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Despite substantial empirical support, correlates of retention and success in community-based parent–child interaction therapy (PCIT) implementation are not well defined. Widespread application of PCIT necessitates improved understanding of intervention components relating to family outcomes beyond highly controlled research trials. Using data collected as part of routine care, this study examined homework completion, time in intervention, and parent perceptions of pre-intervention behavioral issues as predictors of PCIT completion in a community-based sample. Subjects included 78 parents (49 women and 29 men) of 45 children (20 girls, 25 boys; mean age = 5.53 years) participating in PCIT in an outpatient behavioral health clinic in a small Midwestern U.S. city. Unlike previous controlled trials, homework completion did not predict child behavior growth or intervention completion. Reasons for early termination were examined thematically, and parent stress emerged as a possible avenue for future intervention in helping parents successfully complete PCIT. The issue of intervention dosage was also explored to see if families who prematurely terminated from PCIT still evidenced gains in child behavior.

Anxiety and autism spectrum disorder (ASD) commonly co-occur, but school-based assessment practices surrounding identification of co-occurring presentations are not well understood. This study exam...

The importance of early intervention for developmental disabilities, such as Autism Spectrum Disorder, is increasingly recognized as critical to children’s later success, making it necessary to bet...

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

This study examined Head Start’s impact on fathers’ school-based involvement and associations with Black children's cognitive, behavioral, and social-emotional skills. With a sample of 1,354 Black ...

The pre-conceptual layout for an electron cyclotron system (ECS) in DEMO is described. The present DEMO ECS considers only equatorial ports for both plasma heating and neoclassical tearing mode (NTM) control. This differs from ITER, where four launchers in upper oblique ports are dedicated to NTM control and one equatorial EC port for heating and current drive (H&CD) purposes as basic configuration. Rather than upper oblique ports, DEMO has upper vertical ports to allow the vertical removal of the large breeding blanket segments. While ITER is using front steering antennas for NTM control, in DEMO the antennas are recessed behind the breeding blanket and called mid-steering antennas, referred to the radially recessed position to the breeding blanket. In the DEMO pre-conceptual design phase two variants are studied to integrate the ECS in equatorial ports. The first option integrates waveguide bundles at four vertical levels inside EC port plugs with antennas with fixed and movable mid-steering mirrors that are powered by gyrotrons, operating at minimum two different multiples of the fundamental resonance frequency of the microwave output window. Alternatively, the second option integrates fixed antenna launchers connected to frequency step-tunable gyrotrons. The first variant is described in this paper, introducing the design and functional requirements, presenting the equatorial port allocation, the port plug design including its maintenance concept, the basic port cell layout, the transmission line system with diamond windows from the tokamak up to the RF building and the gyrotron sources. The ECS design studies are supported by neutronic and tokamak integration studies, quasi-optical and plasma physics studies, which will be summarized. Physics and technological gaps will be discussed and an outlook to future work will be given. © 2021

The present study compared parent ratings to self-report ratings of depression, anxiety, hyperactivity, attention problems, and atypical behaviors in youth with high-functioning autism spectrum disorder (HFASD) and typically developing (TD) controls. Measures included parent and self-report forms from the Behavioral Assessment System for Children-Second Edition (BASC-2), and self-report forms from the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Results across all five BASC-2 scales indicated parent ratings for the HFASD condition were significantly higher than HFASD self-ratings, and were significantly higher than parent and self-ratings from the TD condition. In addition, average self-report scores did not differ significantly between HFASD and TD conditions on any of the BASC-2 scales, the CDI, or the MASC.

Using data ( N = 1,350) from the Head Start Family and Childhood Experiences Survey, this study examined sociodemographic predictors of parent involvement in educationally enriching activities at home for low-income children with disabilities compared with children without disabilities. Analyses examined whether associations were moderated by aspects of parent–school interactions. Parent involvement was greater for White compared with Black and Hispanic parents of all children. Higher parental education related to greater involvement at the end of the year only for parents of children with disabilities. Parent perceptions of teacher support and school communication differentially moderated associations between predictors and parent involvement for children with and without disabilities. Results inform an individualized approach to fostering involvement among low-income parents of children with disabilities in early education.

