Childhood outcomes following preterm prelabor rupture of the membranes (PPROM): a population-based record linkage cohort study.

OBJECTIVE: The objective of this study is to determine child health, development and educational outcomes for infants born following preterm prelabor rupture of the membrane (PPROM). STUDY DESIGN: Population-based record linkage cohort study using data from NSW, Australia, 2001 to 2014. RESULTS: Of 121 822 births at 20 to 37 weeks, 18 799 (15%) followed PPROM, 56 406 (46%) followed spontaneous labor and 46 617 (38%) were planned. Compared with infants of a similar gestational age born following spontaneous labor or planned delivery, exposure to PPROM did not increase the risk of childhood mortality, childhood hospitalization, developmentally vulnerable at school entry, low reading or numeracy scores. Median latency ranged from 12 days (interquartile range 3 to 37 days) at 25 weeks to 1 day (0 to 2 days) at 36 weeks. Longer latency and more advanced gestational age at birth were associated with better outcomes. CONCLUSION: Infants born following PPROM are at no greater risk of adverse child health, development and education outcomes than those of similar gestational age born without PPROM.

Lattice constant measurement from electron backscatter diffraction patterns.

Kikuchi bands in election backscattered diffraction patterns (EBSP) contain information about lattice constants of crystallographic samples that can be extracted via the Bragg equation. An advantage of lattice constant measurement from EBSPs over diffraction (XRD) is the ability to perform local analysis. In this study, lattice constants of cubic STN and cubic YSZ in the pure materials and in co-sintered composites were measured from their EBSPs acquired at 10 kV using a silicon single crystal as a calibration reference. The EBSP distortion was corrected by spherical back projection and Kikuchi band analysis was made using in-house software. The error of the lattice constant measurement was determined to be in the range of 0.09-1.12% compared to values determined by XRD and from literature. The confidence level of the method is indicated by the standard deviation of the measurement, which is approximately 0.04 Å. Studying Kikuchi band size dependence of the measurement precision shows that the measurement error decays with increasing band size (i.e. decreasing lattice constant). However, in practice, the sharpness of wide bands tends to be low due to their low intensity, thus limiting the measurement precision. Possible methods to improve measurement precision are suggested.

Decreasing infection in neonatal intensive care units through quality improvement.

OBJECTIVE: To decrease the incidence of bloodstream infection (BSI) for neonates <29 weeks gestation through quality improvement. DESIGN: Commencing in September 2011, eight neonatal intensive care units (NICUs) in New South Wales and Australian Capital Territory, Australia participated in the Sepsis Prevention in NICUs Group project, a multicentre quality improvement initiative to reduce neonatal infection through implementation of potentially better practices and development of teaching resources. Data were collected for neonates <29 weeks gestation from D3 to 35, using point of care data entry, for BSI, central line-associated BSI (CLABSI) and antibiotic use. Exponentially weighted moving average data trend lines for rates of BSI, CLABSI and antibiotic use for each NICU were automatically generated and composite charts were provided each month to participating NICUs. RESULTS: Between January 2012 and December 2014, data were collected from D3 to 35 for 1075 neonates <29 weeks gestation who survived >48 h, for a total of 33 933 bed days and 14 447 central line days. There was a significant decrease from 2012 to 2014 in BSI/1000 bed days (7.8±3.0 vs 3.8±1.1, p=0.000), CLABSI/1000 bed days (4.6±2.1 vs 2.1±0.8, p=0.003), CLABSI/1000 central line days (9.9±4.3 vs 5.4±1.7, p=0.012) and antibiotic days/100 bed days (31.1±4.3 vs 25.5±4.2, p=0.046). CONCLUSIONS: This study demonstrates a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across an NICU network, supported by timely provision of data.

Transmission electron microscopy specimen preparation method for multiphase porous functional ceramics.

