Staged Mucosal Advancement Flap versus Staged Fibrin Sealant in the Treatment of Complex Perianal Fistulas

Background. In this prospective randomised study, the staged mucosal advancement flap is compared with staged fibrin sealant application in the treatment of perianal fistulas. Methods. All patients with high complex cryptoglandular fistulas were randomised to closure of the internal opening by a mucosal advancement flap (MF) or injection with fibrin sealant (FS) after treatment with setons. Recurrence rate and incontinence disorders were explored. Results. The MF group (5 females and 10 males) with a median age of 51 years and a median followup of 52 months. The FS group (4 females and 11 males) with a median age of 45 years and a median followup of 49 months. Three (20%) patients of the MF group had a recurrent fistula compared to 9 (60%) of the FS group (P = 0.03). No new continence disorders developed. Conclusion. Staged FS injection has a much lower success rate compared to MF

The role of remote engagement in supporting boundary chain networks across Alaska

AbstractBoundary organizations serve multiple roles in linking science and decision making, including brokering knowledge, supporting local- and cross-level networks, facilitating the co-production of knowledge, and negotiating conflict. Yet they face several challenges in providing services for an ever-increasing number of actors and institutions interested in climate information and adaptation. This study evaluates how the Alaska Center for Climate Assessment and Policy (ACCAP) innovated its boundary spanning role to improve outcomes by partnering with other boundary organizations through its ongoing climate webinar series. We utilize the concept of boundary chains to investigate outcomes associated with different extended network connections. Our evaluation is based on the analysis three datasets, including interviews (2013) and two web-based questionnaires (2010 and 2013–2015). Findings from the evaluation reveal several ways that remote engagement via the ACCAP webinar series facilitates learning, decision application, and cross-level network building, and overcomes barriers associated with large geographic distances between communities. In an organic evolution and innovation of the climate webinar series, ACCAP partnered with other boundary organizations to establish satellite hub sites to facilitate in-person gatherings at remote locations, thereby increasing the number and diversity of participants served and supporting local networking within organizations, agencies, and communities. Leveraging complementary resources through the satellite hub sites provided mutual benefits for ACCAP and partnering boundary organizations. These findings advance our understanding of the value of remote engagement in supporting boundary spanning processes and how boundary organizations innovate their roles to build capacity and increase the usability of climate information

Let's stop dumping cookstoves in local communities. It's time to get implementation right

We most welcome the comment by Thakur, van Schayck and Boudewijns on our article on the effects and acceptability of implementing improved cookstoves. Adoption rates of improved cookstoves by local communities are often strikingly low. The authors underline the urge to advance cookstove implementation strategies, and reinforce the approach used in the FRESH AIR project. They highlight several important factors to increase adoption success and call for further research on the topic. We want to build on this comment by reflecting on decades of substantial discrepancies between the disappointing adoption rates of improved cookstoves, and the subsequent failure to adapt implementation strategies accordingly. We argue that it is not necessarily the lack of evidence that impedes the success of implementation strategies for improved cookstoves. Moreover, it is the lack of use of the evidence by implementors. We propose several ideas for overcoming this evidence-to-practice gap

Recovery of Agricultural Odors and Odorous Compounds from Polyvinyl Fluoride Film Bags

Accurate sampling methods are necessary when quantifying odor and volatile organic compound emissions at agricultural facilities. The commonly accepted methodology in the U.S. has been to collect odor samples in polyvinyl fluoride bags (PVF, brand name Tedlar®) and, subsequently, analyze with human panelists using dynamic triangular forced-choice olfactometry. The purpose of this research was to simultaneously quantify and compare recoveries of odor and odorous compounds from both commercial and homemade PVF sampling bags. A standard gas mixture consisting of p-cresol (40 μg m−3) and seven volatile fatty acids: acetic (2,311 μg m−3), propionic (15,800 μg m−3), isobutyric (1,686 μg m−3), butyric (1,049 μg m−3), isovaleric (1,236 μg m−3), valeric (643 μg m−3), and hexanoic (2,158 μg m−3) was placed in the PVF bags at times of 1 h, 1 d, 2 d, 3 d, and 7 d prior to compound and odor concentration analyses. Compound concentrations were quantified using sorbent tubes and gas chromatography/mass spectrometry. Odor concentration, intensity, and hedonic tone were measured using a panel of trained human subjects. Compound recoveries ranged from 2 to 40% after 1 h and 0 to 14% after 7 d. Between 1 h and 7 d, odor concentrations increased by 45% in commercial bags, and decreased by 39% in homemade bags. Minimal changes were observed in intensity and hedonic tone over the same time period. These results suggest that PVF bags can bias individual compound concentrations and odor as measured by dynamic triangular forced-choice olfactometry

The Diagnostic Accuracy of Serum Alpha-Fetoprotein Levels in Follow-up for Recurrence of Sacrococcygeal Teratoma; a Nationwide Review of SCT Cases in the Netherlands

