A recent stream of studies indicates that variables commonly assumed to be transient causes of public speaking state anxiety are more trait-like than situational in nature. In the present study, dispositional and situational versions of novelty, conspicuousness, and subordinate status, in addition to a measure of public speaking (trait) apprehension, were used to predict state anxiety in response to a public speaking task. The results of multiple regression analysis indicated that (1) trait versions of the variables significantly and meaningfully predicted state anxiety, (2) situational versions of the variables contributed little to the prediction and (3) public speaking apprehension (trait) scores were the single best and only significant predictor of public speaking state anxiety. Moreover, a single-predictor model, employing public speaking trait apprehension scores as the independent variable, was the most efficient model. These findings raise instructional questions regarding the advisability of perpetuating the situational determinant perspective of anxiety in public speaking courses and (2) underscore the importance of particular approaches to the remediation of CA.

BACKGROUND A common aesthetic concern among East Asian women is enlarged calves. Although surgical resection has been a traditional treatment option, botulinum toxin injections into the gastrocnemius muscle are an emerging, noninvasive alternative. OBJECTIVE To perform a literature review on botulinum toxin injections for leg contouring. MATERIALS AND METHODS A literature review was conducted using PubMed, Web of Science, Embase, and Cochrane's CENTRAL database to identify articles relating to combinations of the terms botulinum toxin, gastrocnemius, calves, and leg contouring. RESULTS Based on the limited publications to date, the authors prepared a review on how to treat an enlarged calf with botulinum toxin including injection techniques, anticipated efficacy, outcome monitoring, and potential side effects. CONCLUSION Botulinum toxin injections for calf reduction are an emerging, noninvasive treatment option. Studies to date suggest that it is an efficacious method with few immediate side effects. Future areas for investigation include defining the criteria for calf hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of injections.

BackgroundTotal knee arthroplasty (TKA) is associated with a high incidence of continued opioid use beyond the expected period of recovery. The aim of this study was to determine the influence of inpatient opioid consumption on the development of persistent use.MethodsOpioid-naïve patients undergoing primary, uncomplicated TKA were included in a prospective, observational study at a single institution. Postoperatively, opioids were prescribed by orthopedic advanced practitioners or resident physicians and administered by registered nurses. Individual inpatient prescriptions were adjusted, as needed, to facilitate optimal recovery conditions. Average hourly inpatient opioid consumption was calculated from total usage between midnight on the day of surgery until the time of hospital discharge. Persistent opioid use was defined as a prescription refill written by the orthopedic surgeon at the 6-week surgical follow-up visit. A multivariable regression model was used to identify independent risk factors associated with persistent use.ResultsA total of 351 patients were included in the analysis. Persistent opioid use was identified in 17.4% (61) of patients overall. A history of alcohol abuse (OR 7.80; 95% CI 2.13 to 28.55, p=0.002) was identified as an independent risk factor. Inpatient opioid consumption in the top quartile (equivalent to more than 10 mg of oxycodone every 4 hours) was not found to be associated with persistent use.ConclusionLarger amounts of opioid consumed in the hospital following uncomplicated, primary TKA may not be associated with an increased risk of persistent use at 6 weeks among opioid-naïve patients. Patients may have unique risk factors for prolonged opioid use that may not necessarily be apparent in the early postoperative period.

Identifying cutaneous manifestations associated with systemic diseases is a crucial task for dermatologists and other providers in the outpatient and inpatient settings. Here, we present a rare case of postictal petechiae occurring after a generalized tonic-clonic seizure in a patient with poorly controlled epilepsy. This case illustrates a unique and underrecognized entity that may serve as the only cutaneous clue to assist in the diagnosis of recent seizure activity.