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The crossed beam reaction of the d1-ethynyl radical C[sub 2]D(X [sup 2]Σ[sup +]), with methylacetylene, CH[sub 3]CCH(X [sup 1]A[sub 1]), was investigated at an average collision energy of 39.8 kJ mol-1. Our experimental results were combined with electronic structure calculations. The chemical reaction dynamics are indirect, involve three distinct channels, and are initiated via a barrierless addition of C[sub 2]D to the acetylenic bond through long lived cis and trans CH[sub 3]CCH(C[sub 2]D), 1-ethynylpropen-2-yl, intermediates. The reduced cone of acceptance of the carbon atom holding the methyl group favors a carbon-carbon σ bond formation at the carbon atom adjacent to the acetylenic hydrogen atom. A crossed beam experiment of C[sub 2]D with partially deuterated methylacetylene, CD[sub 3]CCH, shows explicitly that the reactive intermediates decompose to form both methyldiacetylene, CD[sub 3]CCCCD (channel 1, 70%-90%), and to a minor amount ethynylallene, D[sub 2]CCCH(C[sub 2]D) (channel 2; 10%-30%), isomers through exit transition states located 7-15 kJ mol-1 above the products. The computed reaction energies to form both isomers are -135 and -107 kJ mol-1, respectively, with respect to the separated reactants. A minor reaction pathway involves a H shift in CH[sub 3]CCH(C[sub 2]D) to an 1-ethynylpropen-1-yl radical which fragments to methyldiacetylene via a barrier of 8.8 kJ mol-1 (channel 3). Neither methyl group elimination nor the formation of the CC(CH[sub 3])(C[sub 2]D) carbene was observed in our experiments. The experimentally observed "sideways scattering" and ab initio investigation verify our conclusions of a predominate formation of the methyldiacetylene isomer. These electronic structure calculations depict a hydrogen atom loss in the exit transition state to methyldiacetylene almost parallel to the total angular momentum vector J as found in our center-of-mass angular distribution. Since the title reaction and the corresponding... [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials have demonstrated that surgical stabilization of rib fractures (SSRF) in selected trauma patients is associated with potential benefits. This study evaluates the real-world outcomes of SSRF since its implementation at Westmead Hospital, Australia. We hypothesize these outcomes to be similar to that reported by best-evidence in the literature., Materials and Methods: A retrospective analysis of data on all consecutive SSRF performed between January 2013 to December 2018 was completed., Results: Sixty-three patients (54 male; average age 55.9 ± 14.1 y) with median ISS 24 (IQR 17;30) underwent SSRF. Thirty-seven patients were admitted to Intensive Care Unit (ICU), with median ICU length of stay (LOS) 10.0 (5.0-17.0) d. Median hospital LOS was 15.5 (10.0-24.8) d. Fifty-five (87.3%) patients did not have any surgery-specific complications. The highest observed surgical morbidity was wound infection (n = 4, 4.7%). There was one mortality after rib fixation that was not related to surgery. SSRF within 3 d of hospital presentation in ventilated patients with flail chest was associated with significantly reduced median ICU LOS (3.0 [2.0;4.0] versus 10.0 [9.3;13.0] d; P = 0.03). Early (2013-2015) versus late (2015-2018) phase SSRF implementation demonstrated no significant difference in outcome variables., Conclusion: Experience with SSRF demonstrates early outcomes similar to best-evidence in the existing literature. As a quality assurance tool, ongoing evaluation of real-world data is needed to ensure that outcomes remain consistent with benchmarks available from best-evidence., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Day-only laparoscopic cholecystectomy (DOLC) has been shown to be safe and feasible yet has not been widely implemented in Australia. This study explores the introduction of routine DOLC to Westmead Hospital, and highlights the barriers to its implementation., Methods: Routine day-only cholecystectomy protocol was introduced at Westmead Hospital in 2014. A retrospective review of patients who underwent elective laparoscopic cholecystectomy during a 12-month period in 2014 was compared to a 12-month period in 2018, to examine the changes in practice after implementation of a unit protocol. Data were collected on patient demographics, admission category, outcomes and re-presentations., Results: A total of 282 patients were included in the study, of these 169 were booked as day procedures, with 124 (73%) successfully discharged on the same day. There was a significant increase in the proportion of patients booked as day-only from 2014 to 2018 (48% versus 73%, P < 0.001). Day-only failure rates (unplanned overnight admissions), readmissions and complication rates were comparable between the two periods. The most common reason for unplanned overnight admissions were due to intraoperative findings (n = 28/45)., Conclusion: Routine DOLC can be adopted in Australian hospitals without compromise to patient safety. Unplanned overnight admission is predominantly due to unexpected surgical pathology and can be reduced by protocols for the use of drains and planned outpatient endoscopic retrograde cholangiopancreatography. Unplanned outpatient review can be minimized by optimizing both intra- and post-operative pain management. Individual surgeon and anaesthetist preferences remain an obstacle to a standardized protocol in the Australian setting., (© 2020 Royal Australasian College of Surgeons.)

