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Background: Some health care systems have set up referral trauma centers to centralize expertise to improve trauma management. There is scant and controversial evidence regarding the impact of provider’s volume on the outcomes of trauma management. Objective: To evaluate the impact of hospital volume on the outcomes of renal trauma management in a European health care system. Design, setting, and participants: A retrospective multicenter study, including all patients admitted for renal trauma in 17 French hospitals between 2005 and 2015, was conducted. Intervention: Nephrectomy, angioembolization, or nonoperative management. Outcome measurements and statistical analysis: Four quartiles according to the caseload per year: low volume (eight or fewer per year), moderate volume (nine to 13 per year), high volume (14–25/yr), and very high volume (≥26/yr). The primary endpoint was failure of nonoperative management defined as any interventional radiology or surgical procedure needed within the first 30 d after admission. Results and limitations: Of 1771 patients with renal trauma, 1704 were included. Nonoperative management was more prevalent in the very-high- and low-volume centers (p = 0.02). In a univariate analysis, very high hospital volume was associated with a lower risk of nonoperative management failure than low (odds ratio [OR] = 0.54; p = 0.05) and moderate (OR = 0.48; p = 0.02) hospital volume. There were fewer nephrectomies in the high- and very-high-volume groups (p = 0.003). In a multivariate analysis, very high volume remained associated with a lower risk of nonoperative management failure than low (OR = 0.48; p = 0.04) and moderate (OR = 0.42; p = 0.01) volume. Study limitations include all the shortcomings inherent to its retrospective multicenter design. Conclusions: In this multicenter study, management of renal trauma varied according to hospital volume. There were lower rates of nephrectomy and failure of nonoperative management in very-high-volume centers. These results raise the question of centralizing the management of renal trauma, which is currently not the case in our health care system. Patient summary: In this study, management of renal trauma varied according to hospital volume. Very-high-volume centers had lower rates of nephrectomy and failure of nonoperative management.

Abstract Electromechanical morcellation—so called power morcellation—is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11–24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4–14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20–194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13–896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0–39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.

Despite concerns about the loss of industry, industrial land, and buildings in high-value post-industrial cities, there is concurrently a renewed enthusiasm around the potential of “new” urban manufacturing and its contribution to the socio-economic diversity of cities. Yet, little is known about how planning policy can best support the retention and growth of urban manufacturing. To advance this agenda, this article proposes that we need a better understanding of industrial building typologies and resultant urban form. Using concepts developed by Julienne Hanson to analyse residential morphologies undergoing transformation under modernism, we apply these concepts to investigate the industrial, mixed-use contexts in two areas of London with concentrations of urban manufacturing—Hackney Mare Street and Old Kent Road. The research presented examines how both areas have evolved historically to produce distinctive urban tissues and a range of industrial building typologies. The article reveals that, despite territorial similarities in the late 19th century, the mixed land uses and smaller plot sizes of Hackney Mare Street have allowed for a more resilient development pattern, whereas the greater separation of land uses, large plot sizes, and inward-facing development in the Old Kent Road has facilitated its reimagination for large-scale regeneration. We conclude that greater attention needs to be paid to the relationship between urban manufacturing and built urban form if policies that aim to protect or support the revival of manufacturing in cities are to avoid negative unintended consequences.

Abstract Understanding the effect of the complex fault geometry on the dynamic rupture process and discriminating it from the complexity originating from the rheological properties of faults, is an essential subject in earthquake science. The 2014 Northern Nagano earthquake, which occurred near the end zone of a major active fault system, provided unique observations that enabled us to investigate both the detailed geometrical fault structure and surface deformation patterns as well as the temporal sequence led up from a prominent foreshock activity. We first develop a geometrical fault model with a substantial variation along strike, and a model for the regional stress field, which is well constrained by the observations. This significant along-strike variation in fault geometry probably reflects the difference of fault maturity at the end zone of the complex fault system. We used this model in order to conduct a set of dynamic rupture simulations using the highly efficient spatiotemporal boundary integral equation method. Based on our simulations, we show that the observed surface deformation can be reasonably explained as the effect of the non-planar fault geometry with a number of branch faults and bends. Graphical abstract .

