What orthopaedic surgery residents need to know about the hand and wrist?

<p>Abstract</p> <p>Background</p> <p>To develop a Core Curriculum for Orthopaedic Surgery; and to conduct a national survey to assess the importance of curriculum items as judged by orthopaedic surgeons with primary affiliation non-academic. Attention for this manuscript was focused on determining the importance of topics pertaining to adult hand and wrist reconstruction.</p> <p>Methods</p> <p>A 281-item questionnaire was developed and consisted of three sections: 1) Validated Musculoskeletal Core Curriculum; 2) Royal College of Physician and Surgeons of Canada (RCPSC) Specialty Objectives and; 3) A procedure list. A random group of 131 [out of 156] orthopaedic surgeons completed the questionnaire. Data were analyzed descriptively and quantitatively using histograms, a Modified Hotel ling's T²-statistic <abbrgrp><abbr bid="B1">1</abbr></abbrgrp> with p-value determined by a permutation test, and the Benjamini-Hochberg/Yekutieli procedure</p> <p>Results</p> <p>131/156 (84%) orthopaedic surgeons participated in this study. 27/32 items received an average mean score of at least 3.0/4.0 by all respondents thus suggesting that 84% of the items are either "probably important" or "important" to know by the end of residency (SD range 0.007–0.228). The Benjamini-Hochberg procedure demonstrated that for 80% of the 32 × 31/2 = 496 possible pairs of hand and wrist questions did not appear to demonstrate the same distribution of ratings given that one question was different from that of another question.</p> <p>Conclusion</p> <p>This study demonstrates with reliable statistical evidence, agreement on the importance of 27/32 items pertaining to hand and wrist reconstruction is included in a Core Curriculum for Orthopaedic Surgery. Residency training programs need ensure that educational opportunities focusing on the ability to perform with proficiency procedures pertaining to the hand and wrist is taught and evaluated in their respective programs.</p

The Impact of a Filariasis Control Program on Lihir Island, Papua New Guinea

Large-scale intervention programmes to control filariasis are currently underway worldwide. However, a major unresolved question remains: what is the appropriate duration for these programmes? Recent theoretical work and clinical field experience has highlighted how the ecological diversity between different endemic regions hinders decision making processes of when to stop ongoing MDA programs. The goal of our study was to identify the factors determining success for a five year LF elimination program. We undertook different types of surveys together with a pre-existing MDA program in villages from two regions that had different infection prevalence rates. Our study shows that the five yearly cycles of MDA could neither eliminate the disease nor stop transmission in the high prevalence villages, such that low baseline lymphatic filariasis prevalence has a positive influence on the outcome of a program. Thus, the study provides data supporting the recommendation that in certain high prevalence and transmission environments more sustained efforts may be necessary

Comparisons of pKa and log P values of some carboxylic and phosphonic acids: Synthesis and measurement

The changes in the physiochemical properties accompanying the substitution of a phosphonic acid group for a carboxylic acid group on various heterocyclic platforms was determined. A series of low molecular weight heterocyclic carboxylic and phosphonic acids was prepared, and the acid dissociation content (pKa) and log P values were measured potentiometrically. These values were compared to those of substituted benzene phosphonic acids, carboxylic acids, sulfonamides, and tetrazoles. The carboxylic acids included 3 pyrazoles, an imidazole, a triazole, 2 pyrimidine, and 6 aryl compounds. The phosphonic acids included a triazole, 2 pyrazoles, 4 pyrimidines, a thiophene, and 6 aryl compounds. Most of the compounds synthesized had adequate water solubility, although a simple methyl substituent in 2 series had a great effect, completely changing the properties. Log P values for the synthesized carboxylic and phosphonic acid compounds were below 2, and pK1 values for the heterocyclic phosphonic acids were generally 2 to 3 log units lower than for the heterocyclic carboxylic acids

Extending System Design Tools to Facilitate Systemic Innovation in Prospective Ergonomics

