text:
CDIShort for Customer Data Integration, it is the combination of the technology, processes, and services needed to create and maintain an accurate, timely and complete view of the customer across multiple channels, business lines, and, potentially, enterprises, where there are multiple sources of customer data in multiple application systems and databases. [Adapted from Gartner Research]
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From wacky alarm clocks to lecture hall tools and after class entertainment, these Android apps are a good fit for a student's life and budget. Read More »Sharing Threat Intelligence
A growing number of startups make the sharing of threat intelligence a key part of their solutions. Read More »Smiley Faces and Symbols
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Please confirm your places for tomorrow's session- it's looking busy so make sure your child is on the list! Also send us an activity request from your child and we'll see if we can include it!
Out of 'office'
Into the wilds of Galicia for a couple of weeks… bikes and tents are coming with us of course!
See some of you in September!
September session
Who's up for a last gasp of summer fun on Wednesday 2nd September?! Beat those back-to-school blues with some nature immersion at Ironwood ! Get in touch by Wednesday 12th August to register your interest.

subset: commoncrawl


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As the 2012 Toronto International Film Festival draws to a close, we look back at all the red carpet hits and misses and pick out the 10 best and 10 worst looks.
The 10 Best and 10 Worst Outfits at TIFF 2012
6 / 20
10 Best and 10 Worst TIFF 2012 Outfits
WORST: We're sure "Saving Hope" star Wendy Crewson was going for "casually tousled and care-free" with that hair, but it comes off as messy and much too big. Add to that the unfortunately leopard print dress (which may have worked if it were cut with a more flattering neckline) and the gold lamé flowers on her shoes, and this entire look is just one big miss.
Tune in Today for an Exclusive Live Chat With Tom Hanks and Steven Spielberg!
Yahoo Movies Staff


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Early detection.
Accurate diagnosis.
Proper treatment.
"Wear Red for Women's Hearts" Poster 18" x 24"
For all the artists and art lovers! Support WomenHeart by purchasing a
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8/20/2015WomenHeart Launches First Virtual Support Network For Women Living with Atrial Fibrillation
8/19/2015Womenheart To Host First National Policy & Science Summit On Women's Cardiovascular Health


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Man charged with DUI 3October 03,2013Local man faces
third DUI charge
WINHALL Police said a Danby man with two prior charges of drunken driving had a blood-alcohol content three times the legal limit when he was pulled over on Route 30.
George L. Savage Jr., 49, pleaded innocent Monday in Rutland criminal court to a felony charge of drunken driving, third offense, as well as a misdemeanor charge of driving with a suspended license.
Police said they stopped Savage on Route 30 in Winhall for speeding and crossing the double line Saturday night. Police said Savage was slurring his words, slow to respond to questions and had a cold, half-full beer in his cup holder.
Police said a breath test showed Savage had blood-alcohol content of .245, more than three times the legal limit of .08 for driving.
Savage was held in Rutland hail on $2,500 bail until his arraignment Monday. He is now free without bail, but must check in daily with Manchester police for alcohol testing.MORE IN This Just In
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This article is part of the Peculiar Panels series.
E the Shaggy thinks it was a mistake to begin the first installment of Peculiar Panels with a morbid image, and after careful consideration I couldn't agree more.
Source: Batman Vol. 1 #1
Esplanade knows that people have a difficult time wrapping their heads around the sociopolitical atmosphere surrounding the Sochi Olympics. Hopefully this image will clear things up.
Source: Jungle Comics #13
MelvinTheJerk provides a sobering glimpse of Captain America stepping way out of line. Not cool, cap. Not cool at all. What the hell were you thinking, man?
Source: Avengers Vol. 1 #7
Exit Strategy doesn't understand why everyone keeps making fun of Google Glass when it's clearly amazing.
Source: Batman, Inc. #7
Random Stranger suspects that the always demanding J. Jonah Jameson might have pushed Peter Parker too far this time.
Source: Spidey Super Stories #56
Lurdiak knows exactly what's happening here. You do too, don't you?
Source: ???
NoneMoreNegative can hardly believe how much has changed in the sport of football over just a few decades.
Source: 1950s Green Arrow comic
Is the world ready for Staind By Me, St@nd By e-Me, and Crank 3: Stand By Me?
Finally: an advice column for the rest of us! (Who seek to enslave humanity.)
The Goons make political Magic: The Gathering cards (with bonus jokes for people who actually play)!
In the latest Metal Gear twist, Big Boss could be ANYONE - politicians, celebrities, dogs, even YOU!
A Goon outs himself as a wizard and gets a warm reception from the rogues/rangers/paladins gallery!
The Something Awful front page news tackles anything both off and on the Internet. Mostly "on" though, as we're all incredible nerds.
