronal plane corrections were achieved in the NP group for the mean mFTA (preoperative 167.9° ± 3.4° to postoperative 182.1° ± 1.4°), the mean MPTA (preoperative 83.5° ± 2.9° to postoperative 91.3° ± 2.8°) and the mean mLDFA (preoperative 89.8° ± 3.4° to postoperative 85.9° ± 4.4°). Similarly, significant coronal plane corrections were achieved in the DP group for the mean mFTA (preoperative 168.6° ± 4.4° to postoperative 182.2° ± 2°), the mean MPTA (preoperative 84.2° ± 2° to postoperative 88.3° ± 4.1°) and the mean mLDFA (preoperative 90.7° ± 2.9° to postoperative 83.9° ± 1.7°) (all p < 0.05). The mean correction accuracy was higher for the NP versus DP group at 3.4 ± 3.4% versus 7.1 ± 3.9% (intergroup p < 0.05). There were no outliers in the NP group versus two outliers (overcorrected) (16.7%) in the DP group. Significant clinical improvement was reported in both groups at 2 and 5 years postoperatively (all p < 0.05). Conclusion: Superior correction accuracy and no outliers were achieved in hybrid fixation double‐level knee osteotomy compared to the conventional double‐plating technique. The magnetic extendable nail offers the advantage of fine‐tuning the correction postoperatively and could be a potential research template for future designs of postoperative correction implants. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Objectives: Specialized pain rehabilitation is recognized as the treatment of choice for youth with pain‐related disability. Appropriate outcomes for program evaluation are critical. This study aimed to summarize the effect domains and methods used to evaluate pediatric‐specialized outpatient pain rehabilition programs, map them to the PedIMMPACT statement, and highlight future directions. Methods: An integrated review framework, incorporating stakeholders, was used. Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar were searched for studies published in 1999–2021 featuring the treatment effects of specialized outpatient pain rehabilitation on youth with pain‐related disability and their parents. Selected studies were critically appraised using the Quality Assessment Tool for Studies of Diverse Design, organized by study characteristics, and analyzed using constant comparison. Results: From the 1951 potentially relevant titles, 37 studies were selected. Twenty‐five effects targeted youth and 24 focused on parents, with a maximum of 15 youth and 11 parent effect domains (median = 5 domains per study). Although most studies measured a combination of effect domains and were inclusive of some recommended in the PedIMMPACT statement, no effect was measured consistently across studies. Youth physical functioning and parent emotional functioning were measured most often. Eighty‐five instruments were used to assess youth outcomes and 59 for parents, with self‐report questionnaires dominating. Discussion: A lack of standardization exists associated with the domains and methods used to evaluate the effects of pediatric‐specialized outpatient pain rehabilitation programs, hindering comparisons. Future program evaluations should be founded on their theory, aim, and anticipated outcomes. [ABSTRACT FROM AUTHOR]

