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Background: The diagnosis of anterior cruciate ligament (ACL) tear relies on clinical evaluation and magnetic resonance imaging (MRI). Direct and indirect signs of ACL tear have been described with MRI evaluation. Posterior cruciate ligament (PCL) buckling has been described as an indirect radiographic sign of an ACL tear. Purpose: The aim of the present study was to assess the variations in PCL buckling angles in patients with ACL tears and in patients with isolated lesions in the posterior horn of the medial meniscus. In addition, the influence of different patterns of medial meniscus tears in ACL-deficient knees was investigated. Finally, the influences of risk factors such as tibial slope, delay from injury to surgery, absence of medial meniscus tear, degree of Lachman and pivot shift testing were also assessed. Study design: This was a cohort study. Methods: A total of 154 patients (78 in the group with ACL tear and 76 in the control group) were assessed with MRI and lateral weight-bearing X-ray to assess PCL buckling angle and tibial slope by two independent observers. The presence of a medial meniscus bucket handle or ramp lesion of the medial meniscus was assessed and recorded at the time of surgery. Results: PCL buckling angle measurement was highly reliable, with an ICC of 0.866 and 0.894, respectively, in the study group and the control group for interobserver reliability. The intrarater reliability was found to be high in PCL buckling angle for the study group [ICC = 0.955] and the control group [ICC = 0.943]. The mean angle in patients with ACL tear was 110.7 ± 15.2° and 115.3 ± 16.2° (for the two examiners) and 111.4 ± 12° and 114 ± 14.5° (for the two examiners) in patients with an intact, healthy ACL. An association emerged between bucket handle tears of the medial meniscus (p = 0.010) and a decreased PCL buckling angle and between ramp lesions of the medial meniscus and increased PCL buckling angle both (p = 0.024). Conclusions: Good inter- and intraobserver reliability for the measurement of the PCL buckling angle was observed. Increased PCL buckling angle values were observed in patients with concomitant ACL and bucket handle tears of the medial meniscus, while decreased angle values were observed in those who had ACL tear and ramp lesion of the medial meniscus. No statistically significant difference in the PCL buckling angle emerged between patients with ACL tears and those who had a healthy, intact ACL. [ABSTRACT FROM AUTHOR]

Hillary Clinton was the first woman nominated for President by a major political party in the United States. Like most women in politics, she faced negative evaluations, in part, due to the inconsistency between the traits typically associated with leaders (competence) versus women (warmth). Because understanding the categorization of an individual female politician is essential to the development of successful bias interventions, we examined the extent to which Hillary Clinton and a novel female politician were categorized as women versus female politicians. In three studies we investigated how the warmth and competence stereotypes associated with women and female politicians contributed to the warmth and competence traits associated with Hillary Clinton and a novel female political candidate. Consistent with a subtyping account, the warmth and competence stereotypes associated with female politicians, but not women, predicted Hillary Clinton's warmth and competence traits (Studies 1–3). However, consistent with a subgrouping account, the warmth and competence stereotypes associated with both women and female politicians predicted a novel female politician's warmth and competence traits (Study 3). Implications for bias reduction interventions are discussed. [ABSTRACT FROM AUTHOR]

Since 1998, ethylmercury, a vaccine preservative, has often been confused with methylmercury, a dangerous neurotoxin, by the government and public. This confusion has led to a decrease in vaccination rates and an increase in the spread of preventable disease. Despite significant efforts to educate the public on the inaccuracy of studies linking ethylmercury to autism, the public health agencies have been unsuccessful in demonstrating to the public that the substance is safe. This Note analyzes the actions taken by the public health agencies responding to public concerns about ethylmercury's use in vaccines and recommends that the agencies undertake a comprehensive study of ethylmercury to determine its safety and resolve the growing public health crisis. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the opinions of practising neonatologists regarding the ethical permissibility of unilateral Do Not Attempt Resuscitation (DNAR) decisions in the neonatal intensive care unit.Study Design: An anonymous survey regarding the permissibility of unilateral DNAR orders for three clinical vignettes was sent to members of the American Academy of Pediatrics Section of Perinatal Medicine.Results: There were 490 out of a possible 3000 respondents (16%). A majority (76%) responded that a unilateral DNAR decision would be permissible in cases for which survival was felt to be impossible. A minority (25%) responded 'yes' when asked if a unilateral DNAR order would be permissible based solely on neurological prognosis.Conclusions: A majority of neonatologists believed unilateral DNAR decisions are ethically permissible if survival is felt to be impossible, but not permissible based solely on poor neurological prognosis. This has significant implications for clinical care. [ABSTRACT FROM AUTHOR]

