Background: Treatment for sagittal craniosynostosis often involves endoscopic suturectomy (ES) followed by helmet therapy, with cranial shape improvement assessed via cephalic index (CI). The effect of adding barrel-stave osteotomy (BSO) to ES on CI outcomes remains controversial. This study evaluated the impact of BSO on operative burden and postoperative cranial deformity in patients undergoing surgical correction of sagittal craniosynostosis. Methods: A retrospective review of 85 patients treated for sagittal craniosynostosis at BC Children’s Hospital (2010–2021) compared patients undergoing ES alone (n=18) and ES+BSO (n=67). Demographics, operative burden (anesthesia and surgical time, blood loss, hospital stay), and longitudinal CI measurements were analyzed. Mixed effects modeling controlled for age, preoperative CI, and helmet duration. Results: Operative burden did not differ significantly between treatment groups (p > 0.05). The median follow-up duration for CI measurements was 56.0 months. While preoperative CI was similar (67.4 vs. 66.8, p=0.61), CI was significantly improved in the ES+BSO group at all postoperative intervals (p ≤ 0.02). Mixed effects modeling confirmed that BSO independently improved CI (effect size 2.21, p=0.001). Conclusions: In our series, the addition of BSO to ES significantly improved immediate and long-term cranial deformity without increasing operative burden, supporting its use in sagittal craniosynostosis correction.

The interaction of telone with acid and base saturated montmorillonite furnished adsorption isotherms which possessed combined features of H (high affinity) and C (linear rising) class isotherms; a fall in pH, an increase in electrical conductivity and formation of chloride ions. The observations were indicative of a process of chemisorption, both at the planar and lateral sites of montmorillonites, followed by penetration and swelling of the substrate micropores with telone. A reaction mechanism for the process of chemisorption has been proposed.

The effect of pH, time and temperature on the interaction of zinc with acid and base saturated dickites has been investigated. Increase in pH resulted in an increase in adsorption of zinc in the higher concentration range. The adsorption increased rapidly and then slowly with increase in the time of interaction. The variation of rate constants and the half times of reaction suggested an exchange process controlled by film and possibly particle diffusion and thereafter fixation processes. The inferences found support from the nature of adsorption isotherms. Temperature affected adsorption with exothermic interactions. The activation energy of adsorption of zinc on Na-dickite was 14.0 kcal mole−1.

Background: Early placement of a ventricular access device (VAD) may decrease the need for permanent CSF diversion and improve cognitive outcomes in premature infants with intraventricular hemorrhage. In 2019, BC Children’s Hospital implemented a multidisciplinary early intervention pathway for these infants. This study evaluated process and compliance measures related to protocol implementation. Methods: A retrospective quality improvement chart review of enrolled infants was performed. Select measures included time to neurosurgery consult and intervention, compliance with VAD tapping and ultrasound protocols, overall ultrasound resource use, and complications. Results: Sixteen patients were included. Median time to VAD insertion was 6 days (IQR 4-9.5), greater than the 3-day target. Transfer time from peripheral NICUs and access to OR time were found to be important reasons for delay. Patients received a median 92.2% (IQR 85.1-100%) of the ultrasounds required by protocol, with a median of 36.5 (IQR 29-43.25) ultrasounds per patient. VAD tapping was 88.8% (IQR 75.6-94.8%) compliant; most protocol deviations were indicated taps not performed due to technical difficulties. Conclusions: Compliance with the new protocol was satisfactory. Areas for improvement include continued education at peripheral NICU sites to minimize transfer delays, improved access to the OR, and maintenance of technical skills amongst our NICU partners.

