bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of the internal damping rubber elements of the roller wheel of tracked system
Authors: Korostelev S A , Verbilov A F
Published: December 2019

The article presents the formulation and solution of the problem of optimization of the internal damping rubber elements of the roller wheel of tracked system. The optimal design search is based on the results of calculating the stress-strain state of the rubber element caused by the assembly of the roller and operational loads. As an objective function, the specific energy of deformation of the rubber was chosen. The geometric parameters of the rubber element of the roller wheel in the initial state and after installation in the structure are taken as variable parameters. Explicit and functional constraints in the form of inequations are imposed on the variable parameters. As a result of solving the optimal design problem, the shape and design parameters of the internal damping rubber elements of the track roller of the tracked system were obtained, which made it possible to reduce the specific strain energy during radial loading by 1.85 times
Assessment of the technical condition of the units of mobile robotechnical complexes based on the approaches of nonlinear dynamics and artificial intelligence
Authors: Kabaldin Yu.G. , Shatagin D. A. , Sidorenkov D. A. , Zhelonkin M.V. , Anosov M. S.
Published: December 2019

Neural network algorithms for monitoring and diagnosing the technical condition of parts of the MRC drive axle are considered. The formalized task is a comprehensive assessment of the technical condition in the neural network basis. An engineering technique is proposed that can be applied at the stages of bench tests of critical components and assemblies.
Engine-and-transmission installation frequency analysis of a wheeled forestry tractor
Authors: Churakov A.V. , Sokolova V.A. , Markov V.A. , Parfenopulo G.K. , Kalyashov V.A.
Published: December 2019

The article provides a frequency analysis of an engine-and-transmission installation of a wheeled forestry tractor. It can be used for machine-building enterprises of the forest complex. During the wheeled forestry tractors operation in the engine-and-transmission installation, resonance phenomena may occur when the internal frequencies of the system coincide with the external disturbance. The solution of the problem was carried out on the basis of the developed equivalent dynamic circuit, which was described by the differential equations of torsional vibration. As a result of solving these equations, the values of the engine-and-transmission installation natural frequencies were obtained. A comparative analysis of the frequencies obtained with regard to the damping properties of the system has been made, and possible resonance zones have been identified. The information obtained allows selecting the optimal damping indicators for the wheeled forestry tractor engine-and- transmission installation operation in a resonant-free mode.
Sound Generation under Rotary-Screw Propulsion Unit Base Cylinder Bending
Authors: Erasov I. A. , Kuklina I.G. , Molev Y.I. , Mokerov D.S. , Skrebneva T.G.
Published: December 2019

Theoretical results of sound generation parameters under rotary-screw propulsion unit base cylinder bending are dealt with in this article. Base cylinder parameters impact such as diameter, wall thickness, length as well as such vehicle movement parameters impact as speed and mass on noise level appearing at rotary-screw propulsion unit passing a single obstacle are analyzed in the paper. Sound vibrations onset conditions are shown. Research results allow one to conclude that a considerable sound level generated by rotary-screw propulsion units can appear only when the vehicle mass to rotor diameter ratio is greater than 25. The model produced and the results obtained might be useful when designing cross-country vehicles.
Outbreak of an Uncommon Rifampin-resistant blaNDM-1Citrobacter amalonaticus Strain in a Digestive Rehabilitation Center: The Putative Role of Rifaximin
Authors: Royer Guilhem , Fourreau Fréderic , Gomart Camille , Maurand Audrey , Hacquin Bruno , Ducellier David , Cizeau Florence , Lo Stéphane , Cordonnier-Jourdin Catherine , Mercier-Darty Mélanie , Decousser Jean-Winoc
Published: December 2019

We describe a sudden 2-week outbreak due to a blaNDM-1Citrobacter amalonaticus strain in a 22-bed digestive rehabilitation center. Three of the 5 colonized patients received long-term rifaximin treatment to prevent hepatic encephalopathy. The strains were genotypically identical, phenotypically resistant to rifampin, and harbored arr-3, a rifampin adenosine diphosphate-ribosyl transferase.
Are we using the right tools to manage variation, errors and omissions?
Authors: Arya Dinesh K
Published: December 2019

In all processes, there is an inherent risk of variability to occur. In the process of delivering healthcare, variability can occur as a result of an error or omission and compromise the quality of care or affect the safety of the health care consumer. Even though incident reporting, root cause analysis, use of checklists and other quality improvement methods are in wide-spread use, we may not be using these tools appropriately and therefore we are losing an opportunity to improve the quality of care.
Serum-Associated Antibiotic Tolerance in Pediatric Clinical Isolates of Pseudomonas aeruginosa
Authors: Morrison John M , Chojnacki Michaelle , Fadrowski Jeffrey J , Bauza Colleen , Dunman Paul M , Dudas Robert A , Goldenberg Neil A , Berman David M
Published: December 2019

Background

When grown in human serum, laboratory isolates of Pseudomonas aeruginosa exhibit tolerance to antibiotics at inhibitory concentrations. This phenomenon, known as serum-associated antibiotic tolerance (SAT), could lead to clinical treatment failure of pseudomonal infections. Our purpose in this study was to determine the prevalence and clinical impact of SAT in Pseudomonas isolates in hospitalized children.

