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Integrated Marketing Communication (IMC) has been regarded primarily as a marketing concept. However, as an ever more dominant context for communication management, IMC presents opportunities for public relations scholarship's contributions to the discipline, in spite of IMC's recognized threats. This article, which outlines the state of the fields of IMC and public relations literature, proposes the way public relations roles in relationship cultivation and organizational behavior uniquely contribute to IMC, and, at the same time, establish management roles for public relations. This article also addresses three challenges facing public relations research in integration by providing a better definition of IMC, establishing relationship cultivation as a critical point in the theoretical convergence of public relations and IMC, and providing a framework through which to conceptualize communication structures.

The emerging integrated environment for communication functions has put public relations in a potentially compromising position. In particular, literature reviews reveal scholar concerns about an inferior technical role for public relations practitioners. The question of integrating communications may be a question of power: whether the public relations function enacts influence, authority, or capacity to affect decision-making within an integrated organization. This study explores perceptions of 20 public relations professionals in an integrated communication structure. Results show that public relations may gain the ability to enact influence through social media acumen and the interconnected structure of communications, in which practitioner expertise, information, and knowledge may lead to more influence.

Research on global public relations is heavily focused on interpreting practice through the lenses of dominant US ideology. This is particularly the case for analyses of professional communication and public relations in Europe. This research explores the development and current practice of public relations in Spain, a country that has received little attention in global public relations research, but which has followed a unique path of public relations development. The context of Spanish public relations raises questions about the ability of researchers to broadly apply the principles of Excellence to a country’s public relations, and this study uncovers unique cultural principles that fall outside the purview of public relations in Spain, including models that emphasize creativity and improvisation. Perhaps even more importantly, this research reveals that Spanish communication professionals may be operating under a false standard of Excellent public relations, having translated normative US models into a mistaken conceptualization that communications exist as prescribed in the United States

Communication integration, a priority in strategic communication management, is at a crucible in its development. Until now, most research has considered integration a program of centralized control and has explored the impact of messaging and media that are coordinated for strategic impact. Underexplored are the internal implications of a concept that requires organizational change and stands to redefine functional boundaries. This study identifies the social, cultural, and interpretive influences of communication integration in a case of integration.

BACKGROUND Scoliosis surgery is often associated with substantial blood loss, requiring fluid resuscitation and blood transfusions. In adults, dynamic preload indices have been shown to be more reliable for guiding fluid resuscitation, but these indices have not been useful in children undergoing surgery. The aim of this study was to introduce frequency-analyzed photoplethysmogram (PPG) and arterial pressure waveform variables and to study the ability of these parameters to detect early bleeding in children during surgery. METHODS We studied 20 children undergoing spinal fusion. Electrocardiogram, arterial pressure, finger pulse oximetry (finger PPG), and airway pressure waveforms were analyzed using time domain and frequency domain methods of analysis. Frequency domain analysis consisted of calculating the amplitude density of PPG and arterial pressure waveforms at the respiratory and cardiac frequencies using Fourier analysis. This generated 2 measurements: The first is related to slow mean arterial pressure modulation induced by ventilation (also known as DC modulation when referring to the PPG), and the second corresponds to pulse pressure modulation (AC modulation or changes in the amplitude of pulse oximeter plethysmograph when referring to the PPG). Both PPG and arterial pressure measurements were divided by their respective cardiac pulse amplitude to generate DC% and AC% (normalized values). Standard hemodynamic data were also recorded. Data at baseline and after bleeding (estimated blood loss about 9% of blood volume) were presented as median and interquartile range and compared using Wilcoxon signed-rank tests; a Bonferroni-corrected P value

This paper addresses the challenge to differentiate public relations scholarship from other related communication disciplines (i.e., marketing, advertising, communication studies) by examining the concept of the stakeholder–organization relationship and public relations’ unique contributions therein. This paper proposes that public relations scholars move beyond discussing relationship attitudes and examine the central concept of a relationship, which comprises mutual orientation around a common interest point and the multiplicity of stakes and stakeholders. Research imperatives in the integration of relationship stakes and the value of social media in relationship analysis stand to further differentiate public relations from marketing.

Integrated communication has been discussed as both a process and a concept. On the one hand it is mechanical, through message and image matching, channel management, and measurement. On the other hand, it is also conceptual, based on a unique organizing philosophy that underscores communication mechanics. The latter, which can be termed “the spirit” of integration, has received little attention in the literature in spite of its influence on communication. This article proposes contextual variables that underscore and facilitate integration, including flexibility, adaptation, an open social system, and other informal processes. The article concludes by illustrating these contextual variables in the integrated communication efforts at a nationally-ranked hospital.

