Orbital roof fractures as an indicator for concomitant ocular injury.

BACKGROUND: Orbital roof fractures are a significant cause of morbidity in trauma and are associated with a spectrum of orbital and ocular injuries. This study aims to characterize orbital roof fracture patterns and quantify the rate of acute intervention as compared with non-roof involving orbital wall fractures. METHODS: This study is a retrospective analysis of 340 orbital wall fractures diagnosed by CT imaging from August 2015 to October 2016. Orbital wall fractures were categorized as roof involving (N = 50) and non-roof involving (N = 290). Comparisons were made between these two groups to indicate a statistically significant difference in mechanism of injury, subjective symptoms, CT and exam findings, and final plan of care to include acute ophthalmologic intervention at the time of consultation. RESULTS: Assault (40.7%) was the most common cause of non-roof-involving fractures while falls from height (20.0%) were associated with a higher rate of roof fractures. Roof-involving orbital wall fractures were associated with a higher prevalence of corneal abrasions (16.3%), lid lacerations (23.4%), and traumatic optic neuropathy (10.4%). A reliable subjective exam on initial ophthalmic consultation was not achieved in a larger proportion of roof fracture patients (30%). Despite this, the rate of acute intervention in this group (34%) was almost double, including lateral canthotomy and cantholysis. CONCLUSIONS: Concomitant ocular injury is common in roof-involving orbital wall fractures, and may require more urgent ophthalmologic evaluation and acute intervention. As subjective patient data is often less readily available, a high index of suspicion and thorough investigation is warranted in caring for patients with roof-involving orbital wall fractures.

Erysipeloid lesions caused by Erysipelothrix rhusiopathiae in a dog: clinical and histopathological findings, molecular diagnosis and treatment.

BACKGROUND: Erysipelothrix rhusiopathiae is a widespread Gram-positive, nonsporulating rod bacterium predominantly associated with skin disease in swine and cetaceans. Cutaneous lesions have yet to be described in dogs. OBJECTIVE: To describe the clinical presentation, molecular and histopathological diagnosis, and treatment of a case of erysipeloid caused by E. rhusiopathiae in a dog. ANIMALS: A 6-month-old spayed female standard poodle dog presented with lethargy, fever, vomiting and diarrhoea. Skin lesions appeared 20 days post first examination. METHODS AND MATERIALS: Complete blood count, serum chemistry profile, urinalysis, urine culture, blood culture, computed topography, forelimb radiography, joint and cerebrospinal fluid aspiration were performed; samples were collected for skin cytological evaluation, culture and histopathological analysis. RESULTS: Blood cultures yielded Gram-positive, catalase-negative bacilli. Histopathological evaluation of skin biopsies revealed lymphoplasmacytic, neutrophilic and histiocytic perivascular and periadnexal dermatitis, and vasculitis. Cutaneous and blood PCR and sequencing of 16S rRNA identified the bacteria as E. rhusiopathiae. Clinical resolution was observed following the use of of amoxicillin/clavulanic acid and ciprofloxacin therapies. CONCLUSIONS AND CLINICAL IMPORTANCE: To the best of the authors' knowledge, this is the first confirmed case of erysipeloid caused by E. rhusiopathiae in a dog. Clinical resolution was attained with the extended use of antibiotics. After 13 months, no clinical signs had returned.

A randomized crossover study comparing two mandibular repositioning appliances for treatment of obstructive sleep apnea.

