bluuebunny/crossref_metadata_2025 huggingface dataset:
Interfacility Transport Shock Index Is Associated With Decreased Survival in Children
Authors: Jennings Ryan M. , Kuch Bradley A. , Felmet Kathryn A. , Orr Richard A. , Carcillo Joseph A. , Fink Ericka L.
Published: July 2017

Background

Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center.

Methods

We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children’s Hospital of Pittsburgh by our critical care transport team. Subjects were divided into 4 age groups: group 1 (<1 year), group 2 (1–3 years), group 3 (4–11 years), and group 4 (≥12 years). Children were also grouped into sepsis or nonsepsis group based on the International Classification of Diseases, Ninth Revision categories. Primary outcome was survival to hospital discharge.

Results

Of 3519 children studied, 493 (14%) had sepsis. Initial shock index decreased with increasing age: group 1, 1.45 ± 0.42 (mean ± SD); group 2, 1.35 ± 0.32; group 3, 1.20 ± 0.34; and group 4, 1.00 ± 0.32 (P < 0.001). Initial shock index was increased in children with sepsis versus those with no sepsis overall and in all age groups (all P < 0.05). Initial shock index showed a trend for association with survival in univariate analysis (P = 0.05) but was not associated with survival in a multivariable logistic regression. Highest quartile of shock index was associated with need for intensive care unit admission posttransport.

Conclusions

Increased shock index in children requiring intrafacility transport was associated with hospital discharge diagnosis of sepsis but not hospital survival.
Transitions of Care
Authors: Genovesi Andrea Lynn , Olson Lenora M. , Telford Russell , Fendya Diana , Schenk Ellen , Morrison-Quinata Theresa , Edgerton Elizabeth A.
Published: July 2017

Objective

Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families.

Methods

We assessed the presence and components of written interfacility transfer guidelines and agreements for pediatric patients via a survey sent to US hospital emergency department (ED) nurse managers during 2010 and 2013.

Results

Although there was an increase in the presence of written interfacility transfer guidelines and agreements, a third of hospitals did not have either by 2013, and only 50% had guidelines with all recommended pediatric components. Hospitals with medium and low ED pediatric patient volumes were less likely to have written guidelines or agreements compared with hospitals with high volume. Hospitals with advanced pediatric resources, such as a pediatric emergency care coordinator or EDs designated approved for pediatrics, were more likely to have guidelines or agreements than less resourced hospitals.

Conclusions

Although there was improvement over time, opportunities exist for increasing the presence of written interfacility transfer guidelines as well as agreements for pediatric patients. Further studies are needed to demonstrate whether improved delivery of patient care is associated with the presence of written interfacility transfer guidelines and agreements and to identify other elements in the process to ensure optimal pediatric patient care.
Uterine Carcinosarcomas: Clinical, Histopathologic and Immunohistochemical Characteristics
Authors: Chen Xiaowei , Arend Rebecca , Hamele-Bena Diane , Tergas Ana I. , Hawver Melanie , Tong Guo-Xia , Wright Thomas C. , Wright Jason D.
Published: July 2017

Carcinosarcomas (malignant mixed Müllerian tumors or MMMT) are rare malignant tumors in the female genital tract composed of both malignant epithelial and malignant mesenchymal components. They comprise <5% of all neoplasms in the gynecologic tract and have an aggressive clinical course. The purpose of this study is to evaluate the immunophenotype and possible histogenesis of carcinosarcomas of the uterus. Sixty-two cases of uterine carcinosarcomas diagnosed between 1995 and 2011 were retrieved from the gynecologic pathology files at Columbia University Medical Center. Representative tissue blocks containing both epithelial and mesenchymal components were selected from each case for histologic and immunohistochemical studies. Clinical data from each case were retrieved. The epithelial component was poorly differentiated adenocarcinoma in the majority (80.7%) of cases; in 17.7%, the carcinoma was moderately differentiated, and in only 1.6% the carcinoma was well differentiated. 53% of the tumors had homologous stromal elements and 47% displayed heterologous stromal elements. Immunohistochemical study revealed almost equal staining in both epithelial and mesenchymal components of carcinosarcomas for p16 and p53. PAX8 positivity was noted in 73% of epithelial components, but only 13% of stromal components, and PAX8 stromal positivity was never seen in the absence of PAX8 epithelial positivity. Expression of p16, p53, and PAX8 in both malignant components lends support to the monoclonal theory of uterine carcinosarcoma tumorigenesis. The roles of these tumor markers in the diagnosis and pathogenesis of this tumor and associations between clinical characteristics, tumor pathologic features, and prognosis are discussed.
De Novo Tumors of Teratoma: Ganglioneuroma Arising From a Mature Cystic Teratoma of the Ovary
Authors: Coy Shannon , Meserve Emily , Berkowitz Ross , Hirsch Michelle S.
Published: July 2017

