bluuebunny/crossref_metadata_2025 huggingface dataset:
Contralateral Axillary Metastases in Breast Cancer: Stage IV Disease or a Locoregional Event?
Authors: Guru Swadha D. , Loprinzi Charles L. , Yan Elizabeth , Hoskin Tanya L. , Jakub James W.
Published: June 2020

Contralateral axillary metastasis (CAM) in breast cancer is presently treated as a stage IV disease. We hypothesized that this disease pattern is a manifestation of direct aberrant lymphatic drainage and would behave more similar to advanced locoregional disease. This is a single-site, retrospective review of patients with biopsy-proven CAM from 2008–2017. Descriptive analysis was performed. Twenty-three patients met the inclusion criteria. The median disease-free interval from primary tumor treatment to diagnosis of CAM was 68 months (range, 36–155 months). This population had aggressive disease (74% local recurrences and 61% clinical evidence of cutaneous or underlying muscular invasion) and extensive locoregional therapy (70% radiated, 57% mastectomy, and 65% axillary lymph node dissection) before their presentation with CAM. Fifteen (65.2%) patients recurred after treatment of CAM; the median recurrence-free interval was 11 months (range, 5–23 months), and 12 (52.2%) patients developed distant metastases. The median distant metastasis-free survival was 14 months (range, 11–23 months), and the median overall survival was 31 months (range, 22–67.5 months). Development of CAM is associated with aggressive disease and extensive prior locoregional surgery and/or radiation. The short recurrence-free interval and high progression to additional stage IV disease suggest these patients behave similar to traditional stage IV patients with resected oligometastatic disease.
Letting the Numbers Speak for Themselves: A Simple Approach to Cost Reduction for Laparoscopic Appendectomy
Authors: Raffetto Michael L. , Chapple Kristina M. , Israr Sharjeel , Mcgeever Kevin P. , Gagliano Ronald A. , Jacobs Jordan V. , Weinberg Jordan A.
Published: June 2020

Instrument choices are influenced primarily by a surgeon's training and individual preference. Cost is often of secondary interest, particularly in the absence of any contracted fiscal obligation to the hospital. The purpose of this study was to evaluate how a simple intervention involving dissemination of cost data among a surgeon peer group influenced behavior with respect to surgical instrument choice. Cost data for laparoscopic appendectomies between July-December 2016 were disseminated to surgeons belonging to the same department of a teaching hospital. Each surgeon was provided his or her own cost data along with blinded data for his or her peers for comparison. Cost for each disposable instrument used among the group was provided for reference. Costs of laparoscopic appendectomy performed after the intervention (June-December 2017) were compared with costs before the intervention, for both individual surgeons and the group as a whole. A random effects linear regression model clustered on surgeon was then used to assess the average cost saving of the intervention while accounting for the intracorrelation of surgeon costs. One outlier was removed from the analysis, resulting in a cohort of 89 cases before the intervention and 74 postintervention. After outlier removal, data were normally distributed. The mean cost per case decreased for 10 of the 11 surgeons analyzed (minimum decrease of $7 to maximum decrease of $725). The remaining surgeon increased from an average of $985 ± 235 pre-intervention to $1003 ± 227 postintervention. The average cost saving for the group was $238 ± 226 and was associated with an average reduction in cost of 21 per cent. A linear regression analysis clustered on surgeon suggested the intervention was associated with an average saving of $260 (β = -260, SE = 39, P < 0.001). After dissemination of cost data among surgeon peers, a reduction in costs was observed. Most notably, significant savings occurred in the absence of any mandate or incentive to reduce costs. Providing cost data to surgeons to facilitate natural competition among peers is a simple and effective tool for reducing operating room costs.
Response to Neoadjuvant Treatment is Influenced by Grade in Gastric Cancer
Authors: Kwong Mei Li M. , Denham Laura , Selleck Matthew J. , Kim Candice , Kunihira Karissa , Kubba Rohan , Rojas Rachel , Garberoglio Carlos , Senthil Maheswari
Published: June 2020

