Cognitive Deficits and Associated ERP N400 Abnormalities in FXTAS With Parkinsonism

Objective: To examine cognitive deficits and associated brain activity in fragile X-associated tremor/ataxia syndrome (FXTAS) patients with parkinsonism (FXTp+), in relation to FXTAS patients without parkinsonism (FXTp-), and normal elderly controls (NC).Methods: Retrospective reviews were performed in 65 FXTAS patients who participated in the event-related brain potential (ERP) study and also had either a videotaped neurological examination or a neurological examination for extrapyramidal signs. Parkinsonism was defined as having bradykinesia with at least one of the following: rest tremor, postural instability, hypermyotonia, or rigidity. Eleven FXTp+ patients were identified and compared to 11 matched FXTp- and 11 NC. Main ERP measures included the N400 congruity effect, N400 repetition effect, and the late positive component (LPC) repetition effect.Results: When compared with FXTp- and NC, the FXTp+ group showed more severe deficits in executive function, cued-recall, recognition memory, along with a significantly reduced N400 repetition effect (thought to index semantic processing and verbal learning/memory) which was correlated with poorer verbal memory. Across all patients, FMR1 mRNA levels were inversely correlated with delayed recall on the California Verbal Learning Test (CVLT).Interpretation: The findings of more prominent executive dysfunction and verbal learning/memory deficits in FXTp+ than FXTp- are consistent with findings in Parkinson’s disease (PD), and may indicate that concomitant and/or synergistic pathogenetic mechanisms associated with PD play a role in FXTAS. These results have implications not only for understanding the cognitive impairments associated with the parkinsonism subtype of FXTAS, but also for the development of new interventions for these patients

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Trampoline Related Injuries

Category: Trauma Introduction/Purpose: Jump parks (or trampoline parks) have become one of the fastest growing recreational businesses in the United States. With their increasing popularity, notable changes in trampoline related injuries might be evident, particularly involving the lower extremity. There is no published data dedicated to adult trampoline injuries and little information regarding the safety profiles of commercial jump parks. Methods: We conducted a retrospective review including all patients sustaining trampoline related injuries presenting during a two-year period. Data collection included patient demographics and injury characteristics of trampoline injuries in the domestic setting and at commercial jump parks. Results: One hundred fifty patients (34%) sustained injuries at commercial jump parks versus 289 patients (66%) on home trampolines. Fifty-five percent of the jump park injuries were fractures/dislocations, compared to 44% of the home trampoline injuries. Eighteen adults sustained fractures or dislocations at the jump park (45%), while only five adults sustained fractures or dislocations using home trampolines (17%). Seventeen (94%) and 2 (40%) represented adult lower extremity injuries in jump parks and home trampolines respectively. In children, 47 (72%) of the jump park fractures/dislocations were lower extremity, and 41 (33%) of the home trampoline fractures/dislocations were lower extremity. Ten (9%) pediatric and 9 (23%) adult jump park patients required operative intervention, compared to 17 (7%) pediatric and 3 (10%) adult home trampoline patients requiring surgery. Conclusion: Emergency room visits, hospital admissions, and surgical intervention secondary to jump park related injuries are not uncommon in children and adults. There were a higher percentage of total fractures or dislocations, adult fractures, lower extremity fractures, and operative interventions among patients with commercial jump park injuries compared with those who sustained home trampoline injuries

The Workers Compensation Burden: Does Compensation Status Lead to Increased Utilization of Healthcare Resources Following Foot and Ankle Surgery?

