Optimal management of post-traumatic radioulnar synostosis

Post-traumatic radioulnar synostosis is a rare complication after forearm or elbow injury that can result in loss of motion and significant disability. Risk factors include aspects of the initial trauma and of the surgical treatment of that trauma. Surgical intervention for synostosis is the standard of care and is determined based on the location of the bony bridge. Surgical timing is recommended between 6 months and 2 years with recent advocacy for the 6- to 12-month period after radiographs demonstrate bony maturation but early enough to prevent further stiffness and contractures. For most types of synostosis, surgical resection with interposition graft is recommended. The types of materials used include synthetic, allograft, and vascularized and non-vascularized materials, but currently there is no consensus on which is the most preferable. Adjuvant therapy is not considered necessary for all cases but can be beneficial in patients with high risk factors such as recurrence or traumatic brain injury. Postoperative rehabilitation should be performed early to maintain range of motion. © 2017 Osterman and Arief

Midwest Evaluation of the Adult Functioning of Former Foster Youth

The Midwest Evaluation of the Adult Functioning of Former Foster Youth (Midwest Study) is a prospective study that has been following a sample of young people from Iowa, Wisconsin, and Illinois as they transition out of foster care into adulthood. It is a collaborative effort involving Chapin Hall at the University of Chicago; Partners for Our Children at the University of Washington, Seattle; the University of Wisconsin Survey Center; and the public child welfare agencies in Illinois, Iowa, and Wisconsin.The Midwest Study provides a comprehensive picture of how foster youth are faring during this transition since the Foster Care Independence Act of 1999 became law. Foster youth in Iowa, Wisconsin, and Illinois were eligible to participate in the study if they had entered care before their 16th birthday, were still in care at age 17, and had been removed from home for reasons other than delinquency. Baseline survey data were collected from 732 study participants when they were 17 or 18 years old. Study participants were re-interviewed at ages 19 (n = 603), 21 (n = 591), and 23 or 24 (n = 602). A fifth wave of survey data will be collected when study participants are 25 or 26 years old.Because many of the questions Midwest Study participants were also asked as part of the National Longitudinal Study of Adolescent Health, it is possible to make comparisons between this sample of former foster youth and a nationally representative sample of young people in the general population. These comparisons indicate that young people who have aged out of foster care are faring poorly as a group relative to their peers across a variety of domains.The Midwest Study also presents a unique opportunity to compare the outcomes of young people from one state (i.e., Illinois) that allows foster youth to remain in care until their 21st birthday to the outcomes of young people from two other states (i.e., Iowa and Wisconsin) in which foster youth generally age out when they are 18 years old. The data suggest that extending foster care until age 21 may be associated with better outcomes, at least in some domains

Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014-2016: A cross-sectional analysis.

BACKGROUND: Refugees and other select visa holders are recommended to receive a domestic medical examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this examination across multiple resettlement states, preventing evaluation of this voluntary program\u27s potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic medical examination\u27s impact on screening coverage resulting from this examination. METHODS AND FINDINGS: We conducted a cross-sectional analysis to summarize and compare domestic medical examination data from January 2014 to December 2016 from persons receiving a domestic medical examination in seven states (California, Colorado, Minnesota, New York, Kentucky, Illinois, and Texas); one county (Marion County, Indiana); and one academic medical center in Philadelphia, Pennsylvania. We analyzed screening coverage by sex, age, nationality, and country of last residence of persons and compared the proportions of persons receiving recommended screenings by those characteristics. We received data on disease screenings for 105,541 individuals who received a domestic medical examination; 47% were female and 51.5% were between the ages of 18 and 44. The proportions of people undergoing screening tests for infectious diseases were high, including for tuberculosis (91.6% screened), hepatitis B (95.8% screened), and human immunodeficiency virus (HIV; 80.3% screened). Screening rates for other health conditions were lower, including mental health (36.8% screened). The main limitation of our analysis was reliance on data that were collected primarily for programmatic rather than surveillance purposes. CONCLUSIONS: In this analysis, we observed high rates of screening coverage for tuberculosis, hepatitis B, and HIV during the domestic medical examination and lower screening coverage for mental health. This analysis provided evidence that the domestic medical examination is an opportunity to ensure newly arrived refugees and other eligible populations receive recommended health screenings and are connected to the US healthcare system. We also identified knowledge gaps on how screenings are conducted for some conditions, notably mental health, identifying directions for future research

