bluuebunny/crossref_metadata_2025 huggingface dataset:
Moisture Migration in Buildings
Authors: Lieff M , Trechsel HR
Published: March 2009

Description

This publication contains 19 papers on the subject of moisture migration in buildings. It is divided into four sections, the first one covering roofing, the second dealing with walls, the third with standards and test methods, and the fourth with general topics.
Materials Evaluation Under Fretting Conditions
Authors: Brown SR
Published: March 2009

Description

This volume presents a state of the art review of the equipment, devices, and techniques available for controlling fretting test conditions and for assessing damage. The papers comprising the contents address topics such ad: the systematic investigation of fretting phenomena and fretting damage, fretting test devices, the involvement of computers in controlling conditions and correlation results, methods of preventing fretting, and the effects of various factors on fretting wear.
Prevalence of Viral Erythrocytic Necrosis in Pacific Herring and Epizootics in Skagit Bay, Puget Sound, Washington
Authors: Hershberger P. K. , Elder N. E. , Grady C. A. , Gregg J. L. , Pacheco C. A. , Greene C. , Rice C. , Meyers T. R.
Published: March 2009

Epizootics of viral erythrocytic necrosis (VEN) occurred among juvenile Pacific herring Clupea pallasii in Skagit Bay, Puget Sound, Washington, during 2005–2007 and were characterized by high prevalences and intensities of cytoplasmic inclusion bodies within circulating erythrocytes. The prevalence of VEN peaked at 67% during the first epizootic in October 2005 and waned to 0% by August 2006. A second VEN epizootic occurred throughout the summer of 2007; this was characterized by disease initiation and perpetuation in the age-1, 2006 year-class, followed by involvement of the age-0, 2007 year-class shortly after the latter's metamorphosis to the juvenile stage. The disease was detected in other populations of juvenile Pacific herring throughout Puget Sound and Prince William Sound, Alaska, where the prevalences and intensities typically did not correspond to those observed in Skagit Bay. The persistence and recurrence of VEN epizootics indicate that the disease is probably common among juvenile Pacific herring throughout the eastern North Pacific Ocean, and although population-level impacts probably occur they are typically covert and not easily detected.
A Predictive Index of Biotic Integrity Model for Aquatic‐Vertebrate Assemblages of Western U.S. Streams
Authors: Pont Didier , Hughes Robert M. , Whittier Thomas R. , Schmutz Stefan
Published: March 2009

Because of natural environmental and faunal differences and scientific perspectives, numerous indices of biological integrity (IBIs) have been developed at local, state, and regional scales in the USA. These multiple IBIs, plus different criteria for judging impairment, hinder rigorous national and multistate assessments. Many IBI metrics are calibrated for water body size, but none are calibrated explicitly for other equally important natural variables such as air temperature, channel gradient, or geology. We developed a predictive aquatic‐vertebrate IBI model using a total of 871 stream sites (including 162 least‐disturbed and 163 most‐disturbed sites) sampled as part of the U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program survey of 12 conterminous western U.S. states. The selected IBI metrics (calculated from both fish and aquatic amphibians) were vertebrate species richness, benthic native species richness, assemblage tolerance index, proportion of invertivore‐piscivore species, and proportion of lithophilic‐reproducing species. Mean model IBI scores differed significantly between least‐disturbed and most‐disturbed sites as well as among ecoregions. Based on a model IBI impairment criterion of 0.44 (risks of type I and II errors balanced), an estimated 34.7% of stream kilometers in the western USA were deemed impaired, compared with 18% for a set of traditional IBIs. Also, the model IBI usually displayed less variability than the traditional IBIs, presumably because it was better calibrated for natural variability.
Sir Alfred Pugsley OBE, FREng, FRS (1903–1998): his legacy
Authors: Gill J. A. , Muir Wood D. , Blockley D. I. , Sellin R. H. J.
Published: March 2009

Sir Alfred Pugsley's career involved work on aircraft structures and structural engineering from the 1920s onwards. A large archive of his working papers has recently been presented to the University of Bristol, where he was professor of civil engineering from 1945 to 1968. These papers, covering a significant period of development of structural understanding and approaches to structural safety, have recently been catalogued in some detail. The papers cover a wide range of topics based on structural mechanics and structural engineering. Two subjects have been chosen for discussion in this paper to show how Sir Alfred's work is relevant to, and has influenced, current engineering practice: structural safety and suspension bridges. Practising engineers will find that much of the thinking contained in Pugsley's papers is pertinent to today's need for simple, easy-to-understand methods applicable to structural engineering.
Toxicity of two insecticides to california, USA, anurans and its relevance to declining amphibian populations
Authors: Sparling Donald W. , Fellers Gary M.
Published: March 2009