Category: Other Introduction/Purpose: The association between workers’ compensation (WC) patients and the increased risk of complications and poor outcomes following orthopaedic procedures has been well documented. Recent studies have shown that WC patients have a higher rate of subsequent pain or injury than non-WC patients following common foot and ankle procedures. Due to the increased risks of complications, poor outcomes, and chronic pain amongst WC patients following orthopaedic procedures, it is possible that these patients consume more healthcare resources than non-WC patients during the post-surgical period. This study aimed to investigate the amount of healthcare resources utilized by WC patients following a foot or ankle procedure compared with a procedure-matched control group. Methods: A retrospective review was conducted of all WC and non-WC patients who had undergone foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures by a single surgeon from October 2017 through January 2020. Patients were excluded based on age ( 70), bilateral procedures, presence of neuropathy, disability, and insufficient follow-up. Data collection included demographic, social, surgical, perioperative follow-up, and complications. Measures of healthcare burden included patient communications, physical encounters, processed documents, overall total prescriptions, the total number of office visits, days to return to work, and days to discharge from the clinic. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi-square test, or Fisher’s exact test. Power analysis determined the sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 patients met the inclusion criteria including 71 WC patients and 71 non-WC patients. Measures of healthcare burden were greater in WC patients. WC patients had more communication encounters (median 6 vs 3; P<.001), processed documents (median 6 vs 1; P<.001), total prescriptions (median 5 vs 3; P<.001), the total number of office visits (median 8 vs 6; P<.001), days to return to work (median 119 vs 74; P<.001), and days to discharge (median 267 vs 194; P<.001). WC patients were also more likely to have postoperative complications (OR 2.1; P=.045), secondary surgeries (OR 8.2; P<.001), and new complaints during follow-up (OR 1.9; P=.070). WC was less likely to cancel appointments (OR 0.4; P=.028). Conclusion: WC patients demonstrate increased healthcare resource utilization compared to the non-WC population. WC was associated with a higher burden on office staff requiring more time commitment to a single patient. Double the effort was evident on some measured parameters. WC patients also receive more medication prescriptions overall and are more likely to have complications, subsequent surgery, and new complaints remote to the inciting injury

Narcotic Use and Prescribing Trends Among Workers Compensation Patients Undergoing Foot and Ankle Surgery

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Previous studies have shown that workers compensation patients (WC) have worse outcomes, and higher complications rates after orthopaedic surgery. Despite orthopaedic surgeons being the third highest prescribers of narcotic pain medication in the United States there have been no studies to specifically evaluate narcotic use among the WC population. The purpose of this study was to investigate narcotic use among WC patients who underwent foot or ankle operative procedures compared with a procedure matched control group. Methods: A retrospective review was conducted for WC and non-WC patients ages 18 to 70 years old who underwent foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures in an orthopaedic surgery practice from October 2017 through January 2020. Data collection included demographics, social, surgical, perioperative follow-up and complications. Outcomes measures were timing and number of narcotic prescriptions, total morphine milligram equivalents (MME), and procedure type. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi square test, or Fisher’s exact test. Power analysis determined sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 total patients met inclusion criteria, with 71 WC patients and 71 non-WC patients. There were no differences regarding the type of foot or ankle procedure performed (p=0.598). WC patients had double the number of overall narcotic prescriptions (median 2 vs 1; p < 0.001). WC patients were prescribed in total 1,125 oxycodone MME and 871.8 hydrocodone MME (P < 0.001), versus 750 oxycodone MME and 450 hydrocodone MME among the non-WC group (p < .008). There was no difference in the number of tramadol prescriptions (p = 0.571). WC patients experienced more days between the date of last narcotic prescription and both index surgery date (median 27 vs 1, p = 0.001) and initial clinic visit date (median 105 vs 49, p = 0.002). Conclusion: This data demonstrates that WC patients portend worse outcomes and utilize narcotics at twice the rate and for longer periods of time post-operatively than non-WC patients. Increased narcotic use may potentiate narcotic dependence and likely leads to worse outcomes. Treating physicians must be aware of these trends in order to best manage these patients. Physicians may need to have longer discussions with WC patients regarding narcotic use post operatively as well as about outcomes and goals of surgery. Physicians should set early expectations with WC patients and clear limits on the amount of narcotics they are willing to prescribe postoperatively