Spontaneous Diffuse Pyoderma Gangrenosum after Polytrauma and Orthopedic Fixation: A Case Report with Brief Review of Literature.

Introduction: Pyoderma gangrenosum (PG) is a skin condition driven by neutrophil activation resulting in painful ulcers with undermining borders and surrounding erythema. This can be seen, although rarely, post-traumatically. It has been reported in the setting of orthopedic trauma with only 31 cases reported in English literature after orthopedic surgery. Case Report: A 20-year-old Caucasian female presented with multisystem trauma and multiple orthopedic injuries following motor vehicle collision. After fixation of orthopedic injuries, within 1 week post-operatively, the patient began to show signs of wound breakdown characterized by apparent purulence and skin necrosis at surgical sites and subsequently at additional non-surgical sites on bilateral lower extremities. After the failure of aggressive debridement and negative cultures, skin biopsy revealed post-traumatic PG. After diagnosis and treatment with corticosteroid therapy, the patient promptly recovered with the resolution of systemic and musculoskeletal manifestations. Conclusion: Post-traumatic PG should be considered a potential etiology in non-healing wounds with negative cultures. A low threshold for skin biopsy and interdisciplinary involvement should be maintained to expedite diagnosis and guide treatment.

A primer on investigating treatment effect heterogeneity and causal moderation in psychotherapy research.

OBJECTIVE: Experimental designs provide strong evidence for causal claims involving the main effects of a treatment but analyzes that solely focus on the main effects are inherently limited. Considerations for effect heterogeneity allow psychotherapy researchers to investigate for whom and under what conditions a treatment is likely to be effective. Evidence of causal moderation requires more stringent assumptions but is an important extension of treatment effect heterogeneity when interventions on the moderator are possible. METHOD: This primer clarifies and differentiates treatment effect heterogeneity and causal moderation in the context of psychotherapy research. RESULTS: Particular attention is given to the causal framework, assumptions, estimation, and interpretation of causal moderation. An illustrative example is included to ensure an approachable format with colloquial and intuitive language with R syntax provided to encourage and ease future implementation. CONCLUSIONS: This primer encourages proper consideration and interpretation of treatment effect heterogeneity and, when conditions are met, causal moderation. This knowledge improves the understanding of treatment efficacy across participant characteristics and study contexts and, relatedly, the generalizability of treatment effects.

Assessing whole-sounder removal versus traditional control for reducing invasive wild pig (Sus scrofa) populations.

BACKGROUND: Trapping is commonly used as the primary management tool in attempts to reduce invasive wild pigs (Sus scrofa), but traditional trapping techniques are often ineffective. However, recently developed traps permit the capture of entire social groups (sounders) of wild pigs, and the strategy of whole-sounder removal may achieve more effective control. Our objective was to experimentally compare traditional control (TC; primarily traditional trapping, but including hunting with dogs, and opportunistic shooting) and whole-sounder removal (WSR) strategies by assessing density reduction and removal rate after 1 and 2 years of treatment. RESULTS: After 1 year of trapping, average wild pig density on WSR units declined 53% and remained stable after the second year, whereas on TC units, pig density did not differ after trapping, although it declined 33% and remained stable after the second year of trapping. The median removal rate (percentage of uniquely marked pigs present at the beginning of each year that were removed) was 42.5% for WSR units and 0.0% for TC units during 2018 and were 29.6% from WSR units and 5.3% from TC units during 2019. CONCLUSIONS: WSR removal was more effective at reducing wild pig density than TC, but factors such as previous exposure of this population to traditional traps and the lack of barriers to recolonization from surrounding areas may have reduced WSR efficacy. WSR can effectively reduce wild pig density to a greater extent than TC, but managers should recognize the additional time and expense necessary for implementation. Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Croon's Bias-Corrected Estimation for Multilevel Structural Equation Models with Non-Normal Indicators and Model Misspecifications.

