Repair of a wide sternal cleft in a young female

AbstractSternal clefts are rare congenital malformations of the anterior chest wall. Surgical correction is typically recommended as early as possible due to the compliance and growth potential of the infant sternum. Several operative techniques have been employed with great success. However, there is a paucity of data regarding repair in large clefts refractory to standard reparative techniques. We report the successful surgical repair in a 15-month-old female with an excessively large, superior sternal cleft

Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study

UNLABELLED: Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x¯ = 1.51, s = 0.75 v. x¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x¯ = 91.86, s = 22.96 v. x¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x¯ = 1.64, s = 0.95 v. x¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x¯ = 26.43, s = 8.02 v. x¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x¯ = 20.98, s = 10.00 v. x¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. HIGHLIGHTS: Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support

Blueberry Advisory Committee Research Report

The 1987 edition of the Blueberry Advisory Committee Research Reports was prepared for the Maine Wild Blueberry Commission and the University of Maine Wild Blueberry Advisory Committee by researchers with the Maine Agricultural Experiment Station and Maine Cooperative Extension Service at the University of Maine, Orono. Projects in this report include: 1. Effect of Pruning Practices on Blueberry Insect Abundance 2. Economic Thresholds and Control of Secondary Blueberry Pests 3. Control of Blueberry Maggot 4. Evaluation of Fungicides for Control of Botrytis Blight on Lowbush Blueberry, 1987 5. Evaluation of Fungicides for Control of Mummy Berry on Lowbush Blueberry, 1987 6. Miscellaneous Activity: a) Fungicide Residue Analysis b) Blueberry fact sheet c) Berry contamination 7. Effects of Pruning Methods on Mummy Berry Disease Incidence, 1987 8. Effects of Pruning Methods on Powdery Mildew and Red Leaf Disease Incidence, 1987 9. Nutrition Survey 1987 10. Nutritional Responses of Seedlings 11. The Effect of Several Mulches on Frost Heaving, Soil Moisture, Soil Temperature and Rhizome Development 12. Time-temperature Effects on Sugar Migration and Physical Characterization in Lowbush Blueberries 13. Fabricated Blueberry Raisins Prepared from Puree using Alginate as the Gelling Agent 14. Blueberry Gelatin 15. Effect of Hexazinone (VELPAR) on Species Distribution in Lowbush Blueberry Fields 16. Evaluation of Postemergence Herbicides for Grass Control 17. Evaluation of Sulfonyl urea and Imidazoline compounds for Bunchberry Control 18. Use of Mechanical wiper with glyphosate (ROUNDUP) or dicamba for control of dogbane 19. Integrated Weed Management 20. Evaluation of Five Preemergence Herbicides for Control of Oat grass and Bunchgrass 21. Wiper Application of Dicamba for Woody Weed control 22. Hexazinone (VELPAR) and terbacil (SINBAR) combinations for weed control 23. Evaluation of Clopyralid and Lactofen for Bunchberry Control 24. Evaluation of Postemergence Applications of chlorimuron for Bunchberry Control 25. Hexazinone seedling study 26. Seedling Pruning Study 27. Effect of bracken fern on blueberry yield 28. Evaluation of two mechanical harvesters vs hand raking of lowbush blueberrie

Effect of Hypoglycemia on Inflammatory Responses and the Response to Low Dose Endotoxemia in Humans

Context: Hypoglycemia is emerging as a risk for cardiovascular events in diabetes. We hypothesized that hypoglycemia activates the innate immune system, which is known to increase cardiovascular risk. Objective: To determine whether hypoglycemia modifies subsequent innate immune system responses. Design and Setting: Single-blinded, prospective study of three independent parallel groups. Participants and Interventions: Twenty-four healthy participants underwent either a hyperinsulinemic-hypoglycemic (2.5 mmol/l), euglycemic (6.0 mmol/l) or sham-saline clamp (n=8 for each group). Forty-eight hours later, all participants received low-dose (0.3 ng/kg) intravenous endotoxin. Main outcome measures: We studied in-vivo monocyte mobilization and monocyte-platelet interactions. Results: Hypoglycemia increased total leucocytes (9.98±1.14 x109/l vs euglycemia: 4.38±0.53 x109/l; P<0.001 vs sham-saline: 4.76±0.36 x109/l; P<0.001) (mean±SEM), mobilized proinflammatory intermediate monocytes (42.20±7.52/μl vs euglycemia: 20.66±3.43/μl; P<0.01 vs sham-saline: 26.20±3.86/μl; P<0.05) and non-classical monocytes (36.16±4.66/μl vs euglycemia: 12.72±2.42/μl; P<0.001 vs sham-saline: 19.05±3.81/μl; P<0.001). Following hypoglycemia vs euglycemia, platelet aggregation to agonist (AUC) increased (73.87±7.30 vs 52.50±4.04; P<0.05) and formation of monocyte-platelet aggregates increased (96.05±14.51/μl vs 49.32±6.41/μl; P<0.05). Within monocyte subsets, hypoglycemia increased aggregation of intermediate monocytes (10.51±1.42/μl vs euglycemia: 4.19±1.08/μl; P<0.05 vs sham-saline: 3.81±1.42/μl; P<0.05) and non-classical monocytes (9.53±1.08/μl vs euglycemia: 2.86±0.72/μl; P<0.01 vs sham-saline: 3.08±1.01/μl; P<0.05) with platelets compared to controls. Hypoglycemia led to greater leucocyte mobilization in response to subsequent low-dose endotoxin challenge (10.96±0.97 vs euglycemia: 8.21±0.85 x109/l; P<0.05). Conclusions: Hypoglycemia mobilizes monocytes, increases platelet reactivity, promotes interaction between platelets and proinflammatory monocytes, and potentiates the subsequent immune response to endotoxin. These changes may contribute towards increased cardiovascular risk observed in people with diabetes