The authors report a case in which multilevel thoracic pedicle subtraction osteotomy (PSO) was performed to correct post-laminectomy kyphotic deformity in a 9-year-old boy presenting with worsening lower-extremity neurological deficits. Five years prior to presentation, the patient underwent multilevel thoracolumbar laminectomies for resection of an atypical teratoid/rhabdoid tumor (AT/RT), a rare lesion that typically occurs intracranially and has a poor prognosis, making this particular presentation unusual and the patient's subsequent postoperative course remarkable. No fusion was undertaken at the time of resection, given the patient's age and presumptive poor prognosis. Over the next 5 years, the patient developed progressive thoracolumbar kyphotic deformity, with a Cobb angle greater than 110°, despite bracing, and bilateral lower-extremity weakness requiring ankle-foot orthotics for continued ambulation due to progressive foot drop. Worsening gait and the onset of respiratory issues prompted surgical intervention. Multilevel thoracic PSO and thoracolumbar fusion were performed, resulting in improved lower-extremity function and correction of the kyphotic deformity to approximately 65°. This report outlines an unusual AT/RT presentation and postoperative course and also discusses literature related to PSO within the context of pediatric kyphotic deformity. The authors' experience supports the use of multilevel PSO with fusion as a potential treatment option for significant pediatric thoracolumbar kyphotic deformity requiring surgical correction.

Spinal muscular atrophy is a genetic disorder that compromises motor strength and function and typically manifests in childhood. Patients with significant involvement will often develop scoliosis of neuromuscular origin as young children. In the past, brace treatment was of minimal benefit in halting curve progression and frequently added to respiratory compromise. Early spinal fusion surgery would limit trunk or sitting height and impair normal lung development. The strategy of using the growing rod distraction technique to permit longitudinal spinal growth while managing the spinal deformity has emerged as a viable means of managing scoliosis and spinal deformity in this challenging patient population.

PurposeThe purpose of this paper is to progress research on integrated communication management from its current debates on definitions and normative models to research‐based understanding of how integration works and is implemented at an organisation with a high level of integration. Also, the paper seeks to provide insights for communication managers on implementing successful integrated communication programs.Design/methodology/approachThis research incorporated a qualitative single case study of an exemplary organisational case of integrated communication, using three data sources: depth interviews, participant observation, and document analysis.FindingsCommunication integration operates organically, through cross‐functional connections and knowledge sharing and facilitated by an open organisational structure whereby integration occurs naturally.Research limitations/implicationsThough other configurations may exist in high‐functioning integrated programs, this study provides a new direction for theory development, and fills a need in scholarship to identify the interactions that integration creates.Practical implicationsThis research provides research‐based learning on integrated communication management and implementation, and includes steps to establish a successful integrated program.Originality/valueThe paper will be of special interest to strategists, managers, and practitioners for improving communication processes. It also fills a need in the literature to progress understanding from definition debates to the interworking of communication functions.

Inserts are used to transfer localized loads to structures made of sandwich composites. Stress concentrations near inserts are known to cause failures in sandwich panels. Experimental insert pull-out tests show that the load to failure can vary by 20% between batches of sandwich panels. Clearly, uncertainties in the mechanical properties of core and adhesive potting materials have to be accounted for in the optimal design of inserts in sandwich composites. In this paper, we use an one-dimensional computational model of an insert in a homogenized honeycomb sandwich panel to explore the utility of reliability methods in design. We show that the first-order reliability method (FORM) produces accurate estimates of loads that lead to low failure probabilities. We also observe that FORM is sensitive to the failure criteria and may not converge if the failure surface is not smooth and convex.

Musculoskeletal disorders in children are common and comprise 20% to 30% of the complaints observed by primary care physicians. Most primary care physicians prefer to refer patients with pediatric musculoskeletal conditions to the pediatric orthopaedic surgeon; most of whom are treated nonoperatively. Pediatric orthopaedic surgeons are well trained to provide efficient, cost-effective, and definitive quality care. This article supports the supposition that pediatric orthopaedic surgeons are the primary care physicians for children with musculoskeletal disorders. This article focuses on the primary clinical responsibilities of the pediatric orthopaedic surgeon, describes the value of this practice, and contrasts their responsibilities from that of other orthopaedic subspecialties.

This article was updated on January 31, 2011, because of a previous error. In the Abstract (page 252), [Table I][1] (page 254), and the Results section (page 257), the conversion of Fahrenheit into Celsius was incorrect. In all locations, the values that had previously read “>101.5°F (>40.6°C)” now read “>101.5°F (>38.6°C)”. Background: The present study was designed to evaluate the prevalence of Lyme arthritis in children who had a joint aspiration at a tertiary care children’s hospital in an endemic area and to identify clinical factors useful to differentiate Lyme arthritis from septic arthritis at the time of the initial presentation. Methods: The records of all children with an age of eighteen years or less who were managed with aspiration for joint effusions at our institution from 1992 to 2009 were reviewed. Data collection included a review of aspirates; an analysis of cell count, culture results, and hematological inflammatory markers; and a review of surgical intervention. Results: A total of 506 joint aspirations were analyzed. One hundred and fifteen aspirations were excluded. In the remaining group of 391 patients, 123 (31%) were subsequently diagnosed with Lyme arthritis. Fifty-one patients had culture-positive septic arthritis. The two cohorts were significantly different in terms of the presence of a fever of >101.5°F (>38.6°C) at the time of presentation, the refusal to bear weight, the peripheral white blood-cell count, and joint fluid cell count. The erythrocyte sedimentation rate and the C-reactive protein level were not significantly different between the two cohorts. Multivariate analysis demonstrated that refusal to bear weight was the strongest predictor of the diagnosis of septic arthritis over Lyme arthritis. Conclusions: For any child presenting with a joint effusion in a Lyme-endemic area of the Northeastern United States, the likely prevalence of Lyme arthritis is 31% overall and 45% in the presence of knee effusion. Children with joint effusions resulting from Lyme disease are more likely to have knee involvement, a lower peripheral white blood-cell count, and a lower joint fluid cell count, and they are less likely to have fever or complete refusal to bear weight, when compared with children with septic arthritis. Level of Evidence: Diagnostic Level II. See Instructions to Authors for a complete description of levels of evidence. [1]: #T1

