Pattern of Recovery and Outcomes of Patient Reported Physical Function and Pain Interference After Ankle Fusion: A Retrospective Cohort Study

Background: Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods: This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMISPreference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results: The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion: Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence: Level II, prospective single cohort study

Validity of the Paper Pull Test for Strength in Patients with Hallux Valgus

Introduction/Purpose: The purpose of this study was to explore validity of the paper pull test (PPT) to assess hallux flexion strength and function in persons with hallux valgus (HV). The following hypotheses were tested: 1) The PPT is valid for inferring 1st MTP flexion strength and heel rise (HR) performance (e.g. heel height). 2) A specified threshold of force during the PPT can be identified that discriminates patients with HV. 3) Muscle activity (abductor hallucis [AH], flexor hallucis brevis [FHB]), in patients with HV will be distinct from controls across three tasks: 1) PPT, 2) lowering phase of a HR, and 3) rising phase of a HR

Infrared Properties of a Complete Sample of Star-Forming Dwarf Galaxies

We present a study of a large, statistically complete sample of star-forming dwarf galaxies using mid-infrared observations from the {\it Spitzer Space Telescope}. The relationships between metallicity, star formation rate (SFR) and mid-infrared color in these systems show that the galaxies span a wide range of properties. However, the galaxies do show a deficit of 8.0 \um\ polycyclic aromatic hydrocarbon emission as is apparent from the median 8.0 \um\ luminosity which is only 0.004 \lstarf\ while the median $B$-band luminosity is 0.05 \lstarb. Despite many of the galaxies being 8.0 \um\ deficient, there is about a factor of 4 more extremely red galaxies in the [3.6] $-$ [8.0] color than for a sample of normal galaxies with similar optical colors. We show correlations between the [3.6] $-$ [8.0] color and luminosity, metallicity, and to a lesser extent SFRs that were not evident in the original, smaller sample studied previously. The luminosity--metallicity relation has a flatter slope for dwarf galaxies as has been indicated by previous work. We also show a relationship between the 8.0 \um\ luminosity and the metallicity of the galaxy which is not expected given the competing effects (stellar mass, stellar population age, and the hardness of the radiation field) that influence the 8.0 \um\ emission. This larger sample plus a well-defined selection function also allows us to compute the 8.0 \um\ luminosity function and compare it with the one for the local galaxy population. Our results show that below 10$^{9}$ $L$\solar, nearly all the 8.0 \um\ luminosity density of the local universe arises from dwarf galaxies that exhibit strong \ha\ emission -- i.e., 8.0 \um\ and \ha\ selection identify similar galaxy populations despite the deficit of 8.0 \um\ emission observed in these dwarfs.Comment: 13 pages, 11 figures, Published in Ap

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department

Objective We aimed to assess physicians\u27 perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs\u27 listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings

A comparative genomics multitool for scientific discovery and conservation

A whole-genome alignment of 240 phylogenetically diverse species of eutherian mammal-including 131 previously uncharacterized species-from the Zoonomia Project provides data that support biological discovery, medical research and conservation. The Zoonomia Project is investigating the genomics of shared and specialized traits in eutherian mammals. Here we provide genome assemblies for 131 species, of which all but 9 are previously uncharacterized, and describe a whole-genome alignment of 240 species of considerable phylogenetic diversity, comprising representatives from more than 80% of mammalian families. We find that regions of reduced genetic diversity are more abundant in species at a high risk of extinction, discern signals of evolutionary selection at high resolution and provide insights from individual reference genomes. By prioritizing phylogenetic diversity and making data available quickly and without restriction, the Zoonomia Project aims to support biological discovery, medical research and the conservation of biodiversity.Peer reviewe

Male pheromone protein components activate female vomeronasal neurons in the salamander <it>Plethodon shermani</it>

<p>Abstract</p> <p>Background</p> <p>The mental gland pheromone of male Plethodon salamanders contains two main protein components: a 22 kDa protein named Plethodon Receptivity Factor (PRF) and a 7 kDa protein named Plethodon Modulating Factor (PMF), respectively. Each protein component individually has opposing effects on female courtship behavior, with PRF shortening and PMF lengthening courtship. In this study, we test the hypothesis that PRF or PMF individually activate vomeronasal neurons. The agmatine-uptake technique was used to visualize chemosensory neurons that were activated by each protein component individually.</p> <p>Results</p> <p>Vomeronasal neurons exposed to agmatine in saline did not demonstrate significant labeling. However, a population of vomeronasal neurons was labeled following exposure to either PRF or PMF. When expressed as a percent of control level labeled cells, PRF labeled more neurons than did PMF. These percentages for PRF and PMF, added together, parallel the percentage of labeled vomeronasal neurons when females are exposed to the whole pheromone.</p> <p>Conclusion</p> <p>This study suggests that two specific populations of female vomeronasal neurons are responsible for responding to each of the two components of the male pheromone mixture. These two neural populations, therefore, could express different receptors which, in turn, transmit different information to the brain, thus accounting for the different female behavior elicited by each pheromone component.</p

Severe Obesity and High Blood Pressure Among Children, Philadelphia Health Centers, 2010

Background: Child obesity is a major health problem particularly affecting disadvantaged population groups. Severe obesity carries additional health risks for children. In the context of the childhood obesity epidemic, high blood pressure among children is of increasing concern. Methods: Chart reviews were carried out to examine the prevalence of severe obesity and its association with high blood pressure measurements among randomly selected patients aged 3 to 17 years who had well-child care visits at 8 public community health centers during 2010. Results: A majority of the 691 patients reviewed were African American (58%); an additional 16% were Hispanic. The prevalence of severe obesity was 7.7% (95% confidence interval = 5.8% to 9.9%) and the prevalence of high blood pressure measurements was 17.5% (95% confidence interval = 14.8% to 20.6%). Patients who were severely obese were more than twice as likely as other children to have high blood pressure values. Conclusions: Severe obesity is associated with substantially increased frequency of high blood pressure measurements in children, and should be investigated further as a potential marker for hypertension in children. Primary care providers should be prepared to diagnose and treat hypertension in severely obese children

Dust Properties and Star Formation Rates in Star-Forming Dwarf Galaxies

International audienceWe have used the Spitzer Space Telescope to study the dust properties of a sample of star-forming dwarf galaxies. The differences in the mid-infrared spectral energy distributions for these galaxies, which, in general, are low-metallicity systems, indicate differences in the physical properties, heating, and/or distribution of the dust. Specifically, these galaxies have more hot dust and/or very small grains and less PAH emission than either spiral or higher luminosity starburst galaxies. As has been shown in previous studies, there is a gradual decrease in PAH emission as a function of metallicity. Because much of the energy from star formation in galaxies is reradiated in the mid-infrared, star formation rate indicators based on both line and continuum measurements in this wavelength range are coming into more common usage. We show that the variations in the interstellar medium properties of galaxies in our sample, as measured in the mid-infrared, result in over an order of magnitude spread in the computed star formation rates

Screening 1040 Environmental Chemicals in Metabolically Competent Human-Derived Hepatocytes

Presented at the Annual Society for Toxicology meetin