A Practical Guide to Etiquette in the Orthopaedic OR for the Rotating Medical Student

The Operating Room, the operating theatre, the lair of the Orthopaedic surgeon, it goes by many names. It is a place most try to avoid, but this daunting windowless room is a classroom and training ground for many. And for the medical student interested in an orthopaedic surgery career, making an impression in the operating room is vital to matching into their desired orthopaedic residency.1 Unfortunately, making an impression in the operating room is difficult, or more precisely, making a good impression in the operating room is difficult. Furthermore, every operating room dynamic can be different, and the personalities of the surgeon, fellow, resident, and surgical team can vary widely. Stone et al, found that 72% of medical students felt unsure about the expectations in the surgical OR.2Thus, with the approach of orthopaedic rotations, students should undertake some training or at least consider how to act in such an environment

United States Citizens Detained as Enemy Combatants : The Right to Counsel as a Matter of Ethics

The Supreme Court will decide as a matter of law whether an American citizen detained as an enemy combatant has the right to counsel. The author argues that as a matter of ethics, the answer is clear - there is a right to counsel. In this Article, the author analyzes the cases regarding Jose Padilla and Yaser Esam Hamdi discusses ABA Model Rule 4.2, and its application, and proposes an amendment to Rule 4.2\u27s Comment

Successful Rechallenge with Vemurafenib and Corticosteroids in a Patient with Vemurafenib Induced Liver Dysfunction, Previously Treated with Ipilimumab

Introduction: There are multiple new systemic therapies for patients with metastatic melanoma, including vemurafenib and ipilimumab. Because of this, more patients will be exposed to multiple medicines during their treatment course. Here we present the case of a successful rechallenge with vemurafenib and concurrent corticosteroids in a patient with vemurafenib responsive metastatic melanoma and vemurafenib induced liver dysfunction thought to be related to previous treatment of ipilimumab.Presentation of case: A 60-year-old woman with a history of stage 3 melanoma presented with metastases to her liver and lymph nodes, normal liver function tests (LFTs) and was started on ipilimumab. After her symptoms increased and her disease progressed, ipilimumab treatment was stopped and vemurafenib was initiated. She experienced good regression in her disease burden but subsequently experienced a grade 4 elevation in her LFTs, which resolved with a corticosteroid taper. Her disease responded well to a vemurafenib rechallenge at a reduced dose; however, she experienced another increase in her LFTs.  By administering vemurafenib with corticosteroids concurrently, she achieved good tumor shrinkage without liver dysfunction.Conclusion: The reader should have an increased appreciation for the emerging adverse event profile of patients treated with multiple systemic metastatic melanoma therapies during their course and potential management strategies

Local Matching of Surfaces Using Critical Points

The local matching problem on surfaces is: Given a pair of oriented surfaces in 3-space, find subsurfaces that are identical or complementary in shape. A heuristic method is presented for local matching that is intended for use on complex curved surfaces (rather than such surfaces as as cubes and cylinders). The method proceeds as follows: (1) Find a small set of points-called critical points -on the two surfaces with the property that if p is a critical point and p matches q, then q is also a critical point. The critical points are taken to be local extrema of either Gaussian or mean curvature. (2) Construct a rotation invariant representation around each critical point by intersecting the surface with spheres of standard radius centered around the critical point. For each of the resulting curves of intersection, compute a distance map function equal to the distance from a point on the curve to the center of gravity of the curve as a. function of arc length (normalized so that the domain of the function is the interval [0,1]). Cll the set of contours for a given critical point a distance profile. (3) Match distance profiles by computing a correlation between corresponding distance contours. (4) Use maximal compatible subsets of the set of matching profiles to induce a transformation that maps corresponding critical points together, then use a cellular spatial partitioning technique to find all points on each surface that are within a tolerance of the other surface