Social media and communication technology have shifted the power of communication from public relations practitioners to social media users who may not have a recognized role or defined interest in an organization. What results is a social model of public relations in which traditional public relations responsibilities are distributed to social media users, and which depends on interactivity, legitimacy, and a user's social stake. This study explores social public relations through a qualitative analysis of user involvement on Twitter regarding relief efforts to support Haiti following the 7.0 earthquake that hit Port-Au-Prince in January, 2010. This analysis of Twitter posts also expands understanding of interactivity online and demonstrates social media user fulfillment of public relations objectives.

Summary:Ankle fractures occur frequently in the pediatric population with the distal tibia and fibula representing one of the most common sites for physeal injury. A clinician must hold a high index of suspicion for a possible physeal fracture in children versus a simple sprain/strain as in adults.

1. Brian G. Smith, MD* 1. *Associate Professor, Department of Orthopaedics, Yale University, New Haven, CT After completing this article, readers should be able to: 1. Recognize and distinguish congenital clubfoot from metatarsus adductus. 2. Understand treatments and approaches to pes planovalgus or flatfoot. 3. Describe the natural history of torsional lower extremity deformities in children. 4. Discuss the differential diagnosis of idiopathic toe walking in children. Congenital talipes equinovarus or clubfoot is one of the oldest known congenital deformities, and its diagnosis and treatment date back to the time of Hippocrates. With a personal experience of clubfoot treatment over the past 50 years, Ignacio Ponseti from the University of Iowa has maintained that careful serial manipulation and casting followed by a percutaneous heel cord release yields better outcomes than the more extensive posteromedial release performed commonly in the past 2 decades. ### Epidemiology Clubfoot occurs in about 1 in 1,000 live births and is more common in certain races or ethnic groups. For example, among South Pacific natives, the incidence of clubfoot is 7 per 1,000. Involvement is bilateral in about 50% of patients, and there is a male predominance of 2:1. ### Pathogenesis The precise pathogenesis of congenital clubfoot remains unclear. This complex disorder possibly involves genetic, neurologic, muscular, and intrauterine compression influences. A genetic predisposition exists, but a specific genetic cause has not been identified at this time. ### Physical Findings and Presentation Clubfoot may be identified by prenatal ultrasonography as early as 12 weeks of gestational age. Definitive diagnosis is by clinical examination after birth and is characterized by the four components of clubfoot: equinus positioning, cavus positioning, metatarsus adductus, and hindfoot varus (Fig. 1). Figure 1. Congenital club foot, demonstrating equinus (A) and cavus positioning (B), metatarsus adductus (C), and hindfoot varus (D). On physical examination, the foot is resistant to passive correction of the fixed hindfoot varus and typically maintains a rigid equinus position. The hindfoot involvement separates clubfoot from metatarsus adductus. Also in …

Preventing avascular necrosis following surgical management of pediatric slipped capital fernoral epipysis Is a critical goal. The direct intraosseous pressure monitor is a readily availahie- and affordabIe technique that can easily be used by surgeons around the world.

Detection of relapse in acute lymphoblastic leukemia (ALL) is essential for proper management. However, immunophenotypic detection of relapse by flow cytometry in B-lineage ALL can be confounded by several factors, including lack of a unique immunophenotype and modulation of aberrant phenotypes after treatment. We hypothesized that flow cytometric DNA ploidy analysis may detect relapse in aneuploid ALL cases that might be missed by flow immunophenotyping. We retrospectively studied ALL cases at our institution between 1991 and 2003 (n = 114). Aneuploid populations were present at diagnosis in 32% of all patients. Sixty-five percent of all patients had "normal" leukemic immunophenotypes, defined as being similar to normal precursor B-cells, while 35% had "aberrant" immunophenotypes with myeloid or T antigen co-expression. In ALL cases that were originally aneuploid, follow-up ploidy-analysis detected relapsed disease in all cases which were also detected by flow immunophenotyping, suggesting that ploidy analysis is highly sensitive for detecting ALL relapse. However, in 5 cases in which the diagnosis of relapse could not be reliably made by flow immunophenotyping, ploidy analysis successfully detected aneuploid cells, i.e., relapse, in all five; these included 3 patients with normal and 2 with aberrant original immunophenotypes. These results suggest that it may be beneficial to perform ploidy analysis as an adjunct to flow immunophenotyping in following patients with B-lineage ALL who demonstrate aneuploidy at diagnosis.

