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Transfer of the latissimus dorsi muscle was useful in restoring contour and function to a child's acutely injured upper extremity. The procedure provided protection for exposed vital structures. A split-thickness skin graft covered the exposed muscle. Transposition of the latissimus dorsi insertion was not necessary to obtain adequate elbow flexion.

As we approach the James Webb Space Telescope(JWST) era, several studies have emerged that aim to (1) characterize how the instruments will perform and (2) determine what atmospheric spectral features could theoretically be detected using transmission and emission spectroscopy. To some degree, all these studies have relied on modeling of JWST's theoretical instrument noise. With under two years left until launch, it is imperative that the exoplanet community begins to digest and integrate these studies into their observing plans, as well as think about how to leverage the Hubble Space Telescope(HST) to optimize JWSTobservations. To encourage this and to allow all members of the community access to JWST& HSTnoise simulations, we present here an open-source Python package and online interface for creating observation simulations of all observatory-supported timeseries spectroscopy modes. This noise simulator, called PandExo, relies on some aspects of Space Telescope Science Institute's Exposure Time Calculator, Pandeia. We describe PandExoand the formalism for computing noise sources for JWST. Then we benchmark PandExo's performance against each instrument team's independently written noise simulator for JWST, and previous observations for HST. We find that PandExois within 10% agreement for HST/WFC3 and for all JWSTinstruments.

The James Webb Space Telescope (JWST)will likely revolutionize transiting exoplanet atmospheric science, due to a combination of its capability for continuous, long duration observations and its larger collecting area, spectral coverage, and spectral resolution compared to existing space-based facilities. However, it is unclear precisely how well JWSTwill perform and which of its myriad instruments and observing modes will be best suited for transiting exoplanet studies. In this article, we describe a prefatory JWSTEarly Release Science (ERS) Cycle 1 program that focuses on testing specific observing modes to quickly give the community the data and experience it needs to plan more efficient and successful transiting exoplanet characterization programs in later cycles. We propose a multi-pronged approach wherein one aspect of the program focuses on observing transits of a single target with all of the recommended observing modes to identify and understand potential systematics, compare transmission spectra at overlapping and neighboring wavelength regions, confirm throughputs, and determine overall performances. In our search for transiting exoplanets that are well suited to achieving these goals, we identify 12 objects (dubbed "community targets") that meet our defined criteria. Currently, the most favorable target is WASP-62b because of its large predicted signal size, relatively bright host star, and location in JWST's continuous viewing zone. Since most of the community targets do not have well-characterized atmospheres, we recommend initiating preparatory observing programs to determine the presence of obscuring clouds/hazes within their atmospheres. Measurable spectroscopic features are needed to establish the optimal resolution and wavelength regions for exoplanet characterization. Other initiatives from our proposed ERS program include testing the instrument brightness limits and performing phase-curve observations. The latter are a unique challenge compared to transit observations because of their significantly longer durations. Using only a single mode, we propose to observe a full-orbit phase curve of one of the previously characterized, short-orbital-period planets to evaluate the facility-level aspects of long, uninterrupted time-series observations.

Coronagraph technology is advancing and promises to enable direct imaging and spectral characterization of extrasolar Earth-like planets in the 2020 decade with a telescope as small as 1.5m. A small Explorer-sized telescope can also be launched in the 2010 decade capable of seeing debris disks as dim as tens of zodis and potentially a few large planets. The Phase Induced Amplitude Apodization (PIAA) coronagraph makes such aggressive performance possible, providing high throughput and high contrast close to the diffraction limit. We report on the latest results from a testbed at NASA Ames that is focused on developing and testing the PIAA coronagraph. This laboratory facility was built in 2008 and is designed to be flexible, operated in an actively thermally stabilized air environment, and to complement collaborative efforts at NASA JPL's High Contrast Imaging Testbed. For our wavefront control we are using small Micro-Electro- Mechanical-System deformable mirrors (MEMS DMs), which promise to reduce the size of the beam and overall instrument, a consideration that becomes very important for small telescopes. We describe our lab progress and results, which include (as of August 2011): the demonstration of 1.9x10-8average raw contrast in a dark zone from 2.0 - 3.4 /D and of 1.2x10-6contrast from 1.5-2.0 /D (in monochromatic light); the testing of the next-generation reflective PIAA mirror set built by Tinsley and designed for broadband; and finally, discuss our most important past limiting factors as well as expected future ones.

We reviewed 18 patients and two traumatic amputation specimens with injuries involving the distal ulnar physis. Type I growth mechanism injuries were the most common fracture pattern with premature physeal closure and ulnar shortening occurring in 55 of the patients. Other consequences included radial bowing, ulnar angulation of the distal radius, and ulnar translocation of the carpus. Most of the patients, however, were asymptomatic. Initial radiographic diagnosis of this physeal injury may be difficult because of the relatively late ossification of the distal ulnar physis. Concomitant ulnar physeal injuries must be suspected in any injury to the distal radius, especially when an ulnar metaphyseal or styloid fracture is not readily evident.

The development and refinement of the free flap have revolutionized lower limb salvage. Excellent fixation of lower extremity fractures is often marred by the lack of adequate soft tissue coverage. In this article, we discuss the indications for and techniques of soft tissue coverage procedures for the exposed lower extremity fracture.