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Abstract: Ingested foreign bodies may lead to perforation of the gastrointestinal tract. We present a case of a 14-month-old boy who presented with an unusual abdominal mass secondary to ingesting a foreign body 4 months previously. Abdominal computerized tomography scan was valuable in making this diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Medicolegal authorities use forensic dental age assessment of children to establish a biologic profile to assist in human identification, answer questions related to immigration, and answer questions used to substantiate eligibility for social benefits. The goal of this study was to assess the performance reliability of the child dental age assessment data previously published for White and Black children in the United States. A total of 432 dental panoramic radiographs were obtained from 3 geographic locations in the United States: Memphis, Tennessee, Knoxville, Tennessee, and Saint Louis, Missouri. Radiographs were staged, and the estimated age was calculated using the previously published data. Multiple age assessments were conducted to determine the effect of excluding certain teeth on estimated age. The results indicated estimated ages using the previously published reference data set were accurate and concordant with known chronologic age across the ancestral, sex, and geographic categories. The results also indicated that the known chronologic age fell within one standard deviation of the estimated age more than the statistical expectation for most categories. Excluding canines provided the most accurate estimation of known chronologic age., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: This study evaluated traditional and expedited methods for assessing the age of fetal remains. Because of their rare occurrence, the discovery of fresh, decomposing, disfigured, or skeletal fetuses engenders heightened awareness by forensic pathologists primarily tasked with age estimation in relation to viability. With decomposed complete or isolated fetal remains, dentists focus on primary molar mineralization, whereas anthropologists perform long bone measurements along with discernment of other indicators of skeletal maturity to obtain an age estimation.The results of this study are 4-fold: (1) The "best" technique for harvesting fetal tooth buds and long bones is the dissection of the developing tooth buds with maceration for the long bones. (2) Metric analysis was applied to the tooth buds and long bones for age estimation, and the findings were correlated. (3) There is a statistically significant difference between known age and dental age and between dental age and long bone age. The difference between known age and long bone age is not statistically significant, but a type II error exists because of the small sample size. (4) A central incisor staging technique for fetuses younger than 26 weeks was developed as a supplement to the molar staging system of Kraus and Jordan (1965)., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Though applied in bioarchaeology, dental wear is an underexplored age indicator in the biological anthropology of contemporary populations, although research has been conducted on dental attrition in forensic contexts (Kim et al., , Journal of Forensic Sciences, 45, 303; Prince et al., , Journal of Forensic Sciences, 53, 588; Yun et al., , Journal of Forensic Sciences, 52, 678). The purpose of this study is to apply and adapt existing techniques for age estimation based on dental wear to a modern American population, with the aim of producing accurate age range estimates for individuals from an industrialized context., Materials and Methods: Methodologies following Yun and Prince were applied to a random sample from the University of New Mexico (n = 583) and Universidade de Coimbra (n = 50) cast and skeletal collections. Analysis of variance (ANOVA) and linear regression analyses were conducted to examine the relationship between tooth wear scores and age., Results: Application of both Yun et al. () and Prince et al. () methodologies resulted in inaccurate age estimates. Recalibrated sectioning points correctly classified individuals as over or under 50 years for 88% of the sample. Linear regression demonstrated 60% of age estimates fell within ±10 years of the actual age, and accuracy improved for individuals under 45 years, with 74% of predictions within ±10 years., Discussion: This study demonstrates age estimation from dental wear is possible for modern populations, with comparable age intervals to other established methods. It provides a quantifiable method of seriation into "older" and "younger" adult categories, and provides more reliable age interval estimates than cranial sutures in instances where only the skull is available., (© 2017 Wiley Periodicals, Inc.)

Amelogenesis imperfecta is a hereditary enamel protein disorder affecting deciduous and secondary crown formation. The prevalence ranges from 1:700 to 1:14,000 depending on the population. These teeth may be hypoplastic, hypomineralized, or hypermineralized and are often discolored, sensitive and caries vulnerable. Patients often present with psychosocial issues due to appearance. Primary teeth are often treated with stainless steel crowns while secondary teeth are treated with full coverage esthetic crowns. The presenting preteen male here was fitted with Snap-On Smile? (www.snaponsmile.com). This treatment option provided cosmetic enhancement of the patient's appearance besides stabilization without altering the primary and secondary dentition during adolescent development.

