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When approaching complex abdominal wall hernias at either index operation or a subsequent reoperation for recurrent incarcerated abdominal wall hernias, a majority of surgeons consider mesh placement a key step in the prevention of a future recurrence. While the laparoscopic and open approaches show no significant difference in hernia recurrence, the laparoscopic approach to complex abdominal wall hernias does reduce surgical-site infection, postoperative ileus, improves short-term quality-of-life scores, and reduces hospital length of stay (Davies et al. in Am Surg 78(8):888-892, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500604/ , 2012, McGreevy et al. in Surg Endosc 17(11):1778-1780, https://www.ncbi.nlm.nih.gov/pubmed/12958679 , 2003, Bittner et al. in Surg Endosc 33:3069-3139, https://doi.org/10.1007/s00464-019-06907-7 , 2019). In this paper, we describe a robotic approach with a pulley technique to the fixation of polypropylene mesh in complex abdominal wall reconstruction. Our primary aim is to offer a new perspective to the re-creation of challenging abdominal walls and to encourage other surgeons to gain proficiency in the robotic approach. Additionally, the material cost to the technique is lower than that of self-expanding or deployable mesh reinforcements used in other laparoscopic approaches. Over time, as an institution breaks even on the cost of a robot with their return on investment, this technique offers potential cost-saving., (© 2020. Springer-Verlag London Ltd., part of Springer Nature.)

Roles of hospital risk managers have grown over the last 30 years. Once largely focused on hospital liability risk management, risk managers today have a broader set of enterprise risk management responsibilities. The following commentary about a surprise billing case considers roles of risk managers in promoting cost and price transparency., (© 2020 American Medical Association. All Rights Reserved.)

Objective: Stark health inequalities exist in the present day between the North and South of England, with people in the South, overall, experiencing better health across a range of parameters (e.g., life expectancy and number of years spent in good health). Bioarchaeological studies of skeletal remains from cemeteries across this geographical divide have the ability to provide a temporal perspective on the etiology, longevity, and nature of this disparity., Methods: In total 574 non-adults (0-17 years) from six urban sites (c. AD 1711-1856) were analyzed from the North and South of England. Measurements of long bone length, cortical thickness, and vertebral dimensions were analyzed alongside both skeletal and dental palaeopathological data to assess patterns of disease and growth disruption between skeletal samples., Results: There were few significant differences in growth parameters between the six sites in relation to geographical location. However, the northern-based sample Coach Lane (North Shields) demonstrated some of the highest rates of pathology, with metabolic disease being particularly prevalent., Discussion: Northern and southern populations suffered alike from the detrimental environmental conditions associated with urban centers of the 18th-19th centuries. However, the elevated prevalence of vitamin D deficiency seen within the Coach Lane sample is indicative of a regionally specific risk that may be related to latitude, and/or the influence of particular industries operating in the North-East., (© 2019 Wiley Periodicals, Inc.)

Introduction: Unplanned office visits due to cast-related problems in the pediatric orthopedic office are common. Decreasing problems associated with the use of a cast would improve patient safety, increase office productivity, and decrease inconvenience to the child and family., Methods: Pediatric patients treated with a cast in our office were included in the study if they returned for an unplanned office visit due to a cast-related problem. Group 1 received verbal cast care instruction. Group 2 had the same verbal instruction in addition to a written handout identical to the verbal instructions. Group 3 was provided the same verbal instructions and a revised handout limiting the number of instructions and focused on keeping the cast away from water., Results: The study included 550 patients with 146 in group 1, 124 in group 2, and 280 in group 3. Comparing group 1 (10.3%) and group 2 (10.5%), there was almost no difference in the rate of unplanned office visits due to cast-related problems. Combining the revised handout with verbal instructions in group 3, the percentage of patients returning for an unplanned visit was 6%. There was a relative decrease in office visits by 55% and an absolute decrease of 4.5% when comparing group 2 and group 3., Conclusions: There was a decrease in the number of unplanned office visits due to cast problems utilizing a handout focused on keeping the cast dry in collaboration with verbal cast care instructions. However, the decrease was not statistically significant.

Integration of horizontally acquired genes into transcriptional networks is essential for the regulated expression of virulence in bacterial pathogens. In Salmonella enterica, expression of such genes is repressed by the nucleoid-associated protein H-NS, which recognizes and binds to AT-rich DNA. H-NS-mediated silencing must be countered by other DNA-binding proteins to allow expression under appropriate conditions. Some genes that can be transcribed by RNA polymerase (RNAP) associated with the alternative sigma factor σ S or the housekeeping sigma factor σ 70 in vitro appear to be preferentially transcribed by σ S in the presence of H-NS, suggesting that σ S may act as a counter-silencer. To determine whether σ S directly counters H-NS-mediated silencing and whether co-regulation by H-NS accounts for the σ S selectivity of certain promoters, we examined the csgBA operon, which is required for curli fimbriae expression and is known to be regulated by both H-NS and σ S . Using genetics and in vitro biochemical analyses, we found that σ S is not directly required for csgBA transcription, but rather up-regulates csgBA via an indirect upstream mechanism. Instead, the biofilm master regulator CsgD directly counter-silences the csgBA promoter by altering the DNA-protein complex structure to disrupt H-NS-mediated silencing in addition to directing the binding of RNAP., (© 2018 John Wiley & Sons Ltd.)