Through an extensive literature review, this article aims to promote systemic innovation, which is presently too much influenced by context and too limited by rationality. As such, the article argues for the use of systems design methods and tools for anticipating future needs in the development of innovative products and services. Building upon theoretical concepts, such as “Bounded Rationality”, “Situated Design” and “Practice Theory”, systems design methods and tools, such as the Function-Task Interaction Matrix Method and Dependence Structure Matrix, should be made more comprehensive by extending technical and user elements with contextual elements. These matrices help to identify problem fields as well as opportunities by juxtaposing and force-fitting technical, user, and contextual elements. Conclusively, the application of extended system design tools, such as EDSM define and FTCIM define, represents and incorporates design information. It also demonstrates how scenario-based methods can be effective in identifying innovative products, services and contexts

Lymphatic filariasis in Oceania

Lymphatic filariasis caused by the mosquito-transmitted helminth parasite Wuchereria bancrofti is an important problem in Oceania. Of the 33 countries and territories included in this review, 24 have been found to be endemic for this disease at some time in the past, and 18 of these were classified as endemic at the start of the Global Programme to Eliminate Lymphatic Filariasis in 2000. After the implementation of large mass drug administration campaigns and (to a lesser extent) vector control over the last 15 years, only ten Oceania countries and territories were still considered to have ongoing transmission of lymphatic filariasis in 2015. Through a systematic literature search and review, we identified 79 individual studies of filariasis in Oceania that were published in 70 papers between 1995 and 2015. Data on mosquito (by species) and human infection prevalence using all currently available diagnostic tests, as well as estimates of acute and chronic filariasis morbidity, were extracted from these publications and tabulated in chronological order by country and outcome measure, noting sampling method and sample size in order to evaluate study quality and precision. No studies were identified from Micronesia; most studies in Melanesia and Polynesia were found from Papua New Guinea (PNG) (30) and French Polynesia (16), respectively. All other countries in Melanesia and Polynesia were represented by 1–7 studies except Wallis and Futuna. The systematic review identified 19 published studies of mosquito infections and 62 of human infections but only 3 on acute morbidity (all from PNG in the 1990s) and 11 on chronic morbidity. Since Oceania has a diverse set of mosquito vectors, published reviews of relative efficiencies of different mosquito genera were examined to shed light on their transmission dynamics and hence the potential for elimination of filariasis in Oceania. The review indicates the need for collation of unpublished reports and studies in addition to more geographically representative studies of remaining filariasis infection distribution, as well as quantification of the disability (acute attacks, lymphoedema, elephantiasis and hydrocoele) that will remain once transmission is interrupted, in order to plan for services to alleviate these lifelong effects

Mothers Frequent Caves: Lactation Affects Chimpanzee (Pan troglodytes verus) Cave Use in Southeastern Senegal

Caves play an important ecological role for nonhuman primates in Africa and Asia. Savanna chimpanzees (Pan troglodytes verus) living in the Mandingue plateau of Senegal and Mali use caves for thermoregulation, where these refugia provide a cool microclimate during the hot, dry season. In this study, we examined cave use frequency for a chimpanzee community in southeastern Senegal. We used images from a camera trap placed at the mouth of a large laterite cave to investigate the hypotheses that sex, reproductive state, and seasonality influence the frequency of cave use. The camera collected 14,053 still images of chimpanzees between 2011 and 2013 over 325 camera trap days. Our results indicate no difference in cave use frequency between males and females overall. However, female reproductive state did significantly influence cave use, with lactating mothers using the cave more frequently than both males and nonlactating females. Chimpanzees used the cave during the hottest times of the day and were more likely to visit the cave during periods of low water availability and high maximum temperatures associated with the dry season. These results suggest the importance of thermoregulation in extreme heat for all individuals, and specifically for lactating females with nursing infants that likely experience higher metabolic and hydration stress. This study provides insight into the dynamics of primate cave use by contributing evidence that chimpanzee cave use may be influenced by reproductive states in addition to thermoregulatory needs