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OBJECTIVES This proposed systematic review will identify the existing evidence on medication-overuse headache in children and adolescents. BACKGROUND A number of medications have been shown to be effective for acute treatment of migraine in children and adolescents. However, patients may find they need to use their acute medications more frequently when migraine frequency is high. This has led to concern about their potential to develop medication-overuse headache. METHODS We will search PubMed, Embase, Web of Science, PsycINFO, and Cochrane databases from their inception to present time. We will also search conference proceedings of the last 4 scientific meetings of relevant societies and scan the reference lists of studies identified through the search. Study designs will include case series, cross-sectional, cohort, case-control, and interventional studies. Participants will include children and adolescents under 18 years of age with primary headache disorders. We aim to determine whether frequency of acute medication use is associated with headache frequency in children and adolescents. Outcomes of interest include: (1) headache frequency; (2) change in headache frequency, with time and in relationship to use of acute medications; and (3) headache-related disability. We will also review data addressing treatment/management of medication overuse or medication-overuse headache in children and adolescents. Relevant comparators will be withdrawal vs reduction of acute medication, initiation of preventive therapy vs no initiation with or without withdrawal of acute medication, and initiation of preventive therapy early vs late. Outcomes of interest include (1) days of acute medication use; (2) headache frequency; (3) change in headache frequency; and (4) headache-related disability. After screening for inclusion, 2 team members will independently review and extract relevant data, and any discrepancies will be resolved through discussion and arbitration. We will assess risk of bias using appropriate tools (Cochrane Risk of Bias for randomized controlled trials (RCT) and Newcastle-Ottawa Score for observational studies). Data will be summarized descriptively in text and tables. RESULTS This systematic review will provide an overview of the available evidence on medication-overuse headache in children and adolescents. CONCLUSIONS Findings from this review will aid clinicians by clarifying for them the current state of the evidence base, and will inform design of future research on this topic.

Predicting species responses to climate change is a central challenge in ecology. These predictions are often based on lab-derived phenomenological relationships between temperature and fitness metrics. We tested one of these relationships using the embryonic stage of a Chinook salmon population. We parameterised the model with laboratory data, applied it to predict survival in the field, and found that it significantly underestimated field-derived estimates of thermal mortality. We used a biophysical model based on mass transfer theory to show that the discrepancy was due to the differences in water flow velocities between the lab and the field. This mechanistic approach provides testable predictions for how the thermal tolerance of embryos depends on egg size and flow velocity of the surrounding water. We found support for these predictions across more than 180 fish species, suggesting that flow and temperature mediated oxygen limitation is a general mechanism underlying the thermal tolerance of embryos.

Introduction Chronic containment of a ruptured abdominal aortic aneurysm (AAA) is a rare clinical phenomenon that is often accompanied by abstract symptomatology, delayed diagnosis, and treatment. We describe a case of chronic contained rupture (CCR) in a hemodynamically stable and asymptomatic patient detected by duplex ultrasound (DU). Patient Description A 71-year-old white male presented to our medical facility to establish cardiac care for newly diagnosed pleural effusion and bilateral lower extremity edema. Physical examination revealed prominent abdominal aortic pulsations. An abdominal DU was ordered to evaluate for an AAA. Methods An abdominal DU examination was performed utilizing a Philips iU22 xMATRIX Ultrasound System equipped with a C5–1 MHz PureWave transducer. The aorta, common iliac and external iliac arteries were evaluated with gray scale, color, and spectral Doppler applications. Imaging Results The DU confirmed the presence of a 5.6 cm × 5.7 cm infrarenal AAA. The lumen was noted to have irregularities and multiple avascular hypoechoic lesions that were reproducible in multiple imaging planes. Computed tomography (CT) confirmed the presence of the 4.8-cm aneurysm accompanied by a 5.6 cm × 4.0 cm multi-lobular fluid collection extending into the mesentery. Active extravasations were not visualized during contrast administration; nevertheless, the appearance of the irregularity was suspicious of aneurysm leak resulting in evolving hematoma. The CCR was treated with a bifurcated intraluminal stent graft. Conclusion This case describes an extremely rare rupture complication that may be present during routine evaluation of the abdominal aorta. Because of its rarity in case presentation, standardized protocol for detection and sonographic presentation remain undocumented.