STUDY DESIGN A retrospective cohort study. OBJECTIVE The aim of this study was to determine the incidence and risk factors for short-term morbidity following posterior spinal fusion (PSF) for neuromuscular scoliosis (NMS). SUMMARY OF BACKGROUND DATA NMS is a challenging spinal deformity for which PSF is often recommended. There is a lack of information on risk factors for short-term adverse outcomes after PSF for NMS. METHODS Patients who underwent PSF for NMS during 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database. Patient characteristics were tested for association with adverse events, infectious complications, extended length of stay (LOS), and readmission using multivariate regression. RESULTS Of the 940 NMS patients identified, 133 (14.1%) had an adverse event and 99 (10.5%) had a severe adverse event. American Society of Anesthesiologists (ASA) classification ≥3 was found to be the only independent risk factor for any adverse event (relative risk [RR] 2.2, P = 0.012) and severe adverse events (RR 2.5, P = 0.008). Infectious complications were associated with body mass index (BMI)-for-age ≥95th percentile (RR 2.8, P = 0.005), ASA classification ≥3 (RR 5.9, P = 0.003), and instrumentation to the pelvis (RR 1.8, P = 0.039).A total of 254 patients (27%) spent longer than a week in the hospital postoperatively, and ASA classification ≥3 (RR 2.3, P < 0.001), preoperative seizure disorder (RR 1.4, P = 0.002), previous cardiac surgery (RR 1.6, P = 0.004), operative time ≥470 minutes (RR 1.8, P < 0.001), and ≥13 levels instrumented (RR 1.9, P = 0.001) were associated with extended LOS.Seventy-six patients (8.1%) were readmitted, and BMI-for-age ≥95th percentile (RR 1.8, P = 0.033) was the only risk factor found for readmission. CONCLUSION The identified factors associated with poor short-term outcomes after PSF for NMS can be used as benchmark data, be useful for optimizing patient care, and can inform future studies in these patients. LEVEL OF EVIDENCE 3.

Disparity in the treatment of various medical conditions in patient groups with differing racial and economic backgrounds has increasingly been reported. This paper examines the relationship between baseline racial and economic factors and the treatment of pediatric long-bone fractures. The 2000 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) was used to retrospectively examine the incidence and treatment of pediatric fractures. Data were included for supracondylar humerus (n = 2,957), femoral shaft (n = 1,726) or radius and ulna forearm fracture (n = 828) as their primary diagnosis were studied. Hispanic (78%) and black (82%) patients were more likely to receive closed reduction with internal fixation (percutaneous pinning) of supracondylar humerus fractures than whites (73%, P = 0.02). Despite a fairly large sample size, differences in treatment of supracondylar humerus fractures across primary payer or income groups were not statistically significant. Patients with femur fractures and private insurance were more likely to be treated with an external fixation device (7.2%) than patients in the Medicaid (3.8%) or self-pay (4.5%) groups (P = 0.015). No statistically significant difference was found in the treatment of forearm fractures across racial, primary payer or income groups. Racial and economic disparity is an important issue in medicine today. This study did demonstrate statistically significant differences in the treatment of pediatric supracondylar humerus across racial groups, with Blacks and Hispanics being more likely to receive percutaneous pinning of these injuries than Whites. Private insurance patients were also more likely to have femoral shaft fractures treated with an external fixator device than patients with Medicaid or self-pay as their primary payer. However, the clinical significance of these differences is not clear. Further research is needed to gain a more complete understanding of disparities in medicine, and their etiologies, in order to work towards optimizing the quality of medical care for all patient groups.

Both-bone forearm fractures of the radius and ulna are a common injury in children. Closed reduction and casting has historically been the primary means of treatment in over 90% of these fractures. Unstable and irreducible fractures, however, often pose a therapeutic challenge, with little data available to compare outcomes. The authors performed a retrospective review of 50 children with both-bones fractures treated with closed reduction and cast immobilization, open reduction and internal fixation (ORIF), or intramedullary (IM) nailing. Complications were tabulated and separated by treatment modality and subdivided into minor/major complications. Statistical regression was performed. There were 54 operations in 50 patients with both-bones fractures. All fractures healed within 8 to 10 weeks, except for two delayed unions and one nonunion. The complication rate was 5% for closed treatment, 33% for ORIF, and 42% for IM nailing. Complication rates were significantly different between the closed and operative groups. When comparing treatments in pediatric both-bones fractures, there are significantly more complications with operative techniques. Patients with ORIF had more major complications, often requiring a return to the operating room. IM nailing, when done correctly, is as acceptable and safe a form of treatment.