An optimum method is proposed to prepare thin foil transmission electron microscopy (TEM) lamellae of multiphase porous functional ceramics: prefilling the pore space of these materials with an epoxy resin prior to focused ion beam milling. Several advantages of epoxy impregnation are demonstrated by successful preparation of TEM specimens that maintain the structural integrity of the entire lamella. Feasibility of the TEM alignment procedure is demonstrated, and ideal TEM analyses are illustrated on solid oxide fuel cell and solid oxide electrolysis cell materials. Some potential drawbacks of the TEM specimen preparation method are listed for other samples.

Ion beam polishing for three-dimensional electron backscattered diffraction.

Serial sectioning by focused ion beam milling for three-dimensional electron backscatter diffraction (3D-EBSD) can create surface damage and amorphization in certain materials and consequently reduce the EBSD signal quality. Poor EBSD signal causes longer data acquisition time due to signal averaging and/or poor 3D-EBSD data quality. In this work a low kV focused ion beam was successfully implemented to automatically polish surfaces during 3D-EBSD of La- and Nb-doped strontium titanate of volume 12.6 × 12.6 × 3.0 µm. The key to achieving this technique is the combination of a defocused low kV high current ion beam and line scan milling. The line scan was used to restrict polishing to the sample surface and the ion beam was defocused to ensure the beam contacted the complete sample surface. In this study 1 min polishing time per slice increases total acquisition time by approximately 3.3% of normal 3D-EBSD mapping compared to a significant increase of indexing percentage and pattern quality. The polishing performance in this investigation is discussed, and two potential methods for further improvement are presented.

Effects of focused ion beam milling on electron backscatter diffraction patterns in strontium titanate and stabilized zirconia.

This study investigates the effect of focused ion beam (FIB) current and accelerating voltage on electron backscatter diffraction pattern quality of yttria-stabilized zirconia (YSZ) and Nb-doped strontium titanate (STN) to optimize data quality and acquisition time for 3D-EBSD experiments by FIB serial sectioning. Band contrast and band slope were used to describe the pattern quality. The FIB probe currents investigated ranged from 100 to 5000 pA and the accelerating voltage was either 30 or 5 kV. The results show that 30 kV FIB milling induced a significant reduction of the pattern quality of STN samples compared to a mechanically polished surface but yielded a high pattern quality on YSZ. The difference between STN and YSZ pattern quality is thought to be caused by difference in the degree of ion damage as their backscatter coefficients and ion penetration depths are virtually identical. Reducing the FIB probe current from 5000 to 100 pA improved the pattern quality by 20% for STN but only showed a marginal improvement for YSZ. On STN, a conductive coating can help to improve the pattern quality and 5 kV polishing can lead to a 100% improvement of the pattern quality relatively to 30 kV FIB milling. For 3D-EBSD experiments of a material such as STN, it is recommended to combine a high kV FIB milling and low kV polishing for each slice in order to optimize the data quality and acquisition time.

Trends in obstetric practices and meconium aspiration syndrome: a population-based study.

OBJECTIVE: To determine trends in the incidence of meconium aspiration syndrome (MAS), and maternal factors and obstetric practices associated with any decline. DESIGN: Population-based cohort study. SETTING: New South Wales (NSW), Australia. POPULATION: All 877 037 liveborn, singleton, term infants (≥ 37 weeks of gestation) in the period 1997-2007. METHODS: Data were obtained from birth records linked to the neonatal hospital discharge records. The birth data provided information on maternal and obstetric factors, whereas the outcome of interest, MAS, was obtained from hospital data on the neonates. Multivariable logistic regression was used to estimate the risk of MAS while simultaneously adjusting for the explanatory variables. MAIN OUTCOME MEASURES: The incidence of MAS per 1000 births, and odds ratios and 95% confidence intervals for maternal and obstetric factors for the development of MAS. RESULTS: The incidence of MAS declined significantly by 11.3% per annum (95% CI 10.1-12.6; P < 0.001) from 4.1 per 1000 births in 1997 to 1.3 per 1000 births in 2007. This was associated with a statistically significant decline in risk factors: maternal smoking (from 20 to 12%), gestational age (from 57 to 47% ≥ 40 weeks of gestation), delivery at small hospitals (from 15 to 9%) and infants with birthweight below the third percentile (from 3.3 to 2.4%). There were simultaneous statistically significant increases in practices that reduce the risk of MAS: labour inductions (from 22 to 27%) and birth by caesarean section, both elective, prior to 40 weeks of gestation (from 7.3 to 13.8%), and emergency (from 3.0 to 5.3% prior to 40 weeks of gestation, and from 5.1 to 6.7% at 40 weeks of gestation or later). CONCLUSIONS: The rate of MAS is declining, and this decline is associated with a reduction in maternal and pregnancy risk factors, and an increase in protective obstetric practices.