Recent interest in materials culture and artifactual literacies has helped the authors of this article rethink how they teach preservice and inservice teachers and collaborate with K-12 teachers. Each discipline has its own stuff that can help students understand the products and practices of a field beyond what they might be able to glean from text. To that end, every teacher should see their classroom and content area as a 'place for my stuff' because objects speak and communicate more messages through form, color, size, and texture than print alone. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) is the leading cause of poisoning death in the United States. Research has shown that proper use of a CO detector in the home can reduce morbidity and mortality related to unintentional CO exposure. The authors evaluated three CO education workshops that included distribution of free CO detectors for home use, and their intervention reached 133 participants. Pretest surveys and follow-up calls evaluated change in knowledge and behavior factors. Results showed that statistically significant increases were found on three out of five knowledge-based items and 91% of respondents (N = 80) reported installing CO detectors in their home. Follow-up calls provided an opportunity to clarify information and provide tailored information to participants. [ABSTRACT FROM AUTHOR]

Perceived discrimination is a stressor, related to both negative physical and mental health outcomes. Utilizing a sample of 259 undergraduate females from the northeast region of the U.S., the present study examined a model that tested the direct, indirect, and mediated relations among perceived sexist discrimination, psychological distress, self-esteem, and sense of personal control. Path analysis of the model indicated that (a) perceived sexism was related to greater psychological distress, with personal control partially mediating this link and (b) perceived sexism was not related to self-esteem. The path model accounted for 28% of the variance in self-esteem and 37% of the variance in psychological distress. Implications of the findings for women’s health are discussed. [ABSTRACT FROM AUTHOR]

Evidence-based guidelines do not exist for the treatment of patients with chronic mild-moderate digoxin toxicity. We sought to evaluate differences among specialists in the use of digoxin-specific antibody fragments and the decision to admit these patients. A sample of cardiologists, emergency physicians, and medical toxicologists was surveyed. The survey detailed four hypothetical cases of chronic digoxin toxicity created by consensus among authors. All cases had the same digoxin concentration, but signs and symptoms varied in an attempt to explore four different thresholds. For each scenario, clinicians made decisions about admission and treatment. Survey response varied: cardiologists 17%, emergency physicians 6.7%, and toxicologists 39%. Statistically significant difference was found in the administration of Fab among cardiologists (67%), emergency physicians (82%), or toxicologists (91.5%) and admission rate (cardiologists 34%, emergency physicians 28%, and toxicologists 46%). Differences exist among clinicians of various specialties regarding treatment of chronic digoxin toxicity. These differences may reflect diverse perspectives or knowledge gaps and may translate into excess cost or less than ideal care. Exploring these differences may improve patient care, improve interactions among providers, and set the stage for development of consensus guidelines and research. [ABSTRACT FROM AUTHOR]

The article discusses how technology is being used by children to torment their peers. Three types of bullying discussed in the article include physical, verbal, and social bullying. The triangle of individuals involved in a bullying situation is evaluated, which includes the bully, the target, and the bystander. The U.S. National Center for Education Statistics presents information regarding the number of children bullied in schools.

The article focuses on the inaccuracy of the account on the experience of Annie Moore as the first Irish immigrant to be processed at Ellis Island. A guide is offered on how the story of Annie Moore should be taught by social studies teachers in the United States. The teachers must endeavor to assess official and unofficial versions of history for accuracy. They should be aware that students will need help to sort fiction from reality. These are some of the problems related to teaching about Irish immigration in New York and the Irish immigrant Annie Moore.

Biological indicators are critical to the protection of small, headwater streams and the ecological values they provide. Maryland and other state monitoring programs have determined that fish indicators are ineffective in small streams, where stream salamanders may replace fish as top predators. Because of their life history, physiology, abundance, and ubiquity, stream salamanders are likely representative of biological integrity in these streams. The goal of this study was to determine whether stream salamanders are effective indicators of ecological conditions across biogeographic regions and gradients of human disturbance. During the summers of 2001 and 2002, we intensively surveyed for stream salamanders at 76 stream sites located west of the Maryland Coastal Plain, sites also monitored by the Maryland Biological Stream Survey (MBSS) and City of Gaithersburg. We found 1,584 stream salamanders, including all eight species known in Maryland, using two 15 × 2 m transects and two 4 m 2 quadrats that spanned both stream bank and channel. We performed removal sampling on transects to estimate salamander species detection probabilities, which ranged from 0.67-0.85. Stepwise regressions identified 15 of 52 non-salamander variables, representing water quality, physical habitat, land use, and biological conditions, which best predicted salamander metrics. Indicator development involved (1) identifying reference (non-degraded) and degraded sites (using percent forest, shading, riparian buffer width, aesthetic rating, and benthic macroinvertebrate and fish indices of biotic integrity); (2) testing 12 candidate salamander metrics (representing species richness and composition, abundance, species tolerance, and reproductive function) for their ability to distinguish reference from degraded sites; and (3) combining metrics into an index that effectively discriminated sites according to known stream conditions. Final indices for Highlands, Piedmont, and Non-Coastal Plain regions comprised four metrics: number of species, number of salamanders, number of intolerant salamanders, and number of adult salamanders, producing classification efficiencies between 87% and 90%. Partial validation of these indices was obtained when a test of the number of salamanders metric produced an 82% correct classification of 618 MBSS sites surveyed in 1995-97. This study supports the use of stream salamander monitoring and a composite stream salamander index of biotic integrity (SS-IBI) to determine stream quality in Maryland. [ABSTRACT FROM AUTHOR]

Examines the effects of fluconazole on the treatment of tinea capitis in the United States. Prevalence of the dermatophyte infection in children; Interference of the fungal membrane synthesis; Pattern of fungal infection in the disorder.

