Psychodynamic Treatment of Excessive Virtual Reality Environment Use

This clinical case study explores the psychodynamic treatment possibilities of excessive Internet virtual reality environment use. The client discussed resides in the virtual world Second Life and experiences her relationships in this environment as more real and meaningful than those in her real life. Instead of focusing on reducing Internet use, therapy conceptualized use of the virtual environment as a compensatory strategy of escapism and conceptualized the relationships and process in a psychodynamic paradigm. This allowed the therapy to address the defenses of splitting and the recapitulation of traumatic events that were evident in the virtual world within an environment that was safer for the client to explore. As a result of accepting the use of the virtual reality environment as an aid to therapy, the client was able to gain insight into her intrapersonal conflicts and eventually bridge the virtual environment to her real life to initiate a trauma-focused therapy.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Two-dimensional Packing in Prolate Granular Materials

We investigate the two-dimensional packing of extremely prolate (aspect ratio $\alpha=L/D>10$) granular materials, comparing experiments with Monte-Carlo simulations. The average packing fraction of particles with aspect ratio $\alpha=12$ is $0.68\pm0.03$. We quantify the orientational correlation of particles and find a correlation length of two particle lengths. The functional form of the decay of orientational correlation is the same in both experiments and simulations spanning three orders of magnitude in aspect ratio. This function decays over a distance of two particle lengths. It is possible to identify voids in the pile with sizes ranging over two orders of magnitude. The experimental void distribution function is a power law with exponent $-\beta=-2.43\pm0.08$. Void distributions in simulated piles do not decay as a power law, but do show a broad tail. We extend the simulation to investigate the scaling at very large aspect ratios. A geometric argument predicts the pile number density to scale as $\alpha^{-2}$. Simulations do indeed scale this way, but particle alignment complicates the picture, and the actual number densities are quite a bit larger than predicted.Comment: 6 pages + 10 ps/eps figure

The Validity of Patient-Reported Short-Term Complications following Total Hip and Knee Arthroplasty

Introduction: Given the lack of national data on outcomes of on patients who undergo total joint arthroplasty (TJA) and the limitations of hospital databases to capture information on patients who seek post-TJA care elsewhere, there is growing interest in using patient self-report to identify possible complications following surgery. We examined the concordance between patients self-report of potential short-term complications with review of available medical records as well as the location of the reported post-operative care. Material & Methods: Patients undergoing primary hip or knee arthroplasty from 7/1/11 through 12/3/12 participating in a tertiary care center were identified. Patients completed a 6-month post-operative survey regarding needing evaluation at an emergency department, day surgery or hospitalization for possible medical or mechanical complications and the location of care. We reviewed available inpatient and outpatient medical records to identify the location of postoperative care as well as the validity of patient self-report (sensitivity, specificity, positive predictive values and negative predictive values). Results: There were 413 patients who had 431 surgeries and completed the 6-month questionnaire. Patients reported 40 medical encounters including emergency department, day surgery or inpatient care resulting in a 9% reported complication rate, of which 20% occurred at outside hospitals Overall patient self-report of emergency department, day surgery and inpatient care for possible complications was both sensitive (82%) and specific (100%). The positive predictive value was 100% and negative predictive value 98%. Conclusion: Given the prevalence of events requiring care at outlying hospitals and the accuracy of self-report, methods that directly engage patients can augment current surveillance procedures

Trauma Team Activation for Geriatric Trauma at a Level II Trauma Center: Are the Elderly Under-triaged?

Abstract Geriatric patients often sustain life-threatening injuries from minor trauma. A growing body of research suggests that these patients are often under-triaged in the emergency setting.The purpose of this research was to evaluate whether or not geriatric trauma patients are under-triaged at a community based level II trauma center. 1434 trauma patients over the age of 65 presenting from 2010-2015 were retrospectively reviewed from the Cabell Huntington Hospital trauma registry and analyzed for age, gender, arrival type, ED response, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injury cause, ICD-9 diagnosis codes, and mortality. Under-triage and over-triage rates were determined using the Cribari method (under-triage = ISS ≥ 16 without full trauma team activation [TTA]; Over-triage = ISS ≤ 15 with full TTA). The under-triage rate was 9.5% (132/1393) with the majority of under-triaged patients having head trauma (n=423). There were 371 head trauma patients with a recorded GCS and analysis shows those with a GCS ≥ 13 had a 1.2% mortality risk (n=326; ISS 10.2), but that risk drastically increases to 60% with GSC ≤ 12 (n=45; ISS 21.5). Of the 45 patients with GSC ≤ 12, only 4% had priority 1 TTA using the current protocol (2/45). The American College of Surgeons-Committee of Trauma (ACS-COT) recommends an acceptable under-triage rate of \u3c 5%. In order to improve geriatric care and reduce under-triage rates, we recommend that an age-based criteria be added to our TTA protocol at our community based Level II trauma center: priority 1 TTA for all patients 65 years or older sustaining head trauma with a GCS ≤ 12 or suspicion of intracranial hemorrhage

