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Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care.Allergic contact dermatitis (ACD) is an immune-mediated condition that is likely underrecognized in children. ACD is the result of primary sensitization and secondary elicitation by allergy-provoking haptens. A detailed clinical history and physical examination may yield diagnosis. Patch testing is the criterion standard diagnostic tool for confirming the diagnosis of ACD in both children and adults. Herein, we present an overview of pediatric ACD, an analysis of relevant current literature on the topic, focused management recommendations, and a discussion of existing knowledge gaps that must be addressed by future research.This article provides an overview of important practice recommendations from the recently updated Contact Dermatitis Practice Parameter. This updated parameter provides essential recommendations pertaining to clinical history, physical examination, and patch testing evaluation of patients suspected of allergic contact dermatitis. In addition to providing guidance for performing and interpreting closed patch testing, the updated parameter provides concrete recommendations for assessing metal hypersensitivity in patients receiving prosthetic devices, for evaluating workers with occupational contact dermatitis, and also for addressing allergic contact dermatitis in children. Finally, the document provides practical recommendations useful for educating patients regarding avoidance of exposure to known contact sensitizers in the home and at work. The Contact Dermatitis Parameter is designed as a practical, evidence-based clinical tool to be used by allergists and dermatologists who routinely are called upon to evaluate patients with skin disorders.This study investigates the effect of spectral degradation on cortical speech encoding in complex auditory scenes. Young normal-hearing listeners were simultaneously presented with two speech streams and were instructed to attend to only one of them. The speech mixtures were subjected to noise-channel vocoding to preserve the temporal envelope and degrade the spectral information of speech. Each subject was tested with five spectral resolution conditions (unprocessed speech, 64-, 32-, 16-, and 8-channel vocoder conditions) and two target-to-masker ratio (TMR) conditions (3 and 0 dB). Ongoing electroencephalographic (EEG) responses and speech comprehension were measured in each spectral and TMR condition for each subject. Neural tracking of each speech stream was characterized by cross-correlating the EEG responses with the envelope of each of the simultaneous speech streams at different time lags. Results showed that spectral degradation and TMR both significantly influenced how top-down attention modulated the EEG responses to the attended and unattended speech. That is, the EEG responses to the attended and unattended speech streams differed more for the higher (unprocessed, 64 ch, and 32 ch) than the lower (16 and 8 ch) spectral resolution conditions, as well as for the higher (3 dB) than the lower TMR (0 dB) condition. The magnitude of differential neural modulation responses to the attended and unattended speech streams significantly correlated with speech comprehension scores. These results suggest that severe spectral degradation and low TMR hinder speech stream segregation, making it difficult to employ top-down attention to differentially process different speech streams.With breast cancer awareness, the incidence of large invasive tumours is rare. We present a video of locally advanced breast cancer invading the anterior chest wall requiring en bloc resection that resulted in a large chest wall defect with exposed pleural and pericardial surface. Skeletal reconstruction and provision of adequate soft tissue coverage in order to avoid respiratory failure was challenging. A 58-year-old female presented with a 3-year history of locally invasive breast carcinoma with contiguous spread to sternum, clavicles, sternoclavicular joints and bilateral second to fifth ribs. She underwent total sternectomy, bilateral second to fifth ribs and chest wall resection resulting in a 21 × 18 cm chest wall defect. Reconstruction of her sternum was with methyl-methacrylate cement prosthesis. Ribs were reconstructed with titanium plates. Soft tissue coverage was achieved with left vertical rectus abdominis pedicle flap, right external oblique transposition flap and a right latissimus dorsi free flap. Flap failure necessitated a right vastus lateralis free flap. She was discharged ambulant without respiratory compromise. Resection and reconstruction of large chest wall defects is possible due to new bioprosthetic materials and is possible with acceptable morbidity and mortality.

Accelerometers are valid, practical and reliable tools for the measurement of habitual physical activity (PA). Quantification of PA in horses is desirable for use in research and clinical settings. The objective of this study was to evaluate a triaxial accelerometer for objective measurement of PA in the horse by assessment of their practical utility and validity. Horses were recruited to establish both the optimal site of accelerometer attachment and questionnaire designed to explore owner acceptance. Validity and cut-off values were obtained by assessing PA at various gaits. Validation study- 20 horses wore the accelerometer while being filmed for 10min each of rest, walking and trotting and 5 mins of canter work. Practical utility study- five horses wore accelerometers on polls and withers for 18h; compliance and relative data losses were quantified.

Accelerometry output differed significantly between the four PA levels (P < 0•001) for both wither and poll placement. For withers placement, ROC analyhorse.

