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Abstract Background The appropriateness of psychotropic prescriptions in the elderly is a major quality-of-care challenge at hospital. Quality indicators have been developed to prevent inappropriate psychotropic prescriptions. We aimed to select and automatically calculate such indicators, from the Bordeaux University Hospital information system, and to analyze the appropriateness of psychotropic prescription practices, in an observational study. Methods Experts selected indicators of the appropriateness of psychotropic prescriptions in hospitalized elderly patients, according to guidelines from the French High Authority for Health. The indicators were reformulated to focus on psychotropic administrations. The automated calculation of indicators was analyzed by comparing their measure to data collected from a clinical audit. In elderly patients hospitalized between 2014 and 2015, we then analyzed the evolution of the appropriateness of psychotropic prescription practices during hospital stay, using methods of visualization, and described practices by considering patients’ characteristics. Results Two indicators were automated to detect overuse and misuse of psychotropic drugs. Indicators identified frequent inappropriate drug administrations, but practices tended to become more appropriate after quality-of-care improvement actions. In the majority of patients (85%), there was no inappropriate administration of psychotropic drugs during hospital stay; for the remaining 15% with at least one inappropriate administration, physicians tended to limit overuse or misuse during hospital stay. Inappropriate administrations were more frequent in patients suffering from psychiatric disorders, dependence and associated complications or morbidities. Conclusions The automated indicators are structuring tools for the development of a drug prescription monitoring system. Inappropriate psychotropic administrations were limited by physicians during hospital stay; some inappropriate prescriptions might be explained by clinical characteristics of patients.

Abstract Background Pharmacovigilance consists in monitoring and preventing the occurrence of adverse drug reactions (ADR). This activity requires the collection and analysis of data from the patient record or any other sources to find clues of a causality link between the drug and the ADR. This can be time-consuming because often patient data are heterogeneous and scattered in several files. To facilitate this task, we developed a timeline prototype to gather and classify patient data according to their chronology. Here, we evaluated its usability and quantified its contribution to routine pharmacovigilance using real ADR cases. Methods The timeline prototype was assessed using the biomedical data warehouse eHOP (from e ntrepôt de données biomédicales de l’HOPital) of the Rennes University Hospital Centre. First, the prototype usability was tested by six experts of the Regional Pharmacovigilance Centre of Rennes. Their experience was assessed with the MORAE software and a System and Usability Scale (SUS) questionnaire. Then, to quantify the timeline contribution to pharmacovigilance routine practice, three of them were asked to investigate possible ADR cases with the “Usual method” (analysis of electronic health record data with the DxCare software) or the “Timeline method”. The time to complete the task and the data quality in their reports (using the vigiGrade Completeness score) were recorded and compared between methods. Results All participants completed their tasks. The usability could be considered almost excellent with an average SUS score of 82.5/100. The time to complete the assessment was comparable between methods (P = 0.38) as well as the average vigiGrade Completeness of the data collected with the two methods (P = 0.49). Conclusions The results showed a good general level of usability for the timeline prototype. Conversely, no difference in terms of the time spent on each ADR case and data quality was found compared with the usual method. However, this absence of difference between the timeline and the usual tools that have been in use for several years suggests a potential use in pharmacovigilance especially because the testers asked to continue using the timeline after the evaluation.

Wireless sensor networks (WSNs) have several important applications, both in research and domestic use. Generally, their main role is to collect and transmit data from an ROI (region of interest) to a base station for processing and analysis. Therefore, it is vital to ensure maximum coverage of the chosen area and communication between the nodes forming the network. A major problem in network design is the deployment of sensors with the aim to ensure both maximum coverage and connectivity between sensor node. The maximum coverage problem addressed here focuses on calculating the area covered by the deployed sensor nodes. Thus, we seek to cover any type of area (regular or irregular shape) with a predefined number of homogeneous sensors using a genetic algorithm to find the best placement to ensure maximum network coverage under the constraint of connectivity between the sensors. Therefore, this paper tackles the dual problem of maximum coverage and connectivity between sensor nodes. We define the maximum coverage and connectivity problems and then propose a mathematical model and a complex objective function. The results show that the algorithm, called GAFACM (Genetic Algorithm For Area Coverage Maximization), covers all forms of the area for a given number of sensors and finds the best positions to maximize coverage within the area of interest while guaranteeing the connectivity between the sensors.