Methods

The SAT phenotype was assessed in patients aged <18 years admitted with respiratory or blood cultures positive for P. aeruginosa. The SAT phenotype was a priori defined as a ≥2-log increase in colony-forming units when grown in human serum compared with Luria-Bertani medium in the presence of minocycline or tobramycin.

Results

SAT was detected in 29 (64%) patients. Fourteen patients each (34%) had cystic fibrosis (CF) and tracheostomies. Patient demographics and comorbidities did not differ by SAT status. Among CF patients, SAT was associated with longer duration of intravenous antibiotics (10 days vs 5 days; P < .01).

Conclusions

This study establishes that SAT exists in P. aeruginosa from human serum and may be a novel factor that contributes to differences in clinical outcomes. Future research should investigate the mechanisms that contribute to SAT in order to identify novel targets for adjunctive antimicrobial therapies.
Cannabis tourist destinations: risk for vulnerable travellers with pre-existing mental disorders
Authors: Bonny-Noach Hagit , Sagiv-Alayoff Moran
Published: December 2019

In recent years, more countries have decriminalized and legalized cannabis, and have become cannabis tourism destinations. Little has been published about individuals with pre-existing mental health disorders who use cannabis during travel. Health professionals should pay greater attention to cannabis use among vulnerable travellers before, during, and after their travel.
Relationship Between Shoulder Impingement Syndrome and Thoracic Posture
Authors: Hunter Donald J , Rivett Darren A , McKeirnan Sharmain , Smith Lyn , Snodgrass Suzanne J
Published: December 2019

Background

Shoulder impingement syndrome (SIS) is the most common form of shoulder pain and a persistent musculoskeletal problem. Conservative and invasive treatments, aimed at the shoulder joint, have had limited success. Research suggests shoulder function is related to thoracic posture, but it is unknown whether thoracic posture is associated with SIS.

Objective

The objective of this study was to investigate whether there is a relationship between SIS and thoracic posture.

Design

This was a case control study.

Methods

Thoracic posture of 39 participants with SIS and 39 age-, gender-, and dominant arm-matched controls was measured using the modified Cobb angle from a standing lateral radiograph. Thoracic range of motion (ROM) was also measured using an inclinometer. Between-group differences were compared using t tests. The relationship between thoracic posture and thoracic ROM was determined with linear regression.

Results

Twenty women and 19 men with SIS (mean age = 57.1 years, SD = 11.1) and 39 age-matched, gender-matched, and dominant arm-matched controls (mean age = 55.7years, SD = 10.6) participated. Individuals with SIS had greater thoracic kyphosis (mean difference = 6.2o, 95% CI 2.0–10.4) and less active thoracic extension (7.8o, 95% CI = 2.2–13.4). Greater thoracic kyphosis was associated with less extension ROM (ie, more flexion when attempting full extension: β = 0.71, 95% CI = 0.45–0.97).

Limitations

These cross-sectional data can only demonstrate association and not causation. Both radiographic measurements and inclinometer measurements were not blinded.

Conclusion

Individuals with SIS had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with SIS.
Trustee residual obligation: no basis for it
Authors: Davern Ray
Published: December 2019

This article discusses the recent decision of the Hong Kong Court of Final Appeal in Zhang Hong Li and others v DBS Bank (Hong Kong) Limited and others that has rejected the idea of a ‘residual’ or ‘high-level supervisory’ obligation upon trustees and accordingly endorsed the effectiveness of a well-drawn anti-Bartlett clause that sought to exclude any obligation upon the trustee to intervene in the management of an underlying company other than in the case of actual knowledge of dishonesty.
Correction and Control of Hyperammonemia in Acute Liver Failure: The Impact of Continuous Renal Replacement Timing, Intensity, and Duration
Authors: Warrillow Stephen , Fisher Caleb , Bellomo Rinaldo
Published: December 2019

Objectives:

Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continuous renal replacement therapy use in acute liver failure patients and to assess its impact on hyperammonemia.

Design:

Retrospective observational study.

Setting:

ICU within a specialized liver transplant hospital.

Patients:

Fifty-four patients with acute liver failure.

Interventions:

Data were obtained from medical records and analyzed for patient characteristics, continuous renal replacement therapy use, ammonia dynamics, and outcomes.

Main Results:

Forty-five patients (83%) had high grade encephalopathy. Median time to continuous renal replacement therapy commencement was 4 hours (interquartile range, 2–4.5) with 35 (78%) treated with continuous venovenous hemodiafiltration and 10 (22%) with continuous venovenous hemofiltration. Median hourly effluent flow rate was 43 mL/kg (interquartile range, 37–62). The median ammonia concentration decreased every day during treatment from 151 µmol/L (interquartile range, 110–204) to 107 µmol/L (interquartile range, 84–133) on day 2, 75 µmol/L (interquartile range, 63–95) on day 3, and 52 µmol/L (interquartile range, 42–70) (p < 0.0001) on day 5. The number of patients with an ammonia level greater than 150 µmol/L decreased on the same days from 26, to nine, then two, and finally none. Reductions in ammonia levels correlated best with the cumulative duration of therapy hours (p = 0.03), rather than hourly treatment intensity.