Geometrical characterization of interconnected phase networks in three dimensions.

In electrochemical devices such as fuel cells or batteries the microstructure is a determining factor for the performance of the device. To be able to optimize the microstructure it is important to be able to quantitatively measure key structural parameters, such that systematic studies can be made. We present several general methods for quantitative characterization of network structures without prior assumptions of shape or application. The characterization is performed by extracting distributions of values rather than single value descriptions, thus allowing more detailed comparisons between samples to be made. The methods characterize tortuosity, path diameters, the novel dead ends property and a particle shape independent alternative to a particle size distribution. The parameters are calculated by the computation of arrival time maps by the fast marching method. The methods are applied to the analysis of each of the three phases in a solid oxide fuel cell sample.

A framework for automatic segmentation in three dimensions of microstructural tomography data.

Routine use of quantitative three dimensional analysis of material microstructure by in particular, focused ion beam (FIB) serial sectioning is generally restricted by the time consuming task of manually delineating structures within each image slice or the quality of manual and automatic segmentation schemes. We present here a framework for performing automatic segmentation of complex microstructures using a level set method. The technique is based on numerical approximations to partial differential equations to evolve a 3D surface to capture the phase boundaries. Vector fields derived from the experimentally acquired data are used as the driving forces. The framework performs the segmentation in 3D rather than on a slice by slice basis. It naturally supplies sub-voxel precision of segmented surfaces and allows constraints on the surface curvature to enforce a smooth surface in the segmentation. Two applications of the framework are illustrated using solid oxide cell materials as examples.

Educational outcome at 8 years for children who were born extremely prematurely: a controlled study.

OBJECTIVE: To assess the educational outcome and utilization of special education resources at age 8 years in children who were born extremely prematurely, and to compare this outcome with a matched cohort of children born full-term. METHODS: All children with gestational age less than 28 weeks or birthweight of less than 1000 g, born at Royal North Shore Hospital from July 1985 through June 1990 were enrolled in a study of long-term outcome. A cohort of full-term children matched for age, sex and school with non-disabled extremely premature children was enrolled at age 8 years. Children were assessed using standardized measures of cognitive and academic achievement. Information was obtained from teachers regarding educational support and academic progress. RESULTS: Of 82 extremely premature children assessed at age 8 years, 8 (10%) had a severe disability, 13 (16%) had a mild or moderate disability and 61 (74%) were non-disabled (IQ > or = 85, no neurosensory disability). Thirty-five (43%) required special education support, 22 (27%) were below grade level in reading or mathematics and 25 (30%) were performing at grade level without support. Compared with controls, non-disabled extremely premature children had lower scores on standardized measures of academic achievement and were more likely to be reported by teachers as falling below grade level in reading (48% vs 13%; P < 0.001), mathematics (48% vs 10%; P < 0.001) and spelling (48% vs 17%; P < 0.002), and to require special education support (25% vs 4%; P = 0.004). CONCLUSION: Parents and professionals caring for extremely premature children need to be alert to the additional support that these children may require at school.

Behaviour problems in extremely low birthweight children at 5 and 8 years of age.