Mature teratomas are the most common ovarian neoplasms, accounting for 40% to 50% of ovarian tumors, and are histologically defined by the presence of multiple lineages of mature differentiated cells derived from one or more of the 3 embryonic germ layers; ectoderm, mesoderm, and endoderm. Neuroectodermal and neural crest differentiation can be observed in mature teratomas, but it is uncommon to find secondary tumors that arise from the neural crest lineage. Herein we report the uncommon finding of a ganglioneuroma arising in a mature cystic teratoma in a 26-yr-old woman.
Coexisting Primary Ovarian and Omental Hydatid Disease Mimicking an Ovarian Neoplasm: A Case Report
Authors: Tas Emre E. , Yegin Akcay Gulin F. , Yildirim Fatma , Yavuz Filiz
Published: July 2017

Hydatid disease is a parasitic infection that most commonly affects the liver and lungs, although the disease can arise in any part of the body. Cysts may mimic many benign and malignant conditions. The diagnosis cannot be confirmed preoperatively in all cases. A 44-yr-old menopausal woman was admitted to the department of gynecology with complaints of abdominal distention. A fixed abdominopelvic mass was identified. Radiology revealed a 20-cm mass with branched septations and solid components. CA-125 level was 55 kU/L, and Risk of Malignancy Index-2 score was 880. These findings suggested the presence of an ovarian neoplasm, and laparotomy was performed. Cystic masses measuring 22 cm and 4 cm, originating from the omentum majus and left ovary, respectively, were found during surgery. Frozen-section analysis revealed hydatid disease. Infracolic omentectomy and total abdominal hysterectomy with bilateral salpingo-oopherectomy were performed. Results of a serum Echinococcus hemagglutination test performed immediately after surgery were negative. The patient was prescribed albendazole for 6 mo and discharged on the third postoperative day with no complaints. The incidence of hydatid disease in the female reproductive system is very rare; however, clinicians must be aware of this disease and take necessary precautions while operating because any spillage may lead to anaphylactic shock and increased risk of recurrence.
Novel Fumarate Hydratase Mutation in Siblings With Early Onset Uterine Leiomyomas and Hereditary Leiomyomatosis and Renal Cell Cancer Syndrome
Authors: Gunnala Vinay , Pereira Nigel , Irani Mohamad , Lilienthal Debra , Pirog Edyta C. , Soslow Robert , Caputo Thomas A. , Elias Rony , Kligman Isaac , Rosenwaks Zev
Published: July 2017

Hereditary leiomyomatosis renal cell cancer syndrome is an autosomal dominant disorder characterized by uterine and cutaneous leiomyomas and increased predisposition to renal cell carcinoma, papillary type II. The syndrome is caused by heterozygous mutations to the fumarate hydratase (FH) gene located on chromosome 1. Affected females generally present with early onset, atypical uterine leiomyomas and cutaneous findings, however, delays in diagnosis are very common in patients with isolated uterine findings. We present a case series of 2 sisters in their 20s who presented with isolated uterine leiomyomas and were found to carry a novel mutation for the fumarate hydratase gene. One patient was referred for treatment of infertility and recurrent miscarriages and the other was referred for acute symptomatic anemia due to myomas. Prompt diagnosis of hereditary leiomyomatosis renal cell cancer was made due to a high index of clinical suspicion based on early onset disease and familial clustering as well as characteristic pathologic findings on uterine leiomyoma surgical specimen. Timely diagnosis not only allowed for genetic counseling and renal cancer surveillance, but also for fertility counseling given the increased morbidity associated with uterine leiomyoma due to hereditary leiomyomatosis and renal cell cancer syndrome.
Leiomyoma With Bizarre Nuclei: Clinical and Pathologic Features of 30 Patients
Authors: Kefeli Mehmet , Caliskan Sultan , Kurtoglu Emel , Yildiz Levent , Kokcu Arif
Published: July 2017