Abstract Background Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN (“Territoire de Soins Numérique”/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. Methods EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects’ territories and in five comparison territories. Three populations will be considered: “TSN-targeted people” (healthcare system users and people having characteristics targeted by the TSN projects), “TSN patient users” (people included in TSN experimentations or using particular services) and “TSN professional users” (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database. Discussion EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation. Trial registration ClinicalTrials.gov ID: NCT02837406 , 08/18/2016.

Background: Sorafenib is an anti-angiogenic tyrosine kinase inhibitor used to treat patients with renal cell cancer and advanced hepatocellular cancer. Common adverse effects of sorafenib are rash, diarrhea, nausea, and abnormal liver function test and hand-foot syndrome. Case presentation: Here, we present a case of a 90-year-old male who was prescribed sorafenib after being diagnosed with hepatocellular cancer. At 1 week after sorafenib initiation, he was admitted to the emergency room for an evaluation of weakness. The patient had hyponatremia, a common electrolyte abnormality seen in cancer patients. His hyponatremia improved when the sorafenib was stopped, suggesting that this was a rare case of hyponatremia induced by sorafenib. Conclusion: Although sorafenib is used in the treatment of hepatocellular cancer, it can cause life-threatening complication such as hyponatremia. Early identification of the cause of hyponatremia can prevent serious adverse event.

Introduction: Drug interactions could account for 1% of hospitalizations in the general population and 2–5% of hospital admissions in the elderly. However, few data are available on the drugs concerned and the potential severity of the interactions encountered. We thus first aimed to estimate the prevalence of dispensings including drugs Contraindicated or Discommended because of Interactions (CDI codispensings) and to identify the most frequently involved drug pairs. Second, we aimed to investigate whether the frequency of CDI codispensings appeared higher or lower than the expected for the drugs involved.Methods: We carried out a study using a random sample of all drugs dispensings registered in a database of the French Health Insurance System between 2010 and 2015. The distribution of the drugs involved was described considering active principles, detailing the 20 most frequent ones for both contraindicated or discommended codispensings (DCs). To investigate whether the frequency of CDI codispensings appeared higher or lower than the expected for the drugs involved, we developed a specific indicator, the Drug-drug interaction prevalence study-score (DIPS-score), that compares for each drug pair the observed frequency of codispensing to its expected probability. The latter is determined considering the frequencies of dispensings of the individual drugs constituting a pair of interest.Results: We analyzed 6,908,910 dispensings: 13,196 (0.2%) involved contraindicated codispensings (CCs), and 95,410 (1.4%) DCs. For CCS, the most frequently involved drug pair was “bisoprolol+flecainide” (n = 5,036); four out of five of the most represented pairs involved cardiovascular drugs. For DCS, the most frequently involved drug pair was “ramipril+spironolactone” (n = 4,741); all of the five most represented pairs involved cardiovascular drugs. The drug pair involved in the CC with the highest score value was “citalopram+hydroxyzine” (DIPS-score: 3.7; 2.9–4.6); that with the lowest score was “clarithromycin+simvastatin” (DIPS-score: 0.2; 0.2–0.3). DIPS-score median value was 0.4 for CCs and 0.6 for DCs.Conclusion: This high prevalence of CDI codispensings enforces the need for further risk-prevention actions regarding drug-drug interactions (DDIs), especially for arrhythmogenic or anti-arrhythmic drugs. In this perspective, the DIPS-score we develop could ease identifying the interactions that are poorly considered by clinicians/pharmacists and targeting interventions.

Pharmacovigilance consists in monitoring and preventing the occurrence of adverse drug reactions. This activity can be time-consuming because it requires the collection of both patient and medication information. In this paper, we present two visualization and data mining applications to make this task easier for the practitioner. These tools have been developed and tested using the biomedical data warehouse eHOP (Hospital Biomedical Data Warehouse) of the Rennes University Hospital Centre. The first application is a tool to visualize the patient electronic health record in the form of a timeline. All patient data is collected and displayed chronologically. The usability test of the timeline has been very positive (SUS score: 82.5) and the tool is now available for practitioners in their daily practice. The second application is a tool to visualize and search the sequences of a patient cohort. The visual interface allow user to quickly visualize sequences. A query builder allows user to search for sequences in relation with a reference sequence, such as a prescription sequence followed by an abnormal biological value. The sequences are then visually aligned with this reference sequence and ranked by similarity. The GSP (Generalized Sequential Pattern) and Apriori algorithms allow us to display a summary of the sequences list by searching for common sequences and associations. The tool was tested on a use case which consisted in detection of inappropriate drug administration. Compared to a random order, we showed this ranking system saved the practitioner time in this task (to analyze one sequence, 3.49 ± 3.54 vs. 2.26 ± 2.86 s, p = 0.0003). These two visualization and data mining applications will help the daily practice of pharmacovigilance.

