Risky Site Research Articles

Limited incision harvest of the rectus abdominis muscle flap

Rectus abdominis muscle harvest typically uses a long and continuous paramedian approach. To limit donor site morbidity, the senior author performs a limited incision approach particularly useful in medically vulnerable patients, including patients with sternal wound infections. All patients of a single surgeon from 2000 to 2014 who underwent rectus harvest by one or two transverse incisions and use of lighted retractor were identified. Patients were categorized by indication, for “sternal wound coverage” or “non-sternal wound coverage.” Co-morbidities, operative notes, and post-operative courses were evaluated. Comparisons were made to patients undergoing harvest by paramedian approach. Seventeen patients with a mean age of 61 underwent limited-incision rectus harvest. Nine patients had indication for “sternal wound coverage.” Three patients had single transverse incision and six patients had double transverse incisions. One patient expired post-reconstruction day 3. One patient had complete abdominal and partial sternal wound dehiscence. No other donor site complications were observed. Eight patients had indication for “non-sternal wound coverage,” including seven patients requiring free rectus for lower extremity defects and one a pedicled rectus abominis for pelvic osteomyelitis. No post-operative complications were observed in these non-sternal wound coverage patients. There was a trend toward improved wound healing and hospitalization time using the transverse compared to paramedian technique, although this was not significant. The morbidity of the traditional paramedian incision for rectus harvest may be avoided using a limited skin incision approach. This is useful in patients with attenuated healing capacity and offers a lower risk approach to a traditionally risky donor site. Level of Evidence: Level IV, therapeutic study.

Titrating the Cost of Plant Toxins Against Predators: a Case Study with Common Duikers, Sylvicapra grimmia.

Foragers face many variables that influence their food intake. These may include habitat structure, time, climate, resource characteristic, food quality, and plant defenses. I conducted foraging experiments using common duikers that involved: 1) testing the effect of plant toxins on foraging, and 2) titrating toxin intake against safety. I used giving up densities (GUDs, food remaining after foraging) to test for selection among trays containing alfalfa pellets treated with water, with 10% oxalic acid, or 10% quebracho tannin. Pairs of trays were placed within islands of woody vegetation and out in open grass. I also conducted a titration experiment by offering the duikers a choice between a patch with water-treated pellets placed at a risky site, or a patch with one of three oxalic acid-treated pellets at a safe site. This made it possible to determine the concentration of oxalic acid at which the cost of toxin in the safe site equals the predation cost at the risky site. The common duikers showed no selectivity among the three treatments at 10% concentration, however, GUDs in the open grass (i.e., safe) were significantly lower than in the wooded islands (i.e., risky). As the oxalic acid concentration increased at the safe sites, the duiker's food intake from the risky sites increased significantly. The results demonstrate that foraging hazards may come in different forms such as predation and plant toxins, and their interactions may alter habitat use, foraging patterns, and perceptions of risk. These variables occur under natural situations, altering the overall habitat quality.

Cyberbullying: Examining Personality and Victims' Wall Postings as Risk Factors

This study examines the impact of risky social network site practices and individual differences in self-disclosure and personality on the likelihood of cyberbullying victimization among young adult Facebook users. Results from 572 respondents show that, as predicted, posting indiscreet or negative content, having Facebook friends who post such content, number of Facebook friends, and lack of privacy settings were all strong predictors of cyberbullying victimization. In addition, conscientiousness, extroversion and openness were all associated with cyberbullying victimization. Implications for individuals and organizations are provided.

EP-1087 RESULTS FROM A PHASE II NON RANDOMIZED TRIAL ON 145 PATIENTS WITH HEPATO-CELLULAR CARCINOMA WITH VMAT

Materials and Methods: This is a retrospective study of 106 patients with EBDC who received curative intent surgery. The definitions of tumor location were as follows: proximal EBDC from the confluent portion of the bilateral bile ducts to the junction of cystic duct, and distal EBDC between the junction of cystic duct and intrapancreatic portion. Twenty nine patients had proximal EBDC and 77 patients had distal EBDC. A total of 9 patients underwent postoperative adjuvant therapy; chemoradiotherapy for 7 patients and chemotherapy for 2 patients. Complications were graded by the Common Terminology Criteria for Adverse Events v4.0. Results: The median follow-up was 24 months for the surviving patients. The median overall survival (OS) and locoregional progression-free survival (LRPFS) were 46 months and 30 months in all patients, respectively. The 3-year OS and LRPFS rates were 54% and 49% for all locations, 43% and 39% for proximal EBDC, and 57% and 55% for distal EBDC, respectively. A total of 40 patients experienced locoregional recurrence (LRR) initially; 13 (45%) patients with proximal EBDC and 27 (35%) patients with distal EBDC. The area around hepatoduodenal ligament and adjacent tumor bed was the most commonly involved sites. Distant metastases were noted in 10 patients (34%) with proximal EBDC and 15 patients (19%) with distal EBDC. The liver was the most common organ of distant metastasis. In the multivariate analysis, perineural invasion and high level of postoperative CA 19-9 (> 37 U/ml) were associated with poor LRPFS, distant metastasis-free survival, and progression-free survival, while OS had association with angiolymphatic invasion, venous invasion, and CA 19-9. Grade 3 or more acute complications were occurred in 30 patients, and 1 patient died of complicated fluid collection followed by septic shock. Seventeen patients experienced Grade 3 or more chronic complication. Conclusions: Both proximal and distal EBDC showed considerable LRR probabilities without significant difference by tumor locations. The area around hepatoduodenal ligament and adjacent tumor bed, the risky site of LRR, could be routinely encompassed by adjuvant radiotherapy. We can speculate the addition of adjuvant radiotherapy can improve LRPFS in these patients. Especially adjuvant radiotherapy needs to be considered in the patients with perineural invasion and high postoperative CA 19-9 for better LRPFS.

Childcare Practices among Construction Workers in Chira Chas, Jharkhand

This study aims at examining the childcare practices and issues experienced by the low-income construction workers in India. It is concerned with understanding varied aspects relating to problems that construction workers, as parents, face while bringing up their children in one of the small construction companies of eastern India, in the state of Jharkhand. Qualitative methods have been used in order to collect the data based upon phenomenological principles. Ethnography and photo-elicitation were used as a primary method of data collection. Apart from this, in-depth interviews were also conducted with the workers of the construction company. Discussion with the participants led to the emergence of four themes: children left alone; playing at risky site areas; poor health of children; and children working along with parents. The research findings indicate that infants are taken by their parents to their place of work whereas children between five and 10 years had to be left alone at home. It was also found that acute poverty was a major cause leading to the consumption of inadequate and low nutritional food, leading to poor health of the children. Based on the study findings, there is an imperative that societal forerunners and philanthropists continue to use research findings to understand the childcare practices amongst the low-income workers and draft strategies accordingly, to improve the situation.

Measuring the risk of predation in an energy currency: field experiments with foraging blue tits, Parus caeruleus

A technique for measuring the ‘risk of predation’, in an energy currency, is described. Experiments on free-living blue tits determined the extent to which feeding in a risky site was compensated by making food easier to obtain. The birds were trained to use operant feeding devices which were placed at different distances from the edge of woodland tree cover. The reward schedules at the feeders were controlled by a computer, which adjusted the number of hops required to obtain a food reward in relation to the extent to which each feeder was used. When the feeders were used equally the reward schedules stabilized and were recorded. There was little difference in the final reward schedules of feeders placed under the cover of trees, but the frequency of reinforcement required to persuade the birds to feed in the open rose dramatically at relatively short distances (1·5m) from cover.