Using the Head Start Impact Study data, this study examined racial disparities in maternal perceptions of social support and social service receipt, and their associations with depression. Associations between Head Start participation and these variables were also studied. A total of 3,269 mothers were included (n = 971 Black, 1,086 Hispanic, and 1,212 White). Compared to White mothers, Hispanic mothers indicated perceiving less assistance from social supports. Black and Hispanic mothers were less likely to use social services and reported lower levels of depression than White mothers. Head Start mothers perceived more helpfulness from social supports than non-Head Start mothers. Head Start, however, was not associated with social service use or maternal depression. Results suggest Head Start participation may be related to greater ability to reap benefits from relationships with friends and family among low-income mothers.

This study evaluated whether parenting and childcare experience across infancy and toddlerhood were associated with children’s reading, math, and social–behavioural skills prior to kindergarten entry. Analyses also examined whether race or ethnicity moderated associations. A representative sample of Hispanic, Black, and White children from the Early Childhood Longitudinal Study – Birth Cohort (N = 4550) was used. Parents’ responsiveness in infancy and supportiveness in toddlerhood, as well as the home learning environment in toddlerhood, related to academic and social–emotional and behavioural readiness. Associations between certain parenting behaviours and child outcomes varied as a function of race. Additionally, compared to parent-only childcare, attendance in centre-based care at two years of age related to higher early math skills. Findings highlight the need for culturally specific early intervention to support parents in shaping early social–emotional skills in children, and suggest that ex...

Background Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb.

Associated with complex developmental, personal, and environmental risk factors, adolescent parents have been found to display higher rates of unfavorable parenting practices than adult parents, placing their children at high risk for social, emotional and behavioral concerns. Nevertheless, interventions targeting this group often focus solely on adolescents’ personal outcomes. This study evaluated the acceptability and fidelity of a relationship-focused intervention to increase positive parenting among adolescents with young children, adapted from the Parents Interacting with Infants model. The intervention was delivered via groups in high schools that housed daycare centers for children born to adolescents. Multiple-case study data were evaluated for adolescent parents from each group to describe potential effects of the intervention on parenting behaviors. Delivery of the intervention was feasible and acceptable in a high school group context, suggesting this program can be implemented in a hig...

The control of post-operative pain in Italy and other western countries is still suboptimal. In recent years, the Sufentanil Sublingual Tablet System (SSTS; Zalviso; AcelRx Pharmaceuticals, Redwood City, CA, USA), which is designed for patient-controlled analgesia (PCA), has entered clinical practice. SSTS enables patients to manage moderate-to-severe acute pain during the first 72 postoperative hours directly in the hospital setting. However, the role of SSTS within the current framework of options for the management of post-operative pain needs to be better established. This paper presents the position on the use of SSTS of a multidisciplinary group of Italian Experts and provides protocols for the use of this device.

Sternoclavicular and acromioclavicular injuries are challenging injuries directly affecting the long-term function of the upper extremities. They are uncommon, accounting for less than 3% of all shoulder girdle injuries. Dislocations of the sternoclavicular joint can be classified into anterior or posterior by the position of the medical clavicle with respect to the manubrium. Anterior dislocations are generally treated non-operatively while posterior dislocations should undergo urgent reduction in the operating room. Open treatment of these injuries is uncommon and generally associated with late sequelae of the injuries. Acromioclavicular injuries are more common and more varied in their presentation. Type I and II separations are generally treated non-operatively; type III repair is controversial (based on age, activity level, and patient preference); types IV–VI are treated operatively. There are a host of methods for operative repair with the over-riding principle being to restore the normal anatomy of the clavicular strut, place the coraco-clavicular ligaments in apposition, and restore acromioclavicular joint stability.

Parent-focused intervention for children with autism spectrum disorder (ASD) has garnered considerable evidence of effectiveness for treating core symptoms of the disorder. However, these programs often teach parents discrete skills that may or may not align with school-based interventions. Family-school partnerships (FSPs) are essential for children with ASD given the complex presentation of symptoms characteristic of this disorder. It is unclear how and to what degree current school-based interventions for children with ASD include parents and whether their inclusion is consistent with definitions of parent involvement or FSPs established in the literature. A systematic review of the school-based intervention literature for children with ASD was conducted on studies published between 2002 and 2017. Thirty-six articles met inclusion criteria. Results indicated interventions included parents in ways consistent with both parent involvement and FSPs, though the former model was more common. Findings suggest a need for greater focus on measuring parent behavioral outcomes when evaluating intervention effectiveness and developing or refining interventions to include meaningful family-school partnering. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