Zircons are a well-known candidate waste form for actinides and their radiation damage behaviour has been widely studied by a range of techniques. In this study, well-characterised natural single crystal zircons have been studied using Positron Annihilation Lifetime Spectroscopy (PALS). In some, but not all, of the crystals that had incurred at least half of the alpha-event damage of ∼1019 α/g required to render them structurally amorphous, PALS spectra displayed long lifetimes corresponding to voids of ∼0.5 nm in diameter. The long lifetimes corresponded to expectations from published Small-Angle X-ray Scattering data on similar samples. However, the non-observation by PALS of such voids in some of the heavily damaged samples may reflect large size variations among the voids such that no singular size can be distinguished or. Characterisation of a range of samples was also performed using scanning electron microscopy, optical absorption spectroscopy, Raman scattering and X-ray scattering/diffraction, with the degree of alpha damage being inferred mainly from the Raman technique and X-ray diffraction. The observed void diameters and intensities of the long lifetime components were changed somewhat by annealing at 700 °C; annealing at 1200 °C removed the voids entirely. The voids themselves may derive from He gas bubbles or voids created by the inclusion of small quantities of organic and hydrous matter, notwithstanding the observation that no voidage was evidenced by PALS in two samples containing hydrous and organic matter.

Case: A 19-year-old woman sustained a traumatic hip injury with dislocation and fractures of the femoral head and neck. A modified Gibson approach with trochanteric flip osteotomy was performed. We describe the management technique used to reduce and stabilize the femoral head and neck fractures during surgical hip dislocation. The stabilization of the femoral head to the femoral neck was performed primarily in a retrograde manner. Conclusion: Retrograde fixation of combined femoral head and neck fractures can be safely performed during surgical hip dislocation with satisfactory results.

Case: A 36-year-old bicyclist sustained an open anterior hip dislocation through the scrotum after being struck by 2 motor vehicles. There was no osseous injury present. The hip was irreducible by closed means and required open reduction via a Smith-Petersen approach. Postoperatively, the patient did not develop osteonecrosis of the femoral head but did have signs of mild osteoarthritis and heterotopic ossification. Conclusion: Open anterior hip dislocation into the scrotum is an exceedingly rare injury. Closed reduction can be attempted, but open intervention is often required. A Smith-Petersen approach allows visualization for reduction and does not violate the vascularity to the femoral head.

Traditionally, the time-to-fill metric is used as a scorecard for past performance. An organization may use time to fill to assess the performance of its internal recruiting team, or as a way to set service level agreements with outsourced recruiting partners. By first developing a set of quantifiable job features and then applying survival analysis to historical time-to-fill data, we build a predictor to assess the probability a job will remain open beyond its target time-to-fill date, enabling us to commit additional resources to high risk jobs at the beginning of the recruiting process.

Following the World Health Organization (WHO) recommendation, Australia conducts surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age as the main method to monitor its polio-free status. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2014, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.4 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Non-polio enteroviruses can also be associated with AFP and enterovirus A71 and echovirus types 6 and 7 were identified from clinical specimens from cases of AFP. Globally, 359 cases of polio were reported in 2014, with the 3 endemic countries, Afghanistan, Nigeria and Pakistan, accounting for 95% of the cases. In May 2014, the WHO declared the international spread of wild poliovirus to be a public health emergency of international concern and has since maintained recommendations for polio vaccination of travellers from countries reporting cases of wild polio.

Background Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p

Background Torso bleeding remains the most preventable cause of post-traumatic death worldwide. Remote damage control resuscitation (RDCR) endeavours to rescue the most catastrophically injured, but has not focused on prehospital surgical torso hemorrhage control (HC). We examined the logistics and metrics of intraperitoneal packing in weightlessness in Parabolic flight (0g) compared to terrestrial gravity (1g) as an extreme example of surgical RDCR. Methods A surgical simulator was customized with high-fidelity intraperitoneal anatomy, a "blood" pump and flowmeter. A standardized HC task was to explore the simulator, identify "bleeding" from a previously unknown liver injury perfused at 80 mm Hg, and pack to gain hemostasis. Ten surgeons performed RDCR laparotomies onboard a research aircraft, first in 1g followed by 0g. The standardized laparotomy was sectioned into 20-second segments to conduct and facilitate parabolic flight comparisons, with "blood" pumped only during these time segments. A maximum of 12 segments permitted for each laparotomy. Results All 10 surgeons successfully performed HC in both 1g and 0g. There was no difference in blood loss between 1g and 0g (p = 0.161) or during observation following HC (p = 0.944). Compared to 1g, identification of bleeding in 0g incurred less "blood" loss (p = 0.032). Overall surgeons rated their personal performance and relative difficulty of surgery in 0g as "harder" (median Likert, 2/5). However, conducting all phases of HC were rated equivalent between 1g and 0g (median Likert, 3/5), except for instrument control (rated slightly harder, 2.75/5). Conclusion Performing laparotomies with packing of a simulated torso hemorrhage in a high-fidelity surgical simulator was feasible onboard a research aircraft in both normal and weightless conditions. Despite being subjectively "harder," most phases of operative intervention were rated equivalently, with no statistical difference in "blood" loss in weightlessness. Direct operative control of torso hemorrhage is theoretically possible in extreme environments if logistics are provided.

