Search

OBJECTIVES: Despite recent success in tuberculosis (TB) control efforts in the United States, marked declines in TB case rates have not been observed in foreign-born populations. Because foreign-born populations are becoming more important for targeted national TB control efforts, the Federal Bureau of Prisons (BOP) reviewed inmate medical data to evaluate risk factors associated with Mycobacterium tuberculosis infection and active TB disease. To improve screening strategies, BOP implemented chest radiograph screening for all inmates entering a federal detention center in San Diego, California. METHODS: Tuberculin skin test (TST) data from an approximated intake cohort of inmates entering the system from February 1 to June 30, 1999, were analyzed to assess risk factors for M. tuberculosis infection among inmates entering federal prisons. The most recent case reports of inmates diagnosed with TB disease were reviewed. All inmates entering a San Diego detention facility from July 1 to December 31, 1998, were screened for TB by symptom review, TST, and chest radiographs. RESULTS: System-wide, foreign-born inmates were 5.9 times more likely to have a positive TST than US-born inmates, and accounted for 60% of recently diagnosed TB cases. Chest radiograph screening of all inmates entering the San Diego facility reduced exposure time to active TB cases by 75%, but TB incidence remained unchanged. CONCLUSIONS: The high prevalence of M. tuberculosis infection and TB disease among foreign-born inmates entering the federal prison system presents a strategic opportunity to provide preventive therapy to a high-risk population and to identify contagious cases that might elude traditional public health efforts. Universal chest radiograph screening was no more sensitive than TST for detecting active TB cases among newly incarcerated foreign-born inmates with a high prevalence of TB infection, but the screening reduced potential TB exposures through rapid identification of contagious cases. [ABSTRACT FROM AUTHOR]

Over the past 2 decades, several studies comparing intermediate- and long-term outcomes after total ankle replacement (TAR) versus ankle arthrodesis (AA) have reported differing rates of complications and outcomes. Recently, there has been a dramatic increase in patients undergoing TARs without any epidemiologic studies examining the short-term and perioperative complications. The purpose of this prognostic study was to compare perioperative outcomes after TAR and AA using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2017. Patient data were collected from the NSQIP database for surgeries between January 2012 and December 2017 using Current Procedural Terminology codes 27700, 27702, 29899, and 27870. Patients were excluded if treated for fracture, infection, or revision procedures. The outcomes of interest were readmission and reoperation related to initial surgery, surgical site infections, and hospital length of stay. There were 1214 patients included-1027 (84.6%) TAR and 187 (15.4%) AA. The TAR patients were older, had a lower body mass index, and were less likely to have insulin-dependent diabetes. Readmission rate and length of stay was similar between groups. Multivariate regression revealed higher anesthesia severity scores ( P = .0007), diabetes mellitus ( P = .029), and AA ( P = .049) had positive correlations with adverse outcomes. We report a lower complication rate with TAR than previously described. AA arthrodesis is associated with a higher risk of perioperative complications, including deep surgical site infections and reoperations. There were no differences between the 2 groups comparing superficial infection, wound dehiscence, or readmissions in the first 30 days. Levels of Evidence: Level V.

Background: Total ankle arthroplasty through the anterior approach (TAR-AA) is an increasingly popular treatment for ankle arthritis, but it carries a known risk for wound complications. Several products have been investigated to mitigate this risk; however, most are either costly or invasive. Noninvasive skin expansion strips (NSESs) were designed to transfer tension away from the incision and induce new skin growth at the edges of the strips. We hypothesize that postoperative application of NSESs will decrease unplanned clinic visits and wound complications after TAR-AA., Methods: This is a prospective cohort study of 41 patients at a single institution (3 surgeons) treated with NSESs after undergoing TAR-AA. An additional 41 consecutive historical patients treated without NSESs were retrospectively included as a control group. Patients received application of NSESs in the operating room after routine wound closure and again 2 weeks postoperatively. No other changes were made to the surgeons' wound closure technique, immobilization, follow-up timing, or rehabilitation protocols. Primary outcomes included (1) additional clinic visit required for wound assessment or suture removal, (2) superficial wound complication, and (3) deep infection., Results: Baseline demographics did not differ significantly from our 41 consecutively treated historical controls. Additional clinic visits for suture removal or wound evaluation were significantly lower for patients treated with NSESs (15%, 6 of 41) compared to the control group (49%, 20 of 41) ( P = .001). There was also a significant difference in the superficial wound complication rate in the treatment group vs control group, 2% and 12%, respectively ( P = .04). There were no deep infections in either group., Conclusion: Noninvasive skin expansion strips placed after TAR-AA with an anterior approach have the potential to decrease wound complications and unplanned clinic visits. Further high-volume or randomized studies are needed to clarify their cost effectiveness and effect on long-term outcomes., Level of Evidence: Level II, prospective cohort study.