Drug misuse may happen when patients do not follow the prescriptions and do actions which lead to potentially harmful situations, such as intakes of incorrect dosage (overuse or underuse) or drug use for indications different from those prescribed. Although such situations are dangerous, patients usually do not report the misuse of drugs to their physicians. Hence, other sources of information are necessary for studying these issues. We assume that online health fora can provide such information and propose to exploit them. The general purpose of our work is the automatic detection and classification of drug misuses by analysing user-generated data in French social media. To this end, we propose a multi-step method, the main steps of which are: (1) indexing of messages with extended vocabulary adapted to social media writing; (2) creation of typology of drug misuses; and (3) automatic classification of messages according to whether they contain drug misuses or not. We present the results obtained at different steps and discuss them. The proposed method permit to detect the misuses with up to 0.773 F-measure.

Background: We present a method to determine and visualise the functional centre of rotation (FCOR) of the hip during total hip arthroplasty using an augmented reality head mounted display (AR-HMD)., Methods: We developed software allowing a HoloLens to provide inside-out infrared tracking of markers affixed to cadaver femurs and 3D printed acetabuli. Two observers rotated 20 cadaver femurs twice in a matching cup, producing 80 measurements. The FCOR of the acetabulum and femoral head was determined based on the point cloud generated from the displacement of the femoral trackers to the acetabular tracker., Results: Compared to the ground truth, the FCOR resulted in an absolute error of 2.9 ± 1.4 mm for the acetabulum and 2.9 ± 1.2 mm for the femur, with 95th percentiles below 5.6 and 4.7 mm., Conclusion: The proposed AR-HMD system offers an accurate and reproducible way to determine the femoral and acetabular FCOR in an experimental setting., (© 2024 The Author(s). The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.)

In several orthopedic procedures, the accurate use of surgical power tools is critical to avoid damage to surrounding tissues. As such, various guidance techniques and safety measures were developed. Augmented reality (AR) guidance shows promise but requires validation. We evaluated a new approach using an inside-out infrared tracking solution for the HoloLens to compensate for its limited tracking performance. Eighteen participants with varying levels of experience (student, trainee, expert) each drilled twelve trajectories (six perpendicular, six oblique) in equidimensional wooden logs. Three different techniques were evaluated: freehand drilling; proprioception-guided drilling towards the contralateral index finger; and AR-guided drilling using a tracked drill and a virtual overlay of the log with predefined guidance vectors. The angular errors between planned and performed trajectories were compared using a mixed-design ANOVA. The results demonstrated that guidance technique (p < 0.001) and drilling direction (p < 0.001) significantly affected drilling accuracy, while experience (p = 0.75) did not. AR outperformed both other techniques, particularly for oblique trajectories (p < 0.001). For perpendicular trajectories, it only outperformed proprioception guidance (p = 0.04). Target plots revealed an important scatter perpendicular to the longitudinal axis of the log during freehand and proprioception-guided drilling, especially for oblique trajectories. This inaccuracy disappeared during AR-guided drilling. As such, we were able to conclude that AR guidance using inside-out infrared tracking reduced angular uncertainty during directional drilling, resulting in improved drilling accuracy. This improvement was particularly noticeable for complex trajectories and angles. The benefits of AR guidance were observed across all experience levels, highlighting its potential for orthopedic applications. We believe this study opens the way for the methodical evaluation of AR guidance in specific orthopedic use cases., (© 2024. The Author(s).)

In total hip arthroplasty (THA), determining the center of rotation (COR) and diameter of the hip joint (acetabulum and femoral head) is essential to restore patient biomechanics. This study investigates on-the-fly determination of hip COR and size, using off-the-shelf augmented reality (AR) hardware. An AR head-mounted device (HMD) was configured with inside-out infrared tracking enabling the determination of surface coordinates using a handheld stylus. Two investigators examined 10 prosthetic femoral heads and cups, and 10 human femurs. The HMD calculated the diameter and COR through sphere fitting. Results were compared to data obtained from either verified prosthetic geometry or post-hoc CT analysis. Repeated single-observer measurements showed a mean diameter error of 0.63 mm ± 0.48 mm for the prosthetic heads and 0.54 mm ± 0.39 mm for the cups. Inter-observer comparison yielded mean diameter errors of 0.28 mm ± 0.71 mm and 1.82 mm ± 1.42 mm for the heads and cups, respectively. Cadaver testing found a mean COR error of 3.09 mm ± 1.18 mm and a diameter error of 1.10 mm ± 0.90 mm. Intra- and inter-observer reliability averaged below 2 mm. AR-based surface mapping using HMD proved accurate and reliable in determining the diameter of THA components with promise in identifying COR and diameter of osteoarthritic femoral heads., (© 2024. The Author(s).)