Background: Paclitaxel is a chemotherapy drug commonly used in the management of ovarian cancer. Colonic perforation is an extremely rare complication of paclitaxel administration with few case reports in the medical literature. We report a case of a patient with advanced ovarian cancer who had a rectal perforation following administration of paclitaxel. There has only been one other case report of rectal perforation in the medical literature following paclitaxel therapy., Case Presentation: A 55-year-old Caucasian woman with advanced ovarian cancer awaiting elective debulking surgery for her tumor presented to our emergency department with abdominal pain, vomiting, and diarrhea. She was admitted to hospital for neoadjuvant chemotherapy and management of her systemic symptoms. She became acutely unwell following one cycle of chemotherapy with paclitaxel. A computed tomography scan of her abdomen showed typhlitis of her descending colon and a corresponding rectal perforation. Surgical intervention was deemed inappropriate as she had a heavy burden of disease and neutropenia. She died following a period of conservative management with strong intravenously administered antibiotics., Conclusions: This case highlights the importance of recognizing gastrointestinal complications following chemotherapy and the need to be aware of the possibility of bowel perforation. Prompt surgical review and intervention must be requested in patients with acute abdominal pain and persistent gastrointestinal symptoms such as diarrhea and vomiting.

The aim of this study was to determine the association between alcohol dependence and altitude of residence in 11 villages in two high altitude areas of Peru. An analytical cross-sectional study was performed using a survey conducted by physicians in primary health care in 11 villages until 2013, that were divided into low altitude (≤2500m asl (above sea level)), and high altitude (>2500m asl) areas. The CAGE test for alcoholism (cut point, ≥2) was applied to those who responded positively when asked if they consumed alcohol. Statistical associations were obtained with generalised linear models Of the 737 participants, 51% were women and the median age was 36 years [interquartile range, 25-50], 334 (45%) lived at low altitude, and 113 (15%) had alcohol dependence. The highest frequency of alcoholism was positively associated with being a village considered extremely poor (Likelihood Ratio (LP)=2.42; 95%CI, 1.40-4.19), while being female (LP=0.44; 95%CI, 0.23-0.89) and residing at high altitude (LP=0.15; 95%CI, 0.07-0.31) were negatively associated. These were adjusted for nine socio-occupational and pathological variables. According to these data, there is a higher frequency of alcohol dependence in being, male, extremely poor, and residing at low altitude. These results should be taken into account by professionals who work in primary care and those involved in mental health care, because of their implications in society., (Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Scale errors is a term referring to very young children's serious efforts to perform actions on miniature replica objects that are impossible due to great differences in the size of the child's body and the size of the target objects. We report three studies providing further documentation of scale errors and investigating the validity and robustness of the phenomenon. In the first, we establish that 2-year-olds' behavior in response to prompts to "pretend" with miniature replica objects differs dramatically from scale errors. The second and third studies address the robustness of the phenomenon and its relative imperviousness to attempts to influence the rate of scale errors., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This prospective study aimed to determine speech understanding in neurofibromatosis type II (NF2) patients following implantation of a MED-EL COMBI 40+ auditory brainstem implant (ABI). Patients (n = 32) were enrolled postsurgically. Nonauditory side effects were evaluated at fitting and audiological performance was determined using the Sound Effects Recognition Test (SERT), Monosyllable-Trochee-Polysyllable (MTP) test and open-set sentence tests. Subjective benefits were determined by questionnaire. ABI activation was documented in 27 patients, 2 patients were too ill for testing and 3 patients were without any auditory perception. SERT and MTP outcomes under auditory-only conditions improved significantly between first fitting and 12-month follow-up. Open-set sentence recognition improved from 5% at first fitting to 37% after 12 months. The number of active electrodes had no significant effect on performance. All questionnaire respondents were 'satisfied' to 'very satisfied' with their ABI. An ABI is an effective treatment option in NF2 patients with the potential to provide open-set speech recognition and subjective benefits. To our knowledge, the data presented herein is exceptional in terms of the open-set speech perception achieved in NF2 patients., (© 2013 S. Karger AG, Basel.)

