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Background: In general, stable type B ankle fractures are treated conservatively with cast immobilization or a walking boot during six weeks. Some disadvantages of casting are joint stiffness, muscle wasting and lack of comfort. This study was designed to evaluate whether functional treatment with a removeable brace is a safe and more comfortable alternative. Material and methods: Randomized controlled trial. In the period March 2013-May 2015, 44 patients visiting the emergency department due to a stable type B ankle fracture were included. During the first week both groups received a splint. After one week the patients were randomized: one group received a cast, the other a removable brace. For outcome, Olerud & Molander Ankle Score, Visual Analogue Score for comfort and pain, America Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle score questionnaire, EuroQol-5D and range of motion were used. Results: Forty-four patients participated (21 cast, 23 brace). There were no differences in baseline characteristics. After six weeks, VAS for comfort (cast versus brace; 5.74 versus 7.21; p=0.02) and total range of motion (40° versus 49°; p=0.00) showed significant differences in favour of the brace. VAS pain (3.15 versus 2.05; p=0.16), OMA-score (51.75 versus 61.32; p=0.22) and EuroQol-5D (7.26 versus 6.74; p=0.33) did not show significant differences. Week 52 showed no significant differences at OMA-score (89.29 versus 96.18; 0=0.16), EuroQol-5D (6.00 versus 5.35; p=0.15), VAS pain (1.07 versus 0.82; p=0.69) and AAOS score (91.71 versus 96.06; p=0.21). No complications occurred in both groups. Conclusion: Functional bracing showed significant differences for the VAS comfort score and range of motion as six weeks compared to casting. After a year, no significant differences were found. Treatment with a brace is a safe and more comfortable option for stable type B ankle fractures. [ABSTRACT FROM AUTHOR]

