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Precision timing of millisecond pulsars in binary systems enables observers to detect the relativistic Shapiro delay induced by space time curvature. When favourably aligned, this enables constraints to be placed on the component masses and system orientation. Here we present the results of timing campaigns on seven binary millisecond pulsars observed with the 64-antenna MeerKAT radio telescope that show evidence of Shapiro delay: PSRs~J0101$-$6422, J1101$-$6424, J1125$-$6014, J1514$-$4946, J1614$-$2230, J1732$-$5049, and J1909$-$3744. Evidence for Shapiro delay was found in all of the systems, and for three the orientations and data quality enabled strong constraints on their orbital inclinations and component masses. For PSRs~J1125$-$6014, J1614$-$2230 and J1909$-$3744, we determined pulsar masses to be $M_{\rm p} = 1.68\pm 0.17 \, {\rm M_{\odot}} $, $1.94\pm 0.03 \, {\rm M_{\odot}} $ and $1.45 \pm 0.03 \, {\rm M_{\odot}}$, and companion masses to be $M_{\rm c} = 0.33\pm 0.02 \, {\rm M_{\odot}} $, $0.495\pm 0.005 \, {\rm M_{\odot}} $ and $0.205 \pm 0.003 \, {\rm M_{\odot}}$, respectively. This provides the first independent confirmation of PSR~J1614$-$2230's mass, one of the highest known. The Shapiro delays measured for PSRs~J0101$-$6422, J1101$-$6424, J1514$-$4946, and J1732$-$5049 were only weak, and could not provide interesting component mass limits. Despite a large number of millisecond pulsars being routinely timed, relatively few have accurate masses via Shapiro delays. We use simulations to show that this is expected, and provide a formula for observers to assess how accurately a pulsar mass can be determined. We also discuss the observed correlation between pulsar companion masses and spin period, and the anti-correlation between recycled pulsar mass and their companion masses., Comment: 19 pages, 8 figures

High-energy periarticular tibia fractures are challenging injuries with a significant risk of complications. Postoperative infection rates, although improved, remain unacceptable. Intrawound topical antibiotic (TA) application has been popularized to reduce postoperative infections. Although TA may minimize infections, it remains unclear whether TAs have any impact on the development of nonunion. Recent investigations of TA use in fracture care have questioned its efficacy in vivo and suggested a potentially deleterious effect on fracture healing. This study investigates the impact of TA on nonunion rates in surgically treated high-energy periarticular tibia fractures.Retrospective analysis of surgically treated periarticular tibia fractures at a single Level 1 trauma center was conducted. Intervention in question was the clinical effect of intrawound TA powder application at definitive closure. A total of 222 high-energy periarticular tibia fractures were included, 114 with TA use and 108 without. The primary outcome was the occurrence of nonunion, with secondary outcomes being superficial and deep postoperative surgical site infections.Twenty-seven patients (12.1%) were diagnosed with nonunions (14 pilons and 13 plateaus). There was no statistically significant difference in nonunion rates among patients who received topical antibiotics (15.8%) versus the group of patients who did not (8.3%) ( P = 0.23). Odds of developing nonunion was significant for open injuries (odds ratio 6.16, P0.001) and patients with a provisional external fixator (odds ratio 8.72, P = 0.03) before definitive fixation. No notable difference in the number of superficial and deep infections was identified between groups.The use of TA in high-energy periarticular tibia fractures showed no statistically significant increase in nonunion rates but did not conclusively rule out nonunion as a possible effect of intrawound TA. Additional large-scale multicenter prospective studies are needed to confirm these findings. The current body of literature regarding high-energy periarticular tibia fractures does suggest that TAs lower the risk of postoperative infections, but the nonunion risk remains unclear.Level III, Retrospective Cohort Study.

We present the first 2.5 years of data from the MeerKAT Pulsar Timing Array (MPTA), part of MeerTime, a MeerKAT Large Survey Project. The MPTA aims to precisely measure pulse arrival times from an ensemble of 88 pulsars visible from the Southern Hemisphere, with the goal of contributing to the search, detection and study of nanohertz-frequency gravitational waves as part of the International Pulsar Timing Array. This project makes use of the MeerKAT telescope, and operates with a typical observing cadence of two weeks using the L-band receiver that records data from 856-1712 MHz. We provide a comprehensive description of the observing system, software, and pipelines used and developed for the MeerTime project. The data products made available as part of this data release are from the 78 pulsars that had at least $30$ observations between the start of the MeerTime programme in February 2019 and October 2021. These include both sub-banded and band-averaged arrival times, as well as the initial timing ephemerides, noise models, and the frequency-dependent standard templates (portraits) used to derive pulse arrival times. After accounting for detected noise processes in the data, the frequency-averaged residuals of $67$ of the pulsars achieved a root-mean-square residual precision of $< 1 \mu \rm{s}$. We also present a novel recovery of the clock correction waveform solely from pulsar timing residuals, and an exploration into preliminary findings of interest to the international pulsar timing community. The arrival times, standards and full Stokes parameter calibrated pulsar timing archives are publicly available., Comment: 18 pages, 6 figures

