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Rates of surgical management of distal radius fractures are increasing internationally despite the higher cost and limited outcome evidence to support this shift. This study examines the epidemiology of distal radius fractures and asks if the same shift has occurred in Ontario, Canada (population 13.9 million).This population-based, retrospective cohort study examined distal radius fractures in people aged 18 years and older over a 10-year period (2004–2013). The incidence analyses were based on the first occurrence of a fracture within a 2-year time period. The number of fractures, age-adjusted incidence rates and frequency of fracture treatment type by year were assessed. We used a Poisson regression with robust standard errors to determine if there was a statistically significant change in the frequency of fracture treatment type over time.There were 25 355 distal radius fractures among Ontarians 18 years of age and older in 2013. Between 2004 and 2013, the age-adjusted incidence rate for people 35 years of age and older was stable, between 2.32 and 2.70 per 1000 population. Rates of cast immobilization remained stable between 82% and 84%. Of those patients treated surgically, the rate of open reduction and internal fixation rose from 7% in 2004 to 13% in 2013 at the expense of other types of surgical management.In Ontario, rates of cast immobilization are stable and there has been a movement toward open reduction and internal fixation among patients treated surgically.Le taux de prise en charge chirurgicale des fractures du radius distal augmente partout dans le monde, malgré le coût supérieur de l’intervention et le manque de données probantes sur les issues. Cette étude se penche sur l’épidémiologie des fractures du radius distal et cherche à savoir si cette augmentation se reflète en Ontario, au Canada (population : 13,9 millions).Cette étude de cohorte rétrospective basée sur la population examinait les fractures du radius distal chez les personnes âgées de 18 ans et plus sur une période de 10 ans (de 2004 à 2013). Les analyses de l’incidence étaient fondées sur la première occurrence de fracture en 2 ans. Le nombre de fractures, le taux d’incidence ajusté en fonction de l’âge et la fréquence annuelle des types de traitement des fractures ont été évalués. Nous avons utilisé une régression de Poisson avec des erreurs types robustes pour déterminer s’il y avait des changements statistiquement significatifs dans la fréquence des types de traitement des fractures au fil du temps.Il y a eu 25 355 fractures du radius distal chez les Ontariens de 18 ans et plus en 2013. Entre 2004 et 2013, le taux d’incidence ajusté en fonction de l’âge pour les personnes de 35 ans et plus était stable, entre 2,32 et 2,70 pour 1000 personnes. Le taux d’immobilisation plâtrée est demeuré stable entre 82 % et 84 %. Chez les patients traités par chirurgie, le taux de réduction chirurgicale et de fixation interne est passé de 7 % en 2004 à 13 % en 2013, au détriment des autres types de prise en charge chirurgicale.En Ontario, le taux d’immobilisation plâtrée est demeuré stable et il y a eu une augmentation de la réduction chirurgicale et de la fixation interne chez les patients traités par chirurgie.

In the age of information and patient-centered care, new methods of delivering postoperative care must be developed and evaluated.To determine whether follow-up care delivered via a mobile app can be used to avert in-person follow-up care visits compared with conventional, in-person follow-up care in the first 30 days following ambulatory surgery.A randomized clinical trial was conducted from February 1 to August 31, 2015, among ambulatory patients undergoing breast reconstruction at an academic ambulatory care hospital. Patients were randomly assigned to receive follow-up care via a mobile app or at an in-person visit during the first 30 days after the operation. Analysis was intention-to-treat.The primary end point was the number of in-person follow-up visits during the first 30 days after the operation. Secondary end points were the number of telephone calls and emails to health care professionals, patient-reported convenience and satisfaction scores, and rates of complications.Of the 65 women in the study (mean [SD] age, 47.7 [13.4] years), 32 (49%) were in the mobile app group, and 33 (51%) were in the in-person follow-up care group. Those in the mobile app group attended a mean of 0.66 in-person visits, vs 1.64 in-person visits in the in-person follow-up care group, for a difference of 0.40 times fewer in-person visits (95% CI, 0.24-0.66; P .001) and sent more emails to their health care professionals during the first 30 days after the operation (mean, 0.65 vs 0.15; incidence rate ratio, 4.13; 95% CI, 1.55-10.99; P = .005) than did patients in the in-person follow-up care group. This statistically significant difference was maintained at 3 months postoperatively. The mobile app group reported higher convenience scores than the in-person follow-up care group (incidence rate ratio, 1.39; 95% CI, 1.09-1.77; P = .008). There was no difference between groups in the number of telephone communications, satisfaction scores, or complication rates.Patients undergoing ambulatory breast reconstruction can use follow-up care via a mobile app to avert in-person follow-up visits during the first 30 days after the operation. Mobile app follow-up care affects neither complication rates nor patient-reported satisfaction scores, but it improves patient-reported convenience scores.clinicaltrials.gov Identifier: NCT02318953.

