Background: Innovations in shunt technology and neuroendoscopy have been increasingly applied to shunt management. However, the relative life span of shunts and the etiology of shunt failure have not been characterized recently. Methods: We reviewed the records of all shunting procedures at our institution between January 1992 and December 1998. Independent predictors of shunt failure were analyzed via multivariate Cox regression analysis in 836 shunting procedures. Independent predictors of the etiology of failure (infection, proximal obstruction, distal malfunction) were analyzed via multivariate logistic regression analysis in the 383 shunts which failed. Results: A total of 353 pediatric patients underwent 308 shunt placements and 528 revisions. The risk (hazard ratio; HR) of shunt failure decreased as a function of time in both primary placements and revised shunts. In failed shunts, the odds of infection decreased 4-fold per year of shunt function, while the odds of distal malfunction increased 1.45-fold per year. Increasing number of shunt revisions (HR 1.31, p < 0.05), decreasing patient age in years (HR 1.04, p < 0.001), gestational age <40 weeks (HR 2.15, p < 0.001) but not the etiology of hydrocephalus were associated with an increased risk of shunt failure. Revisions versus primary placements, Dandy-Walker cysts and gestational age <40 weeks were independently associated with proximal, distal and infectious causes of failure, respectively. Conclusions: The long-term shunt revision rates observed here are similar to those reported over the past 2 decades. Shunt life span remains poorer in shunt revisions and in younger patients. Patient characteristics may suggest a specific risk and mechanism of failure, aiding in the long-term management of shunted hydrocephalus.
Water exchange is routinely used in shrimp culture. However, there are few, if any, systematic investigations upon which to base exchange rates. Furthermore, environmental impacts of pond effluent threaten to hinder further development of shrimp farming in the U.S. The present study was designed to determine effects of normal (25.0%/d), reduced (2.5%/d) and no (0%/d) water exchange on water quality and production in intensive shrimp ponds stocked with Penaeus setiferus at 44 postlarvae/m2. Additional no‐exchange ponds were stocked with 22 and 66 postlarvae/m2 to explore density effects. Water exchange rates and stocking density influenced most water quality parameters measured, including dissolved oxygen, pH, ammonia, nitrite, nitrate, Kjeldahl nitrogen, soluble orthophosphate, biochemical oxygen demand, phytoplankton and salinity. Reduced‐exchange and no‐exchange treatments resulted in reduced potential for environmental impact. Mass balance of nitrogen for the system indicates that 13–46% of nitrogen input via feed is lost through nitrification and atmospheric diffusion. Growth and survival were excellent in ponds with normal exchange, reduced exchange, and a combination of low density with no water exchange. A combination of higher stocking density and no water exchange resulted in mass mortalities. Mortalities could not be attributed to a toxic effect of any one water quality parameter. Production was 6,400 kg/ha/crop with moderate stocking density (44/m2) and reduced (2.5%/d) water exchange and 3,200 kg/ha/crop with lower stocking density (22/m2) and no water exchange. Results indicate that typical water exchange rates used in intensive shrimp farms may be drastically reduced resulting in a cost savings to farms and reduced potential for environmental impact from effluent.
For the Voluntary Observing Ships Special Observing Project for the North Atlantic (VSOP-NA), the layout, meteorological instrumentation, and observing practices of 45 voluntary observing ships (VOS) operating in the North Atlantic were cataloged. Over a two-year period these ships provided extra information with each observation, and the effect of different observing practices has been quantified by using analysis fields from an atmospheric forecast model as a comparison standard. Biases of order several tenths of a degree Celsius were detected in sea surface temperature data from engine intake thermometers, in dewpoint temperatures from screens (and to a lesser extent, psychrometers), and in air temperatures due to solar heating. Wind speeds from anemometers were high compared to visual winds by about 2 kt for winds up to about 25 kt. The VSOP-NA data do not, however, indicate which is the more accurate. Correction for anemometer height and use of the WMO Commission for Marine Meteorology version of the Beaufort scale reduced this difference significantly. The result of these corrections on mean heat flux estimates was only a few watts per square meter but much greater changes resulted for particular areas and seasons. The project identified observing methods that are to be preferred for future use on the VOS, and demonstrated that the combined use ofVOS data and a forecasting model allowed the detection of biases both in the observations and in the model analyses.
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