BACKGROUND: Opioids are a mainstay for pain control in patients undergoing lumbar spine surgery but are associated with a high risk of dependence and significant adverse effects. Efforts continue to be made to utilize non-narcotic agents such as regional nerve block for pain control as part of a multimodal analgesia regimen. Recently, transversus abdominis plane (TAP) blocks have proven beneficial for patients undergoing lumbar fusion procedures. The purpose of this study is to evaluate the efficacy of TAP blocks for postoperative pain control and the effect on opioid consumption and hospital length of stay (LOS) in patients undergoing anterior lumbar interbody fusion (ALIF). METHODS: A retrospective review of patients undergoing elective ALIF included collection of data on demographics, LOS, pain scores using visual analog scale (VAS), opioid consumption using morphine milligram equivalents (MME) from postoperative day (POD) 0 to 5, and any complications. Patients who underwent primary ALIF or ALIF with concomitant posterolateral lumbar fusion were included. RESULTS: A total of 99 patients met inclusion criteria; 47 had a preoperative TAP block and 52 did not. Demographic data and number of levels fused were equally distributed between the groups. The TAP group had significantly lower MME consumption postoperatively during POD 0 to 2 and 0 to 5. VAS pain scores were lower for TAP block patients on POD 3 and 4; otherwise, there was no significant difference. LOS and complication rates were not significantly different. A multiple regression analysis found male sex to be a predictor of increased postoperative MME, while age and TAP block were significant predictors of decreased MME. CONCLUSIONS: The use of TAP block for patients undergoing ALIF was associated with less cumulative MME consumption in the immediate postoperative period. TAP block may be an effective tool for reducing postoperative opioid consumption in patients undergoing ALIF. CLINICAL RELEVANCE: The data in this study provide clinical relevance supporting the use of TAP blocks for patients undergoing ALIF procedures. LEVEL OF EVIDENCE: 3.

When appropriately used, helicopter emergency medical services (HEMSs) allow for timely delivery of severely injured patients to definitive care. Inappropriate utilization of HEMSs results in increased cost to the patient and trauma system. The purpose of this study was to review current HEMS criteria in the central Gulf Coast region and evaluate for potential areas of triage refinement and cost savings. We hypothesized that a significant number of patients received potentially unwarranted HEMS transport.A retrospective cohort study of all patients with trauma arriving to a level I trauma center by helicopter over 28 mo was performed; 381 patients with trauma and with HEMS transport from the scene were included. Data were collected from prehospital sources, as well as hospital chart review for each patient. The primary outcome was the rate of unwarranted HEMS transport.A total of 381 adult patients with trauma transported by the HEMS were analyzed, of which 34% were deemed potentially nonwarranted transports. The significant factors correlating with warranted HEMS transport included age, multiple long bone fractures, penetrating mechanism, and vehicle ejection. Insurance demographics did not correlate to transport modality. Many of these patients were transported from a location within the same county or the county adjacent to the trauma center. When comparing patients transported by ground and HEMSs from the same scene, no time savings were identified. Unwarranted transports at the trauma center represented an estimated health care expenditure of over $3 million.HEMSs may be overused in the central Gulf Coast region, creating the risk for a substantial resource and financial burden to the trauma system. Further collaboration is needed to establish HEMS triage criteria, that is, more appropriate use of resources.

Background: This study aimed to assess COVID-19 vaccine confidence among healthcare personnel in the safety net sector of the United States and Puerto Rico. The study aimed to examine the extent to which increased knowledge and positive attitudes about COVID-19 vaccine safety and efficacy were associated with healthcare workers' COVID-19 vaccination status and their recommendation of the vaccine to all patients. Methods: The study collected online survey data from healthcare workers working in Free and Charitable Clinics across the United States and Federally Qualified Health Centers in Puerto Rico. The survey consisted of 62 questions covering various demographic measures and constructs related to healthcare workers' vaccination status, beliefs, and their recommendation of COVID-19 vaccination to all patients. Statistical analyses, including multivariate analysis, were conducted to identify the factors associated with COVID-19 vaccine status and recommendation among healthcare personnel. Results: Among the 2273 respondents, 93% reported being vaccinated against COVID-19. The analysis revealed that respondents who believed that COVID-19 vaccines were efficacious and safe were three times more likely to be vaccinated and two times more likely to recommend the vaccine to all their patients. Respondents who believed they had received adequate information about COVID-19 vaccination were 10 times more likely to be vaccinated and four times more likely to recommend it to all their patients. Conclusions: The study findings suggest that healthcare personnel's COVID-19 vaccine confidence is associated with increased knowledge and holding positive beliefs and attitudes about COVID-19 vaccine safety and efficacy. The results also highlight the importance of healthcare personnel feeling adequately informed and confident in their knowledge to recommend the vaccine to their patients. These findings have important implications for developing strategies to increase COVID-19 vaccine confidence among healthcare personnel and improve vaccine uptake among their patients.

