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Baseball coaches often focus on the landing position of a pitcher's front foot as a key aspect of mechanics. Furthermore, controversy persists regarding positioning the rear foot on the first base or third base end of the rubber. The purpose of this study was to determine the effect of rear and front foot placement on pitching biomechanics. Our hypotheses were that there would be significant kinematic and kinetic differences associated with foot placement. This was a retrospective review including 144 healthy right-handed adult baseball pitchers divided into groups based on their rear and front foot placements: first base open (1B-Open), first base closed (1B-Closed), third base open (3B-Open), and third base closed (3B-Closed). Two-way ANOVAs detected no statistically significant main effects for kinetic variables but several for kinematic variables. Open pitchers had less shoulder abduction at the time of ball release and greater maximum shoulder internal rotation velocity in comparison with closed pitchers. They also had less forearm pronation at the time of ball release and greater maximum elbow extension velocity. Additional statistically significant results were found; however, low effect sizes may lessen the clinical significance of many of the results. [ABSTRACT FROM AUTHOR]

Background: Rhinoplasty is a surgical procedure used to reconstruct nasal structures for cosmetic and functional purposes. Modern rhinoplasty surgery can be performed by one of two different approaches, the open or the closed rhinoplasty. However, the preferred method is still a subject for debate. We aimed in this study to compare the outcomes of open versus closed rhinoplasty. Patients and Methods: This is a prospective study included 50 patients divided into two groups according to the approach of rhinoplasty performed. Group A (25 patients) underwent open rhinoplasty, while group B (25 patients) underwent closed rhinoplasty. The outcomes are studied for advantages and limitations of each. Cosmetic outcome was evaluated by the Rhinoplasty Outcome Evaluation (ROE) questionnaire. Results: No significant difference was noted in ROE scores when comparing between rhinoplasty groups (open vs. closed) at the same specific study visit, with p value = 0.872, 0.624 and 0.764 at preoperatively, one month postoperatively, and 6 months post-operatively respectively. Conclusion: Although the closed rhinoplasty group has less operative time, less amount of intraoperative bleeding and less periorbital edoema, there was significant improvement in the cosmetic state compared in both groups and no significant difference occurred in improvement between the two groups. [ABSTRACT FROM AUTHOR]

Objective: This observational study examines the associated risk for concussion following ‘lowering the helmet to initiate contact’ penalties in the National Football League. Methods: Using officially published injury data on the National Football League (NFL) website, the authors reviewed NFL Players diagnosed with a concussion from 2015 to 2022 and who received a ‘lowering the helmet to initiate contact’ penalty from 2018 to 2020. Reported concussions were evaluated for association with ‘lowering the helmet to initiate contact’ penalties. The Friedman test assessed overall differences between the years. Pairwise comparisons were performed using the Wilcoxon signed-rank test with a Bonferroni correction to adjust for multiple comparisons. Results: The average incidence of all concussions per play was 0.45% for regular-season games. From 2018 to 2020, 86 lowering the helmet to initiate contact penalties were called. Three of 86 penalties resulted in concussions, with a 3.5% incidence. The Friedman test indicated significant differences in concussion trends across the years (χ2 = 16.0, p = 0.0003). Pairwise analysis with the Wilcoxon signed-rank test and adjusted for multiple comparisons with a Bonferroni correction (α = 0.05/28 = 0.0018) showed no statistically significant differences between years. There was a significant negative correlation of overall concussion incidence per year. Conclusions: The incidence of concussion with players penalized for lowering the helmet to initiate contact is greater than the overall incidence of concussions in all plays. While there is no difference in total concussions that occur, the concussion rate has a significant negative trend between 2015 and 2022. However, it is difficult to analyze the nonimmediate effects of this penalty on players’ intended play and practice, which may further decrease concussions.

Aiming at the problems of severe pollution and high cost in using the coal-fired curing barn, an intelligent frequency conversion dehumidification heat pump curing barn with frequency conversion heat pump as the heat source was studied and applied. By taking the conventional electric heat pump heating bakery and the coal-fired bulk curing barn as the control, the differences in the baking energy consumption and tobacco leaf quality were compared and analyzed. The results showed that compared with the traditional coal-fired intensive baking houses, the energy consumption cost of EACHTCS intelligent frequency conversion dehumidification heat pump curing barn could be reduced by 40.8 %. Compared with the ordinary heat pump curing barn, the energy-saving effect could reach 14.9%. After baking, the structure of tobacco leaves was loose, the aroma was sufficient, and the oil content was increased. The proportion of high-quality tobacco could be increased by 3%−5% (absolute value). Based on the comprehensive analysis, this type of curing barn could provide reference for optimizing the heating mode of the current intensive baking rooms, improving the baking performance, and promoting the cost reduction and efficiency increase of tobacco leaf curing. [ABSTRACT FROM AUTHOR]

Objective: Open objects encourage interactivity and closed objects discourage it. Repeated experiences with open and closed objects are thought to give rise to spatial concepts that can be used to represent a variety of entities such as societies, others, and the self. The present investigation pursues the idea that preferring that which is open to that which is closed is more compatible with an agreeable mode of interacting with others. Method: Three studies (total N = 901) asked participants whether they preferred "open" or "closed" as spatial concepts. Such preferences were linked to variations in agreeableness, peer perceptions, and daily measures of pro‐social functioning. Results: Open‐preferring, relative to closed‐preferring, individuals scored higher in agreeableness (Study 1) and were rated by peers as interpersonally warmer (Study 2). Open preferences varied within and across persons in a daily diary protocol and, in both cases, higher levels of open preference were linked to higher levels of pro‐social feeling (Study 3). Conclusion: The findings point to a fundamental component of spatial orientation that plays a significant role in encouraging (open) or discouraging (closed) warm, interactive relations with others. [ABSTRACT FROM AUTHOR]