Background: Serum alpha-fetoprotein (AFP) is often used as tumour marker for recurrent sacrococcygeal teratoma (SCT). We aimed to assess the normal dynamics of serum AFP levels after initial resection and diagnostic accuracy of serum AFP levels the follow-up for recurrence in SCT. Methods: This retrospective study included 57 patients treated for SCT in the six pediatric surgical centers in the Netherlands from 1980 to 2018. Main results: 57 patients were included in the study of whom 19 children developed 20 recurrences at a median of 14.0 months after initial resection. No significant difference was found in serum AFP level dynamics between the recurrence and non-recurrence group after initial resection (p = 0.950). Serum AFP levels did not significantly increase before recurrence (p = 0.106) compared to serum AFP levels of children without recurrence at the same time. However, serum AFP levels did significantly increase in malignant recurrences (n = 7) (p = 0.03) compared to patients without recurrence. A cut-off value of 55 μg/L was found to be predictive for recurrent SCT with an Area Under the Curve (AUC) of 0.636 with sensitivity of 50% and specificity of 100%. Conclusion: Dynamics of serum AFP levels are not different between patients with and without recurrence after initial resection of SCT. Serum AFP levels are not predictive for mature or immature recurrent SCT and normal AFP levels do not rule out recurrent SCT. However, serum AFP levels exceeding 55 μg/L can indicate recurrent SCT, especially malignant recurrences.</p

LEARN2MOVE 0-2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy:neuromotor, cognitive, and behavioral outcome

Contains fulltext : 229748.pdf (Publisher’s version ) (Open Access)Purpose: Evidence for efficacy of early intervention in infants at high risk of cerebral palsy (CP) is limited. We compared outcome of infants at very high risk of CP after receiving the family centered program COPing with and CAring for infants with special needs (COPCA) or typical infant physiotherapy.Materials and methods: Forty-three infants were randomly assigned before the corrected age of 9 months to 1 year of COPCA (n = 23) or typical infant physiotherapy (n = 20). Neuromotor development, cognition, and behavior was assessed until 21 months corrected age. Video-recorded physiotherapy sessions were quantitatively analyzed for further process analyses. Outcome was evaluated with nonparametric tests and linear mixed effect models.Results: During and after the interventions, infant outcome in both intervention groups was similar [primary outcome Infant Motor Profile: COPCA 82 (69-94), typical infant physiotherapy 81 (69-89); Hodges Lehman estimate of the difference 0 (confidence interval -5;4)]. Outcome was not associated with contents of intervention.Conclusions: One year of COPCA and 1 year of typical infant physiotherapy in infants at high risk of CP resulted in similar neurodevelopmental outcomes. It is conceivable that combinations of active ingredients from different approaches are needed for effective early intervention.IMPLICATIONS FOR REHABILITATIONFor infants at very high risk of cerebral palsy, 1 year of intervention with the family-centred programme Coping with and Caring for infants with special needs resulted in similar infant outcome as 1 year of typical infant physiotherapy.Infant's neuromotor, cognitive, and behavioural outcome was not associated with specific interventional elements, implying that the various elements may have a similar effect on developmental outcome.We suggest that a specific mix of ingredients of different approaches may work best, resulting in comprehensive care including both infant and family needs

Asthma in 9-year-old children of subfertile couples is not associated with in vitro fertilization procedures

Asthma is a chronic reversible obstructive airway disease, which is common among children and leads to respiratory impairment. Studies showed that asthma is more common among children born after in vitro fertilization (IVF) than among spontaneously conceived children. However, it is unknown which component of the IVF procedure contributes to this putative link. Therefore, the aim of this prospective follow-up study was to differentiate the possible effect of ovarian hyperstimulation from that of the in vitro culture procedure on asthma and rhinitis in 9-year-old children conceived with IVF. The study comprised three groups of singletons: (I) conceived with ovarian hyperstimulation-IVF (COH-IVF, n = 95); (II) conceived with modified natural cycle-IVF (MNC-IVF, n = 48); and (III) naturally conceived to subfertile couples (Sub-NC, n = 68). Parents filled out the validated Dutch version of the asthma questionnaire of the International Study of Asthma and Allergies. Asthma prevalence in the groups did not differ: COH-IVF n = 8 (8%); MNC-IVF n = 0 (0%); and Sub-NC n = 4 (6%). Adjustment for confounders did not alter the results.Conclusion: Neither ovarian hyperstimulation nor the in vitro culture procedure was associated with asthma and rhinitis at 9 years. IVF children had a similar prevalence of asthma compared with children conceived naturally by subfertile couples.Trial registration: ISRCTN76355836 What is Known: • An increased risk for asthma has been observed in children born after in vitro fertilization at preschool and school age. • The association between IVF and asthma may be partly explained by parental subfertility. What is New: • IVF children do not have a higher prevalence of asthma than children of subfertile couples conceived naturally. • Ovarian hyperstimulation used in IVF is not associated with asthma in 9-year-old children of subfertile couples.</p

Culture Wars, Revanchism, Moral Panics and the Creative City. A Reconstruction of a Decline of Tolerant Public Policy: The Case of Dutch Anti-squatting Legislation

Squatting became illegal in the Netherlands on 1 October 2010. The paper examines the dynamics involved. Theoretically drawing on debates about culture wars, revanchism, moral panics and the creative city, it is based on participant observation in squatter meetings, debates with politicians, a parliament hearing, lobbying meetings and various informal encounters, on a survey and on a collection of documents. A key mechanism that the paper explores is the following. Strategies of resistance that seem more or less manageable in the local context of a creative city can, when they backfire, cause a moral panic on the national level. This provides ammunition for revanchist politicians