Blueberry Advisory Committee Extension Report

The 1986 edition of the Blueberry Advisory Committee Extension Reports was prepared for the Maine Blueberry Commission and the University of Maine Blueberry Advisory Committee by researchers with the Maine Agricultural Experiment Station and Maine Cooperative Extension Service at the University of Maine, Orono. Projects in this report include: 1. Fertility Levels 2. Insect and Disease Fact Sheets 3. Development of Insect ID Information for Growers 4. Effect of Pruning Practices an Blueberry Insect Abundance 5. Control of Blueberry Maggot (Alternatives to Guthion) 6. Economic Thresholds and Control of Secondary Blueberry Pests 7. Chemical Control of Mummyberry Disease 8. Chemical Control of Botrytis Bloom Blight 9. Effects of Late Summer Fungicide Applications 10. Mowing vs. Burning - Comparisons of Disease Incidence 11. Long-term Effects of N and NPK Fertilizer on Plant Growth and Yield 12. Effect of Several Mulches on Frost Heaving, Soil Moisture, Soil Temperature and Rhizome Development 13. Interaction of Fertility and Pruning Practices on Soil 14. Effect of Block Freezing on Physical Characterization and Sugar Migration on Lowbush Blueberries 15. Demonstration of the Rota-Cone Vacuum Drying Process on Lowbush Blueberries 16. Production of a Blueberry Gelatin 17. Isolation and Characterization of Blueberry Pectin 18. The Effect of pH, Chemicals and Holding time-temperature on the color of Blueberry Puree 19. Effect of Hexazinone on Species Distribution in Lowbush Blueberry Fields 20. Evaluation of Postemergent Herbicides for Grass Control 21. Evaluation of Sulfonyl urea and lmidazoline compounds for Bunchberry Control 22. Use of Mechanical wiper with glyphosate or dicamba for control of dogbane 23. Hand-wiper Applications of Herbicides on Woody Weeds 24. Dogbane Control with 2% Glyphosate 25. Low Volume Solution of Asulam for Bracken Fern Control 26. Integrated Weed Management 27. 1986 Annual Report to the Maine Lowbush Blueberry Commissio

Assessing the efficacy of a modified assertive community-based treatment programme in a developing country

<p>Abstract</p> <p>Background</p> <p>A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.</p> <p>Methods</p> <p>High frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS.</p> <p>Results</p> <p>At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group.</p> <p>Conclusions</p> <p>Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.</p

Longitudinal Assessment of Growth in Hypoplastic Left Heart Syndrome: Results From the Single Ventricle Reconstruction Trial

Background: We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results: We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient‐ and stage‐specific targets. Clinical Trial Registration URL: http://clinicaltrials.gov/. Unique identifier: NCT00115934

1992 Blueberry Research Progress Reports

The 1992 Blueberry Research Progress Reports pertain to and report on research conducted in 1991, and were prepared for the Maine Wild Blueberry Commission and the University of Maine Wild Blueberry Advisory Committee by researchers at the University of Maine, Orono. Projects in this report include: 1992 CSRS Progress Reports: 1. Investigation of Groundwater Resources 2. Sprinkler Irrigation 3. Investigation of Preprocess Changes Leading to Berry Spoilage 4. Effect of Fertilization and Irrigation on Blueberry Quality 5. Effects of Calcium Salts and Citric Acid on Quality of Canned Lowbush Blueberries 6. Pollination of Lowbush Blueberry by Native Bees 7. Application of Heat for Controlling Insects 8. Investigations of Lowbush Blueberry Fruit Bud Cold-Hardiness 9. Steam Sterilization in Lowbush Blueberry Fields 10. Heat-Tolerant Molds 11. Vacuum Sanitation for Disease Control 12. Evaluation of Infrared Burner for Weed Control 13. Evaluation and Modification of Commercial Herbicide Wipers 14. Evaluation of Remote Sensing to Estimate Plant Cover in Lowbush Blueberry Fields 15. Comparison of Three Mechanical Blueberry Harvesters vs. Hand Raking Advisory Committee Research Reports: 16. Biology and action thresholds of secondary blueberry insects 17. Control of secondary blueberry pests 18. Control of blueberry maggot 19. Effects of calcium salts and citric acid on the quality of canned lowbush blueberries 20. The effects of postharvest handling on the dietary fiber and ellagic acid content of lowbush blueberries 21. Investigation of preprocessing changes that could lead to development of simple and inexpensive method to measure preprocessing berry spoilage 22. Determination of pesticide residue levels in fresh and processed lowbush blueberries 23. Vacuum sanitation for disease control 24. Heat-tolerant molds 25. Seedling pruning study 26. Effect of time and rate of application of Clopyralid for control of Vetch in lowbush blueberries 27. Evaluation and modification of commercial herbicide wipers 28. Effect of time of application and formulation of Hexazinone (Velpar) on Blueberry and Bunchberry 29. Evaluation of postemergence applications of Tribenuron Methyl for Bunchberry control 30. Thresholds of Dogbane and Bracken Fern by mechanical and chemical control in lowbush blueberry fields 31. Evaluation of the suitability of remote sensing to evaluate plant cover in lowbush blueberry fields 32. Evalution of infrared burner for weed control 33. Effect of time of fall pruning on growth and productivity of blueberry and evaluation of infrared burner to prune blueberries 34. Effect of Boron on lowbush blueberry fruit set and yield 35. Winter injury protection by potassium 36. Multiple cropping of wild stands 37. Nitrogen-Phosphorus study 38. Phosphorus dose/response curve 39. Investigations of lowbush blueberry fruit bud cold-hardines