Congenital myelomeningocele - do we have to change our management?

<p>Abstract</p> <p>Background</p> <p>Eagerly awaiting the results of the Management of Myelomeningocele Study (MOMS) and with an increasing interest in setting up intrauterine myelomeningocele repair (IUMR), the optimal management of patients suffering from congenital myelomeningocele (MMC) has become a matter of debate again. We performed a cross-sectional study at our referral-center for MMC to determine the outcome for our expectantly managed patients.</p> <p>Materials and methods</p> <p>A computed chart review at our institution revealed 70 patients suffering from MMC. Forty-three patients were eligible for the study and analyzed further. A retrospective analysis was performed only in patients that underwent MMC repair within the first two days of life and were seen at our outpatient clinic between 2008 and 2009 for a regular multidisciplinary follow-up. Data were collected on: gestational age (GA) and weight at birth, age at shunt placement and shunt status after the first year of life, radiological evidence for Arnold-Chiari malformation (ACM) and tethered cord (TC), need for surgery for TC, bladder function, lower leg function and educational level. Data were compared to published results for IUMR and to studies of historical controls.</p> <p>Results</p> <p>Patients were born with MMC between 1979 and 2009 and are now 13.3 ± 8.9 (mean ± SD) years of age. At birth, mean GA was 37.8 ± 2.3 weeks and mean weight was 2921.3 ± 760.3 g, both significantly higher than in IUMR patients. Shunt placement in our cohort was required in 69.8% at a mean age of 16.0 ± 10.7 days, which was less frequent than for historical controls. Amongst our cohort, radiological observations showed 57.1% had ACM II and 41.9% had TC. Only two of our patients underwent a surgical correction for TC. Clean intermittent catheterization was performed in 69.7% of our patients, 56.4% were (assisted) walkers and 64.1% attended regular classes, both comparable to historical controls.</p> <p>Conclusions</p> <p>With a close and interdisciplinary management by pediatric surgeons, neurologists and urologists, the long-term outcome of patients suffering from MMC can currently be considered satisfactory. With respect to the known drawbacks of fetal interventions for mother and child, especially preterm delivery, the results of the MOMS trial should be awaited with caution before proceeding with a complex intervention like IUMR.</p

Pre-competition cardiac screening in professional handball players - setting up at the EHF European Handball Championship 2010 in Austria

Zusammenfassung: In vielen Sportarten wird ein regelmäßiges, richtliniengetreues kardiales Screening zur Verhinderung des plötzlichen Herztods noch immer nicht gewährleistet. Wir nahmen die Handball Europameisterschaften, welche 2010 in Wien und weiteren Städten in Österreich stattfanden, zum Anlass, die aktuelle Situation bei Toplevel-Handballern zu untersuchen: Ein standardisierter Fragebogen wurde vor dem Turnier an alle qualifizierten Teams und Spieler versandt. Eine Rücklaufrate von 42,7 % kann zum Schluss führen, dass das Problem des plötzlichen Herztods bei den Spielern und Verantwortlichen unterschätzt wird. Die überwiegende Mehrzahl der Spieler (82 %) wurde gemäß der Auswertung der Fragebögen korrekt, entsprechend der aktuellen Screening-Richtlinien untersucht. In gut der Hälfte der Teams wurde das Screening jedoch "inhomogen" durchgeführt. 5 Spieler (4,1 %) wurden zumindest nicht innerhalb der letzten Jahre untersucht, bei 1 Spieler (0,8 %) wurde kein EKG durchgeführt. Während 69 % der Handballer ihr erstes Screening erst nach dem Alter von 18 Jahren durchliefen, wurden 16 Spieler (13,1 %) gar niemals zuvor einer kardialen Vorsorgeuntersuchung unterzogen. Schließlich identifizierten wir aufgrund der Fragebögen 17 Athleten (13,9 %) mit einer hoch suspekten Anamnese, wovon 2 Athleten (1,6 %) niemals zuvor kardiologisch abgeklärt wurde

A fiber-based beam profiler for high-power laser beams in confined spaces and ultra-high vacuum

Laser beam profilometry is an important scientific task with well-established solutions for beams propagating in air. It has, however, remained an open challenge to measure beam profiles of high-power lasers in ultra-high vacuum and in tightly confined spaces. Here we present a novel scheme that uses a single multi-mode fiber to scatter light and guide it to a detector. The method competes well with commercial systems in position resolution, can reach through apertures smaller than $500\times 500$~$\mu$m$^2$ and is compatible with ultra-high vacuum conditions. The scheme is simple, compact, reliable and can withstand laser intensities beyond 2~MW/cm$^2$

Process Selection in RPA Projects – Towards a Quantifiable Method of Decision Making

