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BACKGROUND: Core injuries in professional baseball pitchers have been linked to both diminished performance and time missed during the season injury was sustained. It is currently unclear how a history of a core injury may affect the future pitching performance and mechanics of professional baseball pitchers. PURPOSE: To compare kinetic and kinematic variables between professional baseball pitchers with prior core/groin injuries and those without prior injury. STUDY DESIGN: Descriptive laboratory study. METHODS: Professional baseball pitchers with a history of core injury pitched 8–12 fastball pitches while evaluated with 3D-motion capture (480 Hz). Inclusion criteria necessitated that the core injury occurred within one to four-years prior to biomechanical evaluation and that the core injury required time off from professional play for a minimum of 2 weeks and maximum of 3 months. These pitchers were 4:1 propensity-scored matched by age, height, weight, and handedness to pitchers with no prior injury history (control). Twenty kinematic and eleven normalized and non-normalized kinetic parameters were compared between groups using appropriate parametric testing. Sub-analysis of pitchers with distinct core muscle and spinal injuries were also analyzed. RESULTS: The No Prior Injury (NPI) subgroup (n = 76) had significantly less elbow flexion at ball release (31 ± 5° vs. 35 ± 6° respectfully, p = 0.044) compared to the Core Musculature/Soft Tissue subgroup (CM/ST, n = 10), with no significant difference in kinematics for other injury groups (p > 0.05). The General Core/Groin injury group (GCG, n = 19) had significantly greater normalized elbow anterior force (43.9 ± 4.7 vs. 40.0 ± 5.2 %BodyWeight[BW], p = 0.006) and elbow flexion torque (4.3 ± 0.5 vs. 3.8 ± 0.5 %BWxBodyHeight[BH], p = 0.001) than the NPI pitchers. CM/ST had significantly greater normalized elbow anterior force (p = 0.031), elbow flexion torque (p = 0.002), and shoulder adduction torque (p = 0.007) than NPI pitchers. CONCLUSION: Professional baseball pitchers with prior core/groin injuries demonstrated increased elbow anterior force and elbow flexion torque compared to pitchers with no prior core injuries. One possible explanation for this finding includes inadequate recruitment and utilization of the lower extremities as a component of the kinetic chain leading to compensation at the level of the throwing arm. Whether these kinetic differences arise as a consequence of injury or present a risk for such warrants additional investigation.

This interactive session was held at the 51st Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) in preparation for the transition of Pediatric Surgery training in Canada to Competency by Design (a CBME-based model of residency training developed by the Royal College of Physicians and Surgeons of Canada).

Over the past few years, the Utah Department of Transportation has developed the signal performance metrics (SPMs) system to evaluate the performance of signalized intersections dynamically. This system currently provides data summaries for several performance measures, one of them being turning movement counts collected by microwave sensors. As this system became public, there was a need to evaluate the accuracy of the data placed on the SPMs. A large-scale data collection was carried out to meet this need. Vehicles in the Hi-resolution data from microwave sensors were matched with the vehicles by ground-truth volume count data. Matching vehicles from the microwave sensor data and the ground-truth data manually collected required significant effort. A spreadsheet-based data analysis procedure was developed to carry out the task. A mixed model analysis of variance was used to analyze the effects of the factors considered on turning volume count accuracy. The analysis found that approach volume level and number of approach lanes would have significant effect on the accuracy of turning volume counts but the location of the sensors did not significantly affect the accuracy of turning volume counts. In addition, it was found that the location of lanes in relation to the sensor did not significantly affect the accuracy of lane-by-lane volume counts. This indicated that accuracy analysis could be performed by using total approach volumes without comparing specific turning counts, that is, left-turn, through and right-turn movements. In general, the accuracy of approach volume counts collected by microwave sensors were within the margin of error that traffic engineers could accept. The procedure taken to perform the analysis and a summary of accuracy of volume counts for the factor combinations considered are presented in this paper.