Contaminants have been associated with population declines of several amphibian species in California (USA). Pesticides from the Central Valley of California are transported by winds into the Sierra Nevada Mountains and precipitate into wet meadows where amphibians breed. The present study examined the chronic toxicity of two of the insecticides most commonly used in the Central Valley and found in the mountains, chlorpyrifos and endosulfan, to larval Pacific treefrogs (Pseudacris regilla) and foothill yellow-legged frogs (Rana boylii) and discusses the implications of this toxicity to declining amphibian populations. Larvae were exposed to the pesticides from Gosner stages 25 to 26 through metamorphosis. The estimated median lethal concentration (LC50) for chlorpyrifos was 365 μg/L in P. regilla and 66.5 μg/L for R. boylii. Time to metamorphosis increased with concentration of chlorpyrifos in both species, and cholinesterase activity declined with exposure concentration in metamorphs of both species at Gosner stages 42 to 46. For endosulfan, the estimated LC50 was 15.6 μg/L for P. regilla and 0.55 μg/L for R. boylii. All R. boylii exposed to concentrations of greater than 0.8 μg/L died before they entered metamorphosis. Pseudacris regilla remains relatively abundant and is broadly distributed throughout California. In contrast, R. boylii is among the species experiencing severe population declines. The present study adds to the increasing evidence that pesticides are very harmful to amphibians living in areas that are miles from sources of pesticide application.
Reversibility of estrogenic sex changes in zebrafish (Danio Rerio)
Authors: Larsen Mia G. , Bilberg Katrine , Baatrup Erik
Published: March 2009

Development of male zebrafish (Danio rerio) courtship behavior was studied following estrogenic disruption of sexual differentiation. Sixty zebrafish were exposed at 28C to 5 ng/L (nominal concentration) of 17α-ethinylestradiol (EE2) from the egg stage until adulthood at four months of age, resulting in a female-biased sex ratio. Twenty-five EE2-exposed phenotypic female zebrafish were subsequently held in clean water for eight months. During this period, eight phenotypic males developed. These phenotypic males demonstrated significant behavioral aberrations and a low fertilization rate compared to control males.
Increased Mortality Associated with Well-Water Arsenic Exposure in Inner Mongolia, China
Authors: Wade Timothy , Xia Yajuan , Wu Kegong , Li Yanhong , Ning Zhixiong , Le X Chris , Lu Xiufen , Feng Yong , He Xingzhou , Mumford Judy
Published: March 2009

We conducted a retrospective mortality study in an Inner Mongolian village exposed to well water contaminated by arsenic since the 1980s. Deaths occurring between January 1, 1997 and December 1, 2004 were classified according to underlying cause and water samples from household wells were tested for total arsenic. Heart disease mortality was associated with arsenic exposure, and the association strengthened with time exposed to the water source. Cancer mortality and all-cause mortality were associated with well-water arsenic exposure among those exposed 10-20 years. This is the first study to document increased arsenic-associated mortality in the Bayingnormen region of Inner Mongolia.
Optimizing The Benefit of Sound Processors Coupled to Personal FM Systems
Authors: Wolfe Jace , Schafer Erin C.
Published: March 2009

Background: Use of personal frequency modulated (FM) systems significantly improves speech recognition in noise for users of cochlear implants (CI). There are, however, a number of adjustable parameters of the cochlear implant and FM receiver that may affect performance and benefit,
and there is limited evidence to guide audiologists in optimizing these parameters. Purpose: This study examined the effect of two sound processor audio-mixing ratios (30/70 and 50/50) on speech recognition and functional benefit for adults with CIs using the Advanced Bionics Auria®
sound processors. Research Design: Fully-repeated repeated measures experimental design. Each subject participated in every speech-recognition condition in the study, and qualitative data was collected with subject questionnaires. Study Sample: Twelve adults using Advanced Bionics
Auria sound processors. Participants had greater than 20% correct speech recognition on consonant-nucleus-consonant (CNC) monosyllabic words in quiet and had used their CIs for at least six months. Intervention: Performance was assessed at two audio-mixing ratios (30/70 and 50/50).
For the 50/50 mixing ratio, equal emphasis is placed on the signals from the sound processor and the FM system. For the 30/70 mixing ratio, the signal from the microphone of the sound processor is attenuated by 10 dB. Data Collection and Analysis: Speech recognition was assessed at
two audio-mixing ratios (30/70 and 50/50) in quiet (35 and 50 dB HL) and in noise (+5 signal-to-noise ratio) with and without the personal FM system. After two weeks of using each audio-mixing ratio, the participants completed subjective questionnaires. Results: Study results suggested
that use of a personal FM system resulted in significant improvements in speech recognition in quiet at low-presentation levels, speech recognition in noise, and perceived benefit in noise. Use of the 30/70 mixing ratio resulted in significantly poorer speech recognition for low-level speech
that was not directed to the FM transmitter. There was no significant difference in speech recognition in noise or functional benefit between the two audio-mixing ratios. Conclusions: Use of a 50/50 audio-mixing ratio is recommended for optimal performance with an FM system in quiet
and noisy listening situations.
Speech Perception Outcome in Multiply Disabled Children Following Cochlear Implantation: Investigating a Predictive Score
Authors: Trimble Keith , Rosella Laura C. , Propst Evan , Gordon Karen A. , Papaioannou Vicky , Papsin Blake C.
Published: March 2009