We present baseband radio observations of the millisecond pulsar J1909 − 3744, the most precisely timed pulsar, using the MeerKAT telescope as part of the MeerTime pulsar timing array campaign. During a particularly bright scintillation event the pulsar showed strong evidence of pulse mode changing, among the first millisecond pulsars and the shortest duty cycle millisecond pulsar to do so. Two modes appear to be present, with the weak (lower signal-to-noise ratio) mode arriving 9.26 ± 3.94 μs earlier than the strong counterpart. Further, we present a new value of the jitter noise for this pulsar of 8.20 ± 0.14 ns in one hour, finding it to be consistent with previous measurements taken with the MeerKAT (9 ± 3 ns) and Parkes (8.6 ± 0.8 ns) telescopes, but inconsistent with the previously most precise measurement taken with the Green Bank telescope (14 ± 0.5 ns). Timing analysis on the individual modes is carried out for this pulsar, and we find an approximate $10\, \mathrm{per\,cent}$ improvement in the timing precision is achievable through timing the strong mode only as opposed to the full sample of pulses. By forming a model of the average pulse from templates of the two modes, we time them simultaneously and demonstrate that this timing improvement can also be achieved in regular timing observations. We discuss the impact an improvement of this degree on this pulsar would have on searches for the stochastic gravitational wave background, as well as the impact of a similar improvement on all MeerTime PTA pulsars.

We have developed a new foundation-level course at our institution that links the concept of chemical equilibria from four of the traditional subdisciplines (analytical, biochemistry, inorganic, and physical). The course, entitled Solution and Solid State Chemistry (CHEM 210), is designed to serve our chemistry and biochemistry majors, as well as those students interested in prehealth professions. The course functions as a bridge between the introductory and organic chemistry courses and the in-depth chemistry curriculum at our institution. A week-by-week explanation of the course curriculum is provided, as well as the description of the laboratory experiments conducted during the course.

Limb salvage is the benchmark for pediatric extremity bone sarcomas. However, reconstructive strategies must account for any anticipated remaining growth potential and the resultant limb inequality. Expandable endoprostheses offer the theoretical advantage of immediate weight-bearing, predictable function, and reliable maintenance of leg-length equality. The evolution of the lengthening mechanism now permits noninvasive lengthening, opposed to the multiple open procedures of the past. These design improvements have contributed to their growing popularity. Experience has indicated that these noninvasive implants more reliably achieve leg-length equality, have longer failure-free survival, and decreased complications, although some have noted gearbox and lengthening failures. Currently, no standardize technique exists for managing patients with noninvasive expandable implants from the time of reconstruction to final lengthening at skeletal maturity. This blueprint aims to provide a detailed surgical technique, lengthening schedule, and recommendations for the mitigation and management of complications to achieve successful limb salvage with noninvasive expandable endoprostheses.

The myotendinous junction (MTJ) contributes to the generation of motion by connecting muscle to tendon. At the adult MTJ, a specialized extracellular matrix (ECM) is thought to contribute to the mechanical integrity of the muscle-tendon interface, but the factors that influence MTJ formation during mammalian development are unclear. Here, we combined 3D imaging and proteomics with murine models in which muscle contractility and patterning are disrupted to resolve morphological and compositional changes in the ECM during MTJ development. We found that MTJ-specific ECM deposition can be initiated via static loading due to growth; however, it required cyclic loading to develop a mature morphology. Furthermore, the MTJ can mature without the tendon terminating into cartilage. Based on these results, we describe a model wherein MTJ development depends on mechanical loading but not insertion into an enthesis.