One common challenge of modeling intersection related crash data is the high proportion of sites with zero crashes. Extensive research has been done on appropriate methods to handle excess zeroes. There is some reluctance to use zero-inflated models in the traffic safety literature. The primary purpose of this paper is to evaluate zero-inflated models to determine if they are a suitable method for modeling crash counts. An appropriate approach to model selection is to choose the model that best accomplishes research objectives rather than attempting to discover the true underlying data generating process. Thus using zero-inflated models is warranted when they outperform other models relative to research objectives. In addition, using zero-inflated models does not assume sites are in an inherently safe or unsafe state, and should not be summarily dismissed on the basis of disagreement with the hypothesized underlying data generating process. Secondarily, we compare implementations of zero-inflated Poisson, zero-inflated negative binomial, and negative binomial-Lindley Bayesian hierarchical models using intersection related crash data for the state of Utah from 2014 to 2018. We specifically compare the quality of fit as determined by a Bayesian χ 2 test for goodness-of-fit and their relative predictive accuracy. The zero-inflated negative binomial performs best overall. We conclude that there are cases where zero-inflated models perform as well or better than other comparable models and may be considered as a viable option to model crash counts.

Resistive heating of the metal surface of a supersonic molecular beam nozzle is shown to be very effective in converting CO2 diluted in H2 to CO and H2O via the reverse water–gas shift (RWGS) reaction at temperatures that preclude simple pyrolysis. The conversion of CO2 to CO, referred to herein as “RWGS yield,” exceeds 80% at nozzle temperature above 1000 K, with a detectable methane byproduct. The stainless-steel surface of the nozzle appears to facilitate the reaction as a heterogeneous catalyst. Reaction yield is observed to increase with nozzle temperature and, when the gas mixture contains a significant excess of H2, decrease with increasing in nozzle stagnation pressure. The inverse dependence of the reaction on stagnation pressure is used to propose a reaction mechanism. Additional kinetic control over the mechanism is afforded by adjusting reactant partial pressures and residence times inside the nozzle reactor, highlighting this method’s utility in screening heterogeneous catalysis reactions with fine control over mass flow rates, pressure, and temperature. The results of this study, therefore, present a route to efficient, high pressure, inline catalysis as well as a method to rapidly assess the viability of new catalysts in development.

As urbanization accelerates in Shanghai, land continues to develop along suburban arterials which results in more access points along the roadways and more congested suburban arterials; all these changes have led to deterioration in traffic safety. In-depth safety analysis is needed to understand the relationship between roadway geometric design, access features, traffic characteristics, and safety. This study examined 161 road segments (each between two adjacent signalized intersections) of eight suburban arterials in Shanghai. Information on signal spacing, geometric design, access features, traffic characteristics, and surrounding area types were collected. The effect of these factors on total crash occurrence was investigated. To account for the hierarchical data structure, hierarchical Bayesian models were developed for total crashes. To identify diverse effects on different crash injury severity, the total crashes were separated into minor injury and severe injury crashes. Bivariate hierarchical Bayesian models were developed for minor injury and severe injury to account for the correlation among different severity levels. The modeling results show that the density of signal spacing along arterials has a significant influence on minor injury, severe injury, and total crash frequencies. The non-uniform signal spacing has a significant impact on the occurrence of minor injury crashes. At the segment-level, higher frequencies of minor injury, severe injury, and total crashes tend to occur for the segments with curves, those with a higher density of access points, those with a higher percentage of heavy vehicles, and those in inner suburban areas. This study is useful for applications such as related engineering safety improvements and making access management policy.

