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In this chapter. clinical examination of the spine in the child is described. The main pathology here is scoliosis and a simplified method of assessing a child with scoliosis is described. This method is similar to a lumbar spine examination, except that during the examination process a few specific points are noted: When inspecting, look for other stigmata associated with scoliosis such as café-au-lait spots. When palpating, remember to use a plumb line, which indicates whether the scoliosis is balanced. When asking the patient to move, look for the rib prominence (Adam’s test) indicating structural scoliosis. Finally, when performing a neurological assessment, remember to look at the abdominal reflexes.
This chapter also covers kyphosis and other conditions such as torticollis.
This paper describes a collaborative approach to professional learning that has provided an opportunity for refreshed practices and growth in capacity in schools supporting students with various learning needs in several schools that are part of the Association of Independent Schools in the Australian Capital Territory. An action research approach to professional learning for school staff was facilitated with the participating schools in 2018/2019, centred on the Nationally Consistent Collection of Data on School Students with Disability.
We describe 14 yr of public data from the Parkes Pulsar Timing Array (PPTA), an ongoing project that is producing precise measurements of pulse times of arrival from 26 millisecond pulsars using the 64-m Parkes radio telescope with a cadence of approximately 3 weeks in three observing bands. A comprehensive description of the pulsar observing systems employed at the telescope since 2004 is provided, including the calibration methodology and an analysis of the stability of system components. We attempt to provide full accounting of the reduction from the raw measured Stokes parameters to pulse times of arrival to aid third parties in reproducing our results. This conversion is encapsulated in a processing pipeline designed to track provenance. Our data products include pulse times of arrival for each of the pulsars along with an initial set of pulsar parameters and noise models. The calibrated pulse profiles and timing template profiles are also available. These data represent almost 21 000 h of recorded data spanning over 14 yr. After accounting for processes that induce time-correlated noise, 22 of the pulsars have weighted root-mean-square timing residuals of
in at least one radio band. The data should allow end users to quickly undertake their own gravitational wave analyses, for example, without having to understand the intricacies of pulsar polarisation calibration or attain a mastery of radio frequency interference mitigation as is required when analysing raw data files.
OBJECTIVES/GOALS: Diverse medication-based studies require longitudinal drug dose information. EHRs can provide such data, but multiple mentions of a drug in the same clinical note can yield conflicting dose. We aimed to develop statistical methods which address this challenge by predicting the valid dose in the event that conflicting doses are extracted. METHODS/STUDY POPULATION: We extracted dose information for two test drugs, tacrolimus and lamotrigine, from Vanderbilt EHRs using a natural language processing system, medExtractR, which was developed by our team. A random forest classifier was used to estimate the probability of correctness for each extracted dose on the basis of subject longitudinal dosing patterns and extracted EHR note context. Using this feasibility measure and other features such as a summary of subject dosing history, we developed several statistical models to predict the dose on the basis of the extracted doses. The models developed based on supervised methods included a separate random forest regression, a transition model, and a boosting model. We also considered unsupervised methods and developed a Bayesian hierarchical model. RESULTS/ANTICIPATED RESULTS: We compared model-predicted doses to physician-validated doses to evaluate model performance. A random forest regression model outperformed all proposed models. As this model is a supervised model, its utility would depend on availability of validated dose. Our preliminary result from a Bayesian hierarchical model showed that it can be a promising alternative although performing less optimally. The Bayesian hierarchical model would be especially useful when validated dose data are not available, as it was developed in unsupervised modeling framework and hence does not require validated dose that can be difficult and time consuming to obtain. We evaluated the feasibility of each method for automatic implementation in our drug dosing extraction and processing system we have been developing. DISCUSSION/SIGNIFICANCE OF IMPACT: We will incorporate the developed methods as a part of our complete medication extraction system, which will allow to automatically prepare large longitudinal medication dose datasets for researchers. Availability of such data will enable diverse medication-based studies with drastically reduced barriers to data collection.