For youth with autism spectrum disorder (ASD) and their families, adolescence presents unique challenges that require parents work closely with school teams. Both parent involvement in education and family school partnerships are associated with positive student outcomes. However, research characterizing parents' role in working with school-based teams across the middle and high school years for youth with ASD is limited. The present study presents qualitative data illustrating the perspectives of 23 parents of students with ASD regarding their experiences working with middle and high school teams. Participants completed semistructured interviews, which were analyzed using interpretative phenomenological analysis. Six themes were reflected in the experiences and perspectives of parents, including collaboration/partnership, advocacy, relationships, parental background, expectations, and impact on the parent. Results indicated variability in the nature and impact of parents' experiences and a need for intentional formation of meaningful partnerships between educators and families that honor the unique needs and strengths of youth and maximize team effectiveness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This study examined associations among Head Start attendance, individualized education programmes (IEPs), parental behaviours and child outcomes in a sample of five-hundred and seventy 3- to 4-year-old children with disabilities. Home language, number of disabilities and Head Start enrollment were associated with having an IEP. Parents of children with IEPs and those who participated in Head Start used more social services, while social support was more prevalent for parents of non-Head Start children with IEPs. For all children, frequent parental book reading, greater number of books in the home and greater perceived social support among parents were associated with favourable cognitive and social–emotional outcomes. Greater social service use was adversely associated with reading scores only for non-Head Start children. Findings highlight the need for inclusive IEP policies and Head Start programmes for parents regarding access to special education supports for children who demonstrate developmental concerns. Participation in Head Start may buffer negative effects of social service use on children's reading skill development, although more research is needed to uncover the specific mechanisms responsible for this association.

This study investigated the impact of Head Start, disability status, and receipt of an Individualized Education Program (IEP) on early language, literacy, and mathematics skills for low-income children with language, cognitive, emotional/behavioral, sensory, and physical disabilities. Secondary analysis of data was performed on a sample of children with disabilities (N = 570) drawn from the Head Start Impact Study, a nationally representative study of approximately 5,000 children randomly assigned to Head Start or non–Head Start programs. Results of ordinary least squares regression analyses indicated that Head Start participation enhanced outcomes for children with multiple disabilities; language, literacy, and mathematics skills at age 5–6 years were higher for these children compared to non–Head Start attendees. Head Start children with disabilities were more likely to have an IEP, though IEP receipt was associated with lower language, literacy, and mathematics scores among all children. There ...

Evidence-based practices are rarely translated into school settings. The literature examining the science-to-practice gap provides possible explanations, although these explanations are not supported with empirical evidence. Variables affecting behavior intervention implementation, such as lack of teacher training, lack of time, lack of resources, teacher stress level, and lack of administrative support, were examined in this preliminary study as possible explanations. Surveys were collected from 67 elementary teachers. Results regarding possible barriers to implementation indicate that the majority of respondents rated the severity of 12 of 19 barriers as extremely serious. Barriers rated as extremely serious were related to resources, training, and educator variables. In addition, significant correlations were found between job stress and the severity ratings of barriers related to lack of time, training, and support. Understanding these variables may provide important information to aid in the translat...

Barba A.A., d’Amore M., Rispol M., Marra F., Lamberti G. (2014): Microwave assisted drying of banana: effects on reducing sugars and polyphenols contents. Czech J. Food Sci., 32: 369–375. The effects of microwave assisted drying on banana fruit was evaluated. Water, reducing sugars, and polyphenol contents, as well as poly-phenol-oxidase activity were evaluated along the radial and axial positions in thick slices of banana, according to a properly defined cutting and assaying protocol. The effects of the microwave-assisted drying process were compared to the convective air-assisted drying resulting faster than the conventional process. In particular, the resulting samples were homogeneous in the water content; the contents of reducing sugars were strongly decreased on drying with microwaves; the poly-phenol-oxidase was inactivated by the high temperature produced by the process and thus the polyphenols content remained practically the same as in the fresh product.

Research Findings: Children's early academic achievement is supported by positive social and behavioral skills, and difficulties with these skills frequently gives way to underachievement. Social and behavioral problems often arise as a product of parent–child interactional patterns and environmental influences. Few studies have examined the role of a salient aspect of children's environments, community locale, in the relationship between parenting practices and child outcomes. Using a large, nationally representative sample, we examined whether preschool parenting practices and children's social-behavioral skills in kindergarten were related to geographic setting (rural vs. city, suburban, and town). Results indicated that rural children experienced greater difficulties with parent-reported externalizing behaviors. Furthermore, rural parents displayed less emotional support than parents in other settings. Preschool parenting behaviors were associated with social skills and behavior problems in kindergart...