The 18th and 19th centuries in England were characterised by a period of increasing industrialisation of its urban centres. It was also one of widening social and health inequalities between the rich and the poor. Childhood is well-documented as being a stage in the life course during which the body is particularly sensitive to adverse socio-economic environments. This study therefore aims to examine the relationship between health and wealth through a comprehensive skeletal analysis of a sample of 403 children (0-17 years), of varying socio-economic status, from four cemetery sites in London (c.1712-1854). Measurements of long bone diaphyseal length, cortical thickness, vertebral neural canal size, and the prevalence of a range of pathological indicators of health stress were recorded from the Chelsea Old Church (high status), St Benet Sherehog (middle status), Bow Baptist (middle status), and Cross Bones (low status) skeletal collections. Children from the low status Cross Bones site demonstrated deficient growth values, as expected. However, those from the high status site of Chelsea Old Church also demonstrated poor growth values during infancy. Fashionable child-care practices (e.g. the use of artificial infant feeds and keeping children indoors) may have contributed to poor infant health amongst high status groups. However, differing health risks in the lower status group revealed the existence of substantial health inequality in London at this time., (© 2016 The Authors International Journal of Osteoarchaeology Published by John Wiley & Sons Ltd.)

Objective: Family meals are associated with a healthier diet among children and adolescents, but how family meal frequency varies in the U.S. population overall by household food availability and sociodemographic characteristics is not well characterized., Design: The U.S. National Health and Nutrition Examination Survey 2007-2010 assessed the frequency of family meals eaten at home in the past week and the household availability of fruits, dark green vegetables, salty snacks, and sugar-sweetened beverages., Setting: Computer-assisted face-to-face interviews with a selected adult (≥18 years) who owned or rented the home (i.e., the household reference person)., Subjects: We analyzed information on family meal frequency for 18,031 participants living in multi-person households in relation to sociodemographic characteristics and food availability., Results: Among the U.S. population living in households of two or more individuals, the prevalence (95% confidence interval) of having 0-2, 3-6 and ≥7 family meals/week was 18.0% (16.6-19.3), 32.4% (31.0-33.9), and 49.6% (47.8-51.4), respectively. Greater household availability of fruits and dark green vegetables and less availability of salty snacks and sugar-sweetened beverages was associated with more frequent family meals. Family meals were more prevalent in low-income households and those in which the reference person was ≥65 years, married, or had less than high school education., Conclusions: About half of the US population living in households of 2 or more people shares meals frequently with their family at home. Family meal frequency was positively associated with a healthier pattern of household food availability.

Objective: Traditional methods of detecting growth disruption have focused on deficiencies in the diaphyseal length of the long bones. This study proposes the implementation of vertebral measurements (body height and transverse diameter of the neural canal) from non-adults (0-17 years) as a new methodology for the identification of growth disruption., Methods: Measurements of vertebral body height and transverse diameter were taken from 96 non-adult skeletons and 40 adult skeletons from two post-medieval sites in England (Bow Baptist, London and Coronation Street, South Shields). Non-adult measurements were plotted against dental age to construct vertebral growth profiles through which inter-population comparisons could be made., Results: Results demonstrated that both sites experienced some growth retardation in infancy, evident as deficiencies in transverse diameter. However, analysis of vertebral body height revealed different chronologies of growth disruption between the sites, with a later age of attainment of skeletal maturity recorded in the Bow Baptist sample., Discussion: These vertebral dimensions undergo cessation of growth at different ages, with transverse diameter being "locked-in" by ∼1-2 years of age, while vertebral body height may continue to grow into early adulthood. These measurements can therefore provide complementary information regarding the timing of growth disruption within archaeological populations. Non-adult vertebral measurements can increase our osteobiographical understanding of the timings of episodes of health stress, and allow for the analysis of growth when other skeletal elements are fragmentary., (© 2015 The Authors American Journal of Physical Anthropology Published by Wiley Periodicals, Inc.)

Background: Recruitment into large, preconception randomised clinical trials (RCT) is challenging. We describe clinic and community-based preconception recruitment strategies for the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial and highlight approaches that were and were not successful. This longitudinal RCT was conducted at four major sites in the US. Eligible women had one to two prior pregnancy losses and were actively trying to become pregnant., Methods: Provider/clinic and community-based outreach strategies were utilised, and the recruitment rate and costs of methods were assessed., Results: A screening questionnaire was completed by 5485 women; 42.4% (n = 2323) screened were initially eligible, of whom 50.7% (n = 1228) were randomised. Provider/clinic-based recruitment yielded the highest number eligible of those screened (30.1%) and also the most randomised participants overall (40.3%). The next highest yield came from direct mail and brochures/flyers at 13.1% and 12.5% of women randomised, respectively. However, direct mailings cost $720 per participant randomised. Other than word of mouth, provider/clinic-based recruitment was the most cost effective method, costing an average of $60 per randomised participant. Web-based recruitment yielded 4.7% of participants at a cost of $278 per randomised participant., Conclusions: Provider and clinic-based recruitment was the most effective and cost-efficient method of recruitment in a preconception intervention study of reproduction among women., (© 2015 John Wiley & Sons Ltd.)