Communication skills in children aged 6-8 years, without cerebral palsy cooled for neonatal hypoxic-ischemic encephalopathy.

We assessed communication skills of 48 children without cerebral palsy (CP) treated with therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) (cases) compared to 42 controls at early school-age and examined their association with white matter diffusion properties in both groups and 18-month Bayley-III developmental assessments in cases. Parents completed a Children's Communication Checklist (CCC-2) yielding a General Communication Composite (GCC), structural and pragmatic language scores and autistic-type behavior score. GCC ≤ 54 and thresholds of structural and pragmatic language score differences defined language impairment. Using tract-based spatial statistics (TBSS), fractional anisotropy (FA) was compared between 31 cases and 35 controls. Compared to controls, cases had lower GCC (p = 0.02), structural (p = 0.03) and pragmatic language score (p = 0.04) and higher language impairments (p = 0.03). GCC correlated with FA in the mid-body of the corpus callosum, the cingulum and the superior longitudinal fasciculus (p < 0.05) in cases. Bayley-III Language Composite correlated with GCC (r = 0.34, p = 0.017), structural (r = 0.34, p = 0.02) and pragmatic (r = 0.32, p = 0.03) language scores and autistic-type behaviors (r = 0.36, p = 0.01).

Deep brain stimulation: practical insights and common queries.

The number of patients with deep brain stimulation (DBS) devices implanted is increasing. Although practices vary between centres, patients are typically given training and information from their DBS nurse or clinician, as well as a comprehensive device manual and contact details for their device manufacturer. However, for the lifetime of a patient with a DBS system, most of their secondary care often occurs in a centre without a co-located DBS service. The local neurologist is often asked pragmatic questions regarding the do's and don'ts for patients with DBS systems. While a DBS centre or device manufacturer can provide advice, we thought that it will be helpful to outline the overall management of DBS for movement disorders and the approach to commonly raised questions. We describe briefly the clinical application of DBS and discuss common scenarios where there are possible compatibility issues around the device.

Compatibility of High-Moisture Storage for Biochemical Conversion of Corn Stover: Storage Performance at Laboratory and Field Scales.

Wet anaerobic storage of corn stover can provide a year-round supply of feedstock to biorefineries meanwhile serving an active management approach to reduce the risks associated with fire loss and microbial degradation. Wet logistics systems employ particle size reduction early in the supply chain through field-chopping which removes the dependency on drying corn stover prior to baling, expands the harvest window, and diminishes the biorefinery size reduction requirements. Over two harvest years, in-field forage chopping was capable of reducing over 60% of the corn stover to a particle size of 6 mm or less. Aerobic and anaerobic storage methods were evaluated for wet corn stover in 100 L laboratory reactors. Of the methods evaluated, traditional ensiling resulted in <6% total solid dry matter loss (DML), about five times less than the aerobic storage process and slightly less than half that of the anaerobic modified-Ritter pile method. To further demonstrate the effectiveness of the anaerobic storage, a field demonstration was completed with 272 dry tonnes of corn stover; DML averaged <5% after 6 months. Assessment of sugar release as a result of dilute acid or dilute alkaline pretreatment and subsequent enzymatic hydrolysis suggested that when anaerobic conditions were maintained in storage, sugar release was either similar to or greater than as-harvested material depending on the pretreatment chemistry used. This study demonstrates that wet logistics systems offer practical benefits for commercial corn stover supply, including particle size reduction during harvest, stability in storage, and compatibility with biochemical conversion of carbohydrates for biofuel production. Evaluation of the operational efficiencies and costs is suggested to quantify the potential benefits of a fully-wet biomass supply system to a commercial biorefinery.

Ecological drivers of song evolution in birds: Disentangling the effects of habitat and morphology.

Environmental differences influence the evolutionary divergence of mating signals through selection acting either directly on signal transmission ("sensory drive") or because morphological adaptation to different foraging niches causes divergence in "magic traits" associated with signal production, thus indirectly driving signal evolution. Sensory drive and magic traits both contribute to variation in signal structure, yet we have limited understanding of the relative role of these direct and indirect processes during signal evolution. Using phylogenetic analyses across 276 species of ovenbirds (Aves: Furnariidae), we compared the extent to which song evolution was related to the direct influence of habitat characteristics and the indirect effect of body size and beak size, two potential magic traits in birds. We find that indirect ecological selection, via diversification in putative magic traits, explains variation in temporal, spectral, and performance features of song. Body size influences song frequency, whereas beak size limits temporal and performance components of song. In comparison, direct ecological selection has weaker and more limited effects on song structure. Our results illustrate the importance of considering multiple deterministic processes in the evolution of mating signals.

Correlated evolution of beak morphology and song in the neotropical woodcreeper radiation.

Mating signals may diversify as a byproduct of morphological adaptation to different foraging niches, potentially driving speciation. Although many studies have focused on the direct influence of ecological and sexual selection on signal divergence, the role of indirect mechanisms remains poorly understood. Using phenotypic and molecular datasets, we explored the interplay between morphological and vocal evolution in an avian radiation characterized by dramatic beak variation, the Neotropical woodcreepers (Dendrocolaptinae). We found evidence of a trade-off between the rate of repetition of song syllables and frequency bandwidth: slow paced songs had either narrow or wide frequency bandwidths, and bandwidth decreased as song pace increased. This bounded phenotypic space for song structure supports the hypothesis that passerine birds face a motor constraint during song production. Diversification of acoustic characters within this bounded space was correlated with diversification of beak morphology. In particular, species with larger beaks produced slower songs with narrower frequency bandwidths, suggesting that ecological selection on beak morphology influences the diversification of woodcreeper songs. Because songs in turn mediate mate choice and species recognition in birds, these results indicate a broader role for ecology in avian diversification.

J-tip spring guidewire entrapment by an inferior vena cava filter.

The number of complications between guidewires and inferior vena cava filters is unknown and most likely underreported. Since 1993, at least 17 cases of central venous catheter guidewires entangled in inferior vena cava filters have been reported. The placement of both devices in the intensive care setting has increased the number of incidents in which a guidewire from a central venous catheter becomes entrapped in an inferior vena cava filter. The authors report a case in which entrapment of a guidewire occurred without causing displacement of the filter. In addition, a review of simple but useful recommendations to prevent and manage these complications is presented.

Evaluation of spine injury in blunt trauma.

Although prehospital trauma guidelines call for spine immobilization for many trauma victims, there is a lack of clarity in medical institutions as to how trauma or emergency medicine physicians should proceed to remove cervical immobilization devices (CIDs) and "clear" the spine. Despite wide variations in physicians' approaches to such matters, however, certain specific aspects of vertebral assessment in such circumstances are well documented. The authors describe and explore several of these issues with respect to initial approach to the immobilized patient, clinical clearance of the spine, radiographic evaluation of the vertebrae in victims of blunt trauma, management of spine tenderness or pain, removal of CIDs, and indications for subspecialty consultation. Critical care physicians should be reminded that the responsibility lies with them for removing CIDs and halting other spine precautions--underlying the importance of careful consultation with radiologists and other specialists.