Conclusions:

Continuous renal replacement therapy is associated with reduced ammonia concentrations in acute liver failure patients. This effect is related to greater cumulative dose. These findings suggest that continuous renal replacement therapy initiated early and continued or longer may represent a useful approach to hyperammonemia control in acute liver failure patients.
Plasma lipid concentrations and survival in geriatric population
Authors: Wang Mu-Cyun , Hu Hsiao-Yun , Lin I-Feng , Chuang Jhih-Tung
Published: December 2019

Plasma lipids in mid-life are important predictors for cardiovascular events and deaths. However, the association between plasma lipid concentrations and mortality in late life is controversial. Recent studies showed that older people with extremely low total cholesterol (TC) have poor survival outcome, but this conclusion was drawn mostly from Western cohorts. Our study investigated association between plasma lipid concentrations and mortality in Taiwanese elderly population.

A retrospective cohort study was conducted among the 69,824 elderly people who participated in the Taipei City Geriatric Health Examination between 2006 and 2010, with a mean follow-up of 3.6 years. The measurements of TC, high density lipoprotein (HDL) and triglycerides were obtained from the records of the participants. Low density lipoprotein (LDL) was calculated using Friedewald formula in 69,088 participants. All lipid components were categorized into quartiles. Males and females were analyzed separately using multivariate Cox proportional hazards models.

The elderly with the lowest quartile of TC (<175 mg/dL), HDL cholesterol (<43 mg/dL) and LDL cholesterol (<100.4 mg/dL) were at higher risk of all-cause mortality. Older females with the lowest quartile of TC and LDL cholesterol had higher cardiovascular mortality. Older females with the lowest quartile of HDL had higher mortality from cardiovascular and cerebrovascular diseases.

We concluded that TC, mostly attributed to LDL cholesterol, was inversely related to all-cause mortality. HDL remained to be protective against both cardiovascular and stroke mortality in older females. The target levels of plasma lipids in people older than 65 years should be different from that in younger adults.
Chronic mesh infection complicated by an enterocutaneous fistula successfully treated by infected mesh removal and negative pressure wound therapy
Authors: Liu Hongquan , Liu Xiaochun , Zheng Guofu , Ye Bo , Chen Weiqing , Xie Hailiang , Liu Yunqiang , Guo Yi
Published: December 2019

Rationale:

Tension-free repair of inguinal hernia with prosthetic materials in adults has become a routine surgical procedure. However, serious complications may arise such as mesh displacement, infection, and even enterocutaneous fistula (EF). The management of chronic mesh infection (CMI) complicated by an EF is very challenging. A simple treatment of infected mesh removal and negative pressure wound therapy (NPWT) may cure the patients with EF with CMI.

Patient concerns:

A 75-year-old male patient underwent tension-free treatment for a bilateral inguinal hernia at a county hospital 10 years ago. Three months before admission, the right groin gradually formed a skin sinus with outflow of fetid thin pus, and it could not heal.

Diagnoses:

The patient was diagnosed preoperatively with mesh plug adhesion to the intestine, which resulted in low-flow EF combined with CMI.

Interventions:

The patient received a simple treatment mode consisting of an incision made from the original incision, but the new incision did not penetrate the abdominal cavity; treatment included resection of the fistula, removal of the mesh, repair of the intestine and local tissue, and continuous irrigation of vacuum sealing drainage (VSD) devices for NPWT.

Outcomes:

The infected mesh was completely removed. Five VSD devices were utilized to treat the EF and wound. The time from intervention to wound healing was 35 days, and follow-up for 6 months revealed no infection and no hernia recurrence in the right groin.

Lessons:

The NPWT is effective in treating CMI concomitant with EF and does not increase the risk of hernia recurrence.
Co-infection with Strongyloides stercoralis hyperinfection syndrome and Klebsiella in a nephrotic syndrome patient
Authors: Wang Wei-Li , Zhang Qi-Wu , Tang Sha , Chen Feng , Zhang Jing-Bo
Published: December 2019

Rationale:

Patients with chronic Strongyloides stercoralis infection are usually asymptomatic; therefore, their condition is easily overlooked. In immunosuppressed patients, mortality is high because of disseminated infection and hyperinfection. This report describes a fatal S stercoralis hyperinfection in a patient with nephrotic syndrome after treatment with steroids.

Patient concerns:

A 70-year-old male presented with a history of progressive edema, skin infection, persistent fever, cough, intermittent abdominal pain, and progressive respiratory failure after steroid treatment.

Diagnosis:

Nephrotic syndrome; cellulitis; S stercoralis hyperinfection; Klebsiella pneumonia.

Interventions:

During the first hospital admission, the patient was administered full-dose glucocorticoid and antibiotic therapy after suffering from cellulitis. During the second admission, he was diagnosed and treated for normal digestive discomfort and a bacterial infection. The patient had progressive respiratory failure and was placed on a ventilator. He was immediately treated with albendazole when S stercoralis was found in samples of his sputum and feces.

Outcomes:

The patient died despite treatment with albendazole and antibiotic therapy.

Lessons:

It is essential to consider the possibility of S stercoralis infection in immunosuppressed patients with nephrotic syndrome. Given the lack of classic manifestations and high mortality rate of advanced disease, continuous monitoring, early diagnosis, and proper treatment are imperative.
Comparison of prevalence and associated risk factors of cognitive function status among elderly between nursing homes and common communities of China
Authors: Yang Li , Jin Xiaoqing , Yan Jing , Jin Yu , Xu Shanhu , Xu Ying , Liu Caixia , Yu Wei , Zheng Pinpin
Published: December 2019

Dementia among elderly is a serious problem worldwide. This study was conducted to estimate the prevalence and associated risk factors of dementia and mild cognitive impairment (MCI) in nursing homes (NHs) and common communities (CCs) among elderly in China.

