Non-assisted versus neuro-navigated and XperCT-guided external ventricular catheter placement: a comparative cadaver study.

BACKGROUND AND PURPOSE: Accurate placement of an external ventricular drain (EVD) for the treatment of hydrocephalus is of paramount importance for its functionality and in order to minimize morbidity and complications. The aim of this study was to compare two different drain insertion assistance tools with the traditional free-hand anatomical landmark method, and to measure efficacy, safety and precision. METHODS: Ten cadaver heads were prepared by opening large bone windows centered on Kocher's points on both sides. Nineteen physicians, divided in two groups (trainees and board certified neurosurgeons) performed EVD insertions. The target for the ventricular drain tip was the ipsilateral foramen of Monro. Each participant inserted the external ventricular catheter in three different ways: 1) free-hand by anatomical landmarks, 2) neuronavigation-assisted (NN), and 3) XperCT-guided (XCT). The number of ventricular hits and dangerous trajectories; time to proceed; radiation exposure of patients and physicians; distance of the catheter tip to target and size of deviations projected in the orthogonal plans were measured and compared. RESULTS: Insertion using XCT increased the probability of ventricular puncture from 69.2 to 90.2 % (p = 0.02). Non-assisted placements were significantly less precise (catheter tip to target distance 14.3 ± 7.4 mm versus 9.6 ± 7.2 mm, p = 0.0003). The insertion time to proceed increased from 3.04 ± 2.06 min. to 7.3 ± 3.6 min. (p < 0.001). The X-ray exposure for XCT was 32.23 mSv, but could be reduced to 13.9 mSv if patients were initially imaged in the hybrid-operating suite. No supplementary radiation exposure is needed for NN if patients are imaged according to a navigation protocol initially. CONCLUSION: This ex vivo study demonstrates a significantly improved accuracy and safety using either NN or XCT-assisted methods. Therefore, efforts should be undertaken to implement these new technologies into daily clinical practice. However, the accuracy versus urgency of an EVD placement has to be balanced, as the image-guided insertion technique will implicate a longer preparation time due to a specific image acquisition and trajectory planning.

Predicting positive food challenges in children sensitised to peanuts/tree nuts.

BACKGROUND: Children with atopic diseases in early life are frequently found with positive IgE tests to peanuts/tree nuts without a history of previous ingestion. We aimed to identify risk factors for reactions to nuts at first introduction. METHODS: A retrospective case-note and database analysis was performed. Recruitment criteria were: patients aged 3-16 yr who had a standardized food challenge to peanut and/or tree nuts due to sensitisation to the peanut/tree nut (positive spIgE or SPT) without previous consumption. A detailed assessment was performed of factors relating to food challenge outcome with univariate and multivariate logistic regression analysis. RESULTS: There were 98 food challenges (47 peanut, 51 tree nut) with 29 positive, 67 negative and 2 inconclusive outcomes. A positive maternal history of allergy and a specific IgE >5 kU/l were strongly associated with a significantly increased risk of a positive food challenge (OR 3.73; 95% CI 1.31-10.59; p = 0.013 and OR 3.35; 95% CI 1.23-9.11; p = 0.007, respectively). Adjusting for age, a three year-old with these criteria has a 67% probability of a positive challenge. There was no significant association between types of peanut/tree nut, other food allergies, atopic conditions or severity of previous food reactions and positive challenges. CONCLUSIONS: We have demonstrated an association between the presence of maternal atopic history and a specific IgE >5 kU/l, with a significant increase in the likelihood of a positive food challenge. Although requiring further prospective validation these easily identifiable components should be considered when deciding the need for a challenge.