Neoadjuvant therapy is commonly used in the management of gastric cancer. Primary tumor response to treatment correlates with prognosis. Published studies have compared efficacy of neoadjuvant therapy based on stage but not grade. The objective of this study was to determine the change in staging of gastric cancer after neoadjuvant therapy and resection based on grade. A retrospective analysis of gastric cancer patients treated at our institution between 2005 and 2017 was performed. Patient demographics, tumor characteristics, clinical and pathological stage, and microscopic treatment response were analyzed based on grade. Of the 269 patients identified during this period, 82 patients underwent definitive surgical resection, of which 38 patients received neoadjuvant therapy (low grade (grades 1 and 2), n = 17; high grade (grade 3), n = 18; and unknown grade, n = 3). Pathologic downstaging was observed in 52.9 per cent (9/17) of low-grade tumors compared with 22.2 per cent (4/18) of high-grade tumors. Majority of high-grade tumors (77.8%, 14/18) had either upstaging or unchanged stage. High-grade gastric cancers often lack response to neoadjuvant therapy. Novel targeted therapies based on biologic behavior should be evaluated and incorporated into neoadjuvant treatment. Neoadjuvant studies should stratify patients based on grade and report response by grade.
Presidential Assassinations: Historical Review with Current Technology
Authors: Nguyen Cecilia , Hufford Theadore
Published: June 2020

As many have studied in the past, the real question of a presidential assassination failure or completion of the attempt should focus on the medical outlook, albeit sometimes surgical in nature. In this article, injuries sustained by various assassination attempts will be examined thoroughly to ensure they received the most appropriate medical care possible at that time and, then in turn, evaluate the medical outcomes in light of contemporary medical knowledge. The five presidents include Abraham Lincoln, James Garfield, William McKinley, John Fitzgerald Kennedy, and Ronald Reagan. Although the advent of Advanced Trauma Life Support has dramatically altered the care of the critically ill patient, it was rehabilitated in response to the orthopedic surgeon listed in the following paragraph.
Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury
Authors: Gambhir Sahil , Grigorian Areg , Ramakrishnan Divya , Kuza Catherine M. , Sheehan Brian , Maithel Shelley , Nahmias Jeff
Published: June 2020

Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients with severe TBI of the head. Patients were compared by age (age < 65 and age ≥ 65 years) and survival after WLST (survivors versus non-survivors) at hospitalization discharge. A multivariable logistic regression model was used for analysis. From 1,403,466 trauma admissions, 328,588 (23.4%) patients had severe TBI. Age ≥ 65 years was associated with increased WLST (odds ratio: 1.76, confidence interval: 1.59–1.94, P < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55–0.65, P < 0.001). Compared with non-survivors of WLST, survivors were older (74 vs 61 years, P < 0.001) and more likely to have comorbidities such as hypertension (57% vs 38.5%, P < 0.001). Age ≥ 65 years was an independent risk factor for WLST, and nonwhite race was associated with decreased WLST. Patients surviving until discharge after WLST decision were older (≥74 years) and had multiple comorbidities.
Hospital-Acquired Conditions after Liver Transplantation
Authors: Moghadamyeghaneh Zhobin , Masi Antonio , Silver Michael , Misawa Ryosuke , Renz John F. , Gruessner Angelika C. , Gruessner Rainerw G.
Published: June 2020

Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver transplantation. Multivariate analysis was used to identify HAC risk factors. We found a total of 13,816 patients who underwent liver transplantation during 2002–2014. Of these, 330 (2.4%) had a report of HACs. Most frequent HACs were vascular catheter–associated infection [220 (1.6%)], falls and trauma [66 (0.5%), catheter-associated UTI [24 (0.2%)], and pressure ulcer stage III/IV [22 (0.2%)]. Factors correlating with HACs included extreme loss function (AOR: 52.13, P < 0.01) and major loss function (AOR: 8.11, P = 0.04), hepatopulmonary syndrome (AOR: 3.39, P = 0.02), portal hypertension (AOR: 1.49, P = 0.02), and hospitalization length of stay before transplant (AOR: 1.01, P < 0.01). The rate of HACs for liver transplantation is three times higher than the reported overall rate of HACs for GI procedures. Multiple patient factors are associated with HACs, and HACs may not be a reliable measure to evaluate hospital performance. Vascular catheter–associated infection is the most common HAC after liver transplantation.
Treatment of Acute Cholecystitis at Safety-Net Hospitals: Analysis of the National Inpatient Sample
Authors: Singh Supreet , Armenia Sarah J. , Merchant Aziz , Livingston David H. , Glass Nina E.
Published: June 2020