Charcot neuroarthropathy is a complication of neuropathy often secondary to diabetes mellitus and most commonly affects the midfoot. In these patients, reconstruction of the foot may be required for limb salvage. A superconstruct technique has previously been described using intramedullary beaming fixation of the midfoot and hindfoot to span the zone of injury. Inclusion of the subtalar joint in the arthrodesis construct is not consistently performed among different surgeons. The aim of this study was to describe midfoot beaming constructs and postoperative complications after midfoot reconstruction with and without subtalar arthrodesis. We reviewed medical records of patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct. Patients included in the study had at least 3 months of follow-up and had Sanders-Frykberg II/III classification of Charcot neuroarthropathy. Postoperative radiographs were evaluated for evidence of hardware failure at the latest follow-up evaluation. The main variables of interest were: hardware failure or nonunion requiring revision operation, deep infection, and unplanned reoperation. Thirty patients who underwent midfoot reconstruction were included. The mean follow-up was 67.4 ± 25.9 weeks. Twenty-two (73.3%) patients had concomitant subtalar arthrodesis and midfoot beaming. Overall complications were lower in patients with subtalar arthrodesis (40.9%) than those without subtalar arthrodesis (75%) resulting in an odds ratio of 0.271 (0.042-1.338, p = .146). Furthermore, increased number of screws used in the midfoot construct was negatively correlated with complications (r = -0.44, p = .01). An intramedullary midfoot beaming superconstruct with subtalar arthrodesis has previously been proposed to provide better fixation after midfoot beaming Charcot neuroarthropathy reconstruction. Our results suggest including the subtalar joint as part of a superconstruct for the reconstruction of Sanders-Frykberg II/III Charcot results in an 80% lower complication rate than intramedullary beaming alone. We also found an increased number of screws used in the midfoot results in a lower complication rate., (Copyright © 2020 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Children and adolescents who become involved with the justice system often do so with complex medical, mental health, developmental, social, and legal needs. Most have been exposed to childhood trauma or adversity, which both contribute to their involvement with the justice system and negatively impact their health and well-being. Whether youth are held in confinement or in their home communities, pediatricians play a critical role in promoting the health and well-being of justice-involved youth. Having a working knowledge of the juvenile justice system and common issues facing justice-involved youth may help pediatricians enhance their clinical care and advocacy efforts. This policy statement is a revision of the 2011 policy "Health Care for Youth in the Juvenile Justice System." It provides an overview of the juvenile justice system, describes racial bias and overrepresentation of youth of color in the justice system, reviews the health and mental health status of justice-involved youth, and identifies advocacy opportunities for juvenile justice reform., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Hypothesis: The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair., Methods: We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year., Results: The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies ( Q  = 209.53, I 2  = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate ( P  = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P  = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P  = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P  = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P  = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P  = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P  = .195)., Conclusion: The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years., (© 2020 The Author(s).)

