Rotations 2.0

Todd Fredricks DO MSS
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A weekly discussion of medicine and science trends between people far too old to be trying something this new.

  1. 2D AGO

    Rotations 2.0 Episode 58 Abcesses

    Send a text Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Sidewinder by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use.  Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 57 Cellulitis Question 1 A 68-year-old man is evaluated for recurrent lower extremity cellulitis. In counseling him about prognosis, you reference a 24-year CDC analysis of cellulitis-related mortality in U.S. adults aged ≥65 years from 1999 to 2023. According to this study, which of the following best describes the trend in age-adjusted mortality rates (AAMR per 1,000,000 population) over the study period? C) Overall increase with a steep rise from 2019 to 2023 Question 2 During a public health lecture, you discuss disparities in cellulitis-related mortality among older U.S. adults (≥65 years) based on a recent 24-year CDC WONDER analysis. Which demographic group had the highest age-adjusted mortality rate (AAMR per 1,000,000 population) in this study? C) Non-Hispanic White individuals Question 3 A 72-year-old patient from a rural Midwest community presents with cellulitis. You consider population-level risk factors from a 24-year CDC analysis of cellulitis mortality in older adults. In which of the following settings was cellulitis-related age-adjusted mortality highest? D) Nonmetropolitan (rural) areas Paper for Next Week: Bobe, Jason R., Brandon L. Jutras, Elizabeth J. Horn, Monica E. Embers, Allison Bailey, Robert L. Moritz, Ying Zhang, Mark J. Soloski, Richard S. Ostfeld, Richard T. Marconi, John Aucott, Avi Ma’ayan, Felicia Keesing, Kim Lewis, Choukri Ben Mamoun, Alison W. Rebman, Mecaila E. McClune, Edward B. Breitschwerdt, Panga Jaipal Reddy, Ricardo Maggi, Frank Yang, Bennett Nemser, Aydogan Ozcan, Omai Garner, Dino Di Carlo, Zachary Ballard, Hyou‑Arm Joung, Albert Garcia‑Romeu, Roland R. Griffiths, Nicole Baumgarth, and Brian A. Fallon. “Recent Progress in Lyme Disease and Remaining Challenges.” Frontiers in Medicine 8 (2021): Article 666554.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    44 min

  2. MAR 9

    Rotations 2.0 Episode 57 Cellulitis

    Send a text Episode 57 Cellulitis Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Dark Countdown my Head in the Clouds by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS  Answers for Episode 56 Herpes Simplex Question 1 A 58-year-old man who underwent allogeneic hematopoietic cell transplantation 3 months ago presents with painful vesicular lesions on the vermilion border of the lower lip that have persisted despite 10 days of high-dose intravenous acyclovir (10 mg/kg every 8 hours) with documented adherence and adequate renal dosing. Viral culture confirms HSV-1. Which of the following is the most appropriate next step in management? C) Obtain genotypic or phenotypic drug susceptibility testing and consider transition to foscarnet or cidofovir pending results  Question 2 A 45-year-old woman with a history of solid organ transplantation is hospitalized for recurrent genital HSV-2 lesions unresponsive to 14 days of appropriately dosed intravenous acyclovir. Phenotypic susceptibility testing shows an EC₅₀ within the susceptible range, yet lesions continue to worsen. Which of the following is the most likely explanation for this clinical-phenotypic discordance? A)   Presence of an undetected minority drug-resistant variant within the viral quasispecies  Question 3 In the management of suspected acyclovir-resistant HSV infection in an immunocompromised patient, which of the following statements regarding alternative antiviral agents is most accurate according to current evidence? A) Pritelivir and amenamevir are generally well tolerated with fewer adverse effects than foscarnet or cidofovir and do not require thymidine kinase activation  Paper for Next Week: Sabat, R., Alavi, A., Wolk, K., Wortsman, X., McGrath, B., Garg, A., & Szepietowski, J. C. (2025). Hidradenitis suppurativa. Lancet, 405, 420–438.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    46 min

  3. MAR 2

    Rotations 2.0 Episode 56 Herpes Simplex

    Send a text Episode 56 Herpes Simplex Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Traces in Time by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 55 HIV AIDS Question 1 — Policy shock and key populations A public health team in a sub‑Saharan African country reports that PrEP coverage among key populations exceeds 10%. During a funding review, several policy changes are proposed. Which change is most likely to produce the largest immediate rise in new HIV infections among key populations?  B. The government suspends PEPFAR‑funded PrEP services specifically for key populations, including female sex workers, MSM, transgender women, and people who inject drugs. Question 2 — Prevention paradox and PrEP efficiency A regional primary‑care consortium is planning PrEP scale‑up. Epidemiologic data show incidence is approximately 3 per 100 person‑years in the target cohort. Approximately how many individuals must receive PrEP to prevent one new HIV infection under these conditions?  B. Thirty‑three people must receive PrEP to prevent one infection. Question 3 — Integration, equity, and clinical outcomes A community clinic serving diverse patients with HIV is reevaluating its care model. Among its patients are transgender women on ART with variable adherence. Which programmatic change is most likely to improve viral suppression rates in this group according to evidence cited in the editorial? C. Integrate HIV care with gender‑affirming care, including provision of exogenous estrogen therapy as clinically appropriate. Paper for Next Week: Faheem, M. S. B., Munir, S. U., Javed, M., Hassan, S. T., Masood, M. B., Maryam, K. U. E., Cheema, S., Samadi, S., & Khan, M. I., Mortality trends for cellulitis-related death in older adults in the United States: 24-year CDC analysis of gender, race, and geographical disparities. Annals of Medicine & Surgery, (2025).  87, 8471–8477.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    44 min