Dental trauma is sudden, unscheduled, and the dentist and staff must be adequately equipped to expeditiously and properly treat the patient to assure the best possible outcome. This paper reviews current dental trauma guidelines to provide the correct treatment protocol to ensure the best prognosis. The case report illustrates the technique of avulsion care, RCT care, and functional splinting in a successful manner.

Requisite to routine casework involving unidentified skeletal remains is the formulation of an accurate biological profile, including sex estimation. Choice of method(s) is invariably related to preservation and by association, available bones. It is vital that the method applied affords statistical quantification of accuracy rates and predictive confidence so that evidentiary requirements for legal submission are satisfied. Achieving the latter necessitates the application of contemporary population-specific standards. This study examines skeletal pelvic dimorphism in contemporary Western Australian individuals to quantify the accuracy of using pelvic measurements to estimate sex and to formulate a series of morphometric standards. The sample comprises pelvic multi-slice computer tomography (MSCT) scans from 200 male and 200 female adults. Following 3D rendering, the 3D coordinates of 24 landmarks are acquired using OsiriX® (v.4.1.1) with 12 inter-landmark linear measurements and two angles acquired using MorphDb. Measurements are analysed using basic descriptive statistics and discriminant functions analyses employing jackknife validation of classification results. All except two linear measurements are dimorphic with sex differences explaining up to 65 % of sample variance. Transverse pelvic outlet and subpubic angle contribute most significantly to sex discrimination with accuracy rates between 100 % (complete pelvis-10 variables) and 81.2 % (ischial length). This study represents the initial forensic research into pelvic sexual dimorphism in a Western Australian population. Given these methods, we conclude that this highly dimorphic bone can be used to classify sex with a high degree of expected accuracy.

The statistical quantification of error and uncertainty is inherently intertwined with ascertaining the admissibility of forensic evidence in a court of law. In the forensic anthropological discipline, the robustness of any given standard should not only be evaluated according to its stated error but by the accuracy and precision of the raw data (measurements) from which they are derived. In the absence of Australian contemporary documented skeletal collections, medical scans (e.g. multislice computed tomography-MSCT) offer a source of contemporary population-specific data for the formulation of skeletal standards. As the acquisition of morphometric data from clinical MSCT scans is still relatively novel, the purpose of this study is to assess validity of the raw data that is being used to formulate Australian forensic standards. Six human crania were subjected to clinical MSCT at a slice thickness of 0.9 mm. Each cranium and its corresponding volume-rendered three-dimensional MSCT image were measured multiple times. Whether differences between MSCT and dry bone interlandmark measurements are negligible is statistically quantified; intra- and inter-observer measurement error is also assessed. We found that traditional bone measurements are more precise than their MSCT counterparts, although overall differences between the two data acquisition methods are negligible compared to sample variance. Cranial variation accounted on average for more than 20× the variance explained by MSCT vs. bone measurements. Similarly, although differences between operators were sometimes significant compared to intra-operator variance, they were negligible when compared to sample variance, which was on average 12× larger than that due to inter-operator differences.

In Australia, particularly Western Australia, there is a relative paucity of contemporary population-specific morphometric standards for the estimation of sex from unknown skeletal remains. This is largely a historical artefact from lacking, or poorly documented, repositories of human skeletons available for study. However, medical scans, e.g. MSCT (multislice spiral computed tomography) are an ingenious and practical alternative source for contemporary data. To that end, this study is a comprehensive analysis of sternal sexual dimorphism in a sample of modern Western Australian (WA) individuals with a main purpose to develop a series of statistically robust standards for the estimation of sex. The sample comprises thoracic MSCT scans, with a mean of 0.9 millimeter (mm) slice thickness, on 187 non-pathological sterna. Following 3D volume rendering, 10 anatomical landmarks were acquired using OsiriX(®) (version 3.9) and a total of 8 inter landmark linear measurements were calculated using Morph Db (an in-house developed database application). Measurements were analyzed using basic descriptive statistics and discriminant function analyses, with statistical analyses performed using SPSS 19.0. All measurements are sexually dimorphic and sex differences explain 9.8-47.4% of sample variance. The combined length of the manubrium and body, sternal body length, manubrium width, and corpus sterni width at first sternebra contribute significantly to sex discrimination and yield the smallest sex-biases. Cross-validated classification accuracies, i.e., univariate, stepwise and direct function, are 72.2-84.5%, with a sex bias of less than 5%. We conclude that the sternum is a reliable element for sex estimation among Western Australians., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: Otitis media (OM) is an inflammation of the middle ear. It is very common and associated with serious complications, including hearing loss. This study aimed to estimate the treatment costs of OM in Australia and the associated burden of disease (in disability-adjusted life-years)., Methods: Little Australia-wide epidemiological information is available, so international studies in the main were used to estimate the incidence and prevalence by age and gender. These were triangulated against the available Australian data. Australian health data sets and data collected from the emergency department of a tertiary pediatric hospital were used to estimate the costs of primary care, pharmaceuticals, pathology and imaging, emergency department presentations, specialists, and admitted hospital care., Results: Excluding the costs of the complications and comorbidities associated with OM, treatment costs for the disease in 2008 were between AUS$100 and 400 million. Visits to general practitioners and medicines constituted a high proportion of these costs. Antibiotic prescribing rates remain high despite clear evidence for a limited benefit from antibiotics for most OM cases and concerns regarding bacterial resistance., Conclusion: Treatment costs of OM in Australia are high and can only be estimated within a broad range. Further research on the links between antibiotics for OM and antibiotic resistance, and on the cost-effectiveness of prevention or amelioration of OM would be useful.