Product placement in integrated marketing communications strategy

Perinteisten markkinointiviestintäkanavien menettäessä jatkuvasti tehoaan mediakentän ja kohderyhmien sirpaloituessa yhä pienempiin yksiköihin markkinointiorganisaatiot etsivät vaihtoehtoisia tapoja tavoittaakseen kohdeyleisönsä. Yksi vaihtoehtoinen markkinointiviestintäkeino on tuotesijoittelu (product placement), jossa (merkki)tuotteita sijoitetaan erilaisten viihdetuotantojen, kuten elokuvien, televisio-ohjelmien ja tietokonepelien, tarinan yhteyteen, jotta yhä medialukutaitoisempi kohdeyleisö ei pystyisi välttämään kaupallista viestiä esimerkiksi vaihtamalla televisiokanavaa tai kääntämällä lehden sivua. Koska tuote on sijoitettu kerrottavan tarinan sisään, markkinointiviestin — eli tuotteen havaitsemisen — välttäminen on huomattavasti vaikeampaa kuin perinteisten markkinointiviestintämenetelmien kohdalla. Lisäksi, sijoitellut tuotteet ovat tavallisesti kiinteässä yhteydessä tarinan juonen ja henkilöhahmojen kanssa siten, että tuote saa näistä yhteyksistä positiivista vahvistusta imagolleen. Pro Gradu-tutkielman tarkoituksena oli selvittää tuotesijoittelun käyttökelpoisuutta markkinointiviestinnässä sekä miten kulutushyödykemarkkinoijat voivat hyödyntää menetelmää markkinointiviestintästrategioissaan. Tuotesijoittelun poikkeava luonne markkinointiviestintävälineenä tuotti kysymyksen miten tuotesijoittelua voitaisiin hyödyntää yhteistyössä muiden markkinointiviestintäkeinojen kanssa. Tätä varten tutkimuksessa tuotesijoittelu yhdistettiin integroidun markkinointiviestinnän (IMC) viitekehykseen. IMC-konsepti syntyi markkinointiviestinnässä vastaamaan samaan tarpeeseen kuin tuotesijoittelukin: pirstaloitunut mediakenttä ja yksittäiset kohderyhmät vaativat kehittyneempää ja yhtenäisempää markkinointiviestinnän suunnittelua ja toteutusta. Tutkimuksen johtopäätöksenä tuotesijoittelu todettiin käyttökelpoiseksi markkinointiviestintäkeinoksi mikäli viestinnän tavoitteena on muu kuin tuotteen myyntiin suorasti vaikuttaminen. Tuotesijoittelu on sen sijaan erittäin tehokas tuotetietoisuuden lisäämisessä, erityisesti tunnistamisen kohdalla. Tuotesijoittelu voi myös tuottaa suoran ostotarpeen mutta tällöin viestin vastaanottajalla täytyy olla vallitseva tarve kyseisen tuoteryhmän osalta ennen altistumista ko. markkinointiviestille. Tuotesijoittelu voidaan sisällyttää IMC-suunnitteluprosessiin markkinointiviestintästrategian kiinteänä osana. Integraatio markkinointiviestinnässä siten, että tuotesijoittelua tuettaisiin muilla viestintäkeinoilla yhtenäisen kampanjan kehittämiseksi on kuitenkin paljon ennakoitua harvinaisempaa, johtuen ehkä eniten tuotesijoittelun poikkeuksellisesta luonteesta ja kyseisen viestintämuodon vaikeasta hallittavuudesta markkinoijan taholta. Tutkimus toteutettiin normatiivisena case-tutkimuksena pääasiassa sekundäärisiä tietolähteitä hyödyntäen. Case-tutkimuksia varten kerättiin primääristä tietoa kyselylomakkeella kahdesta tuotesijoittelua käyttävästä kansainvälisestä yhtiöstä, jonka lisäksi myös sekundäärisiä tietolähteitä hyödynnettiin case-osan tiedonkeruussa.

Image guided critical screw placement precision in the cervical spine : important or incidental? : results of a series of 91 consecutive cases using OVEM

Study design: A retrospective study of image guided cervical implant placement precision. Objective: To describe a simple and precise classification of cervical critical screw placement. Summary of Background Data: "Critical" screw placement is defined as implant insertion into a bone corridor which is surrounded circumferentially by neurovascular structures. While the use of image guidance has improved accuracy, there is currently no classification which provides sufficient precision to assess the navigation success of critical cervical screw placement. Methods: Based on postoperative clinical evaluation and CT imaging, the orthogonal view evaluation method (OVEM) is used to classify screw accuracy into grade I (no cortical breach), grade la (screw thread cortical breach), grade II (internal diameter cortical breach) and grade III (major cortical breach causing neural or vascular injury). Grades II and III are considered to be navigation failures, after accounting for bone corridor / screw mismatch (minimal diameter of targeted bone corridor being smaller than an outer screw diameter). Results: A total of 276 screws from 91 patients were classified into grade I (64.9%), grade la (18.1%), and grade II (17.0%). No grade III screw was observed. The overall rate of navigation failure was 13%. Multiple logistic regression indicated that navigational failure was significantly associated with the level of instrumentation and the navigation system used. Navigational failure was rare (1.6%) when the margin around the screw in the bone corridor was larger than 1.5 mm. Conclusions: OVEM evaluation appears to be a useful tool to assess the precision of critical screw placement in the cervical spine. The OVEM validity and reliability need to be addressed. Further correlation with clinical outcomes will be addressed in future studies.

A cytophylogenetic study of Pacific black flies (Diptera: Simuliidae)

The sequential banding patterns of the larval salivary gland polytene chromosomes of seven species of Inseliellum (Diptera: Simuliidae) were mapped. This was completed through the comparison with the standard maps of an eighth species of Inseliellum, Simulium cataractarum. During chromosomal analysis, both fixed and floating inversions were identified. A floating inversion (IIL-l ex,2ex) revealed a cytotype within Simulium exasperans that is distributed between two islands, Moorea and Tahiti. Inversion data revealed three shared fixed inversions that could be used as phylogenetic characters. In addition, the placement of a chromosomal landmark (the nucleolar organizer, or NO) was used as a phylogenetic character. The result of a cytophylogenetic (transformational) analysis showed two groups: the NO-IL group, and the NO-IS group. A combined phylogeny was created using the published morphological data and the cytological data of the eight species. The combined tree did not differ from the morphological data only tree. Possible routes of dispersal are hypothesized using geological, chromosomal, and phylogenetic data. These data showed a general pattern of dispersal and colonization from older islands to younger islands, with one possible instance of dispersal from younger to older islands. It is postulated that inter-island speciation has allowed this dispersal and colonization, but intra-island speciation has created the diversity seen in Inseliellum.