The most outlandish and puzzling comic book panels discovered by the goons in Batman's Shameful Secret.
Copyright ©2015 Rich "Lowtax" Kyanka & Something Awful LLC.


text:
Town Square
Atherton woman pleads no contest to DUI
Original post made on Feb 8, 2012
Read the full story here Web Link posted Wednesday, February 8, 2012, 10:52 AM
Comments (4)
a resident of another community
on Feb 8, 2012 at 12:20 pm
With prior DUI's, certainly she had no driver's license either. DMV & passive judges would NEVER allow that, would they?
a resident of Atherton: West Atherton
on Feb 8, 2012 at 2:15 pm
Can someone post what her car looks like and license plate? I would like to know when to turn off the road to avoid her.
a resident of Atherton: West Atherton
on Feb 8, 2012 at 5:48 pm
Hopefully, she will get the full 6 years. Think of how many of her neighbors will be safer for that period. Shame on the justice system for not locking her up after one of the earlier DUIs.
How badly hurt were the latest victims? Being crushed between cars cannot be fun.
a resident of another community
on Sep 20, 2012 at 9:38 am
Sentenced yesterday to 5 years in prison.
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Su Hong Menlo Park changes hands after 38 years
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SpongeBob SquarePants
this wiki
|I'm Ready!
|~ Spongebob hyped and excited when he was ready.
Full Name
SpongeBob SquarePants
SpongeBob, Mr. Squarepants, Spongeboob
SpongeBob SquarePants
Fry Cook at The Krusty Krab
Limb Regeneration
Making Krabby Patties
Varies on episode
Type of Hero
Aquatic Hero
SpongeBob SquarePants is the titular main protagonist of the popular animated television series of the same name and is voiced by Tom Kenny. He first appeared on television in the series' pilot episode Help Wanted on May 1, 1999. Spongebob was created and designed by cartoonist Stephen Hillenburg shortly after the cancellation of Rocko's Modern Life in 1996. Hillenburg intended to create a series about an over-optimistic sponge that annoys other characters. Hillenburg compared the concept to Laurel and Hardy and Pee-wee Herman. As he drew the character, he decided that a "squeaky-clean square" (like a kitchen sponge) fits the concept. His name is derived from "Bob the Sponge", the host of Hillenburg's comic strip The Intertidal Zone that he originally drew in 1989 while studying at the California Institute of Arts.
SpongeBob is dimwitted (although he is smarter than his starfish friend). However, he is goofy and loyal. He lives in a pineapple house in the fictional underwater town of Bikini Bottom.
SpongeBob has achieved popularity with both children and adults, though he has been involved in public controversy. The character appeared in a We Are Family Foundation video promoting tolerance, which was criticized by James Dobson of Focus on the Family because of the foundation's link to homosexuality. SpongeBob is an anthropomorphic kitchen-type sponge with two buck teeth, blue eyes, wears brown rectangular-like pants (probably attached to the white shirt with the red tie), black shoes, and red/blue-striped socks.
SpongeBob is hyper, clueless, honest, kind-hearted, naive, friendly and optimistic. He works as a fry cook at the Krusty Krab Resturant in the underwater town of Bikini Bottom. He loves his job very much and performs it very well, even though his greedy cheap boss Mr. Krabs pays him poorly if not rarely. He can also get very overly reacted. Like from the episode The Bully, he started getting real petrified of getting his butt kicked from new student Flatts the Flounder. But it was turned out that as a sponge, he did not get hurt much after all. SpongeBob also cares for his loyal pet snail, Gary, who only meows like a cat, and loves hanging out with his best brainless friend, Patrick Star, a friendly but dim-witted pink sea star who lives under rock. Their middle neighbor is Squidward Tentacles, a grumpy, ill-tempered and self-centered octopus who lives in an Easter Island Tiki head-shaped house and hates both SpongeBob and Patrick with a passion because of their annoying antics, maturity you would expect from a sponge and starfish, and them always ruining his day. However, they are both unaware of this and believe him to be their closest friend. SpongeBob's other best friend is Sandy Cheeks, an anthropomorphic female squirrel from Texas, who is a highly scientist and karate expert. It may be hinted she and SpongeBob have crushes on each other, as in Truth of Sponge, a clip scene show them married, though it turned out to be a play despite the priest didn't realized it. There's a possibility however, that Spongebob actually had a part-time job at that moment, and Sandy actually volunteered to help him.
He may be served as Nickelodeon's mascot.