PURPOSE: The purpose of this study was to determine whether treatment outcomes vary according to the design of the mandibular repositioning appliance (MRA). Two titratable MRA's were compared. The designs differ in advancement hardware and configuration of acrylic both in bulk and interocclusal contact. MATERIALS AND METHODS: The primary treatment outcome was the Respiratory Disturbance Index (RDI). Other outcomes that were compared included Sleep Apnea Quality of Life Index (SAQLI), Epworth Sleepiness Scale, oxygen saturation, and subjective feedback regarding experiences with the appliances. Twenty-four subjects were recruited from consecutive referrals for MRA therapy following diagnosis of obstructive sleep apnea (OSA) by polysomnography. Subjects were randomly assigned to a treatment arm of the crossover study. Each subject underwent an initial sleep study with a type III home monitor to establish a baseline RDI. Subjects were then treated with one of the two MRAs determined by random assignment. The MRA self-titration phase was monitored until a treatment position was determined, and the home sleep study was repeated. After a 2-week period without any OSA treatment, subjects received the second MRA and the self-titration treatment protocol was repeated. At completion of treatment with each appliance, subjects answered questionnaires and underwent a sleep study with the type III monitor. The outcome data for each appliance were compared using analysis of variance. RESULTS: Eighteen subjects completed the treatment protocol. There were no significant statistical differences in treatment outcomes between the two appliances. There was a statistically significant (p ≤ 0.05) preference for a MRA design with minimal coverage of teeth and palate. The subjects' appliance selection was consistent with a corresponding reduction in SAQLI score for the selected appliance. CONCLUSION: Although no statistically significant difference was observed between the two appliances in the outcomes measured, there was a trend toward greater improvement with the appliance with less acrylic resin bulk and less interocclusal contact. MRA selection should favor titratable, unobtrusive designs with appropriate construction to promote acceptance and adherence to MRA therapy.

Opportunities and challenges for public libraries to enhance community resilience.

This study bridges a gap between public library and emergency management policy versus practice by examining the role of public libraries in the community resource network for disaster recovery. Specifically, this study identifies the opportunities and challenges for public libraries to fulfill their role as a FEMA-designated essential community organization and enhance community resilience. The results indicate there are several opportunities for libraries to enhance community resilience by offering technology resources and assistance; providing office, meeting, and community living room space; serving as the last redundant communication channel and a repository for community information and disaster narratives; and adapting or expanding services already offered to meet the changing needs of the community. However, libraries also face challenges in enhancing community resilience, including the temptation to overcommit library capacity and staff capability beyond the library mission and a lack of long-term disaster plans and collaboration with emergency managers and government officials. Implications for library and emergency management practice and crisis research are discussed.

Data Science Curriculum in the iField.

Many disciplines, including the broad Field of Information (iField), have been offering Data Science (DS) programs. There have been significant efforts exploring an individual discipline's identity and unique contributions to the broader DS education landscape. To advance DS education in the iField, the iSchool Data Science Curriculum Committee (iDSCC) was formed and charged with building and recommending a DS education framework for iSchools. This paper reports on the research process and findings of a series of studies to address important questions: What is the iField identity in the multidisciplinary DS education landscape? What is the status of DS education in iField schools? What knowledge and skills should be included in the core curriculum for iField DS education? What are the jobs available for DS graduates from the iField? What are the differences between graduate-level and undergraduate-level DS education? Answers to these questions will not only distinguish an iField approach to DS education but also define critical components of DS curriculum. The results will inform individual DS programs in the iField to develop curriculum to support undergraduate and graduate DS education in their local context.

The Association Between Obstructive Sleep Apnea and Cotton-Wool Spots in Nonproliferative Diabetic Retinopathy.

Purpose: This work reports the association of obstructive sleep apnea (OSA) and cotton-wool spots (CWS) seen in patients with nonproliferative diabetic retinopathy (DR). Methods: A random sample of patients diagnosed with DR between January 1, 2015 and December 31, 2018, were selected from medical-billing codes. Dilated funduscopic examination findings and medical history were analyzed by reviewing medical records. Results: CWS were present in 12 of 118 patients without OSA, compared with 11 of 32 patients with OSA (10.2% vs 34.4%, respectively; P = .002). OSA was more common in men (68.8%, P = .03) and associated with a higher body mass index (30.0 ± 5.0 without OSA vs 33.6 ± 5.5 with OSA, P < .001). When comparing those with and without OSA, there was no association with age; glycated hemoglobin A1c; stage of DR; insulin dependence; presence of diabetic macular edema; smoking status; or a history of hypertension, hyperlipidemia, cardiovascular disease, or other breathing disorder. Conclusions: The presence of OSA is associated with CWS in patients with DR, as well as male sex and a higher body mass index. Further research is needed to determine the ophthalmologist's role in the timely referral of patients with CWS for OSA evaluation.