This study assessed the presence, amount, and sensitivity of personally identifiable information and personal health information found in hospital recycling bins in Toronto, Ontario, Canada.

Smartphone technology appears to be the next phase of development in telemedicine. With the increased focus on patient-centred care, mobile technology is being used to connect patients and their health care teams. Numerous mobile applications are available that can assist with both surgical and

Family therapy theory and techniques can be successfully applied in group settings. This article discusses such an application of family therapy theory and describes it in terms of a group treatment setting for adult males with substance addiction. Various treatment rationales and subsequent interventions are explored.

Background: Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications. Objective: The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients. Methods: This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks. Results: This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up. Conclusions: Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective. [J Med Internet Res 2014;16(9):e213]

ObjectiveThe primary aim of this study was to describe the prevalence of select oncogenic viruses within vulvar squamous cell carcinoma (VSCC) and their association with human immunodeficiency virus (HIV) status in women in Botswana, where the national HIV prevalence is the third highest in the world.MethodsA cross-sectional study of biopsy-confirmed VSCC specimens and corresponding clinical data was conducted in Gaborone, Botswana. Polymerase chain reaction (PCR) and immunohistochemistry (IHC) viral testing were done for Epstein-Barr virus, human papillomavirus (HPV) strains, and Kaposi sarcoma herpesvirus, and PCR viral testing alone was done for John Cunningham virus.ResultsHuman papillomavirus prevalence by PCR was 100% (35/35) among tested samples. Human papillomavirus type 16 was the most prevalent HPV strain (82.9% by PCR, 94.7% by either PCR or IHC). Kaposi sarcoma herpesvirus prevalence by PCR had a significant association with HIV status (P = 0.013), but not by IHC (P = 0.650).ConclusionsThe high burden of HPV, specifically HPV16, in vulvar squamous cell cancer in Botswana suggests a distinct HPV profile that differs from other studied populations, which provides increased motivation for HPV vaccination efforts. Oncogenic viruses Kaposi sarcoma herpesvirus and Epstein-Barr virus were also more prevalent in our study population, although their potential role in vulvar squamous cell cancer pathology is unclear.

When delivering services to children and their caregivers, it is important for early intervention professionals to integrate their clinical expertise, the family’s values, and the best research evidence into selecting strategies to improve developmental outcomes. Referred to as evidence-based practice, this process enhances both optimal outcomes and quality of life by utilizing interventions that have been documented through systematic research efforts.

With growing numbers of developmental needs expressed in communities, the way services are delivered to families must change to assist children. A prevention model which provides multiple levels of support from prevention efforts to extensive, individualized interventions can assist practitioners in meeting the needs of children efficiently and effectively. In addition, prevention and intervention efforts are more effective when problems are clearly identified and tied to specific interventions which are evidence-based. The use of a problem-solving process gives practitioners a specific way to think about child concerns and develop and track progress of interventions matched to the child or children’s needs.

Many evidence-based interventions for addressing challenging behavior in young children utilize behavioral strategies. This chapter outlines key behavioral principles (e.g., reinforcement, punishment, schedules of reinforcement and punishment, extinction, imitation, shaping) that can be used to prevent and intervene with problem behaviors in young children.

This chapter outlines a process that early childhood professionals can use to address challenging behavior with behavioral strategies. The process begins with identifying a problem, considering why the problem is occurring, designing an intervention to address the problem, and using data to determine whether the intervention was effective in reducing the behavior and improving adaptive outcomes for the child.

This final chapter utilizes case studies within the prevention framework in an effort to integrate theories of development, evidence-based practice, behavioral principles, progress monitoring data, and evaluation of outcomes. When possible, the outcomes from each case study are graphically presented so that progress can be observed.

Challenging behavior in young children is common. It can be difficult for parents or early childhood professionals to know what behaviors fall within the typical range of behavior. This chapter outlines the prevalence of common behavioral concerns among young children (sleep problems, feeding issues, colic/excessive crying, toileting issues, fears/worries/anxiety, sexual behaviors, aggression, and social skills) and outlines guidelines for how to address these concerns. Strategies to ensure cultural competence in working with a diverse range of families are also outlined.

Developmental theories are useful towards understanding how children learn and grow, and by what means their trajectories can be supported. Most theorists agree that both biology and experience are key factors that shape developmental outcomes. Risk and protective factors are said to contribute to development and often can be modified through intervention efforts. The prevention model emphasizes a foundation of supports and services aimed to foster healthy development.