Background Emotion regulation (ER) is key to young children’s school readiness and mental health. Many children with autism spectrum disorder exhibit emotionally dysregulated behavior, yet no interventions target this skill in the preschool years. This study examined the feasibility and preliminary efficacy of a parent-mediated intervention to promote emotion regulation skills in preschool-age children with autism spectrum disorder. Method Participants included five children (3–6 years old) and their mothers. The intervention, Regulation of Emotional Lability in Autism Spectrum Disorder through Caregiver Supports (RELACS) was delivered in participants’ homes over eight weeks. Results Preliminary results suggest RELACS is acceptable to parents, can be implemented with fidelity, and shows promise in improving parent support for children’s ER skills as well as children’s regulatory capacity. Conclusions Results support the feasibility of using a parent-mediated approach to supporting ER skills in young children with autism spectrum disorder. Though RELACS shows promise in improving parent support for ER and children’s ER capacity, further research is necessary to establish its efficacy.

Preschool children may exhibit a range of problematic behaviors that may impede development and disrupt classroom functioning. As a result, preschool children are often expelled from programs when behavioral issues cannot be adequately addressed. Preschool behavioral consultation serves as a promising alternative to expulsion, as consultants can provide teachers with the expertise and skills they need to manage current and future behavioral challenges. This article presents findings from a pilot study that examined the effect of a preschool behavioral consultation model in reducing inappropriate behaviors and improving prosocial skills in 35 preschoolers. A pretest–posttest design was used. Findings revealed significantly increased positive behaviors as rated by teachers and decreased teacher reports of behavior problems. Implications of these findings and the importance of behavioral consultation in the preschool setting are discussed.

Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk. One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months. The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p

Purpose The purpose of this study was to determine the area and characteristics of the triceps tendon footprint on the olecranon, with special attention to the medial head insertion. The secondary goal was to report 2 cases of isolated avulsions of the medial head of the triceps tendon treated successfully with arthroscopic repair. Methods Fifteen cadaveric upper extremities were examined to investigate the triceps tendon insertion, and two case reports of an arthroscopic repair technique are described. Results In 8 specimens (53%) there was a separate insertion of the medial head of the triceps tendon on the olecranon, which was deep to the long and lateral head insertions. The mean area of the medial head insertion was 44 mm 2 , and the mean area of the combined long and lateral head insertions was 115 mm 2 . In 7 specimens (47%) the long, lateral, and medial heads of the triceps inserted together and had a mean area of 134 mm 2 . Although the 3 heads of the triceps inserted together, the medial head tendon fiber orientation was still directed deep to the long and lateral heads. At 2 years' follow-up, both patients described no pain, had better strength, and had improved Disabilities of the Arm, Shoulder and Hand scores and Mayo Elbow Performance Scores. Conclusions We have determined the characteristics of the distal triceps tendon footprint and the insertional orientation on the olecranon. For cases with an isolated avulsion of the medial head of the triceps tendon, an arthroscopic repair technique is described. Level of Evidence Level IV, anatomic study and therapeutic case series.

We have examined the relief from pain and the functional outcome in 18 patients who underwent resection arthroplasty of the shoulder as a salvage operation between 1988 and 2002. The indications included failed shoulder replacement in 17, with infection in 13, and chronic septic arthritis in one. The mean follow-up was 8.3 years (2.5 to 16.6). Two intra-operative fractures of the humerus occurred, both of which healed. The level of pain was significantly decreased (t-test, p < 0.001) but five patients continued to have moderate to severe pain. The mean active elevation was 70° (0° to 150°) postoperatively and represented an improvement from 39° (0° to 140°) (t-test, p = 0.003), but internal and external rotation were hardly changed. The mean number of positive answers on the 12-question Simple Shoulder Test was 3.1 (0 to 12) but the shoulder was generally comfortable when the arm was positioned at rest by the side. The mean post-operative American Shoulder and Elbow Surgeon’s score was 36 (8 to 73). Despite applying this procedure principally to failed shoulder replacements, the results were similar to those reported in the literature for patients after severe fracture-dislocation. Reduction of pain is possible in one half to two-thirds of patients. The outcome of this operation in providing relief from pain cannot be guaranteed, but the shoulder is usually comfortable at rest, albeit with profound functional limitations.