Background There is significant lack of information regarding the Canadian pediatric surgery workforce. Methods An IRB-approved survey aimed at assessing workforce issues was administered to pediatric surgeons and pediatric surgery chiefs in Canada in 2012. Results The survey was completed by 98% of practicing surgeons and 13 of the 18 division chiefs. Only 6% of surgeons are older than 60years, and only a fifth anticipate retirement over the next decade. The workforce is stable, with 82% of surgeons unlikely to change current positions. Surgical volume showed essentially no growth during the 5-year period 2006–2010. The majority of surgeons felt they were performing the right number or too few cases and anticipated minimal or no future growth in their individual practices or that of their group. Based on anticipated vacancies, the best estimate is a need for 20 new pediatric surgeons over the next decade. This need is significantly surpassed by the current output from the Canadian training programs. Conclusions The Canadian pediatric surgery workforce is currently saturated. The mismatch between the number of graduating trainees and the available positions over the next decade has significant repercussions for current surgery and pediatric surgery residents wishing to practice in Canada.

Purpose Biomechanical evidence has demonstrated that the running interlocking horizontal mattress (RIHM) repair for extensor tendon lacerations is significantly stronger, with higher ultimate load to failure and less tendon shortening compared with other techniques. We investigated the efficacy and safety of primary extensor tendon repair using the RIHM repair technique in the fingers followed by the immediate controlled active motion protocol, and in the thumb followed by a dynamic extension protocol. Methods We conducted a retrospective review of all patients undergoing extensor tendon repair from August 2009 to April 2012 by single surgeon in an academic hand surgery practice. The inclusion criteria were simple extensor tendon lacerations in digital zones IV and V and thumb zones TI to TIV and primary repair performed using the RIHM technique. We included 8 consecutive patients with 9 tendon lacerations (3 in the thumb). One patient underwent a concomitant dorsal hand rotation flap for soft tissue coverage. We used a 3–0 nonabsorbable braided suture to perform a running simple suture in 1 direction to obtain a tension-free tenorrhaphy, followed by an RIHM corset-type suture using the same continuous strand in the opposite direction. Average time to surgery was 10 days (range, 3–33 d). Mean follow-up was 15 weeks (range, 10–26 wk). We applied the immediate controlled active motion protocol to all injuries except those in the thumb, where we used a dynamic extension protocol instead. Results Using the criteria of Miller, all 9 tendon repairs achieved excellent or good results. There were no tendon ruptures or extensor lags. No patients required secondary surgery for tenolysis or joint release. No wound complications occurred. Conclusions The RIHM technique for primary extensor tendon repairs in zone IV and V and T1 to TIV is safe, allows for immediate controlled active motion in the fingers and an immediate dynamic extension protocol in the thumb, and achieves good to excellent functional outcomes. These clinical outcomes support prior biomechanical data. Type of study/level of evidence Therapeutic IV.

Purpose Patent Ductus Arteriosus (PDA) ligation in premature infants is an urgent procedure performed by some but not all pediatric surgeons. Proficiency in PDA ligation is not a requirement of Canadian pediatric surgery training. Our purpose was to determine the outcomes of neonatal PDA ligation done by pediatric surgeons. Methods We performed a retrospective review of premature infants who underwent PDA ligation by pediatric surgeons in 3 Canadian centers from 2005 to 2009. Outcomes were compared to published controls. Results The review identified 98 patients with a mean corrected GA and weight at repair of 29weeks and 1122g, respectively. There were no intraoperative deaths. The 30-day and inhospital mortality rates were 1% and 5%. Mortality and morbidity were comparable to the published outcomes. Conclusions This study documents that a significant number of preterm infant PDA ligations are safely done by pediatric surgeons. To meet the Canadian needs for this service by pediatric surgeons, proficiency in PDA ligation should be considered important in pediatric surgery training programs.

In a traditional four-step urban transportation demand forecasting modeling, passenger trips in a zone generated in the trip generation step are distributed to other zones using various algorithms, such as a gravity model. However, this method does not apply well to commodity flow distribution because commodities are transported by various types of trucks depending on types of commodities, which eventually affect the number of trips generated. A new concept for distributing commodity flows to zones using an enhanced gravity model with composite friction factors was developed and the concept was applied to commodity flow distribution in the state of Utah.