The majority of medical schools have curricula that address the health effects of smoking. However, there are many gaps in smoking education, especially in relationship to vertical integration. The authors aimed to determine whether medical students would better address adolescent smoking within a vertically integrated curriculum in comparison with the previous traditional curriculum. They studied two groups of fifth-year students; one group received a specific smoking intervention. Each group consisted of the entire cohort of students within the Child and Adolescent Health rotation of a newly designed medical curriculum. Two groups of students from the previous traditional undergraduate curriculum were available for direct comparison, one of which had received the same teaching on adolescent smoking. An objective structured clinical examination station was used to measure adolescent smoking enquiry. Intervention students in the new curriculum were more likely to enquire about smoking in the objective structured clinical examination than students who did not receive the intervention (p < 0.005). New curriculum students performed better than students from the previous curriculum, whether or not they had received the smoking intervention (p < 0.001). This study suggests that integrated undergraduate teaching can improve student clinical behaviours with regard to opportunistic smoking enquiry in adolescents.

Background: We developed a 1-hour teaching seminar for medical students on anti-smoking health promotion for adolescents. We report the development of the programme and a performance-based evaluation., Aim: To develop a seminar for medical students with the objective of improving medical student inquiry into smoking and the delivery of advice accordingly for adolescent patients in routine consultations., Method: The seminar was developed using principles of adult learning and delivered to a cohort of medical students (intervention group). Participants were Year 5 medical students in their paediatrics term. A comparison group of 58 medical students who did not receive the seminar was studied in the semester prior to the intervention. The primary outcome measure was a change in anti-smoking health promotion practice within an objective structured clinical examination (OSCE), where taking a smoking history and making links between smoking status and health were indicated in a 15-year-old simulated patient (SP) with poorly controlled asthma. This was part of the summative assessment in the paediatrics term., Results: In the OSCE, 21 of 58 (36%) students in the comparison group asked the asthmatic SP about smoking, compared with 41 of 56 (73%) students in the intervention group (P = 0.0001). In all, 15 (26%) of the comparison group students addressed the patient's smoking, compared with 33 of the 56 (59%) intervention group students (P = 0.0004)., Conclusion: A carefully designed seminar addressing adolescent smoking can increase the frequency of smoking inquiry and advice by medical students.

Aims: To develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination., Methods: Defined strategies were used for the development and implementation of a guideline, assessed by a prospective, descriptive, study using notes review, and patient, nursing, and medical staff telephone contact. The setting was a tertiary referral hospital in Victoria, Australia with 25 000 yearly admissions, and asthma accounting for about 7% of total. The first 200 children and families to use the guideline after its introduction were evaluated., Results: A total of 191 (95.5%) children were treated according to the guideline. Six (3.0%) children were given nebulisers appropriately based on severity; five (2.5%) were given nebulisers at parental or child choice; and four (2.0 %) who did not have severe asthma, received nebulised treatment inappropriately., Conclusions: Successful implementation of a new evidence based guideline can be achieved using specific strategies for promoting the application of research findings in the clinical arena.