Background: Pineal region tumors are a heterogenous group of pathologies often symptomatic due to occlusive hydrocephalus leading to elevated intracranial pressure (ICP). High ICP may not always be associated with clinical signs. A non-invasive technique for assessment of ICP is measuring the optic nerve sheath diameter (ONSD). The goal of this study was to determine the utility of preoperative and postoperative ONSD measurements for assessment of elevated ICP in children with pineal region tumors. Methods: Retrospective data analysis was performed in patients operated for pineal region tumors at our tertiary care center between 2003 and 2022. Preoperative and postoperative MRI scans were reviewed. Clinical data and ONSD at multiple time points were analyzed and correlated. Results: Thirty-four patients with forty operative cases met the inclusion criteria. Hydrocephalus was seen in 80% of patients preoperatively (n=32/40). Presence of hydrocephalus was associated with significantly elevated ONSD preoperatively (p=0.006) and postoperatively (p=0.017). There was significant decrease in ONSD immediately postoperatively (p<0.001), at 3 months (p<0.001) and 12 months (p<0.001). In patients without hydrocephalus, no significant changes in ONSD were observed (p=0.369). Conclusions: ONSD is a useful adjunct for the identification of high ICP preoperatively and evaluation of treatment response postoperatively in patients presenting with pineal region tumors.

A total of 108 diverse sorghum (Sorghum bicolor) accessions were characterized for quantitative and qualitative fodder-related traits and zonate leaf spot (ZLS) (Gloeocercospora sorghi) disease during two successive wet seasons of 2019 and 2020 in augmented randomized block design. The Shannon's diversity index and analysis of variance showed the existence of significant variability among qualitative and quantitative traits. K-mean clustering showed strong relationship between green fodder yield (GFY) and other yield-contributing traits. The dendrogram constructed based on morphological traits classified accessions into four diverse groups and most of genotype fall under cluster II. The principal component analysis bi-plot analysis showed a total variation of 68.96%, where GFY, stem weight per plant, panicle length and dry matter yield (DMY) contributed significantly. From the experimental results, three sorghum genotypes viz., IG-03-424, IG-01-436 and IG-03-438 were identified as promising for higher GFY (808.66 g/plant) and DMY (238.0 g/plant), respectively. Further, based on disease reactions under natural condition, five genotypes viz., EC-512397, EC512393, EC512394, EC512399 and IG-02-437 were identified as potential donor for resistance to ZLS disease. These selected lines could be used as promising sources for high biomass and disease resistance in forage sorghum breeding programme.

U–Pb geochronology, Hf isotopes and trace-element chemistry of zircon grains from migmatite of the upper Sutlej valley (Leo Pargil), Northwest Himalaya, reveal a protracted geological evolution and constrain anatexis and tectonothermal processes in response to Himalayan orogenesis. U–Pb geochronology and ϵHf record separate clusters of ages on the concordia plots in the migmatite (1050–950 Ma, 850–790 Ma and 650–500 Ma). The 1050–950 Ma zircon population supports a provenance from magmatic units related to the assembly of Rodinia. A minor amount of Palaeoproterozoic grains were likely derived from the Indian craton. The potential source rock of the 930–800 Ma detrital zircons may be granitoid present in Greater Himalayan rocks themselves and the Aravalli Range, which has 870–800 Ma granitic rocks. The arc-type basement within the Himalayan–Tibet orogen recorded (900–600 Ma) igneous activity, which may depict a northeasterly extension of juvenile terranes in the Arabian–Nubian Shield. The granitoid of 800 Ma may be a potential source for 790 Ma detrital zircons owing to scatter in 206/238 dates. The 650–500 Ma zircon population suggests their derivation from the East African Orogen and Ross–Delamerian Orogen of Gondwana. The Cambrian–Ordovician magmatism during the Bhimphedian Orogeny and observed late Neoproterozoic to Ordovician detrital zircons have been derived to some extent from Greater Himalayan magmatic sources. We found no detrital zircon grains that cannot be explained as coming from local sources. One sample yielded a discordia lower intercept age of 15.6 ± 2.2 Ma, the age of melt crystallization.