The enzyme polynucleotide kinase/phosphatase (PNKP) plays a key role in DNA repair by resolving the chemistry at DNA strand breaks. Mutations in PNKP (chromosome 19q13.4) are known to cause MCSZ, a serious neurodevelopmental disorder, but to date there has been no link to cancer initiation or progression. However, a child with MCSZ recently presented at Seattle Children's Hospital with a 3-cm glioblastoma. The child was shown to have two germline mutations in PNKP. To study the effects of the PNKP mutations found in this patient, we generated mutant PNKP cDNAs carrying either the individual mutations or the double mutation using site directed mutagenesis. These cDNAs were incorporated into bacterial and mammalian expression vectors. The bacterially expressed mutant proteins as well as the wild type have been purified and are undergoing testing for PNKP DNA kinase and phosphatase activity. The PNKP cDNAs, fused to GFP, were expressed in Hela and HCT116 human cancer cell lines. High-content analysis and micro-irradiation techniques are being used to determine PNKP localization within the cells and recruitment to damaged DNA. Our preliminary results indicate that the mutations alter the ratio of nuclear to cytoplasmic PNKP compared to the wild-type protein.
Reforestation in the Inland Northwest, including northeastern Oregon, USA, is often limited by a dry climate and soil moisture availability during the summer months. Reduction of competing vegetative cover in forest plantations is a common method for retaining available soil moisture. Several spring and summer site preparation (applied prior to planting) herbicide treatments were evaluated to determine their efficacy in reducing competing cover, thus retaining soil moisture, on three sites in northeastern Oregon. Results varied by site, year, and season of application. In general, sulfometuron (0.14 kg ai ha–1 alone and in various mixtures), imazapyr (0.42 ae kg ha–1), and hexazinone (1.68 kg ai ha–1) resulted in 3 to 17% cover of forbs and grasses in the first-year when applied in spring. Sulfometuron+glyphosate (2.2 kg ha–1) consistently reduced grasses and forbs for the first year when applied in summer, but forbs recovered in the second year on two of three sites. Aminopyralid (0.12 kg ae ha–1)+sulfometuron applied in summer also led to comparable control of forb cover. In the second year after treatment, forb cover in treated plots was similar to levels in nontreated plots, and some species of forbs had increased relative to nontreated plots. Imazapyr (0.21 and 0.42 kg ha–1) at either rate, spring or summer 2007, or at lower rate (0.14 kg ha–1) with glyphosate in summer, provided the best control of shrubs, of which snowberry was the dominant species. Total vegetative cover was similar across all treatments seven and eight years after application, and differences in vegetation were related to site rather than treatment. In the first year after treatment, rates of soil moisture depletion in the 0- to 23-cm depth were correlated with vegetative cover, particularly late season soil moisture, suggesting increased water availability for tree seedling growth.
During the past decade, solar power has experienced transformative price declines, enabling it to grow to supply 1% of U.S. and world electricity. Addressing grid integration challenges, increasing grid flexibility, and further reducing cost will enable even greater potential for solar as an electricity source.
During the past decade, solar power has experienced transformative price declines, enabling it to become a viable electricity source that is supplying 1% of U.S. and world electricity. Further cost reductions are expected to enable substantially greater solar deployment, and new Department of Energy cost targets for utility-scale photovoltaics (PV) and concentrating solar thermal power are $0.03/kW h and $0.05/kW h by 2030, respectively. However, cost reductions are no longer the only significant challenge for PV—addressing grid integration challenges and increasing grid flexibility are critical as the penetration of PV electricity on the grid increases. The development of low cost energy storage is particularly synergistic with low cost PV, as cost declines in each technology are expected to support greater market opportunities for the other.
Timing of weed emergence and seed persistence in the soil influence the ability to implement timely and effective control practices. Emergence patterns and seed persistence of kochia populations were monitored in 2010 and 2011 at sites in Kansas, Colorado, Wyoming, Nebraska, and South Dakota. Weekly observations of emergence were initiated in March and continued until no new emergence occurred. Seed was harvested from each site, placed into 100-seed mesh packets, and buried at depths of 0, 2.5, and 10 cm in fall of 2010 and 2011. Packets were exhumed at 6-mo intervals over 2 yr. Viability of exhumed seeds was evaluated. Nonlinear mixed-effects Weibull models were fit to cumulative emergence (%) across growing degree days (GDD) and to viable seed (%) across burial time to describe their fixed and random effects across site-years. Final emergence densities varied among site-years and ranged from as few as 4 to almost 380,000 seedlings m−2. Across 11 site-years in Kansas, cumulative GDD needed for 10% emergence were 168, while across 6 site-years in Wyoming and Nebraska, only 90 GDD were needed; on the calendar, this date shifted from early to late March. The majority (>95%) of kochia seed did not persist for more than 2 yr. Remaining seed viability was generally >80% when seeds were exhumed within 6 mo after burial in March, and declined to <5% by October of the first year after burial. Burial did not appear to increase or decrease seed viability over time but placed seed in a position from which seedling emergence would not be possible. High seedling emergence that occurs very early in the spring emphasizes the need for fall or early spring PRE weed control such as tillage, herbicides, and cover crops, while continued emergence into midsummer emphasizes the need for extended periods of kochia management.
