Double Bubble Trouble: Misdirection in the Diagnosis of Pyloric Stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is a disorder characterized by hypertrophy of the pylorus causing obstruction of the gastric outlet. IHPS occurs in 1 to 3.5 per 1000 live births and normally develops between weeks 3 to 5 of age. Patients commonly present forceful, projectile, nonbilious vomiting. The diagnosis is confirmed with ultrasound in which pyloric muscle thickness (PMT) and pyloric canal length (PCL) are measured as less than or equal to 3.0 mm and 14.5 mm, respectively. Definitive treatment is surgicalpyloromyotomy. Similarly, duodenal atresia can cause projectile, nonbilious vomiting. However, it typically presents within the first 24 to 38 hours of birth. If not diagnosed antenatally, then the classic “double bubble sign” on abdominal x-ray or upper GI series is pathognomonic. In this case study, we discuss a case in which diagnostic imaging leads to the misdiagnosis of a patient presenting with projectile vomiting. Initial presentation, differential diagnosis, and hospital workup will be discussed. We present this case study to raise awareness of the possible misdiagnosis of a common childhood illness due to aberrant radiographic presentation

A comparison of contact lens care costs in the Pacific Northwest

Contact lens wearers find themselves spending increasing amounts of money on solutions to care for their lenses. In caring for contact lenses, most contact lens patients find it difficult to find the store with the lowest prices and ultimately end up going to their local grocery store and spending more money than needed. The purpose of this study is to show how one can benefit from price-shopping for contact lens solutions. This is a comparative study done on the most widely used soft contact lens and rigid gas permeable lens solutions, and their prices in various stores in the Portland, OR metropolitan area

British Contentious Gatherings of 1828

http://deepblue.lib.umich.edu/bitstream/2027.42/50946/1/171.pd

Implicit Models of School Improvement: A Mixed Method Analysis

There is a persistent belief that public schools are profoundly in need of improvement (Berliner & Biddle, 1995). Given substantial research on teaching literature (Borman, Hewes, Overman, & Brown, 2003; Hertling, 2000), it is not clear why more progress has not been made. Perhaps an answer may be found in the complexity of the educational literature, which provides a confused map toward accomplishing school improvement. Educational leaders are left in the position of relying on either imprecisely formulated or idiosyncratic and implicit models of school improvement without clear guidelines to follow for specific contexts. Models appear as ex post facto, reflecting an approach to educational reform on the part of administrators that may be best thought of as implicit

Timing Carbohydrate Beverage Intake During Prolonged Moderate Intensity Exercise Does Not Affect Cycling Performance

Carbohydrate beverages consumed during long-term exercise have been shown to attenuate fatigue and improve performance; however, the optimal timing of ingestion is unclear. Therefore, the purpose of this study was to determine if timing the carbohydrate ingestion (front-loading (FL), continual loading (CL), and end-loading (EL)) during prolonged exercise influenced exercise performance in competitive cyclists. Ten well-trained cyclists completed three separate exercise bouts on a bicycle ergometer, each lasting 2 hours at an intensity of ~67% VO2 max, followed by a 15-minute “all out” time trial. In the FL trial, participants ingested a carbohydrate beverage during the first hour and a placebo beverage during the second hour. In the CL trial, a carbohydrate beverage was ingested throughout the trial. In the EL trial, a carbohydrate beverage was ingested during the second hour and a placebo during the first hour. The amount of carbohydrate consumed (75 g) was the same among conditions. The order of conditions was single-blinded, counterbalanced, and determined randomly. Performance was measured by the work output during the 15-minute performance ride. There were no differences in work output among the three conditions during the final time trial. In the first hour of exercise, peak venous blood glucose was highest in the FL condition. In the second hour, peak venous blood glucose was highest in the EL condition. Following the time trial, venous blood glucose levels were similar among FL, CL, and EL. Overall, the timing of carbohydrate beverage consumption during prolonged moderate intensity cycling did not alter cycling performance

Unpacking Faculty Engagement: The Types of Activities Faculty Members Report as Publicly Engaged Scholarship During Promotion and Tenure

While a growing body of scholarship has focused on the personal, professional, and organizational factors that influence faculty members’ involvement in publicly engaged scholarship, the nature and scope of faculty publicly engaged scholarship itself has remained largely unexplored. What types of activities are faculty members involved in as publicly engaged scholarship? How does their involvement vary by demographic, type of faculty appointment, or college grouping? To explore these questions, researchers conducted a quantitative content analysis of 173 promotion and tenure documents from a research-intensive, land-grant, Carnegie Classified Community Engagement university and found statistically significant differences for the variables age, number of years at the institution, faculty rank, Extension appointment, joint appointment, and college grouping. Recommendations for future research are discussed as well as implications for institutional leadership, faculty development programming, and the structuring of academic appointments

Promises and Lies: Restoring Violated Trust

Trust is critical for organizations, effective management, and efficient negotiations, yet trust violations are common. Prior work has often assumed trust to be fragile—easily broken and difficult to repair. We investigate this proposition in a laboratory study and find that trust harmed by untrustworthy behavior can be effectively restored when individuals observe a consistent series of trustworthy actions. Trust harmed by the same untrustworthy actions and deception, however, never fully recovers—even when deceived participants receive a promise, an apology, and observe a consistent series of trustworthy actions. We also find that a promise to change behaviour can significantly speed the trust recovery process, but prior deception harms the effectiveness of a promise in accelerating trust recovery

Live Soap: Order, Fluctuations and Instabilities in Active Smectics

We construct a hydrodynamic theory of noisy, apolar active smectics, in bulk suspension or on a substrate. Our predictions include: quasi-long-ranged smectic order in dimension d = 2, and long- ranged in d = 3, extending previously published results to all dynamical regimes; Kosterlitz-Thouless melting to an active nematic at high and low concentrations in d = 2; nonzero second-sound speed parallel to the layers; the suppression of giant number fluctuations by smectic elasticity; instability to spontaneous undulation and flow in bulk contractile smectics; a layer spacing instability, possibly oscillatory, for large enough extensile active stresses.Comment: 5 pages, 1 figure, submitted to Phys Rev Let