Leiomyoma with bizarre nuclei (LBN) have significant cytologic atypia, but high mitotic rate and tumor cell necrosis are absent. Although it is a benign leiomyoma variant, recurrent cases have been described. In this study, we investigated the clinical and pathologic features of LBN and compared them with related studies. A total of 30 patients diagnosed with LBN in our department were included in this study. In all cases, clinical data (age, complaint, surgery type), macroscopic features (size, location, number of leiomyomas, necrosis, and hemorrhage), microscopic features (bizarre cell distribution, bizarre cell density, cellularity, mitotic rate, tumor margin, necrosis, nuclear pseudoinclusions, karyorrhectic nuclei, prominent eosinophilic nucleoli with perinucleolar clearing, cytoplasmic eosinophilic inclusions, staghorn vessels, and alveolar-type edema), and follow-up data (recurrence and survival period) were evaluated. The mean age of the patients was 49.76 yr (range: 38–89 yr). Twenty-two patients (73%) had undergone hysterectomy and 8 patients (27%) had undergone myomectomy. The mean tumor diameter was 6.12 cm (range: 0.5–25 cm). The tumor was intramural in 11 patients (37%), subserosal in 7 patients (23%), and submucosal in 4 patients (13%). Microscopically, the bizarre cell distribution was focal in 8 patients (27%), multifocal in 12 patients (40%), and diffuse in 10 patients (33%). Bizarre cell density was low in 15 patients (50%), intermediate in 8 patients (27%), and high in 7 patients (23%). The mean mitotic count was 1.4 (0–4) in 10 high-power fields, and the tumor margin was regular in all cases. We observed pseudoinclusions in 24 of 30 (80%) tumors, karyorrhectic nuclei in 21 of 30 tumors (70%), prominent eosinophilic nucleoli with perinucleolar clearing in 12 tumors (40%), cytoplasmic eosinophilic inclusions in 11 tumors (37%), staghorn vessels in 9 tumors (30%), and alveolar-type edema in 9 tumors (30%). In addition, we examined the follow-up records of 26 patients (average duration: 58.1 mo). One patient had a smooth muscle tumor in the L3-L4 paravertebral region at 67 mo after hysterectomy. This tumor did not share similar microscopic and immunohistochemical findings to the patient’s earlier uterine tumor. The definitive diagnosis of uterine smooth muscle tumors is important for the determination of the prognosis of the patient and the most appropriate therapeutic approach. As in several recent studies, our series has shown that LBN has a benign clinical course. However, other malignant morphologic criteria such as high mitotic rate and tumor cell necrosis should be excluded in the diagnosis of LBN.
A Patient With a Low-grade Mucinous Neoplasm Involving the Ovary and Pseudomyxoma Peritonei Originating in an Isolated Intestinal Duplication
Authors: Simons Michiel , Ebisch Inge , de Hullu Joanne , van Ham Maaike , Snijders Marc , de Kievit Ineke , Bulten Johan
Published: July 2017

A considerable number of mucinous ovarian tumors are metastatic from other primary tumors, mainly from the gastrointestinal tract, and primary malignant mucinous ovarian tumors are considered rare. Mucinous ovarian tumors occurring within the clinical syndrome of pseudomyxoma peritonei are assumed to almost always originate from the appendix. We describe a patient with a low-grade mucinous tumor involving the ovary in coexistence with pseudomyxoma peritonei, who underwent appendectomy 25 yr earlier. The tumor originated from a rare cystic gastrointestinal duplication found in the mesenteric fat showing adenomatous changes. This illustrates that even in absence of the appendix, mucinous ovarian tumors occurring with pseudomyoma peritonei rarely arise from the ovary.
Genital Rhabdomyoma of the Lower Female Genital Tract: A Study of 12 Cases With Molecular Cytogenetic Findings
Authors: Schoolmeester J. Kenneth , Xing Deyin , Keeney Gary L. , Sukov William R.
Published: July 2017

Of the subtypes of extracardiac rhabdomyoma, genital rhabdomyoma is most uncommon and is occasionally classified as fetal rhabdomyoma due to morphologic similarities. In contrast to other forms of rhabdomyoma, the genetic alterations of genital rhabdomyoma are unknown. The clinical and pathologic findings in 12 cases were reviewed and 2 cases were processed for whole genome copy number analysis by single nucleotide polymorphism microarray. Twelve patients ranged in age from 43 to 65 yr (mean: 50.2 yr). Nine tumors arose in the vagina and 3 in the cervix, with their greatest dimension spanning 0.9 to 1.7 cm (mean: 1.4 cm). Follow-up was available for 7 patients and none had evidence of recurrence (67–263 mo, mean: 153.7 mo). No somatic copy number alterations, particularly involving genes in Hedgehog signaling, were identified by microarray. Although genital rhabdomyoma has sufficiently unique clinicopathologic characteristics including age of onset and organs of involvement to distinguish it from fetal rhabdomyoma, the genetic mechanisms underlying its development are unclear given the lack of copy number variation and loss of heterozygosity by single nucleotide polymorphism microarray.
Effect of Emergency Department Mattress Compressibility on Chest Compression Depth Using a Standardized Cardiopulmonary Resuscitation Board, a Slider Transfer Board, and a Flat Spine Board
Authors: Cheng Adam , Belanger Claudia , Wan Brandi , Davidson Jennifer , Lin Yiqun
Published: July 2017

Introduction

Cardiopulmonary resuscitation (CPR) performed on a mattress decreases effective chest compression depth. Using a CPR board partially attenuates mattress compressibility. We aimed to determine the effect of a CPR board, a slider transfer board, a CPR board with a slider transfer board, and a flat spine board on chest compression depth with a mannequin placed on an emergency department mattress.

Methods

The study used a cross-over study design. The CPR-certified healthcare providers performed 2 minutes of compressions on a mannequin in five conditions, an emergency department mattress with: (a) no hard surface, (b) a CPR board, (c) a slider transfer board, (d) a CPR board and slider transfer board, and (e) a flat spine board. Compression depths were measured from two sources for each condition: (a) an internal device measuring sternum-to-spine compression and (b) an external device measuring sternum-to-spine compression plus mattress compression. The difference of the two measures (ie, depleted compression depth) was summarized and compared between conditions.