A cross-sectional survey was conducted in 4 communities across 12 cities in Southern China from May to November of 2014. Qualified psychiatrists and trained nurses carried out relevant diagnosis, assessments, interviews, and information collection. Screening test of mini-mental state examination was conducted among participants firstly, then confirmed diagnosis was carried out among the ones with positive results. Student t test, χ test, univariate, and multivariate logistic regression analysis were conducted to analyze data.

A total of 2015 participants aged 65 or older were included in the final analysis; 908 came from NHs while 1107 came from CCs. The crude prevalence rates of dementia and MCI were 22.0% and 15.8%, respectively among all the participants. Dementia prevalence was 42.4% among those living in NHs, which was significantly higher than that of 5.3% in CCs (P < .0001). There were more moderate and severe dementia in NHs compared with CCs (P < .0001). It showed that older age, illiterate compared with high level of education (adjusted odds ratio, AOR = 3.32, 95% CI: 1.53–7.21), heavy drinking (AOR = 1.51 (1.00–2.24), having a medical history of diabetes (AOR = 1.41, 95% CI: 1.02–2.33), and stroke (AOR = 1.21, 95% CI: 1.01–1.23) were associated with dementia in NHs, and middle socioeconomic status might be a protective factor for dementia (AOR = 0.33, 95% CI: 0.21–0.51).

The problem of senile dementia in NHs is much more serious than our estimation, and there are not enough trained nursing staffs in NHs. More population-based strategies in NHs, including conducting cognitive screening accompanied with routine physical examination among elderly population, carrying out related primary prevention policies and public health services, and paying attention to some modifiable associated risk factors such as heavy smoking and drinking are needed.
Co-existence of well-differentiated fetal adenocarcinoma of the lung with tuberculosis in a young female
Authors: Guo Fengzhu , Wang Jiantao , Hu Haoyue , Xie Xiaoxiao , Liu Kuncheng , Luo Feng
Published: December 2019

Rationale:

Fetal adenocarcinoma of the lung (FLAC) with fetal lung-like morphology is a rare entity of pulmonary adenocarcinoma. Well-differentiated fetal adenocarcinoma (WDFA) belongs to its the low-grade form, which possesses a relatively favorable prognosis. Tuberculosis (TB) is an aggressive infectious disease that has been ranked as one of the top 10 causes of death worldwide. There may be a connection between the 2 and attention should be paid to the differential diagnosis.

Patient concerns:

A 28-year-old non-smoking female was admitted with signs of hemoptysis, and she had been coughing up phlegm for 5 years. The patient was previously diagnosed with TB in another hospital, and underwent an anti-TB regimen.

Diagnosis:

The co-existence of WDFA and TB was confirmed via histopathological evaluation of postoperative samples.

Interventions:

The patient was subjected to a right lower lobectomy together with a wedge resection of the right upper lobe using video-assisted thoracoscopic surgery, with systemic lymphadenectomy.

Outcomes:

The patient tolerated the surgical procedure well and underwent an uneventful postoperative course.

Lessons:

To our knowledge, no previous reports exist of cases with WDFA accompanied by TB. The present case indicated that a prior diagnosis of TB might predispose to lung cancer regardless of smoking history. It is also essential to distinguish WDFA from TB because of the similarity in clinical features and sites of pathological changes. Patients with WDFA usually have a better prognosis and surgery is the preferred treatment.
Transforming a Face-to-Face Legacy Intervention to a Web-Based Legacy Intervention for Children With Advanced Cancer
Authors: Akard Terrah Foster , Wray Sarah , Friedman Debra L. , Dietrich Mary S. , Hendricks-Ferguson Verna , Given Barbara , Gerhardt Cynthia A. , Hinds Pamela S. , Gilmer Mary Jo
Published: December 2019

Research is needed to examine new and innovative web-based intervention delivery methods that are feasible, cost-effective, and acceptable to children and their families to increase access to palliative care services in the home and community. Our previous work included the development of a legacy intervention using face-to-face digital storytelling for children with cancer that showed feasibility and strong promise to improve child outcomes. However, face-to-face intervention delivery techniques limited our recruitment, thus decreasing sample size and potential access to broader populations. Here we present the systematic steps of the development of a web-based legacy intervention for children (7-17 years of age) with relapsed or refractory cancer and their parent caregivers. Counts and frequencies for parent (n = 81) reports on satisfaction surveys are presented and parent suggestions for future work. Results suggest the web-based legacy intervention is feasible and acceptable, with parent-perceived beneficial outcomes for the child, parent, and family. Results provide a foundation for web-based intervention development in palliative care and the implementation of a theoretically grounded intervention to reduce suffering of seriously ill children and their family members, thereby advancing the science of symptom management in vulnerable palliative care populations.
Their Last Breath
Authors: Helsel Deborah , Thao Kao Shoua , Whitney Robin
Published: December 2019