Background Thoracoscopic sympathicotomy is highly effective in treating disabling palmar hyperhidrosis. The ideal level to maximize efficacy and minimize the side effect of compensatory hyperhidrosis (CH) is controversial. This study compared sympathicotomy over the second (R2) vs third (R3) costal head relative to these variables in patients with massive palmar hyperhidrosis. Methods This prospective, randomized study enrolled 121 patients with disabling palmoplantar hyperhidrosis assigned to bilateral sympathicotomy (sympathetic transection), which was done over R2 in 61 (n = 122 extremities) or R3 in 60 (n = 120 extremities). Patients were questioned at 6 months and at 1 year or more to assess efficacy, side effects, and satisfaction with the procedure. Results Sympathicotomy at R2 failed to cure palmar hyperhidrosis in 5 of 122 (4.1%) extremities, but only 2 (1.6%) were to a truly profound dripping level of recurrence. Sympathicotomy at R3 failed to cure palmar hyperhidrosis in 5 of 120 extremities (4.2%), and all were dramatic failures with dripping recurrent sweating. The patients whose palmar hyperhidrosis was not completely cured were aged 19.7 ± 2.5 vs 26.4 ± 8.0 years ( p = 0.04). Two R3 patients with failure underwent three redo R2 sympathicotomies, with curative results. R2 patients showed a trend toward a higher level of CH vs R3 patients at 6 months and after 1 year. The CH severity scale was 4.7 ± 2.7 (n = 38) for R2 vs 3.8 ± 2.8 (n = 36) for R3 ( p = NS) at 6 months and 4.7 ± 2.5 (n = 43) for R2 vs 3.7 ± 2.8 (n = 37) for R3 ( p = NS) after 1 year. Younger age, male sex, and higher levels of preoperative and postoperative plantar sweating were predictors of failed sympathicotomy. Increased age was associated with increased CH. Conclusions R2 and R3 sympathicotomy for massive palmoplantar hyperhidrosis are highly effective, with low recurrence and incidences of severe CH. R2 tends to have a higher level of CH vs R3, and a higher incidence of dramatic failures is suggested in R3 patients, for which reoperation at the R2 level will likely be curative.

Purpose: Parenteral nutrition–associated cholestasis remains a significant problem, especially for the surgical neonate. Aluminum is a toxic element known to contaminate parenteral nutrition. We hypothesize that parenterally administered aluminum causes liver injury similar to that seen in parenteral nutrition–associated cholestasis. Methods: Twenty 3- to 6-day-old domestic pigs were divided into 5 equal groups. A control group received daily intravenous 0.9% sodium chloride. Each subject in experimental groups received intravenous aluminum chloride at 1500 μg/kg per day for 1, 2, 3, or 4 weeks. At the end of the study, blood was sampled for direct bilirubin and total bile acid levels. Liver, bile, and urine were sampled for aluminum content. Liver tissue was imaged by transmission electron microscopy for ultrastructural changes. Results: Transmission electron microscopy revealed marked blunting of bile canaliculi microvilli in all experimental subjects but not the controls. Serum total bile acids correlated with the duration of aluminum exposure. The hepatic aluminum concentration correlated with the duration of aluminum exposure. Conclusions: Parenterally infused aluminum resulted in liver injury as demonstrated by elevated bile acids and by blunting of the bile canaliculi microvilli. These findings are similar to those reported in early parenteral nutrition–associated liver disease.

To quantify the effect of unnecessary motorist hesitation in free right-turn channels and its impact on engineering delay models, the authors observed peak-hour operations at two free right-turn channelized intersections in Utah County, Utah. Regression analysis demonstrated that perceived vehicle conflicts would significantly increase individual vehicle delay at free right-turn channels, and that existing traffic prediction models did not adequately describe this delay. On average, motorists yield about 2seconds for each conflicting vehicle. This finding raises questions about the validity of current delay assumptions for free rightturn channels, or indicates the driving public may need more adequate signage. © 2011 Published by Elsevier Ltd.

