Sensory processing of individuals who have experienced sexual assault

Sensory input is imperative for individuals’ well-being and emotional health (Dunn, 2001). The ability to correctly process incoming sensory information from the environment is integral to engaging in meaningful occupations. But individuals who have difficulty processing incoming stimuli may tend to avoid occupations that are over stimulating due to the inability to modulate their body’s response to sensory input. Trauma, such as sexual assault, is known to significantly alter an individual’s processing of the environment around them (Schumacher et al., 2013). To date, no studies were found in the literature to determine if there is a difference in the way these individuals engage in their everyday occupations. It is hypothesized that, as a result of sexual assault, an individual may alter their participation in everyday occupations. This change in behavior may lead to significant difficulty in accomplishing activities of daily living, social participation and leisure activities. Increasing the individual’s knowledge about sensory processing may allow the survivor to better understand their personal sensory preferences following the assault (Brown, 2001). Providing survivors of sexual assault with a working knowledge of sensory integration may be a useful step in the recovery process. Occupational therapy may be a central part of recovery for the individual who is experiencing difficulty regulating their sensory system due to sexual assault. By working closely with individuals who have experienced trauma during their recovery process from sexual assault, occupational therapists may be able to facilitate adaptive responses and coping mechanisms to empower the individual to effectively integrate noxious stimuli. Therefore, the occupational therapist can work to improve the individuals’ occupational functioning and regain satisfaction in their daily routines by gaining an in-depth understanding of their psychosomatic symptoms and developing appropriate coping strategies. This study explored how individuals who had experienced trauma engage in occupations and if individuals who have reported a history of sexual assault have altered participation in occupations that require touch. A pilot instrument was created to analyze college student’s engagement in occupations. Results were categorized in indices to isolate different areas of touch. 57 participants who had been sexually assaulted and 347 participants had not been participated in the study. Results indicate that sexual assault, not other forms of trauma like mugging or car accidents, had a statistically significant effect on an individual’s participation in everyday occupations

Human Granulocytic Ehrlichiosis Complicating Early Pregnancy

Background. The goal of this case is to review the zoonotic infection, human granulocytic ehrlichiosis, presenting with pyrexia. Case. A 22-year-old multigravid female presented to the emergency department with a painful skin rash, high fever, and severe myalgias. The patient underwent a diagnostic evaluation for zoonotic infections due to her geographical and seasonal risk factors. Treatment of human granulocytic ehrlichiosis was successful though the patient spontaneously aborted presumably due to the severity of the acute illness. Conclusion. Treatment of human granulocytic ehrlichiosis in pregnancy presents unique challenges. Management of pyrexia during pregnancy is limited to external cooling in the setting of thrombocytopenia and elevated aminotransferases. Extensive counseling regarding teratogenic potential of medications allows the patient to weigh the pros and cons of treatment

Tensile strength of a surgeon’s or a square knot

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Objective—To test the integrity of surgeon’s knots and flat square knots using four different suture materials. Study Design—Chromic catgut, polyglactin 910, silk, and polydioxanone sutures were tied in the two types of knot configurations. For all sutures, a 0-gauge United States Pharmacopeia suture was used. Knots were tied by a single investigator (JB). Suture was soaked in 0.9 % sodium chloride for 60 seconds and subsequently transferred to a tensiometer where the tails were cut to 3 mm length. We compared the knots, measuring knot strength using a tensiometer until the sutures broke or untied. Results—A total of 119 knots were tied. We found no difference in mean tension at failure between a surgeon’s knot (79.7 Newtons) and a flat square knot (82.9 Newtons). Using a Chisquare test, we did not find a statistically significant difference in the likelihood of knots coming untied between surgeon’s knots (29%) and flat square knots (38%). Conclusions—Under laboratory conditions, surgeon’s knots and flat square knots did not differ in tension at failure or likelihood of untying

Making Sense of Hip Preservation Procedural Coding--Getting Paid for Your Work!