Evidence supports index cholecystectomy as the quality of care for patients admitted with acute cholecystitis. We sought to examine the role of hospital safety-net status on whether patients received appropriate index procedures for cholecystitis. The National Inpatient Sample was queried for patients with acute cholecystitis. Proportion of Medicaid and uninsured discharges were used to define safety-net hospitals (SNHs). Multivariate logistic regression was used to calculate associations between the frequency of index cholecystectomy and prolonged length of stay (LOS), and the effect of SNH designation. SNHs and non-SNHs had similar rates of index cholecystectomy in all geographic regions, except in the northeast, where the likelihood of having an index cholecystectomy was lower at SNHs. Patients at SNHs had longer LOS for acute cholecystitis, regardless of index or delayed cholecystectomy. When controlling for insurance status, patients at SNHs had longer LOS than those at non-SNHs. There was also increased LOS in SNHs in the Midwest, in urban hospitals, and in large hospitals. Our data showed no difference in the frequency of index cholecystectomy overall between SNHs and non-SNHs, except in the northeast. The variability and increased LOS at SNHs highlight potential opportunities to improve quality and decrease cost of care at our most vulnerable hospitals.
Extending Enhanced Recovery after Surgery Protocols to the Post-Discharge Setting: A Phone Call Intervention to Support Patients after Expedited Discharge after Pancreaticoduodenectomy
Authors: Takchi Rony , Williams Gregory A. , Brauer David , Stoentcheva Tina , Wolf Crystal , Van Anne Brooke , Woolsey Cheryl , Hawkins William G.
Published: June 2020

The goal of this pilot study was to track patient outcomes after an expedited discharge after enhanced recovery after surgery (ERAS) pathway for pancreaticoduodenectomy (PD). A quantitative content analysis approach was used. All PD patients in a single academic medical center between February 2017 and June 2018 were called twice by specialized physician extenders after discharge. A semi-structured interview approach was used to identify patient's symptoms or concerns, proactively educate them, and provide outpatient management when indicated. A detailed narrative of the conversation was documented. Ninety patients (mean age 66.3; 58.1% males) were included in the study. Of all, 88.9 per cent of the patients received follow-up phone calls in accordance with our PD ERAS protocol. Among the 80 patients called, 71 (88.8%) reported at least one symptom, issue, or self-care need. The most common issues involved bowel movements and nutrition. A total of 147 interventions were performed to address patient needs including medication management, local care coordination, and outpatient referral to a healthcare provider. The intervention led to the identification of 15 patients for earlier evaluation. This identification was associated with the total number of reported symptoms ( X2 = 15.6, P = 0.004). Most patients require additional care after discharge after traditional ERAS pathways. ERAS transitional care protocols uncovered an unmet need for additional patient support after PD.
Surgery for the Very Old: Are Nonagenarians Different?
Authors: Kim Tanner I. , Brahmandam Anand , Skrip Laura , Sarac Timur , Dardik Alan , Ochoa Chaar Cassius Iyad
Published: June 2020

Octogenarians and nonagenarians are considered the “very old” and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9 per cent of the population to 4.3 per cent in 2050. This study aimed to underscore the differences in surgical trends, demographics, and outcomes between octogenarians and nonagenarians. The ACS-NSQIP database (2007–2012) was used to derive the type of surgeries, demographics, and outcomes of octogenarian and nonagenarians undergoing nonemergent vascular, orthopedic, and general surgery procedures. Between 2007 and 2012, nonagenarians accounted for an increasing percentage of surgeries (85 to 121 per 10,000 surgeries, relative risk = 1.42; 95% CI: 1.30–1.54) across surgical specialties, including vascular, general, and orthopedic surgery, whereas the percentage of octogenarians undergoing surgery remained unchanged. Nonagenarians had a higher 30-day perioperative mortality and a longer hospital stay than octogenarians after vascular, orthopedic, and general surgery procedures. Nonagenarians are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of nonagenarians needs to be studied to justify the increasing healthcare costs.
Incidence of and Risk Factors for Multiple Readmissions after Kidney Transplantation
Authors: Schucht Jessica , Davis Eric G. , Jones Christopher M. , Cannon Robert M.
Published: June 2020

Unplanned readmission is often used as a surgical quality metric. A subset of kidney transplant recipients undergos multiple readmissions (MRs), although the incidence and risk factors are not well described. The aim of this study was to evaluate risk factors for MR after deceased donor kidney transplantation. All patients undergoing deceased donor kidney transplantation at a single center over a three-year period were analyzed via retrospective chart review for factors associated with MR. P values <0.05 were considered significant. Of 141 patients, the 30-day readmission rate was 26.2 per cent. MR occurred in 43 (30.5%) patients. Age, race, gender, initial organ function, and dialysis vintage were not associated with MR. Diabetic recipients, those who received basiliximab induction, those with acute rejection, and those with unplanned reoperations were at increased risk for MR. Infection was the most common reason for initial readmission in patients with MR (23.3%). One-year patient survival and death-censored graft survival were reduced for patients with MR. MRs are required for 30 per cent of kidney transplant recipients, primarily because of infection and immunologic causes. Recipients with diabetes and those who have acute rejection are at greatest risk.
Intraoperative Observation during Total Extraperitoneal Repair (TEP)
Authors: Wu Lisheng , Li Junsheng , Miao Ran
Published: June 2020