Purpose: To determine success rates over time for strabismus surgery for sensory exotropia and to determine factors associated with successful outcomes., Methods: We retrospectively reviewed medical records of patients with sensory exotropia (best-corrected visual acuity ≤20/200 in the affected eye) who underwent strabismus surgery between May 2009 and December 2019. Patients with paralytic/restrictive exotropia and patients who did not follow up postoperatively were excluded. Surgical success was defined as exotropia of ≤10 Δ or esotropia of ≤6 Δ . Cox-proportional hazard models were used to evaluate covariate relationships with surgical outcome (α = 0.05)., Results: A total of 94 patients (64% female) were included. Mean patient age was 27.2 years (range, 3-69). Mean follow-up was 2.35 ± 2.77 years. The mean preoperative near deviation was 39 Δ ± 14.8 Δ of manifest or intermittent exotropia. Successful alignment was achieved in 51 of 83 patients (61%) at 1 month, 19 of 32 (59%) at 1 year, and 8 of 16 (50%) at 5 years. We found a significant correlation (P value = 0.0476) between success and smaller surgical doses in patients that underwent one- and two-muscle surgeries., Conclusions: In our study cohort of 94 patients, 50% of patients still had satisfactory ocular alignment at 5 years., (Copyright © 2023 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Background: Previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination, independently and combined ("hybrid immunity"), result in partial protection from subsequent infection and strong protection from severe disease. Proportions of the US population who have been infected, vaccinated, or have hybrid immunity remain unclear, posing a challenge for assessing effective pandemic mitigation strategies., Methods: In this serial cross-sectional study, nationwide blood donor specimens collected during January-December 2021 were tested for anti-spike and anti-nucleocapsid antibodies, and donor COVID-19 vaccination history of ≥1 dose was collected. Monthly seroprevalence induced from SARS-CoV-2 infection, COVID-19 vaccination, or both, were estimated. Estimates were weighted to account for demographic differences from the general population and were compared temporally and by demographic factors., Results: Overall, 1 123 855 blood samples were assayed. From January to December 2021, the weighted percentage of donations with seropositivity changed as follows: seropositivity due to vaccination without previous infection, increase from 3.5% (95% confidence interval, 3.4%-3.7%) to 64.0%, (63.5%-64.5%); seropositivity due to previous infection without vaccination, decrease from 15.6% (15.2%-16.0%) to 11.7% (11.4%-12.0%); and seropositivity due to hybrid immunity, increase from 0.7% (0.6%-0.7%) to 18.9% (18.5%-19.3%). Combined seroprevalence from infection, vaccination, or both increased from 19.8% (19.3%-20.2%) to 94.5% (93.5%-94.0%). Infection- and vaccination-induced antibody responses varied significantly by age, race-ethnicity, and region, but not by sex., Conclusions: Our results indicate substantial increases in population humoral immunity from SARS-CoV-2 infection, COVID-19 vaccination, and hybrid immunity during 2021. These findings are important to consider in future COVID-19 studies and long-term pandemic mitigation efforts., Competing Interests: Potential conflicts of interest. M. P. B. reports being an employee of Vitalant Research Institute and receiving grant funding for their institution from Ortho Clinical Diagnostics. E. G. reports research funding to their employer Vitalant Research Institute from Ortho Clinical Diagnostics. They also report the provision of reagents for other studies from Ortho Clinical Diagnostics and Roche. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Trisomy 13 is associated with a variety of ocular findings. As more children with trisomy 13 survive beyond their first year of life, early identification and awareness of associated ocular manifestations is increasingly important. This retrospective case series of 5 patients with trisomy 13 expands on what is known about the complex ocular findings associated with the condition and describes their clinical management, with a mean follow-up of 2 years. All 5 patients had microphthalmos and colobomas of the iris, 4 had corneal opacities, and 2 had kerato-irido-lenticular dysgenesis associated with glaucoma. In addition, these patients were found to have recurrent eyelid infections, congenital glaucoma, cataracts, and persistent fetal vasculature. All 5 patients had cerebral visual impairment., (Copyright © 2022 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Background: Ebola virus disease (EVD) outbreaks in West Africa (2013-2016) and the Democratic Republic of Congo (2018-2020) have resulted in thousands of EVD survivors who remain at-risk for survivor sequelae. While EVD survivorship has been broadly reported in adult populations, pediatric EVD survivors are under-represented. In this cross-sectional study, we investigated the prevalence of eye disease, health-related quality-of-life, vision-related quality-of-life, and the burden of mental illness among pediatric EVD survivors in Sierra Leone., Methods: Twenty-three pediatric EVD survivors and 58 EVD close contacts were enrolled. Participants underwent a comprehensive ophthalmic examination and completed the following surveys: Pediatric Quality of Life Inventory Version 4.0, Effect of Youngsters Eyesight on Quality-of-Life, and the Revised Child Anxiety and Depression Scale., Findings: A higher prevalence of uveitis was observed in EVD survivor eyes (10·8%) cohort compared to close contacts eyes (1·7%, p=0·03). Overall, 47·8% of EVD survivor eyes and 31·9% of close contact eyes presented with an eye disease at the time of our study (p=0·25). Individuals diagnosed with an ocular complication had poorer vision-related quality-of-life (p=0·02)., Interpretation: Both health related quality-of-life and vision-related quality-of-life were poor among EVD survivors and close contacts. The high prevalence of eye disease associated with reduced vision health, suggests that cross-disciplinary approaches are needed to address the unmet needs of EVD survivors., Funding: National Institutes of Health R01 EY029594, K23 EY030158; National Eye Institute; Research to Prevent Blindness (Emory Eye Center); Marcus Foundation Combating Childhood Illness; Emory Global Health Institute; Stanley M. Truhlsen Family Foundation., Competing Interests: The funding organizations highlighted above had no role in the design or conduct of this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors on this manuscript declare no financial conflicts of interest in relationship to the work presented., (© 2022 The Author(s).)

