Management of aseptic nonunions and severe bone defects: let us get this thing healed!

Effective nonunion and bone defect management requires consideration of multiple potential contributing factors including biomechanics, biology, metabolic, and patient factors. This article reviews these factors as well as several potential nonunion or bone defect treatments including bone grafts, bone graft substitutes, the induced membrane technique, and distraction osteogenesis. A summary of these concepts and guidelines for an overall approach to management are also provided

A Modular Tray Growth System for Barley

Determining when a barley plant starts and finishes meiosis is not trivial as when the spikelets undergo meiosis, the spike is not visible as it is still well within the leaf sheath on the developing tiller. This is a general constraint for any experiment involving meiosis, such as cytology, RNA extractions, or abiotic stress treatments aiming to target such a developmental stage. The lack of synchronicity between barley tillers within the same plant exacerbates the difficulty to determine the overall meiotic stage of a plant at a certain time.Given the lack of a nondestructive staging system for predicting the entry into meiosis and the problems of working with large pot plant systems, a modular plant growing is proposed. This system enables the growth of a high number of plants in a small surface, each producing a single tiller. The modular tray system was used to generate a nondestructive prediction tool for meiosis by using external morphological features. As an example, the system is used here for heat treating F1 plants in early meiosis stages to modify recombination.</p

Effectiveness of an online acceptance and commitment therapy programme for perfectionism in soccer players: a randomized control trial

There is currently limited understanding of how to reduce perfectionism in sport. With research outside of sport as impetus, in the current study we evaluated the effectiveness of an online ACT-based intervention for reducing perfectionism and improving pre-competition emotions in soccer players. Following a pre-registered protocol, eighty-one female soccer players (M age = 24.28 years, SD = 6.77) were randomly allocated to either an intervention group (n = 41) or a waitlist control group (n = 40). The intervention group had access to a set of online ACT-based modules for 8-weeks. Athletes completed measures of trait perfectionism, perfectionism cognitions, and pre-competition emotions pre-intervention and post-intervention. A 2 (group) x 2 (time) ANOVA revealed significant interaction effects for trait perfectionism, perfectionism cognitions, and pre-competition emotions. Following the intervention, the two groups displayed significant mean differences for trait perfectionism, perfectionism cognitions, and almost all pre-competition emotions. However, due to lower reliability of some instruments, findings regarding post-competition emotions were discounted. The findings suggest that online ACT-based interventions may be a viable and effective way to reduce perfectionism in soccer players (but not necessarily improving pre-competition emotions)

Epidemiology of Fracture Nonunion in 18 Human Bones

Importance Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors. Objective To test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion. Design, Setting, and Participants An inception cohort study in a large payer database of patients with fracture in the United States was conducted using patient-level health claims for medical and drug expenses compiled for approximately 90.1 million patients in calendar year 2011.The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology codes; comorbidities as per International Classification of Diseases, Ninth Revision codes; and drug prescriptions as per National Drug Code Directory codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion. Data analysis was performed from January 1, 2011, to December 31, 2012, Exposures Continuous enrollment in the database was required for 12 months after fracture to allow sufficient time to capture a nonunion diagnosis. Results The final analysis of 309 330 fractures in 18 bones included 178 952 women (57.9%); mean (SD) age was 44.48 (13.68) years. The nonunion rate was 4.9%. Elevated nonunion risk was associated with severe fracture (eg, open fracture, multiple fractures), high body mass index, smoking, and alcoholism. Women experienced more fractures, but men were more prone to nonunion. The nonunion rate also varied with fracture location: scaphoid, tibia plus fibula, and femur were most likely to be nonunion. The ORs for nonunion fractures were significantly increased for risk factors, including number of fractures (OR, 2.65; 95% CI, 2.34-2.99), use of nonsteroidal anti-inflammatory drugs plus opioids (OR, 1.84; 95% CI, 1.73-1.95), operative treatment (OR, 1.78; 95% CI, 1.69-1.86), open fracture (OR, 1.66; 95% CI, 1.55-1.77), anticoagulant use (OR, 1.58; 95% CI, 1.51-1.66), osteoarthritis with rheumatoid arthritis (OR, 1.58; 95% CI, 1.38-1.82), anticonvulsant use with benzodiazepines (OR, 1.49; 95% CI, 1.36-1.62), opioid use (OR, 1.43; 95% CI, 1.34-1.52), diabetes (OR, 1.40; 95% CI, 1.21-1.61), high-energy injury (OR, 1.38; 95% CI, 1.27-1.49), anticonvulsant use (OR, 1.37; 95% CI, 1.31-1.43), osteoporosis (OR, 1.24; 95% CI, 1.14-1.34), male gender (OR, 1.21; 95% CI, 1.16-1.25), insulin use (OR, 1.21; 95% CI, 1.10-1.31), smoking (OR, 1.20; 95% CI, 1.14-1.26), benzodiazepine use (OR, 1.20; 95% CI, 1.10-1.31), obesity (OR, 1.19; 95% CI, 1.12-1.25), antibiotic use (OR, 1.17; 95% CI, 1.13-1.21), osteoporosis medication use (OR, 1.17; 95% CI, 1.08-1.26), vitamin D deficiency (OR, 1.14; 95% CI, 1.05-1.22), diuretic use (OR, 1.13; 95% CI, 1.07-1.18), and renal insufficiency (OR, 1.11; 95% CI, 1.04-1.17) (multivariate P < .001 for all). Conclusions and Relevance The probability of fracture nonunion can be based on patient-specific risk factors at presentation. Risk of nonunion is a function of fracture severity, fracture location, disease comorbidity, and medication use