Autologous cell therapy using genetically modified T cells to express chimeric antigen receptor (CAR) has yielded durable responses in patients. However, currently only a small portion of patients are privileged to receive the available therapies. High cost and long manufacturing time contribute to the key limitations on a broader adoption. Researchers have recently demonstrated a process of generating functional CAR T cells within 24 hrs with greater potency. This rapid process provides a new hope in making CAR T therapy affordable and accessible. The reported rapid manufacturing process is still manual operation and involves use of multiple tools. To automate the rapid process for quality cell production, we developed a rapid CAR T manufacturing process on a single platform. Rapid process eliminates in vitro cell expansion and requires much smaller doses compared to conventional process. Manufacturing of CAR-T cells is simplified to: (1) T cell selection, (2) viral transduction, and (3) cell purification. Fresh peripheral blood can now replace leukopak as starting material. We conducted feasibility study on a platform equipped with 3x magnetic cell separation modules. Magnetic cell separation process is column-free automated operation within enclosed sterile lines. First, T cells were isolated directly from peripheral blood from a healthy donor using CD4/CD8 nanomagnetic beads. Then isolated T cells were released using cell culture medium. eGFP expressing lentivirus were added to the enriched T cells with other reagents required for viral transduction. After 20 hrs incubation, transfected T cells were purified on a second magnetic module to remove free viruses and transduction medium. T cells were then released and collected in saline solution ready for injection. Starting from 20mL of peripheral blood, we isolated T cells with 95% purity and 70% recovery. >99% of lentivirus was rinsed off during purification. After transduction, >17.5% T cells became GFP positive, with 80% viable cells. Compared to reported process, single platform process saves multiple cell washing steps, achieves cell recovery and purity, and reasonable transduction efficiency. In summary, we demonstrated rapid manufacturing of CART cells on an automated platform is feasible. The platform can be the solution for rapid autologous manufacturing of CAR T cells at close-to-patient settings. [ABSTRACT FROM AUTHOR]

In this study, we comment about a wrong proof, at least incomplete, of the closed Newton Cotes error formulas for integration in a closed interval [a,b].\left[a,b]. These error formulas appear as an intuitive generalization of the simple proof for the error formula of the trapezoidal rule, and their proofs present one controversial step, which converts the proofs in mischievous, or at least, this step needs a clear clarification that it is not easy to derive. The correct proof of such formulas comes from a technique based on the Peano kernel.

IntroductionDecreasing unnecessary cranial computed tomography (CT) use in pediatric head trauma patients remains important for emergency departments (EDs) across the US. Our study evaluated CT use in children with minor blunt head trauma in 21 community EDs within an integrated health-care system.MethodsWe studied all children younger than 18 years old presenting to 21 community EDs between 2016 through 2018 with acute minor blunt head trauma, defined by an algorithm of ED chief complaints and diagnoses. We excluded patients with traumatic brain injuries diagnosed in the prior year, a CT within 24 hours prior to the ED visit, or an ED Glasgow Coma Scale score of less than 14.ResultsAmong 39,792 pediatric minor head trauma ED visits, the aggregate CT use proportion across all EDs was 12.9% [95% confidence interval (CI), 12.6-13.3%; facility-level range, 5.4-21.6%]. The 7 facilities that had previously received a clinical decision support system intervention implementing the Pediatric Emergency Care Applied Research Network rules during 2013 through 2014 had an aggregate mean CT ordering rate of 11.2% (95% CI, 10.7-11.7%; facility-level range, 5.4-14.3%) compared to 14.1% (95% CI, 13.6-14.5%; facility-level range, 7.3-21.6%) for the nonintervention facilities.ConclusionCT use for children with minor blunt head trauma in the community EDs of an integrated health-care system was low and stable across facilities from 2016 through 2018. This may be indicative of the safe stewardship of resources in the system, including the absence of financial or medicolegal incentives to scan very low-risk patients as well the availability of resources for close patient follow-up.

Treatment programs for people with histories of sexual violence form a critical part of criminal justice service rehabilitation. Completion of these programs is often a precondition of release. Meta-analytic reviews suggest moderate benefit is associated with treatment completion, although effect sizes vary. This study examined whether commencement of open versus closed group programs was associated with treatment completion and recidivism. Participants were 426 adult men who commenced treatment between April 1, 2014, and December 31, 2017. Participants were followed-up until June 30, 2018. Programs varied by type (open versus closed), location (in-custody versus in-community) and intensity (moderate versus high). No significant differences were observed between open and closed programs for treatment completion but men who were treated in-custody were more likely to complete treatment when compared to those men who commenced treatment in the community. No significant differences were observed between open and closed programs for sexual or for any recidivism. [ABSTRACT FROM AUTHOR]

It is well known that all subvarieties of the variety of all semigroups are not absolutely closed. So, it is worth to find subvarieties of the variety of all semigroups that are closed in itself or closed in the containing varieties of semigroups. We have gone through this open problem and able to determine that the varieties of right [left] normal bands and left [right] quasinormal bands are closed in the varieties of semigroups defined by the identities axy = xany [axy = aynx], axy = xnay [axy = ayxn] (n > 1); and axy = axnay [axy = ayxny] (n > 1), axy = anxary [axy = ayrxyn] (n, r ∊ N), respectively. [ABSTRACT FROM AUTHOR]