To ascertain the identities of cyclic nucleotide-binding proteins that mediate the insulin secretagogue action of cAMP, the possible contributions of the exchange protein directly activated by cAMP (Epac) and protein kinase A (PKA) were evaluated in a pancreatic beta cell line (rat INS-1 cells). Assays of Rap1 activation, CREB phosphorylation, and PKA-dependent gene expression were performed in combination with live cell imaging and high throughput screening of a fluorescence resonance energy transfer-based cAMP sensor (Epac1-camps) to validate the selectivity with which acetoxymethyl esters (AM-esters) of cAMP analogs preferentially activate Epac or PKA. Selective activation of Epac or PKA was achieved following exposure of INS-1 cells to 8-pCPT-2′-O-Me-cAMP-AM or Bt2cAMP-AM, respectively. Both cAMP analogs exerted dose-dependent and glucose metabolism-dependent actions to stimulate insulin secretion, and when each was co-administered with the other, a supra-additive effect was observed. Because 2.4-fold more insulin was secreted in response to a saturating concentration (10 μm) of Bt2cAMP-AM as compared with 8-pCPT-2′-O-Me-cAMP-AM, and because the action of Bt2cAMP-AM but not 8-pCPT-2′-O-Me-cAMP-AM was nearly abrogated by treatment with 3 μm of the PKA inhibitor H-89, it is concluded that for INS-1 cells, it is PKA that acts as the dominant cAMP-binding protein in support of insulin secretion. Unexpectedly, 10–100 μm of the non-AM-ester of 8-pCPT-2′-O-Me-cAMP failed to stimulate insulin secretion and was a weak activator of Rap1 in INS-1 cells. Moreover, 10 μm of the AM-ester of 8-pCPT-2′-O-Me-cAMP stimulated insulin secretion from mouse islets, whereas the non-AM-ester did not. Thus, the membrane permeability of 8-pCPT-2′-O-Me-cAMP in insulin-secreting cells is so low as to limit its biological activity. It is concluded that prior reports documenting the failure of 8-pCPT-2′-O-Me-cAMP to act in beta cells, or other cell types, need to be re-evaluated through the use of the AM-ester of this cAMP analog.

Recently, we identified a novel signaling pathway involving Epac, Rap, and phospholipase C (PLC)epsilon that plays a critical role in maximal beta-adrenergic receptor (betaAR) stimulation of Ca2+-induced Ca2+ release (CICR) in cardiac myocytes. Here we demonstrate that PLCepsilon phosphatidylinositol 4,5-bisphosphate hydrolytic activity and PLCepsilon-stimulated Rap1 GEF activity are both required for PLCepsilon-mediated enhancement of sarcoplasmic reticulum Ca2+ release and that PLCepsilon significantly enhances Rap activation in response to betaAR stimulation in the heart. Downstream of PLCepsilon hydrolytic activity, pharmacological inhibition of PKC significantly inhibited both betaAR- and Epac-stimulated increases in CICR in PLCepsilon+/+ myocytes but had no effect in PLCepsilon-/- myocytes. betaAR and Epac activation caused membrane translocation of PKCepsilon in PLCepsilon+/+ but not PLCepsilon-/- myocytes and small interfering RNA-mediated PKCepsilon knockdown significantly inhibited both betaAR and Epac-mediated CICR enhancement. Further downstream, the Ca2+/calmodulin-dependent protein kinase II (CamKII) inhibitor, KN93, inhibited betaAR- and Epac-mediated CICR in PLCepsilon+/+ but not PLCepsilon-/- myocytes. Epac activation increased CamKII Thr286 phosphorylation and enhanced phosphorylation at CamKII phosphorylation sites on the ryanodine receptor (RyR2) (Ser2815) and phospholamban (Thr17) in a PKC-dependent manner. Perforated patch clamp experiments revealed that basal and betaAR-stimulated peak L-type current density are similar in PLCepsilon+/+ and PLCepsilon-/- myocytes suggesting that control of sarcoplasmic reticulum Ca2+ release, rather than Ca2+ influx through L-type Ca2+ channels, is the target of regulation of a novel signal transduction pathway involving sequential activation of Epac, PLCepsilon, PKCepsilon, and CamKII downstream of betaAR activation.

