Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

© 2017 The Author(s). Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking

A new radiographic method for evaluating the degree of sliding in devices used in hip-fracture surgery

Purpose: To find a practical method for estimating the degree of sliding that occurs in screw-plate devices used in hip-fracture surgery. Greater understanding of the sliding mechanisms in different fracture types should improve surgical technique and reduce the failure rate. Methods and Results: In dynamic screw-plate devices, the lag screw slides inside the barrel of the plate. A recent innovation allows the barrel-plate to slide inside a side-plate, thus making possible a combined fracture compression along the neck and the shaft of femur. The lengths of the different parts and the angle of a device in vivo, measured on a radiograph, depend on the position of the femur relative to the photographic film and the roentgen source. We obtained these measurements with a ruler and a protractor from sequential a.p. radiographs of the hip and implemented them in a special computerized program that used the principles of the scaled orthographic and the central projection models. These calculations provided the correct amount of sliding by the lag screw and by the barrel-plate within the side-plate. Conclusion: The method presented here can establish the real degree of sliding in screw-plate devices from standard a.p. radiographs independently of the position of the hip

Hydromechanical characterization of fractures close to a tunnel opening: A case study

Important factors influencing the hydromechanical behavior of a fracture are in situ rock stresses (natural and induced) as well as hydraulic heads, fracture orientation, connectivity and fracture geometry, including their infillings. Particular attention is given to larger, water-conducting fractures that intersect or are close to a tunnel. For the Bentonite Rock Interaction Experiment (BRIE) at the \uc4sp\uf6 Hard Rock Laboratory (HRL) in Sweden, the interaction between rock and bentonite in a deposition borehole is of particular interest. The BRIE experiment is being conducted at a depth of 420 meters in crystalline rock. This paper presents results from the initial identification, characterization and modeling of a small number of fractures close to the tunnel opening. So far, these fractures have been identified as the most important water-conducting fractures. In this identification and characterization exercise, core-drilled, vertical, three-meter deep investigation boreholes were made in the tunnel floor. Logging of natural hydraulic heads in boreholes and hydraulic tests, along with borehole and tunnel mapping in combination with modeling, indicate small deformations. This was also confirmed by deformation measurements performed in the boreholes. The description of the site will be further updated and revised and additional investigations into the link between stress history, fracture geometry and selection of fracture mechanical properties will be of particular interest