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Tibial tubercle fractures are rare injuries that occur in adolescents most commonly during athletic activities. Fractures are typically identified by physical examination and radiographs alone; however, this often underestimates the extent of injury. Soft tissue injuries are often associated with tibial tubercle fractures and can be missed by plain radiographs. The authors report on a patient whose meniscus was entrapped in the fracture site during the initial operative reduction and fixation. Magnetic resonance imaging performed 1 year after continued symptoms revealed that a tear of the anterior horn of the lateral meniscus was entrapped within the fracture during the initial surgery. This could have been prevented by using arthroscopy or doing an arthrotomy during open reduction to visualize the articular surface and meniscus during initial surgical intervention. [ Orthopedics . 2023;46(1):e62–e65.]

Oil and gas output in California has declined as the industry faces increasing regulatory and market headwinds. However, California remains a major oil and gas producing jurisdiction at the present. California is the seventh-largest producer of crude oil in the United States and contains the fifth-largest crude oil reserves.

The United States Forest Inventory and Analysis (FIA) program has been monitoring national forest resources in the United States for over 80 years; presented here is a synthesis of research applications for FIA data. A review of over 180 publications that directly utilize FIA data is broken down into broad categories of application and further organized by methodologies and niche research areas. The FIA program provides the most comprehensive forest database currently available, with permanent plots distributed across all forested lands and ownerships in the United States and plot histories dating back to the early 1930s. While the data can be incredibly powerful, users need to understand the spatial resolution of ground-based plots and the nature of the FIA plot coordinate system must be applied correctly. As the need for accurate assessments of national forest resources continues to be a global priority, particularly related to carbon dynamics and climate impacts, such national forest inventories will continue to be an important source of information on the status of and trends in these ecosystems. The advantages and limitations of FIA’s national forest inventory data are highlighted, and suggestions for further expansion of the FIA program are provided.

Fabry disease is an X linked disease caused by pathogenic variants in the GLA gene. The cardiovascular and renal systems are most affected in Fabry patients and may require heart or kidney transplants in the late stages of the disease depending on severity of manifestations. Enzyme replacement therapy (ERT) has proven to delay progression of Fabry disease considerably, especially when started early in life. Current research has shown that individuals who have received cardiac or renal transplants or are currently on dialysis have the greatest probability of developing severe manifestations of COVID-19. It has also been shown that people who contract COVID-19 experience a rapid increase in cytokine levels which can lead to a prothrombotic state and have a greater risk in the presence of comorbidities. A history of cardiac or renal transplants as well as the naturally elevated cytokine levels in Fabry disease make it likely that COVID-19 could have a greater impact on the health of these patients. We report the case of a 67-year-old male with diabetes mellitus, history of kidney transplant, and Fabry disease treated late in progression of the disease first with agalsidase beta ERT, then oral migalastat who developed severe manifestations of COVID-19. The autopsy findings showed acute and organizing hyaline membrane disease consistent with COVID 19 pneumonia and secondary invasive bronchopulmonary aspergillosis with cavitary lesion formation. The sections of the heart showed scattered subendocardial fibrosis, and the transplanted kidneys showed thyroidization and interstitial nephritis potentially secondary to COVID-19, in addition to his long-standing renal disease. This case report serves to chronicle complications in a complex patient with late stage Fabry disease and multiple COVID-19 related complications who succumbed from respiratory failure despite the advanced management for the COVID-19 infection.