Hip preservation and peri-trochanteric procedures are becoming more commonplace for the arthroplasty surgeon. Understanding the reimbursement for these procedures remains a challenge for those looking to expand this portion of their practice. In order to financially maximize the surgeon’s efforts, we present recommendations for hip preservation procedural coding

Novel Cemented Technique for Trochanteric Fixation and Reconstruction of the Abductor Mechanism in Proximal and Total Femoral Arthroplasty: An Observational Study

Background: Little evidence exists regarding the clinical outcomes of cemented trochanteric fixation for abductor mechanism reconstruction in proximal or total femoral replacements. Clinical outcomes were assessed for a novel cemented technique for trochanteric fixation in femoral megaprostheses. Methods: A descriptive series of 13 patients who underwent proximal or total femoral arthroplasty from 2016 to 2019 were reviewed. Radiographic trochanteric displacement \u3e 1 cm defined construct failure. A Kaplan-Meier survival analysis was performed to determine survival rates for these cemented constructs. Demographic information was obtained to better characterize the patient population in whom this technique was used. Results: Eleven patients were included (age = 63.6 years; 45.4% females; body mass index = 31.7). Mean time to final radiographic follow-up was 73.8 weeks. Three of 11 (27.2%) patients had construct failure. Overall, survival at 1 year was 81.8%. At 2 years, survival of cemented constructs was 65.5%. More construct failures occurred in patients who sustained a postoperative dislocation than in those who did not (P = .05). Conclusions: This novel cemented trochanteric fixation technique for reconstruction of the abductor mechanism in femoral megaprostheses had 81.8% survival at 1 year postoperatively. While longitudinal comparative studies with larger samples are needed, the cemented technique may provide a viable alternative to traditional cementless methods of trochanteric fixation. Increased construct failure rates after postoperative dislocation highlight the importance of robust abductor reconstruction in these implants

Measurable residual disease in acute lymphoblastic leukemia: methods and clinical context in adult patients

Measurable residual disease (MRD) is the most powerful independent predictor of risk of relapse and long-term survival in adults and children with acute lymphoblastic leukemia (ALL). For almost all patients with ALL there is a reliable method to evaluate MRD, which can be done using multi-color flow cytometry, quantitative polymerase chain reaction to detect specific fusion transcripts or immunoglobulin/T-cell receptor gene rearrangements, and high-throughput next-generation sequencing. While next-generation sequencing-based MRD detection has been increasingly utilized in clinical practice due to its high sensitivity, the clinical significance of very low MRD levels (<10-4) is not fully characterized. Several new immunotherapy approaches including blinatumomab, inotuzumab ozogamicin, and chimeric antigen receptor T-cell therapies have demonstrated efficacy in eradicating MRD in patients with B-ALL. However, new approaches to target MRD in patients with T-ALL remain an unmet need. As our MRD detection assays become more sensitive and expanding novel therapeutics enter clinical development, the future of ALL therapy will increasingly utilize MRD as a criterion to either intensify or modify therapy to prevent relapse or de-escalate therapy to reduce treatment-related morbidity and mortality

Ex vivo and in vivo coronary ostial locations in humans

Purpose: Knowledge of the normal in vivo distribution and variation of coronary ostial locations is essential in the planning of various interventional and surgical procedures. However, all studies to date have reported the distribution of coronary ostia locations only in cadaver hearts. In this study, we sought to assess the distribution of coronary ostial locations in patients using cardiac dual-source computed tomography (CT) and compare these values to those of human cadaveric specimens. Methods: Measurements of the coronary ostia location were performed in 150 patients undergoing dual-source CT and in 75 cadavers using open measurement techniques. All 150 patients had a normal aortic valve function and no previous cardiac intervention or surgery. The location of the right and left coronary origin in relation to the aortic annulus and the height of the sinus of Valsalva were measured. Results: Mean ostial locations at CT were 17.0 (±3.6)mm and 15.3 (±3.1)mm for the right and left coronary ostia, with large variations of both sides (right: 10.4-28.5mm; left: 9.8-29.3mm). In cadavers, mean locations were 14.9 (±4.3)mm [5-24mm] for right and 16.0 (±3.6)mm [9-24mm] for left coronary ostia. Comparison of CT and cadaver data showed statistically significant differences for right (P<0.0001) but not left (P=0.1675) coronary ostia. Conclusions: This study provides data of normal coronary ostial origins and demonstrates significant differences between in vivo and ex vivo measurements regarding the right coronary ostium. The observed large variations of coronary ostia origins emphasize the importance of considering such anatomic variations in the development of treatment