Treatment of olecranon fractures in older individuals: a cross-sectional survey of surgeon treatment preferences.

Background: With an aging population, the incidence of olecranon fractures in older patients is increasing. The standard of care has traditionally included operative management for displaced fractures. Recent literature has called this standard of care into question. Older patients may be at increased risk of operative complications and may have satisfactory functional outcomes with nonoperative management. Given recently evolving evidence, the current treatment preferences of orthopedic surgeons for older patients with displaced olecranon fractures are unknown. Methods: We administered a cross-sectional survey of Canadian orthopedic surgeons via e-mail invitation and online survey form to determine treatment preferences for patients aged 65-75 and >75 years with simple displaced and comminuted displaced stable olecranon fractures. Respondents reviewed representative images and were asked to indicate their preferred treatment based on patient age. We also asked respondents to indicate their perceived importance of 11 patient factors on treatment decision-making. Results: We received 200 responses (33.8% response rate). For patients aged 65-75 years with simple displaced fractures, surgeons preferred tension-band wiring (n = 110, 56%) to plating (n = 82, 42%, P = .005), while only 3% (n = 5) preferred nonoperative treatment. For patients aged >75 years with simple displaced fractures, surgeons preferred operative (n = 144, 73%) to nonoperative management (n = 51, 26%; P < .01) with either tension-band wiring (n = 77, 39%) or plating (n = 67, 34%). In these patients, early range of motion (n = 35, 18%) was preferred to immobilization (n = 16, 8%; P = .004). For comminuted fractures, plate fixation was preferred for patients aged 65-75 years (n = 189, 95%) and >75 years (n = 131, 68%). In patients aged >75 years, this was followed by early range of motion (n = 35, 18%) and immobilization (n = 24, 13%). Of the 11 factors surveyed, participation in high-intensity activities (mean rank = 9.4), independent living (mean rank = 8.8), and disrupted extensor mechanism (mean rank = 8.3) were ranked most highly for increasing likelihood of surgical treatment. Conclusion: In patients aged 65 to 75 years, operative management is favored by most surgeons, with tension-band wiring preferred over plating for simple displaced fractures. In patients aged >75 years, operative management is again preferred by most respondents for simple and comminuted fractures. Despite operative preferences, there is a paucity of quality evidence to guide treatment decision-making, particularly in patients aged >75 years.

Do we fix front and back of every APC pelvic injury?

HISTORY-A 47-year-old male was on a cliff when he jumped into the water below. He jumped about 50 feet. Upon landing in the water, he felt his legs separate and abduct violently. He was taken to the Emergency unit of the nearest trauma center and was found to have no injuries except to his pelvis. He could not weight bear because of pelvic pain but had normal distal sensory and motor exam and rectal exam. His-pelvis was painful to examination anteriorly with minor left-sided posterior SI pain, and he had no blood at his meatus. X-rays and CT were done, (Figures 1-5).

Word segmentation from transcriptions of child-directed speech using lexical and sub-lexical cues.

We compare two frameworks for the segmentation of words in child-directed speech, PHOCUS and MULTICUE. PHOCUS is driven by lexical recognition, whereas MULTICUE combines sub-lexical properties to make boundary decisions, representing differing views of speech processing. We replicate these frameworks, perform novel benchmarking and confirm that both achieve competitive results. We develop a new framework for segmentation, the DYnamic Programming MULTIple-cue framework (DYMULTI), which combines the strengths of PHOCUS and MULTICUE by considering both sub-lexical and lexical cues when making boundary decisions. DYMULTI achieves state-of-the-art results and outperforms PHOCUS and MULTICUE on 15 of 26 languages in a cross-lingual experiment. As a model built on psycholinguistic principles, this validates DYMULTI as a robust model for speech segmentation and a contribution to the understanding of language acquisition.

Shibboleth: An agent-based model of signalling mimicry.

