Rate of craniometric change following suture release in patients with metopic and sagittal craniosynostosis

2021 ◽  
pp. 1-8
Author(s):  
Nathan K. Leclair ◽  
William A. Lambert ◽  
Joshua Knopf ◽  
Petronella Stoltz ◽  
David S. Hersh ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Current Treatment ◽  
Asymmetry Index ◽  
Rate Of Change ◽  
Width Ratio ◽  
Rates Of Change ◽  
Sagittal Craniosynostosis ◽  
Normalized Units ◽  
Hu Moment ◽  
Metopic Craniosynostosis

OBJECTIVE Craniosynostosis is a congenital disorder resulting from the premature fusion of cranial sutures in the infant skull. This condition results in significant cosmetic deformity and can impede neurodevelopment, if left untreated. Currently, rates of craniometric change following minimally invasive surgery have only been examined for sagittal craniosynostosis. A better understanding of postoperative skull adaptations in other craniosynostosis subtypes is needed to objectively categorize surgical outcomes and guide length of cranial orthosis therapy. METHODS Eleven patients with sagittal and 8 with metopic craniosynostosis treated using endoscopic strip craniectomy and postoperative helmet orthoses were retrospectively reviewed. Using semiautomated image analysis of top-down orthogonal 2D photographs, the following craniometrics were recorded before surgery and at postoperative visits: cephalic index (CI), cranial vault asymmetry index (CVAI), anterior arc angle (AAA), posterior arc angle (PAA), anterior-middle width ratio (AMWR), anterior-posterior width ratio (APWR), left-right height ratio (LRHR), sagittal Hu moment (Sag-Hu), and brachycephaly Hu moment (Brachy-Hu). These craniometrics were then normalized to photograph-based measurements of normocephalic patients and the rates of change between metopic and sagittal craniosynostoses were compared. RESULTS Patients with sagittal craniosynostosis exhibited significantly lower CI, lower PAA, higher AMWR, higher APWR, lower Sag-Hu, and higher Brachy-Hu preoperatively compared to patients with normocephalic craniosynostosis. Patients with metopic craniosynostosis exhibited lower AAA and AMWR preoperatively compared to normocephalic subjects. Sagittal and metopic patients had a rapid initial change in normalized CI or AAA, respectively. Craniometric rates of change that significantly differed between metopic and sagittal patients were found in AAA (p < 0.001), AMWR (p < 0.001), and APWR (p < 0.0001). Metopic patients had a prolonged AAA change with a significantly different rate of change up to 6 months postoperatively (median at 3 months = 0.027 normalized units/day, median at 6 months = 0.017 normalized units/day, and median at > 6 months = 0.007 normalized units/day), while sagittal CI rate of change at these time points was not significantly different. CONCLUSIONS Patients with metopic craniosynostosis have a prolonged rate of change compared to patients with sagittal craniosynostosis and may benefit from longer helmet use and extended postoperative follow-up. Categorizing craniometric changes for other craniosynostosis subtypes will be important for evaluating current treatment guidelines.

scholarly journals Incidental Papillary Thyroid Cancer Identified During Parathyroidectomy

2020 ◽  
pp. 014556132098269
Author(s):  
Megan L. Crenshaw ◽  
Dana Goldenberg ◽  
Darrin V. Bann
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Treatment Guidelines ◽  
Surgical Excision ◽  
Current Treatment ◽  
Papillary Thyroid ◽  
Disease Extent ◽  
Lack Of Information ◽  
Thyroid Lobectomy ◽  
Short And Long Term

Current treatment guidelines recommend surgical excision of papillary thyroid carcinoma. However, the precise surgical treatment, including thyroid lobectomy, total thyroidectomy, and the need for neck dissection, is dictated by disease extent and tumor cytology. Incidental papillary thyroid carcinoma discovered during another surgery therefore presents a surgical conundrum due to lack of information. Surgeons must consider short- and long-term surgical morbidities, as well as individual patient factors, when deciding how to treat an unexpected thyroid carcinoma.

scholarly journals Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chieh-Ying Chou ◽  
Ching-Ju Chiu ◽  
Chia-Ming Chang ◽  
Chih-Hsing Wu ◽  
Feng-Hwa Lu ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Disability ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Disease Diagnosis ◽  
Rate Of Change ◽  
Middle Aged ◽  
Rates Of Change ◽  
Depression Status ◽  
Stage Disease

Abstract Background Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability. Methods This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996–2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling. Results The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9–73.6% and 37.9–100% of the variances in the physical disability intercept and change over time, respectively. Conclusions Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.