Liftable pairs of adjoint functors between braided monoidal categories in the sense of [GV1] provide auto-adjunctions between the associated categories of bialgebras. Motivated by finding interesting examples of such pairs, we study general pre-rigid monoidal categories. Roughly speaking, these are monoidal categories in which for every object X, an object X* and a nicely behaving evaluation map from X* ⊗ X to the unit object exist. A prototypical example is the category of vector spaces over a field, where X* is not a categorical dual if X is not finite-dimensional. We explore the connection with related notions such as right closedness, and present meaningful examples. We also study the categorical frameworks for Turaev's Hopf group-(co)algebras in the light of pre-rigidity and closedness, filling some gaps in literature along the way. Finally, we show that braided pre-rigid monoidal categories indeed provide an appropriate setting for liftability in the sense of loc. cit. and we present an application, varying on the theme of vector spaces, showing how -in favorable cases- the notion of pre-rigidity allows to construct liftable pairs of adjoint functors when right closedness of the category is not available. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare the clinical outcomes of performing a closed tibial high osteotomy with an open osteotomy and the changes in posterior tibia slope and patellar height.MethodsMethods were collected from three hundred and forty patients (440 knees) with high tibial osteotomy performed from January 2019 to January 2020. Forty patients (50 knees) had a lateral closed wedge tibial osteotomy (LCWHTO), and 300 patients (390 knees) had a medial open wedge tibial osteotomy (MOWHTO). The follow-up periods were 20.5 months and 19.9 months, respectively. At the final follow-up visit, both groups evaluated the Lysholm score and joint range of motion (ROM). Changes in preoperative and postoperative mechanical axis deviation (MAD), proximal medial tibial angle (MPTA), posterior tibial slope (PTS), and M-K index were compared between the two groups of patients.ResultsLysholm scores were 79.6 ± 15.6 preoperatively and 96.0 ± 5.0 postoperatively in the LCWHTO group (p 0.05); 136.5° ± 8.4° preoperatively and 135.7° ± 9.3° postoperatively in the MOWHTO group (p > 0.05). the MAD was (26.5 ± 4.1) mm preoperatively and 0.3 ± 2.9 mm postoperatively in the LCWHTO group (p 0.05). 0.78 ± 0.05 before and 0.75 ± 0.05 after surgery in the MOWHTO. 10.8° ± 3.0° PTS before and 8.1° ± 3.4° after surgery in the LCWHTO group (p 0.05).ConclusionsLCWHTO decreases the PTS and has no effect on patellar height; MOWHTO does not affect the PTS but decreases patellar height. The patient should individualize the choice of the osteotomy.

The goal of this study is to evaluate the effect of time-to-surgery following closed ankle fractures on long-term patient reported outcomes, fracture healing, and wound complications. To date, little research has been done focusing on the impact "time to definitive fixation" has on patient reported outcomes. We performed a retrospective analysis of 215 patient records who underwent open reduction and internal fixation (ORIF) for an ankle fracture from July 2011 to July 2018. A total of 86 patients completed the patient reported outcome measurement information systems (PROMIS) survey at long-term follow-up. Primary outcomes were the rate of delayed union, postoperative wound complications, patient reported outcome measurement information system (PROMIS) pain interference (PI), and physical function (PF) scores. No differences were found when comparing time to surgery on a continuous scale with rates of delayed union, nonunion, or wound complications (p =.84,.47, and.63, respectively). PROMIS scores were collected at a median of 4.5 years (2.0 interquartile range (IQR), range 2.5-12.3) postoperatively. The time from ankle fracture to surgery was independently associated with worse PROMIS PI scores (unstandardized β 0.38, 95% CI 0.07-0.68) but not PROMIS PF scores. Severe Lauge-Hansen injuries were independently associated with decreased PROMIS PF scores (unstandardized β −7.02, 95% CI −12.0 to −2.04). Increased time to surgical intervention and severe Lauge-Hansen injuries were independently associated with worse long-term patient reported outcomes. Surgical timing did not impact union rates or wound complications. Surgeons should be aware that delaying ankle fracture repair beyond 12 days after injury may negatively affect long-term patient reported pain scores. [ABSTRACT FROM AUTHOR]

The Glasgow Outcome Scale, Pediatric Revision (GOSE-P) is an assessment of "global outcome" designed as a developmentally appropriate version of the Glasgow Outcome Scale-Extended for use in clinical trials of children with traumatic brain injury (TBI). Initial testing describes validity across a wide age and injury severity spectrum, yet the GOSE-P's utility for monitoring children with milder injuries is less clear. We examined the level of agreement between the GOSE-P and the Health and Behavior Inventory (HBI), a TBI-related symptom checklist used to assess children with mild TBI for clinical and research purposes. Participants included children and adolescents 3-16 years of age (n = 50) who presented to two level 1 trauma centers within 24 h of injury, with a GCS of 13-15, who underwent clinical neuroimaging. Outcome was assessed 2 weeks and 3 months following injury. We examined the severity of TBI-related symptoms across disability categories identified using the GOSE-P, and the level of agreement between the two measures in identifying deficits 2 weeks following injury and improvement from 2 weeks to 3 months. Using the GOSE-P, 62% had deficits at 2 weeks, and 42% improved from 2 weeks to 3 months. Agreement between the GOSE-P and HBI was fair 2 weeks after TBI (k = 0.24-0.33), and poor for identifying subsequent improvement (k = 0.10-0.16). Modest agreement between the GOSE-P and the HBI may reflect restricted participation from diverse causes, including TBI, other bodily injuries, and prescribed activity restrictions, and highlights the need for multi-dimensional outcome batteries.