Competing Interests: None disclosed.

Introduction and establishment of non-indigenous species (NIS) has been accelerated on a global scale by climate change. NIS Magallana gigas' (formerly Crassostrea gigas') global spread over the past several decades has been linked to warming waters, specifically during summer months, raising the specter of more spread due to predicted warming. We tracked changes in density and size distribution of M. gigas in two southern California, USA bays over the decade spanning 2010-2020 using randomly placed quadrats across multiple intertidal habitats (e.g., cobble, seawalls, riprap) and documented density increases by 2.2 to 32.8 times at 7 of the 8 sites surveyed across the two bays. These increases in density were coincident with 2-4° C increases in median monthly seawater temperature during summer months, consistent with global spread of M. gigas elsewhere. Size frequency distribution data, with all size classes represented across sites, suggest now-regular recruitment of M. gigas. Our data provide a baseline against which to compare future changes in density and abundance of a globally-spread NIS of significant concern., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wolfe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The integration of Deep Learning (DL) models with the HoloLens2 Augmented Reality (AR) headset has enormous potential for real-time AR medical applications. Currently, most applications execute the models on an external server that communicates with the headset via Wi-Fi. This client-server architecture introduces undesirable delays and lacks reliability for real-time applications. However, due to HoloLens2's limited computation capabilities, running the DL model directly on the device and achieving real-time performances is not trivial. Therefore, this study has two primary objectives: (i) to systematically evaluate two popular frameworks to execute DL models on HoloLens2-Unity Barracuda and Windows Machine Learning (WinML)-using the inference time as the primary evaluation metric; (ii) to provide benchmark values for state-of-the-art DL models that can be integrated in different medical applications (e.g., Yolo and Unet models). In this study, we executed DL models with various complexities and analyzed inference times ranging from a few milliseconds to seconds. Our results show that Unity Barracuda is significantly faster than WinML ( p -value < 0.005). With our findings, we sought to provide practical guidance and reference values for future studies aiming to develop single, portable AR systems for real-time medical assistance.

Background: This study used the Unified Theory of Acceptance and Use of Technology (UTAUT) to investigate the acceptance of HMD-based AR surgical navigation., Methods: An experiment was conducted in which participants drilled 12 predefined holes using freehand drilling, proprioceptive control, and AR assistance. Technology acceptance was assessed through a survey and non-participant observations., Results: Participants' intention to use AR correlated (p < 0.05) with social influence (Spearman's rho (rs) = 0.599), perceived performance improvement (rs = 0.592) and attitude towards AR (rs = 0.542)., Conclusions: While most participants acknowledged the potential of AR, they also highlighted persistent barriers to adoption, such as issues related to user-friendliness, time efficiency and device discomfort. To overcome these challenges, future AR surgical navigation systems should focus on enhancing surgical performance while minimising disruptions to workflows and operating times. Engaging orthopaedic surgeons in the development process can facilitate the creation of tailored solutions and accelerate adoption., (© 2023 John Wiley & Sons Ltd.)