This study explored the prevalence and stability of behaviour problems and their prediction from neonatal, medical and family context factors in a group of extremely low birthweight (ELBW) infants assessed at 5 and 8 years of age. Behaviour problems were identified on the basis of several measures: the Total Behaviour Problem Scale and the Adaptive Function Scale of the Child Behaviour Checklist, and the Hyperactivity Index and Hyperactivity Scale from the Conners' Rating Scale. In this group of ELBW infants, the prevalence of behaviour difficulties was somewhat lower than that reported in other studies, and varied according to the measure and informant (parent vs. teacher) used. Also, there was little continuity between those children identified by their parents at 5 years of age as having behaviour problems and those children identified by parent and/or teacher report at 8 years of age. Most of the children identified with behaviour difficulties at 8 years were also reported to have academic difficulties. None of the neonatal or medical factors predicted behaviour difficulties at 8 years of age. In contrast, two family context factors, maternal level of education and family stress, were related to behaviour difficulties at 8 years. These findings indicate that ELBW and the often associated medical complications may not necessarily predispose infants to develop subsequent behaviour difficulties later on in childhood.

Adolescent idiopathic scoliosis managed by a nighttime bending brace.

This study evaluated and compared the effectiveness of managing adolescent idiopathic scoliosis with a total contact bending spine orthosis worn only during nighttime sleep with established bracing programs and electrical stimulation treatment. Brace treatment was prescribed for 30 patients with adolescent idiopathic scoliosis for the management of 50 spinal curvatures averaging 28.5 degrees (range: 13 degrees-40 degrees). Average patient age at the initiation of brace wear was 12+/-10 years (range: 9+/-10 to 16+/-8 years). All 30 patients were skeletally immature (Risser sign, 0-3) at initiation of orthotic treatment and underwent follow-up to maturity. Patients were instructed to wear the braces for at least 8-10 hours a day during nighttime sleep. Eighteen of 30 patients were compliant with the bracing program. Compliance with the nighttime bending brace was no better than the reported compliance with established thoracolumbosacral orthosis programs. Moreover, noncompliant patients and those treated by the ineffective electrical stimulation program also did not differ in curve progression. Curve progression was controlled in 56% of the compliant patients, and the nighttime bending brace was considered as effective as the Wilmington brace in controlling adolescent idiopathic scoliosis. Both braces were more effective than the ineffective electrical stimulation treatment.

Congenital splenic cyst: a case report and review of the literature.

There are very few cases of antenatally diagnosed congenital splenic cyst described in literature. The present case of congenital splenic cyst was first suspected on ultrasound examination at 20 weeks of gestation and followed subsequently. Its exact location in the spleen was found on postnatal ultrasound examination. The aetiology, differential diagnosis, complications and management strategies of this lesion are also discussed.

"Porcine bronchus" diagnosed in neonatal period.

"Porcine bronchus" is a right upper lobe bronchus arising directly from the trachea. This is an infrequent congenital abnormality and it usually represents the displaced origin of a normal bronchus. We herewith report a case of a child who was diagnosed to have tracheal bronchus in neonatal period and followed subsequently until 13 months of age.

Factors leading to hip subluxation and dislocation in femoral lengthening of unilateral congenital short femur.

Congenital short femur is a rare and complex deformity. For it to be treated in the most accurate way, we must know of every possible complication. The purpose of this study was to determine the factors leading to hip subluxation or dislocation in patients with an unilateral congenital short femur who underwent a femoral lengthening procedure. Forty-four patients with congenital unilateral short femora types I, II, and IIIA were seen between 1981 and 1993 at Alfred I. duPont Hospital for Children. Seventeen patients had type I, 9 patients had type II, and 18 patients had type IIIA. Twenty patients underwent simultaneous lengthening of the femur and tibia, and 24 patients had primary lengthening of the femur. Eleven patients had an epiphysiodesis of the contralateral femur for residual leg length discrepancies of <6 cm. We observed that in patients with type IIIA, the acetabular dysplasia is severe, as well as the coxa vara deformity, and is associated with progressive subluxation and dislocation of the hip with lengthening. We believe that the combined abnormality of coxa vara and bow of the femoral shaft contributes to hip subluxation and dislocation in congenital short femur in association with an acetabular dysplasia prior to the lengthening. We recommend correction of the varus bow of the femur and the neck-shaft angle to 120 degrees and the acetabular index to <25 degrees prior to lengthening of type IIIA femora.