Study objectiveWe determine the prevalence of significant intracranial injury among adults with blunt head trauma who are receiving preinjury anticoagulant or antiplatelet medications.MethodsThis was a multicenter, prospective, observational study conducted from December 2007 to December 2015. Patients were enrolled in 3 emergency departments (EDs) in the United States. Adults with blunt head trauma who underwent neuroimaging in the ED were included. Use of preinjury aspirin, clopidogrel, and warfarin was recorded. Data on direct oral anticoagulants were not specifically recorded. The primary outcome was prevalence of significant intracranial injury on neuroimaging. The secondary outcome was receipt of neurosurgical intervention.ResultsAmong 9,070 patients enrolled in this study, the median age was 53.8 years (interquartile range 34.7 to 74.3 years) and 60.7% were men. A total of 1,323 patients (14.6%) were receiving antiplatelet medications or warfarin, including 635 receiving aspirin alone, 109 clopidogrel alone, and 406 warfarin alone. Compared with that of patients without any coagulopathy, the relative risk of significant intracranial injury was 1.29 (95% confidence interval [CI] 0.88 to 1.87) for patients receiving aspirin alone, 0.75 (95% CI 0.24 to 2.30) for those receiving clopidogrel alone, and 1.88 (95% CI 1.28 to 2.75) for those receiving warfarin alone. The relative risk of significant intracranial injury was 2.88 (95% CI 1.53 to 5.42) for patients receiving aspirin and clopidogrel in combination.ConclusionPatients receiving preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those receiving aspirin alone. Clinicians should have a low threshold for neuroimaging when evaluating patients receiving warfarin or a combination of aspirin and clopidogrel.

Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, "What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?" Responses were recorded as ordinal categories (5-10%, >10-50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64-85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1-85.5%) and a specificity of 41.5% (37.7-45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1-3) was poorly sensitive (26.3%, 95% CI 17.7-37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9-99.3%) but poorly specific (12.9%, 95% CI 10.4-15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0-80.0%; specificity 35.3%, 95% CI 31.6-38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.

Objective: Pediatric burns pose difficult healthcare issues in underdeveloped nations. Due to the scarcity of pediatric burn care facilities and qualified burn-care staff, patients are frequently referred from a rural hospital. This study explores the burn-treatment approach that could be used in rural hospitals in the absence of a dedicated pediatric burn care facility. Materials and Methods: A retrospective analysis of clinical data of 199 children who received treatment for burn-injury in an isolated general surgical ward. Wound debridement under anesthesia at the earliest was the cornerstone of the treatment plan for this cohort. Until the wounds healed, the treatment was repeated every alternate day. The patient's demographic data, number of surgical dressings, length of hospital stay, and outcome were analyzed. Results: The mean age of the patients was 51.68 ± 23.79 months. The male-female ratio was 1.45:1. The survival rate was 99.00%. The disability rate was 4.52%. Univariate logistic regression identified the age group, total body surface area affected, depth of the wound, and time of intervention as statistically significant variables (P < 0.05) predicting the disfigurement. Multivariate logistic regression identified the time intervals between surgical intervention and injury as an important predictor of morbidity. In addition, delayed presentation and delayed intervention led to a longer hospital stay, and more interventions than the early intervention cohort. Conclusions: Early debridement accelerates recovery and lessens the need for future skin grafts or contracture procedures. This approach can be used in rural hospitals as well because pediatric burns can be manageable in an isolated general ward. [ABSTRACT FROM AUTHOR]

OBJECTIVE: High tibial osteotomy is an effective treatment for medial compartment knee osteoarthritis, and the commonly used clinical procedures are medial open-wedge high tibial osteotomy and lateral closed-wedge high tibial osteotomy. There are some controversies about the basis of the two surgical choices. The article evaluated the clinical efficacy and imaging results of medial open-wedge high tibial osteotomy and lateral closed-wedge high tibial osteotomy by meta-analysis. METHODS: PubMed, Ovid, CNKI, Wanfang, VIP, Cochrane Library, and EMbase databases were searched for articles on the comparison of medial open-wedge tibial osteotomy and lateral closed-wedge tibial osteotomy for osteoarthritis of the knee. The retrieval period was from the database inception to October 2021. Literature screening and data compilation were conducted according to the specified inclusion and exclusion criteria. Randomized controlled trials were evaluated using Cochrane Handbook criteria to assess risk of bias, and cohort studies were evaluated using the NOS scale. RevMan 5.3 software was used for meta-analysis. RESULTS: (1) A total of 13 publications were included, of which 8 were randomized controlled trials, and 5 were cohort studies. The overall quality of the literature was high. (2) Meta-analysis results showed that medial tibial open-wedge osteotomy and lateral tibial closed-wedge osteotomy presented significant differences in postoperative posterior tibial plateau inclination (MD=2.82, 95%CI:1.31-4.33, P=0.000 2), patellar height BPI (MD=-0.09, 95%CI:-0.11 to -0.07, P < 0.000 01), and operative time (MD=-19.48, 95%CI:-31.02 to -7.94, P=0.000 9). Postoperative mechanical axis angle (MD=-0.01, 95%CI:-0.51-0.48, P=0.96), angle of correction (MD=-0.16, 95%CI:-0.75-0.43, P=0.60), HSS score (MD=-0.46, 95%CI:-1.47-0.55, P=0.37), visual analogue scale score (MD=0.12, 95%CI:- 0.24-0.48, P=0.51), Lysholm score (MD=-0.17, 95%CI:-2.53-2.19, P=0.89), and complications (OR=0.68, 95%CI:0.25-1.82, P=0.44) were similarly effective. CONCLUSION: The overall clinical outcomes of the two procedures are similar, and the medial tibial open-wedge osteotomy has the advantage of being easier to perform, but is prone to increased posterior tibial plateau tilt and patellar drop, so adequate preoperative imaging evaluation and individualized selection of the procedure are needed for patients with unicompartmental knee osteoarthritis [ABSTRACT FROM AUTHOR]