Characterizing Waiting Room Time, Treatment Time, and Boarding Time in the Emergency Department Using Quantile Regression

ACADEMIC EMERGENCY MEDICINE 2010; 17:813–823 © 2010 by the Society for Academic Emergency MedicineThe objective was to characterize service completion times by patient, clinical, temporal, and crowding factors for different phases of emergency care using quantile regression (QR).A retrospective cohort study was conducted on 1-year visit data from four academic emergency departments (EDs; N  = 48,896–58,316). From each ED’s clinical information system, the authors extracted electronic service information (date and time of registration; bed placement, initial contact with physician, disposition decision, ED discharge, and disposition status; inpatient medicine bed occupancy rate); patient demographics (age, sex, insurance status, and mode of arrival); and clinical characteristics (acuity level and chief complaint) and then used the service information to calculate patients’ waiting room time, treatment time, and boarding time, as well as the ED occupancy rate. The 10th, 50th, and 90th percentiles of each phase of care were estimated as a function of patient, clinical, temporal, and crowding factors using multivariate QR. Accuracy of models was assessed by comparing observed and predicted service completion times and the proportion of observations that fell below the predicted 10th, 50th, and 90th percentiles.At the 90th percentile, patients experienced long waiting room times (105–222 minutes), treatment times (393–616 minutes), and boarding times (381–1,228 minutes) across the EDs. We observed a strong interaction effect between acuity level and temporal factors (i.e., time of day and day of week) on waiting room time at all four sites. Acuity level 3 patients waited the longest across the four sites, and their waiting room times were most influenced by temporal factors compared to other acuity level patients. Acuity level and chief complaint were important predictors of all phases of care, and there was a significant interaction effect between acuity and chief complaint. Patients with a psychiatric problem experienced the longest treatment times, regardless of acuity level. Patients who presented with an injury did not wait as long for an ED or inpatient bed. Temporal factors were strong predictors of service completion time, particularly waiting room time. Mode of arrival was the only patient characteristic that substantially affected waiting room time and treatment time. Patients who arrived by ambulance had shorter wait times but longer treatment times compared to those who did not arrive by ambulance. There was close agreement between observed and predicted service completion times at the 10th, 50th, and 90th percentile distributions across the four EDs.Service completion times varied significantly across the four academic EDs. QR proved to be a useful method for estimating the service completion experience of not only typical ED patients, but also the experience of those who waited much shorter or longer. Building accurate models of ED service completion times is a critical first step needed to identify barriers to patient flow, begin the process of reengineering the system to reduce variability, and improve the timeliness of care provided.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79320/1/j.1553-2712.2010.00812.x.pd

An Empirical Assessment of Corporate Environmental Crime-Control Strategies

Corporate illegality is often attributed to greed by corporate managers and insufficient legal safeguards. Underlying this argument is an explicit critique of corporate crime regulatory systems. Yet there is little systematic investigation of the relative merits of different types or components of crime-control strategies; research comparing more punitive command-and-control strategies with self-regulatory approaches is particularly lacking. In this Article, we assess these crime prevention-and-control mechanisms in the context of individual and situational risk factors that may increase the likelihood of illegal behavior in the environmental arena. We use data drawn from two groups of business managers who participated in a factorial survey (using vignettes) measuring their intentions to participate in two types of environmental offenses. Generally, results show that the most effective regulatory levers are (1) credible legal sanctions and (2) the certainty and severity of informal discovery by significant others in the firm. We conclude by discussing the implications of our findings for regulatory policy and strategy, and for efforts to account for the role of social norms in corporate environmental compliance

Brief of Fred T. Korematsu Center for Law and Equality as Amicus Curiae in Support of Petitioners

State of Washington v. Anthony A. Moretti, Hung Van Nguyen, and Frederick Or

Brief of Fred T. Korematsu Center for Law and Equality as Amicus Curiae in Support of Petitioner

State of Washington v. Jeremiah James Gilber

Brief of Fred T. Korematsu Center for Law and Equality, American Civil Liberties Union of Washington, Washington Association of Criminal Defense Lawyers, and Washington Defender Association as Amici Curiae in Support of Respondent

State of Washington v. Cristian Delbosqu