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Burn injury in children can cause severe and chronic physical and mental sequelae. Opioids are a mainstay in burn pain management but increasing utilization in this country has led to concern for their continued use and potential for dependence. Methadone is a long-acting analgesic that targets the N-methyl-D-aspartate (NMDA) receptor in addition to the mu opioid receptor and has benefit in adult burn patients. However, its use in the pediatric burn population has been less robustly studied. This is a retrospective cohort study at a single Level 1 Burn Center whose primary aim is to compare opioid utilization 36 hours postoperatively between pediatric burn patients who received intraoperative, intravenous methadone and those who did not. Secondary aim was to describe differences in methadone-related complications between the cohorts. There was decreased opioid utilization measured by median morphine equivalents per kilogram (ME/kg) postoperatively in the methadone cohort compared to the control cohort (0.54 vs 0.77 mg/kg, P = .18). No adverse events were noted upon chart review. The data suggest that methadone use is beneficial in pediatric burn patients, but further prospective studies are warranted on a larger population.

Frequent, small wildfires can pose dangers to homes in the wildland–urban interface, but are not often included in wildfire hazard models. We assessed patterns of small wildfire occurrence probability in the Northeast region of the United States, focusing on (1) spatial and seasonal variations; (2) differences between small and large fires (size threshold of 4 ha); and (3) how predicted probabilities are influenced by inconsistent wildfire definitions in urbanised landscapes. We analysed fire incident report data from 2005 to 2017 to parameterise maximum entropy (MaxEnt) models based on land cover, topography, climatic water deficit, soil moisture and road density. Overall, wildfire occurrence was highest in areas with lower agricultural cover and with more low-density urban development (explaining 53.5 and 28.6% of variance, respectively, in our region-wide model), while larger fires were concentrated in areas with intermediate levels of development, higher climatic water deficit and more rugged topography. These patterns were largely consistent when we assessed models for individual states, but differences in wildfire reporting patterns led to differences in the effect of urban development on fire probability. Our results provide novel understanding of small wildfire patterns in the Northeast and demonstrate the need to more reliably quantify these hazards.

Background There has been an exponential growth in the research base for simulated-based learning experiences (SBLE). The purpose of this paper is to present the findings of an umbrella review, an examination of published reviews, to examine the state-of-the-science in SBLE. Method This project used the Joanna Briggs Institute guidelines for an umbrella review. Eight electronic data bases were searched for eligible reviews from 1990 through August 2016, yielding 97 reviews for inclusion. Results Four themes emerged from the current literature, centering on (a) specific clinical practice area or learner, (b) learner outcomes/identified skill acquisition, (c) elements of simulation design, and (d) simulation as pedagogy. The quality of the reviews ranged widely in methods and rigor. Conclusion The evidence examining SBLE has relied too heavily on self-reported outcomes among learners. Objective evidence obtained through the use of reliable and valid measurement tools used by trained and objective raters is needed. Adherence to standard research reporting guidelines for health care simulation research would benefit the evidence base.

Sarcomas are a rare, encompassing a heterogeneous group of malignancies. Success treatment often requires a combination of surgical resection, chemotherapy, and/or radiation. These life-altering interventions can have lasting impact on function and quality-of-life. There is little known about treatment outcomes from the perspective of sarcoma patients.The initial goal of this investigation was to determine the sources and categories of information patients sought at various time points in their care. In addition, we investigated how participants coped with physical and psychological issues that accompany treatment. Finally, we elicited advice on what the care team did well, and could have been done differently, during their diagnosis and recovery.A qualitative, focus group research method was utilized. A purposive sample of participants with a diagnosis of a sarcoma was identified. Three focus groups (20 total participants) were formed and audio/video recorded. The transcripts were analyzed to identify common themes and a scissor-and-sort technique was used to attribute participant comments to the identified themes.Themes were identified and categorized into four major areas: 1) Information at diagnosis, 2) Relationship with care team, 3) Social support, and 4) Restoration to "normal."We identified several areas that can be addressed to enhance patient counseling, emotional understanding, and expectations of treatment. These can serve as a guide for future research endeavors and program development.

Hepatitis C viral protease inhibitors increase sustained virologic response rates compared to interferon and ribavirin but also add side effects. Telaprevir and boceprevir are structurally similar, and share cross-resistant mutations. This case report highlights successful management of telaprevir skin rash and anal discomfort by switching to boceprevir.