Background: Children with multiple disabilities account for a small percentage of implantees in a cochlear implant program, but they remain the most challenging group for which to predict benefit from the implant and for cooperation with habilitation postoperatively. Purpose:
To assess the relationship of pre-implant functional disabilities with postoperative speech perception scores and determine the feasibility of predicting outcome with a cochlear implant in a multiply disabled pediatric population. Research Design: Retrospective cohort study. Study
Sample: Sixty-six children with a cochlear implant and at least one additional disability. Data Collection And Analysis: We retrospectively examined the relationship between pre-implant Graded Profile Analysis (GPA) scores and postimplant speech perception scores. A pre-implant
functional disability score (based on the Battelle developmental screen) was applied to the same cohort of patients and its association with postimplant speech perception scores was examined. Results: The functional disability score significantly predicted high (k > 24) and low (k
< 7) speech perception scores (p < 0.001 and p < .0001) and had excellent discrimination ability (c statistic  =  0.88 and 0.93 respectively). The GPA score was not significantly associated with speech perception scores (p  =  0.519 and p  =  0.146) and
demonstrated no ability to discriminate postimplant speech perception scores in this implant population (c statistic  =  0.49 and c  =  0.57). Conclusions: Prediction of outcomes following cochlear implantation in multiply disabled children can be facilitated using
this newly developed functional disability score as an adjunct to traditional candidacy assessments.
Measuring Cochlear Implant Satisfaction in Postlingually Deafened Adults With The SADL Inventory
Authors: Ou Hua , Dunn Camille C. , Bentler Ruth A. , Zhang Xuyang
Published: March 2009

Background: Cochlear implants (CI) have become widely used for the management of profound sensorineural hearing loss. However, data relative to satisfaction in CI users are not so readily available. No standard outcome inventory for CI users has been developed. The Satisfaction
with Amplification in Daily Life (SADL) inventory was originally developed for hearing aid users by Cox and Alexander (1999). Because the SADL inventory has been shown to have good psychometric properties for use within hearing aid users, the present study adapted the SADL for CI use and assessed
the validity and reliability of the adapted version. Purpose: (1) To explore the factor structure (i.e., subscales), validity, and reliability of the SADL inventory applied to CI users and compare the resulting factor structure to that reported by Cox and Alexander (1999) for hearing
aid users; and (2) to evaluate the satisfaction level of CI users as measured by the SADL inventory and compare the satisfaction level of unilateral CI users (CI-only) to that of users of a CI and hearing aid in opposite ears (CIHA). Research Design: A cross-sectional survey. All CIHA
users in this study voluntarily elected to wear their hearing aids in conjunction with their CIs. Study Sample: The satisfaction level of postlingually deafened adult CI users was assessed for 100 CI-only and 35 CIHA users using the SADL inventory. Data Collection And Analysis:
The psychometric properties of the adapted SADL following administration to CI-only and CIHA users were examined through a factor analysis. Results: A similar factor structure was found for CI-only users compared to the original published SADL data. The differences were primarily related
to one particular factor. CI users have a moderately high satisfaction level. No significant differences were found between the CI-only and CIHA groups except for hearing aid feedback. Conclusions: It is concluded that the SADL is appropriate for clinical use with CI users.
Management of Autism Spectrum Disorders in Primary Care
Authors: Myers Scott M.
Published: March 2009

CME Educational Objectives

1.

Using a chronic disease management model, describe the key goals in continuous management of autism in the office setting.

2.

Discuss the empiric evidence supporting educational/habilitative interventions used in children with autism spectrum disorders.

3.

Outline the medical interventions available for children with autism spectrum disorders with emphasis on current evidence of proven efficacy and the need for ongoing monitoring.
Genetic Evaluation of the Child with an Autism Spectrum Disorder
Authors: Pickler Laura , Elias Ellen
Published: March 2009

CME Educational Objectives

1.

Recognize the key genetic causes of autism.

2.

Discuss recommended diagnostic testing modalities for genetic conditions in children with autism.

3.

Review the role of CGH microarray and the effect this may have on the diagnostic evaluation of children with ASD.
Normal Pressure Hydrocephalus: Are You Missing the Signs?
Authors: Siedlecki Sandra L.
Published: March 2009

Although normal pressure hydrocephalus (NPH) is a potentially treatable neurological condition, many individuals with NPH will never receive treatment because the diagnosis is missed and the symptoms are attributed to other disorders. Left untreated, NPH causes significant physical and emotional suffering and eventually leads to premature death. It is imperative that patients with gait problems, slowness of thought or actions, or urinary incontinence be evaluated and screened for NPH. Geriatric nurses are in the best position to intervene by recognizing the signs of NPH and making early and appropriate referrals.
Craniosacral Still Point Technique: Exploring Its Effects in Individuals with Dementia
Authors: Gerdner Linda A. , Hart Laura K. , Zimmerman M. Bridget
Published: March 2009

A mixed methodology was used to explore the effects of craniosacral still point technique (CSPT) in 9 older adults with dementia. Participants were monitored at baseline (3 weeks), intervention (6 weeks), and postintervention (3 weeks) using the modified Cohen-Mansfield Agitation Inventory (M-CMAI). CSPT was implemented daily for 6 weeks by a certified craniosacral therapist. Findings indicated a statistically significant reduction in M-CMAI total and subscale scores during the intervention period. This reduction continued during postintervention for subscale scores of physical nonaggression and verbal agitation. Staff and family interviews provided convergent validity to the quantitative findings. Participants were also more cooperative during caregiving activities and displayed meaningful interactions.
Nurse Managers’ Perceptions of Quality of Life of Older Adults Living in Long-Stay Care in Ireland: Is It Time for a Bill of Rights?
Authors: Murphy Kathy , O’Shea Eamon , Cooney Adeline
Published: March 2009

