Walters Public Schools

Staged treatment of high-energy periarticular tibia fractures involves temporization with closed reduction and external fixation, aiming to provide early reduction and stabilization while mitigating soft-tissue complications. Various external fixator configurations exist, including those that use a "multipin" clamp capable of holding multiple pins but limiting pin placement to a single plane. The purpose of this study was to compare clinical and radiographic outcomes and associated costs of standard and multipin outrigger clamp constructs in tibial plateau and pilon fractures treated with temporary external fixation. We hypothesized that use of the multipin clamp may be associated with poorly aligned reductions and increased complication rates. A retrospective review of 100 patients with periarticular tibial plateau (AO/OTA: 41B/C) or pilon (43B/C) fracture at a Level 1 trauma center from 2014 to 2023 was conducted. Patient, injury, and complication characteristics were collected. Patients were categorized based on the external fixator clamp used: multipin (MP) or standard (S). Clinical outcomes and complication rates were assessed. Radiographic alignment was evaluated by the change in anterior and lateral distal tibial angles, and sagittal plane translation for pilon fractures, and medial and posterior proximal tibial angles for plateau fractures. 70 patients underwent standard (25 pilon, 45 plateau) and 30 multipin (10 pilon, 20 plateau) external fixation. MP and S groups showed no notable differences in demographics or injury characteristics. Both groups demonstrated comparable complication rates and radiological alignment outcomes, with no notable differences observed. MP constructs were more costly than standard systems. In this retrospective study of 100 patients, there was no difference in radiographic or clinical outcomes between the standard frame and multipin frame groups. Typical costs for the multipin frame constructs were $635 to $1249 more than the standard frame constructs.

To illustrate possible improvements in recording of gender identity, we investigated discrepancies between gender identity from medical examiner (ME) death investigations and sex as recorded in the final death record. Evaluation of a database used to record information related to medicolegal death investigation with matching to state vital records. Kappa analysis was used to measure concordance between both systems. The Portland, Oregon, metro area (Clackamas, Multnomah, and Washington Counties) and deaths investigated by the Offices of each County Medical Examiner between January 2011 and September 2020. Epidemiologists identified incongruous data that have significant negative implications for transgender populations. Epidemiologists identified key actions that, if taken by death investigators, death record software, and the federal death certificate form, will rectify harmful data discrepancies. Concordance of gender identity and sex in ME data and death record, respectively. We identified 51 deaths in transgender persons; the majority were classified as transgender female (71%). The κ statistic was -0.0657, indicating poor concordance between the gender identity in ME investigation and the death certificate in vital records. Information gathered via medicolegal death investigations is foundational to effective public health/public safety response; MEs and coroners are often the first to document emerging health threats. Discrepancies in official death records impede accurate surveillance of a population disproportionately at risk of violent death.

Ulcerative colitis (UC) is a lifelong disease that peaks in diagnosis between the ages of 15 to 25 years, making UC a significant chronic disease among adolescents that could affect the adolescents throughout their life. This article provides an overview of the role of nurse practitioners as health care providers in managing adolescent patients with UC with a holistic approach that encompasses the physical aspects of the disease, as well as developmental and psychosocial needs. By describing the influence that developmental stage and psychological stress have on patients with UC, the nurse practitioners can facilitate evidence-based and holistic care for adolescents and promote self-management.

In eight rabbits, the common carotid artery was ligated and multiple estimations of brain surface oxygen tension performed using a seven barrelled mini-electrode. In five rabbits ligation of the carotid artery resulted in impairment of cortical oxygenation. The remaining three rabbits showed no impairment in the supply of oxygen to the cerebral cortex after carotid occlusion. In the five rabbits who displayed a reduction in oxygen supply after carotid ligation, ventilation with 33% oxygen after the infusion of 15 ml/kg of Fluosol FC-43 produced an improvement in cortical oxygenation in only three of the five rabbits. When these animals were ventilated with 100% oxygen after carotid ligation and Fluosol infusion, oxygen supply in all five was commensurate with or greater than that during control conditions.