- Harold SquarePants (father)
- Claire Gretchen SquarePants (mother)
- Uncle Captian Blue (paternal uncle)
- Sherm SquarePants (paternal uncle)
- Grandpa SquarePants (paternal grandfather)
- Grandma SquarePants (paternal grandmother)
- BlackJack (cousin)
- Stanley S. SquarePants (cousin)
- Todd SquarePants (cousin)
- Larry SquarePants (cousin)
- Gary (snail)
Similar Heroes
- Bumblebee (Transformers series)
- Dudley Puppy (T.U.F.F. Puppy)
- Little Nicky
- Mickey Mouse (Disney universe)
- Pee Wee Herman
- Spike the Dragon (My Little Pony Friendship is Magic)
- Krusty the Clown (The Simpsons)
- Ned Flanders (The Simpsons)
- Lenny (Shark Tale)
- Po (Kung Fu Panda)
- Shrek
- Oscar (Shark Tale)


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A mother's grief in losing her son was compounded by having to consider whether to file a claim against Los Alamos County for his death.
Tonya Collins' son Logan, 12, died from injuries after being struck by a pickup last fall.
"One thing I struggled with this whole time was the idea of getting money from my son's death," said Collins of White Rock Tuesday. "But I had his medical bills to pay plus my insurance company wanted me to pay because Tylerr (the driver involved in accident) was uninsured."
The county and the estate of Logan Collins reached a settlement agreement approved by the First Judicial District Court June 3. Under the agreement, the county will pay $504,000, through the New Mexico Self Insurer's Fund, into an account set aside for Collins' estate, according to a statement issued by county spokeswoman Julie Habiger.
The New Mexico Self-Insurers Fund, which represented the county in the settlement, is an insurance pool of New Mexico municipalities and other political subdivisions, including the county, through the New Mexico Municipal League.
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Are you Christopher R Forrest?Claim your profile
Publications (122)251.79 Total impact
- [Show abstract] [Hide abstract]
ABSTRACT: Cranio-orbital remodeling aims to correct the dysmorphic skull associated with craniosynostosis. Traditionally, the skull is reconstructed into a shape that is subjectively normal according to the surgeon's perception. We present a novel technique using a mathematical algorithm to define the optimal location for bony osteotomies and to objectively reshape the fronto-orbital bar into an ideal normal skull contour.Using pre-operative computed tomography images, the abnormal skull contour at the frontal-orbital region was obtained for infants planned to undergo cranio-orbital remodeling. The ideal skull shape was derived from an age- and sex-matched normative skull library. For each patient, the mathematical technique of dynamic programming (DP) was applied to compare the abnormal and ideal skull shapes. The DP algorithm identifies the optimal location of osteotomy sites and calculates the objective difference in surface area remaining between the normative and dysmorphic skull shape for each solution applied. By selecting the optimal solution with minimal objective difference, the surgeon is guided to reproducibly recreate the normal skull contour with defined osteotomies.The DP algorithm was applied in 13 cases of cranio-orbital remodeling. Five female and 8 male infants with a mean age of 11 months were treated for craniosynostosis classified as metopic (n = 7), unicoronal (n = 4), or bicoronal (n = 2). The mean OR time was 190.2 min (SD 33.6), mean estimated blood loss 244 cc (SD 147.6), and 10 infants required blood transfusions. Compared with a historical crania-orbital remodeling group treated without application of the algorithm, there was no significant difference in OR time, estimated blood loss, or transfusion rate.This novel technique enables the craniofacial surgeon to objectively reshape the fronto-orbital bar and reproducibly reconstruct a skull shape resembling that of normal infants.The Journal of craniofacial surgery 07/2015; 26(5):e416-e419. DOI:10.1097/SCS.0000000000001878 · 0.68 Impact Factor
Article: Psychometrics: Essential for Valid, Reliable, and Responsive Measurement in the Development of Patient-reported Outcome Instruments in Plastic Surgery12/2014; 2(12):e280. DOI:10.1097/GOX.0000000000000197
Article: Is Linear Advancement Related to Relapse in Unilateral Cleft Lip and Palate Orthognathic Surgery?[Show abstract] [Hide abstract]
ABSTRACT: Objective : To investigate the stability of major versus minor Le Fort I maxillary advancements in unilateral cleft lip and palate (UCLP) patients. Design : A retrospective longitudinal study was undertaken on 30 nonsyndromic UCLP patients treated with the same protocol at The Hospital for Sick Children, Toronto, Canada. Patients were grouped into major and minor movement groups based on planned surgical advancement. Standard lateral cephalometric radiographs were taken preoperatively (T1), immediately postoperatively (T2), and at least 1 year postoperatively (T3). Skeletal and dental variables were measured using cephalometric analysis. Stability was compared between groups using repeated-measures analysis of variance. Linear regression analysis was used to assess the relationship between advancement and relapse for the entire study population. Results : A mean maxillary advancement of 9.8 mm and 4.9 mm was seen for the major (n = 