Silicate-encapsulated yeast alcohol dehydrogenase (ADH) can be employed as a sensor for short-chained alcohols in standard aqueous, harsh nonaqueous, and gas-phase environments. Specifically, the implementation of sensing schemes based on encapsulated ADH/NAD+ or ADH/NADH, and utilization of changes in fluorescence from the soluble, reduced cofactor nicotinamide adenine dinucleotide (NADH) upon exposure to alcohols or aldehydes, allows for semiquantitative determination of both substrates. Additionally, by using fluorescence from NADH, we find that cycling of the enzymatic probe can be accomplished via successive exposure to alcohol and aldehyde substrates, thus converting the system into a multiple-use sensor. Finally, we find that the gel matrix provides sufficient enzyme stabilization to permit the assemblies to be used analytically in hostile and inherently denaturing sample environments, including vapor-phase and nonpolar liquid (e.g., hexane) environments.

No established guidelines currently exist to assist orthopedic surgeons in determining when a patient may safely control a motor vehicle after undergoing simple right knee arthroscopy. Despite this lack of concrete evidence, premature postoperative driving could expose orthopedic surgeons to legal liability and, more importantly, patients to danger and further injury. Through questionnaires directed at physicians, patients, and insurance companies, the authors attempted to identify common postoperative management trends among orthopedic surgeons in an effort to better identify patterns that could help direct practice for the optimized treatment of patients after right knee arthroscopy.Although 29.7% of physicians always incorporated postoperative driving instructions during routine preoperative consultation, 57% of physicians brought up these conversations half of the time or less. In addition, when the preoperative discussions were conducted, approximately 23.6% of physicians never initiated the conversation. The majority of physicians recommended driving after narcotics were discontinued (70%), when the patient felt they could subjectively control their vehicle (57.1%), and when postoperative symptoms would allow safe driving (38.8%); these achievements were most commonly reached at 1 week postoperatively. After simple right knee arthroscopy, the common consensus indicates that patients may safely return to driving 1 week postoperatively when they are narcotic-free and feel safe to control their vehicle.

A questionnaire to determine patterns of neonatal red cell transfusion practice during 1985 was mailed to 2200 blood banks of American Association of Blood Banks (AABB) institutional members and children's hospitals. There were 915 responses (41.6%); 785 responses (86%) contained sufficient data for analysis. The majority (70.6%) of 785 responding hospitals were community/urban institutions. However, more highly specialized, pediatric hospitals were also represented by 92 university/tertiary-care hospitals (11.7% of respondents) and 29 children's hospitals (3.7% of respondents). Two-thirds of hospitals performed a major antiglobulin crossmatch (rather than an abbreviated one) before all neonatal red cell transfusions. The red cell preparation most frequently selected for small-volume transfusions was ABO and Rh group-specific red cell concentrates. When performing only large-volume exchange transfusions, 19.2 percent of hospitals used whole blood; all others prepared reconstituted units of red cells plus fresh-frozen plasma, a practice that frequently causes exposure to two donors per unit. Another practice likely leading to multiple donor exposure is the use of fresh-frozen plasma to adjust the hematocrit of red cell preparations to a predetermined value prior to a small-volume transfusion. Over one-half of hospitals adjusting hematocrits used plasma, presumably from one donor, to dilute packed red cells from another donor, a practice that has no apparent medical benefit. Most hospitals (63.4%) provided red cells with a reduced risk of transmitting cytomegalovirus; blood from seronegative donors was selected by 65 percent of hospitals. The majority of hospitals, including most of the community/urban hospitals, did not irradiate blood products before transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose: Chondroblastoma is a benign, but potentially locally aggressive, bone tumor with predilection for the epiphysis of long bones in growing children. Historically, there is a reported 2% risk of lung metastasis, however these cases are mostly in the form of isolated single reports and the vast majority in adults. The purpose of this study was to identify the “true” risk of lung metastases at presentation in skeletally immature patients with a benign chondroblastoma, and therefore revisit the need for routine chest staging. Methods: This was a multi-institution, international retrospective study of children and adolescents diagnosed and treated for a benign chondroblastoma. We focused on the screening and diagnosis of lung metastasis, type of staging utilized and the incidence of local recurrence. Detailed review of the available literature was also performed for comparison. Results: The final studied cohort included 130 children with an average age of 14.5 years (range: 6 to 18 y). There were 94 boys and 36 girls. Lesions more often involved the proximal humerus (32/130), proximal tibia (30/130), and proximal femur (28/130). At an average follow-up of 50 months, there were 15 local recurrences (11% rate) and no cases of lung metastasis. All patients underwent chest imaging at presentation. The overall reported lung metastases rate in the pulled literature review (larger series only) was 0.4% (7/1625), all patients were skeletally mature. Conclusions: This is the largest cohort of pediatric-exclusive chondroblastoma in the literature. Despite minor differences in management between the centers included, the recurrence rate was similar and there was no evidence of lung metastasis (0 in 130). The incidence of distant involvement in a true benign chondroblastoma in children is much lower than the 2% previously reported in the literature, and the need for routine chest staging should be revisited. Level of Evidence: Level III.

BACKGROUND The purpose of the study was to investigate whether a safety checklist could be used consistently in an academic center, and, whether its presence correlates with a decreased rate of complications, and therefore, improved overall patient safety. METHODS Data from 3 years before and after the implementation of the checklist were compared. Pre-checklist data from August 2008 through August of 2011, including all operative supracondylar humerus fractures treated at our institution, were retrospectively reviewed. Post-checklist data, from August 2011 to August 2014 were prospectively collected. Patients’ charts and their imaging were all reviewed for: fracture type, nerve injury, placement of a medial pin, infection, loss of alignment, loss of fixation, and return to the operating room. Patients who were within the checklist group were reviewed for checklist compliance and concordance of resident and attending-attested checklists. RESULTS 931 operative supracondylar humerus fractures were reviewed - 394 in the pre-checklist group and 537 in the post-checklist group. There was no significant difference in fracture type between the pre- and post-checklist groups. No significant differences were found between pre- and post-checklist patients in regards to loss of fixation, loss of alignment, infection, or nerve injury. In the post-checklist group, the number of medial pins placed was significantly less than in the pre-checklist group [p = 0.0001], but this was not found to have clinical significance. In the pre-checklist group, 11 patients returned to the operating room for a second procedure whereas 4 in the post-checklist group had a return to the operating room. This finding was significant [p = 0.015], but the returns to the operating room were not related to checklist parameters. The checklist compliance of the attending physicians was 85.85% and the residents were compliant 83.11% of the time. There were documented discrepancies between resident and attending checklists in 7.38% of all total checklists. CONCLUSIONS Our patient safety checklists are not necessarily affecting patient care in a clinically significant manner. It is important that we validate and refine these specialty-specific checklists before becoming reliant on them. LEVEL OF EVIDENCE III