Hmong Americans have typically been unwilling to use biomedical palliative care for end-of-life needs. This has resulted in confusion and frustration for Hmong patients, families, and nurses. Hmongs' end-of-life care choices for family members usually involve in-home caregiving provided by the family using a combination of biomedicine and traditional healing methods. Health care decisions are made for the patient by the family and community in this familistic culture. A qualitative approach was used to explore the beliefs that ultimately determine end-of-life care goals and strategies for Hmong patients. Semistructured interviews were conducted with 15 family caregivers of terminally ill patients and 5 shamans and Hmong funeral officiants. Several themes affecting care choices were identified, including cultural legacies of the responsibility of end-of-life caregiving by the family, the desire for family privacy in caregiving, and the role of community in the care for the dying, as well as completion of the rituals that ensure the soul of the deceased reaches the afterlife. Suggestions for improving communication between Hmongs and biomedical providers include providing information about end-of-life care beliefs and strategies to biomedical care providers and providing information to Hmong patients and families about hospice and palliative care options and services to support family care.
Threats to Patient Safety in the Inpatient Maternity Setting
Authors: O'Neill Loraine , Miller Lisa A. , Rohan Annie J.
Published: December 2019

As part of our special topics issue on inpatient maternity care, experts were asked to offer their thoughts about the main issues putting mothers and babies at risk in the maternity inpatient setting and what quality and safety practices may be beneficial in keeping them safe from harm. Each of the experts has a unique perspective. Loraine O'Neill was one of the original perinatal patient safety nurses who were established as part of an effort by a professional liability company to promote patient safety in birthing hospitals that they covered in several states (Will, Hennicke, Jacobs, O'Neill, & Raab, 2006). She now is the perinatal patient safety officer in a large academic medical center in New York City. Lisa Miller is a well-known expert on fetal assessment during labor, certified nurse midwife, attorney, educator, patient safety expert, and editor of a popular fetal monitoring textbook (Miller, Miller, & Cypher, 2020). She has taught fetal monitoring to nurses, midwives, and physicians in multidisciplinary groups all over the United States and consulted on numerous patient safety initiatives. Annie Rohan is a dual-certified neonatal and pediatric nurse practitioner with a 30-plus year clinical practice career with infants, children, and families facing critical and chronic illness. She is currently a healthcare researcher, and oversees advanced practice and doctoral nursing programs at SUNY Downstate Health Sciences University.
A Systematic Process for Evaluating Teaching Methods in Nursing Education
Authors: Thrower Eileen J. B. , Fay Rebecca , Cole Linda , Stone-Gale Vicky , Mitchell Angela , Tenney Erin , Smith Sarah , Swint Charlotte
Published: December 2019

Background

An evidence-based process for the evaluation of teaching methods in nursing education, including classroom assignments, is not well described in the literature.

Problem

Nurse educators are familiar with evidence-based teaching but may be less knowledgeable about evidence-based methodologies to evaluate the effectiveness of teaching methods. Global measures of students' success, such as passing a licensing or certification examination, are often used as benchmarks for nursing education programs.

Approach

The authors suggest an evidence-based, 8-step evaluation process for evaluating the effectiveness of teaching methods. This process is demonstrated using simulation learning experiences in 2 courses in an advanced practice nursing education program.

Outcomes

The 8-step evaluation process was found to be effective for evaluating teaching methods within a graduate-level nursing education program.

Conclusions

The proposed evaluation process is applicable for evaluating teaching methods at all levels of nursing education. This systematic evaluation of teaching methods may ensure that students are engaged in learning activities leading to the attainment of assignment and course objectives.
Electrocardiographic Changes in Children With Acute Opioid Poisoning
Authors: Riasi Hamidreza , Rabiee Navid , Chahkandi Tayebeh , Arzanin Forough , Kafian Atary Siavash , Salehi Forod
Published: December 2019

Objectives

Opioid poisoning in children is a common pediatric emergency in Iran. The emergence and spread of new synthetic opioids have come up with new consequences in case of toxicity. In this study, we aimed to evaluate electrocardiographic changes in children with acute opiate poisoning.

Methods

This cross-sectional study was performed on all children with opioid poisoning admitted to the emergency ward of Vali-e-Asr Hospital, Birjand, Iran, from December 2015 to February 2017. Data (demographics, manifestations, clinical course, and outcome) were collected using a predesigned checklist. An electrocardiogram (ECG) was obtained and evaluated for arrhythmias, corrected QT interval (QTc), and other ECG indices. Data were analyzed using SPSS version 21. A value of P less than 0.05 was considered statistically significant.

Results

A total of 85 children were enrolled in this study. Most of them were male (51.8%). The mean age of the patients was 3.46 ± 3.36 years. Among these children, 38.8% were poisoned with synthetic opioids (methadone). Mean QTc length was 399 ± 24 milliseconds in nonsynthetic opioid poisoning and 407 ± 66 milliseconds in methadone poisoning, and it was prolonged (>450 milliseconds) in 3.5% of cases. Other ECG changes were limited to 1 U wave formation (1.2%) that was detected in a patient with methadone poisoning.

Conclusions

Electrocardiogram changes due to acute opioid toxicity in children are not common, although in the case of methadone poisoning, long QT interval and associated arrhythmias should be anticipated. Moreover, because of life-threatening effects of opioids such as respiratory insufficiency and decreased consciousness, it is necessary to be prepared for these conditions.
Assessing the Utility of Urine Testing in Febrile Infants 2 to 12 Months of Age With Bronchiolitis
Authors: Elkhunovich Marsha A. , Wang Vincent J. , Pham Phung , Arpilleda Joyce C. , Clingenpeel Joel M. , Mansour Karim , Riech Teresa , Yen Ken , Liu Deborah R.
Published: December 2019

Background

The utility of testing for urinary tract infection (UTI) in febrile infants with bronchiolitis is indeterminate.