Aerosol particles undergo physical and chemical changes during cloud processes. In this work, we quantified the changes in aerosol mixing state using a particle‐resolved model. To this end, we coupled the particle‐resolved aerosol model PartMC‐MOSAIC with the aqueous chemistry module CAPRAM 2.4 and designed cloud parcel simulations that mimicked several cloud cycles that a particle population may be exposed to in polluted urban environments. With ammonium nitrate and ammonium sulfate added to the activated particles, after the cloud evaporated, the activation potential of the resuspended aerosol particles increased for supersaturation thresholds lower than the maximum supersaturation attained in the cloud. Formation of sulfate and nitrate increased the internally mixed state of all particle populations, quantified by the mixing state index χ. The change of aerosol mixing state due to aqueous‐phase chemistry was related to the fraction of activated particles. For a case with low aerosol number concentration, where the activated fraction was up to 60%, χ increased by up to 50 percentage points after cloud processing, reaching an almost completely internal mixture. In contrast, for a case with high aerosol emissions and activated fraction of less than 20%, the increase in χ was less than 20 percentage points, and χ remained below 80% after cloud processing. The change in aerosol mixing state caused by coagulation within the cloud parcel was negligible. These findings highlight the complex influence of cloud processing on particle properties. Plain Language Summary: Every cloud droplet contains at least one aerosol nucleus. The composition and mass of this nucleus can be changed during a cloud's lifetime by several chemical and physical processes. Once the cloud evaporates, a modified aerosol population is released into the atmosphere compared to the population that formed the cloud, which may also have different impacts on climate. In this work, we used a particle‐resolved process model to study the effects of cloud processing on aerosols within clouds. This modeling approach is suitable for this research because each particle is tracked individually, which allows us to quantify changes in particle composition without simplifying assumptions, such as averaging composition within predescribed size ranges. Because of the formation of ammonium sulfate and nitrate in the cloud, particles that formed cloud droplets grew larger and were more likely to form cloud droplets in future cloud cycles. Overall, cloud processing by aqueous‐phase chemistry produced aerosol populations where the particles look more similar to each other in composition. Key Points: Aqueous‐phase chemistry processes cause aerosol populations to be more internally mixedThe change of aerosol mixing state due to aqueous phase chemistry was related to the fraction of activated particlesCoagulation within clouds has a negligible impact on aerosol mixing state [ABSTRACT FROM AUTHOR]

Depressive symptoms are more prevalent in persons with HIV (PWH) than HIV‐uninfected individuals. In HIV‐uninfected individuals, depression has been associated with atrophy in the hippocampus and other brain regions. In the present study, we investigated the impact of depression on brain structure in PWH. One hundred PWH participated in a cross‐sectional study (56.6 ± 6.4 yrs, range 41–70 yrs, 24 females, 63 African Americans). The Beck's Depression Inventory‐II (BDI‐II) was used to assess depressive symptoms. Structural MRI images were collected. Both the voxel‐based morphometry (VBM) technique and a region of interest (ROI) based approach were used to examine the relationship between hippocampal gray matter volume (GMv) and depressive symptoms. The impact of HIV CD4 nadir and antidepressants was also investigated. Both VBM and ROI approaches revealed that higher BDI‐II scores (implicating more severe depressive symptoms) were associated with loss of hippocampal GMv, especially in the right hippocampus and the right entorhinal cortex. Low CD4 nadir predicted additional hippocampal volume loss independent of depressive symptoms. Taking antidepressants did not have a detectable effect on hippocampal volume. In summary, having more depressive symptoms is associated with smaller hippocampal volume in PWH, and a history of severe immunosuppression (i.e., low CD4 nadir) correlates with additional hippocampal volume reduction. However, the impact of depression on hippocampal volume may be independent of HIV‐disease severity such as low CD4 nadir. [ABSTRACT FROM AUTHOR]

Objective: Distal sensory polyneuropathy (DSP) and neuropathic pain are important clinical concerns in virally suppressed people with HIV. We determined how these conditions evolved, what factors influenced their evolution, and their clinical impact. Methods: Ambulatory, community‐dwelling HIV seropositive individuals were recruited at six research centers. Clinical evaluations at baseline and 12 years later determined neuropathy signs and distal neuropathic pain (DNP). Additional assessments measured activities of daily living and quality of life (QOL). Factors potentially associated with DSP and DNP progression included disease severity, treatment, demographics, and co‐morbidities. Adjusted odds ratios were calculated for follow‐up neuropathy outcomes. Results: Of 254 participants, 21.3% were women, 57.5% were non‐white. Mean baseline age was 43.5 years. Polyneuropathy prevalence increased from 25.7% to 43.7%. Of 173 participants initially pain‐free, 42 (24.3%) had incident neuropathic pain. Baseline risk factors for incident pain included unemployment (OR [95% CI], 5.86 [1.97, 17.4]) and higher baseline body mass index (BMI) (1.78 [1.03, 3.19] per 10‐units). Participants with neuropathic pain at follow‐up had significantly worse QOL and greater dependence in activities of daily living than those who remained pain‐free. Interpretation: HIV DSP and neuropathic pain increased in prevalence and severity over 12 years despite high rates of viral suppression. The high burden of neuropathy included disability and poor life quality. However, substantial numbers remained pain‐free despite clear evidence of neuropathy on exam. Protective factors included being employed and having a lower BMI. Implications for clinical practice include promotion of lifestyle changes affecting reversible risk factors. [ABSTRACT FROM AUTHOR]