Background: Before starting surgery for the resection of an intracranial tumor, its outlines are typically marked on the skin of the patient. This allows for the planning of the optimal skin incision, craniotomy, and angle of approach. Conventionally, the surgeon determines tumor borders using neuronavigation with a tracked pointer. However, interpretation errors can lead to important deviations, especially for deep-seated tumors, potentially resulting in a suboptimal approach with incomplete exposure. Augmented reality (AR) allows displaying of the tumor and critical structures directly on the patient, which can simplify and improve surgical preparation., Methods: We developed an AR-based workflow for intracranial tumor resection planning deployed on the Microsoft HoloLens II, which exploits the built-in infrared-camera for tracking the patient. We initially performed a phantom study to assess the accuracy of the registration and tracking. Following this, we evaluated the AR-based planning step in a prospective clinical study for patients undergoing resection of a brain tumor. This planning step was performed by 12 surgeons and trainees with varying degrees of experience. After patient registration, tumor outlines were marked on the patient's skin by different investigators, consecutively using a conventional neuronavigation system and an AR-based system. Their performance in both registration and delineation was measured in terms of accuracy and duration and compared., Results: During phantom testing, registration errors remained below 2.0 mm and 2.0° for both AR-based navigation and conventional neuronavigation, with no significant difference between both systems. In the prospective clinical trial, 20 patients underwent tumor resection planning. Registration accuracy was independent of user experience for both AR-based navigation and the commercial neuronavigation system. AR-guided tumor delineation was deemed superior in 65% of cases, equally good in 30% of cases, and inferior in 5% of cases when compared to the conventional navigation system. The overall planning time (AR = 119 ± 44 s, conventional = 187 ± 56 s) was significantly reduced through the adoption of the AR workflow ( p < 0.001), with an average time reduction of 39%., Conclusion: By providing a more intuitive visualization of relevant data to the surgeon, AR navigation provides an accurate method for tumor resection planning that is quicker and more intuitive than conventional neuronavigation. Further research should focus on intraoperative implementations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Van Gestel, Frantz, Buyck, Geens, Neuville, Bruneau, Jansen, Scheerlinck, Vandemeulebroucke and Duerinck.)

Objective: The traditional freehand technique for external ventricular drain (EVD) placement is most frequently used, but remains the primary risk factor for inaccurate drain placement. As this procedure could benefit from image guidance, the authors set forth to demonstrate the impact of augmented-reality (AR) assistance on the accuracy and learning curve of EVD placement compared with the freehand technique., Methods: Sixteen medical students performed a total of 128 EVD placements on a custom-made phantom head, both before and after receiving a standardized training session. They were guided by either the freehand technique or by AR, which provided an anatomical overlay and tailored guidance for EVD placement through inside-out infrared tracking. The outcome was quantified by the metric accuracy of EVD placement as well as by its clinical quality., Results: The mean target error was significantly impacted by either AR (p = 0.003) or training (p = 0.02) in a direct comparison with the untrained freehand performance. Both untrained (11.9 ± 4.5 mm) and trained (12.2 ± 4.7 mm) AR performances were significantly better than the untrained freehand performance (19.9 ± 4.2 mm), which improved after training (13.5 ± 4.7 mm). The quality of EVD placement as assessed by the modified Kakarla scale (mKS) was significantly impacted by AR guidance (p = 0.005) but not by training (p = 0.07). Both untrained and trained AR performances (59.4% mKS grade 1 for both) were significantly better than the untrained freehand performance (25.0% mKS grade 1). Spatial aptitude testing revealed a correlation between perceptual ability and untrained AR-guided performance (r = 0.63)., Conclusions: Compared with the freehand technique, AR guidance for EVD placement yielded a higher outcome accuracy and quality for procedure novices. With AR, untrained individuals performed as well as trained individuals, which indicates that AR guidance not only improved performance but also positively impacted the learning curve. Future efforts will focus on the translation and evaluation of AR for EVD placement in the clinical setting.

Background: Many surgical procedures, such as placement of intracranial drains, are currently being performed blindly, relying on anatomical landmarks. As a result, accuracy results still have room for improvement. Neuronavigation could address this issue, but its application in an urgent setting is often impractical. Augmented reality (AR) provided through a head-worn device has the potential to tackle this problem, but its implementation should meet physicians' needs., Methods: The Surgical Augmented Reality Assistance (SARA) project aims to develop an AR solution that is suitable for preoperative planning, intraoperative visualisation and navigational support in an everyday clinical setting, using a Microsoft HoloLens., Results: Proprietary hardware and software adaptations and dedicated navigation algorithms are applied to the Microsoft HoloLens to optimise it specifically for neurosurgical navigation. This includes a pipeline with an additional set of advanced, semi-automated algorithms responsible for image processing, hologram-to-patient registration and intraoperative tracking using infrared depth-sensing. A smooth and efficient workflow while maintaining high accuracy is prioritised. The AR solution provides a fully integrated and completely mobile navigation setup. Initial preclinical and clinical validation tests applying the solution to intracranial drain placement are described., Conclusion: AR has the potential to vastly increase accuracy of everyday procedures that are frequently performed without image guidance, but could still benefit from navigational support, such as intracranial drain placements. Technical development should go hand in hand with preclinical and clinical validation in order to demonstrate improvements in accuracy and clinical outcomes.