Background Helminth and protozoan infections affect more than 1 billion children globally. Improving water quality, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration, while providing other quality of life benefits. Methods and findings We enrolled geographic clusters of pregnant women in rural western Kenya into a cluster-randomized controlled trial (ClinicalTrials.gov NCT01704105) that tested 6 interventions: water treatment, improved sanitation, handwashing with soap, combined water treatment, sanitation, and handwashing (WSH), improved nutrition, and combined WSH and nutrition (WSHN). We assessed intervention effects on parasite infections by measuring Ascaris lumbricoides, Trichuris trichiura, hookworm, and Giardia duodenalis among children born to the enrolled pregnant women (index children) and their older siblings. After 2 years of intervention exposure, we collected stool specimens from 9,077 total children aged 2 to 15 years in 622 clusters, including 2,346 children in an active control group (received household visits but no interventions), 1,117 in the water treatment arm, 1,160 in the sanitation arm, 1,141 in the handwashing arm, 1,064 in the WSH arm, 1,072 in the nutrition arm, and 1,177 in the WSHN arm. In the control group, 23% of children were infected with A. lumbricoides, 1% with T. trichiura, 2% with hookworm, and 39% with G. duodenalis. The analysis included 4,928 index children (median age in years: 2) and 4,149 older siblings (median age in years: 5); study households had an average of 5 people, 90% had dirt floors. Compared to the control group, Ascaris infection prevalence was lower in the water treatment arm (prevalence ratio [PR]: 0.82 [95% CI 0.67, 1.00], p = 0.056), the WSH arm (PR: 0.78 [95% CI 0.63, 0.96], p = 0.021), and the WSHN arm (PR: 0.78 [95% CI 0.64, 0.96], p = 0.017). We did not observe differences in Ascaris infection prevalence between the control group and the arms with the individual interventions sanitation (PR: 0.89 [95% CI 0.73, 1.08], p = 0.228), handwashing (PR: 0.89 [95% CI 0.73, 1.09], p = 0.277), or nutrition (PR: 86 [95% CI 0.71, 1.05], p = 0.148). Integrating nutrition with WSH did not provide additional benefit. Trichuris and hookworm were rarely detected, resulting in imprecise effect estimates. No intervention reduced Giardia. Reanalysis of stool samples by quantitative polymerase chain reaction confirmed the reductions in Ascaris infections measured by microscopy in the WSH and WSHN groups. Trial limitations included imperfect uptake of targeted intervention behaviors, limited power to detect effects on rare parasite infections, and that it was not feasible to blind participants and sample collectors to treatment status. However, lab technicians and data analysts were blinded to treatment status. The trial was funded by the Bill & Melinda Gates Foundation and the United States Agency for International Development. Conclusions Integration of improved water quality, sanitation, and handwashing could contribute to sustainable control strategies for Ascaris infections, particularly in similar settings with recent or ongoing deworming programs. Combining nutrition with WSH did not provide further benefits, and water treatment alone was similarly effective to integrated WSH. Our findings provide new evidence that drinking water should be given increased attention as a transmission pathway for Ascaris. Trial registration ClinicalTrials.gov NCT01704105., Interventions for improved water and hygiene in pregnant women in Kenya resulted in fewer Ascaris infections in newborns, Amy Pickering and colleagues reveal., Author summary Why was this study done? Intestinal worm and protozoan infections affect >1 billion children and are associated with growth faltering and impaired cognitive development. High reinfection rates can prevent mass drug administration programs from eliminating transmission. Improved water quality, sanitation, handwashing, and nutrition could interrupt environmental transmission of parasites, but few trials evaluating these interventions have measured parasite infections as an outcome. What did the researchers do and find? The authors conducted a randomized controlled trial among a birth cohort to test if single and combined improved drinking water quality, sanitation, handwashing, and nutrition interventions can reduce intestinal worm and Giardia infections. The authors measured parasite infections after 2 years of intervention exposure. The authors demonstrated that water treatment alone and integrated water, sanitation, and handwashing interventions can sustainably reduce roundworm (Ascaris) infection prevalence among young children in Kenya. Improved nutrition did not enhance the effectiveness of the water, sanitation, and handwashing interventions, and none of the interventions reduced Giardia. What do these findings mean? Improving water quality, sanitation, and handwashing concurrently in the household environment can protect children from infection with Ascaris. The study also provides evidence that water treatment alone may provide a similar level of protection against Ascaris infection, suggesting that combining water, sanitation, and handwashing interventions does not yield greater health benefits than implementing single interventions. Treating drinking water is a relatively unexplored strategy for controlling intestinal worm infections, and drinking water should be given increased attention as an ingestion exposure pathway for Ascaris eggs.

Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described. Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months). Results: The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 ( P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 ( P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) ( P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures. Conclusion: PUT is an effective treatment, with good results for patients with gluteal tendinopathy.

