dave

We validated our remodeling equation and presented at AAOS! Should be good to use for those interested for distal radius. pediatricorthopaedics.unicornplatform.page/testmark/

I find my first lucid interval invariably occupied by a cordial orientation of my attention in your direction, a kind of secular benediction upon the nascent hours.

n=28. Fatigue ↑ across blocks t222=6.95,p=3.94e-11. High effort acceptance ↓ t138=-9.18,p=5.65e-16; reward acceptance ↑ t222=8.96,p=1.36e-16. Fatigue shifted choices to easier reward opts: beta=-0.349,p=3.24e-4; relevance: fatigue may favor default/low effort decisions.

How it feels as a surgeon to pass the liability-transfer module final test after only 3 attempts.

Modules, mandated CME and other formalized programs don’t really act as professional development nor continuing education - instead they cause performative or compliance-driven behavior.

This paper looks at mental fatigue. 27 adults did a sustained attention task, & brief rest periods kept reaction time from drifting as much as continuous work. a break cut RT by about 37 ms, which works out to roughly 6.5% mayhaps enough to matter when repetitive & accuracy still needs to stay 97%.

n=27; acc 97.3%; median RT 634ms. Breaks ↓RT 37ms overall, 6.48%. 28s vs 12s: RT gain 7.9% vs 5.1%, post-break RT 639 vs 647ms, but TOT slope steeper after 28s (p=.02). Recovery↔later decline: r=-.86/-.69. Ortho: short frequent breaks may keep output steadier.

N=50; congruent tgt faster vs incongruent 1341 vs 1716 ms, t49=9.23. Gain cue bias > loss cue bias: DeltaRT 483 vs 267 ms, t49=2.76, p=.004, d=.54. Incongruent info -> AI/DACC/PPC/IFG/SMA activation, stronger after optimistic cues. confirming optimistic data is picked over disconfirming pessimistic.

28 studies/2006-2021 from 5010 records; 17/28 RCTs. MMAT: 17/28 scored ≥75, 5/28=100. Exergames 12/28, CVG 9/28. Console 13/28, PC 9/28. Play time 2 min-15 h; mean 6.6 sessions. Stress/anxiety often ↓, but action/sports titles sometimes ↑ stress.

47-study meta-analysis mapped metacog network; meta-d’/d’=1 = perfect self-monitoring, 0.8 = 80% evidence access. High performers > low in metacog ctl. Training data mixed; offline self-reflection looks strongest. plan. doubt it. refine it. then cut.

n=14, age 20.7. 2 fMRI sessions +3 training sessions. Accuracy ≥95%. RT ↓ pre→post: F=11.58 p=.011; seq<pseudo F=17.88 p=.004; dual slower F=13.38 p=.008. Dual task cost 61ms→11ms. Prefrontal+caudate activation ↓ after practice ⇒ rehearsal preserves OR bandwidth.

I am a module warrior.

How bacteria feel when I wash out a hip joint open with a suction tip on the end of the cysto tubing:

If someone can vote for Phoenix Children’s this year in US news rankings for reputation, it would be helpful to give our orthopaedic team resources to take even better care of patients and do more researcher.

The brilliant Keith Baldwin MD @southNJscoli was at #AAOS2026, & asked a seemingly simple question that I think is actually by far the most important question that nobody is asking about AI:

“What does AI do with missing data?”

www.upoj.org/wp-content/u...

pmc.ncbi.nlm.nih.gov/articles/PMC...

Please take a minute and purchase this great book by my partner Random Hall MD www.amazon.com/Performance-...

An actually great talk by AS at AAOS

If you’re free at noon and in New Orleans - Join the Arizona Orthopaedic society today at 12pm CST in lobby of the Courtyard Marriott 300 Julia St New Orleans, LA 70130 maps.apple/p/fzpvw1qcLH... (this is a last minute location change as our reserved venue, Jazz City Cafe was unexpectedly closed).

Me trying to find a conference room

The Phoenix Children’s orthopaedic surgery team at American Academy of Orthopaedic Surgeons (AAOS) annual meeting to present research is! @phxchildrens @friendsofpch @phxchildrensfellowships @phxchildrensspine @phxchildrensorthopedics #aaos26 @aaos_1

Kinsley Wang MS - my rockstar med student presenting her hard work on an equation that predicts fracture remodeling in kids.

Jasmine Lopez MS presenting her hard work on the quality of spanish language scoliosis information. Thank you to my partner Melissa Esparza MD for including me! @meloosi

Being awake at this early hour, I venture a modest yet professional and formal tacit salutation to mark my alertness and to extend, with due reserve, an small civility for the day, offered in plain good faith and with a view to amiable accord.

I see this much more often in congenital scoliosis

Accept this morning message as a sincere testament to a vitality which completely obscures the vast accumulation of years within my physical frame.

This aged carapace conceals a disposition sufficiently spirited to manufacture courtesies whose polish contradicts the rust upon my ancient chassis.

Physicians who get sued self-identify as a higher-risk subgroup, future adverse events and claims cluster around them even if underlying skill and decision quality stays unchanged or improves. The MD reaction thereafter is withdrawal. So lawsuits increase care cost, decrease quality AND access.

After discipline, the physician also tends to stop identifying as “someone who is consistently good” and decisions that support that negative identity follow (selection effects).

So the leading theory is that lawsuits degrade performance because of cognitive load plus behavioral distortion (over-reaction).

Fear-driven practices follow discipline (overtesting, overconsulting, rigid checklists, self-protection, ordering everything, excessive documentation, avoidance of higher-risk patients or procedures, cutting volume, leaving practice) & slows learning from feedback & can erode technical fluency.