Background: Increased levels of secondary bile acids after gallstone disease and cholecystectomy are believed to increase the risk of colorectal cancer. It remains unclear whether there is a similar risk of developing adenomas. The aim of this meta-analysis was to determine the risk of developing colonic adenomas following gallstone disease or cholecystectomy., Methods: The study was based on a systematic search of PubMed, MEDLINE, EMBASE, and Current Contents (1950-2012). Selection criteria were developed to sort for studies exploring the relationship between cholelithiasis, cholecystectomy, and colonic adenoma in an adult population. A random-effects model was used to generate pooled odds ratios (OR) and 95 % confidence intervals (CI). Publication bias and heterogeneity were assessed., Results: Of the 1,276 studies identified, 14 were suitable for final analysis. There were 253,059 subjects in total, 42,543 of whom were diagnosed with colonic adenoma, and 28,281 of whom had gallstones or underwent cholecystectomy. There was a significant risk of developing colonic adenoma if gallstones were present (OR = 2.26; 95 % CI = 1.83-2.81). A risk was also seen with cholecystectomy (OR = 1.15; 95 % CI = 1.04-1.26), but this risk was negated when only adjusted odds were selected (OR = 1.01; 95 % CI = 0.91-1.12). No publication bias and only low levels of heterogeneity existed., Conclusions: Gallstones increase the risk of colonic adenoma. No association exists with cholecystectomy.

Background: Increased levels of secondary bile acids after cholecystectomy and cholelithiasis are believed to increase the risk of colorectal cancer, and several studies have suggested that the risk of colorectal cancer may be the greatest proximally. Numerous conflicting studies have been published and it remains unclear whether the risk is apparent in the rectum. This meta-analysis aims to determine the risk of developing rectal cancer following gallstone disease or cholecystectomy., Methods: The prospective protocol included a literature search of PubMed, MEDLINE, EMBASE, and Current Contents (1950-2011). Selection criteria were developed to sort for studies exploring the relationship between cholelithiasis, cholecystectomy, and rectal cancer in an adult population. A random-effects model was used to generate pooled odds ratios (OR) and 95% confidence intervals (CI). Publication bias and heterogeneity were assessed., Results: Of the 2358 studies identified, 42 were suitable for final analysis. There were 1,547,506 subjects in total, 14,226 diagnosed with rectal cancer, and 496,552 with gallstones or cholecystectomy. There was a statistically significant risk of rectal cancer following cholelithiasis (OR = 1.33; 95% CI = 1.02-1.73), though no risk was apparent following cholecystectomy (OR = 1.14; 95% CI = 0.92-1.41)., Conclusions: Cholelithiasis increases the risk of rectal cancer. No association exists between cholecystectomy and rectal cancer.

Objective: To determine the validity and reliability of a Filipino translation of the Tinnitus Handicap Inventory (THI), a self-report measure of tinnitus handicap., Design: Psychometric cross-sectional validation Study sample: Seventy-five patients, aged 18-82 with tinnitus recruited consecutively at the Ear Unit of the Philippine General Hospital after receiving assessment at the Ear, Nose, and Throat-Out Patient Department., Results: The THI-PH showed robust internal consistency reliability (Cronbach's alpha = 0.92), only slightly lower than the original version (THI-US Cronbach's alpha = 0.93), and its Danish (Cronbach's alpha = 0.93), Portuguese (Cronbach's alpha = 0.94), and German (Cronbach's alpha = 0.93) translations. Two of the subscales, the Functional and Emotional subscales, also showed good internal consistency reliability (Cronbach's alpha = 0.86 and Cronbach's alpha = 0.82, respectively). The Catastrophic subscale showed poorer internal consistency reliability (Cronbach's alpha = 0.63) due to the shorter number of items in that scale., Conclusion: The results of the present study suggest that the THI-PH is a valid and reliable tool that can be used to quantify the effects of tinnitus on the quality of life of Filipino tinnitus patients.

In recent years, parents in the United States and worldwide have purchased enormous numbers of videos and DVDs designed and marketed for infants, many assuming that their children would benefit from watching them. We examined how many new words 12- to 18-month-old children learned from viewing a popular DVD several times a week for 4 weeks at home. The most important result was that children who viewed the DVD did not learn any more words from their monthlong exposure to it than did a control group. The highest level of learning occurred in a no-video condition in which parents tried to teach their children the same target words during everyday activities. Another important result was that parents who liked the DVD tended to overestimate how much their children had learned from it. We conclude that infants learn relatively little from infant media and that their parents sometimes overestimate what they do learn.

