BACKGROUND:Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising ...concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years.
METHODS:The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.
RESULTS:Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identifiedGlasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study.
CONCLUSIONS:CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.
Product Lifecycle management (PLM) is a concept that aims to integrate the various processes and phases involved during a typical product lifecycle. This paper reports on the capture of requirements ...for PLM from five Industrial Partners in a FP7 project “advanced Platform for manufacturing engineering and Product Lifecycle Management” (amePLM). The objective of amePLM is to develop a software platform which will provide a collaborative extensible engineering platform that will leverage state-of-the art research on semantics, heuristics and visualization. The five Industrial Partners in amePLM vary in size (micro, SME to large) and by sector, from electronics, healthcare, advanced technology to engineering services. Independent of the company size and the sector it operates in the PLM requirements gathering reported in this paper shows that there are deficiencies in the support for collaboration, project management and visualization in the current PLM tools used by these companies. To capture requirements from the companies a new PLM requirements gathering methodology was developed which is reported on in the paper.
Spinal cord stimulation is limited by the uncomfortable side effects experienced by the patient as the amplitude of stimulation is increased. These side effects include local segmental paresthesias ...or motor responses, which are objectively demonstrable as frequency-following muscle contractions, attributable to dorsal root stimulation. The authors present evidence for another mechanism of stimulation-evoked discomfort, namely recruitment of small fibers in ligamentum flavum, which occurs when electrodes are inserted percutaneously and their contacts are exposed circumferentially; this does not occur with plate electrodes with insulated dorsal surfaces. In a consecutive series of 79 patients with postsurgical lumbar pain syndromes, percutaneous four-contact electrodes were tested at levels from T-8 through T-12. At one or more levels, 46% of patients described paravertebral, nonradiating discomfort, unaccompanied by frequency-following muscle contractions. This was observed most commonly at the T-8 and T-9 levels. The effect was ameliorated in some cases by using multiple cathodes in parallel, which reduced the current density at individual contacts. In 10 of these patients, this side effect interfered with an otherwise successful trial to such a degree that an insulated plate electrode was selected for permanent implantation at the same level as the percutaneous electrode. This eliminated the uncomfortable side effect completely in all patients. Intraoperative testing with the insulated plate electrode inverted (that is, contacts dorsal) reproduced the side effect in the majority of patients, indicating that structures dorsal to the electrode, such as fibers in ligamentum flavum, mediate the effect. Postoperative testing by computerized techniques demonstrated improved coverage of pain by stimulation paresthesias, with lower stimulation power requirements, using the insulated plate electrode. This technical limitation of percutaneous spinal cord stimulation electrodes, which may confound treatment if unrecognized, has been found to have a straightforward solution which indicates the underlying mechanism.
Engineering workflow management is a key focus for European manufacturing companies, however, issues such as time required to gather data, develop systems and integrate into current manufacturing ...environments presents obstacles for adoption. This paper presents a high level prototype of an engineering workflow system developed in conjunction with a medical device company to address this gap. The prototype data was used to construct a high level artifact which illustrates how the implementation of Advanced Platform for Manufacturing Engineering and Product Lifecycle Management (7th Programme, “amePLM”) engineering workflow management system can improve product design and development processes through increased productivity by capturing workflows which previously went unquantifiable.
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