Delayed cardiac tamponade secondary to blast injury from gunshot wound.

Penetrating injuries are recognized for the direct tissue damage, which is typically evident on physical examination. Secondary injuries resulting from kinetic energy transfer in the case of gunshot wounds (GSWs), often referred to as "blast injuries", may affect tissues distant to the ballistic trajectory and are often occult. We present a case of delayed cardiac tamponade resulting from secondary blast injury. The patient sustained a thoraco-abdominal GSW with entry adjacent to the cardiac box. An Advanced Trauma Life Support (ATLS)-guided assessment revealed intra-abdominal injuries necessitating operative intervention without evidence of cardiac injury. On post-operative day four, the patient developed chest pain, tachycardia, and shortness of breath. Imaging revealed a large pericardial effusion with cardiac tamponade. Emergent exploration revealed hemopericardium secondary to a bleeding epicardial hematoma without evidence of pericardial violation. Clinicians must maintain a high clinical suspicion for occult, indirect blast injuries which may be life-threatening.

De Quervain's Tenosynovitis in Primary Caregivers.

INTRODUCTION: The purpose of this study is to evaluate the incidence of de Quervain's tenosynovitis in newborn caregivers - both male and female - as well as potential associated factors, such as child's age or weight and lactation status. METHODS: Surveys were administered from August 2014 to April 2015 to parents with young children in the greater Buffalo, New York area. Parents were asked to report wrist pain symptoms and location, number of hours spent caregiving, child's age, and lactation status. Participants who reported wrist pain performed a self-guided Finkelstein test and completed a QuickDASH questionnaire. RESULTS: One-hundred twenty-one surveys were returned: 9 from males and 112 from females. Ninety respondents reported no wrist/hand pain (group A), 11 reported wrist/hand pain and a negative Finkelstein test (group B), and 20 reported wrist/hand pain and a positive Finkelstein test (group C). The mean QuickDASH score in group B was significantly smaller than that of group C. On average, child age was statistically significantly different across categories of pain with the oldest population in the positive Finkelstein group (group C) (272.8 ± 196.5 vs 481.9 ± 488.9, P = 0.007). CONCLUSIONS: This study supports the hypothesis that mechanical components of newborn caregiving play a major role in the development of postpartum de Quervain's tenosynovitis. It also supports the concept that hormonal changes in the lactating female are not an important contributor to the development of postpartum de Quervain's tenosynovitis. Our results, as well as previous studies, suggest a high index of suspicion for the condition must be maintained when seeing primary caregivers with wrist pain.

Human cooperation and evolutionary transitions in individuality.

A major evolutionary transition in individuality involves the formation of a cooperative group and the transformation of that group into an evolutionary entity. Human cooperation shares principles with those of multicellular organisms that have undergone transitions in individuality: division of labour, communication, and fitness interdependence. After the split from the last common ancestor of hominoids, early hominins adapted to an increasingly terrestrial niche for several million years. We posit that new challenges in this niche set in motion a positive feedback loop in selection pressure for cooperation that ratcheted coevolutionary changes in sociality, communication, brains, cognition, kin relations and technology, eventually resulting in egalitarian societies with suppressed competition and rapid cumulative culture. The increasing pace of information innovation and transmission became a key aspect of the evolutionary niche that enabled humans to become formidable cooperators with explosive population growth, the ability to cooperate and compete in groups of millions, and emergent social norms, e.g. private property. Despite considerable fitness interdependence, the rise of private property, in concert with population explosion and socioeconomic inequality, subverts potential transition of human groups into evolutionary entities due to resurgence of latent competition and conflict. This article is part of the theme issue 'Human socio-cultural evolution in light of evolutionary transitions'.

Thumb to spinous process is a false metric for glenohumeral internal rotation.

Background: The measurement of internal rotation by noting the maximal vertebral level reached by the patient's thumb behind their back is an established physical examination technique, as outlined in the American Shoulder and Elbow Surgeons Shoulder Assessment Form.7 The purpose of the present study is to correlate real-time glenohumeral internal rotation with thumb to spinous process movement to determine the accuracy of the technique. Methods: Healthy volunteers with no previous history of shoulder injury or symptoms were recruited from the local medical school population. Ultrasound probe was placed over the anterolateral shoulder, and relevant anatomy was identified. Internal rotation was evaluated by measuring displacement of the peak of the medial aspect of the bicipital groove relative to the anterior glenoid rim with the arm held in defined positions of progressively increasing internal rotation. The difference in displacement between arm positions was calculated and recorded. Results: A total of 20 participants (11 women/9 men, aged 22-42 years) were recruited for measurement. A mixed-model repeated-measures analysis of variance was used. The most significant differences in displacement, and therefore internal rotation, were observed between the neutral and anterior superior iliac spine (0.21 ± 0.39 mm, P= .0269) and between the anterior superior iliac spine and peak iliac crest (0.26 ± 0.44 mm, P= .0163). After the peak iliac crest, there was no further statistically significant change in rotation. Conclusion: The present study suggests that most glenohumeral internal rotation occurs before reaching the arm behind the back. Although not directly studied, this supports the notion that the maximal vertebral level reached involves an interplay of various joint motions. While the thumb to spinous process maneuver remains a functional evaluation, our results suggest a different examination technique be used to more accurately test glenohumeral internal rotation.