Objectives: It is unknown whether the addition of M‐mode to B‐mode ultrasound (US) has any effect on the overall accuracy of interpretation of lung sliding in the evaluation of a pneumothorax by emergency physicians. This study aimed to determine what effect, if any, this addition has on US interpretation by emergency physicians of varying training levels. Methods: One hundred forty emergency physicians were randomized via online software to receive a quiz with B‐mode clips alone or B‐mode with corresponding M‐mode images and asked to identify the presence or absence of lung sliding. Results: The sensitivity, specificity, and accuracy of the diagnosis of lung sliding with and without M‐mode US were compared. Overall, the sensitivities, specificities, and accuracies of B‐mode + M‐mode US versus B‐mode US alone were 93.1% and 93.2% (P = .8), 96.0% and 89.8% (P < .0001), and 91.5% and 94.5% (P = .0091), respectively. A subgroup analysis showed that in those providers with fewer than 250 total US scans done previously, M‐mode US increased accuracy from 88.2% (95% confidence interval, 86.2%–90.2%) to 94.4% (92.8%–96.0%; P = .001) and increased the specificity from 87.0% (84.5%–89.5%) to 97.2% (95.4%–99.0%; P < .0001) compared with B‐mode US alone. There was no statistically significant difference observed in the sensitivity, specificity, and accuracy of B‐mode + M‐mode US compared with B‐mode US alone in those with more than 250 scans. Conclusions: The addition of M‐mode images to B‐mode clips aids in the accurate diagnosis of lung sliding by emergency physicians. The subgroup analysis showed that the benefit of M‐mode US disappears after emergency physicians have performed more than 250 US examinations. [ABSTRACT FROM AUTHOR]

Summary: Homology was searched with genes annotated in the Aegilops tauschii pseudomolecules against genes annotated in the pseudomolecules of tetraploid wild emmer wheat, Brachypodium distachyon, sorghum and rice. Similar searches were performed with genes annotated in the rice pseudomolecules. Matrices of collinear genes and rearrangements in their order were constructed. Optical BioNano genome maps were constructed and used to validate rearrangements unique to the wild emmer and Ae. tauschii genomes. Most common rearrangements were short paracentric inversions and short intrachromosomal translocations. Intrachromosomal translocations outnumbered segmental intrachromosomal duplications. The densities of paracentric inversion lengths were approximated by exponential distributions in all six genomes. Densities of collinear genes along the Ae. tauschii chromosomes were highly correlated with meiotic recombination rates but those of rearrangements were not, suggesting different causes of the erosion of gene collinearity and evolution of major chromosome rearrangements. Frequent rearrangements sharing breakpoints suggested that chromosomes have been rearranged recurrently at some sites. The distal 4 Mb of the short arms of rice chromosomes Os11 and Os12 and corresponding regions in the sorghum, B. distachyon and Triticeae genomes contain clusters of interstitial translocations including from 1 to 7 collinear genes. The rates of acquisition of major rearrangements were greater in the large wild emmer wheat and Ae. tauschii genomes than in the lineage preceding their divergence or in the B. distachyon, rice and sorghum lineages. It is suggested that synergy between large quantities of dynamic transposable elements and annual growth habit have been the primary causes of the fast evolution of the Triticeae genomes. [ABSTRACT FROM AUTHOR]