Currently, there is little information available concerning the outcome of patients with infection after rotator cuff repair. The purpose of this study was to review retrospectively the incidence, clinical presentation, bacteriology, treatment, and outcomes of patients with rotator cuff repair complicated by deep infection. Between 1975 and 2003, 39 cases of deep infection after rotator cuff repair were identified in 38 patients. At a final follow-up of 8.2 years (range, 30 months to 19.8 years), 7 patients had died and 2 had been lost to follow-up, leaving 29 for outcome evaluation. Propionibacterium acnes was the most common organism isolated, infecting 20 of 39 cases (51%). At final follow-up, mean active elevation was 120 degrees and mean external rotation was 45 degrees . The American Shoulder and Elbow Surgeons score averaged 67 points (range, 5-100 points), and the Simple Shoulder Test score averaged 7.3 points (range, 1-12 points). The results were excellent in 7 shoulders, satisfactory in 9, and unsatisfactory in 11. The data from this study suggest that the eradication of deep infection after rotator cuff repair is possible; however, substantial functional limitations are not unusual. In addition, the treating surgeon should be aware of the high incidence of Propionibacterium and the importance of allowing a minimum of 7 days of culture to identify this organism.

OBJECTIVES We aimed to determine the prevalence of hydronephrosis in patients who underwent renal sonography for new-onset acute kidney injury (AKI) and to identify clinical factors predictive of hydronephrosis. In patients with hydronephrosis, we sought to investigate how routine renal sonography affects patient treatment, including performance of interventional procedures. METHODS A retrospective chart review identified 274 adults with AKI who underwent renal sonography at an urban teaching hospital from January through July 2011. The prevalence of hydronephrosis was determined. Electronic medical records were reviewed for comorbidities, including risk factors for hydronephrosis such as a pelvic mass, prior renal or pelvic surgery, and neurogenic bladder, and for subsequent interventions and outcomes. RESULTS Sonography showed hydronephrosis in 28 patients (10%); 5 (18%) had subsequent interventions. In a multivariable logistic regression model with the outcome being hydronephrosis, all considered risk factors (pelvic mass, prior renal or pelvic surgery, and neurogenic bladder) were significantly associated with hydronephrosis (odds ratio, 6.4; 95% confidence interval, 2.7-15.4; P < .001) when adjusting for age and diabetes mellitus. Diabetes had a negative predictive value for hydronephrosis. No diabetic patients younger than 85 years and without clinical risk factors had hydronephrosis. CONCLUSIONS Hydronephrosis is infrequently seen on sonograms in hospitalized patients with AKI who lack risk factors for urinary tract obstruction. Deferral of sonography pending a trial of medical treatment is safe and will reduce medical costs. Adoption of clinical guidelines to assess patients' risk levels for hydronephrosis is critical to avoid unnecessary imaging.

Review essay on: ELMAN, J., BATES, E., JOHNSON, M., KARMILOFF-SMITH, A., PARISI, D. & PLUNKETT, K. Rethinking innateness: a connectionist perspective on development. Cambridge, MA: MIT Press (1996). Pp. 447.I believe that the field of developmental psycholinguistics suffers from two major weaknesses. The first is its impressionistic and inexact formulations. The second is its divisive polarizations. One can see the reasons for the first weakness. Developmental psycholinguistics is only about 30 years old (ignoring diary studies which preceded the linguistic and cognitive surge of the sixties). But speculation and hypothesizing on the basis of relatively little data and passing acquaintance with phenomena has reached the level of customary ‘business as usual’. We are skilful at hypothesis construction, yet we are regretfully delinquent at formulating clear tests of our hypotheses. We are fond of conjecture about causal relationships, but our empirical tests progress no further than weak forms of correlation.With regard to our second major weakness, our knack for polarizing opinion regarding chimerical questions such as the innateness of language can also be understood. After all, are we not following the classical dialectic model of thesis, antithesis and eventual synthesis? I think this is an idealized view of ourselves. In fact, we are driven by hunch and bias far more often than we would like to admit. Following hunches may be a real sign of creativity and vitality in our thinking. However, polarization driven by biases is ultimately detrimental. At some point we must disentangle ourselves from customary dialogue and transcend our deeply rutted patterns of thought.When I began Rethinking innateness, I had hoped that the book might help us overcome these two weaknesses. I believe that it contributes positively to the goal of increasing the precision of our hypotheses and their empirical substantiation. At the same time, I am afraid that it will have a negative impact by aggravating the degree of polarization in our field.