Picture books are ubiquitous in young children's lives and are assumed to support children's acquisition of information about the world. Given their importance, relatively little research has directly examined children's learning from picture books. We report two studies examining children's acquisition of labels and facts from picture books that vary on two dimensions: iconicity of the pictures and presence of manipulative features (or "pop-ups"). In Study 1, 20-month-old children generalized novel labels less well when taught from a book with manipulative features than from standard picture books without such elements. In Study 2, 30- and 36-month-old children learned fewer facts when taught from a manipulative picture book with drawings than from a standard picture book with realistic images and no manipulative features. The results of the two studies indicate that children's learning from picture books is facilitated by realistic illustrations, but impeded by manipulative features.

This study examines the contribution of the Responsive Classroom (RC) Approach, a set of teaching practices that integrate social and academic learning, to children's perceptions of their classroom, and children's academic and social performance over time. Three questions emerge: (a) What is the concurrent and cumulative relation between children's perceptions of the classroom and social and academic outcomes over time? (b) What is the contribution of teacher's use of RC practices to children's perceptions and social and academic outcomes? (c) Do children's perceptions of the classroom mediate the relation between RC teacher practices and child outcomes? Cross-lagged autoregressive structural equation models were used to analyze teacher and child-report questionnaire data, along with standardized test scores collected over 3 years from a sample of 520 children in grades 3-5. Results indicate a significant positive relation between RC teacher practices and child perceptions and outcomes over time. Further, children's perceptions partially mediated the relation between RC teacher practices and social competence. However, the models did not demonstrate that child perceptions mediated the relation between RC practices and achievement outcomes. Results are explained in terms of the contribution of teacher practices to children's perceptions and student performance.

Conclusion: Evoked otoacoustic emission (OAE) and auditory brainstem response (ABR) results for hearing screening among infants have good concordance. However, good correlation with the Griffiths Developmental Scales remains to be desired., Objective: To correlate hearing screening outcomes of a cohort of infants with developmental outcomes at 6 and 12 months., Subjects and Methods: A cohort of pregnant women was identified in several communities in a rural area (Bulacan province) from April 2002 to February 2003 as part of a population-based study determining maternal exposure to pollutants and infant outcomes, with a total follow-up of 2 years. Pregnant mothers were identified and followed up until delivery at a secondary, provincial hospital. Hearing screening was performed with OAEs and ABR. Mental development of infants was assessed at 6 and 12 months using Griffiths Mental Developmental Scales - locomotor, personal-social, hearing and speech, hand and eye coordination, performance tests., Results: Among the 1086 babies recruited, there were 724 with hearing assessment. Of these 724 babies, 565 had both OAE testing and ABR. Overall in 1130 ears, OAE and ABR testing showed an observed agreement of 99%, agreement due to chance of 96%, and kappa agreement of 79% (p=0.00) in diagnosing bilateral hearing losses. OAEs had a sensitivity of 86.4% (95% CI 64-96.4%) and a specificity of 99.4% (95% CI 98.6-99.7%). At the end of the study, there were 708/724 (97.8%) infants with normal hearing, 7/724 (1.0%) with unilateral hearing loss, 8/724 (1.1%) with bilateral mild hearing loss, and 1/724 (0.1%) with bilateral profound hearing loss, who demonstrated consistent mental delay throughout. Follow-up rates for developmental examinations at 6 and 12 months were 98% and 81.25%, respectively. In these groups, there were 8 (1%) infants at 6 months and 18 (2.4%) at 12 months with developmental delay (Griffiths Mental Developmental Scales).

This study reviews the hearing results in 80 consecutive patients who underwent complete removal of histologically proven acoustic neuromas by use of the suboccipital approach. Of these, 56 patients had successful monitoring of cochlear compound action potentials; 20 were not monitored because their surgery predated monitoring; and 4 had unsuccessful monitoring. A significant difference was found in hearing preservation rates between the group in whom compound action potential monitoring was performed and those in whom monitoring was either unavailable or failed (p = 0.02). Overall, 38% (30 of 80) had preserved hearing. There were 51 patients in whom the click threshold for the cochlear compound action potential was measured during surgery. Twenty-one patients had a threshold shift of 20 dB or less, 15 (71%) of these retained serviceable hearing (speech reception threshold < or = 50 dB; speech discrimination score > or = 60%). Of 12 patients in whom the threshold shift was 30 to 60 dB, none had serviceable hearing after surgery. The click threshold shift was predictive of a significant postoperative hearing change (p < 0.001).

Vestibular symptoms following cochlear implantation are relatively rare, in spite of well-documented evidence of a significant surviving vestibular neuron population in profoundly deaf individuals. This report details the electro-oculographic (EOG) findings before and after insertion of the Nucleus 22-channel cochlear implant in 25 adults. These findings are correlated to the clinical course of these patients.