IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools.

Post-diagnostic lived experiences of individuals with essential tremorWord count: 6998Lived experience of essential tremor AbstractPurpose: This research study aimed to explore the lived experience of individuals with essential tremor.Method: This study was qualitative in nature and informed by interpretative phenomenological analysis methodology. Semi-structured interviews were conducted with a relatively homogenous sample of nine individuals with a diagnosis of essential tremor.Results: Three major themes were constructed: "But they often look at you like you're some drug addict or smackhead": Social attitudes to difference; "I just couldn't do it anymore":The restrictive nature of essential tremor; and "You've got to cope; you've got to learn to fight different ways": Rescuing some normality amid physical deterioration.Conclusion: This study offers much needed experiential understanding and interpretation of one of the most prevalent neurological conditions with regard to the emotions associated with specific day-to-day experiences, the restrictions placed upon everyday practicalities and the coping strategies employed. This study has highlighted the need for health care professionals to provide individuals with information regarding psychological support, and a need for more public awareness campaigns centred around essential tremor.

The notion of the roundness of a metric space was introduced by Per Enflo as a tool to study geometric properties of Banach spaces. Recently, roundness and generalized roundness have been used in the context of group theory to investigate relationships between the geometry of a Cayley graph of a group and the algebraic properties of the group. In this paper, we study roundness properties of connected graphs in general. We explicitly calculate the roundness of members of two classes of graphs and we give results of computer calculations of the roundness of all connected graphs on 7, 8 and 9 vertices. We also show that no connected graph can have roundness between log 2 3 and 2. Recently, more work has been done on the roundness and generalized roundness properties of finitely generated groups, for example in [Jaudon 2008; LaFont and Passidis 2006], relating algebraic properties of a group to the possible values that can be taken by the roundness or generalized roundness of its Cayley graphs with respect to different finite generating sets. However, very little work has been done regarding roundness properties of graphs in general, and a better understanding of MSC2000: primary 05C99; secondary 46B20, 20F65.

Introduction Breast surgical oncology is a defined sub-specialty of general surgery that focuses on the surgical management of breast disease and malignancy within a multidisciplinary context. The fellowship directors (FD) that lead these programs have been selected for their abilities. As programs do research to ensure proper training for the next generation of breast surgical oncologists, we wanted to look into the FDs responsible for their training. Methods The Breast Surgical Oncology care program list was compiled via the Society of Surgical Oncology and American Society of Breast Surgeons Accredited programs ( n = 60). The demographic information that was of interest included, but was not limited to, gender, age, ethnicity/background, past residency training, past fellowship training, year graduated from residency and fellowship, year since graduation to FD appointment, time at institution till FD appointment, and Hirsch index (h-index). Results Data were collected on all 60 FDs. The average age of FDs was 52 years old, 27% of FDs are men and 73% of FDs are women. The average H-index, number of publications, and number of citations were 19, 67, and 2648, respectively. The mean graduation year from residency was 2003, and from fellowship was 2006; with a mean of 9 years post fellowship graduation until becoming an FD. The most frequently attended residency was Rush ( n = 4), and the most common fellowships were Memorial Sloan Kettering ( n = 8), MD Anderson Cancer Center ( n = 7), and John Wayne Cancer Institute ( n = 4). Nine of the FDs stayed at the same institution after doing both residency and fellowship there (15%). Conclusion This is the first study to examine the demographics of those in FD positions in Surgical Breast Oncology, which is a relatively young fellowship. We found that FDs in Breast Surgical Oncology are defined by their high output of research. This qualification may be why the average age, and the number of years to FD are higher compared to other specialties where this research has been undertaken. Initial evaluation of FDs suggest more diversity in this field is needed. Further insight into the leaders training our next generation of surgeons is warranted.