Objective

The objective of this study was to investigate if the incidence of UTIs in febrile infants 2 to 12 months of age with bronchiolitis is higher than the presumed incidence of asymptomatic bacteriuria and determine risk factors associated with UTIs in this population.

Methods

This prospective multicenter cross-sectional study was conducted in the emergency departments of 6 children's hospitals between November 2011 and June 2015. We obtained a convenience sample of febrile infants with bronchiolitis 2 to 12 months of age who were tested for UTI. Patient characteristics analyzed included age, maximum temperature, duration of fever, ethnicity, sex, and circumcision status.

Results

A total of 442 patients (including 86 from a previously published pilot study) were enrolled. Mean age was 5.5 months, 65.2% were Latino, 50.9% were male, and 27.6% of male infants were circumcised. Urinary tract infections were found in 33 patients (7.69%, binomial; 95% confidence interval [CI], 5.19%–10.33%). Urinary tract infections were not related to age, height of temperature, duration of fever, or ethnicity. Uncircumcised males were significantly more likely to have UTIs than circumcised males (7.64% vs 0%, P = 0.03). Odds ratios (ORs) were lower for circumcised males but not uncircumcised males when compared with females (OR, 0.12; CI, 0.0–0.71; P = 0.01 vs OR, 0.77; CI, 0.33–1.74; P = 0.64).

Conclusions

Febrile infants 2 to 12 months of age with bronchiolitis have a clinically significant incidence of UTI, suggesting that UTI evaluation should be considered in these patients.
Detecting the Near Infrared Autofluorescence of the Human Parathyroid
Authors: Solórzano Carmen C. , Thomas Giju , Baregamian Naira , Mahadevan-Jansen Anita
Published: December 2019

Objective:

With the recent approval of 2 NIRAF-based devices for label-free identification of PG by the Food and Drug Administration, it becomes crucial to educate the surgical community on the realistic scope of this emerging technology. Here, we have compiled a review of studies that utilize NIRAF and present a critical appraisal of this technique for intraoperative PG detection.

Background:

Failure to visualize PGs could lead to accidental damage/excision of healthy PGs or inability to localize diseased PGs, resulting in postsurgical complications. The discovery that PGs have NIRAF led to new avenues for intraoperatively identifying PGs with high accuracy in real-time.

Methods:

Using the following key terms: “parathyroid, near infrared, autofluorescence” in various search engines such as PubMed and Google Scholar, we identified various publications relevant to this review of NIRAF as a technique for PG identification. Articles were excluded if they focused solely on contrast agents, served as commentaries/overviews on NIRAF or were not written in English.

Results:

To date, studies have investigated the potential of NIRAF detection for (i) identifying PG tissues intraoperatively, (ii) locating PGs before or after dissection, (iii) distinguishing healthy from diseased PGs, and (iv) minimizing postoperative hypocalcemia after total thyroidectomy.

Conclusions:

Because NIRAF-based identification of PG is noninvasive and label-free, the popularity of this approach has considerably surged. As the present limitations of various technologies capable of NIRAF detection are identified, we anticipate that newer device iterations will continue to be developed enhancing the current merits of these modalities to aid surgeons in identifying and preserving PGs. However, more concrete and long-term outcome studies with these modalities are essential to determine the impact of this technique on patient outcome and actual cost-benefits.
Hybrid emergency room system improves timeliness of angioembolization for pelvic fracture
Authors: Ito Kaori , Nagao Tsuyoshi , Tsunoyama Taichiro , Kono Kaori , Tomonaga Ayumi , Nakazawa Kahoko , Chiba Hiroto , Kondo Hiroshi , Sugawara Toshimasa , Yamamoto Masayoshi , Yokoyama Taro , Zako Ryusei , Suzuki Akiyoshi , Inui Shohei , Miyake Yasufumi , Sakamoto Tetsuya , Fujita Takashi
Published: December 2019

BACKGROUND

Timely angioembolization (AE) is known to improve outcomes of patients with hemorrhage resulting from pelvic fracture. The hybrid emergency room system (HERS) is a novel trauma resuscitation room equipped with a computed tomography scanner, fluoroscopy equipment, and an operating room setup. We hypothesized that the HERS would improve the timeliness of AE for pelvic fracture.

METHODS

A retrospective medical record review of patients who underwent AE for pelvic fracture at our institution from April 2015 to December 2018 was conducted. Patients' demographics, location of AE, Injury Severity Score, Revised Trauma Score, probability of survival by the trauma and injury severity score (TRISS Ps) method, presence of interventional radiologists (IRs) upon patient arrival, time from arrival to AE, and in-hospital mortality were analyzed. These data were compared between patients who underwent AE in the HERS (HERS group) and in the regular angio suite (non-HERS group).