The propensity for hip dislocation in patients with spinal muscular atrophy (SMA) is well documented, but the appropriate treatment and even the long-term outcome of these hips in this patient population have not been well defined. The purpose of this study was to determine by long-term follow-up the natural history of dislocated hips in a cohort of SMA patients from a single institution. Pain and functional difficulties (positioning, skin and perineal care) were assessed and radiographs were reviewed in a total of 41 patients with a mean of 18 years of follow-up. Seventeen of 82 hips (21%) were dislocated in 14 patients and 20 hips were subluxed. Only two patients had any hip pain at follow-up, one had difficulty with seating, and no patients had difficulty with perineal care. Given the small number of patients with symptoms with dislocated hips, observation rather than surgical intervention seems warranted in SMA patients with hip dislocation.

Background: The risk of a contralateral slip in patients who are first seen with a unilateral slipped capital femoral epiphysis has been reported to be 2335 times higher than the risk of an initial slip. The overall prevalence of bilaterality varies widely throughout the literature, with some reports indicating rates as high as 80%. This finding has led many authors to recommend prophylactic pinning of the contralateral asymptomatic hip in patients presenting with a unilateral slipped capital femoral epiphysis. Methods: A decision analysis model with probabilities for the occurrence of contralateral slip and for the severity of slip at different intervals of follow-up was used in the present study. These probabilities were compared with those for various outcomes when the contralateral hip is prophylactically pinned. Scores representing long-term outcome, according to the Iowa hip-rating system, were used in the model as a measure of utility. The probabilities of contralateral slip and the rates of slip severity were taken from large retrospective series. All meaningful clinical scenarios with regard to long-term outcome for the hip were considered in the model. Variables of uncertainty were subjected to sensitivity analyses in order to explore the effect on outcome over the range of plausible values for variables of interest. Results: The results showed a benefit in the long-term outcome for patients who had prophylactic pinning of the contralateral hip. The threshold level at which a benefit is obtained with prophylactic pinning is expressed according to the rates of sequential slip, rates of slips overlooked at follow-up, and complications associated with prophylactic pinning of the contralateral hip. Conclusions: The decision model shows that, when pooled data are used to predict probabilities of sequential slip, treatment of the contralateral hip with prophylactic pinning is beneficial to the long-term outcome for that hip. When considering prophylactic pinning of the contralateral hip, the clinician should use sound clinical judgment with respect to the age, sex, and endocrine status of the patient. Long-term follow-up studies are needed to establish the efficacy of prophylactic pinning, but the predictions in the present study, which are based on findings in the literature, support the safety of this procedure.

Back pain in the pediatric athlete is rare compared to the adult population. However, the diagnosis should be accurate as most have specific etiologies and treatment. Nearly 50% of the time, the cause of the pain is an injury to the pars interarticularis. A thorough history and careful physical examination should guide the physician to a working differential diagnosis. Based on this, appropriate laboratory and imaging work-up is pursued to arrive at a timely diagnosis and subsequent treatment regimen.

Purpose To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle. Methods We conducted a retrospective case review of 11 consecutive children and adolescents with an incarcerated medial epicondyle fracture after elbow dislocation. All patients underwent open reduction internal fixation using a similar technique. We characterized outcomes at final follow-up. Results Average follow-up was 14 months (range, 4–56 mo). All patients had clinical and radiographic signs of healing at final follow-up. There was no radiographic evidence of loss of reduction at intervals or at final follow-up. There were no cases of residual deformity or valgus instability. Average final arc of elbow motion was 4° to 140°. All patients had forearm rotation from 90° supination to 90° pronation. Average Mayo elbow score was 99.5. Four of 11 patients had ulnar nerve symptoms postoperatively and 1 required a second operation for ulnar nerve symptoms. In addition, 1 required a second operation for flexion contracture release with excision of heterotopic ossification. Three patients had ulnar nerve symptoms at final follow-up. Two of these had mild paresthesia only and 1 had both mild paresthesia and weakness. Conclusions Our results suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation leads to satisfactory motion and function; however, the injury carries a high risk for complications, particularly ulnar neuropathy. Type of study/level of evidence Therapeutic IV.

Blogging, though a personal medium for self-expression, has also become a channel for public relations to represent organizational interests. This study addresses blogger considerations of public relations in such a personal arena. Results show that as bloggers go through an evolutionary process of blogosphere introduction, community membership, and autonomy, which influences their content considerations and willingness to work with public relations practitioners.

We present a novel dielectric resonator (DR)-based resonant structure that accommodates aqueous sample capillaries in orientations that are either parallel (i.e., side-access) or perpendicular to the direction of an external (Zeeman) magnetic field, B 0 . The resonant structure consists of two commercially available X-band DRs that are separated by a Rexolite spacer and resonate in the fundamental TE 01δ mode. The separator between the DRs is used to tune the resonator to the desired frequency and, by appropriately drilled sample holes, to provide access for longitudinal samples, notably capillaries containing oriented, spin-labeled muscle fibers. In contrast to the topologically similar cylindrical TE 011 cavity, the DR-based structure has distinct microwave properties that favor its use for parallel orientation of lossy aqueous samples. For perpendicular orientation of a dilute (6.25 μM) aqueous solution of IASL spin label, the S / N ratio was at least one order of magnitude better for the side-access DR-based structure than for a standard TE 102 cavity. EPR spectra acquired for maleimide spin-labeled myosin filaments also revealed ca. 10 times better S / N ratio than those obtained with a standard TE 102 cavity. For the side-access DR with sample capillaries oriented either parallel or perpendicular to the external magnetic field, the Q - and filling factors are in good agreement with the theoretical estimates derived from the distribution of magnetic ( H 1 ) and electric ( E 1 ) components.