Background: The frontal eye fields (FEFs) are linked to oculomotor control and hypothesized to reside in the prefrontal cortex, where electrical stimulation reportedly evokes contraversive eye movements. The exact location and function of the FEFs in humans is controversial. Stereo-electroencephalography (SEEG) is a minimally invasive technique used to guide epilepsy surgery. It provides a unique opportunity to collect human neurophysiological data outside of the operating room and has been used by other groups to advance our understanding of specific brain functions. Methods: Two pediatric subjects undergoing non-lesional epilepsy workup were enrolled into this prospective, IRB-approved study, and received brain MRI prior to SEEG implantation. SEEG recordings were collected with video of the subjects’ eyes while performing gaze-related tasks. Results: Stimulation testing elicited contraversive head turning with or without eye deviation, and hemifacial spasm, depending on the site of stimulation. Low-threshold sites eliciting these stereotyped movements were located just deep to the inferior precentral gyrus. Stimulation of sites in the posterior middle frontal gyrus did not elicit eye movements. Conclusions: Our findings suggest that the FEFs are located more posteriorly than widely held, involving the motor cortex. Further testing in pediatric and adult subjects is warranted to confirm this hypothesis.

Background: Hydrocephalus is a common pediatric condition but many neurosurgeons cannot continue to care for patients into adulthood. Although gaps in care are thought to exist for youth transitioning to adult care, little is known about how patients/caregivers feel about the process. This study examined the perceptions of adolescents and young adults transitioning from pediatric to adult care at a single centre. Methods: We explored the perceptions of patients/caregivers with hydrocephalus about the transitioning process using semi-structured interviews and the qualitative research methodologies of grounded theory. 40 patient/caregivers (7 adolescents, 13 young adults, 20 parents) from BC Children’s Hospital and the Hydrocephalus Clinic at Vancouver General Hospital. Interviews were transcribed verbatim and coded, with common themes identified. Results: Four themes relating to transitioning from pediatric to adult care were identified: (1): Poor communiction; (2) Uncertainty relating to living life as an adult with hydrocephalus; (3) Anxiety and fear regarding navigating a new health care environment; (4) sadness in the loss of the relationship with the pediatric health care team. Conclusions: We identified a general dissatisfaction with the transitioning process for hydrocephalus. Common themes and concerns identified may form the basis of an improved transitioning model for youth with hydrocephalus as they become adults.

The SARS-CoV-2 is transmitted not only through coughing, but also through breathing, speaking or singing. We perform direct numerical simulations of the turbulent transport of potentially infectious aerosols in short conversations, involving repetitive phrases separated by quiescent intervals. We estimate that buoyancy effects due to droplet evaporation are small, and neglect them. A two-way conversation is shown to significantly reduce the aerosol exposure compared with a relative monologue by one person and relative silence of the other. This is because of the ‘cancelling’ effect produced by the two interacting speech jets. Unequal conversation is shown to significantly increase the infection risk to the person who talks less. Interestingly, a small height difference is worse for infection spread, due to reduced interference between the speech jets, than two faces at the same level. For small axial separation, speech jets show large oscillations and reach the other person intermittently. We suggest a range of lateral separations between two people to minimize transmission risk. A realistic estimate of the infection probability is provided by including exposure through the eyes and mouth, in addition to the more common method of using inhaled virions alone. We expect that our results will provide useful inputs to epidemiological models and to disease management.

Presence of antimicrobial resistance (AMR) genes in Escherichia coli inhabiting anthropogenic rivers is an important public health concern because plasmid-mediated AMR genes can easily spread to other pathogens by horizontal gene transfer. Besides β-lactams, quinolones and aminoglycosides are the major antibiotics against E. coli. In the present study, we have investigated the presence of plasmid-mediated quinolone resistance (PMQR) and aminoglycoside resistance genes in E. coli isolated from a major river of northern India. Our results revealed that majority of the strains were phenotypically susceptible for fluoroquinolones and some aminoglycosides like amikacin, netilmicin, tobramycin and gentamicin. However, 16.39% of the strains were resistant for streptomycin, 8.19% for kanamycin and 3.30% for gentamicin. Of the various PMQR genes investigated, only qnrS1 was present in 24.59% of the strains along with ISEcl2. Aminoglycoside-resistance genes like strA-strB were found to be present in 16.39%, aphA1 in 8.19% and aacC2 in only 3.30% of the strains. Though, no co-relation was observed between phenotypic resistance for fluorquinolones and presence of PMQR genes, phenotypic resistance for streptomycin, kanamycin and gentamicin exactly co-related with the presence of the genes strA-strB, aphA1 and aacC2, respectively. Moreover, all the AMR genes discerned in aquatic E. coli were found to be situated on conjugative plasmids and, thus easily transferrable. Our study accentuates the importance of routine surveillance of urban rivers to curtail the spread of AMR genes in aquatic pathogens.