We show that all subvarieties of the variety of rectangular bands are closed in the variety of all bands. Further, we show that the variety of regular bands is closed. Next, we introduce the varieties of generalized left [right] regular semigroups and show that all such varieties are saturated and, subsequently, epis from generalized left [right] regular semigroups are surjective. [ABSTRACT FROM AUTHOR]

This case report describes an incident of pneumothorax in 4-month old male German Shorthaired Pointer caused by a grass awn. The patient was brought to the Small Animal Clinic of the Faculty of Veterinary Medicine at Trakia University, Stara Zagora, Bulgaria with respiratory distress and anxi-ety. Tachypnea, cyanotic mucous membranes and tachycardia were observed during physical exami-nation. Abnormal collection of air in the pleural space between the lung and the chest was observed radiographically. A diagnosis of primary spontaneous closed pneumothorax was made based on these findings. Later pathoanatomical findings showed the presence of the grass awn that had penetrated through the skin.

Background and purposeThe effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period.Materials and methodsSeventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis.ResultsThe mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory.ConclusionsOur findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.

An estimated 5.3 million Americans are living with a disability from a traumatic brain injury (TBI). There is emerging evidence of the detrimental effects from repeated mild TBIs (rmTBIs). rmTBI manifests its own unique set of behavioral and neuropathological changes. A subset of individuals exposed to rmTBI develop permanent behavioral and pathological consequences, defined postmortem as chronic traumatic encephalopathy. We have combined components of two classic rodent models of TBI, the controlled cortical impact model and the weight drop model, to develop a repeated mild closed head injury (rmCHI) that produces long-term deficits in several behaviors that correlate with neuropathological changes. Mice receiving rmCHI performed differently from 1-hit or sham controls on the elevated plus maze; these deficits persist up to 6 months postinjury (MPI). rmCHI mice performed worse than 1-hit and control sham mice at 2 MPI and 6 MPI on the Morris water maze. Mice receiving rmCHI exhibited significant atrophy of the corpus callosum at both 2 MPI and 6 MPI, as assessed by stereological volume analysis. Stereological analysis also revealed significant loss of cortical neurons in comparison with 1-hit and controls. Moreover, both of these pathological changes correlated with behavioral impairments. In human tau transgenic mice, rmCHI induced increases in hyperphosphorylated paired helical filament 1 tau in the hippocampus. This suggests that strategies to restore myelination or reduce neuronal loss may ameliorate the behavioral deficits observed following rmCHI and that rmCHI may model chronic traumatic encephalopathy in human tau mice.

Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact on patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as 'the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically'. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation. [ABSTRACT FROM AUTHOR]

In this paper, first we have shown that all the homotypical varieties defined by the identities axy=xyax, axy=xxya and axy=yaxx are closed. Further, we partially generalize a result of Isbell on semigroup dominions from the class of commutative semigroups to some classes of permutative semigroups by showing that dominions of such semigroups belongs to the same class. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is one of the most common operations in children. To improve outcome, several techniques are used. However, it has not been established if the open or the closed hernia sac preparation technique is superior in (premature) neonates and older children. Methods: Retrospective study including all cases of inguinal hernia repair in children at two large centers. Demographic data and outcome parameters including procedure time and intra as well as postoperative complications were evaluated. To compare open vs. closed hernia sack preparation, cases with secondary open preparation were excluded and propensity score matching was performed. Regression analysis was used to determine factors affecting operative time and recurrence rate. Results: In total 2476 cases of inguinal hernia repair were identified. After exclusion of direct hernias as well as revision cases, 2257 cases were analyzed. Overall mean operative time was 25.8 min. Intraoperative complications occurred in 0.1% and. postoperative complications occurred in 3.0% of all cases, the most frequent postoperative complication being recurrence (1.7%). Closed preparation technique resulted in significantly faster procedure time and lower recurrence rates in premature neonates and older children compared to the open hernia sac preparation technique. Operative technique, prematurity, gender and training of the surgeon are highly associated with operative time, whereas operative technique is the main factor affecting recurrence rate. Conclusions: It appears that closed hernia sack preparation is superior to open regarding speed and recurrence. This was true for premature neonates, neonates and older children. All other outcome parameters including intra- and postoperative complications were similar. Thus, we recommend to use the closed preparation technique whenever possible. [ABSTRACT FROM AUTHOR]

Introduction: Ventilator-associated events (VAEs) are one of the main sources of concern in critically ill patients due to the high frequency and mortality. We conducted this analysis to compare the effects of open endotracheal suctioning system with closed one on the incidences of VAEs in adult patients receiving mechanical ventilation (MV). Materials and methods: A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library, and hand searching bibliographies of retrieved articles. The search was confined to randomized controlled trials with human adults comparing closed tracheal suction systems (CTSS) vs open tracheal suction systems (OTSS) in prevention of ventilator-associated pneumonia (VAP). Full-text articles were used in order to extract the data. Data extraction was only started after completing the quality assessment. Results: The search resulted in 59 publications. Among them, 10 were identified as eligible for meta-analysis. There was a significant increase in incidence of VAP when using OTSS compared to CTSS, so that OCSS increased the incidence of VAP by 57% (OR 1.57, 95% CI 1.063-2.32, p = 0.02). Discussion: Our results showed that using CTSS can significantly decrease VAP development compared to OTSS. This conclusion does not yet mean the routine use of CTSS as a standard VAP prevention measure for all patients since individual patient's disease and cost are other factors that should be in mind when determining the choice of the suctioning system. High-quality trials with a larger sample size are highly recommended. [ABSTRACT FROM AUTHOR]