RESULTS

Ninety-six patients met the inclusion criteria. The HERS group comprised 24 patients, and the non-HERS group, 72 patients. Interventional radiologists were more frequently present upon patient arrival in the HERS than non-HERS group (IRs, 79% vs. 22%, p < 0.01). The time from arrival to AE was shorter in the HERS than non-HERS group (median [range], 46 [5–75] minutes vs. 103 [2–690] minutes, p < 0.01). There were no differences in the rate of in-hospital mortality (13% vs. 15%, p = 0.52) between the two groups. Survivors in the HERS group had a lower probability of survival by the trauma and injury severity score (median [range], 61% [1%–98%] vs. 93% [1%–99%], p < 0.01) than survivors in the non-HERS group.

CONCLUSION

The HERS improved the timeliness of AE for pelvic fracture. More severely injured patients were able to survive in the HERS. The new team building involving the addition of IRs to the traditional trauma resuscitation team will enhance the benefit of the HERS.

LEVEL OF EVIDENCE

Therapeutic, level IV.
Long-term functional outcomes after traumatic popliteal artery injury: A 20-year experience
Authors: Magnotti Louis J. , Sharpe John P. , Tolley Betsy , Thomas Fritjof , Lewis Richard H. , Filiberto Dina M. , Evans Cory , Kokorev Leo , Fabian Timothy C. , Croce Martin A.
Published: December 2019

BACKGROUND

Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome.

METHODS

Patients with TPAI for 20 years were identified. All patients had at least a 2-year follow-up. Functional outcomes were measured using the Boston University Activity Measure for Post-Acute Care to assess basic mobility (BM) and daily activity (DA). Multiple linear regression, adjusted for age, severity of injury and shock, operative complexity, associated injuries, ischemic time, and length of follow-up were used to identify predictors of functional outcome after TPAI.

RESULTS

A total of 214 patients were identified: 123 penetrating (57%) and 91 blunt (43%). Overall mortality was 1.9% (all in-hospital), and amputation occurred in 10%. Of the 210 survivors, follow-up was obtained in 145 patients (69%). Median follow-up was 9.2 years (interquartile range, 5.7–15.7 years). Mean Activity Measure for Post-Acute Care scores for BM and DA were 78 and 75, respectively, both signifying mild impairment (normal, >84). Multiple linear regression failed to identify increasing length of follow-up as a predictor of improved functional outcomes. Only age, lower extremity fracture, and ischemic time were identified as predictors of decreased BM and DA.

CONCLUSION

Increasing age, lower extremity fracture, and prolonged ischemic time worsened long-term functional outcomes. Functional outcome did not improve over time, suggesting that maximal recovery may be achieved within the first 2 years postinjury. Thus, early and effective revascularization remains the only potentially modifiable risk factor for improving functional outcomes following TPAI.

LEVEL OF EVIDENCE

Prognostic, level III.
Dense and dangerous: The tissue plasminogen activator-resistant fibrinolysis shutdown phenotype is due to abnormal fibrin polymerization
Authors: Dow Nathan , Coleman Julia R. , Moore Hunter , Osborn Zachary T. , Sackheim Adrian M. , Hennig Grant , Butenas Saulius , Nelson Mark T. , Moore Ernest E. , Freeman Kalev
Published: December 2019

BACKGROUND

Both hyperfibrinolysis and fibrinolysis shutdown can occur after severe trauma. The subgroup of trauma patients with fibrinolysis shutdown resistant to tissue plasminogen activator (t-PA)-mediated fibrinolysis have increased mortality. Fibrin polymerization and structure may influence fibrinolysis subgroups in trauma, but fibrin architecture has not been characterized in acutely injured subjects. We hypothesized that fibrin polymerization measured in situ will correlate with fibrinolysis subgroups.

METHODS

Blood samples were collected from trauma patients and noninjured controls. We selected samples across a range of fibrinolysis phenotypes (shutdown, physiologic, hyperfibrinolysis) and t-PA sensitivities (sensitive, physiologic, resistant) determined by thrombelastography. Plasma clots were created in situ with fluorescent fibrinogen and imaged using confocal microscopy for analysis of clot architecture in three dimensions. For each clot, we quantified the fiber resolvability, a metric of fiber distinctness or clarity, by mapping the variance of fluorescence intensity relative to background fluorescence. We also determined clot porosity by measuring the size and distribution of the gaps between fibrin fibers in three-dimensional space. We compared these measures across fibrinolysis subgroups.

RESULTS

Fiber resolvability was significantly lower in all trauma subgroups compared with controls (n = 35 and 5, respectively; p < 0.05). We observed markedly different patterns of fibrin architecture among trauma patients stratified by fibrinolysis subgroup. Subjects with t-PA–resistant fibrinolysis shutdown exhibited abnormal, densely packed fibrin clots nearly devoid of pores. Individuals with t-PA–hypersensitive fibrinolysis shutdown had highly irregular clots with pores as large as 2500 μm3 to 20,000 μm3, versus 78 μm3 to 1250 μm3 in noninjured controls.

CONCLUSION

Fiber resolvability was significantly lower in trauma patients than controls, and subgroups of fibrinolysis differ in the porosity of the fibrin clot structure. The dense fibrin network in the t-PA–resistant group may prevent access to plasmin, suggesting a mechanism for thrombotic morbidity after injury.
A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL)
Authors: Pieracci Fredric M. , Leasia Kiara , Bauman Zach , Eriksson Evert A. , Lottenberg Lawrence , Majercik Sarah , Powell Ledford , Sarani Babak , Semon Gregory , Thomas Bradley , Zhao Frank , Dyke Cornelius , Doben Andrew R.
Published: December 2019

BACKGROUND

The efficacy of surgical stabilization of rib fracture (SSRF) in patients without flail chest has not been studied specifically. We hypothesized that SSRF improves outcomes among patients with displaced rib fractures in the absence of flail chest.