Background —Cardiopulmonary bypass (CPB) induces a systemic inflammatory response that causes substantial clinical morbidity. Activation of complement during CPB contributes significantly to this inflammatory process. We examined the capability of a novel therapeutic complement inhibitor to prevent pathological complement activation and tissue injury in patients undergoing CPB. Methods and Results —A humanized, recombinant, single-chain antibody specific for human C5, h5G1.1-scFv, was intravenously administered in 1 of 4 doses ranging from 0.2 to 2.0 mg/kg before CPB. h5G1.1-scFv was found to be safe and well tolerated. Pharmacokinetic analysis revealed a sustained half-life from 7.0 to 14.5 hours. Pharmacodynamic analysis demonstrated significant dose-dependent inhibition of complement hemolytic activity for up to 14 hours at 2 mg/kg. The generation of proinflammatory complement byproducts (sC5b-9) was effectively inhibited in a dose-dependent fashion. Leukocyte activation, as measured by surface expression of CD11b, was reduced ( P P =0.05) in patients who received 2 mg/kg. Sequential Mini-Mental State Examinations (MMSE) demonstrated an 80% reduction in new cognitive deficits ( P P Conclusions —A single-chain antibody specific for human C5 is a safe and effective inhibitor of pathological complement activation in patients undergoing CPB. In addition to significantly reducing sC5b-9 formation and leukocyte CD11b expression, C5 inhibition significantly attenuates postoperative myocardial injury, cognitive deficits, and blood loss. These data suggest that C5 inhibition may represent a novel therapeutic strategy for preventing complement-mediated inflammation and tissue injury.

Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) is an uncommon but potentially fatal complication of allogeneic stem cell transplantation. We report here two patients who underwent T cell-depleted mismatched-related stem cell transplantation for hematologic malignancies and required aggressive post-transplant immunosuppression for graft-versus host disease (GVHD). Both patients subsequently developed markedly elevated EBV-DNA titers in association with monoclonal, light chain-restricted B cell populations in the blood. Although immunosuppressive medications were rapidly tapered, neither patient could receive potentially curative therapy with unmanipulated donor-derived lymphocyte infusions (DLI) because of the substantial risk of severe GVHD. Therefore, both patients received repeated courses of rituximab, an anti-CD20 monoclonal antibody, in combination with irradiated DLI. This therapeutic strategy resulted in normalization of the elevated EBV-DNA titers and disappearance of the monoclonal B cell populations. Our results suggest that rituximab and possibly irradiated DLI played an important role in controlling early EBV-LPD in these two patients and may be an effective alternative therapeutic strategy for patients who develop EBV-LPD post transplant and are unable to receive unmanipulated DLI.

Hall, W. C. (2007). The right words: Great Republican speeches that shaped history. Hoboken, NJ: John Wiley & Sons. ISBN: 0-471-75816-7. $24.95 (cloth). “Words matter” (p. 1); so Hall begins his bo...

Multiple regression and logistic regression equations were derived for the prediction of hail size based on data from 1992 through 1994. The multiple regression equation was formulated to predict hail diameter. The logistic regression equation was developed to predict the probability of hail size greater than or equal to 1.9 cm in diameter. Variables used for this study consisted of vertically integrated liquid (VIL) computed from the Weather Surveillance Radar-1988 Doppler (WSR-88D) radar and convective parameters derived from the skew-T/Hodograph analysis and research program. Data were obtained from the Baltimore, Maryland/Washington D.C., WSR-88D radar and Dulles, Virginia, upper-air soundings. Numerous parameters were tested; however, only VIL, 85-kPa temperature, freezing level, and mean storm-relative inflow in the lowest 2-km were retained for the multiple regression equation. These four parameters were used as a base to derive the logistic regression equation, and this derivation process...

Background Although Lyme and septic arthritis of the knee may have similar clinical presentations, septic arthritis requires prompt identification and treatment to avoid joint destruction. We sought to determine whether synovial fluid cell counts alone can discriminate between Lyme, septic, and other inflammatory arthritis. Methods We conducted a retrospective cohort study of children aged 1 to 18 years with knee monoarthritis who presented to 1 of 2 pediatric emergency departments located in Lyme endemic areas. We included children who had both a synovial fluid culture and an evaluation for Lyme disease. Septic arthritis was defined as a positive synovial fluid culture or synovial fluid pleocytosis (white blood cell [WBC] ≥40,000 cells/μL) with a positive blood culture. Lyme arthritis was defined as positive Lyme serology without a positive bacterial culture. All other children were considered to have other inflammatory arthritis. We compared the synovial fluid counts by arthritis type. Results We identified 384 children with knee monoarthritis, of whom 19 (5%) had septic arthritis, 257 (67%) had Lyme arthritis and 108 (28%) had other inflammatory arthritis. Children with other inflammatory arthritis had lower synovial WBC and absolute neutrophil count, as well as percent neutrophils, than those with either Lyme or septic arthritis. There were no significant differences in the synovial fluid WBC, absolute neutrophil count, and percent neutrophils for children with Lyme and septic arthritis. Conclusions In Lyme endemic areas, synovial fluid results alone do not differentiate septic from Lyme arthritis. Therefore, other clinical or laboratory indicators are needed to direct the care of patients with knee monoarthritis.