Glaucoma is the leading cause of irreversible blindness in the world. Estimated to affect 60 million people worldwide, this figure is expected to rise to 80 million by 2020. Untreated, glaucoma leads to visual decay and eventually to blindness, and can significantly reduce quality of life. Verteporfin First-line treatment in patients with primary open-angle glaucoma and exfoliative glaucoma is topical medical therapy with ocular hypotensives as eye drops. However, eye drops have several disadvantages including cost, possible local and systemic side effects, and adherence and perseverance issues. Randomised controlled trials have demonstrated that selective laser trabeculoplasty is equally as effective in lowering intraocular pressure as eye drops. However, the impact of these two treatment modalities from the patient and economic perspectives has not been adequately determined. Thus, it remains unclear whether topical medical therapy or selective laser trabeculoplasty should be recommended as first-line treatment for g. Regular clinic follow-ups will continue as clinically indicated between study outcome visits.

The Glaucoma Initial Treatment Study is the first multi-centred RCT to determine the optimum first-line therapy for people with glaucoma. Our trial will have an unprecedented capacity to meaningfully transform the treatment and management of glaucoma in Australia and overseas.

ACTRN12611000720910; Date registered 11 July 2011.

ACTRN12611000720910; Date registered 11 July 2011.

To compare scleral buckling (SB) and pars plana vitrectomy (PPV) using a wide angle viewing system (WAVS) for uncomplicated phakic rhegmatogenous retinal detachment (RRD).

The medical records of patients with uncomplicated phakic RRD were retrospectively reviewed. Eyes with pseudophakic or attached fovea were excluded. Patients treated with SB were classified as group B, and PPV using WAVS as group V. Primary success rate, visual acuity (VA), macular complications, and sustained subretinal fluid (SRF) were compared between groups.

Seventy-two eyes were included in group B and 57 eyes in group V. Group B had better preoperative VA (1.38 ± 0.87 vs 1.84 ± 0.97 in LogMAR, P = 0.010), but worse final VA (0.51 ± 0.48 vs 0.30 ± 0.23, P = 0.012) than group V. The primary success rate of 94.7% in group V was higher than 77.8% in group B (P = 0.010). Final success rate was 100% in both groups. There was no significant difference in macular complications between groups (P = 0.087). Sustained SRF was found in 22 eyes in group B (38.6%), while only two eyes in group V exhibited sustained SRF (2.8%, P < 0.001).

Pars plana vitrectomy using WAVS was more efficacious than SB for treating uncomplicated phakic RRD.

Pars plana vitrectomy using WAVS was more efficacious than SB for treating uncomplicated phakic RRD.

Given the popularity of mobile applications (apps) designed to increase exercise participation, it is important to understand their effects on psychological predictors of exercise behavior.

This study tested a performance feedback-based app compared to a game-based app to examine their effects on aspects of immediate response to an exercise bout.

Twenty-eight participants completed a 30-min treadmill run while using one of two randomly assigned mobile running apps Nike + Running, a performance-monitoring app which theoretically induces an associative, goal-driven state, or Zombies Run!, an app which turns the experience of running into a virtual reality game, theoretically inducing dissociation from primary exercise goals.

The two conditions did not differ on primary motivational state outcomes; however, participants reported more associative attentional focus in the performance-monitoring app condition compared to more dissociative focus in the game-based app condition.

Game-based and performance-tracking running apps may not have differential effects on goal motivation during exercise. However, game-based apps may help recreational exercisers dissociate from exercise more readily. Increasing the enjoyment of an exercise bout through the development of new and innovative mobile technologies is an important avenue for future research.

Game-based and performance-tracking running apps may not have differential effects on goal motivation during exercise. However, game-based apps may help recreational exercisers dissociate from exercise more readily. Increasing the enjoyment of an exercise bout through the development of new and innovative mobile technologies is an important avenue for future research.

Targeted echocardiographic assessments of haemodynamic status are increasingly utilised in many settings. Application in the neonatal intensive care units (NICU) is increasingly demanded but challenging given the risk of underlying structural lesions. This statement follows discussions in UK led by the Neonatologists with an Interest in Cardiology and Haemodynamics (NICHe) group in collaboration with the British Congenital Cardiac Association (BCCA) and the Paediatricians with Expertise in Cardiology Special Interest Group (PECSIG). Clear consensus was agreed on multiple aspects of best practice for neonatologist-performed echocardiogram (NoPE)-rigorous attention to infection control and cardiorespiratory/thermal stability, early referral to paediatric cardiology with suspicion of structural disease, reporting on standardised templates, reliable image storage, regular skills maintenance, collaboration with a designated paediatric cardiologist, and regular scan audit/review. It was agreed that NoPE assessments should confidently exclude structural lesions at first scan.