Mimicry is an essential strategy for exploiting competitors in competitive co-evolutionary relationships. Protection against mimicry may, furthermore, be a driving force in human linguistic diversity: the potential harm caused by failing to detect mimicked group-identity signals may select for high sensitivity to mimicry of honest group members. Here we describe the results of five agent-based models that simulate multi-generational interactions between two groups of individuals: original members of a group with an honest identity signal, and members of an outsider group who mimic that signal, aiming to pass as members of the in-group. The models correspond to the Biblical story of Shibboleth, where a tribe in conflict with another determines tribe affiliation by asking individuals to pronounce the word, 'Shibboleth.' In the story, failure to reproduce the word phonetically resulted in death. Here, we run five different versions of a 'Shibboleth' model: a first, simple version, which evaluates whether a composite variable of mimicry quality and detection quality is a superior predictor to the model's outcome than is cost of detection. The models thereafter evaluate variations on the simple model, incorporating group-level behaviours such as altruistic punishment. Our results suggest that group members' sensitivity to mimicry of the Shibboleth-signal is a better predictor of whether any signal of group identity goes into fixation in the overall population than is the cost of mimicry detection. Thus, the likelihood of being detected as a mimic may be more important than the costs imposed on mimics who are detected. This suggests that theoretical models in biology should place greater emphasis on the likelihood of detection, which does not explicitly entail costs, rather than on the costs to individuals who are detected. From a language learning perspective, the results suggest that admission to group membership through linguistic signals is powered by the ability to imitate and evade detection as an outsider by existing group members.

Lateral Patellar Instability.

➤: Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient. ➤: Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity. ➤: Cartilage or osteochondral lesions and/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment. ➤: Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability. ➤: Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation. ➤: Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (>20 mm), and/or in the setting of patella alta. ➤: The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding. ➤: Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of >30° to improve patient outcomes and reduce recurrence rates.

Open Reduction Internal Fixation Versus Distal Femoral Replacement (DFR) for Treatment of OTA/AO 33C Fractures in the Elderly: A Review of Functional Outcomes and Cost Analysis.

OBJECTIVES: To determine the economic cost associated with the treatment of OTA/AO 33C fractures in patients older than 65 years of age using open reduction internal fixation (ORIF) or DFR and to assess the perioperative outcomes of elderly patients treated surgically following OTA/AO 33C fractures. DESIGN: Retrospective cohort over a 10-year period. SETTING: A single level-1 trauma center. PARTICIPANTS AND INTERVENTION: Thirty-nine patients 65 or older with OTA/AO 33C fractures who underwent treatment with ORIF (n = 27) or DFR (n = 12) were included. MAIN OUTCOME MEASUREMENTS: Direct cost associated with surgical treatment along with LOS, functional outcomes, patient-reported outcomes, and all-cause reoperation. RESULTS: Index procedure costs were as follows: DFR: $ 61,259 vs. ORIF: $44,490 (P = 0.056). Five (20%) ORIF patients required revision versus one (8%) in the DFR group. Total cost when including reoperation resulted in DFR being $14,805 more costly, which was not significant. Hospital LOS was similar between groups; however, convalescent LOS was longer in ORIF patients (43.2 vs. 23.1 days, P = 0.02). CONCLUSION: This study demonstrates that there is no significant difference in overall cost between ORIF and DFR when all costs are considered. A larger portion of DFR patients were able to mobilize postoperatively, with subacute length of stay being longer in ORIF patients. A multicenter trial is warranted to determine optimal treatment for this complex problem. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The cross-linguistic performance of word segmentation models over time.

We select three word segmentation models with psycholinguistic foundations - transitional probabilities, the diphone-based segmenter, and PUDDLE - which track phoneme co-occurrence and positional frequencies in input strings, and in the case of PUDDLE build lexical and diphone inventories. The models are evaluated on caregiver utterances in 132 CHILDES corpora representing 28 languages and 11.9 m words. PUDDLE shows the best performance overall, albeit with wide cross-linguistic variation. We explore the reasons for this variation, fitting regression models to performance scores with linguistic properties which capture lexico-phonological characteristics of the input: word length, utterance length, diversity in the lexicon, the frequency of one-word utterances, the regularity of phoneme patterns at word boundaries, and the distribution of diphones in each language. These properties together explain four-tenths of the observed variation in segmentation performance, a strong outcome and a solid foundation for studying further variables which make the segmentation task difficult.