10) and minor (n = 20) movement groups, respectively. The mean skeletal horizontal relapse was 1.8 mm (18%) for the major advancement group and 1.5 mm (31%) for the minor advancement group. There was no significant difference in skeletal horizontal relapse between the groups (P > .05). The correlation coefficient (r) between linear horizontal advancement and relapse was calculated to be .31 (P > .05). Dental horizontal relapse was not significant for either the major or minor groups, and no significant difference was found between the groups (P > .05). Conclusion : Skeletal and dental relapse was found to be unrelated to the amount of maxillary linear advancement using conventional Le Fort I osteotomies in UCLP.The Cleft Palate-Craniofacial Journal 09/2014; DOI:10.1597/14-061.1 · 1.20 Impact Factor
Article: Maxillary Advancement and Velopharyngeal Insufficiency (VPI): Assessing risk and determining management options in high risk patientsJournal of Oral and Maxillofacial Surgery 09/2014; 72(9):e46-e47. DOI:10.1016/j.joms.2014.06.078 · 1.43 Impact Factor
Article: Maxillary Advancement and the presence of pre-operative pharyngeal flap in cleft palate patients: Speech and Relapse ImplicationsJournal of Oral and Maxillofacial Surgery 09/2014; 72(9):e23. DOI:10.1016/j.joms.2014.06.040 · 1.43 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Hemifacial microsomia is a hypoplastic disorder of the first and second branchial arches that significantly impacts on the development of the jaws, leading to malocclusion and facial asymmetry. There is little in the literature regarding the application of orthodontic/orthognathic approaches to the correction of these deformities and the stability of the surgical results. To address this, a retrospective chart review of 10 patients with complete orthodontic records and greater than 1 year of follow-up was performed. Posteroanterior cephalograms were assessed by modified Grummons analysis to determine mandibular offset (deviation of the chin point from the skeletal midline) and occlusal cant. These measurements were performed at 3 time points (T1: preoperative, T2: immediate postoperative, T3: follow-up) to elucidate the surgical movement (T2-T1), the postoperative relapse (T3-T2), and the net gain movement (T3-T1). Maxillary movements were quantified, and the occlusal cant was expressed as a ratio between vertical heights of the maxilla at the first molar on each side. One sample t test demonstrated statistically significant surgical movement and net gain. Relapse was statistically insignificant. Repeated-measures analysis of variance demonstrated similar results for chin point position relative to the putative midline. Our results suggest that a combined orthodontic/orthognathic approach at skeletal maturity delivers improved occlusal outcomes in the long term as assessed by chin point deviation and occlusal cant, but secondary surgery rates are higher than those for orthognathic surgery in other patient groups. We advocate limiting surgery to skeletal maturity whenever possible to achieve stable long-term results while limiting morbidity and number of procedures.Journal of Craniofacial Surgery 07/2014; 25(5). DOI:10.1097/01.SCS.0000435808.91512.58 · 0.68 Impact Factor
Article: Single Versus Segmental Maxillary Osteotomies and Long-Term Stability in Unilateral Cleft Lip and Palate Related Malocclusion[Show abstract] [Hide abstract]
ABSTRACT: Purpose To investigate the stability of single piece versus segmental (2-piece) maxillary advancement in unilateral cleft lip and palate (UCLP) patients treated using conventional Le Fort I orthognathic surgery. Methods A retrospective study was undertaken on 30 non-syndromic UCLP patients treated with the same surgical and orthodontic protocol between 2002 and 2011. Standard lateral cephalometric radiographs were taken preoperatively, immediately postoperatively, and at least 1 year postoperatively. Patients were divided into single piece and segmental Le Fort I groups based on planned surgical movement. Postoperative movements were compared between groups using repeated measure analysis of variance. Results The mean skeletal horizontal advancement was 7.3 and 7.5mm in the single piece and segmental groups, respectively. The skeletal horizontal relapse was 1.3mm (18%) for the single piece group and 1.9mm (25%) for the segmental group. The skeletal surgical extrusion was 2.7mm for both groups. The skeletal vertical relapse was 0.6mm (22%) and 1.5mm (56%) for the single piece and segmental groups, respectively. The mean dental horizontal postoperative movement for the single piece group was advancement of 0.4mm and for the segmental group a relapse of 0.2mm (3%). The mean dental vertical relapse was 0.1mm (4%) for the single piece and 0.3mm (11%) for the segmental group. There was no statistically significant difference in relapse between the single and segmental groups for all movements (p>0.05). Conclusion Skeletal and dental relapse was similar between single piece and segmental maxillary advancements using conventional Le Fort I orthognathic surgery in UCLP patients.Journal of Oral and Maxillofacial Surgery 07/2014; 72(12). DOI:10.1016/j.joms.2014.07.005 · 1.43 Impact Factor
Article: Direct Genesis of Functional Rodent and Human Schwann Cells from Skin Mesenchymal Precursors[Show abstract] [Hide abstract]