Reminiscence About Physical Activity: A Pilot Study to Reduce Pain in Older Adults.

The aim of the current randomized attention control pilot study was to conduct a preliminary test of a facilitated reminiscence intervention about past physical activity for the effect on increased physical activity and reduced pain in older adults with osteoarthritis. Thirteen older adults were randomized to the facilitated reminiscence or health education group and participated in six individual sessions over 6 weeks. Reminiscence functions, self-reported physical activity, pain intensity, and pain interference with function were measured at baseline and 1 and 3 months postintervention. Facilitated reminiscence did not result in increased physical activity, but instead resulted in increased pain intensity. Content analysis of reminiscence session transcripts indicated most reminiscence was conversational. Benefits from reminiscence included reconnecting with estranged family and distraction from pain. Past physical activities might be helpful to include as part of a program of facilitated integrated reminiscence for individuals with sufficient history of past physical activity. [Res Gerontol Nurs. 2019; 12(4):193-202.].

Morphological characteristics of preparator air-scribe marks: Implications for taphonomic research.

Taphonomic analyses of bone-surface modifications can provide key insights into past biotic involvement with animal remains, as well as elucidate the context(s) of other biostratinomic (pre-burial) processes, diagenesis, excavation, preparation and storage. Such analyses, however, first require researchers to rigorously disambiguate between continuums of damage morphologies prior to attributing individual marks to specific actors and effectors (e.g., carnivore tooth, stone tool cutting edge, etc.). To date, a number of bone-modifying agents have been identified, and criteria for identifying their traces have been published. Relatively little research, however, has focused on bone-surface modifications imparted during specimen preparation. Herein we report that air scribes, small pneumatic tools commonly used for preparation in museum contexts, can generate unintentional marks that may mimic surficial modification caused by carnivores. To aid investigators in assessing the hypothesis that a mark in question is derived from air-scribe preparation activities, we provide high-resolution, detailed morphological information imaged with scanning electron microscopy (SEM). The main diagnostic characteristic of air-scribe damage is the occurrence of sequential, variously spaced, sub-millimeter scallop-like stepped bone removals. This morphology can resemble damage imparted by carnivore teeth. In contrast to marks produced by trampling, stone tools and carnivores, however, no continuous internal features, such as linear microstriations, were observed within grooves produced by the air scribe. Thus, the presence of such features can be used to disprove an air-scribe origin. A culmination of the morphological criteria presented herein, cross-cutting relationships with other surficial features (e.g., diagenetic discoloration, weathering textures), the position of occurrence, and an overall contextual framework for the assemblage is suggested for accurate identification of such traces. The ability to recognize or disprove air-scribe damage will allow researchers to confidently proceed with interpreting past biological and sedimentological interactions with animal remains.

When Hiring New Trauma and Surgical Critical Care Fellowship Graduates, What Qualities Are Most Desirable? A Survey of Trauma Directors and Trauma Program Administrators.

A general surgeon shortage exists and fewer surgical residents specialize in trauma and surgical critical care (TSCC). We conducted a survey of trauma directors and administrators to determine what qualities are most desirable when hiring new TSCC fellowship graduates. METHODS: The survey, entitled "A Survey of Directors of Trauma on Hiring New Attending Trauma Surgeons," was submitted to the Eastern Association for the Surgery of Trauma (EAST) and distributed to the association members in January 2016. Categorical data were summarized using frequency counts and percentages. Comparisons of responses were analyzed using the chi-squared or Fisher's exact test. Statistical significance was denoted by P < 0.05. RESULTS: A total of 317 respondents from 1364 submitted surveys presented a response rate of 23.2 per cent. Of these respondents, 85.8 per cent (n = 272) decide whether or not a new trauma surgeon is hired and 33.7 per cent were trauma directors. In all, 82.9 per cent work at academic centers and have an Accreditation Council for Graduate Medical Education-approved general surgery residency and 58.4 per cent have an Accreditation Council for Graduate Medical Education-approved surgical critical care or acute care surgery fellowship. In total, 72.6 per cent work in American College of Surgeons-verified trauma centers and 45.0 per cent hire new trauma surgeons as needed. Of the 272 respondents who decide whether or not a new trauma surgeon is hired, the recommendation of the residency and fellowship program director is important. Word of mouth was the most important manner of finding a new hire and the most important qualities of a new TSCC physician were personality and likeability. CONCLUSION: The survey revealed that well-trained, likeable, enthusiastic, and personable TSCC physicians are the best candidates for hire.