This study reports preliminary findings for total phenolics, flavonoids, ascorbic acid, reducing potential, and radical scavenging of pawpaw pulp extracts from underripe, ripe, and overripe fruits. Total phenolics were affected by ripeness {underripe = ripe > overripe}, as were flavonoids (ripe

The percentage of Pacific cod available to Alaskan bottom trawl surveys was estimated from the proximity of tagged cod to the seafloor. Archival tags recorded time and depth data at 15- or 30-min intervals. The distance of a cod above the bottom was computed by subtracting tag depth from bottom depth, estimated as the maximum depth recorded during each 24-h day. These estimates of bottom depth are based on the assumption that cod approach the seafloor at least once a day, and do not undergo migrations up or down bottom gradients. To ensure that migrations over variable bottom gradients did not confound our estimates of bottom depth, we narrowed our analysis to 11 tagged cod that were recaptured in areas of flat bathymetry, and only analyzed data recorded within one month prior to recapture (N = 29,462 depth recordings). Pacific cod maintained short distances above the seafloor that often differed between day and night. Over 95% of the daytime tag recordings occurred within 10 m of the seafloor. Average effective headrope heights for survey bottom trawls currently used in the eastern Bering Sea and Alaska Gulf/Aleutian Islands groundfish surveys are approximately 2.5 and 7 m, respectively. In the absence of any behavior responses to an approaching trawl, we would expect 47.3% of the cod within the water column are available to the trawl used on the eastern Bering Sea survey and 91.6% are available to the trawl used on the Gulf/Aleutian Islands surveys. This study demonstrated that Pacific cod are highly demersal, and current values of trawl survey catchability (Q) used in current stock assessments are consistent with estimates of cod availability to the trawl gear.

Inositol 1,4,5-trisphosphate (IP(3)) receptors are endoplasmic reticulum (ER) membrane calcium channels that, upon activation, become substrates for the ER-associated degradation (ERAD) pathway. Although it is clear that IP(3) receptors are polyubiquitinated upon activation and are transferred to the proteasome by a p97-based complex, currently nothing is known about the proteins that initially select activated IP(3) receptors for ERAD. Here, we sought to identify novel proteins that associate with and mediate the ERAD of endogenous activated IP(3) receptors. SPFH2, an uncharacterized SPFH domain-containing protein, rapidly associated with IP(3) receptors in a manner that preceded significant polyubiquitination and the association of p97 and related proteins. SPFH2 was found to be an ER membrane protein largely residing within the ER lumen and in resting and stimulated cells was linked to ERAD pathway components, apparently via endogenous substrates undergoing degradation. Suppression of SPFH2 expression by RNA interference markedly inhibited IP(3) receptor polyubiquitination and degradation and the processing of other ERAD substrates. Overall, these studies identify SPFH2 as a key ERAD pathway component and suggest that it may act as a substrate recognition factor.