Music Interventions and Dementia: A Systematic Review

Purpose or Research Questions: The purpose of this project is to provide a systematic review on available research on how therapy techniques involving the use of music affect the cognitive or communication outcomes or symptoms of dementia in elderly patients with dementia. Background: There is limited research on non-pharmacological methods for treating patients with dementia. Alternative treatments to medicine can be financially beneficial and also have the potential to reduce negative side effects of drugs. One potential avenue for behavioral treatment is interventions that incorporate music. Methods/Proposed Methods: For this systematic review, the researchers searched CINAHL Plus with Full Text, PubMed, and Health Source: Nursing/Academic Edition for any applicable research up to the end of January 2017 with the following search terms: (dementia OR Alzheimer’s OR memory loss OR cognitive impairment) AND (therapy OR treatment OR intervention OR strategies OR techniques) AND (music*) AND (cogniti* OR communicat* OR language). The inclusion/exclusion criteria were: exclude studies in which the studied population has coexisting neurological impairments (not dementia), only include studies published in English, and only include studies reporting original data. The cognitive and communication outcomes are defined as those involving memory, executive functioning, and language. The original search resulted in 265 articles. After the two researchers completed a title/abstract review independently, 74 articles remained. The inter-rater reliability was found to be 80% and any disparities were discussed and resolved. Then, the researchers independently completed full text reviews. The reliability was 92.5% and any disparities were discussed and resolved. Results/Anticipated Results: A total of 11 articles were reviewed for evidence appraisal after the full text review. Four articles were qualitative studies, five were randomized controlled trials, one was a clinical controlled trial, and one was a cohort-prospective/retrospective study. The researchers determined all to be good quality studies except for two, which were determined to be of lesser quality. The researchers’ inter-rater reliability for the quality appraisal was 85.7%, and all disagreements were discussed and resolved. Effects of therapy and interventions involving music on language and cognition aspects of dementia will be reported. Discussion Music therapies could be a cost effective, clinically significant way to aid behavioral or emotional outcomes. However, there is varying research on the effects of music on cognitive outcomes for dementia patients. Clinical implications and future directions for research will be discussed

The Predictive Relationship Between Psychological Capital and Academic Burnout in Postgraduate Students

Purpose: The purpose of this quantitative correlational study was to determine if, or to what extent, the composite and sub-composite categories of Psychological Capital (PsyCap) predict academic burnout in American postgraduate health science students at a university in the Southeastern United States. Methods: The variables of the study were measured by the Psychological Capital Questionnaire (PCQ-24) and the Maslach Burnout Inventory-Student Survey (MBI-SS). A convenience sampling method was used to collect data from the target population, which included a final sample of 90 health science postgraduate students. Results: A simple linear regression analysis revealed that PsyCap was a significant and negative predictor of academic burnout (F(1,88) = 12.00, p \u3c .001, R2 = 0.12; B = -0.28, t(88) = -3.46, p \u3c .001). Additionally, multiple linear regression analysis revealed that only one sub-category of PsyCap, labeled as Optimism, was a significant and negative predictor of academic burnout (F(4,85) = 5.17, p \u3c .001, R2= 0.20; B = -0.90, t(85) = -3.17, p = .002). Conclusion: The findings may be used by higher education instructors, advisors, and administrators in the United States to adopt policies, practices, programs, student advising, and student mentorship that foster PsyCap and Optimism development in students, which may mitigate the risks and consequences of academic burnout

Rate of Intraoperative Proximal Femoral Fractures with Automated Broaching

Intraoperative proximal femur fractures (PFF) occur in 3.7% of total hip arthroplasties (THA) using the standard mallet broaching technique and increase a patient’s risk of revision surgery from 3.4% to 10%. The Depuy KINCISE automatic broaching system is designed to attenuate the risk of these fractures by applying consistent co-linear force to the broach. The aim of this study is to determine if the KINCISE system decreases the rate of intraoperative PFF fracture during THA compared to the standard mallet technique

TEMPUS: A System for the Design and Simulation of Human Figures in a Task-Oriented Environment

A system called TEMPUS is outlined which is being developed to simulate graphically the task-oriented activities of several human agents in a three-dimensional environment. TEMPUS is a task simulation facility for the evaluation of complex workstations vis-a-vis the normal and emergency procedures they are intended to support and the types and number of individuals who must carry them out. TEMPUS allows a user to interactively: * Create one or more human figures which are correctly scaled according to a specific population, or which meet certain size constraints. * View the human figure in any of several graphical modes: stick figure, line or shaded polygons, or shaded BUBBLEPERSON. * Position the figure in any admissible position within joint angle constraints, and with the assistance of a robotics reach positioning algorithm for limbs. * Combine the figures with three-dimensional polyhedral objects derived from an existing CAD system. * Create shaded graphics images of bodies in such environments. * Use all TEMPUS features in an extensible and uniform user-friendly interactive system which does not require any explicit programming knowledge. A brief summary of the software engineering of this system in a University environment is included. Other features of TEMPUS and differences between TEMPUS and other available body modeling systems are also discussed