Uncemented vs Cemented Cruciate Retaining Total Knee Arthroplasty in Patients With Body Mass Index Greater Than 30.

BACKGROUND: Aseptic loosening of cemented and uncemented tibial components continues to be a source of implant failure after total knee arthroplasty (TKA) in the obese population. There is limited literature reviewing uncemented cruciate retaining (CR) components in the obese population. METHODS: A clinical and radiographic review was performed on 325 patients who underwent a cemented or uncemented TKA with a CR knee prosthesis and body mass index ≥30 kg/m2 between January 2010 and June 2013. Charts were reviewed for the incidence of revision due to aseptic loosening of the tibial baseplate, revision for any reason, incidence of radiolucent lines around the tibial baseplate, range of motion, and patient reported outcomes. RESULTS: There was no statistically significant difference between groups in survivorship for aseptic loosening of the tibial component (99.4% uncemented, 99.3% cemented, P = .94) and overall survivorship (98.1% uncemented, 98.3% cemented, P = .90). The Lower Extremity Activity Scale and Forgotten Joint Score-12 clinical outcome measures were similar between groups (10.2 ± 3.7 vs 9.7 ± 3.4 and 66.1 ± 28.2 vs 64.9 ± 24.3, P = .33, P = .78, respectively). Postoperative knee flexion was similar between groups (114.6 ± 9.3 vs 114.1 ± 9.3, P = .67). CONCLUSION: Our study demonstrated similar survivorship of this CR design for aseptic loosening of the tibial baseplate and overall revision rates in obese patients undergoing either an uncemented or cemented TKA. The uncemented and cemented groups had comparable clinical and radiographic short to mid-term outcomes when implanted in good alignment when treating end-stage knee osteoarthritis.

Bovid ecomorphology and hominin paleoenvironments of the Shungura Formation, lower Omo River Valley, Ethiopia.

The Shungura Formation in the lower Omo River Valley, southern Ethiopia, has yielded an important paleontological and archeological record from the Pliocene and Pleistocene of eastern Africa. Fossils are common throughout the sequence and provide evidence of paleoenvironments and environmental change through time. This study developed discriminant function ecomorphology models that linked astragalus morphology to broadly defined habitat categories (open, light cover, heavy cover, forest, and wetlands) using modern bovids of known ecology. These models used seven variables suitable for use on fragmentary fossils and had overall classification success rates of >82%. Four hundred and one fossils were analyzed from Shungura Formation members B through G (3.4-1.9 million years ago). Analysis by member documented the full range of ecomorph categories, demonstrating that a wide range of habitats existed along the axis of the paleo-Omo River. Heavy cover ecomorphs, reflecting habitats such as woodland and heavy bushland, were the most common in the fossil sample. The trend of increasing open cover habitats from Members C through F suggested by other paleoenvironmental proxies was documented by the increase in open habitat ecomorphs during this interval. However, finer grained analysis demonstrated considerable variability in ecomorph frequencies over time, suggesting that substantial short-term variability is masked when grouping samples by member. The hominin genera Australopithecus, Homo, and Paranthropus are associated with a range of ecomorphs, indicating that all three genera were living in temporally variable and heterogeneous landscapes. Australopithecus finds were predominantly associated with lower frequencies of open habitat ecomorphs, and high frequencies of heavy cover ecomorphs, perhaps indicating a more woodland focus for this genus.

American alligator proximal pedal phalanges resemble human finger bones: Diagnostic criteria for forensic investigators.

A scientific approach to bone and tooth identification requires analysts to pursue the goal of empirical falsification. That is, they may attribute a questioned specimen to element and taxon only after having ruled out all other possible attributions. This requires analysts to possess a thorough understanding of both human and non-human osteology, particularly so for remains that may be morphologically similar across taxa. To date, forensic anthropologists have identified several potential 'mimics' for human skeletal remains, including pig teeth and bear paws. Here we document another possible mimic for isolated human skeletal elements--the proximal pedal phalanges of American alligators (Alligator mississippiensis) closely resemble the proximal and intermediate hand phalanges of adult humans. We detail morphological similarities and differences between these elements, with the goal of providing sufficient information for investigators to confidently falsify the hypothesis that a questioned phalanx is derived from an American alligator.

Earliest archaeological evidence of persistent hominin carnivory.