In 2018 an ultra-wide-bandwidth low-frequency (UWL) receiver was installed on the 64-m Parkes Radio Telescope enabling observations with an instantaneous frequency coverage from 704 to 4032 MHz. Here, we present the analysis of a three-year data set of 35 millisecond pulsars observed with the UWL by the Parkes Pulsar Timing Array (PPTA), using wideband timing methods. The two key differences compared to typical narrow-band methods are, firstly, generation of two-dimensional templates accounting for pulse shape evolution with frequency and, secondly, simultaneous measurements of the pulse time-of-arrival (ToA) and dispersion measure (DM). This is the first time that wideband timing has been applied to a uniform data set collected with a single large-fractional bandwidth receiver, for which such techniques were originally developed. As a result of our study, we present a set of profile evolution models and new timing solutions including initial noise analysis. Precision of our ToA and DM measurements is in the range of 0.005 $-$ 2.08 $\mu$s and (0.043$-$14.24)$\times10^{-4}$ cm$^{-3}$ pc, respectively, with 94% of the pulsars achieving a median ToA uncertainty of less than 1 $\mu$s., Comment: 29 pages, 12 figures, Accepted for publication in ApJ

MeerTime is a five-year Large Survey Project to time pulsars with MeerKAT, the 64-dish South African precursor to the Square Kilometre Array. The science goals for the programme include timing millisecond pulsars (MSPs) to high precision (< 1 $\mu$s) to study the Galactic MSP population and to contribute to global efforts to detect nanohertz gravitational waves with the International Pulsar Timing Array (IPTA). In order to plan for the remainder of the programme and to use the allocated time most efficiently, we have conducted an initial census with the MeerKAT "L-band" receiver of 189 MSPs visible to MeerKAT and here present their dispersion measures, polarization profiles, polarization fractions, rotation measures, flux density measurements, spectral indices, and timing potential. As all of these observations are taken with the same instrument (which uses coherent dedispersion, interferometric polarization calibration techniques, and a uniform flux scale), they present an excellent resource for population studies. We used wideband pulse portraits as timing standards for each MSP and demonstrated that the MeerTime Pulsar Timing Array (MPTA) can already contribute significantly to the IPTA as it currently achieves better than 1 $\mu$s timing accuracy on 89 MSPs (observed with fortnightly cadence). By the conclusion of the initial five-year MeerTime programme in July 2024, the MPTA will be extremely significant in global efforts to detect the gravitational wave background with a contribution to the detection statistic comparable to other long-standing timing programmes., Comment: Accepted to PASA. 27 figures. Data to be made available under the DOI 10.5281/zenodo.5347875 at the time of publication

Accurate detection and segmentation of single cells in three-dimensional (3D) fluorescence timelapse images is essential for observing individual cell behaviors in large bacterial communities called biofilms. Recent progress in machine-learning-based image analysis is providing this capability with every increasing accuracy. Leveraging the capabilities of deep convolutional neural networks (CNNs), we recently developed bacterial cell morphometry in 3D (BCM3D), an integrated image analysis pipeline that combines deep learning with conventional image analysis to detect and segment single biofilm-dwelling cells in 3D fluorescence images. While the first release of BCM3D (BCM3D 1.0) achieved state-of-the-art 3D bacterial cell segmentation accuracies, low signal-to-background ratios (SBRs) and images of very dense biofilms remained challenging. Here, we present BCM3D 2.0 to address this challenge. BCM3D 2.0 is entirely complementary to the approach utilized in BCM3D 1.0. Instead of training CNNs to perform voxel classification, we trained CNNs to translate 3D fluorescence images into intermediate 3D image representations that are, when combined appropriately, more amenable to conventional mathematical image processing than a single experimental image. Using this approach, improved segmentation results are obtained even for very low SBRs and/or high cell density biofilm images. The improved cell segmentation accuracies in turn enable improved accuracies of tracking individual cells through 3D space and time. This capability opens the door to investigating timedependent phenomena in bacterial biofilms at the cellular level.

This study aims to determine the prevalence of metabolic disturbance in all fracture nonunion cases and identify the most common endocrine abnormalities seen using a simple screening algorithm.A retrospective review study was performed evaluating patients who underwent operative intervention for nonunion from January 2010 to December 2018 at 2 level-1 trauma centers. Preoperative laboratory values were recorded for a 9-test "nonunion panel." A metabolic or endocrine abnormality, specifically an abnormality in the thyroid or parathyroid axis, was evaluated.42% of patients had an undiagnosed metabolic laboratory abnormality. When multiple tests were used, the rate of metabolic dysfunction was between 60% and 75%, depending on the definition of vitamin D insufficiency vs deficiency used.Results indicate a relatively high prevalence of metabolic disturbance in patients with nonunion and suggest metabolic screening for all nonunion patients not only those without a mechanical or infectious cause.IV, retrospective case series.

