Deformational Plagiocephaly: A Case Report

Plagiocefalija je izraz kojim se obično opisuju kongenitalne asimetrije čela. Frontalnu plagiocefaliju ima oko pet posto pacijenata, uglavnom muške djece s predominacijom desnostranih jednostranih slučajeva. Dijagnoza se obično postavlja odmah nakon rođenja ili u prvom mjesecu života. U ovom prikazu opisujemo devetomjesečno dijete s deformacijskom plagiocefalijom te facijalnom asimetrijom s lijeve strane. Preporučena terapija uključivala je kraniostenozu i ljevostranu orbitalnu osteotomiju. Facijalnu asimetriju znatno je poboljšalo stvaranje novih zona koštanoga rasta.Plagiocephaly is a term commonly used to describe congenital forehead asymmetry. Frontal plagiocephaly has been shown to occur in approximately 5% of patients, mostly males, with predominance of right-sided unilateral cases. The diagnosis is usually done at birth or within the first month of life. This paper reports a case of a 9-month old infant female with deformational plagiocephaly who presented left-sided facial asymmetry. The proposed treatment plan included craniostenosis and left orbital osteotomy. The creation of new bone growth zones produced a significant improvement of facial asymmetry

TROPOMI/S5P total ozone column data: global ground-based validation and consistency with other satellite missions

In this work, the TROPOMI near real time (NRTI) and offline (OFFL) total ozone column (TOC) products are presented and compared to daily ground-based quality-assured Brewer and Dobson TOC measurements deposited in the World Ozone and Ultraviolet Radiation Data Centre (WOUDC). Additional comparisons to individual Brewer measurements from the Canadian Brewer Network and the European Brewer Network (Eubrewnet) are performed. Furthermore, twilight zenith-sky measurements obtained with ZSL-DOAS (Zenith Scattered Light Differential Optical Absorption Spectroscopy) instruments, which form part of the SAOZ network (Système d'Analyse par Observation Zénitale), are used for the validation. The quality of the TROPOMI TOC data is evaluated in terms of the influence of location, solar zenith angle, viewing angle, season, effective temperature, surface albedo and clouds. For this purpose, globally distributed ground-based measurements have been utilized as the background truth. The overall statistical analysis of the global comparison shows that the mean bias and the mean standard deviation of the percentage difference between TROPOMI and ground-based TOC is within 0 –1.5 % and 2.5 %–4.5 %, respectively. The mean bias that results from the comparisons is well within the S5P product requirements, while the mean standard deviation is very close to those limits, especially considering that the statistics shown here originate both from the satellite and the ground-based measurements.This research has been supported by the European Space Agency “Preparation and Operations of the Mission Performance Centre (MPC) for the Copernicus Sentinel-5 Precursor Satellite” (contract no. 4000117151/16/1-LG)

Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes

BackgroundThe Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated.MethodsThis study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient’s preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices.ConclusionKey elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D

How Certain are We of the Uncertainties in Recent Ozone Profile Trend Assessments of Merged Limbo Ccultation Records? Challenges and Possible Ways Forward

Most recent assessments of long-term changes in the vertical distribution of ozone (by e.g. WMO and SI2N) rely on data sets that integrate observations by multiple instruments. Several merged satellite ozone profile records have been developed over the past few years; each considers a particular set of instruments and adopts a particular merging strategy. Their intercomparison by Tummon et al. revealed that the current merging schemes are not sufficiently refined to correct for all major differences between the limb/occultation records. This shortcoming introduces uncertainties that need to be known to obtain a sound interpretation of the different satellite-based trend studies. In practice however, producing realistic uncertainty estimates is an intricate task which depends on a sufficiently detailed understanding of the characteristics of each contributing data record and on the subsequent interplay and propagation of these through the merging scheme. Our presentation discusses these challenges in the context of limb/occultation ozone profile records, but they are equally relevant for other instruments and atmospheric measurements. We start by showing how the NDACC and GAW-affiliated ground-based networks of ozonesonde and lidar instruments allowed us to characterize fourteen limb/occultation ozone profile records, together providing a global view over the last three decades. Our prime focus will be on techniques to estimate long-term drift since our results suggest this is the main driver of the major trend differences between the merged data sets. The single-instrument drift estimates are then used for a tentative estimate of the systematic uncertainty in the profile trends from merged data records. We conclude by reflecting on possible further steps needed to improve the merging algorithms and to obtain a better characterization of the uncertainties involved

Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers

Background: Injury rates among professional baseball players may reach as high as 5.8 per 1000 encounters, with pitchers being most vulnerable on account of the excessive biomechanical load on the upper extremity during the throwing motion. Anatomically, the shoulder is the most common site of pitching-related injury, accounting for 30.7% of injuries, closely followed by the elbow at 26.3%. Characteristic valgus loading imparts a predictable constellation of stresses on the joint, including medial tension, lateral compression, and posterior medial shearing. The degenerative cohort of tissue changes that result are readily detected on magnetic resonance imaging (MRI). It is not yet known whether such findings predict future placement on the disabled list (DL) in asymptomatic Major League pitchers. Hypothesis: Abnormal soft tissue and osseous changes detected on MRI of the throwing elbow in asymptomatic professional pitchers will impart an increased risk of subsequent transfer to the DL in the season after MRI. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: The study aimed to examine a potential association between the total number of innings pitched (approximate lifetime valgus load) and the typical MRI degenerative changes, hypothesizing a rejection of the null hypothesis. A total of 26 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization and its various minor league affiliates underwent MRI of their dominant elbow from 2003 to 2013 as a condition of their contract signing or trade. Twenty-one of those pitchers played at the Major League level while 5 played with the team’s minor league affiliates including both the AA and AAA levels. Asymptomatic was defined as no related stints on the DL due to elbow injury in the 2 seasons prior to MRI. A fellowship-trained musculoskeletal radiologist reevaluated the studies after being blinded to patient name, injury history, and baseball history. A second investigator collected demographic data; this included total career number of innings pitched and any subsequent DL reports for each subject while remaining blinded to the MRI results. Results: The mean age at the time of MRI was 29.6 years (range, 19-39 years). The mean number of innings pitched was 1111.7. Of the 26 pitchers, 13 had scar remodeling of the anterior bundle of the ulnar collateral ligament (UCL). Of those, 4 had partial-thickness tears of the anterior bundle of the UCL, ranging from 10% to 90% of the total thickness. Twelve had articular cartilage loss within the posteromedial margin of the ulnohumeral joint, and 12 had posteromedial olecranon marginal osteophytes. Seven pitchers had degeneration of the common extensor tendon origin, 10 had degeneration of the flexor pronator mass, 9 had insertional triceps tendinosis, 2 had enthesopathic spurs at the sublime tubercle, 3 had osteochondral intra-articular bodies, and 2 subjects had joint effusions. In the year after MRI, 6 pitchers were placed on the DL for elbow-related injuries. There was no robust correlation between any single MRI finding and subsequent transfer to the DL, and no statistically significant correlation between number of innings pitched and MRI findings, although some trends were observed for both. Conclusion: MRI findings in asymptomatic MLB pitchers were not associated with placement on the DL within the subsequent year. While a trend was observed with olecranon osteophytes and subsequent DL placement ( P = 0.07), this finding did not reach statistical significance. Furthermore, there was no robust correlation between the number of innings pitched with the presence of any of the aforementioned degenerative changes on MRI. Clinical Relevance: The characteristic structural transformation that occurs in the throwing elbow of professional pitchers is predictable and readily detectable on MRI. However, this study suggests that these changes are not predictive of near-term placement on the DL in those who are asymptomatic. Abnormal findings on MRI, even high-grade partial UCL tears, do not correlate with near-term placement on the DL, mitigating their potential negative impact on signing decisions. </jats:sec

Editorial : 20 anos da Revista de Informática Teórica e Aplicada

Este número da Revista de Informática Teórica e Aplicada (RITA) tem significado especial. Trata-se do primeiro número publicado no ano em que a revista completa 20 anos. Durante duas décadas, muitos trabalharam para construir a história da RITA.Os artigos deste número ilustram que os objetivos iniciais da RITA foram atingidos: publicamos trabalhos em um amplo espectro da Ciência da Computação, permitindo que pesquisadores de diversas áreas de pesquisa do Brasil e exterior divulguem seus resultados junto à sociedade