Recently we demonstrated that PLC(epsilon) plays an important role in beta-adrenergic receptor (betaAR) stimulation of Ca(2+)-induced Ca(2+) release (CICR) in cardiac myocytes. Here we have reported for the first time that a pathway downstream of betaAR involving the cAMP-dependent Rap GTP exchange factor, Epac, and PLC(epsilon) regulates CICR in cardiac myocytes. To demonstrate a role for Epac in the stimulation of CICR, cardiac myocytes were treated with an Epac-selective cAMP analog, 8-4-(chlorophenylthio)-2'-O-methyladenosine-3',5'-monophosphate (cpTOME). cpTOME treatment increased the amplitude of electrically evoked Ca(2+) transients, implicating Epac for the first time in cardiac CICR. This response is abolished in PLC(epsilon)(-/-) cardiac myocytes but rescued by transduction with PLC(epsilon), indicating that Epac is upstream of PLC(epsilon). Furthermore, transduction of PLC(epsilon)(+/+) cardiac myocytes with a Rap inhibitor, RapGAP1, significantly inhibited isoproterenol-dependent CICR. Using a combination of cpTOME and PKA-selective activators and inhibitors, we have shown that betaAR-dependent increases in CICR consist of two independent components mediated by PKA and the novel Epac/(epsilon) pathway. We also show that Epac/PLC(epsilon)-dependent effects on CICR are independent of sarcoplasmic reticulum loading and Ca(2+) clearance mechanisms. These data define a novel endogenous PKA-independent betaAR-signaling pathway through cAMP-dependent Epac activation, Rap, and PLC(epsilon) that enhances intracellular Ca(2+) release in cardiac myocytes.

Objective To evaluate the pattern of clinical results in patients with neurogenic thoracic outlet syndrome (N-TOS) after operative decompression and longitudinal follow-up. Methods From May 1994 to December 2002, 254 operative sides in 185 patients with N-TOS were treated by the same operative protocol: (1) transaxillary first rib resection and the lower part of scalenectomy for the primary procedure with or without (2) the subsequent upper part of scalenectomy with supraclavicular approach for patients with persistent or recurrent symptoms. This retrospective cohort study included 38 men and 147 women with an age range of 19 to 80 years (mean, 40 years). Evaluated were primary success, defined as uninterrupted success with no procedure performed, and secondary success, defined as success maintained by the secondary operation after the primary failure. Success was defined as ≥50% symptomatic improvement judged by the patient using a 10-point scale, returning to preoperational work status, or both. Results Follow-up was 2 to 76 months (mean, 25 months). Eighty sides underwent a secondary operation for the primary clinical failure. No technical failures and no deaths occurred ≤30 days after the operations. The complication rate was 4% (13/334) and consisted of 7 pneumothoraxes, 3 subclavian vein injuries, 1 nerve injury, 1 internal mammary artery injury, and 1 suture granuloma. Of 254 operative sides, the primary and secondary success was 46% (118/254) and 64% (163/254). Most the primary failures (90%, 122/136) and the secondary failures (66%, 23/35) occurred ≤18 months after the respective operation. Conclusions The long-term results of operations for TOS in this study were much worse than those initially achieved, and most of the primary and secondary failures occurred ≤12 months of the respective operations. A minimum of 18-month follow-up on patients and standardized definition of the outcomes are necessary to determine the true effectiveness and outcome of operative treatment of N-TOS.

The mechanism by which glucose and other fuels stimulate phosphoinositide-specific phospholipase C (PLC) in pancreatic islet beta cells is not known. Previous studies have suggested that glucose may couple to PLC beta 1 and PLC delta 1. To determine directly if fuels activate these PLC isozymes, clones stably overexpressing PLC beta 1 or PLC delta 1 were generated in the fuel-sensitive beta cell line RINm5F, and secretagogue regulation of these PLC isoforms was determined. Overexpression of PLC beta 1 or PLC delta 1 significantly increased PLC activity in isolated cell fractions, consistent with overexpression of active PLC isoforms in these clones. In paired experiments, stimulation of inositol phosphate (IP) accumulation by the fuel glyceraldehyde was enhanced in clones overexpressing PLC beta 1, in parallel with the G-protein alpha subunit activator, AlF(4)(-), suggesting a coupling between glyceraldehyde and this PLC isoform. In contrast, overexpression of PLC delta 1 had no effect on glyceraldehyde- or AlF(4)(-)-stimulated IP accumulation. Similarly, IP accumulation stimulated by ionomycin was enhanced in PLC beta 1, but not PLC delta 1 clones, indicating that increases in intracellular free calcium [Ca(2+)](i) can regulate PLC beta 1 but not PLC delta 1 overexpressed in this cell line. Interestingly, [Arg(8)] vasopressin-stimulated, but not carbachol-stimulated, IP accumulation was significantly increased in clones overexpressing either PLC beta 1 or PLC delta 1. These studies illustrate unique pathways coupling diverse secretagogues to specific PLC isoforms in islet beta cells, and demonstrate that glyceraldehyde can activate PLC beta 1 but not PLC delta 1; whereas, vasopressin, but not carbachol, can stimulate either isoform.