Background: Shoulder injuries account for a large portion of all recorded injuries in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population are unknown. We examined the epidemiology of AC joint injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players and determined the impact on time missed., Methods: The MLB Health and Injury Tracking System was used to compile records of all MLB and MiLB players from 2011 to 2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data extracted included laterality, date of injury, player position, activity, mechanism of injury, length of return to play, and need for surgical intervention., Results: A total of 312 AC joint injuries (183 in MiLB players and 129 in MLB players; range, 39-60 per year) were recorded: 201 acute (64.4%) and 111 chronic (35.6%). A total of 81% of acute and 59% of chronic injuries resulted in time missed, with a mean length of return to play of 21 days for both. Of the injuries in outfielders, 79.6% were acute (P < .0001), as were 66.3% of injuries in infielders (P = .004). Pitchers and catchers had more equal proportions of acute and chronic AC injuries (P > .05 for all). Acute AC injuries occurred most often while fielding (n = 100, 84.7%), running (n = 25, 80.6%), and hitting (n = 19, 61.3%), whereas chronic injuries tended to be more common while pitching (n = 26, 68.4%). Of contact injuries, 82.5% were acute (P < .0001), whereas 59.0% of noncontact injuries were chronic (P = .047). MLB players showed consistently higher regular-season rates of both acute and chronic AC injuries than MiLB players (P < .0001 for each)., Conclusion: Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders while fielding that result in 3 weeks missed before return to play, whereas chronic AC joint injuries occur more commonly in pitchers and catchers from noncontact repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of 2 common injury patterns in the AC joint., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

An unusual case of a 37-year-old woman with bullous tinea manuum caused by an infection with Trichophyton mentagrophytes is described. The patient presented with a pruritic erythematous vesicular rash on the right palm and interdigital web spaces between the first and second digits. The preliminary diagnosis was acute contact dermatitis, which was treated with oral and topical corticosteroids. The rash failed to respond to treatment, resulting in tinea incognito. At 2-week follow-up, a potassium hydroxide (KOH) preparation performed in clinic was positive for T mentagrophytes. The suspected source of infection was a domestic 4-toed, white-bellied African pygmy hedgehog (Atelerix albiventris). There was remarkable improvement of the lesion after 2 weeks with appropriate topical and systemic antifungal agents. This case illustrates that popular exotic pets such as the hedgehog can increase the risk for zoophilic dermatophytic infection, which can present as bullous lesions with little or no scale and can be confused with acute contact dermatitis. It is important for the clinician to recognize this presentation and provide close follow-up for lesions not responding to treatment.

Background: Self-application of topicals on the back can be challenging., Objective: The aim was to assess topical back coverage using commercially available back applicators., Materials and Methods: Ten subjects applied sunscreen to their back using their hands and then with 3 back applicators (large foam tip, small foam tip, roller tip). The amount of lotion used and the time it took to perform the application were recorded. The resulting distribution of sunscreen was assessed with a Wood's lamp; the area covered fluoresced less than the uncovered skin. Images were captured and then analyzed using an automated thresholding technique., Results: Subjects applied more lotion when using the large foam tip (7.58 g, 95% CI 6.47-8.70 g; P < .004) and small foam tip (7.46 g, 95% CI 6.35-8.57 g; P < .006) applicators compared to hands alone (6.22 g, 95% CI 5.10-7.33 g). Application time was longer with the small foam tip applicator (113.4 s, 95% CI 96.7-130.1 s) relative to hand application (78.7 s, 95% CI 62-95.4 s) ( P < .03). Coverage of the back was higher for the large foam tip (84.8%, 95% CI 78.4%-91.3%; P < .03), small foam tip (88.0%, 95% CI 81.6%-91.5%; P < .006), and roller tip (84.3%, 95% CI 77.9%-90.8%; P < .04) applicators compared to hand application (71.5%, 95% CI 65%-78%). The middle back tended to have less coverage when applying with the hands., Conclusions: Topical coverage of the back is improved with the use of applicator devices during self-application.

