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BACKGROUND: The Orthopaedic Surgery Match is highly competitive, with more applicants than residency spots. With the Step 1 Exam moving to a pass/fail result, residency programs and applicants have fewer objective data to determine applicants' relative competitiveness. Through this study, we sought to provide the mean number of accepted publications on PubMed a successfully matched orthopedic surgery applicant has by the time of submission of their application. MATERIALS AND METHODS: Orthopedic surgery residency programs participating in the National Resident Matching Program were identified by their ranking on the Doximity Residency Navigator. Each program's intern class and their medical schools were identified. Their names were searched in PubMed and Scopus and articles with their name and affiliations were recorded. RESULTS: In total, 877 orthopedic surgery interns published a mean of 3.30±5.27 articles each on PubMed. They were first or second author on 1.44±2.58, and 1.96±3.89 publications were related to orthopedic surgery. There were no statistical differences between degree, sex, or residency program rank from the Doximity Residency Navigator. The mean number of publications from a successful applicant was approximately 3. There was a great range in the number of publications, and 27.3% of successful applicants did not have a single publication. CONCLUSION: Future applicants and programs can use this number to gauge relative research output. [Orthopedics. 202x;4x(x):xx-xx.].

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INTRODUCTION: Ewing sarcomas of the axial skeleton represent a notable challenge for clinicians because of their aggressive presentation and tendency to obstruct neurovascular structures; however, little data exist regarding axial tumors in children. This study is the first population-based analysis assessing treatment regimens for axial Ewing sarcomas and their effects on cancer-specific survival and overall survival (OS). METHODS: Data from 2004 to 2019 were collected for all patients aged 1 to 24 years from the Surveillance, Epidemiology, and End Results (SEER) database. Primary groups included pelvic tumors, thoracic tumors, and vertebral tumors. Chi-squared and Kaplan-Meier tests were used to assess associations between demographic variables, clinical and treatment characteristics, and patient survival. RESULTS: Pelvic tumors were most common, and 49.7% received chemotherapy/radiation. Vertebral tumors were least common, and 56.7% received chemotherapy/surgery/radiation. 53.5% of thoracic tumors received chemotherapy/surgery. Surgery was most common for thoracic tumors (80.2%) and rare for pelvic tumors (38.9%). Radiation therapy was most common for vertebral tumors (83.6%) and least common for thoracic tumors (36.0%). Pelvic tumors exhibited the lowest OS (1-year, 5-year, and 10-year OS: 96%, 70%, and 59%), followed by thoracic tumors (1-year, 5-year, and 10-year OS: 97%, 79%, and 66%) and vertebral tumors (1-year, 5-year, and 10-year OS: 92%, 77%, and 68%). CONCLUSION: This study underpins the importance of both early detection and chemotherapy-based multimodal therapy in the treatment of axial Ewing sarcoma in a pediatric population. A comparatively large decline in OS was observed between 5 and 10 years for patients with thoracic tumors, and this cohort's 10-year OS has not improved when compared with a similar SEER cohort from 1973 to 2011. Despite a growing body of research supporting definitive radiation therapy, a notable portion of patients with pelvic Ewing sarcoma did not receive radiation, representing an unmet need for this population.

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Introduction: Young people with intellectual disabilities (ID) are at an increased risk for experiencing mental health issues compared to their peers without disabilities. Further, there are limited resources available to help accurately assess mental health disorders and that are accessible for adolescents with ID. Method: This paper describes the iterative development and pilot testing of the Diagnostic Interview for Adolescents and Adults with Intellectual Disabilities (DIAAID). The authors utilized Evidence Center Design and Universal Design principals to develop the DIAAID; a multi-informant diagnostic interview. Results: The DIAAID development resulted in the creation of 15 adolescents disorder interviews and 24 caregiver disorder interviews. Preliminary results suggest that the DIAAID is a feasible and accessible diagnostic interview for adolescents with ID and their caregivers. Discussion: Lessons learned from DIAAID implementation and future areas research are discussed.

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Spanning ankle external fixation is a commonly used technique for the treatment of fractures of the lower extremity. Traditionally, a single pin is placed in the safe zone of the calcaneus to provide a point of traction for fracture reduction and stabilization. Complications include infection and pin loosening with subsequent loss of fracture reduction. We aim to highlight the benefits and techniques of adding a second calcaneal pin to reduce the likelihood of infection, pin loosening, and possible loss of fracture reduction. Using the standard medial-to-lateral placement technique, two centrally threaded Schanz pins were placed within the safe zone of the calcaneus approximately 2 cm apart and were connected by clamps and a short carbon fiber rod. The remainder of the external fixation apparatus is assembled using a standard technique after obtaining fracture reduction. There is an increased incidence of infection and pin loosening with decreased bone quality and a longer duration within an external fixator. The addition of a second calcaneal pin can be used to reduce the incidence of pin loosening and associated sequela, especially in patients with decreased bone quality, thus improving outcomes for patients undergoing spanning ankle external fixation.