ABSTRACT: Recent reports of directed reprogramming have raised questions about the stability of cell lineages. Here, we have addressed this issue, focusing upon skin-derived precursors (SKPs), a dermally derived precursor cell. We show by lineage tracing that murine SKPs from dorsal skin originate from mesenchymal and not neural crest-derived cells. These mesenchymally derived SKPs can, without genetic manipulation, generate functional Schwann cells, a neural crest cell type, and are highly similar at the transcriptional level to Schwann cells isolated from the peripheral nerve. This is not a mouse-specific phenomenon, since human SKPs that are highly similar at the transcriptome level can be made from neural crest-derived facial and mesodermally derived foreskin dermis and the foreskin SKPs can make myelinating Schwann cells. Thus, nonneural crest-derived mesenchymal precursors can differentiate into bona fide peripheral glia in the absence of genetic manipulation, suggesting that developmentally defined lineage boundaries are more flexible than widely thought.Stem Cell Reports 07/2014; 3(1). DOI:10.1016/j.stemcr.2014.05.011 · 5.37 Impact Factor
Article: Abstract 150Plastic & Reconstructive Surgery 03/2014; 133:166-167. DOI:10.1097/01.prs.0000444978.37313.56 · 2.99 Impact Factor
Article: Quantitative Facial Asymmetry: Using Three-Dimensional Photogrammetry to Measure Baseline Facial Surface Symmetry[Show abstract] [Hide abstract]
ABSTRACT: Although symmetry is hailed as a fundamental goal of aesthetic and reconstructive surgery, our tools for measuring this outcome have been limited and subjective. With the advent of three-dimensional photogrammetry, surface geometry can be captured, manipulated, and measured quantitatively. Until now, few normative data existed with regard to facial surface symmetry. Here, we present a method for reproducibly calculating overall facial symmetry and present normative data on 100 subjects. We enrolled 100 volunteers who underwent three-dimensional photogrammetry of their faces in repose. We collected demographic data on age, sex, and race and subjectively scored facial symmetry. We calculated the root mean square deviation (RMSD) between the native and reflected faces, reflecting about a plane of maximum symmetry. We analyzed the interobserver reliability of the subjective assessment of facial asymmetry and the quantitative measurements and compared the subjective and objective values. We also classified areas of greatest asymmetry as localized to the upper, middle, or lower facial thirds. This cluster of normative data was compared with a group of patients with subtle but increasing amounts of facial asymmetry. We imaged 100 subjects by three-dimensional photogrammetry. There was a poor interobserver correlation between subjective assessments of asymmetry (r = 0.56). There was a high interobserver reliability for quantitative measurements of facial symmetry RMSD calculations (r = 0.91-0.95). The mean RMSD for this normative population was found to be 0.80 ± 0.24 mm. Areas of greatest asymmetry were distributed as follows: 10% upper facial third, 49% central facial third, and 41% lower facial third. Precise measurement permitted discrimination of subtle facial asymmetry within this normative group and distinguished norms from patients with subtle facial asymmetry, with placement of RMSDs along an asymmetry ruler. Facial surface symmetry, which is poorly assessed subjectively, can be easily and reproducibly measured using three-dimensional photogrammetry. The RMSD for facial asymmetry of healthy volunteers clusters at approximately 0.80 ± 0.24 mm. Patients with facial asymmetry due to a pathologic process can be differentiated from normative facial asymmetry based on their RMSDs. Diagnostic, II.The Journal of craniofacial surgery 01/2014; 25(1):124-8. DOI:10.1097/SCS.0b013e3182a2e99d · 0.68 Impact Factor
Article: Computed Tomography-Based Morphometric Analysis of Extended Strip Craniectomy for Sagittal Synostosis[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study is 2-fold: (1) to identify computed tomography (CT)-based morphometric parameters that differentiate the normal skull from one with sagittal synostosis and (2) to evaluate correction of sagittal synostosis with extended strip craniectomy and postoperative helmeting based on morphometric parameters. An institutional review board-approved, retrospective review was carried out at the Hospital for Sick Children for all patients who underwent an extended strip craniectomy and postoperative helmeting for sagittal synostosis from 1999 to 2005. Inclusion criteria consisted of patients who underwent a routine craniofacial CT preoperatively and 12 months postoperatively. Craniofacial CT scans of age-matched control subjects were used for preoperative and postoperative comparison. Thirty-nine patients with sagittal synostosis met inclusion criteria. Median age at preoperative CT was 3.0 months. Nine control subjects were identified, with a median age at CT scan of 5.0 months. Patients with sagittal synostosis preoperatively had a significantly longer maximum cranial length, smaller maximum cranial breadth, more acute frontal takeoff and occipital incline angles, lower cephalic index, and an anteriorly positioned vertex. Postoperative CT scans (median, 17.0 months) were compared with 10 control subjects (median, 19.0 months). Patients with sagittal synostosis postoperatively had equivalent maximum cranial breadth, frontal takeoff, and occipital incline angles as compared with controls. Sagittal synostosis patients remained with a significantly longer maximum cranial length, lower cephalic index, and anteriorly positioned vertex. Twelve months following extended strip craniectomy and helmeting for sagittal synostosis, CT-based morphometric analysis demonstrated correction of cranial breadth, frontal bossing, and occipital bulleting. Skull length and vertex position did not fully correct.The Journal of craniofacial surgery 01/2014; 25(1):42-7. DOI:10.1097/SCS.0000000000000478 · 0.68 Impact Factor