Background: Application of current retinopathy of prematurity (ROP) screening criteria results in many unnecessary examinations, because only 5%-10% of infants screened require treatment. Application of screening criteria established by the Postnatal Growth and Retinopathy of Prematurity Study could significantly reduce unnecessary examinations without sacrificing sensitivity to detect treatment-requiring ROP. We evaluated the performance of the G-ROP criteria in a population of high-risk, outborn infants., Methods: The medical records of consecutive infants screened and/or treated for ROP at Children's Health Care of Atlanta Hospitals from May 1, 2013, to September 6, 2019, were reviewed retrospectively. The sensitivity of the G-ROP birthweight and gestational age screening criteria to detect treatment-requiring ROP was calculated., Results: During the study period, 901 children underwent examinations for ROP; of these, 5 were excluded from the analysis because birth weight (BW) data was lacking. Of the 896 remaining patients, 120 patients were treated for ROP. Application of G-ROP birth weight and gestational age (GA) criteria alone resulted in a sensitivity of 99.2% to detect infants requiring treatment. Application of weight gain criteria was problematic, because many patients were transferred into our institutions after the specified intervals of 10-19, 20-29, and 30-39 days., Conclusions: G-ROP BW and GA screening criteria were highly sensitive in detecting treatment-requiring ROP. Applying weight gain criteria in referral centers can be problematic. Intake procedures at referral centers should include documentation of weight gain during 10-19, 20-29, and 30-39 days of life., (Copyright © 2022 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

The advent of recombinant DNA technology fundamentally altered the drug discovery landscape, replacing traditional small-molecule drugs with protein and peptide-based biologics. Being susceptible to degradation via the oral route, biologics require comparatively invasive injections, most commonly by intravenous infusion (IV). Significant academic and industrial efforts are underway to replace IV transport with subcutaneous delivery by wearable infusion devices. To further complement the ease-of-use and safety of disposable infusion devices, surface disinfection of the drug container can be automated. For ease of use, the desired injector is a combination device, where the drug is inside the injector as a single solution combination device. The main obstacle of the desired solution is the inability to sterilize both injector and drug in the same chamber or using the same method (Gamma for the drug and ETO for the injector). This leads to the assembly of both drug container and injector after sterilization, resulting in at least one transition area that is not sterilized. To automate the delivery of the drug to the patient, a disinfection step before the drug delivery through the injector is required on the none-sterilized interface. As an innovative solution, the autoinjector presented here is designed with a single ultraviolet light-emitting diode (UV LED) for surface disinfection of the drug container and injector interface. In order to validate microbial disinfection similar to ethanol swabbing on the injector, a bacterial 3 or 6 log reduction needed to be demonstrated. However, the small disinfection chamber surfaces within the device are incapable of holding an initial bacterial load for demonstrating the 3 or 6 log reduction, complicating the validation method, and presenting a dilemma as to how to achieve the log reduction while producing real chamber conditions. The suggested solution in this paper is to establish a correlation model between the UV irradiance distribution within the disinfection chamber and a larger external test setup, which can hold the required bacterial load and represents a worse-case test scenario. Bacterial log reduction was subsequently performed on nine different microorganisms of low to high UV-tolerance. The procedure defined herein can be adopted for other surface or chamber disinfection studies in which the inoculation space is limited., Competing Interests: The authors have no conflicts of interest to disclose., (© 2022 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement.)

Vinifera cultivation is a thriving and growing industry across the state of Michigan (MI), United States. Extensive time, funds, and effort have been applied by the industry to promote growth and the onset of new producers. Specifically, Vitis vinifera wine grapes, which have been cultivated in MI since the 1970s, have seen a rapid expansion and investment from both first-time and legacy growers. However, historically, the climate of MI presented a challenge for cultivation because of low growing season temperatures (GSTs), short growing seasons, and excessive precipitation at the time of harvest. Over time, two key factors have led the MI wine industry to overcome the challenging climate. First, as seen in the literature, there are noted changes in climate, especially since the late 1980s, leading to more favorable conditions for cultivation. Second, MI growers traditionally focused on V. vinifera cultivation, which is susceptible to low winter temperatures, selected less vulnerable regions within the state while also focusing on vine protection techniques. Given the rapid growth of the wine industry across MI, there is a need to understand suitability and its drivers to help all growers make economically impactful decisions on production and expansion of wine grapes. This article looked to study the suitability of MI vinifera across the state in two ways. Initially, through an extensive literature review, the key drivers and commonly noted trends guiding vinifera production were chronicled. Second, through a trend analysis of the key drivers of suitability, the study investigated how such variables are changing significantly over space and time. The results of this study expand the knowledge of cool climate agriculture production and suitability for cultivation and highlight the complexity of relating suitability drivers for non-cool climate to cool climate vinifera cultivation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bunting, Wanyama, Goodwin, Weil, Sabbatini and Andresen.)