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Background Screw fixation continues to be a commonly used treatment for syndesmotic disruption; however, screw breakage remains a complication post-fixation. Despite this complication, investigation on the variability of surgical placement in conjunction with syndesmotic screw characteristics affecting breakage has not been fully elucidated. The purpose of this study is to compare patients with syndesmotic screw breakage versus those with intact screws based on surgically controlled variables. Methods A total of 176 patients and 260 syndesmotic screws were included in the study, 88 patients each with and without broken syndesmotic screws. A retrospective analysis of patients who underwent syndesmotic screw fixation was performed. Patients with syndesmotic screw breakage were compared to those with intact screws. Screw width and length, the number of screws used, fracture type, and the number of cortices for fixation were all collected. Further analysis included radiographic measurement of syndesmotic screw angle and height of placement above the tibial plafond. Results Decreased screw width, increased number of screws used, and younger age were all associated with increased rates of screw breakage (p < .001, p = .019, p = 0.020). No statistical difference was appreciated between groups based on screw length, number of cortices used, or angle relative to the tibial plafond (p = .2432, p = .4699, p = .9233). Conclusion Higher placement of syndesmotic screws above the tibiotalar joint, specifically greater than 20 mm above the tibial plafond, increases the screw breakage rate. Decreased screw width, increasing numbers of screws used, and younger age were all also associated with increased rates of screw breakage. No difference was appreciated based on the screw angle relative to the tibial plafond.

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CASE: A 62-year-old Caucasian man presented with a comminuted subtrochanteric fracture after a low-energy fall. Physical examination postoperatively revealed a firm hard gluteal compartment in the contralateral buttocks. The patient underwent a fasciotomy, using the Kocher-Langenbeck approach, to release the gluteus maximus and lateral thigh fascia. At the most recent 6-month follow-up, gluteal function was intact with no long-term sequelae from compartment syndrome. CONCLUSION: Prolonged positioning on a fracture table can result in gluteal compartment syndrome of the contralateral extremity.

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Several articles support the use of cancellous iliac crest bone grafting in the treatment of clavicle nonunion; however, there is very little literature on the use of tricortical iliac crest grafts in the setting of clavicle nonunion with bone loss. When it has been studied, tricortical grafting has been shown to produce radiologically confirmed union in the clavicle, leaving patients satisfied with the ultimate outcome. We present two cases of clavicle fracture nonunion successfully treated with tricortical interposition bone grafting. In the first case, a 45-year-old female presented with an atrophic left midshaft clavicle fracture nonunion with failed hardware that had undergone two previous attempts at fixation without achieving union. She was treated with a structural interposition iliac crest bone graft with plate fixation and regained full painless function of the arm with radiographic fracture union. In the second case, a 50-year-old male presented after a left midshaft clavicle fracture that had undergone acute stabilization, followed by revision for nonunion that was unsuccessful, resulting in persistent nonunion with bone loss. He was treated with a tricortical iliac crest bone graft and plate fixation. Cultures from the time of surgery did grow Staphylococcus epidermidis and Propionibacterium acnes, and he was treated with intravenous vancomycin for six weeks. The patient's clavicle went on to union and he regained full, painless function by his six-month follow-up visit. These cases demonstrate the use of tricortical interposition bone grafting with compression plating as a viable option for rare instances in which previous surgical intervention has failed to progress a midshaft clavicle fracture to union.

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Rapid turning and swimming contribute to ecologically important behaviors in fishes such as predator avoidance, prey capture, mating and the navigation of complex environments. For riverine species, such as knifefishes, turning behaviors may also be important for navigating locomotive perturbations caused by turbulent flows. Most research on fish maneuvering focuses on fish with traditional fin and body morphologies, which primarily use body bending and the pectoral fins during turning. However, it is uncertain how fishes with uncommon morphologies are able to achieve sudden and controllable turns. Here, we studied the turning performance and the turning hydrodynamics of the black ghost knifefish (Apteronotus albifrons, N=6) which has an atypical elongated ribbon fin. Fish were filmed while swimming forward at ∼2 body lengths s-1 and feeding from a fixed feeder (control) and an oscillating feeder (75 Hz) at two different amplitudes. 3D kinematic analysis of the body revealed the highest pitch angles and lowest body bending coefficients during steady swimming. Low pitch angle, high maximum yaw angles and large body bending coefficients were characteristic of small and large turns. Asynchrony in pectoral fin use was low during turning; however, ribbon fin wavelength, frequency and wave speed were greatest during large turns. Digital particle image velocimetry (DPIV) showed larger counter-rotating vortex pairs produced during turning by the ribbon fin in comparison to vortices rotating in the same direction during steady swimming. Our results highlight the ribbon fin's role in controlled rapid turning through modulation of wavelength, frequency and wave speed.

