Repair of complex esophageal atresia with tracheobronchial remnant using special magnets.

Esophageal atresia (EA) repair can be complicated by associated malformations such as a tracheobronchial remnant in the distal esophagus. We describe our experience with a patient found to have long-gap EA with a distal cartilaginous ring who was managed using a combination of esophageal lengthening and magnetic compression anastomosis. A 5-month-old girl was referred to us from an outside hospital with type C EA including a very high upper pouch. She had undergone a prior thoracotomy with fistula ligation during which a clip was placed on the lower esophagus, leaving a 2-cm diverticulum on the trachea and a short lower esophageal pouch. Upon endoscopic evaluation at our center, we found a tracheobronchial remnant in the lower esophagus between the clip and the carina. An open thoracotomy was performed to approximate the esophageal pouches and a magnet anchor (Connect EA, Myka Laboratories, San Francisco, California, United States) was placed retrograde through the distal esophageal cartilaginous ring into the lower pouch. On postoperative day 8, after adequate growth and decreased pouch tension, a second magnetic anchor was placed endoscopically to the upper pouch to mate with the previously placed lower pouch anchor. The anastomosis formed within 14 days. Due to the tracheobronchial remnant, the device did not pass distally and was removed endoscopically. On postoperative day 8, balloon dilation of the anastomosis and tracheobronchial remnant was performed. Subsequently, the patient required a total of 6 dilations in an 18-month follow-up. This case report illustrates the utility of using magnets to create an esophageal anastomosis in complex cases of EA with concomitant esophageal malformations. The parents of the patient gave their written consent to publish this technical report.

Does the COVID-19 pandemic lockdown affect risk attitudes?-Evidence from rural Thailand.

Empirical research provides evidence on changes in individuals' risk attitudes after experiencing exogenous shocks. The global outbreak of the COVID-19 pandemic has had various adverse impacts on economies and households. This study utilizes the COVID-19 pandemic and the accompanying lockdown to explore its impact on risk attitudes in rural Thailand using a difference-in-difference (DiD) approach. Overall, we do not find evidence on considerable changes in the willingness to take risks of rural household members after experiencing a lockdown during the pandemic. However, a significant heterogenous effect is found between individuals working inside and outside the agricultural sector. Individuals working outside the agricultural sector have a statistically significant reduction in their willingness to take risks after experiencing a lockdown. Our study provides additional empirical evidence to understand the impact of shocks on rural households' risk attitudes. This sheds light on how policy designs can better help mitigate downward economic trends following exogenous shocks.

Using a joint triage model for multi-hospital response to a mass casualty incident in New York city.

This paper defines a specific plan which allows two separate institutions, with different capabilities, to function as a single receiving entity in the event of a mass casualty incident. The street between the two institutions will be closed to traffic and a two-phase process initiated. Arriving ambulances will first be quickly screened to expedite the most critical patients followed by formal triage and directing patients to one of the two facilities. Preparation for this plan requires prior coordination between local authorities and the administrations of both institutions. This plan can serve as a general model for disaster preparedness when two or more institutions with different capabilities are located in close proximity.