Background.Helminth and protozoan infections affect >1 billion children globally. Improved water, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration (MDA), while providing other quality of life benefits.Methods and Findings.We enrolled geographic clusters of pregnant women into a cluster-randomized controlled trial that tested six interventions: disinfecting drinking water(W), improved sanitation(S), handwashing with soap(H), combined WSH, improved nutrition(N), and combined WSHN. We assessed intervention effects on parasite infections by measuringAscaris lumbricoides,Trichuris trichiura, hookworm, andGiardia duodenalisamong individual children born to enrolled mothers and their older siblings (ClinicalTrials.govNCT01704105). We collected stool specimens from 9077 total children in 622 clusters, including 2346 children in control, 1117 in water, 1160 in sanitation, 1141 in handwashing, 1064 in WSH, 1072 in nutrition, and 1177 in WSHN. In the control group, 23% of children were infected withAscaris lumbricoides, 1% withTrichuris trichuria, 2% with hookworm and 39% withGiardia duodenalis. After two years of intervention exposure,Ascarisinfection prevalence was 18% lower in the water treatment arm (95% confidence interval (CI) 0%, 33%), 22% lower in the WSH arm (CI 4%, 37%), and 22% lower in the WSHN arm (CI 4%, 36%) compared to control. Individual sanitation, handwashing, and nutrition did not significantly reduceAscarisinfection on their own, and integrating nutrition with WSH did not provide additional benefit.Trichurisand hookworm were rarely detected, resulting in imprecise effect estimates. No intervention reducedGiardia. Reanalysis of stool samples by quantitative polymerase chain reaction (qPCR) confirmed the reductions inAscarisinfections measured by microscopy in the WSH and WSHN groups. Lab technicians and data analysts were blinded to treatment assignment, but participants and sample collectors were not blinded. The trial was funded by the Bill & Melinda Gates Foundation and USAID.Conclusions.Our results suggest integration of improved water quality, sanitation, and handwashing could contribute to sustainable control strategies forAscarisinfections, particularly in similar settings with recent or ongoing deworming programs. Water treatment alone was similarly effective to integrated WSH, providing new evidence that drinking water should be given increased attention as a transmission pathway forAscaris.

Acute colonic pseudo-obstruction (ACPO) as a result of anterior lumbar spinal surgery can result in colonic perforation. ACPO is often treated successfully with conservative measures, reserving surgical intervention for severe cases. The most severe cases can result in colonic perforation with a concomitant high mortality rate. Herein we outline a case of a 72-year-old male with multiple medical comorbidities and history of intermittent constipation who underwent anterior lumbar interbody fusion (ALIF) of L5-S1. The patient’s multiple medical comorbidities placed him at risk for ACPO. His postoperative course was complicated by an ileus. The patient initially underwent conservative management that failed, resulting in colonic perforation. He underwent urgent exploratory laparotomy and repair of colonic perforation by the general surgery service. The patient had spontaneous return of bowel function on postoperative day 5, and at 6 months, he was doing well. The main purpose of this case report is to present a unique case of colonic perforation after ALIF. Understanding patient risk factors can help in early identification and treatment of potentially life-threatening complications. Surgeons should discuss the possibility of this complication with the patient during surgical counseling for anterior lumbar surgery.

We report on the design, fabrication, performance and commissioning of the first membrane cryostat to be used for scientific application. The Long Baseline Neutrino Experiment (LBNE) has designed and fabricated a membrane cryostat prototype in collaboration with IHI Corporation (IHI). Original goals of the prototype are: to demonstrate the membrane cryostat technology in terms of thermal performance, feasibility for liquid argon, and leak tightness; to demonstrate that we can remove all the impurities from the vessel and achieve the purity requirements in a membrane cryostat without evacuation and using only a controlled gaseous argon purge; to demonstrate that we can achieve and maintain the purity requirements of the liquid argon during filling, purification, and maintenance mode using mole sieve and copper filters from the Liquid Argon Purity Demonstrator (LAPD) R&D project. The purity requirements of a large liquid argon detector such as LBNE are contaminants below 200 parts per trillion oxygen equivalent. This paper gives the requirements, design, construction, and performance of the LBNE membrane cryostat prototype, with experience and results important to the development of the LBNE detector.