Hypothesis It is unknown whether certain methods of distal biceps tendon repair lead to an increased propensity of impingement of the repaired tendon. The purpose of this study was to evaluate various repair techniques in a cadaveric model to determine the radioulnar space available for the repaired biceps tendons. Methods Nine matched pairs of quartered, fresh-frozen cadaveric arms were transected at the level of the humeral mid shaft and the distal radiocarpal joint. Distance measurements and the angular relation of the bicipital tuberosity were measured at 5 forearm pronation-supination positions. These measurements were taken under each of the following conditions: intact native biceps, resected native tendon, suture anchor fixation of the biceps, suspensory suture device fixation of the biceps, tendon repair using a tenodesis technique, and fixation of the tendon using a trough technique. Results There were no significant differences in radioulnar space available after biceps tendon repair with the forearm in a supinated position. However, when the forearm was in a neutral or pronated position, the suture anchor method consistently had the lowest biceps insertion–to–ulna distance (0.6 to 2.1 cm). All forearm positions, except full supination, showed significant differences in terms of radioulnar space available for the repaired biceps. Discussion This study shows that the space available for the biceps tendon decreases with forearm pronation after reconstruction for all repair techniques. It appears that using suture anchors to repair the biceps tendon may predispose the repaired tendon to impingement when compared with other fixation techniques.

Since the beginning of the conflicts in Iraq and Afghanistan more than a decade ago, much has been learned with regard to combat casualty care. Although progress has been significant, knowledge gaps still exist. The seventh Extremity War Injuries symposium, held in January 2012, reviewed the current state of knowledge and defined knowledge gaps in acute care, reconstructive care, and rehabilitative care in order to provide policymakers information on the areas in which research funding would be the most beneficial.

Important advances have been made in the management of complex trauma through careful scientific analysis of outcomes. Outcomes analysis in combat extremity trauma is exemplified and highlighted by scholarly work in the treatment of catastrophic lower extremity trauma. The success of this line of research in civilian trauma is exemplified by the Lower Extremity Assessment Project (LEAP) study on the outcomes of civilian lower extremity trauma. This highly successful effort was followed by the Military Extremity Trauma Amputation/Limb Salvage (METALS) study. Current ongoing analysis of both the LEAP and METALS studies by the Major Extremity Trauma Research Consortium seeks to compare and contrast the similarities and differences of both studies and to advance evidence-based patient-centered care. The effects of psychological trauma on the injured individual underscore the global effect of severe trauma and the need for a multidisciplinary approach to trauma care. Statistical modeling is being used to analyze outcomes to further the ability to scientifically and definitively determine the best practices for patient care.

A wealth of research demonstrates the importance of early parent-child interactions on children's social functioning. However, less is known about the interrelations between child and parent characteristics and parent-child interactions in early childhood. Moreover, few studies have broadly examined the longitudinal relations between these constructs and social competence. This study is an examination of the relations between parent responsiveness, negativity, and emotional supportiveness, attachment security, and child temperament, and their impact on children's social competence from infancy to kindergarten entry. The sample was derived from the Early Childhood Longitudinal Study--Birth Cohort and included 6850 parent-child dyads. Observational and rating scale data were used. The proposed model was nearly fully supported by path analysis, and it provides insight into the complex relations between early parenting behaviors, child characteristics, and parent-child interactions in the development of social competence.

Background There have been reports of total radial head allografts showing variable outcomes. This case series reports the novel use of an allograft for partial radial head replacement in the treatment of elbow fracture-dislocation. Methods Eight patients underwent partial radial head allograft reconstruction to restore stability for complex fracture-dislocations involving fractures of the coronoid and radial head, with collateral ligament disruption. Two patients were treated acutely. Six were referred from other centers 2 to 48 weeks after injury following failure of primary treatment. In each case, it was not possible to perform stable open reduction–internal reduction of the radial head fracture, or the fracture fragment had already been excised. A fresh-frozen partial radial head allograft was used to replace the defect and restore the joint surface. The coronoid fracture and injury to collateral ligaments were also managed surgically. Patient charts, surgical records, and radiographs were reviewed. Patients were contacted at a mean of 79 months after treatment to answer questions to determine the Mayo Elbow Performance Score and the score on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Results Clinical and radiologic reviews confirmed union of graft in all cases. None resorbed or collapsed. Three patients had resorption of the coronoid fragment resulting in poor outcomes, with one patient ultimately undergoing total elbow arthroplasty. Conclusion Partial radial head allograft may be a useful alternative to radial head prosthesis in unstable fracture-dislocations in which the radial head cannot be restored fully.