Background: Treatment of atopic dermatitis and psoriasis in children is difficult due to lack of standardized treatment guidelines and few FDA-approved treatment options. Treatments approved for adults may be used off-label in pediatric patients., Objective: This review evaluates the topical and oral treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric atopic dermatitis and psoriasis., Methods: A PubMed review of topical and systemic treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments., Results: The search identified seven topical and five systemic treatments that are routinely employed to treat pediatric atopic dermatitis and psoriasis., Limitations: Standardized guidelines regarding treatment choice, dosing, and long-term safety are scarce. Reviews may be subject to ascertainment bias., Conclusions: Current treatment guidelines are based on clinical experience and expert advice with few treatments officially approved for atopic dermatitis and psoriasis in children.

Background: Childhood atopic dermatitis is a chronic inflammatory skin condition that causes significant psychological and financial costs to the individual and society. Treatment regimens may require long-term medication adherence and can be associated with poor patient satisfaction. There is considerable interest in complementary and integrative medicine (CIM) approaches for childhood atopic dermatitis., Objective: To assess the effects of CIM approaches on childhood atopic dermatitis outcomes as defined by randomized, controlled clinical trials., Methods: A PubMed review of CIM-related treatments for pediatric atopic dermatitis was performed, and data related to age, study population, efficacy, treatment regimen, length of treatment, and sample size were included., Results: The search yielded 20 trials related to probiotic/prebiotic treatments for atopic dermatitis, three on the effects of vitamins on children with atopic dermatitis, and two on the effects of Chinese herbal treatments for atopic dermatitis in children and adolescents. The strongest evidence was for supplementation with the probiotics L. fermentum and L. plantarum ., Conclusions: Certain strains of probiotics, specifically L. plantarum and L. fermentum, may improve clinical severity scores in children with atopic dermatitis. However, additional trials are needed to more thoroughly delineate the effects of additional integrative therapies on childhood atopic dermatitis.

A novel CoFe 2 O 4 /chitosan magnetic composite, where CoFe 2 O 4 is known as cobalt ferrite, was synthetized, characterized and applied to adsorb indigotine blue dye (IBD). According to the central composite design (CCD), adsorption of IBD onto CoFe 2 O 4 /chitosan composite was favored when initial pH and adsorbent dosage were 3.0 and 0.75 g L -1 , respectively. Adsorption was a fast process, well represented by pseudo-first order model, being the equilibrium reached at 15 min. Concerning the equilibrium behavior, the adsorption was satisfactorily modeled by the Langmuir model, reaching maximum adsorption capacity of 380.88 mg g -1 at 328 K. The thermodynamic parameters indicated a spontaneous, favorable and endothermic adsorption process. CoFe 2 O 4 /chitosan magnetic composite is an efficient adsorbent to remove dyes from aqueous media, presenting advantages like fast kinetic, high adsorption capacity and interesting magnetic properties that allows the easy separation after the adsorption operation., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: Large acetabular defects secondary to metastatic disease frequently require extensive acetabular reconstruction. Techniques of acetabular reconstruction have been described, but no consensus for the management of these defects has been reached so far. We present our technique and patient outcomes for acetabular reconstruction by cementing a dual mobility cup into an acetabular cage., Methods: We reviewed 152 total hip arthroplasties and identified 19 patients with periacetabular metastatic disease and large defects who required acetabular reconstruction utilizing a dual mobility cup cemented into an acetabular reconstructive cage. The following outcomes were evaluated: pain relief, functional improvement, postoperative complications., Results: Mean follow-up was 3 years, with 13 of the 19 patients eligible for 2-year follow-up. Patients reported a significant improvement in both pain and functional outcomes. There were no dislocations or signs of loosening. Two patients developed postoperative infections. One patient required hemipelvectomy 16 months postop due to recurrence of metastatic disease., Conclusions: Cementing a dual mobility cup into an acetabular cage provides a highly stable and durable option for patients with periacetabular metastatic disease and large defects. Patients are able to return to immediate full weight bearing with significant improvement in both function and pain at 2 years., (© 2019 Wiley Periodicals, Inc.)