  4. FEB 23

    Rotations 2.0 Episode 55 HIV AIDS

    Send a text Episode 55 HIV/AIDS Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Leap in the Dark by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 54 STI Question 1: Gonorrhea treatment and AMR A 22-year-old man presents with dysuria and purulent urethral discharge after unprotected sex. NAAT for Neisseria gonorrhoeae is positive and Chlamydia trachomatis NAAT is negative. He has no drug allergies and no signs of disseminated infection. According to current evidence in the review, which is the preferred first-line regimen for uncomplicated urogenital gonorrhea? A. Ceftriaxone monotherapy Question 2: Syphilis diagnostic algorithm A 28-year-old pregnant patient at her first prenatal visit has risk factors for sexually transmitted infections but no symptoms. You plan screening for syphilis. Which testing strategy best aligns with the diagnostic approach in the review? A. Screen with a nontreponemal test (VDRL or RPR) and confirm positives with a treponemal test (TPPA or FTA‑ABS) Question 3: Persistent NGU and Mycoplasma genitalium A 30-year-old man is treated for presumed non-gonococcal urethritis (NGU) with azithromycin and returns 2 weeks later with persistent dysuria and urethral discharge. Repeat NAATs for C. trachomatis and N. gonorrhoeae are negative. Which next step is most consistent with the review’s recommendations? C. Order NAAT for Mycoplasma genitalium with resistance testing and treat with a resistance‑guided or two‑step regimen Paper for Next Week:  Dähne T, Jaki L, Gosert R, Fuchs J, Krumbholz A, Nägele K, Pletz MW, Khanna N, Leuzinger K, Panning M. Herpes simplex virus and drug resistance—comprehensive update on resistance mutations and implications for clinical management: a narrative review. Clinical Microbiology and Infection. 2025 Sep;31(9):1484-1490 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    37 min

  5. FEB 16

    Rotations 2.0 Episode 54 STI

    Send a text Episode 54 STI Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Claim We Are Able by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Not So Quiet on the Western Front- VD https://not-so-quiet.com/supporters/audio/193970?utm_medium=copy-share-link&utm_source=share-link&utm_campaign=post-share-supporter Answers for Episode 53 UTI Question 1 — Pathophysiology of CAUTI in a Post‑operative Patient A 68‑year‑old man undergoes hip arthroplasty. He receives tranexamic acid perioperatively to limit bleeding and has a Foley catheter in place for 48 hours. On day 3 he develops fever (38.4 °C), suprapubic discomfort, and leukocyturia. Urine culture is negative, but catheter tip culture later shows E. faecalis, UPEC, and Candida albicans in a mixed biofilm. Which mechanism best explains his severe catheter‑associated UTI (CAUTI) presentation and the negative urine culture? C. Antifibrinolytic therapy causes fibrin accumulation that scaffolds fibrin(ogen)‑dependent polymicrobial biofilms on the catheter and urothelium, under‑represented in planktonic urine cultures Question 2 — Antibiotic Selection & Dosing in CAUTI A 72‑year‑old woman in a nursing facility has a 7‑day indwelling catheter and develops dysuria and suprapubic pain. Empiric TMP–SMX 160/800 mg orally for 3 days is started for presumed UTI. She returns 48 hours later with persistent symptoms. Which management is most appropriate given CAUTI treatment outcomes cited in the review? B. Switch to an oral fluoroquinolone (e.g., ciprofloxacin or levofloxacin) 500–1,000 mg daily for 5–7 days, while tailoring to urine culture and resistance data Question 3 — uUTI Symptom Control & COX‑2 Biology A 45‑year‑old otherwise healthy woman presents with an uncomplicated UTI (uUTI): dysuria, frequency, and suprapubic pain for 24 hours. She asks whether she can avoid antibiotics if possible. Which statement best reflects the clinical evidence and mechanistic context presented in the article? B. In a randomized 3‑day pilot trial, ibuprofen (COX‑2 inhibition) and ciprofloxacin produced a similar ~50% reduction in mean symptomatic scores, with the ibuprofen arm showing no additional adverse effects or need for rescue antibiotics Paper for Next Week:  Beyrer, C., Ratevosian, J., Gelderblom, H., & Rosenberg, N. E. (2025). The HIV/AIDS pandemic: where are we now? AIDS, 39(11), 1497–1504. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the conten