Background: Female athletes and active women require adequate nutrition for optimal health and performance. Nutrition assessments are needed to identify potential nutrients of concern. Folate, vitamin B6, and vitamin B12 function in important pathways used during physical activity and female athletes may be at risk for poor status of these micronutrients. This cross-sectional study described a comprehensive nutrition assessment of the B-vitamins (folate, vitamin B6, and vitamin B12) using both dietary (food and dietary supplements) and biochemical assessments among highly active and sedentary women. Methods: Highly active (n = 29; age 20 ± 2 years; body mass index (BMI) 23.8 ± 3.5 kg/m2) and sedentary (n = 29; age 24 ± 3 years; BMI 22.6 ± 3.0 kg/m2) women were recruited for this study. Participants completed 7-day weighed food records and a fasting blood draw. Results: Although the highly active women reported higher intakes of energy (p < 0.01), folate (p < 0.01), vitamin B6 (p < 0.01), and vitamin B12 (p < 0.01), no significant differences were found between the groups for biomarkers of folate, vitamin B6, and vitamin B12. All of the highly active women had biomarkers within the desired reference ranges, suggesting good status. In general, most participants were able to meet the 1998 Recommended Daily Allowance (RDA) from food alone. For the women that reported using dietary supplements, micronutrient intakes met the 1998 RDA and in some cases, exceeded the Tolerable Upper Intake Level. Conclusion: This nutrition assessment documented good status for folate, vitamin B6, and vitamin B12 in the highly active women. Similar assessment approaches (food, dietary supplements, and biomarkers) should to completed with other nutrients of concern for the female athlete.

ObjectivesTo help athletic trainers promote a “food-first” philosophy to support health and performance, understand federal and sport governing body rules and regulations regarding dietary supplements and banned substances, and become familiar with reliable resources for evaluating the safety, purity, and efficacy of dietary supplements.BackgroundThe dietary supplement industry is poorly regulated and takes in billions of dollars per year. Uneducated athletes need to gain a better understanding of the safety, eligibility, and efficacy concerns associated with choosing to take dietary supplements. The athletic trainer is a valuable athletic team member who can help in the educational process. In many cases, athletic trainers are asked to help evaluate the legality, safety, and efficacy of dietary supplements. For this position statement, our mission is to provide the athletic trainer with the necessary resources for these tasks.RecommendationsProper nutrition and changes in the athlete's habitual diet should be considered first when improved performance is the goal. Athletes need to understand the level of regulation (or lack thereof) governing the dietary supplement industry at the international, federal, state, and individual sport-participation levels. Athletes should not assume a product is safe simply because it is marketed over the counter. All products athletes are considering using should be evaluated for purity (ie, truth in labeling), safety, and efficacy.

Background Although studies have investigated the effects of hydration on performance measures, few studies have investigated how the temperature of the ingested liquid affects performance and core temperature during an exercise session. The hypothesis of the present study was that cold water would improve thermoregulation and performance as measured by bench repetitions to fatigue, broad jump for force and power and total time to exhaustion for cardiovascular fitness Methods Forty-five, physically fit, adult males (30.28 ± 5.4 yr, 1.77 ± 7.8 m, 83.46 ± 11.5 kg; 13.7 ± 4.8 %BF; 49.8 ± 6.3 ml/kg/min V02) completed two 60-minute exercise sessions. Subjects consumed either COLD (4°C) or room temperature (RT) water (22°C) in randomized order. Core temperature was measured every 15 minutes throughout each trial using a digestible thermometer. Three performance tests were performed upon completion of the exercise session: bench press to fatigue, standing broad jump, and bicycle time to exhaustion Results Although both groups significantly increased their core temperature (p Conclusion Drinking cold water can significantly mediate and delay the increase in core body temperature during an exercise session in a moderate climate with euhydrated subjects. The ingestion of COLD improved performance for 49% and 51% of the participants in the broad jump and TTE performance tests respectively, but did not reach statistical significance. Moreover, although minimal, subjects experienced a decrease in performance on the bench press during the COLD.

PurposeTo compare the effectiveness of two worksite wellness programs. MethodsEmployees participated in a 14-week cohort-randomized trial comparing a Traditional Worksite Wellness Program [TWP] and...

Cytomegalovirus (CMV) is the most common cause of congenital infection and complicates approximately 1% of all live births. Primary maternal CMV infection carries a 30% to 40% risk of vertical transmission to the fetus. In cases where maternal CMV infection is suspected, it is important to evaluate the risk to the fetus to provide appropriate counseling and guidance to parents. This article reviews the published literature and summarizes current diagnostic and management recommendations to help answer the question, should all women be screened for CMV infection in pregnancy?

Pregnant women and their fetuses are at high risk of infection with the novel H1N1 influenza A virus. Obstetric providers need to be prepared to provide the care necessary to address the increased morbidity, mortality, and pregnancy-related complications (including spontaneous miscarriage and preterm birth) faced by pregnant women during an influenza pandemic. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention strategies for the current H1N1 influenza pandemic.