Article: Surgical outcomes in craniosynostosis reconstruction: The use of prefabricated templates in cranial vault remodelling[Show abstract] [Hide abstract]
ABSTRACT: Cranio-orbital reshaping for anterior cranial-vault deformities associated with craniosynostosis traditionally relies on the surgeon's subjective estimate of the shape and appearance of a normal forehead. Computer-aided design/computer-aided manufacture (CAD/CAM) bandeau templates to guide reconstruction were introduced in our centre to eliminate this subjectivity and to effect more reproducible surgical results. The aim of this study was to compare two groups of patients (template, n = 14 vs. no template, n = 23) to measure surgical outcomes. The virtual, computational version of the template was used as an outcome assessment tool. It was used to calculate an intervening area under the curve (AUC) between the normative template and the patient's reconstructed supra-orbital bar on a representative computed tomography (CT) axial section. A comprehensive chart review was conducted of patients in both groups to examine the preoperative and postoperative variables. Based on the analysis performed on the immediate postoperative CT scans, in the template group - as compared to the control, no-template group - the use of the bandeau template led to a greater reduction in AUC (74% vs. 56%, p = 0.016), indicating a better conformity between the reconstructed supra-orbital bar and the ideal, normal bandeau shape. The duration of operation was significantly reduced with the use of the template (212 vs. 258 min, p < 0.001). The application of prefabricated templates in cranio-orbital reshaping is highly useful for accurate preoperative planning; reproducible and efficient intra-operative correction of dysmorphology; and objective surgical outcomes assessment. Therapeutic Level III.Journal of Plastic Reconstructive & Aesthetic Surgery 09/2013; 67(1). DOI:10.1016/j.bjps.2013.09.009 · 1.42 Impact Factor
Article: Paediatric craniofacial fibrous dysplasia: The Hospital for Sick Children experience and treatment philosophy[Show abstract] [Hide abstract]
ABSTRACT: Craniofacial fibrous dysplasia is a benign developmental anomaly in which normal bone is replaced by fibro-osseous tissue. The aim of this study was to audit the patient population at a tertiary paediatric centre and report our treatment protocols. A retrospective chart review of all patients with craniofacial fibrous dysplasia treated at the Hospital for Sick Children between 1999 and 2010 was performed. The treatment algorithm used by our centre is presented. A total of 55 patient records were reviewed; 37 patients had sufficient documentation for study; 27 (16 male, 11 female) patients underwent surgery at our institution, of these patients, 26 had post-operative follow up of greater than one year (mean 41 months; median 24 months). Mean age at presentation was 9.9 years (median 10 years) and mean age of surgery was 13 years. Ten patients underwent surgery on the fronto-orbital region, 7 of the calvarium, 2 the skull base and 8 upon tooth-bearing bones. Fourteen cases underwent debulking surgery as their primary therapy whereas 13 patients had complete resection. Nine patients experienced recurrence and all but one case of these occurred in patients that underwent debulking therapy. When age of surgery is considered, total resection and reconstruction or debulking surgery after skeletal maturity has a lower recurrence rate (1/7 cases) than earlier surgery (8/16). Complete resection at any age and debulking surgery once skeletal maturity has been reached may be associated with lower recurrence rates than incomplete resections at an earlier age. Patients with McCune-Albright syndrome may benefit from repeated debulking procedures rather than complex resections and reconstructions.Journal of Plastic Reconstructive & Aesthetic Surgery 07/2013; 66(10). DOI:10.1016/j.bjps.2013.05.031 · 1.42 Impact Factor
Article: Abstract 138Plastic & Reconstructive Surgery 05/2013; 131:105. DOI:10.1097/01.prs.0000430080.26061.ec · 2.99 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: This article discusses the measurement of outcomes in craniofacial and pediatric plastic surgery, using examples of craniosynostosis and cleft lip and/or palate (CLP). The challenges in measuring the standard outcomes of function, aesthetics, and health-related quality of life are discussed, along with the importance of developing evidence and studying quality improvement in this specialty. The need to define specific and comprehensive goals is discussed with a focus on patient-reported outcomes (PROs). Examples from the development of the CLEFT-Q, a PRO instrument for patients with CLP, are provided to support the need to seek the patient perspective.Clinics in plastic surgery 04/2013; 40(2):305-312. DOI:10.1016/j.cps.2012.11.005 · 0.91 Impact Factor