Introduction/Background* The COVID-19 pandemic has had a dramatic impact on many aspects of healthcare, with changes in clinical practice aimed at reducing hospital appointments for patients who are classified as clinically vulnerable. In oncology this has resulted in a move towards the uptake of innovative follow-up schemes, such as patient-initiated or telephone follow-up, in particular for patients who are deemed to be at lower risk of recurrence. The aim of this study was to explore clinician’s views of the impact of the COVID19 pandemic on the uptake of such schemes and the challenges in maintaining such schemes in the future. Methodology A mixed methods study was performed consisting of an online questionnaire of clinical nurse specialists and a qualitative interview study of clinicians involved in the follow-up of patients after a diagnosis of endometrial cancer. The interviews were conducted virtually, audio recorded, transcribed verbatim and analysed using framework analysis. Result(s)* In total, 22 clinical nurse specialists responded to the survey. Interview participants included gynaecological oncologists, cancer unit gynaecologist, oncologists and clinical nurse specialists. There was universal support to reduce face-to-face consultations during the COVID-19 pandemic and strong support for telephone and patient initiated follow-up. 70% of the participants of the online survey reported that in their opinion COVID-19 pandemic had had an impact on their clinic service by causing accelerated transition to patient initiated or telephone follow-up. The participants also reported patient support for the introduction of virtual follow-up compared to face-to-face appointments. Conclusion* The COVID-19 pandemic has resulted in a transition towards telephone and patient initiated follow-up for the follow-up of endometrial cancer. Further research is needed to ensure that these schemes are able to address patients’ clinical and information needs if the change from face-to-face clinical follow-up is to be continued following the COVID-19 pandemic.

A nanohertz-frequency stochastic gravitational-wave background can potentially be detected through the precise timing of an array of millisecond pulsars. This background produces low-frequency noise in the pulse arrival times that would have a characteristic spectrum common to all pulsars and a well-defined spatial correlation. Recently the North American Nanohertz Observatory for Gravitational Waves collaboration (NANOGrav) found evidence for the common-spectrum component in their 12.5-year data set. Here we report on a search for the background using the second data release of the Parkes Pulsar Timing Array. If we are forced to choose between the two NANOGrav models $\unicode{x2014}$ one with a common-spectrum process and one without $\unicode{x2014}$ we find strong support for the common-spectrum process. However, in this paper, we consider the possibility that the analysis suffers from model misspecification. In particular, we present simulated data sets that contain noise with distinctive spectra but show strong evidence for a common-spectrum process under the standard assumptions. The Parkes data show no significant evidence for, or against, the spatially correlated Hellings-Downs signature of the gravitational-wave background. Assuming we did observe the process underlying the spatially uncorrelated component of the background, we infer its amplitude to be $A = 2.2^{+0.4}_{-0.3} \times 10^{-15}$ in units of gravitational-wave strain at a frequency of $1\, \text{yr}^{-1}$. Extensions and combinations of existing and new data sets will improve the prospects of identifying spatial correlations that are necessary to claim a detection of the gravitational-wave background., 10 pages, 5 figures

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

Patient: Male, 70 Final Diagnosis: Fear of falling syndrome Symptoms: Inability to get up from a chair and ambulate independently Medication: — Clinical Procedure: Lumbar puncture Specialty: Neurology Objective: Rare disease Background: Fear of falling syndrome is a rare and often-missed disorder among patients with new-onset gait abnormality. The disorder is often mistaken for an organic neurologic problem, with some considering it to be a medical emergency. Case Report: This case report presents a 70-year-old man who presented to the Emergency Department due to inability to rise from a chair or ambulate independently. Onset of his chief complaint occurred subsequent to a traumatic fall in a public location. He underwent extensive workup, and an organic neurologic cause was ruled out. He was subsequently diagnosed with fear of falling syndrome after obtaining a detailed fall history, as well as utilizing a verified survey (the Falls Efficacy Scale-International). After extensive inpatient treatment, the patient improved significantly. However, upon discharge to a skilled nursing facility, he was not offered the recommended treatment. When he was readmitted for an unrelated reason 3 months later, he had regressed to the state he was in at the time of prior admission. Conclusions: This case presents a rare debilitating but reversible gait disorder, and highlights the importance of assessing “fall history” and fear of falling in older adults. Uniquely, this case presents the rapid fluctuation in outcomes dependent on treatment, and what happens when a patient fails to complete treatment regimens. The report also provides an overview of fear of falling with the corresponding gait disorder.