TEAM: A Low-Cost Alternative to ATLS for Providing Trauma Care Teaching in Haiti.

OBJECTIVE: Trauma resuscitation protocols have unified the care of trauma patients and significantly improved outcomes. However, the success of the Advanced Trauma Life Support course is difficult to reproduce in developing countries due to set-up costs, limitations of resources, and variations of practice. The objective of this study is to assess the Trauma Evaluation and Management (TEAM) course as a low-cost alternative for trauma resuscitation teaching in Low and Middle Income Countries (LMIC). DESIGN: As part of the Team Broken Earth initiative, TEAM course was provided to the health care professionals in Haiti. At its conclusion, participants were asked to complete a survey evaluating the course. Qualitative and quantitative data were analyzed to evaluate the perception of the course. SETTING: The course was provided in Port-au-Prince, Haiti. PARTICIPANTS: A total of 80 health care professionals participated in the course. Response was obtained from 69 participants, which comprised of 32 physicians, 10 Emergency Medical Technicians (EMT), 22 nurses, and 5 medical trainees. RESULTS: The course was well received by physicians, nurses, and EMT with an average score of 90.6%. Question analysis revealed a lower satisfaction of physicians for the course manual and teaching materials, and information related to decisions for transfer of patients. EMT consistently felt that the course was not tailored to their learning and practice needs. Written feedback demonstrated several areas of weaknesses including need for improvements in translations, hands-on practice, and educational materials. CONCLUSIONS: Overall, the TEAM course was well received. Analysis demonstrated a need for adjustments specific to LMIC including a focus on prehospital assessment, increased nursing responsibilities, and unavailability of specialist's referrals. Team Broken Earth intends to take these findings into consideration and continue to provide the TEAM course to other LMIC.

Automatically identifying the function and intent of posts in underground forums.

The automatic classification of posts from hacking-related online forums is of potential value for the understanding of user behaviour in social networks relating to cybercrime. We designed annotation schema to label forum posts for three properties: post type, author intent, and addressee. The post type indicates whether the text is a question, a comment, and so on. The author's intent in writing the post could be positive, negative, moderating discussion, showing gratitude to another user, etc. The addressee of a post tends to be a general audience (e.g. other forum users) or individual users who have already contributed to a threaded discussion. We manually annotated a sample of posts and returned substantial agreement for post type and addressee, and fair agreement for author intent. We trained rule-based (logical) and machine learning (statistical) classification models to predict these labels automatically, and found that a hybrid logical-statistical model performs best for post type and author intent, whereas a purely statistical model is best for addressee. We discuss potential applications for this data, including the analysis of thread conversations in forum data and the identification of key actors within social networks.

Effect of using a suspension training system on muscle activation during the performance of a front plank exercise.

The objective of the study was to examine the effect of suspension training on muscle activation during performance of variations of the plank exercise. Twenty-one participants took part. All individuals completed 2 repetitions each of 4 different plank exercises that consisted of a floor based plank, or planks with arms suspended, feet suspended, or feet and arms suspended using a TRX Suspension System. During plank performance, muscle activation was recorded from rectus abdominis, external oblique, rectus femoris, and serratus anterior (SA) muscles using electromyography. All planks were performed for a total of 3 seconds. Resulting muscle activation data were amplitude normalized, and root mean square activation was then determined over the full 3 second duration of the exercise. A significant main effect of plank type was found for all muscles. Post hoc analysis and effect size examination indicated that abdominal muscle activation was higher in all suspended conditions compared to the floor based plank. The highest level of abdominal muscle activation occurred in the arms suspended and arms/feet suspended conditions, which did not differ from one another. Rectus femoris activation was greatest during the arms suspended condition, whereas SA activity peaked during normal and feet suspended planks. These results indicate that suspension training as performed in this study seems to be an effective means of increasing muscle activation during the plank exercise. Contrary to expectations, the additional instability created by suspending both the arms and feet did not result in any additional abdominal muscle activation. These findings have implications in prescription and progression of core muscle training programs.