The relationship between stem-form, stand-closure and site -conditions : the influence of environmental conditions on tree allometry and forest structure in west-central Alberta

Changes in the configuration of a tree stern result insignificant differences in its total volume and in the proportion of that volume that is merchantable timber. Tree allometry, as represented by stem-fo~, is the result of the vertical force of gravity and the horizontal force of wind. The effect of wind force is demonstrated in the relationship between stem-form, standclosure and site-conditions. An increase in wind force on the individual tree due to a decrease in stand density should produce a more tapered tree. The density of the stand is determined by the conditions that the trees are growing under. The ability of the tree to respond to increased wind force may also be a function of these conditions . This stem-form/stand-closure/site-conditions relationship was examined using a pre-existing database from westcentral Alberta. This database consisted of environmental, vegetation, soils and timber data covering a wide range of sites. There were 653 sample trees with 82 variables that formed the basis of the analysis. There were eight tree species consisting of Pinus contorta, Picea mariana, Picea engelmannii x glauca, Abies lasiocarpa, Larix laricina, Populus tremuloides, Betula papyrifera and Populus balsamifera plus a comprehensive all-species data set. As the actual conformation of the stern is very individual, stem-fo~was represented by the diameter at breast height to total height r~tio. The four stand-closure variables, crown closure, total basal area, total volume and total number of stems were reduced to total basal area and total number of stems utilizing a bivariate correlation matrix by species. Site-conditions were subdivided into macro, meso and micro variables and reduced in number 3 using cross-tabulations, bivariate correlation and principal components analysis as screening tools. The stem-fo~/stand-closure relationship was examined using bivariate correlation coefficients for stem-fo~ with total number of stems and stem-fo~ with total basal area. The stem-fo~/site-conditions and the stand-closure/site- conditions relationships were examined using multiple correlation coefficients. The stem-form/stand-closure/site-conditions relationship was examined using multiple correlation coefficients in separate analyses for both total number of stems and total basal area. An increase in stand-closure produced a decrease in stem-form for both total number of stems and total basal area for most species. There was a significant relationship between stem-form and site-conditions and between stand-closure and site-conditions for both total number of stems and total basal area for most species. There was a significant relationship between the stemform and site-conditions, including the stand-closure, for most species; total number of stems was involved independently of the site-conditions in the prediction of stem-form and total basal area was not. Larix laricina and Betula papyrifera were the exceptions to the trends observed with most species. The influence of both stand-closure (total number of stems in particular) and site-conditions (elevation in particular) suggest that forest management practices should include these- ecological parameters in determining appropriate restocking levels.

Joyce Chapman posing by an orange tree, 1998

Joyce Chapman posing by an orange tree, West Covina, California, 1998.

Excavating a fossilized tree that is now in front of Hashinger Hall

Excavating a fossilized tree, which was later placed in front of Hashinger Hall, Chapman University, 346 N. Center Street, Orange, California. The late Dr. Edward H. Hashinger, former trustee and past chairman of the board is the man whose name has graced the walls of this building since 1969. The Hashinger Science Center (3 floors, 65,364 sq.ft.) houses all science departments including biology, natural and applied sciences, environmental and chemical sciences, food science and nutrition, kinesiology and physical therapy.

Placing a fossilized tree in front of Hashinger Hall, Chapman College, Orange, California

Placing a fossilized tree in front of Hashinger Hall, Chapman College, 346 N. Center Street, Orange, California. The late Dr. Edward H. Hashinger, former trustee and past chairman of the board is the man whose name has graced the walls of this building since 1969. The Hashinger Science Center (3 floors, 65,364 sq.ft.) houses all science departments including biology, natural and applied sciences, environmental and chemical sciences, food science and nutrition, kinesiology and physical therapy.

Exploring Teacher Candidates’ Perception of Practicum Placement Within Concurrent Teacher Education in Two Ontario Universities

In this study, teacher candidates’ perception of their concurrent education program at two Ontario universities were examined, with specific emphasis on how the programs utilized practicum placements, to determine the effectiveness in preparing teacher candidates to teach. This research also strived to uncover the best ways to optimize concurrent teacher education through practicum placements. A questionnaire and interviews were used to uncover teacher candidates’ perceptions at one teacher education program that used full integration of practicum and one that used minimal integration of practicum. The findings revealed that teacher candidates were generally more satisfied with the overall program when there was full integration of practicum. There were statistically significant differences found between the two concurrent programs with regard to practicum time and preparedness and context of the practicum and a highly significant difference found for theory-practice divide. There was also a statistically significant difference (p < .05) observed between the teacher candidates at each university in terms of their beliefs about the need for improvement of their program. Some of the improvements that participants believed could be made to their respective programs included having (a) exceptional mentor teachers and teacher educators, (b) longer placements with a balance of observation and practicum teaching, (c) clear expectations and evaluations of practicum placement, and (d) more distinct connections between theory and practice made within the programs.