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Spin echo T1- and T2-weighted images and intravenously administered gadopentetate dimeglumine-enhanced T1-weighted images were obtained in 4 normal volunteers and 11 patients (11 joints) with painful, intermittent, or persistent joint swelling of unknown etiology. These studies were retrospectively reviewed to assess the benefits of contrast-enhanced magnetic resonance imaging (MRI) in evaluating the synovium. Normal synovium and joint fluid showed no visually apparent enhancement on images obtained immediately after intravenous injection of gadopentetate dimeglumine. Abnormal synovium enhanced significantly, allowing the precise identification of equivocal or unsuspected synovial disease processes. These results suggest that, in selected cases, enhanced MRI can be a useful adjunct in the evaluation of suspected synovial disease processes. [ABSTRACT FROM AUTHOR]

Myxoid tissue forms part of many benign and malignant soft-tissue tumors. The advent of percutaneous needle biopsy has made it important to be aware of the diagnostic implications of biopsy samples containing myxoid tissue. To determine whether the magnetic resonance imaging (MRI) characteristics could help establish the diagnosis, we compared the MR images of 11 tumors containing myxoid tissue with the resected tumor tissue. In our small series of these rare tumors, the MRI characteristics allowed differentiation of intramuscular myxomas from malignant neoplasms containing myxoid tissue. Intramuscular myxomas meet the following conditions: (a) they are well circumscribed; (b) they arise within muscle; (c) T1-weighted images demonstrate uniform, decreased signal intensity; (d) T2-weighted images demonstrate uniform increased signal intensity; (e) contrast-enhanced images exhibit an inhomogeneous increase in signal intensity. If any of these conditions is not met, then a malignancy containing myxoid tissue should be suspected. [ABSTRACT FROM AUTHOR]

Fractures of the pisiform are often missed due to improper radiographic evaluation and a tendency to focus on other, more obvious injuries. Delayed diagnosis may result in disabling sequelae. A high index of clinical suspicion and appropriate radiographic examination will establish the correct diagnosis. Ten patients with pisiform fracture are presented. The anatomy, mechanism of injury, clinical presentation, radiographic features, and evaluation of this injury are discussed. [ABSTRACT FROM AUTHOR]

Fractures of the anterior process of the calcaneus are often missed. This error follows from the tendency to focus exclusively on the mortise and malleoli when a history of ankle trauma is supplied. Seven patients with this fracture are presented. The anatomy, mechanism of injury, clinical presentation, and the radiographic features of this injury are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions., Design: We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting., Setting: Australian primary care., Participants: Registered physiotherapists who are members of a practice-based research network (n=31)., Results: The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application., Conclusion: High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at coproducing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe (i) clinicians' motivations behind, and enablers to, participating in a network, (ii) the process of network establishment and (iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research coproduction., Methods: We describe the methods and outcomes of the three steps we used to establish the network. Step 1 involved consultation with local opinion leaders and a formative evaluation to understand clinicians' motivations behind, and enablers to, participating in a network. Step 2 involved establishment activities to generate a founding membership group and codesign a governance model. Step 3 involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritizing research areas., Results: Through formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists' involvement in the network. Establishment activities led to a founding membership group (n = 29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 [70%] are private practice clinicians). Our problem-mapping and prioritization process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes., Conclusions: Clinicians are motivated to break down traditional siloed research generation and collaborate with researchers to solve a wide array of issues with the delivery of care. Practice-based research networks have promise for both researchers and clinicians in the common goal of improving patient outcomes., (© 2023. The Author(s).)

Drawing from ethnographic research on lead poisoning in Uruguay and secondary literature from lead poisoning cases around the world, the commentary argues that public health policy guided by pragmatism presents multiple dangers to effective health intervention.

Using a generalized random recurrent neural network model, and by extending our recently developed mean-field approach [J. Aljadeff, M. Stern, and T. Sharpee, Phys. Rev. Lett. 114, 088101 (2015)], we study the relationship between the network connectivity structure and its low-dimensional dynamics. Each connection in the network is a random number with mean 0 and variance that depends on pre- and postsynaptic neurons through a sufficiently smooth function g of their identities. We find that these networks undergo a phase transition from a silent to a chaotic state at a critical point we derive as a function of g. Above the critical point, although unit activation levels are chaotic, their autocorrelation functions are restricted to a low-dimensional subspace. This provides a direct link between the network's structure and some of its functional characteristics. We discuss example applications of the general results to neuroscience where we derive the support of the spectrum of connectivity matrices with heterogeneous and possibly correlated degree distributions, and to ecology where we study the stability of the cascade model for food web structure.

We report on the first lattice calculation of the QCD phase transition using chiral fermions with physical quark masses. This calculation uses 2+1 quark flavors, spatial volumes between (4 fm)(3) and (11 fm)(3) and temperatures between 139 and 196 MeV. Each temperature is calculated at a single lattice spacing corresponding to a temporal Euclidean extent of N(t) = 8. The disconnected chiral susceptibility, χ(disc) shows a pronounced peak whose position and height depend sensitively on the quark mass. We find no metastability near the peak and a peak height which does not change when a 5 fm spatial extent is increased to 10 fm. Each result is strong evidence that the QCD "phase transition" is not first order but a continuous crossover for m(π) = 135 MeV. The peak location determines a pseudocritical temperature T(c) = 155(1)(8) MeV, in agreement with earlier staggered fermion results. However, the peak height is 50% greater than that suggested by previous staggered results. Chiral SU(2)(L) × SU(2)(R) symmetry is fully restored above 164 MeV, but anomalous U(1)(A) symmetry breaking is nonzero above T(c) and vanishes as T is increased to 196 MeV.

At a conference held at Stony Brook University in December 2007, "Dangerous Trade: Histories of Industrial Hazard across a Globalizing World," participants endorsed a Code of Sustainable Practice in Occupational and Environmental Health and Safety for Corporations. The Code outlines practices that would ensure corporations enact the highest health and environmentally protective measures in all the locations in which they operate. Corporations should observe international guidelines on occupational exposure to air contaminants, plant safety, air and water pollutant releases, hazardous waste disposal practices, remediation of polluted sites, public disclosure of toxic releases, product hazard labeling, sale of products for specific uses, storage and transport of toxic intermediates and products, corporate safety and health auditing, and corporate environmental auditing. Protective measures in all locations should be consonant with the most protective measures applied anywhere in the world, and should apply to the corporations' subsidiaries, contractors, suppliers, distributors, and licensees of technology. Key words: corporations, sustainability, environmental protection, occupational health, code of practice.

The authors report the arthrographic features of adhesive capsulitis of the wrist in a patient who had undergone prolonged wrist immobilization. The diagnosis was made on the basis of pain and early filling of the lymphatic vessels during the injection of contrast material, as well as small joint capacity.