Background: Deep soft-tissue defects often present in high-energy trauma and during the surgical treatment of infection. Injuries caused by high-velocity projectiles can create deep soft-tissue defects that are challenging to manage. Persistent, deep wound cavities have been associated with infection and prolonged wound healing. This article presents a technique that marries vacuum-assisted wound closure technology with traditional drains to allow for management of deep soft-tissue cavities. Methods: A deep drain was placed in the cavitary lesion with application of a negative-pressure wound therapy sponge in the standard fashion. The deep drain was brought into the sponge and fenestrated as to allow the sponge to evacuate the deep drain. Several illustrative cases are presented. Results: Conversion of deep cavitary defects to superficial defects allowed for delayed primary or secondary closure of the wound defects without the need for increasing the size of the superficial wound to facilitate drainage. Deep infection was also successfully controlled without incurring the additional surgical soft-tissue trauma typical of standard technique. Conclusions: The use of the active deep suction decreases edema and dead space, theoretically reducing the chance of infection. It also prevents premature walling off of deeper cavities, which can occur with the use of vacuum-assisted closure therapy on superficial defects. Our method of wound management allows for the reduction of the deep cavitary defects without delaying wound closure or creating more tissue damage.

Nel contributo gli autori presentano alcune nuove letture nei papiri che compongono il II libro della Poetica di Filodemo. In particolare, vengono modificati in maniera decisiva alcuni passi dell'edizione di F. Sbordone del 1976.

Objectives To determine the clinical effectiveness of precontoured parallel plating for the management of Orthopaedic Trauma Association (OTA) type C distal humerus fractures. Design Retrospective case series. Setting Level I trauma center. Patients/participants Between 2001 and 2005, 37 patients with OTA type C distal humerus fractures underwent open reduction and internal fixation exclusively with the Mayo Elbow Congruent Plating system. Thirty-two patients consented to participate in the study. Intervention All patients underwent open reduction and internal fixation with a precontoured bicolumn parallel plating system. Main outcome measurements Range of motion, Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand score (DASH), complication rate, and radiographic evaluation. Results At a mean of 27 months follow up, the mean arc of elbow flexion-extension motion was 97 degrees (range, 10 degrees -145 degrees ). The mean Mayo Elbow Performance Score was 82 points and the mean DASH score was 24 points. There were no implant failures and all distal humerus fractures healed. A total of 24 complications occurred in 17 patients (53%) with five patients (16%) having postoperative nerve injuries. Conclusions Open reduction and internal fixation with a precontoured parallel plating system is an effective treatment method for OTA type C distal humerus fractures. Despite this, the fact that over half of the patients had a significant complication will require utmost vigilance on the part of the surgeon to avoid intraoperative complications. Patient counseling is paramount.

Ulnar neuropathy presents as a complication in 5% to 10% of total elbow replacements, but subsequent ulnar neurolysis is rarely performed. Little information is available on the surgical management of persistent ulnar neuropathy after elbow replacement. We describe our experience with the surgical management of this problem. Of 1607 total elbow replacements performed at our institution between January 1969 and December 2004, eight patients (0.5%) had a further operation for persistent or progressive ulnar neuropathy. At a mean follow-up of 9.2 years (3.1 to 21.7) six were clinically improved and satisfied with their outcome, although, only four had complete recovery. When transposition was performed on a previously untransposed nerve the rate of recovery was 75%, but this was reduced to 25% if the nerve had been transposed at the time of the replacement.

The decision to operate and the selection of the appropriate surgical modality for proximal humerus fractures are largely based on the fracture pattern. Understanding the particular fracture pattern in each case is complicated. Most well-accepted classification systems were developed based on radiographs complemented by intraoperative findings. Three-dimensional reconstructions based on CT currently available in most institutions allow a much better understanding of complex fractures. Modern thinking about fracture classification probably should be revisited in the light of improved imaging techniques.