The free-volume of a matrix is a fundamental parameter that relates to its molecular and bulk characteristics, such as crystalline change and glass transition behavior. In starch-based bionanocomposite, we investigated the effect of the addition of montmorillonite nanoclay (MMT) and food plasticizers (glycerol and sorbitol) on changes of molecular pore size (including pore volume and pore distribution) using the Positron Annihilation Lifetime Spectroscopy (PALS) method. The results demonstrated counter-intuitive impact of MMT on the total free-volume where the total free-volume increased within the polymeric matrix. When compared to the pure matrix free-volume, the addition of MMT also resulted in the appearance of a broader distribution of the void sizes. The plasticizers, on the other hand, apparently occupied the void spaces, and therefore decreased the free-volume of the matrix. Further, together with the small angle X-ray scattering (SAXS) analysis, we concluded that this is a result of interplay between the plasticizer-plasticizer interactions and the polymer–plasticizer interactions. For example, in the starch/glycerol/MMT system, the pore radii slightly decrease upon the increasing of glycerol amount (OG210 = O.27 nm and OG220 = 0.26 nm), but the relative weight did increase with the increasing glycerol concentration. However, increasing the sorbitol amount increased the pore size from 0.23 nm(OS210) to 0.28 nm(OS220). Furthermore, the addition MMT in the OS010 system, promote the emergence of a new dateable pore radius(0.90 nm), and the total weight significantly increased from 13.70 (OS010) to 19.5% (OS210). We suggest that the pore variation (size and distribution) due to the MMT and plasticizers are reflected in the polymer glass transition and crystallinity because ultimately, the, total free-volume is a reflection of level of interactions existing within the bulk of these nanocomposites.

Compte tenu de la croissance remarquable de la recherche sur l'incapacite et la readaptation au cours de la derniere decennie, il est imperatif d'appuyer la recherche de la plus grande qualite possible. Comme le financement de la recherche a subi des compressions, la recherche sur la readaptation est maintenant sous le microscope comme jamais auparavant et il est crucial de nous montrer sous notre meilleur jour. Afin de garantir la qualite de la recherche sur l'incapacite et la readaptation qui est publiee, les 28 journaux de readaptation qui publient simultanement cet editorial (voir la rubrique remerciements) ont convenu d'adopter une position plus agressive au sujet de l'usage de lignes directrices sur les rapports*. Les rapports de recherche doivent contenir suffisamment d'information pour permettre aux lecteurs de comprendre comment une etude a ete concue et realisee, y compris les definitions des variables, les instruments et autres moyens de mesure, ainsi que les techniques d'analyse1. Dans le cas des articles de critique, que la critique soit systematique ou narrative, il faut informer les lecteurs de la justification et des details qui sous-tendent la strategie de recherche dans les publications. Il arrive trop souvent que des articles ne precisent pas leur norme d'inclusion et leurs criteres d'evaluation de la qualite de l'etude2. Comme le signalait Doug Altman, coauteur de l'enonce sur les normes consolidees relatives aux rapports sur les essais (CONSORT) et chef du Centre de la statistique en medecine a l'Universite d'Oxford, « Un bon rapport ne constitue pas un supplement facultatif : c'est un element essentiel d'une bonne recherche3 ».