The goal of this study is to see how mental training overlap affects the development of closed and open skills in middle school five-a-side football. Identifying each group's advantage in developing closed and open skills in five-a-side football. The study community consisted of 72 of seventh grade students in the intermediate level, and the research sample consisted of twenty students divided into two groups: control and experimental which represents (27%) of the research community sample. The pre and post tests were carried out, and the results were analyzed using appropriate statistical methods. The exercises used had an effect on the development of the skills under study and for the two groups, and the overlap of mental training exercises contributes to the development of some closed skills. The authors recommend using these exercises in training curricula and using mental training as an aid to developing and teaching closed skills with a fixed middle in five-a-side football. [ABSTRACT FROM AUTHOR]

While establishing the bijection between near-ring congruences and various types of ideals of seminearrings, different kinds of restrictions were imposed either on the seminearrings under consideration or on the near-ring congruences. In this paper we consider a seminearring S without any restriction and establish that there exists an inclusion preserving bijective correspondence between the set { I ⊆ S : I is a strong, dense, reflexive and closed additive subsemigroup of S with I S ⊆ I } and the set of all near-ring congruences on S. We also show that in any seminearring S, there exists an inclusion preserving bijective correspondence between the set { I ⊆ S : I is a strong, dense, reflexive and closed additive subsemigroup of S with I S , S I ⊆ I } and the set of all zero-symmetric near-ring congruences on S. [ABSTRACT FROM AUTHOR]

Objective: We conducted a systematic review to determine the prevalence and characteristics of earthquake-associated head injuries for better disaster preparedness and management. Methods: We searched for all publications related to head injuries and earthquakes from 1985 to 2018 in MEDLINE and other major databases. A search was conducted using "earthquakes," "wounds and injuries," and "cranio-cerebral trauma" as a medical subject headings. Results: Included in the analysis were 34 articles. With regard to the commonly occurring injuries, earthquake-related head injury ranks third among patients with earthquake-related injuries. The most common trauma is lower extremity (36.2%) followed by upper extremity (19.9%), head (16.6%), spine (13.1%), chest (11.3%), and abdomen (3.8%). The most common earthquake-related head injury was laceration or contusion (59.1%), while epidural hematoma was the most common among inpatients with intracranial hemorrhage (9.5%) followed by intracerebral hematoma (7.0%), and subdural hematoma (6.8%). Mortality rate was 5.6%. Conclusion: Head injuries were found to be a commonly occurring trauma along with extremity injuries. This knowledge is important for determining the demands for neurosurgery and for adequately managing patients, especially in resource-limited conditions. [ABSTRACT FROM AUTHOR]

A word w is said to be closed if it has a proper factor x which occurs exactly twice in w , as a prefix and as a suffix of w. Based on the concept of Ziv–Lempel factorization, we define the closed z -factorization of finite and infinite words. Then we find the closed z -factorization of the infinite m -bonacci words for all m ≥ 2. We also classify closed prefixes of the infinite m -bonacci words. [ABSTRACT FROM AUTHOR]

Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99.0%. A secondary goal of the study was to complete an independent validation and comparison of the Canadian and NEXUS Head CT rules among the subgroup of patients meeting the inclusion and exclusion criteria.We conducted a prospective observational study of the NEXUS Head CT DI in 4 hospital emergency departments between April 2006 and December 2015. Implementation of the rule requires that patients satisfy 8 criteria to achieve "low-risk" classification. Patients are excluded from "low-risk" classification and assigned "high-risk" status if they fail to meet 1 or more criteria. We examined the instrument's performance in assigning "high-risk" status to patients requiring neurosurgical intervention among a cohort of 11,770 blunt head injury patients. The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurosurgical intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1%-100.0%]). The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurosurgical intervention (specificity, 24.9% [95% CI: 24.1%-25.7%]). None of the 2,823 low-risk patients required neurosurgical intervention (negative predictive value [NPV], 100.0% [95% CI: 99.9%-100.0%]). The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0%-99.6%]). The instrument assigned low-risk status to 2,815 of 11,003 patients who did not have significant injuries (specificity, 25.6% [95% CI: 24.8%-26.4%]). Significant injuries were absent in 2,815 of the 2,823 patients assigned low-risk status (NPV, 99.7% [95% CI: 99.4%-99.9%]). Of our patients, 7,759 (65.9%) met the inclusion and exclusion criteria of the Canadian Head CT rule, including 111 patients (1.43%) who required neurosurgical intervention and 306 (3.94%) who had significant intracranial injuries. In our study, the Canadian criteria for neurosurgical intervention identified 108 of 111 patients requiring neurosurgical intervention to yield a sensitivity of 97.3% (95% CI: 92.3%-99.4%) and exhibited a specificity of 58.8% (95% CI: 57.7%-59.9%). The NEXUS rule, when applied to this same cohort, identified all 111 patients requiring neurosurgical intervention, yielding a sensitivity of 100% (95% CI: 96.7%-100.0%) with a specificity of 32.6% (95% CI: 31.5%-33.6%). Our study found that the Canadian medium-risk factors identified 301 of 306 patients with significant injuries (sensitivity = 98.4%; 95% CI: 96.2%-99.5%), while the NEXUS rule identified 299 of these patients (sensitivity = 97.7%; 95% CI: 95.3%-99.1%). In our study, the Canadian medium-risk rule exhibited a specificity of 12.3% (95% CI: 11.6%-13.1%), while the NEXUS rule exhibited a specificity of 33.3% (95% CI: 32.3%-34.4%). Limitations of the study may arise from application of the rule by different clinicians in different environments. Clinicians may vary in their interpretation and application of the instrument's criteria and risk assignment and may also vary in deciding which patients require intervention. The instrument's specificity is also subject to spectrum bias and may change with variations in the proportion of "low-risk" patients seen in other centers.The NEXUS Head CT DI reliably identifies blunt trauma patients who require head CT imaging and could significantly reduce the use of CT imaging.