Study design Prospective study. Objective Evaluate the impact of the distal fusion level on overall spine motion in patients with adolescent idiopathic scoliosis. Summary of background data In the surgical treatment of adolescent idiopathic scoliosis, the impact of incorporating a single additional distal lumbar fusion level on residual spinal motion is unclear. This study uses radiographs and computerized motion capture technology to determine whether the addition of a single lumbar level in a posterior fusion construct produces a detectable alteration in spinal motion. Methods Twenty-three patients with adolescent idiopathic scoliosis were evaluated with standing radiographs and computerized motion analysis preoperatively and 1 year after fusion. Patients were divided into 2 groups: L1-L2 group (distal fusion ended at L1-L2) and an L3 group (distal fusion ended at L3). Cobb angle, coronal vertical alignment, sagittal vertical alignment, thoracic kyphosis, and lumbar lordosis were measured from radiographs. Three-dimensional motion data were obtained for static standing and repeated bending or twisting motions. Statistical analysis was performed with Student t test, analysis of variance, and Fisher exact methods. Results Both the L1-L2 and L3 groups demonstrated loss of spinal motion compared with preoperative values. The L1-L2 group showed a significant loss of rotational motion but no significant loss of motion in the sagittal and coronal planes. The L3 group demonstrated significant loss of motion in both the coronal plane and the rotational plane. When the 2 groups were compared, the L3 group showed a significant loss of coronal plane bending (18° ± 10°, P = 0.002). Conclusion Distal extension of a posterior spinal fusion construct to include L3 results in a significant decrease in spine motion in at least one plane. Preservation of a single lumbar segment may improve overall spine motion in the short term and may have implications for the long-term health of the unfused spine. Level of evidence 3.

OBJECTIVE: Because Lyme and septic arthritis may present similarly, we sought to identify children with knee monoarthritis at low risk for septic arthritis who may not require arthrocentesis. METHODS: We performed a retrospective study of children with knee monoarthritis presenting to 1 of 2 pediatric centers, both located in Lyme disease–endemic areas. Septic arthritis was defined by a positive result on synovial fluid culture or synovial fluid pleocytosis with a positive blood culture result. Lyme arthritis was defined as a positive Lyme serologic result or physician-documented erythema migrans rash. All other children were considered to have other inflammatory arthritis. A clinical prediction model was derived by using recursive partitioning to identify children at low risk for septic arthritis, and the model was then externally validated. RESULTS: We identified 673 patients with knee monoarthritis; 19 (3%) had septic arthritis, 341 (51%) had Lyme arthritis, and 313 (46%) had other inflammatory arthritis. The following predictors of knee septic arthritis were identified: peripheral blood absolute neutrophil count ≥10 × 103 cells per mm3 and an erythrocyte sedimentation rate ≥40 mm/hour. In the validation population, no child with a absolute neutrophil count CONCLUSIONS: Laboratory criteria can be used to identify children with knee monoarthritis at low risk for septic arthritis who may not require diagnostic arthrocentesis.

We present a tunable Q‐band cavity for performing electron paramagnetic resonance and electron nuclear double resonance experiments at cryogenic temperatures. The resonator is a TE011 brass cavity with radio frequency and magnetic field modulation (100 kHz) posts inside the microwave resonator. These posts are located close to the central sample position and thereby enhance the effective modulation and radio frequency fields. The crucial novel design aspect is the provision for continuously tuning the cavity resonant frequency, even under pumped liquid helium conditions over a broad frequency range (≳2.0 GHz). Such a range will compensate for cooling‐induced cavity contraction, presence of cryogenic in the cavity, and insertion of high dielectric frozen aqueous samples. The tuning range is indispensable for use with present commercial Q‐band bridges whose low noise Gunn diode oscillators provide a small ∼50 MHz tuning range.

Current surgical treatment of idiopathic scoliosis involves the use of various segmental instrumentation. Various pedicle screws have allowed for improved correction. Although monoaxial screws have improved rotational control compared with polyaxial screws, their use may increase screw–bone interface or vertebral endplate forces if not inserted in an exactly straight trajectory. Uniaxial screws potentially decrease these forces while retaining the advantages of monoaxial screws with respect to better rotational control. The purpose of this study was to compare the vertebral endplate forces with monoaxial or uniaxial screws when being reduced to a rod. Thirty-two plastic, surrogate T11 vertebrae were prepared with monoaxial (n=16) or uniaxial (n=16) screws. Screw angles relative to inferior vertebral endplates were assessed with lateral radiographs. The vertebrae were fixed to a load cell, and loads were measured as the screw was reduced to a rod. Monoaxial screws demonstrated a linear progression of endplate force with increasing screw angle. Uniaxial screws demonstrated minimal endplate force until approximately 20°, coinciding with screwhead excursion angle. As this maximum excursion angle was passed, uniaxial screws demonstrated a force slope similar to the monoaxial screws. The measured endplate forces should be equivalent to forces at the screw–bone interface. The reduced force with uniaxial screws is expected to have less cranial–caudal plow potential as the screw is coupled to a rod for deformity correction. This could have potential implications for screw failure, especially in less dense bone.