Introduction: The NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) conducts independent investigations of selected fire fighter line-of-duty deaths (LODD) and offers recommendations to prevent similar deaths. The purpose of the current study was to provide information on more recent FFFIPP recommendations and to determine if recommendations have changed over time. Methods: Fatality investigations completed from 2006 to 2014 were selected for this study with recommendations being assigned into twelve major categories when possible. The most frequently occurring recommendations were then rank ordered overall and then by medical and traumatic fire fighter LODD. Results: There were 1,067 total recommendations made in the published fire fighter investigative reports for both medical and trauma-related fire fighter fatalities for the period 2006–2014. Of these, 784 (73%) could be placed within one of the 12 categories noted previously. The top 10 recommendation categories overall were: 1. Medical screening, 2. Fitness and wellness program, 3. Training, 4. Medical clearance, 5. Standard Operating Procedures/Standard Operating Guidelines (SOPs/SOGs), 6. Incident command, 7. Strategy and tactics, 8. Communications, 9. Personal protective equipment and 10. Staffing. Conclusions: The leading recommendations from the NIOSH FFFIPP medical investigations between 2006 and 2014 did not change compared to those made between 1998 and 2005, with the exception of the addition of “medical clearance for duty”. There were changes for the traumatic injury leading recommendations for 2006–2014, with the major change being “training”, which was the leading FFFIPP recommendation for traumatic injuries for this time period. Practical applications: The intent of the FFFIPP is to influence fire departments and fire fighters to critically assess and evaluate situations/circumstances similar to those identified by NIOSH investigations and implement the recommendations offered to prevent additional fire fighter fatalities.

Important interactions between memory and decision-making processes are required to maintain high-levels of spatial working memory task performance. Past research reveals that the medial prefrontal cortex (mPFC) and hippocampus (HPC) are both vital structures involved in these processes. Recent evidence suggests that interactions between these two structures are dynamic and task dependent. However, there exists uncertainty surrounding the specific conditions that recruit mPFC contributions to these tasks, specifically regarding its role in retaining information online during delay periods. To address this issue, we tested rats on a spatial-delayed alternation task in which we utilized a closed-loop optogenetic system to transiently disrupt mPFC activity during different task epochs (delay, choice, return). By analyzing the effects of mPFC disruption on choice accuracy and a deliberative behavior known as vicarious-trial-and-error (VTE), our study revealed several interesting findings regarding the role of the mPFC in spatial-working memory tasks. The main findings include: (a) choice accuracy in the spatial-delayed alternation (SDA) task was impaired when the mPFC was disrupted during the choice epoch and not delay or return epochs, (b) mPFC disruption resulted in a non-epoch specific reduction in VTE occurrence which correlated with impairments in task performance. Taken together, findings from this study suggest that, during spatial decision-making, contributions made by the mPFC are specific to points of deliberation and choice (not delay), and that VTEs are a deliberative behavior which relies on intact mPFC function.

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Midfoot fusions have long been used to treat a variety of procedures in the foot. Indications may include hallux valgus correction, first ray instability, midfoot arthritis, pes planovalgus, trauma, and Charcot reconstruction. One of the drawbacks of this procedure is nonunion, which has been consistently reported between 5-10%. Placing implants and obtaining fixation along the plantar surface of the bone may create a tension band implant construct during physiologic loading that helps to compress the arthrodesis site and thereby may further optimize the healing potential. This study reports on the radiographic and clinical outcomes of plantar plating and arthrodesis of midfoot joints for a variety of procedures. Methods: A retrospective review was undertaken of consecutive patients between 2012-2019 that underwent a midfoot fusion with plantar positioned implants by a fellowship-trained foot and ankle orthopedic surgeon at a single institution. 62 patients underwent arthrodesis of the midfoot as part of a correction for hallux valgus, flatfoot deformity, midfoot arthritis, Lisfranc injury, Charcot correction or a combination these diagnoses. Average follow-up was 36.2 months (range, 16-66 months). For those treated for a flatfoot deformity, the lateral talus-first metatarsal (Meary’s) angle and medial arch sag angle (MASA) were compared on preoperative and postoperative imaging to obtain the magnitude of radiographic correction achieved. For those treated for hallux valgus deformity, the inter-metatarsal angle (IMA) was utilized to establish the magnitude of deformity correction. Serial weight-bearing radiographs were independently evaluated for malunion, nonunion, or hardware migration to be logged as complications at the arthrodesis site. Results: The 1st TMT joint was fused in 43 patients, and the NC joint was fused in 23 patients. Five patients had simultaneous fusion of the 1st TMT and NC joints. Two patients underwent arthrodesis of the talonavicular (TN) joint with one patient having simultaneous arthrodesis of the TN and NC joints. We found statistically significant improvement in the lateral talus-first metatarsal-angle (Meary’s) and medial arch sag angle (MASA) for those treated for flatfoot corrections. For those treated for hallux valgus, there was significant reduction in the Intermetatarsal angle (IMA) from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The nonunion rate was reduced to 3.3%when excluding the Charcot neuroarthropathy patients. There was one symptomatic nonunion requiring revision surgery (1.7%). Conclusion: Deformity correction was successfully maintained in those treated for hallux valgus and flatfoot deformities. There were significant improvements in the IMA, the MASA, and Meary’s angle Plates implanted on the plantar bone surface for midfoot arthrodesis provided and maintained deformity correction without hardware irritation for a variety of orthopedic conditions. A clinical and radiographic union rate of94% (97% when excluding Charcot neuroarthropathy patients) was achieved. The risk of nonunion appeared to be higher in diabetic patients, in smokers, with the utilization of claw plates, and when fusion constructs included the NC joint. [Table: see text]