    48 min

  6. FEB 9

    Rotations 2.0 Episode 53 UTI

    Send a text Episode 53 UTI (Now with Chapter Markers!) Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Fate Embrace by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS  Answers for Episode 52 Brain Immune Gut Axis Question 1 Which of the following best describes the role of short-chain fatty acids (SCFAs) in the gut–immune–brain axis? C. SCFAs modulate immune responses by promoting regulatory T cell differentiation and influencing microglial maturation Question 2 Which immune cell type is most associated with IL-17A production in the meninges, influencing synaptic plasticity and anxiety-like behaviors? C. γδ T cells Question 3 Which statement about the vagus nerve in gut–brain communication is correct? C. Vagus nerve acts as a bidirectional pathway, transmitting microbial and immune signals to the brain and modulating gut immunity Question 4 Which of the following best explains the mechanism by which maternal immune activation (MIA) increases autism spectrum disorder (ASD) risk in offspring? C. IL-17A produced by Th17 cells in response to segmented filamentous bacteria disrupts fetal brain development Question 5 Which of the following is a therapeutic implication of targeting the gut microbiota in neurodegenerative disorders such as Alzheimer’s disease (AD)? C. Administering probiotics to reduce microglial activation and improve barrier integrity Question 6 Which of the following best describes the role of astrocytes in neuroinflammation? C. Astrocytes release TNF-α and IL-6, amplifying microglial activation and sustaining neuroinflammation Paper for Next Week: Esin S, Del Bono L, Pistello M. Sexually Transmitted Infections: Global Trends, Diagnostic Advances, and Emerging Challenges. New Microbiol. 2025 Jul;48(2):113-136. PubMed PMID: 41123498.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    50 min

  7. FEB 2

    Rotations 2.0 Episode 52 Brain Immune Gut Axis

    Send a text Episode 52 Brain Immune Gut Axis Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Trap Beat (Dripin’ Sauce) by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 51 Sprains and Strains  1) Acute management and expected outcome A 24‑year‑old recreational basketball player presents 36 hours after an inversion injury. Examination is consistent with a grade II lateral ankle sprain; Ottawa ankle rules are negative. He asks what intervention is most likely to reduce his pain at rest over the next 1–2 weeks. Which is the best evidence‑based recommendation?  A. Early, supervised physical therapy using a multimodal program (e.g., progressive exercise, stretching, thermotherapy/ultrasound or hydrotherapy, and functional training) 2) Outcome interpretation A 19‑year‑old soccer player undergoes early physical therapy after a grade I ankle sprain. At follow‑up, the clinician reviews expected benefits from the literature. Which outcome did not show a significant difference between physical therapy and conventional treatment in the pooled analysis? C. Dorsiflexion range of motion (ROM) 3) Evidence synthesis and methodology In the same review, Trial Sequential Analysis (TSA) showed the Z‑curve crossed the monitoring boundary and reached the required information size for the primary pain outcome. What is the best interpretation of this finding? A. The cumulative evidence is sufficient to conclude that physical therapy reduces pain versus conventional care while controlling for type I and type II errors   Paper for Next Week: Jonathan J. Molina, Ana L. Flores-Mireles, CAUTIon – not all UTIs are the same, Nat Rev Urol. 2025 December ; 22(12): 799–814 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    49 min

  8. JAN 26

    Rotations 2.0 Episode 51 Sprains and Strains

    Send a text Episode 51 Sprains and Strains  Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Power of the Hero by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 50 Tendonitis Question 1 A 32-year-old marathon runner presents with chronic Achilles tendon pain for 3 months. He has tried rest and NSAIDs without improvement. According to current evidence, which of the following is the most effective treatment for his condition? C. Heavy slow resistance training program Question 2 A professional soccer player sustains an acute hamstring strain. Which rehabilitation approach is associated with the fastest return to play and lowest re-injury rate? B. Early initiation of progressive eccentric exercises and running drills Question 3 A 40-year-old recreational basketball player suffers an acute Achilles tendon rupture. He asks about long-term outcomes. Which statement is most accurate based on current evidence? C. Both surgical and non-surgical treatments often lead to permanent functional deficits Paper for Next Week: O’Riordan KJ, Moloney GM, Keane L, Clarke G, Cryan JF. The gut microbiota-immune-brain axis: Therapeutic implications. Cell Reports Medicine. 2025; 6 Park JC, Chang L, Kwon H-K, Im S-H. Beyond the gut: decoding the gut–immune–brain axis in health and disease. Cellular & Molecular Immunology. 2025; 22:1287–1312 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

    40 min
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A weekly discussion of medicine and science trends between people far too old to be trying something this new.

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  • Creator
    Todd Fredricks DO MSS
  • Years Active
    2025 - 2026
  • Episodes
    67
  • Rating
    Clean
  • Copyright
    © 2026 Rotations 2.0
  • Show Website
    Rotations 2.0