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In this paper, A retrospective review was performed for all the patients who underwent surgery with the Goldman technique by the senior author from 2004 to 2009 for correction of the broad nasal tip. The clinical and pathologic findings of these patients were reviewed, and an independent observer evaluated the pre- and postoperative photos of the patients using five parameters: projection, rotation, symmetry, shape, and distance of the tip-defining points. The evaluation was performed using a scale of -1 to +1 for each of the five parameters. Of the 205 patients who underwent the technique, 115 (56%) were patients with broad tips, and 90 (44%) were patients with broad (boxy) tips. A total of 189 cases (92.2%) involved primary rhinoplasties, and 16 cases (7.8%) involved revision. During this period, complications were observed in five patients (2.4%), who underwent revision rhinoplasty with a successful result. The average score for the five parameters already mentioned for primary rhinoplasties according to the scale of -5 to +5 showed a significant postoperative improvement (score, +4.3). It implied that the cartilage rhinoplasty with Goldman technique is safe when performed by experienced surgeons and according to specific indications. This conclusion is indicated by the low rate of complications in the large series of patients in this study.

Abstract Background While pediatric cases of COVID-19 are at low risk for adverse events, schoolchildren should be considered for surveillance as they can become infected at school and serve as sources of household or community transmission. Our team assessed the feasibility of young children self-collecting SARS-CoV-2 samples for surveillance testing in an educational setting. Methods Students at a K-8 school were tested weekly for SARS-CoV-2 from September 2020 - June 2021. Error rates were collected from September 2020 - January 2021. Clinical staff provided all students with instructions for anterior nares specimen self-collection and then observed them to ensure proper technique. Instructions included holding the sterile swab while making sure not to touch the tip, inserting the swab into their nostril until they start to feel resistance, and rubbing the swab in four circles before repeating the process in their other nostril. An independent observer timed random sample self-collections from April - June 2021. Results 2,590 samples were collected from 209 students during the study period when data on error rates were collected. Errors occurred in 3.3% of all student encounters (n=87). Error rates over time are shown in Figure 1, with the highest rate occurring on the first day of testing (n=20/197, 10.2%) and the lowest in January 2021 (n=1/202, 0.5%). 2,574 visits for sample self-collection occurred during the study period when independent timing data was collected (April - June 2021). Of those visits, 7.5% (n=193) were timed. The average duration of each visit was 70 seconds. Figure 1. Swab Error Rates Over Time Conclusion Pediatric self-collected lower nasal swabs are a viable and easily tolerated specimen collection method for SARS-CoV-2 surveillance in school settings, as evidenced by the low error rate and short time window of sample self-collection during testing. School administrators should expect errors to drop quickly after implementing testing. Disclosures All Authors: No reported disclosures

Objectives: The aim of this study is to review the short-term results of total hip arthroplasty (THA) for the management of delayed arthritis after acetabular fractures. Methods: This is a retrospective study of operated cases of THA post-acetabular fracture arthritis. Data were collected from computerized hospital records from January 2010 to December 2019. We analyzed post-operative outcomes, which included revision surgery due to any reason, post-operative infection, hip dislocation, sciatic nerve injury, and deep venous thrombosis. In addition, radiographs were evaluated for restoration of the center of rotation (COR), horizontal offset (HO), and vertical offset (VO) by an independent observer. Results: A total of 36 cases (30 males and six females) were included in the study. The average age was 55 years. Road traffic accidents were the most common cause of fractures followed by falls from height. The mean time between the fracture and the development of symptoms of arthritis was 48 months. One THA was complicated by post-operative dislocation. Infection was reported in three cases and sciatic nerve injury occurred in one patient. Heterotopic ossification was seen in four cases and thromboembolism developed in one patient. The COR, HO, and VO showed a normal pattern. Conclusion: THA after acetabular fractures is a complex surgical procedure with relatively high short-term complications. Restoring the hip biomechanics can help in achieving results that are comparable to primary total hip replacement.

Background: The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented. Purpose: To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%). Results: After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%. Conclusion: Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics.

Background: Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures. Purpose: To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed. Results: The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts’ shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation. Conclusion: The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.

There are long-standing and ongoing concerns about the welfare of animals in the Australian live export trade by sea. However, scrutiny of animal welfare on board vessels is generally hindered by a lack of independent reporting. Cattle voyages from Australia to China have concerned animal welfare advocates due to their long duration and lack of consistent veterinary oversight. In April 2018, following a media exposé of animal cruelty and declining public trust, the Australian government installed Independent Observers on some live export voyages. Summaries of Independent Observer (IO) reports by the Department of Agriculture and Water Resources (DAWR) provided a new and independent source of information about management of animals in the live export trade. The IO summaries on live cattle export voyages to China for the period July 2018 to December 2019 (n = 37) were reviewed. The IO summaries detailed voyages that carried 147,262 slaughter, feeder or breeder cattle which included both dairy and beef breeds. The long-haul voyages averaged 20 days in duration, generally departing the ports of Fremantle and Portland and discharging at ports in northern China. Key animal welfare risk factors identified in the IO summaries included: hunger, thirst, exposure to extreme temperatures, poor pen conditions, health issues, absence of veterinarians, rough seas, poor ship infrastructure, mechanical breakdown and mismanagement at discharge.

In this paper, conformal invariant gravitation, based on Weyl geometry, is considered. In addition to the gravitational and matter action integrals, the interaction between the Weyl vector (entered in Weyl geometry) and the vector, representing the world line of the independent observer, are introduced. It is shown that the very existence of such an interaction selects the exponentially growing scale factor solutions among the cosmological vacua.

Growing awareness of global ecological crises has provoked a set of new practices in journalism that we suggest labelling transformative journalisms. The term encompasses a diversity of new role conceptions and practices that converge around an explicit and transparent commitment to contribute to the social-ecological transformation of societies by doing journalism. It is thus a form of advocacy journalism that is special in being dedicated to the most common of common goods, preserving the eco-systems and natural resources of the planet. Transformative journalism challenges some aspects of objectivity, such as the idea of the neutral, distanced observer. Instead, it emphasizes the elements of relevant and factually correct coverage as well as values such as transparency about values and moderating the debates that enable society to develop more sustainable ways of life. While the tension between the poles of being a critical, independent observer and sharing a mission of ecological transformation is the source of criticism by proponents of more traditional role conceptions, we also see this tension as a productive source for creativity, complementing traditional journalism with new forms of content, production, and interactions audiences as well as increased awareness of the ecological footprint of doing journalism.

AbstractOverdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177–1187, 2016). However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. Trainees (N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10; modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees’ overdose knowledge, t(71) = − 8.12, p < 0.001, 95% CI [− 6.54, − 3.96], and attitudes, t(65) = − 6.85, p < 0.001, 95% CI [− 0.59, − 0.33], improved significantly from pre- to post-training. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees’ overdose knowledge or attitudes. OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention. Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention).

Abstract Needle-associated fear and pain in children can lead to poor health consequences and lower uptake rates of medical services. Information and distraction are significant methods in reducing pain and anxiety in children. We aimed to evaluate the effects of giving information and an active distraction method for pediatric venipuncture -related pain and anxiety in 3-8 years old children. Children were randomized into three groups as the control, the informed, the informed and distracted. Fear and pain experience were found to be significantly lower in the informed and distracted group rather than the control and the informed group according to the parents/caregivers. Fear and pain experience were similarly found to be significantly lower in the informed and distracted group than the other groups according to the independent observer. Informing, preparing, coping, distracting methods should be used before, during, and after the invasive procedures to reduce children's pain and anxiety.