Article: Pharmacologic Prophylactic Treatment for Perioperative Protection of Skeletal Muscle from Ischemia-Reperfusion Injury in Reconstructive Surgery[Show abstract] [Hide abstract]
ABSTRACT: : In autogenous muscle transplantation, unpredictable complications can cause prolonged ischemia, resulting in ischemia-reperfusion injury. The authors investigated the efficacy and mechanism of nicorandil, a nitrovasodilator and adenosine triphosphate-sensitive potassium channel opener, in inducing perioperative protection of muscle flaps from ischemia-reperfusion injury. : Pigs (18.2 ± 2.4 kg) were assigned to one control and eight treatment groups. Bilateral latissimus dorsi muscle flaps were raised after saline administration (control) and 0, 4, 8, 12, 24, 48, 72, and 96 hours after nicorandil administration. Subsequently, flaps were subjected to 4 hours of ischemia and 48 hours of reperfusion. Viability was assessed, and biochemical probes were used to study nicorandil-induced infarct protection. : Protection by nicorandil was biphasic. Infarction reduced from 40.2 ± 1.9 percent (control) to 27.3 ± 1.7 percent and 24.0 ± 2.3 percent (p < 0.05) 0 and 4 hours after nicorandil administration, respectively (early phase protection). No difference was seen between control and treatment groups between 8 and 12 hours after nicorandil administration compared with the control. Infarct protection increased again (p < 0.05) at 24 (22.4 ± 2.0 percent), 48 (25.1 ± 2.1 percent), and 72 hours (28.5 ± 2.1 percent) but not at 96 hours (43.9 ± 4.6 percent) compared with control (late phase protection). The sarcolemmal and mitochondrial channels played a central role in the trigger and mediator mechanisms, respectively. Late protection was associated with lower myeloperoxidase activity and mitochondrial calcium overload and higher adenosine triphosphate content (p < 0.05). : Nicorandil induced 48-hour uninterrupted muscle infarct protection, starting 24 hours after intravenous administration. This category of clinical drug is a potential prophylactic treatment against skeletal muscle ischemia-reperfusion injury in reconstructive surgery.Plastic and Reconstructive Surgery 03/2013; 131(3):473-85. DOI:10.1097/PRS.0b013e31827c6e0b · 2.99 Impact Factor
Article: Outcome analysis after helmet therapy using 3D photogrammetry in patients with deformational plagiocephaly: The role of root mean square[Show abstract] [Hide abstract]
ABSTRACT: Deformational plagiocephaly (DP) is a multifactorial non-synostotic cranial deformity with a reported incidence as high as 1 in 7 infants in North America. Treatment options have focused on non-operative interventions including head repositioning and the use of an orthotic helmet device. Previous studies have used linear and two dimensional outcome measures to assess changes in cranial symmetry after helmet therapy. Our objective was to demonstrate improvement in head shape after treatment with a cranial molding helmet by using Root Mean Square (RMS), a measure unique to 3D photogrammetry, which takes into account both changes in volume and shape over time. Three dimensional photographs were obtained before and after molding helmet treatment in 40 infants (4–10 months old) with deformational plagiocephaly. Anatomical reference planes and measurements were recorded using the 3dMD Vultus® analysis software. RMS was used to quantify symmetry by superimposing left and right quadrants and calculating the mean value of aggregate distances between surfaces. Over 95% of the patients demonstrated an improvement in symmetry with helmet therapy. Furthermore, when the sample of infants was divided into two treatment subgroups, a statistically significant correlation was found between the age at the beginning of treatment and the change in the RMS value. When helmet therapy was started before 7 months of age a greater improvement in symmetry was seen. This work represents application of the technique of RMS analysis to demonstrate the efficacy of treatment of deformational plagiocephaly with a cranial molding helmet.Journal of Plastic Reconstructive & Aesthetic Surgery 01/2013; 67(2). DOI:10.1016/j.bjps.2013.09.036 · 1.42 Impact Factor
Article: Craniofacial Syndromes and Surgery[Show abstract] [Hide abstract]
ABSTRACT: Learning objectives: After studying this article, the participant should be able to: (1) Understand craniofacial dysmorphology and identify basic pediatric craniofacial syndromes. (2) Understand the functional concerns associated with these syndromes. (3) Achieve familiarity with the management protocols for the treatment of pediatric craniofacial syndromes. Summary: This article provides an overview of the diagnosis and management of infants and children with craniofacial syndromes. Treatment protocols from The Hospital for Sick Children, Toronto, Ontario, Canada, and Seattle Children's Hospital, Seattle, Washington, are highlighted.Plastic and Reconstructive Surgery 01/2013; 131(1):86e-109e. DOI:10.1097/PRS.0b013e318272c12b · 2.99 Impact Factor