The aim of this study was to explore nurse managers’ perceptions of quality of life of older adults living in residential care in Ireland and key policy issues. Residential care facilities ultimately determine residents’ quality of life. A qualitative descriptive design was used in all seven focus groups with 67 participants. Two themes were identified: Factors Influencing Quality of Life and Factors Influencing Policy. Managers highlighted that the physical environment, making it like home, involving the family, the social environment, meaningful recreational activities, and community connections were central to residents’ quality of life. It is argued that a Bill of Rights for older adults should be developed.
Predictors of Staff-Supportive Organizational Culture in Assisted Living
Authors: Sikorska-Simmons Elzbieta
Published: March 2009

This study examined predictors of staff-supportive organizational culture in assisted living settings. The sample included 294 staff members in 52 facilities. Organizational culture was assessed according to staff perceptions of teamwork, morale, information flow, involvement, supervision, and meetings. Hierarchical linear modeling was used to examine the effects of organizational factors (i.e., facility size, chain membership, ownership, level of care, level of residents’ disability) on staff-supportive organizational culture. More staff-supportive culture was associated with smaller facility size, chain membership, and a higher level of care. These findings point to the importance of organizational factors in shaping a staff-supportive organizational culture.
Promoting Successful Aging with HIV Through Hardiness: Implications for Nursing Practice and Research
Authors: Vance David E. , Burrage Joe , Couch Alison , Raper Jim
Published: March 2009

A growing number of adults will age with HIV due to the introduction of highly active antiretroviral therapy, an increase in later-life infections, and an overall aging of the population. Unfortunately, how successful aging will be expressed in this population is unknown. In the gerontological literature, the concept of hardiness is used to describe and hypothesize how people can age successfully. Using the extant HIV literature, this article extrapolates how hardiness may help people age well with this disease. Because nurses provide care for older adults with HIV, possible interventions and clinical implications for incorporating hardiness into practice and research are suggested.
Spousal Bereavement Assessment: A Review of Bereavement-Specific Measures
Authors: Minton Mary E. , Barron Cecilia R.
Published: March 2009

The death of a spouse represents a common form of bereavement among adults and is associated with significant distress and adaptation. This 10-year review of the bereavement literature highlights 12 tools used to assess bereavement in spousally bereaved samples. Pertinent measurement foci and psychometric properties of each tool are presented. Applicability of each tool within the spousal bereavement process is discussed, and aspects of the spousal bereavement process not currently addressed or under-addressed provide direction for future tool development.
The Sister Model: A Framework for Academic and Service Partnerships in Nursing Home Settings
Authors: Campbell Sara L. , Jeffers Brenda Recchia
Published: March 2009

A unique teaching nursing home project was developed between a college of nursing and four nursing homes for the purpose of providing diverse teaching-learning experiences for nursing students, sharing resources among all participants, and attracting new nursing graduates to consider a career in long-term care. The Sister Model, a partnership model, served as a framework for the project and was designed to increase communication, share resources, promote interactive learning, and use nursing expertise to develop competence of nursing students. Evaluations of model activities were positive, and the model serves as an example of how schools of nursing and nursing homes can work together toward common goals.
Oral Health, Nutrition, and Oral Health-Related Quality of Life Among Korean Older Adults
Authors: Jung Young-Mi , Shin Dong-soo
Published: March 2009

Oral health affects older adults and their quality of life. Oral care is reported to have a low priority in nursing care of older adults, and repeated assessments to detect oral health problems are seldom performed. The purpose of this study was to investigate the relationships among level of oral health, nutrition, and oral health-related quality of life (OHRQL) and to identify predictors of OHRQL in Korean older adults. The design was a descriptive, correlational study. The level of oral pain contributed most significantly to OHRQL, followed by nutrition and number of teeth. These three predictor variables explained 46.4% of the variance in OHRQL. Older adults could benefit from oral health care, such as routine screening for oral health and nutritional status. Nurses are at the forefront in providing such services, and it is recommended they integrate oral health care into their routine nursing care plans.
Day-To-Day Care: The Interplay of CNAS’ Views of Residents & Nursing Home Environments
Authors: Fisher Lucy Takesue , Wallhagen Margaret I.
Published: March 2009

This qualitative study identified certified nursing assistants’ (CNAs’) perspectives of nursing home residents and how these perspectives translate into care practices. Data included observations of and interviews with 27 CNAs in three dissimilar nursing homes. All participants were people of color, and all but 3 were immigrants. CNAs constructed three views of residents: as fictive kin, as a commodity, and as an autonomous person. Although individual CNAs held one primary view of residents in general, select residents were viewed from an alternative perspective, resulting in variations in care practices. These findings suggest that such distinctions, in tandem with structural, organizational, and cultural differences in nursing homes, present opportunities for nursing leadership to affect the visible, everyday practice of nursing CNAs. To target interventions, further research is needed on how CNAs come to differentially view residents and how these differences influence CNAs’ care relationships with residents.
Hot Tea and Juk: The Institutional Meaning of Food for Chinese Elders in an American Nursing Home
Authors: Wu Shirley , Barker Judith C.
Published: March 2009