Category: Midfoot/Forefoot; Other Introduction/Purpose: Midfoot arthrodesis is a reliable procedure for deformity correction and pain relief. First tarsometatarsal arthrodesis can be used for correction of hallux valgus deformity with large intermetatarsal angles or first-ray hypermobility. Midfoot arthrodesis is also integral in correction of pes planovalgus deformity with midfoot collapse. First tarsometatarsal arthrodesis has a nonunion rate of 2-15%. Arthrodesis is completed traditionally through a dorsal approach. Due to high nonunion rates, recent studies have investigated plater based plates. These have been shown to have superior strength by creating a tension band construct as the foot is loaded. Tibialis anterior footprint is at risk when accessing first tarsometatarsal joint for arthrodesis. We explore whether the tibialis insertional footprint can be released and repaired with no deleterious effects. Methods: Patients included were undergoing first tarsometatarsal joint or naviculocuneiform joint arthrodesis with a plantar based plate and screw construct for hallux valgus deformity with large intermetatarsal angle or first-ray hypermobility, and those with first TMT joint arthritis, pes planovalgus, Lisfranc injury, or Charcot neuroarthropathy. Medial based surgical approach is centered over the first tarsometatarsal joint. Saphenous neurovascular bundle is retracted dorsally. Release of the capsular structures allowed for complete visualization and distraction of the joint. The distal-most attachment of the tibialis anterior tendon onto the first metatarsal is release in line with the capsulotomy. Primary insertion on the medial cuneiform was preserved. A cuff of released insertional tissue is preserved and reflected distally for repair. Standard tarsometatarsal arthrodesis joint preparation was completed. Plantar plate then fixed and compressed. Deep fascial layers were then closed over the plated were previous tendon release was performed. Results: In 62 patients, none had tibialis anterior tendon rupture, weakness, or irritation, with average follow-up of 36.2 months. Nine wound complications were recognized during the study. Twelve percent of patients experiencing delayed incisional healing that went on to heal with local wound care. Smokers accounted for six of the seven patients (OR 24.62, pConclusion: One advantage of applying a plate and screw construct plantarly for midfoot arthrodesis is biomechanical stability. Multiple studies have indicated this plantar construct may be superior. Another benefit may be less hardware prominence due to increased soft-tissue coverage. Subcutaneous positions of dorsal plates have been reported to contribute to incisional irritation and symptomatic hardware. Tibialis anterior tendon damage has been suggested as a limitation of the plantar approach for midfoot arthrodesis, and the tendon insertion must be released to prepare the joint adequately to apply implants. This series shows tendon release can be safely accomplished without any deleterious effects. [Table: see text]

Hands-on learning in a laboratory is an integral part of the undergraduate experience for chemistry students. However, with the onset of the COVID-19 pandemic, an opportunity for this approach was ...

Case A 47-year-old obese woman presented with a vertical shear (VS) pelvic ring injury after a motor vehicle accident around her previous posterior pelvic hardware. The patient underwent closed reduction with percutaneous posterior screw fixation using combined fluoroscopy and O-arm (Medtronic). Conclusion A rare case of VS pelvic injury with indwelling posterior pelvic hardware does not automatically preclude placement of percutaneous sacroiliac and transiliac-transsacral screws. Combining fluoroscopic imaging and O-arm enables safe screw placement, saving patients from invasive surgeries.