Ipsilateral Proximal Femur and Shaft Fractures Treated With Hip Screws and a Reamed Retrograde Intramedullary Nail

Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results

University of Illinois Year of Cyberinfrastructure Final Report

The University of Illinois at Urbana-Champaign is a leader in computing and information technology (IT). Our leadership role has both produced and been produced by a culture of innovation. Many efforts have arisen over the years that have been the product of this culture. While the university’s commitment to developing digital infrastructure, resources, and support services has served campus researchers well, it has become clear that a more coherent and unified approach to assessing and addressing the IT services and support needs of campus researchers is imperative. With the support of the Vice Chancellor for Research and the Chief Information Officer, we embarked on the Year of Cyberinfrastructure (Year of CI). Through this effort, we engaged researchers across disciplines to gain an understanding of the challenges they face in order to inform how we, as a campus, should move together to address these needs. We confirmed that researchers tend to assemble needed resources and services on their own, often out of necessity. While this practice has allowed those with the ambition or, more frequently, the absolute need, to advance their fields, it has primarily benefitted only those researchers and their collaborators. Providers of resources and services have brought value to the research process, but this value has been accrued in a largely disjointed manner that has tended to favor the power users of technology. The Year of CI effort has made clear that our research support landscape is not only lacking coherence but is also very uneven across academic and research units. To support modern research practices and to be competitive and preeminent in the academic community and the world, the 21st century research university must provide a foundation of research IT infrastructure and services that are accessible by all disciplines. Our campus needs a strong vision for how IT supports research, along with the ability to realize and evolve that vision in lockstep with the changing needs of the research community and the technologies available to meet those needs. Though Illinois faces significant financial challenges, it is time to be bold and make an investment to allow the university to emerge from these challenges as the premier destination for faculty, postdocs, graduate students, undergraduate students, and research staff who seek to work in a world-class modern research environment. It is time to provide the infrastructure that will grow the campus research portfolio to new heights. The Year of CI has provided the initial assessment of the campus and indicates the steps we must take to develop the digital support ecosystem that will allow the campus to realize its vision of preeminence in research.Ope

Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study

The Lantern Vol. 44, No. 2, Spring 1978

• Ode To the Death of a Patient • The Bloody Brand of Honor • Deserted Trail • The Apple Revisited • Consciousness in Awares • Middle Class • Clock • Snow • The Case • Your Eyes Speak Falsely • Finding a Place • Legacy of Ellis Island • John • Work • A Gift • When She is Gone • Qual. Lamenthttps://digitalcommons.ursinus.edu/lantern/1112/thumbnail.jp