A 3-week-old premature female infant was referred to our institution with progressively worsening respiratory distress. She was born at 29 weeks’ gestational age with radiologic evidence of mild respiratory distress syndrome. She required only minimal supplemental oxygen until her third week of life, when she developed worsening respiratory distress requiring mechanical ventilation. A new chest radiograph (Fig. 1) demonstrated hyperinflation of the left hemithorax with coarse reticular markings throughout the left lung. Computed tomography (CT; Fig. 2) revealed innumerable cystic spaces of varying sizes occupying the entirety of the left upper lobe, with no appreciable normal lung parenchyma interposed. She failed to wean from mechanical ventilation and underwent an urgent left thoracotomy. The entire upper lobe was grossly involved with cystic lung pathology (Fig. 3). This was treated by an uncomplicated left upper lobectomy, and the patient was weaned from mechanical ventilation over the next 3 days. The histopathology (Fig. 4) demonstrated cyst-like cavities lined by an irregular layer of cells within the lung parenchyma. These cells were mostly mononuclear admixed with foreign body–type multinucleated giant cells. The cysts were interspersed with essentially normal-appearing pulmonary tissue. Occasional air spaces were questionably dilated, particularly at the periphery of the lung beneath the pleural surface. However, widespread emphysematous changes were not apparent; neither was there any significant intraalveolar or interstitial inflammatory cell infiltrate. These findings were diagnosed as localized persistent pulmonary interstitial em

Purpose: The aim of this study was to document the experience and patient satisfaction with providing pediatric surgery consultations and follow-up appointments to remote locations via audiovisual telecommunications technology. Methods: From January 2000 to April 2001, 16 consecutive pediatric general surgery clinics were reviewed for the type of patient (new or review), the diagnosis, the adequacy and accuracy of the evaluation, and the ability to formulate a plan. In the first year, first-time users were requested to complete a satisfaction survey of 15 questions. Responses to 13 questions were recorded on a 4-point Likert scale, and 2 questions required a "yes" or "no" response. Results: One hundred eighteen appointments were scheduled. Twenty patients did not show up or cancelled. There were 45 new patient consultations. Thirty-three patients were scheduled for surgery, of which, 21 are completed, and 12 are pending. There were no errors in diagnosis or changes in planned procedures. There were 42 patients seen in 53 follow-up sessions. Thirty-six surveys of a possible 53 were available for analysis. The mean rating of overall treatment experience at Telehealth was 3.47 (95% confidence interval 0.17). One hundred percent responded they would use Telehealth again and would recommend it to another person. Conclusion: Telehealth is an effective and acceptable way to provide pediatric general surgery clinics to remote locations. J Pediatr Surg 37:752-754. Copyright 2002, Elsevier Science (USA). All rights reserved.

This Article challenges the global science standard for putting new drugs on pharmacy shelves. The primary premise is that the “gold standard” of group experimental design is an antiquated extension of drug development's crude-science past, and is inconsistent with the precision of contemporary genetics - the science that increasingly dominates the drug development pipeline. The Article identifies law-policy options that would raise the standard for human clinical research under the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use.