Patient: Female, 25-year-old Final Diagnosis: Posterior reversible encephalopathy syndrome Symptoms: Visual disturbances Medication: — Clinical Procedure: — Specialty: Neurology Objective: Rare co-existance of disease or pathology Background: Posterior reversible encephalopathy syndrome (PRES) is a poorly characterized and enigmatic syndrome. Despite consistently presenting with nervous system vasogenic edema, this malady has been associated with variable triggers, neurological symptoms, and natural history. Case Report: The report presents a 25-year old African American female who presented with altered mental status and bilateral cortical blindness. Neuroimaging identified vasogenic edema in the cerebellum, parietal lobe, and occipital lobe. Her PRES was associated with a hypertensive emergency, renal failure, and an atrial septum vegetation (culture-negative endocarditis). All 3 contributing etiologies were addressed, upon which the patient began to recover. During recovery, the patient experienced cerebral metamorphopsia, visualizing her entire environment in the form of a cartoon. After 2 weeks of treatment she recovered to baseline state of heath, with vasogenic edema resolved on follow-up neuroimaging. Conclusions: This case presents a rarely catalogued phenomena during PRES recovery, cerebral metamorphopsia, along with a new potential association (culture negative atrial septum endocarditis). The report also highlights how PRES recovery patients (with cortical blindness) should be explicitly assessed for cerebral metamorphopsia and Charles Bonnet syndrome – which may distress patients. Lastly, the atypical presentation of cerebellar vasogenic edema in our patient validates existing literature that PRES does not have a uniform picture and is not well served by its current name or proposed diagnostic criteria. Therefore, renaming the disorder to reversible vasogenic edema syndrome and derestricting the diagnostic criteria, may prevent clinicians from being discouraged when faced with diagnosing PRES in the face of atypical findings.

A review of the literature indicated denosumab is gaining favorability in the oncology community, particularly with increasing frequency in GCTB. Will denosumab be the breakthrough GCTB treatment? Here, we provide a pertinent case example, a review of the literature regarding the history and basic science behind the use of denosumab for GCTB, highlight the newest insights into the dosing and duration of treatment, and note advancements in the field.

The growth and solubility of quantum dots (QDs) are important factors that must be examined before these nanoparticles are incorporated into a variety of potential applications. In this work, monolayer-protected CdSe QDs surrounded by water-soluble thiols were prepared using various cadmium salts. The use of a variety of cadmium salts did not have a significant impact on the spectral properties of the CdSe QDs. CdSe QDs were synthesized at rather low temperatures (< 0°C), resulting in slow nanoparticle growth upon subsequent heating of the reaction mixture. The effect of multiple drying and redissolving cycles of the QD samples was examined. The effect of heating temperature on QD growth was studied, with more rapid nanoparticle growth associated with higher temperatures. The results show that QDs can be synthesized at low temperatures and their subsequent growth can be controlled during the heating process.

Aims Maternal breastmilk (MBM) is the one of the most important interventions a preterm infant can receive. It reduces morbidity, improves neurodevelopmental outcome and reduces the incidence of necrotising enterocolitis. Early expressing is associated with improved milk supply and longevity of breast feeding. The aim of this QI project was to improve early MBM expressing and time to early colostrum in infants born Methods This project was part of a package of ten evidence-based interventions to optimise outcomes for preterm infants (the NeoPremQI Project), launched 2017. QI strategies for early MBM included: Midwife champions promoting benefits of MBM for preterm infants to MDT. Charity funded electric breast pump for intrapartum/immediate postpartum expressing on delivery suite. Improved parental awareness of the benefits of MBM for preterm infants, and the importance of early expressing (parental information leaflets, structured antenatal consultations about MBM). Data was collected about these interventions, and Time interval between birth and infant receiving colostrum MBM at discharge. Core neonatal outcomes (outcome data available for 54 infants at time of submission). Results Pre QI data was collected on all in-born Outcome Data Conclusion Simple multi-disciplinary QI measures have led to a significant reduction in time to infants receiving colostrum, an increased proportion of babies receiving breast milk at discharge, and may be associated with improvements seen in other important outcomes.

Here we present the discovery of 895 s-process-rich candidates from 454,180 giant stars observed by the Large Sky Area Multi-Object Fibre Spectroscopic Telescope (LAMOST) using a data-driven approach. This sample constitutes the largest number of s-process enhanced stars ever discovered. Our sample includes 187 s-process-rich candidates that are enhanced in both barium and strontium, 49 stars with significant barium enhancement only and 659 stars that show only a strontium enhancement. Most of the stars in our sample are in the range of effective temperature and log g typical of red giant branch (RGB) populations, which is consistent with our observational selection bias towards finding RGB stars. We estimate that only a small fraction (0.5 per cent) of binary configurations are favourable for s-process enriched stars. The majority of our s-process-rich candidates (95 per cent) show strong carbon enhancements, whereas only five candidates (less than 3 percent) show evidence of sodium enhancement. Our kinematic analysis reveals that 97 percent of our sample are disc stars, with the other 3 percent showing velocities consistent with the Galactic halo. The scaleheight of the disc is estimated to be zh=0.634kpc, comparable with values in the literature. A comparison with the yields from asymptotic giant branch (AGB) models suggests that the main neutron source responsible for the Ba and Sr enhancements is the 13C(alpha,n)16O reaction. We conclude that the s-process-rich candidates may have received their overabundances via mass transfer from a previous ABG companion with an initial mass in the range 1-3Msun., Comment: 9 pages, 6 figures