Article: Combination of Hypoxic Preconditioning and Postconditioning Does Not Induce Additive Protection of Ex Vivo Human Skeletal Muscle From Hypoxia/Reoxygenation Injury[Show abstract] [Hide abstract]
ABSTRACT: We previously demonstrated that hypoxic preconditioning (HPreC) or postconditioning (HPostC) protected ex vivo human skeletal muscle from hypoxia/reoxygenation injury. Here, we investigated if combined HPreC and HPostC could convey additive protection. Human rectus abdominis muscle strips were cultured in normoxic Krebs buffer for 5 hours (control) or in 3 hours hypoxic/2 hours normoxic buffer (treatment groups). HPreC and HPostC were induced by 1 cycle of 5 minutes hypoxia/5 minutes reoxygenation immediately before or after 3 hours hypoxia, respectively. Muscle injury, viability, and adenosine triphosphate (ATP) synthesis were assessed by measuring lactate dehydrogenase release, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide reduction, and ATP content, respectively. Hypoxia/reoxygenation caused lactate dehydrogenase to increase and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide reduction and ATP content to decrease (P < 0.05; n = 7). HPreC, HPostC, and combination of both were equally effective in protection of muscle from hypoxia/reoxygenation injury. Atractyloside (5 × 10 M), a mitochondrial permeability transition pore opener, abolished the protective effect of HPreC or HPostC. We conclude that HPreC and HPostC protect ex vivo human skeletal muscle against hypoxia/reoxygenation injury by closing the mitochondrial permeability transition pore. For that reason, they are equally effective and do not demonstrate an additive effect. Moreover, the potent effect of HPostC indicates ischemic postconditioning as an effective clinical intervention against reperfusion injury in autogenous skeletal muscle transplantation and replantation surgery.Journal of cardiovascular pharmacology 06/2012; 60(4):347-56. DOI:10.1097/FJC.0b013e318262c961 · 2.14 Impact Factor
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ABSTRACT: Abstract Objective: This study explored the experiences of adolescent girls with cleft lip and palate who were preparing for orthognathic surgery. Design: A qualitative study, based on a phenomenological approach, explored adolescents' experiences. Two one hour long semi-structured interviews were conducted before surgery, and member checking was employed to verify findings with each participant. Setting: A tertiary care pediatric hospital in central Canada. Participants: A criterion sampling technique was used to recruit a sample of seven participants with cleft lip and palate ranging in age from 15 to 20 years who were scheduled for cleft orthognathic surgery. Results: Participants described experiencing teasing, bullying and stares. In many cases, participants sought to resist and dismiss negative social attitudes about their visible difference while working to combat this with a positive view of who they really are. To varying degrees, participants felt constricted in engaging in the community as they were worried what others thought of their visible difference. They worked at finding ways to reduce the impact of social stigma through coping strategies, social supports and reconstructive surgery. Conclusions: Adolescent girls can experience strain associated with living with a facial difference; however, they find strategies to cope with the perception of difference. Reconstructive surgery is viewed as a means to increase confidence. Further intervention is needed in understanding and addressing stigma and fostering resiliency related to female adolescents living with a facial difference. Key Words: craniofacial, cleft lip and palate, adolescents, qualitative research, orthognathic surgery, social stigma.The Cleft Palate-Craniofacial Journal 05/2012; 50(2). DOI:10.1597/10-278 · 1.20 Impact Factor
Top Journals
Toronto, Ontario, Canada
- Division of Plastic Surgery
University of Toronto
Toronto, Ontario, Canada
- • Hospital for Sick Children
- • Department of Surgery
- • Sunnybrook Health Sciences Centre
St. Michael's HospitalToronto, Ontario, Canada
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
- Department of Plastic Surgery


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"The people helped us sing when I walked up. And I started saying, 'Come on, come on.' And when the people started helping us sing it made it easier for me because had it just been us I don't know if we would have made it through. But as I started encouraging the people to sing it made it a lot easier for me and for her. And she was able to finish it."
Brian Facchini, former Blazers basketball communications coordinator, now with the Thunder
"I remember walking into the arena a little later than I normally would and the announcer was going through his read. So I stopped in the tunnel and listened to the start of the anthem. Then it just stopped. I felt so bad for her that I turned and walked about 20 yards to the press room. As soon as I get in there I see Mo on the T.V. standing with here and remember saying to the stats crew, "What the heck is Mo doing out there?" I immediately went back out and when I get there the entire arena is signing the anthem. It was amazing. When you watch it now, what I notice most is the way he encouraged her. It was pure Mo."