This qualitative study describes how Chinese elders in an American nursing home perceived their food and mealtime experiences. Data collection included 20 meal observations and interviews with 7 residents, 9 family members, and 17 staff members. Field notes and interviews were coded and analyzed using an iterative approach similar to grounded theory. All participant groups described institutional food and meals as individualized, nutritious therapy for medical illnesses. Mealtimes lacked sociability and sharing, and although family members provided Chinese food, they did not eat with residents. Residents generally did not consider the institution’s effort to provide an “Asian diet” of hot tea and juk (rice porridge) to be Chinese food. These findings suggest that, for these Chinese elders, the biomedicalized, individualized food service and mealtime caregiving practices stripped food of its meaning as a social, shared mealtime experience with family. Nursing professionals and researchers should understand that provision of culturally competent mealtime care for ethnic (Chinese) long-term care residents involves important food service practices in addition to kinds of food.
Family Satisfaction with Care of a Dying Loved One in Nursing Homes: What Makes the Difference?
Authors: Thompson Genevieve N. , Menec Verena H. , Chochinov Harvey M. , McClement Susan E.
Published: March 2009

As part of a larger study examining end-of-life care in nursing homes, qualitative focus groups were conducted with bereaved family members to explicate those factors contributing to satisfaction and dissatisfaction with end-of-life care in the nursing home setting. Content analysis of focus group data revealed two overarching themes that influenced family members’ satisfaction with care. These included: (a) ability of staff to recognize signs of imminent dying, and (b) communication and information sharing about the resident’s status and plan of care. Family members dissatisfied with their relative’s end-of-life care expressed feelings of guilt, anger, and frustration, both while the resident was alive and in the bereavement period. The findings of this study have implications for clinicians committed to delivering quality end-of-life care to residents and their families and provides the basis for educational interventions and quality care improvement initiatives in the long-term care setting.
Advantages and Disadvantages of Using MDS Data in Nursing Research
Authors: Shin Juh Hyun , Scherer Yvonne
Published: March 2009

The purpose of this article is to review the advantages and disadvantages of using Minimum Data Set (MDS) data for nursing research, the psychometric characteristics of the MDS 2.0, and threats to the validity of its psychometric characteristics. The defined major advantages of the MDS are: (a) it provides continuous evaluation of residents' health and functional status, and (b) it enables facility evaluation at the nursing home level. The reviewed articles from the literature report that MDS 2.0 has moderate to moderate/high validity and reliability; however, the psychometric properties of MDS 2.0 are still controversial, mainly because the instrument has failed to identify depression in older nursing home residents.
Novel Use of Antimicrobial Hand Sanitizer in Treatment of Nosocomial
Acinetobacter
Infection
Authors: Donahue Meghan , Watson Luke R. , Torress-Cook Alfonso , Watson Paul A.
Published: March 2009

Colonization of wounds with multidrug-resistant organisms is a difficult orthopedic problem.
Acinetobacter
infections are especially difficult because they are resistant to all currently available antibiotics. We present the use of a novel skin sanitizer, Stay Byotrol Clean (Byotrol Inc, Spartanburg, South Carolina), to treat a multidrug-resistant wound infection.

A 31-year-old T10 paraplegic man presented with chronic bilateral stage IV decubitus trochanteric ulcers. Cultures grew methicillin-resistant
Staphylococcus aureus
and vancomycin-resistant
Enterococcus
. The ulcers were initially treated with irrigation and debridement and vancomycin, levaquin, and cefepime. After 4 months of aggressive treatment, the cultures continued to be positive for
Escherichia coli
and
Acinetobacter baumannii
. The patient was started on amikacin and tigecycline. Despite 1 additional month of aggressive wound care, debridements, and intravenous antibiotics, the cultures continued to grow
A baumannii
and
Pseudomonas aerug
. The
A baumannii
was resistant to all available antibiotics tested. The ulcers were then treated with daily application of Stay Byotrol Clean hand and skin sanitizer. Four days later, cultures were negative for any bacterial growth, with no
A baumannii
. After 1 week, the ulcers showed new granulation tissue with no visible necrotic tissue. After 3 months of treatment, the ulcers had healed.

Stay Byotrol Clean is nonirritating and contains no iodine or alcohol. It is currently being used for decolonization of patients on admission to the hospital, however, there is great potential for its use in wound treatment, preoperative surgical sterilization, and orthopedic devices.
Concurrent Osteochondroma and Osteoblastoma of the Proximal Humeral Shaft
Authors: Downing Kristopher L. , Crawford Eileen A. , Ogilvie Christian M.
Published: March 2009

We present what we believe is the first reported case of synchronous osteochondroma and osteoblastoma, occurring in the proximal humerus of a young man.

A 15-year-old boy presented with a painful left arm mass for 3 months. A firm mass was palpable in the proximal medial arm, and he had mild triceps weakness secondary to pain. Imaging showed an eccentric lesion involving the proximal one-third of the humerus, with central lysis, surrounding sclerosis and edema, endosteal scalloping, and cortical thinning and expansion. The humeral diaphysis contained a bony exostosis with corticomedullary continuity, consistent with an osteochondroma with a cartilage cap <5 mm thick. Within the proximal portion of the osteochondroma was a 2-cm, edematous, rim-enhancing cystic lesion, concerning for a secondary process such as malignant transformation. On open biopsy, the mass grossly appeared to be a sessile osteochondroma, and was removed with a rongeur. The cystic lesion was curetted out of the bone. Pathology confirmed that the raised lesion was an osteochondroma. The cystic lesion contained osteoblasts in a matrix of osteoid and immature bone, characteristic of an osteoblastoma. The multidisciplinary team agreed that this was an osteoblastoma within an exostosis. At follow-up, the patient's pain had fully resolved and radiographs showed good early healing.

