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BACKGROUND: Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS: We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. RESULTS: Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3-95.7%) and 93.8% (79.2-99.3%), respectively. CONCLUSIONS: This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.

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ABSTRACT: Achilles tendon injuries are common in the adolescent population, particularly in individuals who participate in sports. The diagnosis of Achilles tendon rupture can be missed on clinical examination in 20% to 30% of patients. In the adult literature, there are several case reports describing the diagnosis of Achilles tendon rupture by point-of-care ultrasound POCUS. There is currently no literature examining POCUS for the diagnosis of Achilles tendon rupture in pediatric patients. This case series describes 2 pediatric patients who were diagnosed with Achilles tendon rupture by POCUS.

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PURPOSE: To describe the implementation and impact of integrating a clinical pharmacist into interdisciplinary Acute Care for Elderly (ACE) rounds at a teaching hospital. METHODS: Pre- and postanalyses were performed 6 months before and 12 months after the intervention. We report the total number, type, and frequency of recommendations made by the clinical pharmacist, the acceptance rate by the physician, and interventions on potentially inappropriate medications (PIM). RESULTS: Among the 588 patients who met the ACE inclusion criteria, mean age was 81.2 years, 54.9% were female, and 79.8% were of white race. A total of 1243 pharmacy recommendations were recorded. The median number of recommendations per patient increased from a median of 1 (range: 1-7) in the preintervention to 2 (1-13) in the postintervention period, resulting in an incidence rate ratio of 1.25 (95% confidence interval [CI]: 1.10-1.40). The main categories of recommendations were dose adjustment, avoidance of inappropriate therapy, and prevention of adverse drug events. In the postintervention period, there was an increase in recommendations among analgesics (from 3.7% to 7.5%), PIMs (from 12% to 14%), and, in particular, antidepressant/antipsychotics (from 1.9% to 6.0%). The acceptance rate of the recommendations remained roughly the same (86.5% vs 84.4%). CONCLUSION: Proactive involvement of a clinical pharmacist in ACE rounds resulted in a substantial increase in recommendation for medication changes, most notably for PIMs. These recommendations generally were accepted by physicians. The integration of a clinical pharmacist requires significant dedicated time but leads to increased recognition of drug-related problems in the acute-care setting, resulting in improved patient outcomes.

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A common task in microscopy is to fit an image of a fluorescent probe to a point spread function (PSF) in order to estimate the position of the probe. The PSF is often approximated as a Gaussian for mathematical simplicity. We show that the separable property of the Gaussian PSF enables a reduction of computational time from O(L2) to O(L), where L is the width (in pixels) of the image. When tested on realistic simulated data, our algorithm is able to localize the probes with precision close to the Cramér-Rao lower bound.

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Explanations of variability in long-term recall typically appeal to encoding and/or retrieval processes. However, for well over a century, it has been apparent that for memory traces to be stored successfully, they must undergo a post-encoding process of stabilization and integration. Variability in post-encoding processes is thus a potential source of age-related and individual variance in long-term recall. We examined post-encoding variability in each of two experiments. In each experiment, 20-month-old infants were exposed to novel three-step sequences in each of three encoding conditions: watch only, imitate, and learn to criterion. They were tested for recall after 15 min (as a measure of the success of encoding) and either weeks (1, 2, or 3: Experiment 1) or days (1, 2, or 4: Experiment 2) later. In each experiment, differential relative levels of performance among the conditions were observed at the two tests. The results implicate post-encoding processes are a source of variance in long-term recall.

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BACKGROUND: Despite the impact of highly active antiretroviral therapy (HAART), mycobacterial infections in patients with AIDS remain a frequent complication. In disseminated cases, both tuberculous and non-tuberculous mycobacterial infections may involve the gastrointestinal system and cause abdominal pain and diarrhea. While there have been cases of small bowel perforation in AIDS patients with Mycobacterium tuberculosis (MTB) infection, no case of bowel perforation in non-tuberculous mycobacterial (NTM) infection has been reported to date. CASE REPORT: We report a case of spontaneous perforation of the terminal ileum in an AIDS patient with disseminated non-tuberculous mycobacterial infection who was responding to HAART. CONCLUSIONS: Non-tuberculous mycobacteria can lead to spontaneous bowel perforation in patients with AIDS who are responding to HAART.

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BACKGROUND: Participation of women in the medical profession has increased during the past four decades, but issues of concern persist regarding disparities between the sexes in academic medicine. Advancement is largely driven by peer-reviewed original research, so we sought to determine the representation of female physician-investigators among the authors of selected publications during the past 35 years. METHODS: Original articles from six prominent medical journals--the New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA), the Annals of Internal Medicine (Ann Intern Med), the Annals of Surgery (Ann Surg), Obstetrics & Gynecology (Obstet Gynecol), and the Journal of Pediatrics (J Pediatr)--were categorized according to the sex of both the first and the senior (last listed) author. Sex was also determined for the authors of guest editorials in NEJM and JAMA. Data were collected for the years 1970, 1980, 1990, 2000, and 2004. The analysis was restricted to authors from U.S. institutions holding M.D. degrees. RESULTS: The sex was determined for 98.5 percent of the 7249 U.S. authors of original research with M.D. degrees. The proportion of first authors who were women increased from 5.9 percent in 1970 to 29.3 percent in 2004 (P<0.001), and the proportion of senior authors who were women increased from 3.7 percent to 19.3 percent (P<0.001) during the same period. The proportion of authors who were women increased most sharply in Obstet Gynecol (from 6.7 percent of first authors and 6.8 percent of senior authors in 1970 to 40.7 percent of first authors and 28.0 percent of senior authors in 2004) and J Pediatr (from 15.0 percent of first authors and 4.3 percent of senior authors in 1970 to 38.9 percent of first authors and 38.0 percent of senior authors in 2004) and remained low in Ann Surg (from 2.3 percent of first authors and 0.7 percent of senior authors in 1970 to 16.7 percent of first authors and 6.7 percent of senior authors in 2004). In 2004, 11.4 percent of the authors of guest editorials in NEJM and 18.8 percent of the authors of guest editorials in JAMA were women. CONCLUSIONS: Over the past four decades, the proportion of women among both first and senior physician-authors of original research in the United States has significantly increased. Nevertheless, women still compose a minority of the authors of original research and guest editorials in the journals studied.

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OBJECTIVE: The purpose of this study was to determine whether a junior faculty mentoring program is beneficial to participants and to identify particular positive and negative aspects of such a program to enable others to institute similar programs. STUDY DESIGN: In 2001 a pilot program was instituted in our obstetrics and gynecology department for interested faculty members. There were 3 focus groups and a written survey that assessed the project. A combination of qualitative and quantitative methods were used for data analysis; Fisher's exact test was used. RESULTS: Two recurring themes emerged from the focus group sessions: participants felt better supported by the department and appreciated a greater sense of camaraderie. Most mentees noted the program's success in the following areas of having a role model (83.3%), having increased visibility (82.3%), and having to whom someone to turn (93.8%). CONCLUSION: The faculty mentoring program had significant benefits for everyone who participated.

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