The emergence of lithic technology by ≈ 2.6 million years ago (Ma) is often interpreted as a correlate of increasingly recurrent hominin acquisition and consumption of animal remains. Associated faunal evidence, however, is poorly preserved prior to ≈ 1.8 Ma, limiting our understanding of early archaeological (Oldowan) hominin carnivory. Here, we detail three large well-preserved zooarchaeological assemblages from Kanjera South, Kenya. The assemblages date to 2.0 Ma, pre-dating all previously published archaeofaunas of appreciable size. At Kanjera, there is clear evidence that Oldowan hominins acquired and processed numerous, relatively complete, small ungulate carcasses. Moreover, they had at least occasional access to the fleshed remains of larger, wildebeest-sized animals. The overall record of hominin activities is consistent through the stratified sequence - spanning hundreds to thousands of years - and provides the earliest archaeological evidence of sustained hominin involvement with fleshed animal remains (i.e., persistent carnivory), a foraging adaptation central to many models of hominin evolution.

Oldest evidence of tool making hominins in a grassland-dominated ecosystem.

BACKGROUND: Major biological and cultural innovations in late Pliocene hominin evolution are frequently linked to the spread or fluctuating presence of C(4) grass in African ecosystems. Whereas the deep sea record of global climatic change provides indirect evidence for an increase in C(4) vegetation with a shift towards a cooler, drier and more variable global climatic regime beginning approximately 3 million years ago (Ma), evidence for grassland-dominated ecosystems in continental Africa and hominin activities within such ecosystems have been lacking. METHODOLOGY/PRINCIPAL FINDINGS: We report stable isotopic analyses of pedogenic carbonates and ungulate enamel, as well as faunal data from approximately 2.0 Ma archeological occurrences at Kanjera South, Kenya. These document repeated hominin activities within a grassland-dominated ecosystem. CONCLUSIONS/SIGNIFICANCE: These data demonstrate what hitherto had been speculated based on indirect evidence: that grassland-dominated ecosystems did in fact exist during the Plio-Pleistocene, and that early Homo was active in open settings. Comparison with other Oldowan occurrences indicates that by 2.0 Ma hominins, almost certainly of the genus Homo, used a broad spectrum of habitats in East Africa, from open grassland to riparian forest. This strongly contrasts with the habitat usage of Australopithecus, and may signal an important shift in hominin landscape usage.

Accuracy of mild traumatic brain injury diagnosis.

OBJECTIVE: To determine how often emergency department (ED) patients meeting the Centers for Disease Control and Prevention (CDC) mild traumatic brain injury (TBI) criteria were diagnosed with a mild TBI by the ED physician. DESIGN: Prospective identification of cases of mild TBI in the ED by study personnel using scripted interviews and medical record data was compared with retrospective review of ED medical record documentation of mild TBI. SETTING: EDs of a level I trauma center and an academic nontrauma hospital. PARTICIPANTS: Prospective cohort of subjects (N=197; mean age, 32.6 y; 70% men) with arrival at the ED within 48 hours of injury, Glasgow Coma Scale score of 13 to 15, and injury circumstances, alteration of consciousness, and memory dysfunction consistent with the CDC mild TBI definition. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: ED medical record documentation of mild TBI. RESULTS: Fifty-six percent of mild TBI cases identified by study personnel did not have a documented mild TBI-related diagnosis in the ED record. The greatest agreement between study personnel and ED physicians for positive mild TBI-related findings was for loss of consciousness (72% vs 65%) with the greatest discrepancy for confusion (94% vs 28%). CONCLUSIONS: The diagnosis of mild TBI was frequently absent from ED medical records despite patients reporting findings consistent with a mild TBI diagnosis when interviewed by study personnel. Asking a few targeted questions of ED patients with likely mechanisms of injury that could result in mild TBI could begin to improve diagnosis and, in turn, begin to improve patient management and the accuracy of estimates of mild TBI incidence.

Partial cranium of Cercopithecoides kimeui Leakey, 1982 from Rawi Gully, southwestern Kenya.

The Rawi Gully, located on the Homa Peninsula in southwestern Kenya, has produced several fossil elements of a large cercopithecid from sediments approximately 2.5 million years old (Ma). Nearly all of these elements appear to represent a single adult male individual of the colobine species Cercopithecoides kimeui Leakey, 1982. Part of the face, mandible, dentition, and several small postcranial fragments were collected by the Homa Peninsula Paleoanthropological Project (HPPP) in 1994 and 1995. This individual also appears to be represented by material collected in two previous expeditions to the site, one led by David Pilbeam in the 1970s and an earlier expedition led by L.S.B. Leakey in 1933. This specimen may extend the first appearance of C. kimeui by approximately 500 Kyr, and provides the first evidence for much of the male facial morphology in this species. Furthermore, Rawi may represent a more wooded habitat than the other occurrences of C. kimeui at Olduvai Gorge, Tanzania, and Koobi Fora, Kenya, indicating that C. kimeui may have been relatively flexible in its habitat preferences.