Results

A total of 10,203 individual compressions from 10 participants were analyzed. The mean depleted compression depths (percentage depletion) secondary to mattress effect were the following: 23.6 mm (29.7%) on a mattress only, 13.7 mm (19.5%) on a CPR board, 16.9 mm (23.1%) on a slider transfer board, 11.9 mm (17.3%) on a slider transfer board plus backboard, and 10.3 mm (15.4%) on a flat spine board. The differences in percentage depletion across conditions were statistically significant.

Conclusion

Cardiopulmonary resuscitation providers should use a CPR board and slider transfer board or a flat spine board alone because these conditions are associated with the smallest amount of mattress compressibility.
Multi-institutional Validation Study of Pancreatic Cyst Fluid Protein Analysis for Prediction of High-risk Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Al Efishat Mohammad A. , Attiyeh Marc A. , Eaton Anne A. , Gönen Mithat , Prosser Denise , Lokshin Anna E. , Castillo Carlos Fernández-del , Lillemoe Keith D. , Ferrone Cristina R. , Pergolini Ilaria , Mino-Kenudson Mari , Rezaee Neda , Dal Molin Marco , Weiss Matthew J. , Cameron John L. , Hruban Ralph H. , D’Angelica Michael I. , Kingham T. Peter , DeMatteo Ronald P. , Jarnagin William R. , Wolfgang Christopher L. , Allen Peter J.
Published: July 2017

Objective:

Preliminary work by our group suggested that proteins within the pancreatic cyst fluid (CF) may discriminate degree of IPMN dysplasia. We sought to externally validate these markers and determine whether their inclusion in a preoperative clinical nomogram could increase diagnostic accuracy.

Summary Background Data:

IPMN is the most common radiographically identifiable precursor to pancreatic cancer; however, the timing and frequency of its malignant progression are unknown, and there are currently no reliable preoperative tests that can determine the grade of dysplasia in IPMN.

Methods:

Clinical and radiographic data, as well as CF samples, were obtained from 149 patients who underwent resection for IPMN at 1 of 3 institutions. High-risk disease was defined as the presence of high-grade dysplasia or invasive carcinoma. Multianalyte bead array analysis (Luminex) of CF was performed for 4 protein markers that were previously associated with high-risk disease. Logistic regression models were fit on training data, with and without adjustment for a previously developed clinical nomogram and validated with an external testing set. The models incorporating clinical risk score were presented graphically as nomograms.

Results:

Within the group of 149 resected patients, 89 (60%) had low-risk disease, and 60 (40%) had high-risk disease. All 4 CF markers (MMP9, CA72–4, sFASL, and IL-4) were overexpressed in patients with high-risk IPMN (P < 0.05). Two predictive models based on preselected combinations of CF markers had concordance indices of 0.76 (Model-1) and 0.80 (Model-2). Integration of each CF marker model into a previously described clinical nomogram leads to increased discrimination compared with either the CF models or nomogram alone (c-indices of 0.84 and 0.83, respectively).

Conclusions:

This multi-institutional study validated 2 CF protein marker models for preoperative identification of high-risk IPMN. When combined with a clinical nomogram, the ability to predict high-grade dysplasia was even stronger.
Procedure Choice in Primary Versus Recurrent Prolapse: A Study of Fellowship-Trained Surgeons
Authors: High Rachel , Kavanagh Alex , Khavari Rose , Stewart Julie , Antosh Danielle D.
Published: July 2017

Objective

This retrospective study describes procedures of choice in management of patients with primary prolapse compared with recurrence prolapse patients by fellowship-trained surgeons.

Methods

Surgically managed primary and recurrent prolapse cases from 2012 to 2015 at Houston Methodist Hospital were reviewed. Baseline characteristics, compartment defects, and stage were compared. Mean interval from the index surgeries to management of prolapse recurrence was recorded. In recurrence cases, mesh complaints were noted if present. Primary outcome was the procedure type used to manage cases of recurrence and primary prolapse. Logistic regression was used to determine odds ratio (OR) for the procedure of choice in recurrence and primary repairs of prolapse.

Results

Of 386 cases reviewed, 379 met criteria for inclusion; 25.8% of repairs were for recurrence. Recurrence patients were significantly older than primary cases (mean, 63.6 vs 60.5; P = 0.03) and had been postmenopausal for longer (P = 0.004). Median time interval to surgical management of recurrence was 8 years. Thirty percent of recurrence patients treated previously by mesh had mesh complaints. There was no difference in the distribution of defects or stage. Sacrocolpopexy was more frequently used to manage recurrent prolapse (OR, 2.6334; P < 0.0005). Vaginal mesh repairs showed no difference in utilization. Uterosacral ligament fixation (OR, 0.347; P = 0.002) was used more often in primary prolapse. Anterior colporrhaphy (OR, 0.398; P = 0.0005) and uterosacral ligament fixation (OR, 0.347; P = 0.002) were performed less in recurrence cases.