The great sculptor Vincenzo Danti wrote one of the longest poems to have survived from a Renaissance artist, but the text’s close thematic and conceptual connections to its author’s art have gone entirely unnoticed. What Danti’s poem and sculpture share, this essay argues, is a concern with mystified identity. Danti’s poetic sensibility stands at odds with the biographical frameworks that typically guide the interpretation of Renaissance art and literature. At the same time, his example shows how much there is to be gained from an investigation of how artists learned to be writers, and of what came of those efforts.
The development of medical school courses on medical responses for disaster victims has been deemed largely inadequate. To address this gap, a 2-week elective course on Terror Medicine (a field related to Disaster and Emergency Medicine) has been designed for fourth year students at Rutgers New Jersey Medical School in Newark, New Jersey (USA). This elective is part of an overall curricular plan to broaden exposure to topics related to Terror Medicine throughout the undergraduate medical education.
A course on Terror Medicine necessarily includes key aspects of Disaster and Emergency Medicine, though the converse is not the case. Courses on Disaster Medicine may not address features distinctively associated with a terror attack. Thus, a terror-related focus not only assures attention to this important subject but to accidental or naturally occurring incidents as well.
The course, implemented in 2014, uses a variety of teaching modalities including lectures, videos, and tabletop and hands-on simulation exercises. The subject matter includes biological and chemical terrorism, disaster management, mechanisms of injury, and psychiatry. This report outlines the elective’s goals and objectives, describes the course syllabus, and presents outcomes based on student evaluations of the initial iterations of the elective offering.
All students rated the course as “excellent” or “very good.” Evaluations included enthusiastic comments about the content, methods of instruction, and especially the value of the simulation exercises. Students also reported finding the course novel and engaging.
An elective course on Terror Medicine, as described, is shown to be feasible and successful. The student participants found the content relevant to their education and the manner of instruction effective. This course may serve as a model for other medical schools contemplating the expansion or inclusion of Terror Medicine-related topics in their curriculum.
ColeLA, NatalB, FoxA, CooperA, KennedyCA, ConnellND, SugalskiG, KulkarniM, FeravoloM, LambaS. A Course on Terror Medicine: Content and Evaluations. Prehosp Disaster Med. 2016;31(1):98–101.
The main theme of this part is the collapse and partial restoration of the liberal, capitalist, and imperial orders that allowed Europeans to dominate most of the world. For Europeans, the nineteenth century was a time of unprecedented prosperity and power. Their mastery of the new industrial technologies had given them direct control of over half of the world’s peoples and huge influence over the rest. The great global linkages created by the European empires drew in commodities and labor from all over the world to create the products that went out to consumers everywhere. The USA, too, enjoyed its Gilded Age of wealth and empire, and Japan was rising quickly to join the elite club of great powers. It seemed that this machinery of expanding production and power could continue indefinitely. Many predicted, in the words of the historian Arnold Toynbee, the coming of an age of universal peace, wealth, and justice, an “earthly paradise.”
It was not to be. The Great War which broke out in 1914 destroyed the international imperial order, devastating all the European societies far beyond anyone’s expectations. Worse was to come. The brief, precarious stability of the 1920s fell apart in the 1930s under the impact of a savage world depression and the rise of a new, vicious mass movement: fascism. The world plunged into a new global war even more destructive than the first.
The first textbook to present world history via social history, drawing on social science methods and research. This interdisciplinary, comprehensive, and comparative textbook is authored by distinguished scholars and experienced teachers, and offers expert scholarship on global history that is ideal for undergraduate students. Volume 2 takes us from the early modern period to speculation about the world in 2050, visiting diverse civilizations, nation-states, ecologies, and people along the journey through time and place. The book pays particular attention to the ways in which ordinary people lived through the great changes of their times, and how everyday experience connects to great political events and the commercial exchanges of an interconnected world. With 75 maps, 65 illustrations, timelines, boxes, and primary source extracts, the book enables students to use historical material and social science methodologies to analyze the events of the past, present, and future.