Experimental epiphysiodesis: magnetic resonance imaging evaluation with histopathologic correlation.

We performed an experimental epiphysiodesis on the tibia in 16 immature New Zealand white rabbits. The purpose was to study the process of trauma-induced growth plate closure. The animals were killed at weekly intervals over 8 weeks. We correlated the histological findings with serial magnetic resonance images. The undamaged, central part of the growth plate became histologically abnormal within 1 week. Mature bone bridge formation in the area of the epiphysiodesis was seen after 3 to 4 weeks. The study suggests that growth arrest starts before the bone bridge formation. Factors regulating cartilage growth may also play a role.

Multiplier method for predicting limb-length discrepancy.

BACKGROUND: In patients with a congenital or developmental limb-length discrepancy, the short limb grows at a rate proportional to that of the normal, long limb. This is the basis of predicting limb-length discrepancy with existing methods, which are complicated and require multiple data points. The purpose of our study was to derive a simple arithmetic formula that can easily and accurately predict limb-length discrepancy at skeletal maturity. METHODS: Using available databases, we divided the femoral and tibial lengths at skeletal maturity by the femoral and tibial lengths at each age for each percentile group. The resultant number was called the multiplier. Using the multiplier, we derived formulae to predict the limb-length discrepancy and the amount of growth remaining. We verified the accuracy of these formulae by evaluating two groups of patients with congenital shortening who were managed with epiphysiodesis or limb-lengthening. We also calculated and compared the multipliers for other databases according to radiographic, clinical, and anthropological lower-limb measurements. RESULTS: The multipliers for the femur and tibia were equivalent in all percentile groups, varying only by age and gender. Because congenital limb-length discrepancy increases at a rate proportional to growth, the discrepancy at maturity can be calculated as the current discrepancy times the multiplier for the current age and the gender. This calculation can be performed with use of a single measurement of limb-length discrepancy. For progressive developmental (noncongenital) discrepancies, the discrepancy at skeletal maturity can be calculated as the current discrepancy plus the growth inhibition times the amount of growth remaining. The timing of the epiphysiodesis can also be calculated with the multiplier. The predictions made with use of the multiplier method correlated well with those made with use of the Moseley method as well as with the actual limb-length discrepancy in both the limb-lengthening and epiphysiodesis groups. The multipliers derived from the radiographic, clinical, and anthropological measurements of femora and tibiae were all similar to each other despite differences in race, ethnicity, and generation. CONCLUSIONS: The multiplier method allows for a quick calculation of the predicted limb-length discrepancy at skeletal maturity, without the need to plot graphs, and is based on as few as one or two measurements. This method is independent of percentile groups and is the same for the prediction of femoral, tibial, and total-limb lengths. The multiplier values are also independent of generation, height, socioeconomic class, ethnicity, and race. We verified the accuracy of this method clinically by evaluating patients who had been managed with limb-lengthening or epiphysiodesis. The method was also comparable with or more accurate than the Moseley method of limb-length prediction.

Cortical evoked potentials of the dorsal nerve of the clitoris and female sexual dysfunction in multiple sclerosis.

PURPOSE: We evaluated whether disrupting genital central nervous system pathways is associated with subjective reports of sexual dysfunction in women with multiple sclerosis. MATERIALS AND METHODS: We performed pudendal somatosensory evoked potential testing in and had sexual questionnaires completed by 14 women with a mean age of 47 years who had multiple sclerosis. RESULTS: The mean expanded disability status score was 5. All but 1 woman reported the desire for sexual intercourse. There was a high rate of dissatisfaction with their sex life and all study participants had concomitant bladder and bowel function problems. The most common sexual complaint was difficult or no orgasm, which was statistically associated with abnormalities or absence of 1 or both pudendal cortical evoked potentials. Fatigue and arousal disorders were also common. CONCLUSIONS: Women with multiple sclerosis have a high self-reported rate of sexual dysfunction, which decreases quality of life. Electrodiagnostic data imply that pudendal somatosensory innervation is necessary for normal female orgasmic function. More study is needed to confirm these findings.