The digital age requires companies to invest in value-creating rather than routine activities to drive innovation as a future source of competitiveness and business success. Thus, many companies are reluctant to invest in large-scale, costly backend integration projects and seek adaptable solutions to automate their front-office activities. Bridging artificial intelligence and business process management, robotic process automation (RPA) provides the promise of robots as a virtual workforce that performs these tasks in a self-determined manner. Many studies have highlighted potential benefits of RPA. However, little data is available on operationalizing and automating RPA to maximize its benefits. In this paper, we shed light on the automation potential of processes with RPA and operationalize it. Based on process mining techniques, we propose an automatable indicator system as well as present and evaluate decision support for companies that seek to better prioritize their RPA activities and to maximize their return on investment

Characterization and sorption properties of low pH cements

Characterization of three low pH cement pastes, including the description of their sorption properties for tritiated water (HTO), 36Cl- and 129I- is described in this work. SEM-EDX and NMR analyses show that after 90 days of hydration, the main hydrated phases are C-S-H and C-A-S-H gels with a Ca:Si ratio between 0.8 - 1.0 and a Al:Si ratio of 0.05. TG-DSC and XRD indicate the presence of calcite in the mixtures where limestone filler has been used. Additional techniques were used to identify minor hydrated solid phases like ettringite (i.e., XRD and solid state NMR). Porosity and pore size distribution was characterized by MIP observing that the size of the pores in the hydrated cement phases varies from the micro to the nanoscale. Uptake studies of HTO, 36Cl- and 129Ifrom batch sorption experiments indicate very weak sorption (Kd < 0.40 ± 0.13 L/kg) for the 3 selected radionuclides. The uptake process of 36Cl- and 129I- is probably associated with surface processes in the C-S-H and C-A-S-H phases with competition for sorption sites, between them. In the case of HTO, isotopic exchange with the interlayer water of the C-S-H and the C-A-S-H seems to be the main uptake process

The Leeway of Shipping Containers at Different Immersion Levels

The leeway of 20-foot containers in typical distress conditions is established through field experiments in a Norwegian fjord and in open-ocean conditions off the coast of France with wind speed ranging from calm to 14 m/s. The experimental setup is described in detail and certain recommendations given for experiments on objects of this size. The results are compared with the leeway of a scaled-down container before the full set of measured leeway characteristics are compared with a semi-analytical model of immersed containers. Our results are broadly consistent with the semi-analytical model, but the model is found to be sensitive to choice of drag coefficient and makes no estimate of the cross-wind leeway of containers. We extend the results from the semi-analytical immersion model by extrapolating the observed leeway divergence and estimates of the experimental uncertainty to various realistic immersion levels. The sensitivity of these leeway estimates at different immersion levels are tested using a stochastic trajectory model. Search areas are found to be sensitive to the exact immersion levels, the choice of drag coefficient and somewhat less sensitive to the inclusion of leeway divergence. We further compare the search areas thus found with a range of trajectories estimated using the semi-analytical model with only perturbations to the immersion level. We find that the search areas calculated without estimates of crosswind leeway and its uncertainty will grossly underestimate the rate of expansion of the search areas. We recommend that stochastic trajectory models of container drift should account for these uncertainties by generating search areas for different immersion levels and with the uncertainties in crosswind and downwind leeway reported from our field experiments.Comment: 25 pages, 11 figures and 5 tables; Ocean Dynamics, Special Issue on Advances in Search and Rescue at Sea (2012

Simulation of truncated normal variables

We provide in this paper simulation algorithms for one-sided and two-sided truncated normal distributions. These algorithms are then used to simulate multivariate normal variables with restricted parameter space for any covariance structure.Comment: This 1992 paper appeared in 1995 in Statistics and Computing and the gist of it is contained in Monte Carlo Statistical Methods (2004), but I receive weekly requests for reprints so here it is

Random template placement and prior information

In signal detection problems, one is usually faced with the task of searching a parameter space for peaks in the likelihood function which indicate the presence of a signal. Random searches have proven to be very efficient as well as easy to implement, compared e.g. to searches along regular grids in parameter space. Knowledge of the parameterised shape of the signal searched for adds structure to the parameter space, i.e., there are usually regions requiring to be densely searched while in other regions a coarser search is sufficient. On the other hand, prior information identifies the regions in which a search will actually be promising or may likely be in vain. Defining specific figures of merit allows one to combine both template metric and prior distribution and devise optimal sampling schemes over the parameter space. We show an example related to the gravitational wave signal from a binary inspiral event. Here the template metric and prior information are particularly contradictory, since signals from low-mass systems tolerate the least mismatch in parameter space while high-mass systems are far more likely, as they imply a greater signal-to-noise ratio (SNR) and hence are detectable to greater distances. The derived sampling strategy is implemented in a Markov chain Monte Carlo (MCMC) algorithm where it improves convergence.Comment: Proceedings of the 8th Edoardo Amaldi Conference on Gravitational Waves. 7 pages, 4 figure