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Neotropical freshwater fishes such as knifefishes are commonly faced with navigating intense and highly unsteady streams. However, our knowledge on locomotion in apteronotids comes from laminar flows, where the ribbon fin dominates over the pectoral fins or body bending. Here, we studied the 3D kinematics and swimming control of seven black ghost knifefish (Apteronotus albifrons) moving in laminar flows (flow speed U∞≈1-5 BL s-1) and in periodic vortex streets (U∞≈2-4 BL s-1). Two different cylinders (∼2 and ∼3 cm diameter) were used to generate the latter. Additionally, fish were exposed to an irregular wake produced by a free oscillating cylinder (∼2 cm diameter; U∞≈2 BL s-1). In laminar flows, knifefish mainly used their ribbon fin, with wave frequency, speed and acceleration increasing with U∞. In contrast, knifefish swimming behind a fixed cylinder increased the use of pectoral fins, which resulted in changes in body orientation that mimicked steady backward swimming. Meanwhile, individuals behind the oscillating cylinder presented a combination of body bending and ribbon and pectoral fin movements that counteract the out-of-phase yaw oscillations induced by the irregular shedding of vortices. We corroborated passive out-of-phase oscillations by placing a printed knifefish model just downstream of the moving cylinder, but when placed one cylinder diameter downstream, the model oscillated in phase. Thus, the wake left behind an oscillating body is more challenging than a periodic vortex shedding for an animal located downstream, which may have consequences on inter- and intra-specific interactions.

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We discovered that knifefish (Apteronotus albifrons) during suction feeding can produce millimeter-sized cavitation bubbles and flow accelerations up to ~ 450 times the acceleration of gravity. Knifefish may use this powerful suction-induced cavitation to cause physical damage on prey hiding in narrow refuges, therefore facilitating capture.

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Mechanistically connecting genotypes to phenotypes is a longstanding and central mission of biology. Deciphering these connections will unite questions and datasets across all scales from molecules to ecosystems. Although high-throughput sequencing has provided a rich platform on which to launch this effort, tools for deciphering mechanisms further along the genome to phenome pipeline remain limited. Machine learning approaches and other emerging computational tools hold the promise of augmenting human efforts to overcome these obstacles. This vision paper is the result of a Reintegrating Biology Workshop, bringing together the perspectives of integrative and comparative biologists to survey challenges and opportunities in cracking the genotype to phenotype code and thereby generating predictive frameworks across biological scales. Key recommendations include promoting the development of minimum "best practices" for the experimental design and collection of data; fostering sustained and long-term data repositories; promoting programs that recruit, train, and retain a diversity of talent; and providing funding to effectively support these highly cross-disciplinary efforts. We follow this discussion by highlighting a few specific transformative research opportunities that will be advanced by these efforts.

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Fractures about the tibial tubercle are uncommon fracture patterns, seen most often in adolescent males as they approach skeletal maturity. Compartment syndrome has a high association with these fractures requiring close monitoring, and a heightened level of suspicion. Tibial tubercle fractures are typically stratified using the Ogden classification. The type of intra-articular involvement and degree of displacement guide appropriate treatment. This report highlights a 14-year-old male patient who suffered a type IV tibial tubercle fracture with a unique Salter-Harris II, or transitional, component posteriorly that was unable to be closed reduced and developed compartment syndrome. He underwent fasciotomy, open reduction, and temporary external fixation. Once the status of the soft tissues improved, he underwent staged open reduction and internal fixation with skin grafting. The patient's fracture and soft tissues healed and he currently ambulates without assistance or pain, and has returned to all desired activities including competitive sports.

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Low dissolved oxygen (hypoxia) can severely limit fish performance, especially aerobically expensive behaviours including swimming and acquisition of sensory information. Fishes can reduce oxygen requirements by altering these behaviours under hypoxia, but the underlying mechanisms can be difficult to quantify. We used a weakly electric fish as a model system to explore potential effects of hypoxia on swim performance and sensory information acquisition, which enabled us to non-invasively record electric signalling activity used for active acquisition of sensory information during swimming. To quantify potential effects of hypoxia, we measured critical swim speed (Ucrit) and concurrent electric signalling activity under high- and low-dissolved oxygen concentrations in a hypoxia-tolerant African mormyrid fish, Marcusenius victoriae Fish were maintained under normoxia for 6 months prior to experimental treatments, and then acclimated for 8 weeks to normoxia or hypoxia and tested under both conditions (acute: 4 h exposure). Acute hypoxia exposure resulted in a significant reduction in both Ucrit and electric signalling activity in fish not acclimated to hypoxia. However, individuals acclimated to chronic hypoxia were characterized by a higher Ucrit under both hypoxia and normoxia than fish acclimated to normoxia. Following a 6 month re-introduction to normoxia, hypoxia-acclimated individuals still showed increased performance under acute hypoxic test conditions, but not under normoxia. Our results highlight the detrimental effects of hypoxia on aerobic swim performance and sensory information acquisition, and the ability of fish to heighten aerobic performance through acclimation processes that can still influence performance even months after initial exposure.