In March 2020, a Suburban Taskforce was established by Members of Parliament (MPs) in the UK. This Taskforce argued that the experiences of suburbs in England were poorly understood by policy-makers and developers, practitioners, and the general public. Over the two years of research and engagement that followed, a key consideration to emerge was the management of change and particularly in the context of growth pressures evident in Outer London. This has synergies with recent trends in suburban research that turn away from negative framings of places in extended metropolitan areas, such as 'edgeness' (not in the city) and 'in-between-ness' (neither urban nor rural activity). Instead, there is increasing focus on suburban cultural dynamics and political ecology. Drawing on these ideas, this paper looks at suburbs as landscapes with natural and built elements, as well as diverse activities, and focuses on the processes of blending. The evidence and views presented to the Taskforce are used to investigate the blended landscapes of Outer London. The paper explores the elements and development rationalities in two London Boroughs, Sutt on and Waltham Forest, and the context that shapes choices. The findings suggest that, while not discounting the significance of growth pressures and limits to local control, suburban landscapes are heavily influenced by responses to local socio-economic concerns, historic urban form, and the politics of local development. The paper concludes by reflecting on the directions of change in the study areas, and the significance of dynamics of ongoing blending of the landscapes across outer parts of major cities. [ABSTRACT FROM AUTHOR]

We report a 66-year-old woman with slowly progressive ataxia due to cerebellar atrophy. Imaging studies revealed multiple lesions in both the lungs and dorsal subpleural space. A biopsy identified the lesions as metastases of a low-grade endometrial stromal sarcoma containing sex-cord elements. The histological appearance was identical to a uterine tumor the patient was treated for with hysterectomy 16 years before. The metastases were removed surgically, and after 3 months ataxia had regressed. We conclude that the presenting cerebellar degeneration in this patient resulted from the metastatic recurrence of the endometrial tumor.

BACKGROUND: In the preschool period, allergic rhinitis (AR) is infrequent and thus under-diagnosed. However, recent works have highlighted the occurrence of AR in toddlers although the causes of AR in this young population remain unknown. The objective of this study was to identify determinants of AR in young children with asthma. METHODS: We carried out a case-control study of 227 children with active asthma and enrolled in the Trousseau Asthma Program. AR and other allergic diseases (asthma, food allergy and eczema) were diagnosed by medical doctors using standardized questionnaires. Parental history of AR and asthma, biological markers of atopy (total IgE, blood eosinophilia, allergic sensitization towards food and aeroallergens) and environmental parameters were also collected. RESULTS: Forty one of the children (18.1%) had AR. By univariate logistic regression analysis, AR was mainly associated with peanut sensitization (OR = 6.75; p = 0.002); food allergy (OR = 4.31; p = 0.026); mold exposure (OR = 3.81 p

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Hemangioma of the rib is an uncommon benign vascular tumour. A case of rib hemangioma in a 29-year-old woman is presented. Chest roentgenogram and computed tomography revealed a mass along the inner surface of the 7th left rib with bone destruction. She underwent resection of the 7th rib. The pathologic diagnosis was cavernous hemangioma. Hemangiomas of the rib are rare tumours but should be kept in mind in the differential diagnosis of rib tumours.

Highlights • Comprehensive investigation of Industrial Symbiosis activity in Europe, with a mapping exercise. • Description of network typologies, size, main sectors of activity and geographical scope of networks in Europe. • Discussion of key drivers and challenges for Industrial Symbiosis activity in Europe. • Exploration of the main areas of contribution of Industrial Symbiosis to the Circular Economy. Abstract Last years have seen a surge of Industrial Symbiosis (IS) development in association with ad-hoc widespread policies to encourage more circular and sustainable practices in the manufacturing sector. Developments in Europe, despite having attracted less attention in the literature, have been significant, driven both by public and private initiative. This paper provides an updated overview of IS activity in Europe, with a mapping of key networks, and a study of prevailing typologies of networks, size, geographical distribution and main streams/ resources traded. The analysis is based on a combination of desk research, gathering of primary data from case studies, a survey to IS network facilitators (n = 22) and in-depth interviews and focus groups (3) with IS practitioners, policy officers and industry representatives (n = 25). The analysis identified pockets of IS activity across all Europe, although varying in nature, resources exchanged and scale and scope of the initiatives. The average size of the mapped networks is approx. 473 members, but the median is approx. 100 members, which indicates high variability of sizes. The geographical scope of the synergies also seems to be dependent upon the following factors: 1) the type of waste stream/by-product; 2) transport costs and 3) market value of secondary materials. Types of waste streams exchanged common to most networks, are chemicals (e.g. chemical base products), biomass and agriculture by-products, wood and wood pellets, plastics, reusable construction materials, equipment, inert waste and water (different qualities including industrial water), residual heat and steam. The paper also discusses key obstacles facing IS development in Europe highlighting: 1) weakness of economic incentives given the low margin of IS projects associated to undeveloped secondary markets; 2) geographical variation of incentives and drivers, given differences in policy frameworks and support mechanisms (e.g. landfill tax levels) and 3) legislative issues that make transport over geographic boundaries extremely complex and administratively burdensome. Finally, the paper concludes with a general discussion of the potential of IS to contribute to the transition to the circular economy (CE) in Europe and identifies some key areas of future research. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)