Background: Although drill use is fundamental to orthopaedic surgery, the risk of plunging past the far cortex and potentially damaging the surrounding soft tissues remains unavoidable with conventional drilling methods. A dual motor drill may decrease that risk by providing controlled drill-bit advancement and real-time monitoring of depth and energy expenditure. We hypothesized that using the dual motor drill would decrease plunge depth regardless of the user's level of experience., Methods: Sixty-six subjects of varying operative experience (20 attending orthopaedic surgeons, 20 orthopaedic surgery residents, and 26 senior medical students) drilled 3 holes with a conventional drill and 3 holes with a dual motor drill in a bicortical Sawbones block set in ballistic gel. The depth of drill penetration into the ballistic gel was measured for each hole using a digital caliper., Results: Overall, subjects plunged less with the dual motor drill (0.9 mm) than with the conventional drill (4.2 mm) (p < 0.001). This finding was consistent within each group: attending surgeons (0.9 compared with 3.2 mm; p = 0.02), residents (1.0 compared with 3.0 mm; p < 0.001), and students (0.7 compared with 6.0 mm; p < 0.001). Plunge depths were also stratified into 3 categories: 0 to <2 mm, 2 to 5 mm, and >5 mm. Using the dual motor drill, subjects were more likely to plunge <2 mm (97% plunged, on average, 0 to <2 mm and 3% plunged, on average, 2 to 5 mm), whereas subjects were more likely to plunge deeper with the conventional drill (27% plunged, on average, 0 to <2 mm, 45% plunged, on average, 2 to 5 mm, and 27% plunged, on average, >5 mm). Notably, no subject plunged ≥2 mm on the third attempt with the dual motor drill. Attending surgeons (p = 0.02) and residents (p = 0.01) plunged less than students with the conventional drill. There was no significant difference between attending surgeons and residents with the conventional drill (p = 0.96). There was no significant difference in plunge depth between groups using the dual motor drill., Conclusions: The dual motor drill significantly decreased plunge depth for both surgically experienced and inexperienced subjects. Although inexperienced subjects performed worse with the conventional drill than those with experience, there was no difference in their performance with the dual motor drill., Clinical Relevance: Use of a controlled advancement drill may decrease the chance of plunge-related neurovascular injury during in vivo drilling.

Background: Femoral head fractures are an uncommon but severe injury. These high-energy injuries typically occur in association with traumatic hip dislocations. Initial treatment includes urgent concentric reduction; however, controversy exists regarding specific fracture management. The well-known complications of avascular necrosis (AVN), posttraumatic arthritis (PTA), and heterotrophic ossification can leave patients with a significant functional loss of their affected hip. The purpose of this study is to evaluate the clinical and radiographic outcomes of femoral head fractures., Methods: A retrospective review was performed at our institution assessing all patients who presented from 2007 to 2015 with a femoral head fracture associated with a hip dislocation and at least 6 months of clinical and radiographic follow-up. Twenty-two patients met our inclusion criteria. There were 15 males and 7 females with an average age of 36 years (range: 17-55). The average follow-up time was 18 months (range: 6-102). Fractures were classified according to the Pipkin classification. The Thompson and Epstein score was used to determine functional outcomes., Results: There were five, Pipkin I, 3 Pipkin II, 0 Pipkin III, and 14 Pipkin IV, femoral head fractures. Sixteen patients were successfully closed reduced in the emergency department (ED) and six patients required open reduction after failed reduction in the ED. Four patients (18%) were successfully treated with closed reduction alone and 18 patients (82%) required operative intervention. Of those undergoing operative intervention, one patient underwent excision of the femoral head fragment, seven underwent open reduction internal fixation (ORIF) of the femoral head, nine underwent ORIF of the acetabulum, and one underwent ORIF of the femoral head and the acetabulum. Nine patients (41%) had an uneventful postoperative course. Two patients (9%) developed AVN, both requiring total hip arthroplasty (THA). Five patients (23%) developed PTA, two eventually requiring a THA. Two patients (9%) had sciatic nerve palsy. One patient (5%) developed a postoperative infection and four patients (18%) developed heterotrophic ossification (HO), none requiring operative treatment. Two patients (9%) had persistent anterolateral (AL) thigh numbness. Overall functional results were excellent in six patients (27%), good in six (27%), fair in seven (32%), and poor in three patients (14%). Four patients (18%) required a THA., Conclusion: Femoral head fractures are a rare injury with well-known complications. Early diagnosis and concentric reduction are the prerequisites for successful treatment. This study adds to the growing literature on femoral head fractures associated with hip dislocations in efforts to define treatment plans and to guide patient expectations., How to Cite This Article: Del Core MA, Gross B, Ahn J, et al. Clinical and Radiographic Outcomes of Femoral Head Fractures Associated with Traumatic Hip Dislocations. Strategies Trauma Limb Reconstr 2019;14(1):6-10., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.)

