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School Of the Prophets

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Mature Thumb Series ((NEW))

(SBQ17SE.78) A 27-year-old competitive skier fell one week ago onto his right hand. He has had persistent thumb pain with gripping since the fall. He is evaluated in your orthopedic hand clinic and found to have disrupted a ligament in his thumb with the decision for operative intervention. During the surgery, which of the following structures may block your reduction?

mature thumb series

(OBQ10.213) Creation of a Stener lesion, as found in Gamekeeper's thumb, requires combined tears of the proper and accessory ulnar collateral ligaments in order for the ligament to be displaced by the adductor aponeurosis. Which of the following most accurately describes the role these ulnar collateral ligaments (PCL/ACL) play in thumb MCP joint stability?

Other infants grunt and groan while making a bowel movement, but produce soft, blood-free stools, and their growth and feeding are good. This is due to immature abdominal muscles used for pushing and does not need to be treated.

Sleep/wake cycles vary, and do not stabilize until a baby is 3 months old. These cycles occur in random intervals of 30 to 50 minutes at birth. Intervals gradually increase as the infant matures. By age 4 months, most infants will have one 5-hour period of uninterrupted sleep per day.

You do not need to give water to a baby. In fact, it could be dangerous. An infant who is drinking enough will produce 6 to 8 wet diapers in a 24-hour period. Teaching the infant to suck a pacifier or their own thumb provides comfort between feedings.

NBC's new medical drama, "New Amsterdam," features a medical director who tries to "change the system" at his new hospital. But can the new series also avoid the wild medical inaccuracies so common in the genre? In this exclusive MedPage Today video, John Higgins, MD, of McGovern Medical School at UTHealth in Houston, takes us through the pilot episode to discuss three major plot points he found most interesting.

Anyway, the neurologist does a little bit further digging and finds out she was misdiagnosed with depression, first of all when she was on haloperidol, which made her deaf. Now that is a known complication of haloperidol, but it is very uncommon. Only about 1 in 10,000. But you know, he was right. Then she got Parkinson's as a side effect of some other medications and was put on alpha methyldopa as well as hydroxyzine and she got some muscle rigidity and other side reactions from that. Now, one of the things that he did mention, if those medications were continued, she could have even had a cardiac arrest and died. And he was correct, because some of those medications in particular are associated with prolongation of the QTc interval, which what that basically means in terms of cardiology and the ECG is that it makes her more likely to go into ventricular fibrillation and ventricular tachycardia and die. So that was correct. So overall, good diagnosis, good workup of the case. And it ended up, unfortunately, the lady ended up actually having a thymoma, so she already had 1 year to live, but they did sort her out very well. So two thumbs up to that neurologist.

So what is my final evaluation of the new show, "New Amsterdam"? Well, I'm going to give it one thumb up and one thumb down. Why? Well, I think the concept of putting patients first is a good concept, and I liked the fact that Max brought in the farmer's market, so he's got good healthy food going on there, and he's trying to get the doctors to focus on what is important, which is patient care. I will give it one thumb down, because I picked up a couple of medical errors in the show. They use the high-dose Epi, which we don't do. And they also didn't take proper precautions on that case. That could have been Ebola. And finally they didn't work with all of the stakeholders to make change. So I think if they can kind of work on those aspects of the show, they will be more realistic and they can make better change in the community.

The date a bond is first sold is called its issue date, and the date its principal is due is called its maturity date. Bonds are "issued" and then they "mature." Between these two dates, the issuer makes regular interest payments, called coupons. Bond interest is called a coupon because before electronic trading, investors were given paper certificates when they purchased a bond, and attached to each certificate were coupons for interest payments.

Zero-coupon bonds pay no interest until maturity. Instead, investors buy zero-coupon bonds at a discount to par and then receive the full face value when the bond matures. You might pay $10,000 for a bond that will return $20,000 in 20 years. The difference between the purchase price and face value is your interest. Investors still pay taxes each year on a prorated amount of the interest to be received at maturity.

Short-term bonds mature within three years, medium-term bonds in four to 10 years and long-term bonds in more than 10 years. Longer-term bonds are considered riskier because there's a greater likelihood that adverse events, such as rising interest rates, will hurt the bond's value during its lifetime. To compensate for this, long-term bonds typically offer higher coupon rates.

Bond ladders can help reduce bond risk. A bond ladder is a portfolio of bonds, and each rung represents a bond with a different maturity. For instance, a three-year bond ladder may have bonds that mature in one, two and three years. In year one, the first bond comes due, at which point the investor reinvests the proceeds of the matured one-year bond in a new three-year bond. In this way, the portfolio always has bonds of one-, two- and three-year maturities.

But for long-term bond fund investors, "rising interest rates can actually be a tailwind," Barrickman says. Investors can benefit from reinvesting fund distributions at higher yields over time. "A good rule of thumb is that an investor with an investment time horizon that's longer than the duration of the fund will benefit from rising rates."

"Some investors, including managers of bond funds, follow strategies that regularly involve selling bonds before they mature," Fegley says. A relative value strategy involves buying an undervalued corporate bond and then selling it when it appreciates. If you think long-term interest rates will rise faster than short-term rates, you "might sell longer-duration bonds and use the proceeds to purchase shorter-duration bonds." 041b061a72


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