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

Evaluation and Management of Sleep Disorders in the Hand Surgery Patient.

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition

Market Access Analysis of Biologics and Small-Molecule Inhibitors for Inflammatory Bowel Disease Among US Health Insurance Policies.

BACKGROUND AND AIMS:Treatment pathways for ulcerative colitis (UC) and Crohn's disease (CD) are shifting to a more individualized, risk-stratified approach. The perception is that insurance policies may not have implemented this paradigm shift, particularly regarding access to newer agents. We evaluated patient access to advanced therapies by analyzing policy information from the Managed Markets Insight and Technology database. METHODS:Coverage status as of December 2018 for all US lives was queried for adalimumab, infliximab, infliximab-dyyb, tofacitinib, ustekinumab, and vedolizumab by indication (UC and/or CD) and medical or pharmacy coverage benefit. Coverage status was classified by the number of biologic steps before access to specified drug as "No Biologic," "1 Prior Biologic," "2+ Prior Biologics," "Not Covered." Unknown lives were excluded from the analyses. RESULTS:Coverage analysis was available for approximately 302 million lives under each medical and pharmacy benefit. Our analysis indicates that approximately half of covered lives had access to all agents (except tofacitinib) as first-line therapy; two-thirds had access after one biologic exposure. Among newer agents, vedolizumab had the widest coverage. For indications of UC and CD, 81% of known lives had access to vedolizumab with no prior biologic exposure required ("No Biologic"), 95% after "No Biologic" + "1 prior Biologic." Geographic variations were identified for coverage patterns. CONCLUSIONS:This US-based healthcare policy analysis points to an increased access to advanced therapies for UC and CD. An individualized, risk-stratified treatment approach integrating advanced therapies, including those recently approved, into treatment pathways for UC and CD is feasible

A 12.5 GHz-Spaced Optical Frequency Comb Spanning >400 nm for near-Infrared Astronomical Spectrograph Calibration

A 12.5 GHz-spaced optical frequency comb locked to a Global Positioning disciplined oscillator for near-IR spectrograph calibration is presented. The comb is generated via filtering a 250 MHz-spaced comb. Subsequency nonlinear broadening of the 12.5 GHz comb extends the wavelength range to cover 1380 nm to 1820 nm, providing complete coverage over the H-band transmission widow of Earth's atmosphere. Finite suppression of spurious sidemodes, optical linewidth and instability of the comb have been examined to estmiate potential wavelength biases in spectrograph calibration. Sidemode suppression varies between 20 db and 45 dB, and the optical linewidth is ~350 kHz at 1550 nm. The comb frequency uncertainty is bounded by +/- 30 kHz (corresponding to a radial velocity of +/- 5 cm/s), limited by the Global Positioning System disciplined oscillator reference. These results indicate this comb can readily support radial velocity measurements below 1 m/s in the near-IR.Comment: 16 pages, 12 figures, new file fixes some readability problems on Mac

SHEARING IRRADIATED URANIUM PLATES

Natural U plates that were irradiated to 600 and 1500 Mwd/t were cut under water by a guillotine-iype shear. Irradiation reduced the force required for shearing to 50% of that required for unirradiated U. Measurements were made of radioactivity released to treated and untreated water in which the cut sections were stored. (auth

A Near Infrared Laser Frequency Comb for High Precision Doppler Planet Surveys

We discuss the laser frequency comb as a near infrared astronomical wavelength reference, and describe progress towards a near infrared laser frequency comb at the National Institute of Standards and Technology and at the University of Colorado where we are operating a laser frequency comb suitable for use with a high resolution H band astronomical spectrograph.Comment: 8 pages, 5 figures. Conference Proceedings, New Technologies for Probing the Diversity of Brown Dwarfs and Exoplanets, Shanghai, China, 19-24 July, 2009. Submitted to Eur. Phys. J. Conference

The PreAmplifier ShAper for the ALICE TPC-Detector

In this paper the PreAmplifier ShAper (PASA) for the Time Projection Chamber (TPC) of the ALICE experiment at LHC is presented. The ALICE TPC PASA is an ASIC that integrates 16 identical channels, each consisting of Charge Sensitive Amplifiers (CSA) followed by a Pole-Zero network, self-adaptive bias network, two second-order bridged-T filters, two non-inverting level shifters and a start-up circuit. The circuit is optimized for a detector capacitance of 18-25 pF. For an input capacitance of 25 pF, the PASA features a conversion gain of 12.74 mV/fC, a peaking time of 160 ns, a FWHM of 190 ns, a power consumption of 11.65 mW/ch and an equivalent noise charge of 244e + 17e/pF. The circuit recovers smoothly to the baseline in about 600 ns. An integral non-linearity of 0.19% with an output swing of about 2.1 V is also achieved. The total area of the chip is 18 mm$^2$ and is implemented in AMS's C35B3C1 0.35 micron CMOS technology. Detailed characterization test were performed on about 48000 PASA circuits before mounting them on the ALICE TPC front-end cards. After more than two years of operation of the ALICE TPC with p-p and Pb-Pb collisions, the PASA has demonstrated to fulfill all requirements