Adsorption of Al (III) and Fe (III) onto chitosan films from individual and binary systems were investigated. The matrix effect was evaluated using an industrial effluent of the scrubber of gases from the production process of Al 2 (SO 4 ) 3 . The adsorption study was carried out by response surface methodology to optimize the adsorption operation as a function of pH (3, 4.5 and 6) and film dosage (FD) (100, 200 and 300 mg L -1 ).The possible interactions film-ions were investigated by thermal analysis, X-ray diffraction, scanning electron microscopy and dispersive energy X-ray spectroscopy. The more suitable conditions for all experimental designs were the FD values in 100 mg L -1 and pH 4.5.The adsorption capacity of Fe (III) in the individual and binary systems were 140.2 mg g -1 and 132.3 mg g -1 respectively; however, in the experiment conducted on the real effluent, the adsorption capacity was reduced to 66.30 mg g -1 .Already to Al (III), the adsorption capacities in the individual and binary systems were 665.5 mg g -1 to 621.2 mg g -1 respectively, and when the operation was performed using real effluent the adsorption capacity was reduced to 275.7 mg g -1 ., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Major hurdles for Microsoft's HoloLens as a tool in medicine have been accessing tracking data, as well as a relatively high-localisation error of the displayed information; cumulatively resulting in its limited use and minimal quantification. The following work investigates the augmentation of HoloLens with the proprietary image processing SDK Vuforia, allowing integration of data from its front-facing RGB camera to provide more spatially stable holograms for neuronavigational use. Continuous camera tracking was able to maintain hologram registration with a mean perceived drift of 1.41 mm, as well as a mean sub 2-mm surface point localisation accuracy of 53%, all while allowing the researcher to walk about a test area. This represents a 68% improvement for the later and a 34% improvement for the former compared with a typical HoloLens deployment used as a control. Both represent a significant improvement on hologram stability given the current state-of-the-art, and to the best of the authors knowledge are the first example of quantified measurements when augmenting hologram stability using data from the RGB sensor.

Background: Pelvic and retroperitoneal trauma is a major cause of morbidity and mortality in multiply injured patients. The Injury Severity Score (ISS) has been criticized for underrepresenting and inaccurately defining mechanical injury. The influence of pelvic injury volume on organ dysfunction and multiple organ failure (MOF) has not been described. Through the use of CT, this investigation sought to precisely define volumes of mechanical tissue damage by anatomic region and examine its impact on organ failure., Questions/purposes: (1) Do patients with MOF have a greater volume of pelvic and retroperitoneal tissue damage when compared with those without MOF? (2) In patients who sustained pelvic trauma, does the magnitude of pelvic injury differ in patients with MOF? (3) Does the magnitude of organ dysfunction correlate with pelvic tissue damage volume?, Methods: Seventy-four multiply injured patients aged 18 to 65 years with an ISS ≥ 18 admitted to the intensive care unit for a minimum of 6 days with complete admission CT scans were analyzed. Each identifiable injury in the head/neck, chest, abdomen, and pelvis underwent volumetric determination using CT to generate regional tissue damage volume scores. Primary outcomes were the development of MOF as measured by the Denver MOF score and the degree of organ dysfunction by utilization of the Sequential Organ Failure Assessment (SOFA) score. Mean pelvic and retroperitoneal tissue damage volumes were compared in patients who developed MOF and those who did not develop MOF using Student's t-test. Among patients who sustained pelvic injuries, we compared mean volume of tissue damaged in patients who developed MOF and those who did not. We assessed whether there was a correlation between organ dysfunction, as measured by the SOFA score as a continuous variable, and the volume of pelvic and retroperitoneal tissue damage using the Pearson product-moment correlation coefficient., Results: The average volume of tissue damage was greater in patients with MOF when compared with those without (MOF: 685.667 ± 1081.344; non-MOF: 195.511 ± 381.436; mean difference 490.156 cc [95% confidence interval {CI}, 50.076-930.237 cc], p = 0.030). Among patients who sustained pelvic injuries, those with MOF had higher average tissue damage volumes than those without MOF (MOF: 1322.000 ± 1197.050; non-MOF: 382.750 ± 465.005; mean difference 939.250 [95% CI, 229.267-1649.233], p = 0.013). Organ dysfunction (SOFA score) correlated with higher volumes of pelvic tissue damage (r = 0.570, p < 0.001)., Conclusions: This investigation demonstrated that greater degrees of pelvic and retroperitoneal tissue damage calculated from injury CT scans in multiply injured patients is associated with more severe organ dysfunction and an increased risk of developing MOF. Early identification of polytrauma patients at risk of MOF allows clinicians to implement appropriate resuscitative strategies early in the disease course. Improved stratification of injury severity and a patient's anticipated clinical course may aid in the planning and execution of staged orthopaedic interventions. Future avenues of study should incorporate the ischemic/hypoperfusion component of pelvic injury in conjunction with the mechanical component presented here for improved stratification of multiply injured patients at higher risk of MOF., Level of Evidence: Level III, prognostic study.