We wished to document the extraordinary, simultaneous existence of an osteochondroma and adjacent osteoblastoma in the proximal humerus of a young patient. Although similar in presentation, the tumors consist of cells of different origins, making the pathogenesis unclear.
Bladder Exstrophy Masquerading as a Pelvic Fracture
Authors: Haim Amir , Sternheim Amir , Drexler Michael , Marmor Meir , Steinberg Eli L.
Published: March 2009

Bladder exstrophy-epispadias complex is a rare spectrum of congenital anomalies that includes a midline abdominal wall defect and a widened pelvis with an anterior diastasis. Our patient was involved in a motorcycle accident with severe multiple injuries and concomitant bladder extrophy. In a unique and urgent clinical setting, his congenital pubic diastasis was initially misdiagnosed as a traumatic finding.

A 21-year-old man presented with pelvic and extremity injuries following a motorcycle accident. Multiple fractures in the lower and upper extremities were diagnosed. Marked deformity and diastases of the pubic bones were observed on pelvic inspection. Ninety minutes later, hemodynamic deterioration ensued and was thought to be related to internal pelvic bleeding. The patient was prepared for immediate pelvic stabilization with an external fixator; however, after reevaluation, an intact posterior pelvic complex and lack of a hematoma was observed on a computed tomography scan. The stability of the pelvis was tested under an image intensifier. No instability was present, and pelvic injury was ruled out.

Exstrophy-epispadias syndrome constitutes a potential pitfall in emergency trauma medicine. As demonstrated in the present case, in the emergency management of an unstable trauma patient, nontraumatic etiologies are often not considered in the differential diagnosis of pelvic diastasis. Avoiding false diagnosis and needless procedures necessitates familiarity with this condition.
Apophyseal Avulsion Fractures of the Hip and Pelvis
Authors: McKinney Bart I. , Nelson Cory , Carrion Wesley
Published: March 2009

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Describe the anatomy and mechanism of injury associated with apophyseal avulsion fractures of the hip and pelvis.

2.

List the different stages of nonoperative management in patients with apophyseal avulsion.

3.

Discuss the operative treatment options and surgical approaches for treatment of these injuries.

4.

Identify the controversies and common complications in the treatment of apophyseal avulsion fractures of the hip and pelvis.
Multilevel Diskitis and Vertebral Osteomyelitis After Diskography
Authors: Mikhael Mark M. , Bach Harold G. , Huddleston Paul M. , Maus Timothy P. , Berbari Elie F.
Published: March 2009

Diskitis is a rare but serious complication following diskography. The signs and symptoms may be easily confused or attributed to patients' preexisting chronic axial degenerative conditions. Unrecognized, it can progress to deep-seated infection with vertebral osteomyelitis. This article presents a case involving a 4-level destructive vertebral osteomyelitis following multilevel diskography despite prophylactic antibiotics and a double-needle technique. A 38-year-old man with radicular symptoms underwent a microdiskectomy at L4-5. Due to only minimal improvement in pain postoperatively, the patient underwent a diagnostic lumbar diskography at L2-3, L3-4, L4-5, and L5-S1 at an outside institution in consideration for repeat surgical treatment. Following this procedure, the patient continued to have debilitating symptoms and presented to our institution, where evaluation revealed elevated inflammatory biomarkers. Magnetic resonance imaging (MRI) suggested diskitis and vertebral osteomyelitis with compression fractures at the 4 levels where the diskography was performed. The patient was successfully treated with parenteral antibiotics targeted at
Staphylococcus saccharolyticus
, which was isolated in the culture from an open biopsy specimen after an initial percutaneous biopsy was inconclusive. Magnetic resonance imaging is the best radiologic modality for early diagnosis of this complication. This case demonstrates that early changes on MRI should warrant immediate workup and treatment. Treatment involves at least 6 weeks of parenteral antimicrobial therapy.
Incorporation of Methotrexate in Calcium Phosphate Cement: Behavior and Release in Vitro and in Vivo
Authors: Yang Zhiping , Li Dong , Han Jian , Li Jianmin , Li Xin , Li Zhenfeng , Li Shuhong
Published: March 2009