In this work, a MEMS-based directional acoustic sensor operating underwater is explored. The sensor operates in a narrow frequency band centered at the mechanical resonance. The studied sensor consists of two wings coupled by a bridge which is pivoted to a substrate. Interdigitated comb finger capacitors attached to the wings allow for electronic readout of the mechanical oscillations, which are proportional to the sound direction of incidence. For underwater testing, the sensor was immersed in silicone oil, contained by a urethane housing with near unity acoustic transmission. The characteristics of the MEMS sensor both in air and silicone oil were analyzed using finite element modeling. Performance of the sensor was characterized both in air and underwater. Measured underwater frequency response showed that the resonance frequency of the sensor was shifted to a lower value compared to that of in air. This is primarily due to mass loading from the silicone oil used for immersing the sensor. Peak sensitivity of the sensor was found to be about 6 mV/Pa or –165 dB re 1 V/mPa. The sensor showed good directional response with a dipole pattern. Results show the potential of MEMS sensors for underwater applications to detect the bearing of sound sources.

Solid-state batteries are widely considered the most promising candidate to begin displacing conventional lithium ion batteries for electric vehicles and consumer electronics in the next decade, but several challenges remain. High energy density and long cycle must still be demonstrated in large automotive-relevant cells. Low cost and scalable production also need to be proven. Solid Power is working to meet these challenges by combining a sulfide-based solid electrolyte, a nickel-rich NMC cathode, and a lithium metal anode in cells that surpass conventional lithium ion in energy density and safety. Solid Power and its collaborators have developed a suite of solid electrolytes, cathode materials, Nb-free surface treatments and production processes that deliver excellent energy density and cycle life in laboratory-scale cells. The attached figure shows early cycling performance for a recent 2 cm2 laboratory type lithium metal cell at 70°C and C/10 rate with a 4.3V charge voltage. This cell delivers 193 mAh/g based on surface-treated LiNi0.6Mn0.2Co0.2O2 (NMC622) mass and retains 191 mAh/g after 80 cycles at 100% depth-of-discharge. The excellent cycling stability of this composite cathode comes from improved electrochemical stability at the cathode-electrolyte interfaces as well as the ability to accommodate the volume changes of the NMC during cycling. Now focus is on scaling of both cell capacity and production throughput. Cells are currently produced up to 250 mAh, and larger cells up to 20 Ah in capacity with improved performance are planned for the next year as Solid Power’s pilot scale production line is completed in early 2019. This production line is built on low-cost processes and equipment that mirror lithium ion production and will be capable of producing up to 1 MWh per month when fully operational. Remaining challenges for Solid Power include demonstrating long life with lithium metal anodes in full-scale cells and working toward low-temperature operation. Figure 1

That's where the filthy rich live, on that side of the wall.* You can't even see the houses for the forest. There's a house over there that's like 68,000 [square] feet man. —Medina1 *Research was p...

Objective: Osseointegrated hearing implants have been readily available and extensively used in developed countries for over twenty years. Despite a great need for this technology, use of these implants in developing countries has been limited due to the prohibitive cost of the surgical implant system as well as the implant devices themselves. To address this problem we have developed a drill and implant system that mimics the currently available instrumentation using materials that are readily available at a fraction of the cost. Study Design: Proof of Concept. Methods: The construction of the drill and implant system will be described. Testing of the system so that it adhered to Cochlear’sTM Bone anchored hearing aid system specifications including the drill speed and torque settings were measured. Temperature readings were also recorded during procedures performed on human cadaveric temporal bones. Results: The speed of the drill with the guide drill and countersink drill bits ranged from 1400 revolutions per minute (rpm) to 2300 rpm’s. The temperature change of the room temperature temporal bones varied from 0 degrees to +0.2 degrees Fahrenheit during the drilling process with both drill bits. All five implants were stable in the cadaver bone after being checked for initial stability. Conclusion: This low cost implant system may make the BAHA technology more easily available to developing countries pending future studies with animal models.

Background Calcaneal fractures are commonly seen and treated in the emergency department. There are subsets of calcaneal fractures that pose a high risk to the adjacent soft tissue of the heel and can result in full-thickness tissue necrosis. Objective To identify which calcaneal fractures need to be managed within hours and triaged to the orthopedic team and which can be temporized in a neutral or plantarflexed ankle splint and seen in an outpatient setting. Discussion Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Communication with the orthopedic surgery service is essential and splinting in a specific manner is important to stabilize the soft tissue envelope. Conclusion Recognizing the calcaneal injury pattern and implementing the correct treatment strategy is paramount to having successful patient outcomes. A delay or error in treatment can turn a closed fracture into an open fracture.