METHODS

Multicenter, prospective, controlled, clinical trial (12 centers) comparing SSRF within 72 hours to medical management. Inclusion criteria were three or more ipsilateral, severely displaced rib fractures without flail chest. The trial involved both randomized and observational arms at patient discretion. The primary outcome was the numeric pain score (NPS) at 2-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema >24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared.

RESULTS

One hundred ten subjects were enrolled. There were no significant differences between subjects who selected randomization (n = 23) versus observation (n = 87); these groups were combined for all analyses. Of the 110 subjects, 51 (46.4%) underwent SSRF. There were no significant baseline differences between the operative and nonoperative groups. At 2-week follow-up, the NPS was significantly lower in the operative, as compared with the nonoperative group (2.9 vs. 4.5, p < 0.01), and RD-QoL was significantly improved (disability score, 21 vs. 25, p = 0.03). Narcotic consumption also trended toward being lower in the operative, as compared with the nonoperative group (0.5 vs. 1.2 narcotic equivalents, p = 0.05). During the index admission, pleural space complications were significantly lower in the operative, as compared with the nonoperative group (0% vs. 10.2%, p = 0.02).

CONCLUSION

In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at 2-week follow-up among patients with three or more displaced fractures in the absence of flail chest. These data support the role of SSRF in patients without flail chest.

LEVEL OF EVIDENCE

Therapeutic, level II.
Readmissions after nonoperative trauma: Increased mortality and costs with delayed intervention
Authors: McCrum Marta L. , Zhang Chong , Presson Angela P. , Nirula Raminder
Published: December 2019

BACKGROUND

We sought to examine patterns of readmission after nonoperative trauma, including rates of delayed operative intervention and mortality.

METHODS

The Nationwide Readmissions Database (2013–2014) was queried for all adult trauma admissions and 30-day readmissions. Index admissions were classified as operative (OI) or nonoperative (NOI), and readmissions examined for major operative intervention (MOR). Multivariable regression modeling was used to evaluate risk for readmission requiring MOR and in-hospital mortality.

RESULTS

Of 2,244,570 trauma admissions, there were 59,573 readmissions: 66% after NOI, and 35% after OI. Readmission rate was higher after NOI compared with OI (3.6% vs. 1.7% p < 0.001). Readmitted NOI patients were older, with a higher proportion of Injury Severity Score ≥15 and were readmitted earlier (NOI median 8 days vs. OI 11 days). Thirty-one percent of readmitted NOI patients required MOR and experienced higher overall mortality compared with OI patients with operative readmission (NOI 2.9% vs. OI 2%, p = 0.02). Intracranial hemorrhage was an independent risk factor for NOI readmission requiring MOR in both the overall (hazard ratio, 1.11; 95% confidence interval [CI], 1.01–1.22) and Injury Severity Score of 15 or greater cohorts (hazard ratio, 1.46; 95% CI, 1.24–1.7), with a predominance of nonspine neurosurgical procedures (20.3% and 55.1%, respectively). Operative readmission after NOI cost a median of $17,364 (interquartile range, US $11,481 to US $27,816) and carried a total annual cost of US $147 million (95% CI, US $141 million to $154 million).

CONCLUSIONS

Nonoperative trauma patients have a higher readmission rate than operative index patients and nearly one third require operative intervention during readmission. Operative readmission carries a higher overall mortality rate in NOI patients and together accounts for nearly US $150 million in annual costs.

LEVEL OF EVIDENCE

Epidemiological, level III.
Rhodobacter sediminicola sp. nov., isolated from a fresh water pond
Authors: G Suresh , Kumar Dhanesh , A Krishnaiah , Ch Sasikala , Ch.V Ramana
Published: December 2019

A phototrophic bacterium, designated as strain JA983T, was isolated from a freshwater pond in Gujarat, India. The strain was yellowish brown, catalase- and oxidase-positive, rod-to-oval shaped, Gram-stain-negative and motile. Growth was observed at 20–35 °C. NaCl was not required for optimum growth and up to 5 % was tolerated. Growth was observed at pH 6.0–8.0, with an optimum at pH 7.0. An unidentified glycolipid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, two unidentified aminolipids (AL1, AL2) and two unidentified lipids (L1 and L2) are the polar lipids of JA983T. Q10 is the only quinone. C18 : 1 ω7c/C18 : 1 ω6c is the major fatty acid. JA983T showed highest 16S rRNA gene sequence similarity with the type strains of

Rhodobacter sphaeroides

(98.99%),

Rhodobacter megalophilus

(98.99 %),

Rhodobacter johrii

(98.99 %) and other members of the genus

Rhodobacter

with less than 98.7 % similarity. In a 16S rRNA gene sequence-based phylogenetic tree, JA983T formed a different sub-clade with its nearest phylogenetic members of genus

Rhodobacter

. Phenotypic, chemotaxonomic, phylogenetic and genomic [average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) differences indicated that JA983T is significantly different from other species of the genus

Rhodobacter

and thus represents a novel species of the genus for which the name Rhodobacter sediminicola sp. nov. is proposed. The type strain is JA983T (=KCTC 15782T=NBRC 113843T).