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4–10 cm). D2: 4.9 ± 0.8 cm (3.5–7 cm). D3: 6.8 ± 0.9 cm (5–9 cm). D4: 6.1 ± 1 cm (4.8–8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.
Synoptic Operative Reporting: Documentation of Quality of Care Data for Rectal Cancer Surgery
Authors: Robertson Reagan L. , Vergis Ashley
Published: June 2020

Operative reports can be used to evaluate quality of care indicators in surgical patients. This study evaluated documentation of preoperative and intraoperative quality of care indicators for rectal cancer surgery in synoptic reports and traditional dictated reports. Two surgeons independently reviewed 40 prospectively collected synoptic operative reports from rectal cancer cases and a case-matched historical cohort of 40 dictated reports. Rectal cancer–specific quality measures were scored in both report groups using two separate, previously validated checklists. Synoptic reports had significantly higher overall scores on both checklists 1 (mean adjusted score ± SD 76 ± 4 vs 41 ± 19, P < 0.01) and 2 (54 ± 3 vs 24 ± 11, P < 0.01; maximum score of 100 for both checklists). Synoptic reports scored significantly higher in reporting preoperative and intraoperative care indicators. Data were extracted quickly from synoptic reports (mean 3:46 vs 6:21, minutes:seconds to complete checklists, P < 0.05). Synoptic reports are associated with accurate documentation of quality of care data for rectal cancer surgery. Refining the synoptic templates used will further enhance the collection of quality indicators and reporting in complex oncologic procedures.
Self-Inflicted Gun Violence Injuries Epidemic in the United States: A Closer Look at the Nation's Well-Being
Authors: Dowd Brianna , Khan Irfan , Boneva Dessy , Mckenney Mark , Elkbuli Adel
Published: June 2020

Gun-related injuries are a hotly debated sociopolitical topic in the United States. Annually, more than 33 million Americans seek heathcare services for mental health issues. These conditions are the leading cause of combined disability and death among women and the second highest among men. Our study's main objective was to identify cases of self-inflicted penetrating firearm injuries with reported pre-existing psychiatric conditions as defined in the 2013–2016 National Trauma Data Standard. The 2013–2016 Research Data Sets (RDSs) were reviewed. Cases were identified using the ICD-9 external cause codes 955–955.4, and ICD 10th Edition Clinical Modification external cause codes X72–X74. Odds ratios were calculated, and categorical data were analyzed by using the chi-squared test, with significance defined as P < 0.05. The 2013–2016 Research Data Set consists of 3,577,168 reported cases, with 15,535 observations of self-inflicted penetrating firearms injuries. Of those patients, 18.4 per cent had major psychiatric illnesses, 7.5 per cent had alcohol use disorder, 6.4 per cent had drug use disorder, and 0.6 per cent had dementia. An upward trend in the proportion of patients with major psychiatric illnesses was observed, from 15.5 per cent in 2013 to 18.6 per cent in 2016, peaking in 2015 at 20.9 per cent. Nearly one in three self-inflicted penetrating firearm injuries in the United States is associated with pre-existing behavioral health conditions. Advances in understanding the behavioral and social determinants leading to these conditions, and strategies to improve the diagnosis of mental illness and access to mental health care are required.
Operative Surgery is Rarely Required in the Acute Management of Diverticulitis in the Modern Era
Authors: Dissanayake Bhanuka , Burstow Matthew J. , Jeyakumar Arunan , Yuide Peter J. , Gundara Justin , Chua Terence C.
Published: June 2020

Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016–2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender ( P = 0.039), increased length of hospital stay ( P < 0.001), temperature ≥37.5 ( P = 0.025), increased white cell count ( P < 0.001), and elevated C-reactive protein ( P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diver-ticulitis with sepsis or peritonitis.
Use of CT Scans for Abdominal Pain in the ED: Factors in Choice
Authors: Mwinyogle Aubrey A. , Bhatt Astha , Ogbuagu Onyebuchi U. , Dhillon Neer , Sill Anne , Kowdley Gopal C.
Published: June 2020

