Hook of Hamate Fractures in Major and Minor League Baseball Players.

PURPOSE: The purpose of this study was to describe an approach to surgical management of the hook of hamate fractures in professional baseball players. METHODS: A retrospective chart review was performed on Major and Minor League Baseball players who underwent surgical excision for the hook of hamate fracture between the years 2003 and 2019 by a single surgeon. Patient demographics, the mechanism and timing of the injury, diagnostic and operative details, postoperative complications, and timeline to return to baseball activities were recorded. RESULTS: A total of 145 professional baseball players affiliated with 17 Major League Baseball organizations were studied, with the majority of athletes playing at the Minor League Baseball level (91.7%). Subacute or chronic patterns of injury (81.7%) were found to be more common than acute patterns based on radiographic and intraoperative findings. Two patients reported transient numbness in the fourth and fifth digits after surgery, 6 patients reported pisotriquetral pain when returning to a hitting program, and 1 patient developed heterotopic ossification after surgery. All complications resolved during a strength and conditioning program. On average, players in our cohort began a hitting program at 4.6 weeks after surgery and were released into full baseball activities at 7.1 weeks after surgery. CONCLUSIONS: Surgical excision remains an effective method of management, with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Level IV.

Nonoccupational Postexposure Human Immunodeficiency Virus Prophylaxis: Acceptance Following Sexual Assault.

BACKGROUND: Nonoccupational postexposure prophylaxis (nPEP) for HIV following sexual assault may decrease the likelihood of HIV transmission. OBJECTIVE: The purpose of this exploratory chart review study was to examine factors associated with patients accepting post-sexual assault nPEP at three forensic nurse examiner programs in urban settings. METHODS: Forensic nursing charts of patients presenting for acute sexual assault care were reviewed as part of a mixed-methods study. RESULTS: Patients assaulted by more than one or an unknown number of assailants were over 12 times more likely to accept the offer of nPEP (adjusted odds ratio [aOR] = 12.66, 95% CI [2.77, 57.82]). In cases where no condom was used (aOR = 8.57, 95% CI [1.59, 46.10]) or when any injury to the anus or genitalia was noted (aOR = 4.10, 95% CI [1.57, 10.75]), patients were more likely to accept nPEP. Patients with any injury to the face or head were less likely to initiate nPEP (aOR = 0.32, 95% CI [0.11, 0.97]). DISCUSSION: This study is an important first step in understanding factors associated with nPEP acceptance after sexual assault.

Assessing stimulus preference using response force in a conjugate preparation: A replication and extension.

The current study examined 98 participants' preferences for five pictorial stimuli. The researchers used a verbal multiple-stimulus-without-replacement (VMSWO) preference assessment with each participant to identify high-preference and low-preference pictorial stimuli. Next, participants viewed each pictorial stimulus in a randomized order on a computer while using a hand dynamometer that measured the amount of force they exerted to increase or maintain the visual clarity of each image. The results indicate that over 75% of participants' force response ranks corresponded with participants' VMSWO high-preference stimuli, VMSWO low-preference stimuli, or both. The results of the current study provide further evidence for the use of conjugate schedules in the assessment of stimulus preference with potential for use as a reinforcer assessment. Implications along with directions for future research and limitations of the findings are discussed.

Evaluating the network adequacy of vision care services for children in Arizona: A cross sectional study.

Background: Vision challenges are among the most prevalent disabling conditions in childhood, affecting up to 28% of school-age children. These issues can impact the development, learning, and literacy skills of affected children. While vision problems are correctable with timely diagnosis and treatment, insufficient networks can impede children's access to comprehensive, and high-quality care. Objective: The study aims to determine where pediatric vision care network adequacy exists in the state of Arizona and where there are gaps in receiving vision care for children. Methods: This cross-sectional study assessed the adequacy of pediatric vision care networks in Arizona through a "secret shopper" phone survey. Calls were made to practices that accept Arizona's Medicaid program, Arizona Health Care Cost Containment System (AHCCCS) and/or commercial insurance. Providers were contacted following a standardized script to schedule routine appointments on behalf of 10 and 3-year-old patients enrolled in either Medicaid or commercial health insurance plans. The study examined various components of children's access to vision care services, including the reliability of provider directory information, time until the next available appointment, bilingual service offerings, ages served, region of practice and types of care available. Results: A total of 556 practices in Arizona were evaluated through simulations as patients on AHCCCS, and 510 practices were assessed through simulations as patients with commercial health insurance plans. The average wait time for the next available appointment was 13 days for both insurance types. Alarmingly, up to 74% of vision care practices in Arizona do not serve children covered by AHCCCS. Furthermore, only 41% provide services to children 5 years and younger. Conclusions: Our findings underscore the need to improve access to vision care services for children in Arizona, especially racial/ethnic minorities, low-income groups, and rural residents.

Evaluating change in bruise colorimetry and the effect of subject characteristics over time.

UNLABELLED: Forensic clinicians are routinely asked to estimate the age of cutaneous bruises. Unfortunately, existing research on noninvasive methods to date bruises has been mostly limited to relatively small, homogeneous samples or cross-sectional designs. PURPOSE: The purpose of this prospective, foundational study was to examine change in bruise colorimetry over time and evaluate the effects of bruise size, skin color, gender, and local subcutaneous fat on that change. METHOD: Bruises were created by a controlled application of a paintball pellet to 103 adult, healthy volunteers. Daily colorimetry measures were obtained for four consecutive days using the Minolta Chroma-meter(®). The sample was nearly equal by gender and skin color (light, medium, dark). Analysis included general linear mixed modeling (GLMM). RESULTS: Change in bruise colorimetry over time was significant for all three color parameters (L*a*b*), the most notable changes being the decrease in red (a*) and increase in yellow (b*) starting at 24 h. Skin color was a significant predictor for all three colorimetry values but sex or subcutaneous fat levels were not. Bruise size was a significant predictor and moderator and may have accounted for the lack of effect of gender or subcutaneous fat. CONCLUSION: Study results demonstrated the ability to model the change in bruise colorimetry over time in a diverse sample of healthy adults. Multiple factors, including skin color and bruise size must be considered when assessing bruise color in relation to its age. This study supports the need for further research that could build the science to allow more accurate bruise age estimations.