Biomechanical comparison of two percutaneous gastropexy techniques for securing percutaneous endoscopic gastrostomy tubes in canine cadavers.

OBJECTIVE: To biomechanically assess outcomes for 2 percutaneous gastropexy techniques and determine the amount of time necessary to perform the techniques for securing percutaneous endoscopic gastrostomy (PEG) tubes in canine cadavers. ANIMALS: 18 canine cadavers. PROCEDURES: 6 cadavers were assigned to each of 3 groups (PEG tube only, PEG tube with T-fastener gastropexy, and PEG tube with U-stitch gastropexy). Time to completion of placement of a PEG tube and gastropexy was recorded. After tubes were placed, the stomach and body wall on the left side of the abdomen were removed and biomechanically tested. Maximum tension at the time of initial failure of the PEG tube or gastropexy was recorded. RESULTS: Significantly more force was required to induce failure for the T-fastener and U-stitch techniques than for the PEG tube only technique. In addition, both the T-fastener and U-stitch techniques required significantly more time for placement than did the PEG tube only technique. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that performing a T-fastener or U-stitch gastropexy may decrease the risk of early dislodgement of a PEG tube in dogs. However, studies conducted with these techniques in live dogs would be necessary to confirm this hypothesis. The additional amount of time needed to perform the T-fastener or U-stitch gastropexy would likely be clinically unimportant.

Endoscopic-guided laser lithotripsy for removal of an encrusted ureteral stent in a dog.

CASE DESCRIPTION: An 8-year-old spayed female Dalmatian was evaluated because of recurrent urinary tract infections following ureteral stent placement 3 years earlier. CLINICAL FINDINGS: Polyuria, pollakiuria, and hematuria were reported by the owner. Abdominal radiography revealed well-defined, faintly mineralized material superimposed over the distal portion of the previously placed ureteral stent. Abdominal ultrasonography revealed thickening of the bladder wall, right hydroureter, and right pyelectasia; the ureteral stent appeared to extend into a region containing cystic calculi. Cystoscopy revealed small uroliths and mineralized encrustation of the distal portion of the ureteral stent. TREATMENT AND OUTCOME: A holmium:yttrium-aluminum-garnet laser was used to fragment mineralized material from the distal end of the stent and allow endoscopic transurethral removal. Stone analysis revealed ammonium urate as the major component of the mineralized material. The owner was instructed to feed the dog a diet formulated to decrease the likelihood of urate stone recurrence and to administer marbofloxacin for 6 weeks because of suspected pyelonephritis. Follow-up bacterial culture of a urine sample and abdominal ultrasonography revealed resolution of urinary tract infection, pyelectasia, hydroureter, and associated clinical signs. CLINICAL RELEVANCE: Results suggested that endoscopic-guided laser lithotripsy can be used as a minimally invasive alternative to surgery for removal of severely encrusted ureteral stents in dogs.

Redundant manipulator techniques for partially decentralized path planning and control of a platoon of autonomous vehicles.

An approach to real-time trajectory generation for platoons of autonomous vehicles is developed from well-known control techniques for redundant robotic manipulators. The partially decentralized structure of this approach permits each vehicle to independently compute its trajectory in real-time using only locally generated information and low-bandwidth feedback generated by a system exogenous to the platoon. Our work is motivated by applications for which communications bandwidth is severely limited, such for platoons of autonomous underwater vehicles. The communication requirements for our trajectory generation approach are independent of the number of vehicles in the platoon, enabling platoons composed of a large number of vehicles to be coordinated despite limited communication bandwidth.

Role of benzylsuccinate in the induction of the tutE tutFDGH gene complex of T. aromatica strain T1.

Expression of the tutE tutFDGH gene cluster of Thauera aromatica strain T1 was examined by Northern and Western analysis in a wild-type strain and chromosomally deleted strains with or without in-frame deletion plasmids. While expression was observed when the wild-type strain was induced with toluene, various chromosomally deleted strains exhibited little or no expression of the tut genes. In contrast, both wild-type and chromosomally deleted strains expressed the tut genes when induced with benzylsuccinate. We conclude that benzylsuccinate is required for the full induction of the tutE tutFDGH gene cluster of T. aromatica strain T1.