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CTis a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers’ decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CTscan and the acuity of CTscan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged <60 years. There is a need for committed efforts to optimize CT scan utilization and eliminate socioeconomic disparities in health care.
Chemoprophylaxis and Venous Thromboembolism in Traumatic Brain Injury at Different Trauma Centers
Authors: Yeates Eric O. , Grigorian Areg , Schubl Sebastian D. , Kuza Catherine M. , Joe Victor , Lekawa Michael , Borazjani Boris , Nahmias Jeffry
Published: June 2020

Patients with severe traumatic brain injury (TBI) are at an increased risk of venous thromboembolism (VTE). Because of concerns of worsening intracranial hemorrhage, clinicians are hesitant to start VTE chemoprophylaxis in this population. We hypothesized that ACS Level I trauma centers would be more aggressive with VTE chemoprophylaxis in adults with severe TBI than Level II centers. We also predicted that Level I centers would have a lower risk of VTE. We queried the Trauma Quality Improvement Program (2010–2016) database for patients with Abbreviated Injury Scale scores of 4 and 5 of the head and compared them based on treating the hospital trauma level. Of 204,895 patients with severe TBI, 143,818 (70.2%) were treated at Level I centers and 61,077 (29.8%) at Level II centers. The Level I cohort had a higher rate of VTE chemoprophylaxis use (43.2% vs 23.3%, P < 0.001) and a shorter median time to chemoprophylaxis (61.9 vs 85.9 hours, P < 0.001). Although Level I trauma centers started VTE chemoprophylaxis more often and earlier than Level II centers, there was no difference in the risk of VTE ( P = 0.414) after controlling for covariates. Future prospective studies are warranted to evaluate the timing, safety, and efficacy of early VTE chemoprophylaxis in severe TBI patients.
Decreased Length of Stay After Laparoscopic Diaphragm Repair for Isolated Diaphragm Injury After Penetrating Trauma
Authors: Chaudhry Haris H. , Grigorian Areg , Lekawa Michael E. , Dolich Matthew O. , Nguyen Ninh T. , Smith Brian R. , Schubl Sebastian D. , Nahmias Jeffry T.
Published: June 2020

Background

Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI.

Methods

The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups.

Results

From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications ( P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group.

Conclusions

Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.
Clinical Analysis of BRAFV600E Mutation and Its Correlation With Sonographic Image Characteristics in Papillary Thyroid Carcinoma in Chinese Coastal Areas
Authors: Dong Si-Yang , Chen Jie , Xia Er-Jie , Lin Ri-Xu , Du Hai-Yan , Wang Ou-Chen , Zhang Xiao-Hua , Hao Ru-Tian
Published: June 2020

This study analyzed the characteristics of BRAFV600E mutation in papillary thyroid carcinoma (PTC) in Chinese coastal areas. We intended to identify noninvasive methods to determine BRAFV600E status in thyroid nodules prior to surgery. BRAFV600E mutation and the sonographic characteristics of thyroid nodules were investigated in 670 PTC patients in our hospital. We aimed to determine the relationship between BRAFV600E mutation and the clinicopathological and sonographic imaging characteristics of PTC. The mutation rate of the BRAFV600E was 78.2%. BRAFV600E mutation was significantly associated with central node (univariate analyses, P = .005; multivariate analyses, P < .001, odds ratio [OR] = 10.255) and lateral node metastases (univariate analyses, P = .001; multivariate analyses, P < .001, OR = 22). It was less frequent in PTC coexisting with Hashimoto’s thyroiditis (univariate analyses, P = .016; multivariate analyses, P < .001, OR = .034). Nodules without blood flow had a significantly higher mutation rate of BRAFV600E in PTC patients (univariate analyses, P = .026). BRAFV600E mutation was significantly associated with high suspicion in the Thyroid Imaging Reporting and Data System 5 (univariate analyses, P = .004; multivariate analyses, P = .014, OR = 6.456). Our results strongly suggest that BRAFV600E mutation plays a potential role in lymph node metastasis (central node metastasis, OR = 10.225; lateral node metastasis, OR = 22). Some sonographic imaging features might be helpful in estimating the status of BRAFV600E preoperatively.
Extracutaneous Manifestations of Calciphylaxis: Ogilvie’s Syndrome With Perforation
Authors: Mitchell Thomas A. , Hoffer Zachary S. , Cancio Leopoldo C.
Published: June 2020