Conclusion

Fellowship-trained urogynecologists at this institution utilize sacrocolpopexy mesh more frequently in recurrent prolapse, and uterosacral ligament fixation was used more frequently in primary prolapse cases.
An examination of traffic-related traumatic injuries among children at a Level-1 pediatric trauma center, 2005–2014
Authors: Ma Ping , Hussain Nazia , Abbe Marisa
Published: July 2017

BACKGROUND

Traffic-related injuries are the leading fatal injury among children in the United States, but no published study compares the different types of traffic-related pediatric injuries to date. Thus, this study was aimed at examining the10-year trend of traffic-related injury among children at a pediatric hospital and to assess if there were differences in injury mechanism.

METHODS

All data were drawn from a Level-1 pediatric trauma center in North Texas in 2005–2014. Demographic characteristics, length of hospitalization, and patient type were included. Severity of injury outcome was assessed by injury severity score and fatality. The traffic-related injury mechanism included motor vehicle collision (MVC), motor-pedestrian collision (MPC), and motorcycle/moped collision (MMC). Description analyses and multinominal logistic regressions were applied to examine the factors associated with the type of motor-related injuries adjusting for covariates. All analyses were conducted by STATA version 14.0.

RESULTS

A total of 3,742 traffic-related pediatric injuries were identified. The mean (SD) age was 6.4 (4.0) years; most patients were boys (59%) and Hispanic (40%). There was a waving trend of the number of traffic-related injuries over the 10-year period. Compared with MVC, demographic disparities exist with children experiencing an MPC injury. Hispanic and African American children were more likely to have an MPC but less likely to have a motorcycle/moped collision injury (relative risk [RR], 1.6; 95% confidence interval, 1.3–1.9; RR, 2.0; 95% confidence interval, 1.9–2.4, respectively). Children with an MPC injury had a more severe outcome than those with an MVC injury, but no difference was found in fatality. The MCC injuries did not significantly differ from MVC in injury severity.

CONCLUSIONS

Although efforts have been made to prevent MVC-related pediatric injuries, the trend of MVCs was stable in the most recent years. The MPC-related injury continues to be a higher likelihood of severe pediatric trauma. Thus, continuing efforts and innovative intervention programs are still needed to prevent traffic-related pediatric injuries.

LEVEL OF EVIDENCE

Epidemiologic study, level III.
Injuries sustained during contact with law enforcement: An analysis from US trauma centers
Authors: Schellenberg Morgan , Inaba Kenji , Cho Jayun , Tatum James M. , Barmparas Galinos , Strumwasser Aaron , Grabo Daniel , Bir Cynthia , Eastman Alexander , Demetriades Demetrios
Published: July 2017

BACKGROUND

Injuries sustained by civilians from interaction with police are a polarizing contemporary sociopolitical issue. Few comprehensive studies have been published using national hospital-based data. The aim of this study was to examine the epidemiology of these injuries to better understand this mechanism of injury.

METHODS

Patients entered into the National Trauma Data Bank (NTDB) (January 2007 to December 2012) with E-codes E970.0 to E976.0 (International Classification of Diseases, Ninth Revision, Clinical Modification), identifying injuries associated with law enforcement in the course of legal action, were enrolled. Patients' demographics, injury characteristics, procedures, and outcomes were collected and analyzed. Patients injured by other civilians (E960.0–E968.0) were used for comparison.

RESULTS

Of 4,146,428 patients in the NTDB, 7,203 (0.17%) were injured during interaction with police. The numbers of patients in consecutive study years were 858, 1,103, 1,148, 1,274, 1,316, and 1,504. The incidence of these injuries was stable over time (0.17–0.18%) (p = 0.129). Patients had a median age of 31 years (range, 0–108), and 94.3% were male. Median injury severity score was 9 (interquartile range [IQR], 4–17). The most common mechanism of injury was gunshot wound (44%).

Patients were white, 43%; black, 30%; Hispanic, 17%; Asian, 1%; and Other, 9%. As a proportion of the total race-specific NTDB trauma population, there was an average of 1.13 white patients, 2.71 Hispanic patients, and 3.83 black patients per 1,000. Mechanism, injury severity score, and outcomes did not vary by race. Compared to patients injured by civilians, patients injured by police are more likely to be white (43% vs 25%, p < 0.001) and injured by gunshot wounds (44% vs 32%, p < 0.001).

CONCLUSIONS

Based on data from trauma centers across the United States, the rate of injuries sustained during interactions with police has been stable over time. Gunshot wounds are the most common mechanism of injury. Proportionally, black patients are the most frequently injured race. When compared to patients injured by civilians, however, patients injured by police are more likely to be white. This study provides a step toward a better understanding of police-associated injuries.

LEVEL OF EVIDENCE

Prognostic/epidemiologic study, level III.
Outcome differences in adolescent blunt severe polytrauma patients managed at pediatric versus adult trauma centers
Authors: Rogers Amelia T. , Gross Brian W. , Cook Alan D. , Rinehart Cole D. , Lynch Caitlin A. , Bradburn Eric H. , Heinle Colin C. , Jammula Shreya , Rogers Frederick B.
Published: July 2017

BACKGROUND

Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTCs) and adult trauma centers (ATCs) for this population.