Multilevel structural equation models (MSEMs) are well suited for educational research because they accommodate complex systems involving latent variables in multilevel settings. Estimation using Croon's bias-corrected factor score (BCFS) path estimation has recently been extended to MSEMs and demonstrated promise with limited sample sizes. This makes it well suited for planned educational research which often involves sample sizes constrained by logistical and financial factors. However, the performance of BCFS estimation with MSEMs has yet to be thoroughly explored under common but difficult conditions including in the presence of non-normal indicators and model misspecifications. We conducted two simulation studies to evaluate the accuracy and efficiency of the estimator under these conditions. Results suggest that BCFS estimation of MSEMs is often more dependable, more efficient, and less biased than other estimation approaches when sample sizes are limited or model misspecifications are present but is more susceptible to indicator non-normality. These results support, supplement, and elucidate previous literature describing the effective performance of BCFS estimation encouraging its utilization as an alternative or supplemental estimator for MSEMs.

Pediatric Posterior Sternoclavicular Dislocation Closed Reduction and Management.

SUMMARY: Posterior sternoclavicular joint (SCJ) dislocations are rare shoulder girdle injuries. Despite the paucity of cases, posterior SCJ dislocations pose an important threat to patient safety because of the proximity of the medial clavicle to the mediastinum, resulting in possible compression and/or injury to these structures. Current guidelines recommend attempting closed reduction in the acute setting followed by open reduction if closed reduction is unsuccessful. This video highlights a case of posterior SCJ dislocation in a pediatric patient who presented with dyspnea after a football injury.

Effect of Age at Primary Intraocular Lens Implantation on Refractive Growth in Young Children.

PURPOSE: To evaluate the effect of age at primary intraocular lens (IOL) implantation on rate of refractive growth (RRG3) during childhood. METHODS: A retrospective chart review was performed for children undergoing primary IOL implantation during cataract surgery. RRG3 was calculated for one eye from each patient using the first postoperative refraction, last refraction that remained stable (< 1.00 diopters [D] change/2 years), and the corresponding ages. RRG3 values for pseudophakic patients operated on from ages 0 to 5 months were compared with values for patients operated on at ages 6 to 23 months and 24 to 72 months. Patients with refractive errors that stabilized were grouped by age at surgery to compare age at refractive plateau. RESULTS: Of 296 eyes identified from 219 patients, 46 eyes met the inclusion criteria. There was a statistically significant difference in RRG3 among age groups. The mean RRG3 value was -19.82 ± 5.23 D for the 0 to 5 months group, -22.32 ± 7.45 D for the 6 to 23 months group (0 to 5 months vs 6 to 23 months, P = .43), and -9.64 ± 11.95 D for the 24 to 72 months group (0 to 5 months vs 24 to 72 months, P = .01). CONCLUSIONS: Age at primary IOL implantation affects the RRG3, especially for children 0 to 23 months old at surgery. Surgeons performing primary IOL implantation in infants may want to use age-adjusted assumptions, because faster refractive growth rates can be expected in young children. [J Pediatr Ophthalmol Strabismus. 2020;57(4):264-270.].

Artificial Light Increases Local Predator Abundance, Predation Rates, and Herbivory.

Human activity is rapidly increasing the radiance and geographic extent of artificial light at night (ALAN) leading to alterations in the development, behavior, and physiological state of many organisms. A limited number of community-scale studies investigating the effects of ALAN have allowed for spatial aggregation through positive phototaxis, the commonly observed phenomenon of arthropod movement toward light. We performed an open field study (without restricted arthropod access) to determine the effects of ALAN on local arthropod community composition, plant traits, and local herbivory and predation rates. We found strong positive phototaxis in 10 orders of arthropods, with increased (159% higher) overall arthropod abundance under ALAN compared to unlit controls. The arthropod community under ALAN was more diverse and contained a higher proportion of predaceous arthropods (15% vs 8%). Predation of immobilized flies occurred 3.6 times faster under ALAN; this effect was not observed during the day. Contrary to expectations, we also observed a 6% increase in herbivory under ALAN. Our results highlight the importance of open experimental field studies in determining community-level effects of ALAN.

Success and failure of ecological management is highly variable in an experimental test.