The importance of physical activity during childhood and adolescence has come to light, with an increase in sports-related acute traumatic and overuse injuries as a major disadvantage. A solid understanding of the physiology of the growing skeleton, together with knowledge about age- and sex-related differences in the occurrence of acute traumatic and overuse injuries is necessary. Every musculoskeletal radiologist should also be familiar with the appearances of these injuries on different imaging modalities. This review focuses on all these aspects concerning acute traumatic and overuse injuries among children and adolescents., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: Goal of this study was to investigate whether a gravity stress radiograph is beneficial in determining instability in Supination-External rotation (SER)-type ankle fractures without a medial fracture., Methods: 39 Patients with a SER-type ankle fracture without a medial or posterior fracture and medial clear space (MCS) < 6 mm at regular mortise view were included. A gravity stress radiograph and Magnetic Resonance imaging (MRI)-scan were made. The MCS measurements of the regular and gravity stress radiographs were compared with the MRI findings (set as reference standard) to determine the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values as indication for a complete deltoid ligament rupture., Results: Mean MCS at regular mortise views was 3.11 (range 1.73-5.93) mm, compared to 4.54 (range 2.33-10.40) mm at gravity stress radiographs. With MCS ≥ 4 mm as threshold for predicting a complete rupture at regular ankle mortise views the sensitivity was 66.7, specificity 91.7, PPV 40.0 and NPV 97.0. Gravity stress radiographs with MCS ≥ 6 mm as threshold led to a sensitivity of 100, specificity 91.7, PPV 50.0 and NPV 100., Conclusion: Gravity stress radiographs have more discriminative ability for diagnosing SER-type fractures with or without a complete deltoid ligament tear than regular ankle mortise views.

Background: In general, stable type B ankle fractures are treated conservatively with cast immobilization or a walking boot during six weeks. Some disadvantages of casting are joint stiffness, muscle wasting and lack of comfort. This study was designed to evaluate whether functional treatment with a removable brace is a safe and more comfortable alternative., Material and Methods: Randomized controlled trial. In the period March 2013 - May 2015, 44 patients visiting the emergency department due to a stable type B ankle fracture were included. During the first week both groups received a splint. After one week the patients were randomized: one group received a cast, the other a removable brace. For outcome Olerud & Molander Ankle Score, Visual Analogue Score for comfort and pain, American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle score questionnaire, EuroQol-5D and range of motion were used., Results: 44 patients participated (21 cast, 23 brace). There were no differences in baseline characteristics. After 6 weeks, VAS for comfort (cast vs brace; 5.74 vs 7.21; p = 0.02) and total range of motion (40° vs 49°; p = 0.00) showed significant differences in favour of the brace. VAS pain (3.15 vs 2.05; p = 0.16), OMA-score (51.75 vs 61.32; p = 0.22) en EuroQoL-5D (7.26 vs 6.74; p = 0.33) did not show significant differences. Week 52 showed no significant differences at OMA-score (89.29 vs 96.18; p = 0.16), EuroQoL-5D (6.00 vs 5.35; p = 0.15), VAS pain (1.07 vs 0.82; p = 0.69) and AAOS score (91.71 vs 96.06; p = 0.21). No complications occurred in both groups., Conclusion: Functional bracing showed significant differences for the VAS comfort score and range of motion at 6 weeks compared to casting. After a year no significant differences were found. Treatment with a brace is a safe and more comfortable option for stable type B ankle fractures., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Adhesion bonds between membranes and surfaces are attracted to each other via effective interactions whose origin is the entropy loss due to the reduction in the amplitude of the membrane thermal fluctuations in the vicinity of the adhesion bonds. These fluctuation-induced interactions are also expected to drive the adhesion bonds toward the rim of the cell as well as toward the surfaces of membrane inclusions. In this paper we analyze the attraction of adhesion bonds to the cell inner and outer boundaries. Our analysis shows that the probability distribution function of a single (diffusing) adhesion bond decays algebraically with the distance from the boundaries. Upon increasing the concentration of the adhesion bonds, the attraction to the boundaries becomes strongly self-screened.