A strategic approach to changing clinical practice that is managed by a multidisciplinary team is an effective way of implementing new treatment methods or approaches to patient care. The Royal Children's Hospital, Melbourne, Australia, a tertiary pediatric hospital, instituted new Asthma Delivery Device Guidelines in recognition of current evidence that described the benefits of treating acute pediatric asthma with pressurized metered dose inhalers and spacer devices. The working group that coordinated the project attributes the successful change in practice to a multifaceted, multidisciplinary approach, a significant planning stage, initial and ongoing intensive staff and patient/parent education, and accessibility of information.

Objective: To study interns' perceptions of their learning during their rotation through a short stay unit (SSU)., Design: Case-based, qualitative research study., Setting: A tertiary care pediatric hospital (The Children's Hospital, Boston, Mass)., Participants: Ten interns who had worked in the SSU in the 3 months prior to June 1, 1995, and on a general medical team in the previous 12 months., Intervention: None., Main Outcome Measures: In July 1995, the interns participated in focused, open-ended interviews lasting about 40 to 60 minutes to document their perceptions of their learning during their SSU rotation. The interviews were recorded on audiotape and transcribed prior to analysis. Data were analyzed to discern and categorize themes from the interns' responses., Results: All interns responded favorably to their educational and learning experiences during their rotation through the SSU. Two major themes emerged: (1) the interns' learning, which was affected by the role of the attending physician, the organization and structure of the SSU, and the teaching strategies in the SSU; and (2) the interns' collaborative work with the nursing staff in the SSU, which affected patient care but did not facilitate the interns' learning., Conclusion: Clustering in the SSU of patients whose symptoms suggested straightforward diagnoses enhanced interns' educational experiences.

Objective: The aims of this study were to assess aspects of the response of a small thermocouple to temperature change, and to evaluate whether such a thermocouple could be used intermittently to measure respiratory rate and timing by detecting the changes in nasal temperature occurring with breathing., Methods: The study had three parts. First, three similar, fast-responding thermocouples were immersed repeatedly in warm water. Second, the influence of atmospheric temperature on the signal of a thermocouple placed at different sites within the nasal orifice was studied. The signals produced were continuously displayed and analyzed using a laptop computer to allow evaluation of the thermocouples' response characteristics. Third, simultaneous respiratory recordings were acquired using a nasal thermocouple and a nasal pneumotachograph in 12 teenaged subjects. The respiratory rate and the periods of time taken for inspiration (Ti) and expiration (Te) were calculated and compared., Results: The thermocouples' responses to the temperature changes associated with breathing and immersion into water were rapid and consistent. The rate of the signals' decay, following the peak signal marking expiration, was influenced by the atmospheric temperature. The time constants of the thermocouples were similar (mean time constant = 0.41 sec, standard deviation (SD) = 0.07). Optimal respiratory recordings were obtained, with least discomfort, when the thermocouple was positioned at 0 to 4 mm within the nasal orifice. In comparing the respiratory recordings acquired simultaneously with a thermocouple and pneumotachograph, the respiratory rates were identical, and the Ti and Te values were similar (mean difference 0.04 sec (95% CI: -0.11 to 0.21 sec) and -0.04 sec (95% CI: -0.20 to 0.12 sec), respectively)., Conclusions: Intermittent measurements of respiratory rate and timing using a nasal thermocouple accurately reflected measurements obtained from nasal airflow using a pneumotachograph.

Previous studies of respiratory rate in children have had a number of methodological problems. The aim of this study was to construct age specific reference ranges for respiratory rate. Respiratory rate in children attending childcare centres, kindergartens, and schools was measured using a nasal thermocouple to obtain respiratory waveforms. Reference ranges were constructed using data from 293 awake children between 12 and 84 months, and from 123 sleeping children between 12 and 60 months. The mean respiratory rate declined with increasing age and was significantly lower, with lower variability, during sleep than wakefulness. Neither the awake nor sleeping reference ranges were significantly affected by sex, nor by the presence of past respiratory nor current respiratory symptoms.

A case of obstructive jaundice caused by a solitary myofibroma in an 18-week-old infant is presented. Preoperative investigations demonstrated total biliary and partial pancreatic obstruction, although no obstructing lesion was identified radiologically. At operation a 3-cm solitary myofibroma was found in the head of the pancreas. Because of the morbidity associated with resection at this site, a bypass procedure was performed in the hope that the lesion will regress.