Sex differences in interpersonal problems: does sexual orientation moderate?

Sexual orientation was examined as a moderator in the relation between biological sex and interpersonal problems. Participants were 60 lesbians, 45 heterosexual women, 37 gay men, and 39 heterosexual men, who completed the Inventory of Interpersonal Problems-Circumplex. Sexual orientation was found to moderate one of the eight interpersonal problems under study. Heterosexual women scored significantly higher than lesbian women in Non-assertive. Although hypothesized, gay men did not differ from heterosexual men along the Dominant-Cold quadrant. Implications of these results are discussed.

SOX9-positive pituitary stem cells differ according to their position in the gland and maintenance of their progeny depends on context.

Stem cell (SC) differentiation and maintenance of resultant progeny underlie cell turnover in many organs, but it is difficult to pinpoint the contribution of either process. In the pituitary, a central regulator of endocrine axes, adult SCs undergo activation after target organ ablation, providing a well-characterized paradigm to study an adaptative response in a multi-organ system. Here, we used single-cell technologies to characterize SC heterogeneity and mobilization together with lineage tracing. We show that SC differentiation occurs more frequently than thought previously. In adaptative conditions, differentiation increases and is more diverse than demonstrated by the lineage tracing experiments. Detailed examination of SC progeny suggests that maintenance of selected nascent cells underlies SC output, highlighting a trophic role for the microenvironment. Analyses of cell trajectories further predict pathways and potential regulators. Our model provides a valuable system to study the influence of evolving states on the mechanisms of SC mobilization.

Case report: Dendritic cell-cytokine induced killer cell therapy in subjects with chronic lymphocytic leukemia and peritoneal cancer.

This study aimed to characterize the safety and efficacy of DC-CIK therapy in two patients with previously treated chronic lymphocytic leukemia or peritoneal cancer, respectively. Participants had received conventional chemotherapy treatment for their specific cancers, and in addition, 1-2 treatments of DC-CIK therapy were administered to subjects over the course of 1 year. Subject A received an initial dosage of 3 intravenous infusions of DC-CIK therapy on three successive days and a repeat dosage 6 months later. Subject B received an initial dosage of 3 intravenous infusions of DC-CIK therapy on three successive days and received further chemotherapy after approximately 1 year. No treatment-related adverse events were reported, and both patients experienced favorable outcomes from the treatment, including enhanced treatment response, increased chemotherapy tolerance, and prolonged survival in comparison to typical 5-year survival rates.

Nonoccupational postexposure prophylaxis following sexual assault in industrialized low-HIV-prevalence countries: a review.

Although available for over a decade, use of nonoccupational postexposure prophylaxis (nPEP) remains controversial in the United States. There are concerns over sexual assault survivors' adherence, or lack thereof, leading to increased costs without an appreciable decrease in human immunodeficiency virus (HIV) transmission. This review examines and synthesizes the available literature from the past 10 years to determine the true rates of provision and adherence to nPEP regimens in sexual assault survivors in low HIV prevalence, industrialized nations. Findings suggest that further prospective research is necessary to better understand the process of post-assault nPEP evaluation and subsequent follow-up and adherence.

Female genital injury following consensual and nonconsensual sex: state of the science.

INTRODUCTION: Nurses who evaluate patients following sexual assault are often faced with the task of identifying genital injuries and providing legal testimony regarding the nature of the injuries. Following a 2000 Virginia State court decision, sexual assault nurse examiners have had to struggle to answer the questions, "Are the genital injuries consistent with the patient's history?" and "Are the genital injuries consistent with sexual assault?" METHODS: A search of the relevant scientific literature was conducted. Sources were examined and reviewed to identify what is presently known about adult female genital injuries associated with either consensual or nonconsensual sexual intercourse. RESULTS: Female genital injuries occur with both consensual and nonconsensual sexual contact. Although some studies suggest that differences in injury patterns, types, or locations may exist, the data do not unequivocally confirm these findings. DISCUSSION: Currently, the presence or absence of genital injury should not be used to render an opinion regarding consent to sexual intercourse. Further research is necessary to determine if injury patterns can indeed distinguish consensual from nonconsensual sex.

Predicting alternate light absorption in areas of trauma based on degree of skin pigmentation: Not all wavelengths are equal.

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n = 2777, 11.2%; 450 nm: n = 2747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n = 2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

Evaluation of a workplace bullying cognitive rehearsal program in a hospital setting.

Workplace bullying is a serious problem faced by nurses nationally. This study was conducted to determine the frequency of workplace bullying and evaluate the effectiveness of a training program on cognitive rehearsal of responses to common bullying behaviors. This program to increase staff nurses' knowledge of management of workplace bullying consisted of three components: pilot survey testing, a piloted Internet-based survey administered to the medical and surgical nurses, and a 2-hour cognitive rehearsal training program on management of workplace bullying. The results showed that 80% of the nurses surveyed had experienced workplace bullying over the previous year. After the training program, nurses' knowledge of workplace bullying management significantly increased. Additionally, nurses were significantly more likely to report that they had observed bullying and had bullied others. Further, nurses felt more adequately prepared to handle workplace bullying. Results of the research support the provision of a workplace bullying management program for nurses and the need for a specific policy on workplace bullying.