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Annual increases in global travel have resulted in more individuals being exposed to varying environmental conditions abroad and, thereby, subject to air pollution related health risks. Individuals who travel abroad may be exposed to varying levels of air pollution within a matter of hours. We wish to consider whether exposure to air pollution could be a significant contributor to the risk of illness and death in travelers, particularly those who travel to highly polluted cities. We report the findings of a study in which the peak expiratory flow (PEF) of a traveler decreased in Shanghai relative to baseline in New York City; the decline in PEF correlated to concentration of particulate matter (PM2.5). We discuss the health implication of these results on global travel.

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OBJECTIVE: To explore clinicians views of the barriers and facilitators to use of C-reactive protein (CRP) point-of-care tests (POCT) in US family medicine clinics for the management of acute respiratory tract infections (ARTIs) in adults. SETTING: Five family medicine clinics across two US states. PARTICIPANTS: 30 clinicians including 18 physicians, 9 physician residents, 2 physician assistants and 1 nurse practitioner, took part in the study. DESIGN: A qualitative study using a grounded theory approach to thematically analyse focus group interviews. RESULTS: These clinicians had limited access to diagnostic tests for patients with ARTI, and very little knowledge of CRP POCT. Three major themes were identified and included the potential clinical role of CRP POCT, concerns related to implementing CRP POCT and evidence needed prior to wider adoption in family medicine. Clinicians believed CRP POCT could support decision-making for some presentations of ARTIs and patient populations when used in conjunction with clinical criteria. Clinicians had concerns about possible overuse and inaccuracy of CRP POCT which they believed might increase antibiotic prescribing rates. Other concerns identified included integration of the test with clinic workflows and cost-effectiveness. CONCLUSIONS: Clinicians stand at the forefront of antibiotic stewardship efforts, but have few diagnostic tests to help them confidently manage ARTIs. CRP POCT may facilitate some aspects of clinical practice. Incorporating CRP POCT with clinical guidelines may strengthen utility of this test, when there is diagnostic uncertainty.

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Key components of the pretravel consultation include intake questions regarding the traveler's anticipated itinerary and medical history; immunizations; malaria prophylaxis; and personal protection measures against arthropod bites, traveler's diarrhea, and injury. Most vaccinations that are appropriate for international travelers are included in the routine domestic immunization schedule; only a few travel-specific vaccines must also be discussed. The most common vaccine-preventable illnesses in international travelers are influenza and hepatitis A. Malaria prophylaxis should be offered to travelers to endemic regions. Personal protection measures, such as applying an effective insect repellent to exposed skin and permethrin to clothing and using a permethrin-impregnated bed net, should be advised for travelers to the tropics. Clinicians should offer an antibiotic prescription that travelers can take with them in case of traveler's diarrhea. Additional topics to address during the pretravel consultation include the risk of injury from motor vehicle crashes and travel-specific risks such as altitude sickness, safe sex practices, and emergency medical evacuation insurance.

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Vaccinations are a cornerstone of the pretravel consultation. The pretravel provider should assess a traveler's past medical history, planned itinerary, activities, mode of travel, and duration of stay and make appropriate vaccine recommendations. Given that domestic vaccine-preventable illnesses are more common in international travelers than are exotic or low-income nation-associated vaccine-preventable illnesses, clinicians should first ensure that travelers are current regarding routine immunizations. Additional immunizations may be indicated in some travelers. Familiarity with geographic distribution and seasonality of infectious diseases is essential. Clinicians should be cognizant of which vaccines are live, as there exist contraindications for live vaccines.

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Familiarity with the distribution, mode of transmission, and risk factors for acquisition of illnesses commonly transmitted to travelers to low-income nations can help guide clinicians in their work-up of an ill returned traveler. The 3 most common categories of illness in returned international travelers are gastrointestinal illness, fever, and dermatoses. Diarrhea is the most common illness reported in returned international travelers. Fever is a marker of a potentially significant illness; work-up of the ill febrile returned traveler should be conducted promptly.

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Given the ever-changing nature of travel medicine, practitioners who provide pretravel and posttravel care are obligatorily students for the duration of their professional careers. A large variety of resources are available for medical practitioners. Providers should join at least one travel or tropical medicine professional association, attend its annual meeting, and read its journal. The largest general travel medicine association is the International Society of Travel Medicine.

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