Comparison of Transient Modeling Techniques for a Micro Turbine Engine

2006 ◽  
Author(s):  
Craig R. Davison ◽  
A. M. Birk
Keyword(s):  
Gas Turbines ◽  
Relative Size ◽  
Rate Of Change ◽  
Single Stage ◽  
Radial Compression ◽  
Shaft Speed ◽  
Transient Effects ◽  
Rates Of Change ◽  
Experimental Apparatus ◽  
Transient Modeling

A large number of papers have been published on transient modeling of large industrial and military gas turbines. Few, however, have examined micro turbines. The decrease in size affects the relative rates of change of shaft speed, gas dynamics and heat soak. This paper compares the modeled transient effects of a micro turbojet engine comprised of a single stage of radial compression and a single stage of axial expansion, with a diameter of 12cm. The model was validated with experimental data. Several forms of the model were produced starting with the shaft and fuel transients. Conservation of mass, and then energy, was subsequently added for the compressor, combustor and turbine, and a large inlet plenum that was part of the experimental apparatus. Heat soak to the engine body was incorporated into both the shaft and energy models. Heat soak was considered in the compressor, combustor and turbine. Since the engine diameter appears in the differential equations to different powers, the relative rates of change vary with diameter. The rate of change of shaft speed is very strongly influenced. The responses of the different transient effects are compared. The relative solution times are also discussed, since the relative size of the required time steps changes when compared to a large engine.

scholarly journals Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Shu Su ◽  
Shifu Li ◽  
Shunxiang Li ◽  
Liangmin Gao ◽  
Ying Cai ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Waiting Time ◽  
Cox Regression ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Treatment Data ◽  
Poor Treatment

Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P<0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

scholarly journals The Association Between Treatment Interval and Survival in Patients With Colon or Rectal Cancer: A Systematic Review

2021 ◽  
Author(s):  
Ruud F. W. Franssen ◽  
Maud T. A. Strous ◽  
Bart C. Bongers ◽  
F. Jeroen Vogelaar ◽  
Maryska L. G. Janssen-Heijnen
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Optimal Treatment ◽  
Reliable Estimate ◽  
Original Research ◽  
Curative Surgery ◽  
Cancer Specific Survival ◽  
Treatment Interval

Abstract Background Surgery for colon or rectal cancer is associated with a high incidence of complications, especially in patients with a low aerobic fitness. Those patients might benefit from a comprehensive preoperative workup including prehabilitation. However, time between diagnosis and treatment is often limited due to current treatment guidelines. To date, it is unclear whether the treatment interval can be extended without compromising survival. Methods A systematic review concerning the association between treatment intervals and survival in patients who underwent elective curative surgery for colon or rectal cancer was performed. A search up to December 2020 was conducted in PubMed, Cinahl and Embase. Original research articles were eligible. Quality assessment was performed using the Downs and Black checklist. Results Eleven observational studies were included (897 947 patients). In colon cancer, treatment intervals that were statistically significant associated with reduced overall survival or cancer-specific survival ranged between > 30 and > 84 days. In rectal cancer, only one out of four studies showed that treatment intervals > 49 days was associated with reduced cancer-specific survival. Conclusions This systematic review identified that studies investigating the association between treatment intervals and survival are heterogeneous with regard to treatment interval definitions, treatment interval time intervals and used outcome measures. These aspects need standardization before a reliable estimate of an optimal treatment interval can be made. In addition, further research should focus on establishing optimal treatment intervals in patients at high risk for postoperative complications, as particularly these patients might benefit from extended diagnosis to treatment intervals permitting comprehensive preoperative preparation.

346. Measurements of the rate of change of temperature in high temperature-short time pasteurization plant

1947 ◽  
Vol 15 (1-2) ◽  
pp. 18-23
Author(s):  
F. Steghart
Keyword(s):  
High Temperature ◽  
Time Constant ◽  
Rate Of Change ◽  
Hot Water ◽  
Water Pipe ◽  
Temperature Changes ◽  
Rates Of Change ◽  
High Temperature Short Time ◽  
Short Time

It has recently been claimed that in modern high temperature-short time pasteurization plant fluctuations in temperature of the order of 1° F./sec. are unusual and probably artefacts, and that an instantaneous drop is certainly fictitious.It has, nevertheless, been shown that such rapid drops in temperature do in fact occur frequently in high temperature-short time plants of the type investigated. The plant investigated was not of the latest design incorporating devices for speeding up the control by injecting steam directly into the hot-water pipe.Temperature changes of the order of those in question were first observed by Mattick & Hiscox(1) of the National Institute for Research in Dairying, who carried out tests on pasteurization plant using a small mirror galvanometer with a very short time constant. The maximum rates of change were, however, not observed.

The Anthropocene equation

2017 ◽  
Vol 4 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Owen Gaffney ◽  
Will Steffen
Keyword(s):  
Limit Cycle ◽  
Late Quaternary ◽  
Rate Of Change ◽  
Earth System ◽  
Human Influence ◽  
Rates Of Change ◽  
The Earth ◽  
Uncertain Future ◽  
External Forces ◽  
Anthropogenic Forcings

The dominant external forces influencing the rate of change of the Earth System have been astronomical and geophysical during the planet’s 4.5-billion-year existence. In the last six decades, anthropogenic forcings have driven exceptionally rapid rates of change in the Earth System. This new regime can be represented by an ‘Anthropocene equation’, where other forcings tend to zero, and the rate of change under human influence can be estimated. Reducing the risk of leaving the glacial–interglacial limit cycle of the late Quaternary for an uncertain future will require, in the first instance, the rate of change of the Earth System to become approximately zero.

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