To compare the steric bulk of a cationic substituent with that of the corresponding neutral one, the conformational equilibria of cis-N-(4-methylcyclohexyl)imidazole (1-c), cis-N-(4-phenylcyclohexyl)imidazole (2-c), and their conjugate acids were measured by low-temperature NMR. The A value of an imidazolyl group (equatorial-to-axial free-energy change of N-cyclohexylimidazole) is 2.2±0.1 kcal/mol, in both dichloromethane and methanol. The A value of an N-protonated imidazolyl group in these solvents is 2.2±0.1 kcal/mol. Within the experimental error of this method, the cationic substituent is the same size as the neutral. To measure the relative sizes more precisely, an NMR titration method, applicable to a mixture of isomers, was developed

The anomeric effect is thought to be the result of either molecular orbital interactions, which stabilize the axial conformer, or electrostatic interactions, which destabilize the equatorial. To test which of these is more important, it is proposed to determine the change in the anomeric effect on replacing the oxygen of an anomeric molecule by nitrogen. Nitrogen is less electronegative than oxygen, leading to weaker electrostatic interactions and stronger molecular orbital interactions, so the two interactions act in opposite directions. Accordingly, the conformational equilibrium of 2-methoxy-1,3-dimethylhexahydropyrimidine (3) was measured by 1 H and 13 C NMR. The proportion of axial conformer is almost the same as in 2-methoxy-1,3-dioxane

Currently clinicians in sub-Saharan Africa have limited access to the Internet, whereas mobile phone access and use is extensive. The University of Pennsylvania in collaboration with the National Library of Medicine launched txt2MEDLINE, a short messaging service (SMS) query of PubMed/MEDLINE, and SMS-optimized clinical guidelines in Botswana. The objective of this project was to establish and evaluate the utility of these tools for clinicians in Botswana.A local server was established at the University of Botswana that allowed clinicians to send queries and receive results via local (in-country) SMS text messaging on any type of cellular phone. The queries sent via txt2MEDLINE were returned as abbreviated "the bottom line" summaries of abstracts. The 2007 Botswana Treatment Guide was converted into a format that can be queried by SMS. Various types of healthcare workers were recruited to use and evaluate these services.Seventy-six healthcare workers attended training sessions for these services. In the preusage survey, most said they would use the services daily or weekly. During a 4-week trial period, use of these services dropped off dramatically. Participant feedback was collected and indicated that improvements in ease of use would increase the usage.This pilot project enables clinicians to query and receive PubMed abstract summaries and country-specific clinical guidelines using mobile phones. Feedback offers insight on how to improve this technology so that it can be adopted for long-term use. With further adjustments, these resources may provide an effective working model for other countries where limited Internet access impedes upon patient care.

Background: A review of scientific literature reveals a sparse documentation of periungual pyogenic granulomas as an adverse effect of isotretinoin therapy. Main observations: Periungual pyogenic granulomas appeared in four patients receiving isotretinoin therapy for severe acne. Oral and topical antibiotic treatments were ineffective and all cases spontaneously resolved once isotretinoin is discontinued. Conclusion: This report demonstrates the idiosyncratic nature of this side effect. We suggest that, although infection is possible due to the transformed nature of the normally protective skin barrier, oral and topical antibiotic treatments appear ineffective. Pyogenic granulomas spontaneously resolve once isotretinoin is discontinued. ____________________________________________________ Armstrong K, Weinstein M. Pyogenic granulomas during isotretinoin therapy. J Dermatol Case Rep. 2011; 5(1): 5-7.

Despite the generality of the anomeric effect (the axial tendency exhibited by many electronegative groups at C1 of a tetrahydropyran), some cationic substituents prefer the equatorial position. This preference is claimed to exceed that due to steric repulsion, and it has been called a «reverse anomeric effect». Such an effect is sometimes invoked to account for relative reactivities and stereoselectivities when there are cationic leaving groups. However, all such substituents have been bulky aromatic rings whose steric factors are difficult to judge, and it is advantageous to compare NHR and NH 2 R + groups of known axial preference

The conformations of several oligoisocyanates have been investigated by NMR in order to study the onset and dynamics of helicity in polyisocyanates. Pentaethylbiuret and hexaethyltriuret were found to adopt turns and helices in solution. For hexaethyltriuret, symmetric and asymmetric helices are present. Not only is an interconversion of these forms observed (DeltaG(SA)(double dagger) = 9.3 +/- 0.4 kcal/mol) but also a reversal of helicity (DeltaG(PM)(double dagger) = 9.0 +/- 0.4 kcal/mol). The coalescence pattern for the latter process provides direct evidence for a concerted, conrotatory helical inversion.

This paper reports on a survey of engineering firms in the West Midlands to investigate the introduction of advanced technological production systems. The results show a relatively low level of adaption compared with major competitors and that training is concentrated in a small number of firms. The evaluation of rates of return to investment in new technological systems is more complex than investment decisions generally because the anticipated costs and benefits are difficult to qualify, and, since it ususlly involves a joint investment in both human and physical capital, the risks of nonrecoupment of benefits are exacerbated. Copyright 1988 by Scottish Economic Society.