The objective of this study was to identify the tick species parasitizing Richardson's ground squirrels (Spermophilus richardsonii) in southern Saskatchewan (Canada). Morphological examination of the adult ticks revealed the presence of three tick species, Ixodes sculptus, Ixodes kingi and Dermacentor andersoni. However, given the difficulties in identifying some of the larval and nymphal (immature) ticks using this approach, PCR-based single-strand conformation polymorphism (SSCP) and DNA sequence analyses of a portion of the mitochondrial (mt) 16S rRNA gene were used to determine their species identity. The results showed that each tick species had a unique set of SSCP profiles and DNA sequences using this mt marker. The species identity of larval and nymphal ticks was determined based on a comparison of these profiles and sequences with those of morphologically-identified adults. The detection of three tick species, which are known vectors of disease-causing agents, on the same host has important implications for understanding the ecology of vector-borne diseases, and provides an opportunity to examine fundamental questions regarding the structure and composition of the bacterial communities (i.e., both endosymbiotic and pathogenic species) in these ticks. This study shows the utility and benefits of using the present molecular method for the accurate identification of ticks at any stage of development., (Copyright © 2013. Published by Elsevier Ltd.)

Can face actions that carry significance within language be perceived categorically? We used continua produced by computational morphing of face-action images to explore this question in a controlled fashion. In Experiment 1 we showed that question--type--a syntactic distinction in British Sign Language (BSL)--can be perceived categorically, but only when it is also identified as a question marker. A few hearing non-signers were sensitive to this distinction; among those who used sign, late sign learners were no less sensitive than early sign users. A very similar facial-display continuum between "surprise" and "puzzlement" was perceived categorically by deaf and hearing participants, irrespective of their sign experience (Experiment 2). The categorical processing of facial displays can be demonstrated for sign, but may be grounded in universally perceived distinctions between communicative face actions. Moreover, the categorical perception of facial actions is not confined to the six universal facial expressions.

The speeded categorisation of gender from photographs of men's and women's faces under conditions of vertical brow and vertical head movement was explored in two sets of experiments. These studies were guided by the suggestion that a simple cue to gender in faces, the vertical distance between the eyelid and brow, could support such decisions. In men this distance is smaller than in women, and can be further reduced by lowering the brows and also by lowering the head and raising the eyes to camera. How does the gender-classification mechanism take changes in pose into account? Male faces with lowered brows (experiment 1) were more quickly and accurately categorised (there was little corresponding 'feminisation' of raised-brow faces). Lowering gaze had a similar effect, but failed to interact with head lowering in a simple manner (experiment 2). We conclude that the initial classification of gender from the facial image may not involve normalisation of the face image to a canonical state (the 'mug-shot view') for expressive pose (brow movement and direction of gaze). For head pose (relative position of the features when the face is not viewed head-on), normalisation cannot be ruled out. Some perceptual mechanisms for these effects, and their functional implications, are discussed.

What are the species boundaries of face processing? Using a face-feature morphing algorithm, image series intermediate between human, monkey (macaque), and bovine faces were constructed. Forced-choice judgement of these images showed sharply bounded categories for upright face images of each species. These predicted the perceptual discrimination boundaries for upright monkey-cow and cow-human images, but not human-monkey images. Species categories were also well-judged for inverted face images, but these did not give sharpened discrimination (categorical perception) at the category boundaries. While categorical species judgements are made reliably, only the distinction between primate faces and cow faces appears to be categorically perceived, and only in upright faces. One inference is that humans may judge monkey faces in terms of human characteristics, albeit distinctive ones.

"While a generalized utility maximization approach to migration decisionmaking is not innovative, the principal extensions of this paper involve the search for an instrument capable of measuring changes in utility levels consistent with all preferences (i.e., with all forms of utility functions), requiring only data on observed behaviour. Our approach is to construct a Location-Specific Utility Index (LSUI), whose component variables serve as proxies for the arguments in [U.S.] households' utility functions.... The testable hypothesis is formulated as follows: Assuming constant household preferences and expansion of the household's feasible set over time, the household's utility level is greater following the migration decision.... The results are compared with the households' migration decisions. The empirical evidence shows that migration may reasonably be modelled as a consumption activity by households to maximize utility." (SUMMARY IN FRE AND SPA), (excerpt)

This paper describes the life responses of two adult patients with facial deformities associated with untreated Crouzon's disease. Each patient has normal intelligence, and each has two children and close family relatives who exhibit variable degrees of Crouzon's disease. The impact of untreated facial deformity is considered, and recommendations are made for psychosocial management of these patients and their families.