Magnetic resonance imaging (MRI) was used to evaluate physeal fracture-separations in children soon after at-risk lower-extremity fractures. MRI scans taken during the "acute" period (within 10 days of fracture) resulted in a change in three of four of the Salter-Harris classifications from the injury radiographs. Twelve children had MRI scans performed in the "early" period (3-17 weeks following fracture). Physeal narrowing or tethering and the absence of Harris arrest lines were found in those patients who subsequently required late surgical intervention. Acute MRI provides the most accurate evaluation of the physeal fracture anatomy. Early MRI can demonstrate transphyseal bridging or altered arrest lines in physeal fracture before they become manifest on radiographs.

Background: Reduction of pediatric forearm fractures with the patient under sedation in the emergency department is a common practice throughout the United States. We hypothesized that the use of a mini-c-arm fluoroscopy device as an alternative to routine radiographs for evaluation of fracture reduction would (1) allow a more anatomic fracture reduction, (2) decrease the number of repeat reductions or subsequent procedures, (3) reduce overall radiation exposure to the patient, and (4) decrease the orthopaedic consultation time in the emergency department. Methods: A retrospective cohort analysis of 279 displaced forearm and wrist fractures treated with closed reduction and casting with the patient under sedation in the emergency department of a level-I pediatric trauma center was performed, and the data were compared with historical controls. One hundred and thirteen fracture reductions were assessed with a mini-c-arm device, and 166 fracture reductions were evaluated with radiographs. All patients had radiographs of the injury. Blinded, independent reviewers graded the quality of reduction for residual angulation and translation of the reduced fracture. Radiation exposure was determined by the average number of radiographs made through either modality. Emergency department and outpatient charts were reviewed to determine the total orthopaedic consultation time and the need for repeat reductions or operative intervention. Results: Pediatric forearm fractures undergoing closed reduction with assistance of the mini c-arm had a significant improvement in reduction quality (average angulation [and standard deviation], 6° ± 4° vs. 8 ± 6°; p = 0.02), a decrease in repeat fracture reduction and need for subsequent operative treatment (two [2%] of 113 fractures vs. fourteen [8.4%] of 166 fractures; p ≤ 0.0001), and a decrease in radiation exposure to the patient (mean, 14.0 ± 10.3 mrem vs. 50.0 ± 12.7 mrem). The average orthopaedic consultation time was decreased with use of a mini c-arm (28 ± 12 min vs. 47 ± 19 min, p < 0.001). Conclusions: Use of the mini c-arm to assist in the closed reduction of pediatric forearm and wrist fractures in the emergency department can improve the quality of the reduction, decrease the radiation exposure to the patient, and decrease the need for repeat fracture reduction or additional procedures. Mini-c-arm imaging can also decrease the average orthopaedic consultation time for fracture reduction. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

The growing influence of consumer-generated media (CGM), including blogs, online forums, podcasts, and other social media tools, has changed the environment in which public relations practitioners conduct campaigns for their clients and connect with their stakeholders. Rather than working solely with journalists to reach publics—practitioners may now become part of “the quirky blogging community” to influence the online conversations about their clients. This shifting media environment raises questions about the future practice of public relations, in particular, the strategies practitioners use to work with new media representatives (i.e. bloggers) who are inexperienced in media relations. Results of this study show that practitioner-blogger relations can be tracked on a continuum between impersonal mass message distribution to personal relationship-building, based on blogger experience with communication professionals. Furthermore, blogger exposure to promotion influences practitioners’ communication and negotiation strategies, including use of creative communication, creating win-win situations for bloggers, and emphasis on client interests in blogger relations.

Lyme disease is the most common tick-borne disease in the United States and Europe. Increased awareness of the clinical manifestations of the disease is needed to improve detection and treatment. In the acute and late stages, Lyme disease may be difficult to distinguish from other disease processes. The epidemiology and pathophysiology of Lyme disease are directly related to the Borrelia burgdorferi spirochete and its effects on the integumentary, neurologic, cardiac, and musculoskeletal systems. Lyme arthritis is a common clinical manifestation of Lyme disease and should be considered in the evaluation of patients with monoarticular or pauciarticular joint complaints in a geographic area in which Lyme disease is endemic. Management of Lyme arthritis involves eradication of the spirochete with antibiotics. Generally, the prognosis is excellent. Arthroscopic synovectomy is reserved for refractory cases that do not respond to antibiotics.