Calciphylaxis or calcific uremic arteriolopathy is a rare entity associated with the end-stage renal disease that presents with necrotic cutaneous lesions that may require surgical management. Extracutaneous manifestations of calciphylaxis including visceral ischemia have been reported; however, surgical intervention for colonic ischemia has only been reported twice. We report a 49-year-old male with calciphylaxis who subsequently developed Ogilvie’s syndrome complicated by perforation requiring total abdominal colectomy with end ileostomy. Surgeons treating this disease should have a heightened awareness of the extracutaneous sequelae of calciphylaxis.
Book review: Niti Mehta and Anita Arya (Eds.), Role of Public Policy in Development Process: Emerging Socio-Economic Scenario in the Indian Economy
Authors: Ojha Anil Kumar
Published: June 2020

Niti Mehta and Anita Arya (Eds.), Role of Public Policy in Development Process: Emerging Socio-Economic Scenario in the Indian Economy. Academic Foundation, 2018, 449 pp., ₹1495 (Hardbound). ISBN: 9789332704213.
Death by Wasting Away: The Life, Last Days, and Legacy of Lucy Byard
Authors: Baker Benjamin
Published: June 2020

Lucille Spence Byard is one of the most pivotal figures in the history of the Seventh-day Adventist Church. Her rejection for medical treatment due to her race at an Adventist sanitarium on the Maryland-Washington, D.C., border in 1943 was the major catalyst for the formation of regional conferences, or Black-administered governance units, within the North American administrative structure of the Seventh-day Adventist Church. However, almost since the day Lucy Byard was refused treatment, the major details of the event have been subject to the whim of the teller, and variant versions have become embedded in church lore. What has been particularly problematic, though, is that historians have not made the effort to explore what actually happened to Byard, which would require bypassing the entrenched legends and consulting primary sources. This article reconstructs the Byard event from primary sources, allowing the participants in the event, especially those of color, to be heard. What finally emerges is Lucy Byard the person—much more than just an icon of tragedy—whose last days sparked the most effective grassroots movement in Adventist history.
Participation in Leisure Activities by Portuguese Children With Cerebral Palsy
Authors: Vila-Nova Fabio , Oliveira Raul , Cordovil Rita
Published: June 2020

Leisure participation contributes to the health and wellbeing of children with and without physical disabilities. In the present cross-sectional study, we aimed to assess the influence of child and family factors on leisure activity participation of children with cerebral palsy (CP) aged 8-18 years. A convenience sample of 69 participants with CP (M age = 12.75 years, SD = 2.95; 45 males) responded to the Children’s Assessment of Participation and Enjoyment questionnaire to report participation diversity, frequency, companies, environment and enjoyment in leisure activities. From these questionnaires, we used descriptive statistics to summarize overall participation, two activity domains (formal and informal) and five activity types (recreational, social, active physical, skill-based, and self-improvement). Regression analysis assessed child and family factors’ influence on participation. On average, children with CP were involved in 21 leisure activities in the last four months. Within activity types, social and recreational activities were the most frequently reported. Participation in physical and skill-based activities was low. Overall children with CP experienced high enjoyment with engagement in leisure activities. Collectively, factors of age, cognitive function, gross motor function, and mother’s education level predicted 33% of activity diversity and 30% of activity frequency. We concluded that children with CP show diverse leisure activity participation and high leisure activity enjoyment. Health, education and sports professionals should consider the child’s functional profile and family context when promoting participation.
Numerical modeling for the frame structure of light van-type electric truck
Authors: Zhang Hongshen , Huang Gan , Yu Dali
Published: June 2020

The structural design of vehicles plays an important role in improving vehicle safety and driving performance. In this study, the frame structure of a van-type electric truck was taken as a research object. Stress, strain, and modal analyses of this frame structure were performed using Abaqus, a finite element software, to verify the rationality and safety of the structural design. The frame structure was optimized by numerical analysis. The fourth beam was moved 524 mm forward between the installation points of the power battery pack and the rear lifting lug of the front leaf spring. Results showed that the optimized frame bending, the full-load braking condition, and the full-load torsional operating condition stresses decreased by 44.499%, 23.364%, and 31.303%, respectively. The bending stiffness of an optimized frame increased by 4.026%, whereas the front and rear torsional stiffnesses increased by 4.442% and 4.092%, respectively.
Residential mobility and the geography of low-income households
Authors: Schouten Andrew
Published: June 2020