ObjectivePrehospital provider assessment of the use of anticoagulant or antiplatelet medications in older adults with head trauma is important. These patients are at increased risk for traumatic intracranial hemorrhage and therefore field triage guidelines recommend transporting these patients to centers capable of rapid evaluation and treatment. Our objective was to evaluate EMS ascertainment of anticoagulant and antiplatelet medication use in older adults with head trauma.MethodsA retrospective study of older adults with head trauma was conducted throughout Sacramento County. All 5 transporting EMS agencies and all 11 hospitals in the county were included in the study, which ran from January 2012 to December 2012. Patients ≥55 years who were transported to a hospital by EMS after head trauma were included. We excluded patients transferred between two facilities, patients with penetrating head trauma, prisoners, and patients with unmatched hospital data. Anticoagulant and antiplatelet use were categorized as: warfarin, direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, and apixaban), aspirin, and other antiplatelet agents (e.g., clopidogrel and ticagrelor). We calculated the percent agreement and kappa statistic for binary variables between EMS and emergency department (ED)/hospital providers. A kappa statistic ≥0.60 was considered acceptable agreement.ResultsAfter excluding 174 (7.6%) patients, 2,110 patients were included for analysis; median age was 73 years (interquartile range 62-85 years) and 1,259 (60%) were male. Per ED/hospital providers, the use of any anticoagulant or antiplatelet agent was identified in 595 (28.2%) patients. Kappa statistics between EMS and ED/hospital providers for the specific agents were: 0.76 (95% CI 0.71-0.82) for warfarin, 0.45 (95% CI 0.19-0.71) for DOAC agents, 0.33 (95% CI 0.28-0.39) for aspirin, and 0.51 (95% CI 0.42-0.60) for other antiplatelet agents.ConclusionsThe use of antiplatelet or anticoagulant medications in older adults who are transported by EMS for head trauma is common. EMS and ED/hospital providers have acceptable agreement with preinjury warfarin use but not with DOAC, aspirin, and other antiplatelet use.

Purpose To examine the effects of subconcussive impacts resulting from a single season of youth (age range, 8-13 years) football on changes in specific white matter (WM) tracts as detected with diffusion-tensor imaging in the absence of clinically diagnosed concussions. Materials and Methods Head impact data were recorded by using the Head Impact Telemetry system and quantified as the combined-probability risk-weighted cumulative exposure (RWECP). Twenty-five male participants were evaluated for seasonal fractional anisotropy (FA) changes in specific WM tracts: the inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus, and superior longitudinal fasciculus (SLF). Fiber tracts were segmented into a central core and two fiber terminals. The relationship between seasonal FA change in the whole fiber, central core, and the fiber terminals with RWECP was also investigated. Linear regression analysis was conducted to determine the association between RWECP and change in fiber tract FA during the season. Results There were statistically significant linear relationships between RWEcp and decreased FA in the whole (R2 = 0.433; P = .003), core (R2 = 0.3649; P = .007), and terminals (R2 = 0.5666; P < .001) of left IFOF. A trend toward statistical significance (P = .08) in right SLF was observed. A statistically significant correlation between decrease in FA of the right SLF terminal and RWECP was also observed (R2 = 0.2893; P = .028). Conclusion This study found a statistically significant relationship between head impact exposure and change of FA fractional anisotropy value of whole, core, and terminals of left IFOF and right SLF's terminals where WM and gray matter intersect, in the absence of a clinically diagnosed concussion. © RSNA, 2016.

This case report describes an incident of pneumothorax in 4-month old male German Shorthaired Pointer caused by a grass awn. The patient was brought to the Small Animal Clinic of the Faculty of Veterinary Medicine at Trakia University, Stara Zagora, Bulgaria with respiratory distress and anxiety. Tachypnea, cyanotic mucous membranes and tachycardia were observed during physical examination. Abnormal collection of air in the pleural space between the lung and the chest was observed radiographically. A diagnosis of primary spontaneous closed pneumothorax was made based on these findings. Later pathoanatomical findings showed the presence of the grass awn that had penetrated through the skin. [ABSTRACT FROM AUTHOR]

Seventy-five percent of all traumatic brain injuries are mild and do not cause readily visible abnormalities on routine medical imaging making it difficult to predict which individuals will develop unwanted clinical sequelae. Microglia are brain-resident macrophages and early responders to brain insults. Their activation is associated with changes in morphology or expression of phenotypic markers including P2Y12 and major histocompatibility complex class II. Using a murine model of unrestrained mild closed head injury (mCHI), we used microglia as reporters of acute brain injury at sites of impact versus sites experiencing rotational stress 24 h post-mCHI. Consistent with mild injury, a modest 20% reduction in P2Y12 expression was detected by quantitative real-time PCR (qPCR) analysis but only in the impacted region of the cortex. Furthermore, neither an influx of blood-derived immune cells nor changes in microglial expression of CD45, TREM1, TREM2, major histocompatibility complex class II or CD40 were detected. Using magnetic resonance imaging (MRI), small reductions in T2 weighted values were observed but only near the area of impact and without overt tissue damage (blood deposition, edema). Microglial morphology was quantified without cryosectioning artifacts using ScaleA(2) clarified brains from CX3CR1-green fluorescence protein (GFP) mice. The cortex rostral to the mCHI impact site receives greater rotational stress but neither MRI nor molecular markers of microglial activation showed significant changes from shams in this region. However, microglia in this rostral region did display signs of morphologic activation equivalent to that observed in severe CHI. Thus, mCHI-triggered rotational stress is sufficient to cause injuries undetectable by routine MRI that could result in altered microglial surveillance of brain homeostasis. Acute changes in microglial morphology reveal brain responses to unrestrained mild traumatic brain injury In areas subjected to rotational stress distant from impact site In the absence of detectable changes in standard molecular indicators of brain damage, inflammation or microglial activation. That might result in decreased surveillance of brain function and increased susceptibility to subsequent brain insults.