When managing natural systems, the importance of recognizing the role of uncertainty has been formalized as the precautionary approach. However, it is difficult to determine the role of stochasticity in the success or failure of management because there is almost always no replication; typically, only a single observation exists for a particular site or management strategy. Yet, assessing the role of stochasticity is important for providing a strong foundation for the precautionary approach, and learning from past outcomes is critical for implementing adaptive management of species or ecosystems. In addition, adaptive management relies on being able to implement a variety of strategies in order to learn-an often difficult task in natural systems. Here, we show that there is large, stochastically driven variability in success for management treatments to control an invasive species, particularly for moderate, and more feasible, management strategies. This is exactly where the precautionary approach should be important. Even when combining management strategies, we show that moderate effort in management either fails or is highly variable in its success. This variability allows some management treatments to, on average, meet their target, even when failure is probable. Our study is an important quantitative replicated experimental test of the precautionary approach and can serve as a way to understand the variability in management outcomes in natural systems which have the potential to be more variable than our tightly controlled system.

Optimal Design of Cluster- and Multisite-Randomized Studies Using Fallible Outcome Measures.

BACKGROUND: Evaluation studies frequently draw on fallible outcomes that contain significant measurement error. Ignoring outcome measurement error in the planning stages can undermine the sufficiency and efficiency of an otherwise well-designed study and can further constrain the evidence studies bring to bear on the effectiveness of programs. OBJECTIVES: We develop simple formulas to adjust statistical power, minimum detectable effect (MDE), and optimal sample allocation formulas for two-level cluster- and multisite-randomized designs when the outcome is subject to measurement error. RESULTS: The resulting adjusted formulas suggest that outcome measurement error typically amplifies treatment effect uncertainty, reduces power, increases the MDE, and undermines the efficiency of conventional optimal sampling schemes. Therefore, achieving adequate power for a given effect size will typically demand increased sample sizes when considering fallible outcomes, while maintaining design efficiency will require increasing portions of a budget be applied toward sampling a larger number of individuals within clusters. We illustrate evaluation planning with the new formulas while comparing them to conventional formulas using hypothetical examples based on recent empirical studies. To encourage adoption of the new formulas, we implement them in the R package PowerUpR and in the PowerUp software.

Clinical outcomes involving patients that develop septic arthritis with methicillin sensitive staphylococcus aureus versus methicillin resistant staphylococcus aureus.

Septic Arthritis is an orthopedic emergency that requires prompt diagnosis and treatment. Staphylococcus aureus is the most common pathogen causing septic arthritis. This review seeks to describe clinical characteristics and outcomes associated with patients with methicillin-resistant (MRSA) vs. methicillin-sensitive staphylococcus aureus (MSSA) septic arthritis. The review showed that those infected with MRSA were older, had more chronic medical conditions, and higher values of inflammatory markers. MRSA septic arthritis was also associated with more complications, longer duration of antibiotics, and increased mortality. Thus, health care providers should maintain a high index of suspicion, diagnose, and treat aggressively to prevent adverse outcomes.

Genome assembly with in vitro proximity ligation data and whole-genome triplication in lettuce.

Lettuce (Lactuca sativa) is a major crop and a member of the large, highly successful Compositae family of flowering plants. Here we present a reference assembly for the species and family. This was generated using whole-genome shotgun Illumina reads plus in vitro proximity ligation data to create large superscaffolds; it was validated genetically and superscaffolds were oriented in genetic bins ordered along nine chromosomal pseudomolecules. We identify several genomic features that may have contributed to the success of the family, including genes encoding Cycloidea-like transcription factors, kinases, enzymes involved in rubber biosynthesis and disease resistance proteins that are expanded in the genome. We characterize 21 novel microRNAs, one of which may trigger phasiRNAs from numerous kinase transcripts. We provide evidence for a whole-genome triplication event specific but basal to the Compositae. We detect 26% of the genome in triplicated regions containing 30% of all genes that are enriched for regulatory sequences and depleted for genes involved in defence.

Role of Vismodegib in the Management of Advanced Periocular Basal Cell Carcinoma.

BACKGROUND: Vismodegib is the first selective hedgehog pathway inhibitor approved to treat locally advanced and metastatic basal cell carcinoma (BCC). Limited information is available concerning its role in managing advanced BCC around the eye. METHODS: The medical literature was searched for cases of nonsyndromic periocular BCC treated with vismodegib. Clinical information was abstracted and analyzed. In addition, a review of the pharmacology of vismodegib, including general effectiveness and safety, was conducted. RESULTS: Thirty study patients with nonsyndromic periocular BCC treated with vismodegib were found in the literature. Vismodegib was used in 3 ways: medical therapy, adjuvant therapy prior to surgery or radiotherapy, and treatment of positive surgical margins. Complete regression was reported in 9 study patients (30%), with follow-up visits after therapy averaging fewer than 5 months. Four study participants developed squamous cell carcinoma while receiving treatment. CONCLUSIONS: Too few cases exist to draw any conclusions on the role that vismodegib might play in the management of periocular BCC. In addition, long-term follow-up data are not yet available. Although the objective response rate of advanced BCC is impressive in study patients receiving vismodegib, well-controlled clinical studies are needed to determine whether vismodegib has any impact on survival or quality of life.