In contrast to the traditional image of suburban communities as stable and secure enclaves surrounding a more volatile urban core, scholars have noted considerable increases in suburban poverty over the past several decades. Using data from the Panel Study of Income Dynamics (PSID) from 1999 to 2015 and a seven-category neighbourhood typology, this analysis seeks to better understand the growing economic distress of suburban areas in two stages: first by examining the degree to which low-income residents have left urban communities for suburban neighbourhoods; and second by identifying the types of low-income households that have made urban-to-suburban moves. Results show that although low-income households rapidly suburbanised during the study period, higher-income households left urban areas for suburban neighbourhoods at nearly the same rate. This finding suggests that while the overall number of economically disadvantaged residents in the suburbs has grown, population flows have had only a modest impact on the income composition of suburban neighbourhoods. Results also highlight important differences between low-income households that suburbanised during the study period and those that remained in urban communities. In particular, urban-to-suburban movers were more likely to be white, had more household resources and lived in origin neighbourhoods with fewer urban characteristics than the origin neighbourhoods of those who relocated within central-city areas.
Status of human toxocariasis, a neglected parasitic zoonosis in Iran: a systematic review from past to current
Authors: Shafiei Reza , Rahimi Mohammad T , Emameh Reza Zolfaghari , Mirzaei Mehdi , Perez-Cordon Gregorio , Ahmadpour Ehsan
Published: June 2020

Although human toxocariasis can lead to serious complications including neurological, ocular and visceral complications, there is a lack of comprehensive epidemiological information about the seroprevalence of Toxocara species in humans. In the present study, we analysed and reviewed the overall seroprevalence of human toxocariasis in Iran. The data collection was systematically undertaken on published articles using the PubMed, Google Scholar, ScienceDirect and Scopus databases. A total of 27 studies from the past two decades reporting seroprevalence of human toxocariasis met our eligibility criteria. The pooled proportion of Toxocara infection was estimated as 6.58% (95% confidence interval = 3.98–9.77). A wide variation between different studies was observed (Q statistic = 799.37, df = 26, P < 0.0001, and I2 = 96.7%). The seroprevalence rate of toxocariasis in the Iranian population is relatively high; contamination of the environment by eggs from the host as well as from household dogs and cats should be blamed.
Perceptions of Pretrial Risk Assessment: An Examination Across Role in the Initial Pretrial Release Decision
Authors: Terranova Victoria A. , Ward Kyle , Slepicka Jessie , Azari Anthony M.
Published: June 2020

Pretrial risk assessments are used to inform pretrial release decisions by judicial officers and criminal justice entities. Existing research indicates that negative perceptions of risk assessment can interfere with adherence to the tool. Although perception plays an important role in the implementation of pretrial risk assessment, little is known about what those involved in the initial pretrial release decision—including pretrial officers, judges, prosecutors, and defense attorneys—think about this practice. This study utilized a mixed-methods approach to examine the perceptions of pretrial risk assessment by practitioners and stakeholders across roles in the system. Furthermore, themes relevant to the perceived value of pretrial risk assessment are identified that pertain to the face validity of risk items and the reliability of self-reported information.
Parents’ roles in talent development
Authors: Luo Linlin , Kiewra Kenneth A.
Published: June 2020

Talent development research has uncovered common conditions for nurturing talented individuals: enriched early environment, appropriate instruction, long-term and deliberate practice, singleness of purpose, and centers of excellence. Talent research also reveals that parents play a critical role in arranging and facilitating these conditions and helping their child’s talent to blossom. This article reports six talent-nurturing things parents do according to case-study research by Kiewra and colleagues across various talent domains such as chess, figure skating, baton twirling, violin, writing, and spelling. Parents provide an enriched early environment, arrange for appropriate instruction, facilitate long-term and deliberate practice, support singleness of purpose, gravitate to or establish a center of excellence, and are fully committed and make life-changing sacrifices to nurture their child’s talents.
Relationship-oriented values and marital and life satisfaction among Chinese couples
Authors: Chi Peilian , Wu Qinglu , Cao Hongjian , Zhou Nan , Lin Xiuyun
Published: June 2020

Objective and background:

The present study tested whether the similarity levels of relationship-oriented values among Chinese couples would be higher than those among randomly matched male–female pairs. Furthermore, we examined whether couple similarity of relationship-oriented values would predict spouses’ marital satisfaction and life satisfaction above the actor and partner effects of relationship-oriented values over time and the potential marriage cohort differences.

Method:

Data were retrieved from the China Family Panel Studies data set in 2010–2014. Our study included a nationally representative sample of 10,860 first-married couples who provided data on relationship-oriented values, marital satisfaction, and life satisfaction.

Results:

The average profile similarity on relationship-oriented values of the real couples was higher than that of the randomly matched male–female pseudo couples. Actor–Partner Interdependence Model analyses showed that (1) couple similarity of relationship-oriented values was positively associated with husbands’ and wives’ life satisfaction indirectly through wives’ marital satisfaction among couples with short to medium marital duration, even after controlling for life satisfaction 4 years ago and a set of sociodemographic variables; (2) husbands’ relationship-oriented values were positively associated with couples’ life satisfaction indirectly through husbands’ marital satisfaction among couples with short to medium and long marital duration.