The application of antibiotic-loaded calcium phosphate bone cement in the treatment and prevention of osteomyelitis suggests that calcium phosphate cement could also be used as an anticancer drug carrier to reduce the local recurrence of bone tumors and systemic toxicities of chemotherapy. We added 0 to 400 mg of methotrexate to 40 g cement, with final methotrexate concentrations of 0% to 1% (weight/weight). The setting times, mechanical properties, microstructures, and in vitro methotrexate release kinetics of these methotrexate-calcium phosphate bone cement specimens were evaluated, along with in vivo methotrexate release kinetics in 24 rabbits. Methotrexate did not significantly alter the cement setting time. The compressive and tensile strengths of the methotrexate-calcium phosphate bone cement specimens were significantly less when 400 mg methotrexate was used, compared to control samples without methotrexate addition. Nevertheless, the cement remained compliant with the minimum requirements for clinical application. The scanning electron microscopy micrographs showed that the basic crystal structure did not alter. The methotrexate release kinetics in vitro and in vivo confirmed that methotrexate-calcium phosphate bone cement was a monolithic matrix system, with a burst effect in the initial stage and a sudden drop thereafter. Drug delivery in vivo was faster than in vitro. We estimated that the incorporated methotrexate could be continuously released over 2 to 4 months at a higher than minimum concentration. The methotrexate had no apparent toxicity on the host rabbits, even at the highest dose of methotrexate tested. The methotrexate-calcium phosphate bone cement system may be a potentially effective therapy for bone tumors in humans.
Fluorescein Angiography of Iris Juvenile Xanthogranuloma
Authors: Danzig Carl J. , Shields Carol L. , Mashayekhi Arman , Ehya Hormoz , Manquez Maria E. , Shields Jerry A.
Published: March 2009

A 3-year-old boy was referred because of the presence of a non-pigmented, highly vascular mass with tapioca appearance involving the superior portion of the left iris. Iris fluorescein angiography revealed early hyperfluorescence of the iris tumor with diffuse, intense late leakage of dye throughout the entire iris, not just in the region of the tumor. Cytopathologic examination revealed Touton giant cells and the presence of histiocytes, confirming the diagnosis of iris juvenile xanthogranuloma. The patient was prescribed topical prednisolone acetate, and the lesion resolved during the next 3 months. Fluorescein angiography may be useful in differentiating iris juvenile xanthogranuloma from malignant or non-inflammatory benign iris lesions.
Conjunctivitis
Authors: Coats David , Medow Norman
Published: March 2009

Wagner: An 8-year-old boy presented with bilateral, itchy eyes, a condition that seems to happen every year in the spring. He has a history of atopy and has been using some over-the-counter eye drops, including tears, but is not getting much better. Looking at these photographs of both eyes (Figure), can you describe what you see and give us a tentative diagnosis?
Anterior Sub-Tenon’s Anesthesia for the Treatment of Retinopathy of Prematurity
Authors: Ah-Chan John , Rubinstein Adrian , Patel Chetan Kantibhai
Published: March 2009

The authors describe a technique of combined oral chloral hydrate and sub-Tenon’s anesthesia that is simple, avoids the risks of general anesthesia, and provides superior anesthesia to topical agents alone.
Neurofibromatosis Type 2 in Twins
Authors: Walton David S. , Abbott Joseph , Sivaraj Ramesh R. , Ng Antony , Cole Trevor R. P. , MacPherson Lesley K. R. , Ragge Nicola K.
Published: March 2009

The Images in Pediatric Ophthalmology column is a 1-page photo essay showing encounters in the field of pediatric ophthalmology.
Oculocerebrocutaneous Syndrome
Authors: Saatci A. Osman , Arikan Gul , Saatci Pinar , Saatci Ýsil , Kavukcu Salih
Published: March 2009

The authors describe a patient with oculocerebrocutaneous syndrome, also called Delleman–Oorthuys syndrome. This patient is the first reported case in Turkey. The 19-month-old boy had characteristic features of oculocerebrocutaneous syndrome, such as unilateral orbital cyst, skin tags and skin hypoplasia, hypoplastic left cerebellar hemisphere, Dandy–Walker variant anomaly, corpus callosum agenesis, and left cerebral hemispheric diffuse migration anomaly.
What’s Your Diagnosis?
Authors: Walton David S. , Katsavounidou Garyfallia
Published: March 2009

A 9-month-old boy was seen for further evaluation of an esotropia that had been present for approximately 3 months. A heart murmur had been detected at 1 month of age and benign pulmonary stenosis was suspected. His birth weight was 5 pounds 9 ounces and his weight gain had been slow. Pediatric examination had revealed generalized hypotonia and borderline elevated serum calcium levels, which were corrected with a low vitamin D diet. On eye examination, he appeared well with facies possessing an upturned nose, long philtrum, malar hypoplasia, prominent lips, and periorbital fullness associated with bilateral epicanthal folds. Good visual interest in toys was present with excellent bilateral fixation and following. Alternate fixation preference was present with 20 diopters of esotropia and low hyperopia The corneas were clear without band keratopathy. The irides were blue with easily identified anterior stromal white spokes directed toward the peripheral iris leaf from each collarette. The lenses, intraocular pressure, and fundi were normal. A genetics consultation was advised and a fluorescent in situ hybridization (FISH) test was recommended.
Cortical Visual Impairment in Hypomelanosis of Ito
Authors: Scott Andrew , Micallef Caroline , Hale Sarah L. , Watts Patrick
Published: March 2009

Hypomelanosis of Ito is a multisystem disorder that is thought to be due to chromosomal mosaicism. The authors report a case of cortical visual impairment in an infant diagnosed as having hypomelanosis of Ito. Cortical dysplasia was evident on magnetic resonance imaging and its presence in key areas of the visual pathway may explain the patient’s cortical visual impairment.
Chronic Anterior Uveitis Following Bacille Calmette–Guérin Vaccination: Molecular Mimicry in Action?
Authors: Spratt Alexander , Key Tim , Vivian Anthony J.
Published: March 2009

