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Paul Revere was a very important figure in American History. Readers explore the life of this honored patriot and discover his impact on the American Revolution. They learn the story behind his historic midnight ride as well as many additional facts about his life. Accessible text is accompanied by historical images in a way that will keep readers engaged and entertained as they learn.

Young readers will learn the basics of decomposition and the impact recycling organic material can have on our world. Readers will also learn about soil makeup, nutrients, humus, and more.

With ever-increasing energy and materials costs, manufacturers are more motivated to improve productivity by streamlining processes, dramatically cutting human resources and budgets and optimizing production processes. For example, shops pay more attention to a molds thermal dynamics during design, molding and preventative maintenance (PM) to reduce cycle time, decrease energy consumption, improve plastic part quality and increase yield. Manufacturers have optimized hot runner systems, gating and finite element method (FEM) simulations to control better fill and cycle times. However, what is rarely discussed is cooling. The cooling cycle can be as much as 70% of a part run cycle, so thermal management to reduce overall cycle times is critical for process optimization. Lower cycle times and lower scrap rates equate to higher part production.

\"This book shows readers what they might expect when entering foster care. The age-appropriate text provides guidance for dealing with the many emotions that come with a major life event such as meeting a new foster family. The book also touches on what to expect if a foster family situation doesn't work out\"--Provided by publisher.

Category: Other Introduction/Purpose: As both fellowship training and opportunities for leadership's popularity increase, understanding a Foot and Ankle Fellowship Directors' (FD's) necessary components is crucial for evaluating Orthopaedic improvement methods and providing a template for the field's aspiring leaders. However, despite a FD's significance in trainee's development, future success, and careers in Foot and Ankle via Orthopaedic Surgery, no literature analyzing Foot and Ankle FD's demographics, surgical training, nor experience currently exists. This article aims to illustrate the trends in the characteristics and qualifications needed for leadership as an Orthopaedic Surgery Foot and Ankle FD. Methods: The American Orthopaedic Foot and Ankle Society (AOFAS) identified the FDs for all 2021 participating Orthopaedic Foot and Ankle fellowship programs in the United States. The characteristics, demographics, and educational background data for each fellowship director was gathered and consolidated by author review of available curricula vitae (CV's). Information that could not be obtained from the CV's were then further gathered from resources such as Scopus web of science, institutional biographies, and emailed questionnaires. To ensure adequate response and data points, with absence of email response, information not readily available was obtained through telecommunications. These data points were then consolidated into 1 database. The information gathered to be used as data points were: Age, sex, race/ethnicity, residency/fellowship training location and graduation year, name of current institution, length of time at current institution, time since training completion until being appointed fellowship director, length in fellowship director role, and personal research H-index. Results: 51 Foot and Ankle FDs were appraised. The mean age of Current FD's was 51.27 years old with a mean H-Index of 14.69. 94.1% of these FD's were male and 5.9% were female; 90.2% were Caucasian, 5.9% were Asian American, and 3.9% were African American. The mean residency graduation year was 2001.31; and the most attended Residency program was the Harvard Combined Orthopaedic Residency Program. The mean fellowship graduation year was 2002.30; and the most attended fellowship program was the MedStar Union Memorial Foot and Ankle Fellowship. The time from completion of fellowship until FD appointment was 11.42 years; the mean number of years spent as a FD is 4.37. 19.61% of FD's work at the same institution where they completed residency; 9.8 % of FD's currently work at the same institution where they completed fellowship. The FD with the highest research impact displayed a Scopus H-index of 48. Conclusion: This study serves as an objective summary and analysis of the current leadership within Foot and Ankle Fellowship Programs in the US. Orthopaedics sees a large disparity in diversity in percentage of women and minorities within the field as compared to several different specialties; however, that same disparity is further pronounced amongst leadership as lower percentages of women and minorities hold leadership positions within orthopaedics compared to other specialties. This study provides data to be used as a template for candidates aspiring for leadership while displaying trends that establish a more comprehensive sense of diversity and equality.

