Musculoskeletal deformities following repair of large congenital diaphragmatic hernias

Split-abdominal wall muscle flap Purpose: Large congenital diaphragmatic hernias (CDH) can be repaired with either a muscle flap or prosthetic patch. The purpose of this study was to assess the frequency and severity of scoliosis, chest wall, and abdominal wall deformities following these repairs. Methods: Neonates who underwent CDH repair (1989-2012) were retrospectively reviewed. We then validated our retrospective review by comparing results of a focused radiologic evaluation and clinical examination of patients with large defects seen in prospective follow-up clinic. Tests for association were made using Fisher's exact test. Results: 236 patients survived at least 1 year. Of these patients, 30 had a muscle flap, and 13 had a patch repair. Retrospectively, we identified pectus in 9% of primary repairs, 47% of flap repairs, and 54% of patch repairs. We identified scoliosis in 7% of primary repairs, 13% of flap repairs, and 15% of patch repairs. Prospectively, 75% of flap patients and 67% of patch patients had pectus and 13% of flap patients and 33% of patch patients had scoliosis. There was no significant difference between flap and patch patients. Conclusions: Scoliosis and pectus deformity were common in children with large CDH. The operative technique did not appear to affect the incidence of subsequent skeletal deformity. © 2014 Elsevier Inc. All rights reserved. Large congenital diaphragmatic hernias (CDHs) require repair with either a patch or an autologous tissue transfer. Repair with a prosthetic patch is the technique used by most surgeons Methods Study population After obtaining approval from the Institutional Review Board, a retrospective review of all children with CDH repair at our regional tertiary care children's hospital from 1989 to 2012 was performed. The patients were categorized by the technique of their repair. Repair types included primary repair, split abdominal wall muscle flap and synthetic patch. Paper and electronic medical records were reviewed to obtain demographic data, and diagnosis of skeletal deformities as well as any treatment for the skeletal deformities. Electronic charts were searched for the key words "pectus" and "scoliosis," and those specific notes were reviewed. These diagnoses were made by a variety of physicians including radiologists, orthopedists and primary care physicians and were not always confirmed by a focused follow-up visit by a pediatric surgeon. In order to check the validity of our retrospective review, patients with large defects were seen prospectively for focused follow-up and a single pediatric radiologist (G.H.) reviewed the most current chest radiograph to evaluate for scoliosis greater than 10 degrees. The results of follow-up were correlated with our retrospective review

Radio Continuum Surveys with Square Kilometre Array Pathfinders

In the lead-up to the Square Kilometre Array (SKA) project, several next-generation radio telescopes and upgrades are already being built around the world. These include APERTIF (The Netherlands), ASKAP (Australia), e-MERLIN (UK), VLA (USA), e-EVN (based in Europe), LOFAR (The Netherlands), MeerKAT (South Africa), and the Murchison Widefield Array. Each of these new instruments has different strengths, and coordination of surveys between them can help maximise the science from each of them. A radio continuum survey is being planned on each of them with the primary science objective of understanding the formation and evolution of galaxies over cosmic time, and the cosmological parameters and large-scale structures which drive it. In pursuit of this objective, the different teams are developing a variety of new techniques, and refining existing ones. To achieve these exciting scientific goals, many technical challenges must be addressed by the survey instruments. Given the limited resources of the global radio-astronomical community, it is essential that we pool our skills and knowledge. We do not have sufficient resources to enjoy the luxury of re-inventing wheels. We face significant challenges in calibration, imaging, source extraction and measurement, classification and cross-identification, redshift determination, stacking, and data-intensive research. As these instruments extend the observational parameters, we will face further unexpected challenges in calibration, imaging, and interpretation. If we are to realise the full scientific potential of these expensive instruments, it is essential that we devote enough resources and careful study to understanding the instrumental effects and how they will affect the data. We have established an SKA Radio Continuum Survey working group, whose prime role is to maximise science from these instruments by ensuring we share resources and expertise across the projects. Here we describe these projects, their science goals, and the technical challenges which are being addressed to maximise the science return

Complement pathway changes at age 12 are associated with psychotic experiences at age 18 in a longitudinal population-based study: evidence for a role of stress