A 13-year-old girl developed bilateral chronic anterior uveitis following bacille Calmette–Guérin (BCG) vaccination. HLA testing was negative for B27 but positive for DRB1*0404, a variant of DR4 often associated with rheumatoid arthritis. The authors propose her HLA repertoire allowed for a BCG-induced abnormal autoimmune response by the mechanism of molecular mimicry.
Management of a Case of Simultaneous Abduction
Authors: Crouch Earl R. , Murray Anthony , Madigan William P.
Published: March 2009

Wagner: As you can see in the photographs, an 8-month-old infant presented with a right face turn, which has been present clearly ever since the mother can remember. There is no significant medical history and on examination you find a right face turn and a large exotropia in primary gaze. The eyes are aligned in gaze to the left, but on attempted gaze to the right there is absent adduction and increased abduction of the left eye, as shown in the photographs. There is no limitation of vertical eye movements, the retinal examination is normal, and the cycloplegic retinoscopy is +2.5 diopters in each eye. What is going on here and what would be your plan to treat this infant?
Pupillography of Relative Afferent Pupillary Defects in Amblyopia Associated With Peripapillary Myelinated Nerve Fibers and Myopia
Authors: Miki Atsushi , Iijima Atsuhiko , Takagi Mineo , Tanimoto Naoyuki , Usui Tomoaki , Hasegawa Shigeru , Abe Haruki , Bando Takehiko
Published: March 2009

Pupillary responses to light were recorded in three patients with unilateral extensive myelinated nerve fibers and amblyopia by means of binocular infrared video pupillography. All of the patients had an afferent pupillary defect in the eye with myelinated nerve fibers. This finding supports the notion that this type of amblyopia is a severe form of anisometropic amblyopia that is often resistant to treatment.
Conservative Management of Upper Eyelid Entropion
Authors: Maycock Nicholas J. R. , Sahu Debendra N. , Mota Peter M. , Gaston Hannah , Hodgkins Peter R.
Published: March 2009

The authors report for the first time two cases of upper eyelid entropion secondary to neonatal conjunctivitis that resolved spontaneously following the insertion of a bandage contact lens. Previous reports advocate early surgical intervention to correct the eyelid abnormality and prevent any permanent corneal scarring and visual loss.
Bell’s Phenomenon Protects the Tear Film and Ocular Surface After Frontalis Suspension Surgery for Congenital Ptosis
Authors: Yoon Jin Sook , Lew Helen , Lee Sang Yeul
Published: March 2009

Purpose:
To assess alterations in the tear film and ocular surface after frontalis suspension repair in patients with pediatric congenital ptosis with either intact or poor Bell’s phenomenon.

Methods:
The study involved 15 patients (23 eyes) with poor Bell’s phenomenon (group 1) and 21 patients (33 eyes) with intact Bell’s phenomenon (group 2) who underwent frontalis suspension surgery using autogenous fascia lata. The control group comprised 15 age-matched subjects (30 eyes) (group 3). Corneal esthesiometry, tear film break-up time (BUT) measurement, Schirmer II tests, and vital staining were performed prospectively before surgery and 1, 3, and 6 months postoperatively.

Results:
Group 1 had a lower mean BUT at all postoperative follow-up time points compared to group 2. Group 1 had a greater mean fluorescein staining score (FSS) at 6 months postoperatively compared to group 2. The degree of lagophthalmos strongly correlated with BUT and FSS at 6 months postoperatively in group 1, but not in group 2. In group 1, mean lagophthalmos (5.2 mm) and amount of eyelid elevation (5.8 mm) were higher in abnormal FSS eyes (n = 17) than in normal FSS eyes (n = 6) (3.3 and 3.9 mm, respectively).

Conclusion:
Bell’s phenomenon prevents tear film instability and ocular surface damage in eyes with lagophthalmos induced by frontalis suspension surgery. In patients with poor Bell’s phenomenon, ptosis correction of more than 5.5 mm or lagophthalmos of more than 5.0 mm could increase the risk of exposure keratopathy, necessitating careful postoperative monitoring.
The Safety and Efficacy of Glaucoma Medication in the Pediatric Population
Authors: Coppens Greet , Stalmans Ingeborg , Zeyen Thierry , Casteels Ingele
Published: March 2009

Topical glaucoma medications are widely used for childhood glaucoma, although little is known concerning the use of the newer glaucoma medications in this population. The majority of the references cited were extracted from PubMed. A literature review of all English language reports related to glaucoma medication in the pediatric population since 1980 was performed. Medical therapy of pediatric glaucoma contains four groups of drugs: β-blockers (timolol and betaxolol), carbonic anhydrase inhibitors (dorzolamide), α2-agonists (brimonidine), and prostaglandin analogs (latanoprost). Timolol is the first choice in pediatric glaucoma. In cases with insufficient reduction of the intraocular pressure (IOP), the combination of timolol once a day and dorzolamide twice a day brings about a good control of the IOP. Both medications are effective and well tolerated. The α2-agonists have more and potentially serious adverse effects in children and are contraindicated for children younger than 2 years of age. Latanoprost tends to be less effective in lowering IOP in children than in adults. However, no studies are reported where latanoprost is used in monotherapy. Additional study may further delineate this drug's role in treating pediatric glaucoma. The safety profile of latanoprost in children appears excellent.
[J Pediatr Ophthalmol Strabismus 2009;46:12–18.]