Abstract: A feeding trial was conducted to determine the maximum substitution limits of poultry by‐product meal (PBM; 66% crude protein) protein for fish meal (FM; 59% crude protein) protein in the diet of juvenile Black Sea Bass Centropristis striata (family Serranidae). Eight isonitrogenous (44% crude protein) and isolipidic (13% crude lipid) diets were formulated to replace FM protein with PBM protein at 0 (control), 40%, 50%, 60%, 70%, 80%, 90%, and 100% in Black Sea Bass diets. Diets were fed twice daily to triplicate groups of juveniles (initial mean weight = 1.2 g) to apparent satiation for 8 weeks in a recirculating aquaculture system. Final survival was excellent (95–100%) in all diet treatments, with no significant differences. No significant differences in body weight gain (BWG) were observed in fish fed the 40–90% PBM protein diets (1,136–1,357%) compared with the control diet (1,307%). However, BWG of fish fed the 100% PBM protein diet (1,045%) was significantly lower than in the control group. Regression analysis with BWG indicated that PBM protein can replace FM protein in Black Sea Bass diets at levels as high as 81.8%, with no reduction in fish growth performance. For fish fed diets with up to 90% PBM protein, feed conversion (1.08–1.17) and protein efficiency ratios (2.01–2.14) were not significantly different from fish fed a control 100% FM‐protein‐based diet (0.99 and 2.29, respectively). Apparent digestibility coefficients of dietary protein remained high (81.6–87.0%) under all levels of FM replacement with PBM protein. After the feeding trial, whole body and muscle protein content and the concentrations of whole body n‐3 polyunsaturated fatty acids showed no significant differences among the treatments at FM protein replacement levels up to 90%. Poultry by‐product meal is a promising alternative protein source for sustainable diet development in Black Sea Bass. [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2012; 19:876-879 © 2012 by the Society for Academic Emergency Medicine Abstract Background: Ultrasound (US) has well-documented utility in critical procedures performed in the emergency department. It has been described as a 'skill integral to the practice of emergency medicine' in the 2007 Model of Clinical Practice of Emergency Medicine. One of the ideal uses for US in critical care may be in the performance of emergent cricothyroidotomy. To the best of our knowledge there is currently no description of how to perform an US-guided open cricothyroidotomy in the literature. Objectives: This study aimed to develop and describe an US-guided technique for emergent open cricothyroidotomy and evaluate the time to completion and failure rate of this technique. Methods: This study was performed in a cadaver lab on 21 cadavers. The procedure was performed by two independent operators with US guidance using a linear transducer in the longitudinal orientation placed on the anterior midline of the neck. The cricothyroid membrane was incised with a No. 20 scalpel and a bougie with a coude tip was inserted into the trachea. A 6.0 endotracheal tube was then advanced over the bougie and the cuff was inflated. Endotracheal tube placement was confirmed by dissection. The procedure was timed to evaluate the length of time to identification of the cricothyroid membrane and completion of the procedure. There was no control group for this study. Results: There were 12 female and nine male cadavers. The mean body mass index (BMI) was 21.9 (range = 12.2 to 44.9). There was a median time to identification of the cricothyroid membrane of 3.6 seconds (interquartile range [IQR] = 1.9 to 15.3 seconds) and median time to completion of the procedure of 26.2 seconds (IQR = 10.7 to 50.7 seconds). The failure rate was 1 out of 21, with one incision placed between the cricoid cartilage and the first tracheal ring. In this case, the trachea was still cannulated. Similar completion times were obtained with high- and low-BMI cadavers. Conclusions: Ultrasound-guided bougie-assisted cricothyroidotomy is a novel technique that may be beneficial in emergent open cricothyroidotomy. The data suggest that this technique is rapid, with a median time to completion of 26.2 seconds. The data also suggest that the procedure may have a low failure rate, with 20 of 21 cadavers undergoing successful cricothyroidotomy. [ABSTRACT FROM AUTHOR]

This article relates a resident's fascination with emergency department (ED) ultrasound. He calls the day when he first became fascinated with ultrasound, as well as the transformation of his fascination into a deep respect and admiration. He describes his experience of working in community and rural EDs as a senior resident. He expresses his concern over the lack of ultrasound capability in community EDs, which he believes are settings that need ultrasound for life-saving purposes.