Background: Hydrocephalus is a common pediatric neurosurgical condition that requires lifelong care into adulthood. Significant gaps in care are thought to exist for youth transitioning to adult care, but little is known about how patients and their caregivers feel about the process. This study examines the perceptions of adolescents, young adults and caregivers when transitioning from pediatric to adult care at a single Canadian center. Methods: 40 patient/caregivers (7 adolescents, 13 young adults and 20 parents) treated at BC Children’s Hospital participated in semi-structured interviews using the qualitative research methodologies of grounded theory. Interviews were transcribed verbatim and coded, with common themes identified. Results: Four overarching themes relating to the process of transitioning from pediatric to adult care were identified: (1): Inadequacy of communication between pediatric and adult care teams and patients/caregivers; (2) Uncertainty relating to the prospect of life as an adult with hydrocephalus; (3) Anxiety and fear regarding navigating a new health care environment; and (4) sadness at the loss relationships with the pediatric health care team. Conclusions: We identified a general dissatisfaction with the transitioning process for hydrocephalus. Common themes and concerns identified may form the basis of an improved transitioning model for youth with hydrocephalus as they become adults.

In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, New Delhi was expedited at war footing level and converted into a COVID-19 Emergency response Centre (ERC). Engineering works were completed in a speedy manner and various patient care areas were equipped as deemed necessary for providing tertiary care to COVID-19 patients. A highly spirited team comprising of Emergency Medicine Specialists, Anesthesia and Critical Care specialist, Hospital Administrators and Nursing Officers was formed. Effective segregation of patient care areas into clean, contaminated, and intermediate zones was done using physical barriers and air conditioning modifications. The screening area for patients suspected of having COVID-19 was created in addition to a 2-step process i.e., Triage 1 and Triage 2, thereafter, patients requiring admission would be referred to the emergency area. An in-house designed and fabricated sampling booth was created to bring down the use of PPEs and for better infection control. The ERC has a general ward and state of the art intensive care units. Mobilizing resources (machinery, manpower, consumables etc.) during the lockdown required commitment from top leadership, motivated teams, expeditious procurement, coordination with multiple agencies working on site, expediting statutory clearances, coordination with police services, transportation of labor etc.

ABSTRACT IMPACT: Measuring and analyzing qualitative and quantitative traits using phenomics approaches will yield previously unrecognized heart failure subphenotypes and has the potential to improve our knowledge of heart failure pathophysiology, identify novel biomarkers of disease, and guide the development of targeted therapeutics for heart failure. OBJECTIVES/GOALS: Current classification schemes fail to capture the broader pathophysiologic heterogeneity in heart failure. Phenomics offers a newer unbiased approach to identify subtypes of complex disease syndromes, like heart failure. The goal of this research is to use data-driven associations to redefine the classification of the heart failure syndrome. METHODS/STUDY POPULATION: We will identify < 10 subphenotypes of patients with heart failure using unsupervised machine learning approaches for dense multidimensional quantitative (i.e. demographics, comorbid conditions, physiologic measurements, clinical laboratory, imaging, and medication variables; disease diagnosis, procedure, and billing codes) and qualitative data extracted from an integrated health system electronic health record. The heart failure subphenotypes we identify from the integrated health system electronic health record will be replicated in other heart failure population datasets using unsupervised learning approaches. We will explore the potential to establish associations between identified subphenotypes and clinical outcomes (e.g. all-cause mortality, cardiovascular mortality). RESULTS/ANTICIPATED RESULTS: We expect to identify < 10 mutually exclusive phenogroups of patients with heart failure that have differential risk profiles and clinical trajectories. DISCUSSION/SIGNIFICANCE OF FINDINGS: We will attempt to derive and validate a data-driven unbiased approach to the categorization of novel phenogroups in heart failure. This has the potential to improve our knowledge of heart failure pathophysiology, identify novel biomarkers of disease, and guide the development of targeted therapeutics for heart failure.