METHODS

All severely injured adolescent (aged 12–17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003 to 2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, whereas standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables.

RESULTS

A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (adjusted odds ratio [AOR]: 1.10, 95% CI 0.54–2.24; p = 0.794; area under the receiver operating characteristic: 0.89) was observed between designations in adjusted analysis; however, FSD (AOR: 0.38, 95% CI 0.15–0.97; p = 0.043) was found to be lower and total complication trends higher (AOR: 1.78, 95% CI 0.98–3.32; p = 0.058) at PTC for adolescent polytrauma patients.

CONCLUSION

Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12–17 presenting with polytrauma may experience improved overall outcomes when managed at adult compared to pediatric trauma centers.

LEVEL OF EVIDENCE

Epidemiologic study, level III.
Improving Phenotypic Measurements in High-Content Imaging Screens
Authors: Ando D. Michael , McLean Cory Y. , Berndl Marc
Published: July 2017

Image-based screening is a powerful technique to reveal how chemical, genetic, and environmental perturbations affect cellular state. Its potential is restricted by the current analysis algorithms that target a small number of cellular phenotypes and rely on expert-engineered image features. Newer algorithms that learn how to represent an image are limited by the small amount of labeled data for ground-truth, a common problem for scientific projects. We demonstrate a sensitive and robust method for distinguishing cellular phenotypes that requires no additional ground-truth data or training. It achieves state-of-the-art performance classifying drugs by similar molecular mechanism, using a Deep Metric Network that has been pre-trained on consumer images and a transformation that improves sensitivity to biological variation. However, our method is not limited to classification into predefined categories. It provides a continuous measure of the similarity between cellular phenotypes that can also detect subtle differences such as from increasing dose. The rich, biologically-meaningful image representation that our method provides can help therapy development by supporting high-throughput investigations, even exploratory ones, with more sophisticated and disease-relevant models.
CropQuant: An automated and scalable field phenotyping platform for crop monitoring and trait measurements to facilitate breeding and digital agriculture
Authors: Zhou Ji , Reynolds Daniel , Cornu Thomas Le , Websdale Danny , Orford Simon , Lister Clare , Gonzalez-Navarro Oscar , Laycock Stephen , Finlayson Graham , Stitt Tim , Clark Matthew D. , Bevan Michael W. , Griffiths Simon
Published: July 2017

Automated phenotyping technologies are capable of providing continuous and precise measurements of traits that are key to today’s crop research, breeding and agronomic practices. In additional to monitoring developmental changes, high-frequency and high-precision phenotypic analysis can enable both accurate delineation of the genotype-to-phenotype pathway and the identification of genetic variation influencing environmental adaptation and yield potential. Here, we present an automated and scalable field phenotyping platform called CropQuant, designed for easy and cost-effective deployment in different environments. To manage infield experiments and crop-climate data collection, we have also developed a web-based control system called CropMonitor to provide a unified graphical user interface (GUI) to enable realtime interactions between users and their experiments. Furthermore, we established a high-throughput trait analysis pipeline for phenotypic analyses so that lightweight machine-learning modelling can be executed on CropQuant workstations to study the dynamic interactions between genotypes (G), phenotypes (P), and environmental factors (E). We have used these technologies since 2015 and reported results generated in 2015 and 2016 field experiments, including developmental profiles of five wheat genotypes, performance-related traits analyses, and new biological insights emerged from the application of the CropQuant platform.
DrosophilaPLP forms centriolar-clouds that promote centriole stability, cohesion and MT nucleation
Authors: Roque Helio , Pratt Metta , Johnson Errin , Raff Jordan W.
Published: July 2017

Pericentrin is a conserved centrosomal protein whose dysfunction has been linked to several human diseases. The precise function of Pericentrin, however, is controversial. Here, we examineDrosophilaPericentrin-like- protein (PLP) functionin vivo, in tissues that form both centrosomes and cilia.PLPmutant centrioles exhibit four major defects: (1) They are too short and have subtle structural defects; (2) They separate prematurely, and so overduplicate; (3) They organise fewer MTs during interphase; (4) They fail to establish and/or maintain a proper connection to the plasma membrane— although, surprisingly, mutant centrioles can still form an axoneme and recruit transition zone (TZ) proteins. We show that PLP helps to form “ pericentriolar clouds” of electron-dense material that emanate from the central cartwheel spokes and spread outward to surround the mother centriole. The partial loss of these structures may explain the complex centriole, centrosome and cilium defects we observe inPLPmutant cells.
LM6-M: a high avidity rat monoclonal antibody to pectic α-1,5-L-arabinan
Authors: Cornuault Valérie , Buffetto Fanny , Marcus Susan E , Crépeau Marie-Jeanne , Guillon Fabienne , Ralet Marie-Christine , Knox J Paul
Published: July 2017

1,5-arabinan is an abundant structural feature of side chains of pectic rhamnogalacturonan-I which is a matrix constituent of plant cell walls. The study of arabinan in cells and tissues is driven by putative roles for this polysaccharide in the generation of cell wall and organ mechanical properties. The biological function(s) of arabinan is still uncertain and high quality molecular tools are required to detect its occurrence and monitor its dynamics. Here we report a new rat monoclonal antibody, LM6-M, similar in specificity to the published rat monoclonal antibody LM6 (Willats et al. (1998) Carbohydrate Research 308: 149-152). LM6-M is of the IgM immunoglobulin class and has a higher avidity for α-1-5-L-arabinan than LM6. LM6-M displays high sensitivity in its detection of arabinan in in-vitro assays such as ELISA and epitope detection chromatography and in in-situ analyses.