We developed a simple antigen capture enzyme immunosorbent assay (AgC-ELISA) for identifying dengue (DEN) virus. The method employed serotype-specific monoclonal antibodies as capture antibodies and an enzyme conjugate of a flavivirus-reactive monoclonal antibody as a detecting antibody. Most DEN virus strains, representing all 4 serotypes isolated from various parts of the tropics, were identical either visually of spectrophotometrically when infected cell culture fluids were used as sources of antigen. The shelf life of the solid phase presensitized with monoclonal antibodies was 4 mth at -15 degrees C. DEN prototype viruses were still identified after storage at -15 degrees C for 1 yr or at room temperature for 1 mth.

An enzyme-linked immunosorbent assay (ELISA) was developed using microtiter plates for the immunodiagnosis of fascioliasis in rats and rabbits using extracts of adult worms partially purified by gel filtration chromatography using Sephacryl S-200. Partial purification was necessary to eliminate cross-reactivity with antisera having antibodies to schistosomes. Soft polyvinyl plates clearly gave superior results over hard polystyrine plates. Titers rose by 4 weeks of infection in rats with fascioliasis, by 6 weeks in the case of rabbits, and remained high through at least 12 and 28 weeks, respectively. Titers drop rapidly when animals are successfully treated with a fasciolicidal drug at 4--6 weeks of infection. The results show that the ELISA can be employed for the serodiagnosis of fascioliasis in rats and rabbits and is useful for the prediction of chemotherapeutic success.

Twenty participants responded to inquiries about strategies used, and thoughts during, each of three electromyograph biofeedback sessions. The purpose of the study was to learn more about what individuals report doing during biofeedback and, specifically, to determine if individuals construct a response using feedback to sense subtle differences in muscle tension (feedback processes), or select a response from an existing repertoire using feedback primarily for confirmation (feed-forward processes). Protocol analyses found considerable support for feed-forward processes and little support for feedback processes. Such results are important because early reliance on feed-forward processes may result in limited control and limited transfer.

The significance of a visual dialogue between patient and therapist in assisting tension regulation for patients with severe narcissistic injury is proposed. Non-verbal interactions may unfold spontaneously and contribute to development of a "holding environment" in its broadest sense. There will be inevitably both countertransference and real elements in this bipersonal field. The development of a visual holding environment at a symbiotic level may be based on a counter-transference response by the therapist of an earlier need to "hold or be held." It has been suggested that it is difficult for the therapist to feel a "gleam in the eye" for patients who have missed early mirroring. Developmental stages of treatment involving active mutuality of eye contact, considered a "language of silence" beyond verbal interpretation, are suggested. These observations agree with Searles' paper that facial expressions form a bridge to personal relatedness.

When F. hepatica adult worm antigen is fractionated with Sephadex G-200, four major peaks are obtained. The first peak, when used as antigen in counterelectrophoresis, reacts with the serum of normal rats as well as from rats infected with F. hepatica for 5 weeks or longer. The crest and descending portion of peak II and the third peak are nonreactive with normal rat serum, but highly reactive with the serum of rats with F. hepatica. In addition, F. hepatica antigens cross-reacting with S. mansoni adult worm antisera are absent in these fractions. It is suggested, then, that these fractions of F. hepatica adult worm antigen be utilized for the immunodiagnosis of fascioliasis by CEP. Optimum antigen concentration for this test has been determined to be approximately 1.80 mg/ml protein.