Postoperative shift in ocular alignment following single vertical rectus recession on adjustable suture in adults without thyroid eye disease.

PURPOSE: To determine whether overcorrection shifts occur after vertical rectus recession on adjustable suture in the absence of thyroid eye disease. METHODS: The medical records of patients without thyroid eye disease who underwent vertical rectus recession surgery from 2001 to 2008 were retrospectively reviewed for shifts in alignment between suture adjustment at postoperative day 1 and 2 months' follow-up. Superior rectus and inferior rectus recessions were compared. In addition, we compared the use of a nonabsorbable polyester suture to an absorbable polyglactin 910 suture in nonthyroid patients undergoing inferior rectus recessions. RESULTS: A total of 59 patients were included (superior rectus, 30; inferior rectus, 29). We found a mean undercorrection shift of 1.1 (range, 17.5(Δ) undercorrection to 16(Δ) overcorrection) and 1.0(Δ) (range, 12(Δ) undercorrection shift to 6(Δ) overcorrection shift) for superior and inferior rectus recessions, respectively, between 1 day and 2 months postoperatively. CONCLUSIONS: There was no trend toward overcorrection following unilateral vertical rectus adjustable suture recessions in patients without thyroid eye disease, suggesting that thyroid myopathy may account for overcorrection shifts seen with this surgery.

Phenotypic expression of Bardet-Biedl syndrome in patients homozygous for the common M390R mutation in the BBS1 gene.

PURPOSE: To characterize the phenotype of Bardet-Biedl syndrome (BBS) patients homozygous for the BBS1 M390R mutation. METHODS: Three patients [PT1, F, 27 years old (yo) at last examination, 14-year follow-up (F/U) PT2, F, 15-yo PT3, M, 15-yo, both 1-year F/U] underwent eye exams, Goldmann visual fields (GVFs), dark- (DA) and light-adapted (LA) electroretinograms (ERGs), spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). Vision and systemic history were also collected. RESULTS: All patients had night blindness, hyperopic astigmatism, ptosis or mild blepharospasm, foot polydactyly, 5th finger clinodactyly, history of headaches, and variable, diet-responsive obesity. Two had asthma, PT1 was developmentally delayed, PT2 had Asperger-like symptoms, and PT3 had normal cognition. At age 14, acuity was 20/100 in PT1, who had nystagmus since age 2, 20/40 in PT2 and 20/30 in PT3. By 27yo PT1 progressed to 20/320, by 15 yo PT2 was 20/60 and PT3 remained stable. PT1 had well preserved peripheral GVFs, with minimal progression over 10 years of F/U. PT2 and PT3 presented with ring scotomas and I4e<5°. All patients had severe generalized visual sensitivity depression. ERGs were consistently recordable (also rod ERG in PT3 after 60 min DA), but progressed to non-recordable in PT1. Mixed DA ERGs exhibited electronegativity. In PT3, this was partly due to a bleaching effect during bright-flash DA averaging, partly to ON≫OFF LA response compromise. PT2 and 3 had, on SD-OCTs, generalized macular thinning, normal retinal lamination, and widespread photoreceptor outer/inner segment attenuation except foveally, and multiple rings of abnormal FAF configuring a complex bull's eye-pattern. PT1 had macular atrophy. All patients also had peripapillary nerve fiber layer thickening. CONCLUSIONS: The observed phenotype matches very closely that reported in patients by Azari et al. (IOVS 2006) and in the Bbs1-M390R knock-in mouse model, and expands it to the characterization of important ERG response characteristics that provide insight in the pathogenesis of retinopathy in these patients. Our findings confirm the consistent pathogenicity of the BBS1 M390R mutation.