Abbreviations

Ara

Arabinose

BSA

Bovine Serum Albumin

Gal

Galactose

GalA

Galacturonic acid

EDC

Epitope detection chromatography

ELISA

Enzyme-Linked Immunosorbent Assay

mAb

Monoclonal antibody

PBS

Phosphate-buffered saline

Rha

Rhamnose

RG-I

Rhamnogalacturonan-I
Transcriptional responses ofEscherichia coliduring recovery from inorganic or organic mercury exposure
Authors: LaVoie Stephen , Summers Anne O.
Published: July 2017

Background

The protean chemical properties of mercury have long made it attractive for diverse applications, but its toxicity requires great care in its use, disposal, and recycling. Mercury occurs in multiple chemical forms, and the molecular basis for the distinct toxicity of its various forms is only partly understood. Global transcriptomics applied over time can reveal how a cell recognizes a toxicant and what cellular subsystems it marshals to repair and recover from the damage. The longitudinal effects on the transcriptome of exponential phaseE. coliwere compared during sub-acute exposure to mercuric chloride (HgCl2) or to phenylmercuric acetate (PMA) using RNA-Seq.

Results

Differential gene expression revealed common and distinct responses to the mercurials throughout recovery. Cultures exhibited growth stasis immediately after each mercurial exposure but returned to normal growth more quickly after PMA exposure than after HgCl2exposure. Correspondingly, PMA rapidly elicited up-regulation of a large number of genes which continued for 30 min, whereas fewer genes were up-regulated early after HgCl2exposure only some of which overlapped with PMA up-regulated genes. By 60 min gene expression in PMA-exposed cells was almost indistinguishable from unexposed cells, but HgCl2exposed cells still had many differentially expressed genes. Relative expression of energy production and most metabolite uptake pathways declined with both compounds, but nearly all stress response systems were up-regulated by one or the other mercurial during recovery.

Conclusions

Sub-acute exposure influenced expression of ~45% of all genes with many distinct responses for each compound, reflecting differential biochemical damage by each mercurial and the corresponding resources available for repair. This study is the first global, high-resolution view of the transcriptional responses to any common toxicant in a prokaryotic model system from exposure to recovery of active growth. The responses provoked by these two mercurials in this model bacterium also provide insights about how higher organisms may respond to these ubiquitous metal toxicants.
Agility in assembly systems: a comparison model
Authors: Barbazza Luca , Faccio Maurizio , Oscari Fabio , Rosati Giulio
Published: July 2017

Purpose

This paper aims at analyzing different possible assembly systems, including innovative potential configurations such as the fully flexible assembly systems (FAS), by defining a novel analytical model that focuses on the concept of agility and its impact on the whole system performance, also evaluating the economic convenience in terms of the unit direct production cost.

Design/methodology/approach

The authors propose a comparison model derived by Newton’s second law, introducing a quantitative definition of agility (acceleration), resistance of an assembly system to any change of its operative state (inertia) and unit direct production cost (force). Different types of assembly systems (manual, flexible and fully FAS) are analyzed and compared using the proposed model, investigating agility, system inertia and their impact on the unit direct production cost.

Findings

The proposed agility definition and the proposed comparison model have been applied considering different sets of parameters as independent variables, such as the number of components to assemble (product model complexity) and the target throughput of the system. The main findings are a series of convenience areas which either, for a given target unit direct production cost (force), defines the most agile system to adopt or, for a given target agility (acceleration), defines the most economical system to adopt, as function of the independent variables.

Originality/value

The novelty of this work is, first, the analytical definition of agility applied to assembly systems and contextualized by means of the definition of the new comparison model. The comparison between different assembly systems on the basis of agility, and by using different sets of independent variables, is a further element of interest. Finally, the resulting convenience areas represent a desirable tool that could be used to optimally choose the most suitable assembly system according to one or more system parameters.
Agricultural price volatility and speculation by commodity index funds: a theoretical analysis
Authors: Gohin Alexandre , Cordier Jean
Published: July 2017

Purpose

The role that speculation in futures markets plays during food price spikes is a subject of lively dispute. This issue is often addressed with empirical analyses. They suffer from data limitations and focus on the short-term impacts. The paper aims to discuss these issues.

Design/methodology/approach

The authors develop a theoretical model to explain the behaviour of speculators and producers in futures and cash markets. Compared to the only two theoretical analyses by Vercammen and Doroudian where informational externalities are excluded and by Fishe et al. where production responses are excluded, the authors introduce both informational externalities and lagged production responses.