Conclusion:

With a large dyadic sample of Chinese couples, our findings expand the literature on the significant role of couple similarity of relationship-oriented values in personal and relational well-being.
‘This is your golden time. You enjoy it and you’ve plenty time for crying after’: How dysphagia impacts family caregivers of people with amyotrophic lateral sclerosis – A qualitative study
Authors: Lisiecka Dominika , Kelly Helen , Jackson Jeanne
Published: June 2020

Background:

Dysphagia (swallowing impairments) is a well-recognised symptom of amyotrophic lateral sclerosis. Caring for a person with amyotrophic lateral sclerosis has been recognised as a complex and demanding task. No study to date investigated the impact of dysphagia on the lives of caregivers of people with amyotrophic lateral sclerosis.

Aim:

To investigate the experiences of dysphagia from the perspective of family caregivers of people diagnosed with amyotrophic lateral sclerosis.

Design:

Interpretative phenomenological analysis was employed. Individual interviews (n = 15) plus observations of mealtime preparation were conducted, where possible (seven or n).

Setting/participants:

Participants comprised family caregivers of people with amyotrophic lateral sclerosis and dysphagia living in the South West of Ireland ( n = 10).

Findings:

Dysphagia transformed the mealtime experiences of the caregivers and changed their approaches to food. Frustration related to the inability to stabilise the weight of the person with amyotrophic lateral sclerosis and the fear of choking emerged strongly. The caregivers strived to ensure the safety of people with amyotrophic lateral sclerosis during meals by providing constant supervision. Despite the challenges precipitated by dysphagia and amyotrophic lateral sclerosis, the caregivers wished to maintain normality for as long as they perceived it to be possible.

Conclusion:

This study provides a unique contribution in advancing our understanding of the impact of dysphagia on the caregivers of people with amyotrophic lateral sclerosis. Professionals must explore and recognise the needs of the caregivers and provide them with appropriate support, especially how to manage choking.
Opposed hemodynamic responses following increased excitation and parvalbumin-based inhibition
Authors: Lee Joonhyuk , Stile Chloe L , Bice Annie R , Rosenthal Zachary P , Yan Ping , Snyder Abraham Z , Lee Jin-Moo , Bauer Adam Q
Published: June 2020

Understanding cellular contributions to hemodynamic activity is essential for interpreting blood-based brain mapping signals. Optogenetic studies examining cell-specific influences on local hemodynamics have reported that excitatory activity results in cerebral perfusion and blood volume increase, while inhibitory activity contributes to both vasodilation and vasoconstriction. How specific subpopulations of interneurons regulate the brain’s blood supply is less examined. Parvalbumin interneurons are the largest subpopulation of GABAergic neurons in the brain, critical for brain development, plasticity, and long-distance excitatory neurotransmission. Despite their essential role in brain function, the contribution of parvalbumin neurons to neurovascular coupling has been relatively unexamined. Using optical intrinsic signal imaging and laser speckle contrast imaging, we photostimulated awake and anesthetized transgenic mice expressing channelrhodopsin under a parvalbumin promoter. Increased parvalbumin activity reduced local oxygenation, cerebral blood volume, and cerebral blood flow. These “negative” hemodynamic responses were consistent within and across mice and reproducible across a broad range of photostimulus parameters. However, the sign and magnitude of the hemodynamic response resulting from increased parvalbumin activity depended on the type and level of anesthesia used. Opposed hemodynamic responses following increased excitation or parvalbumin-based inhibition suggest unique contributions from different cell populations to neurovascular coupling.
An Evaluation of Redeploy Illinois on Juvenile Reoffending
Authors: Kethineni Sesha , Grubb Jonathan A.
Published: June 2020

The Redeploy Illinois (RI) program was created to provide services to nonviolent, moderate to high-risk youth who were likely to be committed to the Illinois Department of Juvenile Justice (IDJJ), which oversees juvenile correctional institutions. Participating counties received financial support from the state to offer various community-based services to youth instead of incarceration. The current research evaluated the impact of the RI program in reducing recidivism from the four pilot sites during state fiscal years (FY) 2006 through 2010. Results showed that youth who completed the program had fewer convictions compared with pre-program (Pre-RI) youth as well as those who were deemed unsuccessful. The findings also demonstrated a longer survival time for RI successful youth relative to those who were unsuccessful and pre-program youth. A discussion of limitations, implications, and future directions was also provided.