Background: Ankle fractures are among the most common injuries treated by orthopaedic surgeons, yet little guidance exists in postoperative protocols for ankle fractures concerning time of immobilization. Here, we aim to investigate the association between early mobilization and patient-reported outcomes. Our null hypothesis was that no difference in Patient-Reported Outcomes Measurement Information System (PROMIS) scores would be identified in patients when comparing the effect of time of immobilization. Methods: A retrospective review identified ankle fractures that underwent surgical fixation between 2015 and 2020 at a level 1 trauma center and its associated facilities. One hundred nineteen patients from 9 providers met inclusion criteria for our final analysis. Forty-seven patients were immobilized for <6 weeks (early) and 68 patients were immobilized for ≥6 weeks (late). Our primary outcome measures included the PROMIS questionnaire, time of immobilization, and time to full weightbearing. Our secondary outcome measures included time to return to work, wound complications (infection, delayed healing), and complications associated with fracture fixation (loss of reduction, delayed union, reoperation, hardware failure). Repeated measures analysis of variance as well as linear mixed outcome regression were used to predict each of the PROMIS outcomes of anxiety, depression, physical function, and pain interference. Each model included the predictors of age, sex, race, body mass index (BMI), diabetes, rheumatoid arthritis, smoking status, payor, provider, time to radiographic union, time to return to work, time to full weightbearing, and early vs late immobilized groups. Results: We found no differences in PROMIS scores between mobilization groups even when controlling for possible confounders such as age, BMI, rheumatoid arthritis, smoking status, and diabetes mellitus (P > .05). Furthermore, we found no differences in complications associated with fracture fixation (P > .05). Across our cohort, lower physical function scores were associated with higher BMI, increasing age, and longer time to return to work/play (P < .05). Our analysis further showed that depression, anxiety, pain interference, and physical function levels improve as a function of time (P < .05). Higher BMI was also noted to have a significant impact on PROMIS depression and anxiety when controlling for other variables. African Americans had greater pain interference scores (P < .05). Conclusion: Our study suggests that early mobilization in a walker boot after operative treatment of ankle fractures is a safe alternative to casting in non-neuropathic patients. When considering operative treatment of ankle fractures, factors such as increasing age and BMI are likely to negatively affect postoperative anxiety, physical function, and depression PROMIS scores regardless of immobilization time. Level of Evidence: Level III, retrospective cohort study.

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are among the most common injuries that Orthopaedic Surgeons treat; yet, little guidance exists in postoperative protocols for ankle fractures concerning time of immobilization and weightbearing. Results from previous studies have been mixed; demonstrating improved outcomes, no difference in outcome, or poorer outcomes including increased wound complications in patients who are mobilized early. Here, we aim to investigate the association between early immobilization and patient reported outcomes. Our null hypothesis was that no difference in PROMIS scores would be identified in patients when comparing the effect of time of immobilization and time of weightbearing. Methods: A chart review identified ankle fractures that underwent surgical fixation between 2015 and 2020 at a level 1 trauma center and its associated facilities. One-hundred nineteen patients from 8 providers met inclusion criteria for our final analysis. Fifty patients were immobilized for <6 weeks and 69 patients were immobilized for at least 6 weeks. Our primary outcome measures included the PROMIS questionnaire, time of immobilization, and time to full weightbearing. Our secondary outcome measures included time to return to work, wound complications (infection, delayed healing), and complications associated with fracture fixation (loss of reduction, delayed union, reoperation, hardware failure). Repeated-measures ANOVAs were used to predict each of the PROMIS outcomes of anxiety, depression, physical function, and pain interference. Each model included the predictors of age, sex, race, BMI, payor, provider, time to radiographic union, time to return to work, time to full weightbearing, and early vs late immobilized groups. Results: There were no differences in PROMIS scores between mobilization groups and time to full weightbearing (p>0.05). Furthermore, there were no differences in wound complications nor complications associated with fracture fixation (p>0.05). Across our cohort, physical function scores were negatively impacted by higher BMI, increasing age and longer time to return to work/play (p<0.05). Our analysis further showed that depression, anxiety, pain interference and physical function levels improve as a function of time (p<0.05). African Americans showed more pain interference than other groups of patients (p<0.05). No difference in PROMIS scores were identified between treating providers (p>0.05). Conclusion: In this study, the null hypothesis was accepted. Data from our analysis shows no significant differences between the early and late mobilization and weightbearing groups in terms of PROMIS outcomes nor with wound complications and complications associated with fracture fixation. Our study does suggest that early mobilization after operative treatment of ankle fractures is safe and results in similar patient reported outcomes with no increased risk of complication. We did find that African American patients experienced more pain that other groups and we aim to further explore this topic to find potential modalities to address this disparity.