Improving Rural Bone Health and Minimizing Fracture Risk in West Virginia: Validation of the World Health Organization FRAX® Assessment Tool as a Phone Survey for Osteoporosis Detection

West Virginia ranks second nationally in population ≥ 65 years old placing our state at greater risk for osteoporosis and fracture. The gold standard for detecting osteoporosis is dual X-ray absorptiometry (DXA), yet over half of West Virginia’s counties do not have this machine. Due to access barriers, a validated phone-administered fracture prediction tool would be beneficial for osteoporosis screening. The World Health Organization’s FRAX® fracture prediction tool was administered as a phone survey to 45 patients; these results were compared to DXA bone mineral density determination. Results confirmed that the FRAX® phone survey is as reliable as DXA in detecting osteoporosis or clinically significant osteopenia: 92% positive predictive value, 100% negative predictive value, 100% sensitivity and 91% specificity when compared to the gold standard. These promising results allow for the development of telephone-based protocols to improve osteoporosis detection, referral and treatment especially in areas with health care access barriers

Orthopaedic Surgeon Density in West Virginia

Abstract West Virginia (WV) has many healthcare disparities and access barriers. For bone and joint disorders, WV has some of the highest rates of musculoskeletal problems, including the highest reported rate of adult arthritis in the nation (36.2%). We hypothesized that WV has one of the lowest Orthopaedic surgeon densities in the country, which can negatively impact the delivery of musculoskeletal care. Using the WV Board of Medicine practitioner databank, the Veterans Administration practitioner data, and national Orthopaedic surgeon census data, we demonstrated a considerably low Orthopaedic surgeon density in WV (7.71/100,000 population versus the national average of 8.51/100,000 population) with 54% of our counties (n=30) having no Orthopaedic surgeons. This data is currently being used to further determine the appropriate allocation of resources to help improve access to specialized orthopaedic care for our state

Characterization of Adherent Bacteroidales from Intestinal Biopsies of Children and Young Adults with Inflammatory Bowel Disease

There is extensive evidence implicating the intestinal microbiota in inflammatory bowel disease [IBD], but no microbial agent has been identified as a sole causative agent. Bacteroidales are numerically dominant intestinal organisms that associate with the mucosal surface and have properties that both positively and negatively affect the host. To determine precise numbers and species of Bacteroidales adherent to the mucosal surface in IBD patients, we performed a comprehensive culture based analysis of intestinal biopsies from pediatric Crohn's disease [CD], ulcerative colitis [UC], and control subjects. We obtained biopsies from 94 patients and used multiplex PCR or 16S rDNA sequencing of Bacteroidales isolates for species identification. Eighteen different Bacteroidales species were identified in the study group, with up to ten different species per biopsy, a number higher than demonstrated using 16S rRNA gene sequencing methods. Species diversity was decreased in IBD compared to controls and with increasingly inflamed tissue. There were significant differences in predominant Bacteroidales species between biopsies from the three groups and from inflamed and uninflamed sites. Parabacteroides distasonis significantly decreased in inflamed tissue. All 373 Bacteroidales isolates collected in this study grew with mucin as the only utilizable carbon source suggesting this is a non-pathogenic feature of this bacterial order. Bacteroides fragilis isolates with the enterotoxin gene [bft], previously associated with flares of colitis, were not found more often at inflamed colonic sites or within IBD subjects. B. fragilis isolates with the ability to synthesize the immunomodulatory polysaccharide A [PSA], previously shown to be protective in murine models of colitis, were not detected more often from healthy versus inflamed tissue