The complement cascade is a major component of the immune defence against infection, and there is increasing evidence for a role of dysregulated complement in major psychiatric disorders. We undertook a directed proteomic analysis of the complement signalling pathway (n = 29 proteins) using data-independent acquisition. Participants were recruited from the UK avon longitudinal study of parents and children (ALSPAC) cohort who participated in psychiatric assessment interviews at ages 12 and 18. Protein expression levels at age 12 among individuals who reported psychotic experiences (PEs) at age 18 (n = 64) were compared with age-matched controls (n = 67). Six out of the 29 targeted complement proteins or protein subcomponents were significantly upregulated following correction for multiple comparisons (VTN↑, C1RL↑, C8B↑, C8A↑, CFH↑, and C5↑). We then undertook an unbiased plasma proteomic analysis of mice exposed to chronic social stress and observed dysregulation of 11 complement proteins, including three that were altered in the same direction in individuals with PE (C1R↑, CFH↑, and C5↑). Our findings indicate that dysregulation of the complement protein pathway in blood is associated with incidence of psychotic experiences and that these changes may reflect exposure to stress

Knowledge Management : En Studie Av SAAB Barracuda AB

Flera forskare går så långt att de säger att kunskap kan vara den enda bestående konkurrensfördelen ett företag har i dagens föränderliga omvärld. Knowledge Management som begrepp tog fart i början av 1990-talet och har sedan dess varit föremål för omfattande forskning. Samtidigt sägs det att kunskap kan vara svår att kommunicera och överföra. Vi började fundera på vilka företag som kan tänkas använda strategier för att hantera kunskap, och om Knowledge Management är så utbrett bland företagen som forskarna ger sken av, är det en så betydelsefull komponent i utvecklandet av företags konkurrensfördelar? Vi valde att undersöka Saab Barracuda AB som är världsledande inom signaturanpassning och titta på hur de, som svenskt multinationellt företag, hanterar tillvaratagande och överföring av kunskap. Undersökningen genomfördes genom en intervju med ekonomichefen på Saab Barracuda AB på plats vid huvudkontoret i Gamleby. I uppsatsen presenteras teorier kring kunskap, Knowledge Management och multinationella företag med dotterbolag. Utifrån dessa teorier analyserades Saab Barracuda AB:s syn på och strategier för tillvaratagande, spridning och skapande av kunskap. I vår undersökning fann vi att man inom Saab Barracuda AB inte arbetar med strategier för kunskapsspridning, men att det ändå fanns en del inslag av spridning på det sätt det beskrivs i teorierna. Det var dock förvånande att se att ett så framgångsrikt företag, vars främsta resurs ansågs vara kunskap, enligt oss endast omedvetet hanterade kunskap. Kunskapsvinster var mer en bieffekt av andra strategier. Det framgick även tydligt av undersökningen att e-post är det verktyg som användes mest frekvent vid utbyten och interaktion

Child physical abuse and COVID-19: Trends from nine pediatric trauma centers

BackgroundEconomic, social, and psychologic stressors are associated with an increased risk for abusive injuries in children. Prolonged physical proximity between adults and children under conditions of severe external stress, such as witnessed during the COVID-19 pandemic with "shelter-in-place orders", may be associated with additional increased risk for child physical abuse. We hypothesized that child physical abuse rates and associated severity of injury would increase during the early months of the pandemic as compared to the prior benchmark period.MethodsWe conducted a nine-center retrospective review of suspected child physical abuse admissions across the Western Pediatric Surgery Research Consortium. Cases were identified for the period of April 1-June 30, 2020 (COVID-19) and compared to the identical period in 2019. We collected patient demographics, injury characteristics, and outcome data.ResultsThere were no significant differences in child physical abuse cases between the time periods in the consortium as a whole or at individual hospitals. There were no differences between the study periods with regard to patient characteristics, injury types or severity, resource utilization, disposition, or mortality.ConclusionsApparent rates of new injuries related to child physical abuse did not increase early in the COVID-19 pandemic. While this may suggest that pediatric physical abuse was not impacted by pandemic restrictions and stresses, it is possible that under-reporting, under-detection, or delays in presentation of abusive injuries increased during the pandemic. Long-term follow-up of subsequent rates and severity of child abuse is needed to assess for unrecognized injuries that may have occurred

Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger than 3 Years: a Multi-Center Study of the American Association for the Surgery of Trauma.

BACKGROUND: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years. METHODS: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third. RESULTS: Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identified: Glasgow Coma Score CONCLUSIONS: CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population