The article focuses on the citizen involvement in cooperative education decision-making. There had been significant increase in citizen involvement in cooperative educational decision making which received considerable impetus from a variety of compensatory education programs authorized by the U.S. Congress in the mid-1960s. The increase in citizen involvement in the decisions made by local school districts could help to increase program responsiveness to the needs of children. The concept of cooperative decision making has gained increasingly stronger endorsement at the federal and state levels. The case study of cooperative decision making described in this article employs a variety of field study techniques--community surveys, personal interviews, and participant observation--to examine the viability of citizen advisory boards as vehicles for community input to the decision-making process. A major objective of the Piedmont Schools Project was greater involvement of the lay community in the decision-making process. The points raised in the study indicate that the Board of Cooperatives was a listening and questioning rather than a policy-making organ of the Project, that it had little impact on administration thinking.

Costs associated with musculoskeletal diseases in the United States account for 5.7% of the Gross Domestic Product (GDP) (Weinstein et al. 2018). As such, there is a need to pursue new ideas in orthopaedic implants that can decrease cost and improve patient care. In the recent years, 3D printing of polymers using Fused Deposition Modeling (FDM) and metals using Direct Metal Laser Sintering (DMLS) has opened several exciting possibilities to create customized orthopaedic implants. Such implants can be engineered to release antibiotics in a controlled manner by infusing the drug into the material during manufacturing stage. However, the prevalence of high temperature could impact the anti-bacterial effectiveness of the eluted antibiotics in such implants. An alternative approach to circumvent this issue would be to modify the implant geometry to incorporate built-in design features such as micro-channels and reservoirs in which antibiotics can be introduced prior to the surgical procedure. Irrespective of the approach used, the ability of 3D printed orthopaedic implants to elute antibiotics, and the rate of elution are not well understood. The purpose of this article is to study the elution of doxycycline through 3D printed femoral implants using three different materials: Poly-Lactic Acid (PLA), Poly-Caprolactone (PCL) and Titanium grade Ti-6Al-4V. The PLA and Ti-6Al-4V implants were designed with built-in reservoirs and micro-channels in which doxycycline was introduced post the manufacturing stage. However, the PCL implants were printed from a PCL spool that was infused with doxycycline using an extruder. The PLA and Ti-6Al-4V experiments were run for a period of 31 days and the PCL experiment for one day. The antibacterial ability of eluted doxycycline from all implants were examined using Kirby-Bauer test on the bacteria E.coli k-12. The results show that most of doxycycline eluted through the three materials in the first 24 hours. After the initial spike, a steady release was achieved for the PLA and Ti-6Al-4V implants for 30 days. During this timeframe, Ti-6Al-4V implants released more doxycycline than the PLA implant. The eluted antibiotics through all the implants demonstrated the ability to kill bacteria in the subsequent Kirby-Bauer test. These outcomes show that irrespective of how the antibiotics were introduced, 3D printed polymeric and metallic implants have great potential in orthopaedic applications. [ABSTRACT FROM AUTHOR]

This case explores the legal and ethical considerations for pediatricians surrounding gestational carrier pregnancies in the United States. Because of high success rates for assisted reproduction, state laws supporting same-sex adoption and surrogacy, and established legal precedents, gestational carrier pregnancies are increasingly common. The case presented involves a gestational carrier in preterm labor at 30 weeks' gestation with malpositioned twins who declines a cesarean delivery. Three commentaries are presented. The first highlights the importance of understanding the ethical implications of gestational carrier pregnancies in prenatal counseling. The second commentary emphasizes the pregnant person's right to autonomy and bodily integrity, and discusses considerations in surrogacy pregnancies, including the authority to authorize a cesarean delivery, valid informed consent, and decision-making for neonates. The third commentary discusses autonomy, emphasizing the importance of contracts in surrogacy pregnancies, and suggests that, in the case of a conflict between the gestational carrier and the intended parent(s), the gestational carrier's preference should be decisive regarding medical care during pregnancy. These discussions highlight key concepts for ethically informed and family-centered care in gestational carrier pregnancies and deliveries. [ABSTRACT FROM AUTHOR]

The article deals with the long hours worked by resident physicians and the mandated reduction of those hours. Presumably, the reduction is aimed at protecting patients from the mistakes that exhausted physicians are likelier to make. Of course nursing errors are also a concern, but it has never been standard practice in U.S. hospitals to require, or even allow, nurses to work anything approaching a twenty-four-hour shift. However, attending physicians in many hospitals may work all day, through the night and still have significant clinical responsibilities the next day.