Findings

The authors find that the expanded net long positions of commodity index funds (CIF) are inconsistent with lower stock levels that typically prevail before the price spikes. These positions stimulate production, hence stocks, before the price spikes. Thus they contribute to soften the price volatility.

Practical implications

The simulation results indicate that before imposing new regulations on financial markets, such as position limits on index funds, their beneficial medium-term effect as a hedging instrument for commercial participants should not be omitted or underestimated.

Originality/value

Because the authors develop a second-best theoretical framework, the authors find that CIF are not a systematic cause of medium-term market swings.
Masking neo-liberal development: Polanyi, rule of law and dis-embedding dynamics
Authors: Findlay Mark
Published: July 2017

Purpose

Polanyi in his analysis of market dis-embedding suggests a drift in economic relations from the social to the fictitious. The purpose of this paper is to add two crucial components to the dis-embedding dynamic: rule of law discourse as a market force away from the social, and through suspension of imagination and of disbelief, the incongruous compatibility of actual and fictional markets that further works against embedding.

Design/methodology/approach

Theory building through the application and testing of the Polanyian market dis-embedding analysis is a central concern for the paper. Through the example of foreign direct investment (FDI) and the manner in which the rule of law discourse masks neo-liberal development inequities, the paper offers an understanding of the forces behind market dis-embedding North to South Worlds and the manner in which through the collusion of legal orientalist, the true impact of the development inequities are concealed.

Findings

The empirical value of the theorising is to allow for studies on the impact of FDI on fragmented South World market economies using Polanyian dis-embedding refined by the suspension of critique which the rule of law discourse enables.

Originality/value

The masking functions of the rule of law discourse in global trade contexts, the paper argues, conceal stark market power asymmetries hardwired into South World development policy through post-colonial free-trade regimes. The legal certainty and commercial predictability that the institutions and processes of dispersed law are said to ensure, have an established market relationship with global trade. However, while resting on ideologies of liberty and equality, the rule of law discourse hides their market suspension in favour of stabilising and auctioning universally inequitable market conditions for the purposes of the neo-liberal global trade agenda.
Physics-based integrated vehicle health management system for predicting the remaining useful life of an aircraft planetary gear transmission
Authors: Cubillo Adrian , Vermeulen Jeroen , Rodriguez de la Peña Marcos , Collantes Casanova Ignacio , Perinpanayagam Suresh
Published: July 2017

Purpose

Integrated vehicle health management has been developed for several years in different industries, to be able to provide the required inputs to determine the optimal maintenance operations depending on the actual health status of the system. The purpose of this paper is to demonstrate the potential of a physics-based model (PbM) for prognostics with a real case study, based on the detection of incipient faults and estimate the remaining useful life of a planetary transmission of an aircraft system.

Design/methodology/approach

Most of the research in the area of health assessment algorithms has been focused on data-driven approaches that are not based on the knowledge of the physics of the system, while PbM approaches rely on the understanding of the system and the degradation mechanisms. A physics-based modelling approach to represent metal-metal contact and fatigue in the gears of the planetary transmission of an aircraft system is applied.

Findings

Both the failure mode caused by metal-metal contact as caused by fatigue in the gears is described. Furthermore, the real-time application that retrieves the results from the simulations to assess the health of the system is described. Finally the decision making that can be executed during flight in the aircraft is incorporated.

Originality/value

The paper proposes an innovative prognostics health management system that assesses two important failure modes of the planetary transmission that regulates the speed of the generators of an aircraft. The results from the models have been integrated in an application that emulates a real system in the aircraft and computes the remaining useful life in real time.
Splitting to survive: understanding terrorist group fragmentation
Authors: Morrison John Francis
Published: July 2017

Purpose

From Al-Qaeda to the IRA, almost all terrorist organisations have experienced splits in some shape or form. This can spell the dawn of violent spoiler groups, but it may equally play a significant role in the overall politicisation of a group. The purpose of this paper is to provide a greater understanding of these splits by assessing the issue from a political organisational perspective.

Design/methodology/approach

The author proposes that by addressing splits through the lens of organisational survival, we may gain a greater insight into the process which takes place in the lead up to, and in the aftermath of, organisational cleavage.

Findings

It is posited that the rationale behind schism can, at times, be the result of a desire from at least one side to maintain the survival of the organisation in a form they both respect and recognise. In order to achieve this, it might require forming an independent, autonomous organisation, or alternatively promoting the exit of internal factional competitors.

Research limitations/implications

Within the paper, three organisational hypotheses are proposed. It is vital that in order to assess their validity, these are empirically tested by future researchers.

Practical implications

To be able to counter terrorist organisations, one must first have an understanding of the external and internal events and processes. While much of our attention is on understanding paid to the external violent activity of the groups, we must also develop a significant understanding of the non-violent internal activities as well. This paper provides a theoretical basis for understanding one of these process, organisational split.

Originality/value

By addressing splits from an organisational survival viewpoint, the paper challenges the previously held assumption that splits should be analysed as part of the “end of terrorism.”