ImportanceIncreased use of computed tomography (CT) in children is concerning owing to the cancer risk from ionizing radiation, particularly in children younger than 2 years. A guardian report that a child is acting abnormally is a risk factor for clinically important traumatic brain injury (ciTBI) and may be a driving factor for CT use in the emergency department.ObjectiveTo determine the prevalence of ciTBIs and TBIs in children younger than 2 years with minor blunt head trauma and a guardian report of acting abnormally with (1) no other findings or (2) other concerning findings for TBI.Design, setting, and participantsSecondary analysis of a large, prospective, multicenter cohort study that included 43 399 children younger than 18 years with minor blunt head trauma evaluated in 25 emergency departments. The study was conducted on data obtained between June 2004 and September 2006. Data analysis was performed between August 21, 2014, and March 9, 2015.ExposuresA guardian report that the child was acting abnormally after minor blunt head trauma.Main outcomes and measuresThe prevalence of ciTBI (defined as death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights in association with TBI on CT imaging) and TBI on CT imaging in children with a guardian report of acting abnormally with (1) no other findings and (2) other concerning findings for TBI.ResultsOf 43 399 children in the cohort study, a total of 1297 children had reports of acting abnormally, of whom 411 (31.7%) had this report as their only finding. Reported as percentage (95% CI), 1 of 411 (0.2% [0-1.3%]) had a ciTBI, and 4 TBIs were noted on the CT scans in 185 children who underwent imaging (2.2% [0.6%-5.4%]). In children with reports of acting abnormally and other concerning findings for TBI, 29 of 886 (3.3% [2.2%-4.7%]) had ciTBIs and 66 of 674 (9.8% [7.7%-12.3%]) had TBIs on CT.Conclusions and relevanceClinically important TBIs are very uncommon, and TBIs noted on CT are uncommon in children younger than 2 years with minor blunt head trauma and guardian reports of the child acting abnormally with no other clinical findings suspicious for TBI. Computed tomographic scans are generally not indicated in these children although observation in the emergency department may be warranted.

The buffer allocation problem for closed finite queueing networks is a nonlinear integer programming problem which is -Hard. A queueing network decomposition methodology based upon a mean value analysis algorithm is coupled with a nonlinear sequential quadratic programming algorithm to compute the simultaneous optimal buffer allocations and network population via a branch-and-bound scheme for various network topologies. The joint optimisation problem is essentially multi-objective where the decision variable on the population will be treated as a constraint linking the buffer allocation and the throughput which is to be maximised. The fact that the optimisation problem is a concave programming problem assists in the search for an optimal solution. The material handling or transportation system for transferring the finite customer population between the nodes in the network is also examined. Extensive numerical results demonstrate the efficacy of the optimisation methodology. [ABSTRACT FROM AUTHOR]

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We have shown that a variety of left(right) normal bands is closed in some homotypical varieties. Further, we partially generalize a result of Isbell from the class of commutative semigroups to some generalized classes of commutative semigroups by showing that dominion of such semigroups belongs to same classes. [ABSTRACT FROM AUTHOR]

BackgroundTraumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients.MethodsTwenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory.ResultsMean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 - 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading.ConclusionsCFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment.

We give a relativization of the notions of essential, uniform, closed, injective and extending modules with respect to a left exact preradical on the ring. We also give useful examples and show that several classical properties hold for these kinds of modules. [ABSTRACT FROM AUTHOR]

Objective. The variability of the design of the arterial circle of the human brain (ACHB) has been studied.Materials and methods. The systematization was carried out and the original classification of the variants of ACHB was compiled. The study was performed on 116 brain preparations of adult people (64 men and 52 women). The causes of death of these people were not associated with diseases or trauma of the brain. Dissection of the vessels ACHB and central arteries was carried out after the injection of contrasting arteries mixture (mascara - gelatin).Results. There are two types of ACHB design, including two subtypes (4 in total). First of all, the variants of the individual-typological variability (VITV) of the circle design were combined depending on the presence or absence of the sign of its closure in the types of construction of the ACHB - closed or open. The type of construction is one of the integral and basic principles of classification. It serves as a criterion for the morphofunctional consistency of the ACHB. The second level of systematization of the VITV structure of ACHB is associated with the allocation in types of two subtypes in each of them. This is based on the presence or absence of symmetry of the ACHB form. This sublevel is a systemic - all variants of AKBM are caused by the presence or absence, or the degree of development (from hypoplasia to hyperplasia) of the arteries forming it. In accordance with the selected types and subtypes of the ACHB, the identified VITV circle was classified.Conclusions. The statistically significant prevalence of closed and asymmetric ACHB among both men and women has been established. The proposed integral classification is based on the basic morphogeometric characteristics of the ACHB. It takes into account the anatomy of both individual arteries and the circle as a whole, without dividing it into the front and back sections and treating the arterial circle as a single entity.