bluuebunny/crossref_metadata_2025 huggingface dataset:
Supplemental Fixation of Supracondylar Distal Femur Fractures: A Biomechanical Comparison of Dual-Plate and Plate-Nail Constructs
Authors: Wright David J. , DeSanto Donald J. , McGarry Michelle H. , Lee Thay Q. , Scolaro John A.
Published: February 2020

Objectives:

This biomechanical study compares the effectiveness of dual-plate (DP) and plate-nail (PN) constructs for fixation of supracondylar distal femur fractures in synthetic and cadaveric specimens.

Methods:

Twenty-four synthetic osteoporotic femurs were used to compare 4 constructs in an extra-articular, supracondylar fracture gap model (OTA/AO type 33-A3). Constructs included: (1) distal lateral femoral locking plate (DLFLP), (2) retrograde intramedullary nail (rIMN), (3) DLFLP + medial locking compression plate (DP construct), and (4) DLFLP + rIMN (PN construct). DP and PN constructs were then directly compared using 7 matched pairs of cadaveric femurs. Specimens underwent cyclic loading in torsion and compression. Biomechanical effectiveness was measured by quantifying the load-dependent stiffness of each construct.

Results:

In synthetic osteoporotic femurs, the DP construct had the greatest torsional stiffness (1.76 ± 0.33 Nm/deg) followed by the rIMN (1.67 ± 0.14 Nm/deg), PN construct (1.44 ± 0.17 Nm/deg), and DLFLP (0.68 ± 0.10 Nm/deg) (P < 0.01). The DP construct also had the greatest axial stiffness (507.9 ± 83.1 N/mm) followed by the PN construct (371.4 ± 41.9 N/mm), DLFLP (255.0 ± 45.3 N/mm), and rIMN (109.2 ± 47.6 N/mm) (P < 0.05). In cadaveric specimens, the DP construct was nearly twice as stiff as the PN construct in torsion (8.41 ± 0.58 Nm/deg vs. 4.24 ± 0.41 Nm/deg, P < 0.001), and over one-and-a-half times stiffer in compression (2148.1 ± 820.4 vs. 1387.7 ± 467.9 N/mm, P = 0.02).

Conclusions:

DP constructs provided stiffer fixation than PN constructs in this biomechanical study of extra-articular distal femur fractures. In the clinical setting, fracture morphology, desired healing mode, surgical approach, and implant cost should be considered when implementing these fixation strategies.
Capital Femoral Epiphyseal Cupping and Extension May Be Protective in Slipped Capital Femoral Epiphysis: A Dual-center Matching Cohort Study
Authors: Morris William Z. , Liu Raymond W. , Marshall Danielle C. , Maranho Daniel A. , Novais Eduardo N.
Published: February 2020

Background:

Peripheral cupping of the capital femoral epiphysis over the metaphysis has been reported as a precursor of cam morphology, but may also confer stability of the epiphysis protecting it from slipped capital femoral epiphysis (SCFE). The purpose of this study was to investigate the relationship between a novel morphologic parameter of inherent physeal stability, epiphyseal cupping, and the development of SCFE in a dual-center matched-control cohort study.

Methods:

We performed a dual-center age-matched and sex-matched cohort study comparing 279 subjects with unilateral SCFE and 279 radiographically normal controls from 2 tertiary children’s hospitals. All SCFE patients had at least 18 months of radiographic follow-up for contralateral slip surveillance. Anteroposterior and frog lateral pelvis radiographs were utilized to measure the epiphyseal cupping ratio and the current standard measure of inherent physeal stability, the epiphyseal extension ratio.

Results:

Control hips were found to have greater epiphyseal cupping than the contralateral uninvolved hip of SCFE subjects both superiorly (0.28±0.08 vs. 0.24±0.06; P<0.001) and anteriorly (0.22±0.07 vs. 0.19±0.06; P<0.001). The 58/279 (21%) subjects who went on to develop contralateral slip had decreased epiphyseal cupping superiorly (0.25±0.07 vs. 0.23±0.05; P=0.03) and anteriorly (0.20±0.06 vs. 0.17±0.04; P<0.001). When we compared controls with hips that did not progress to contralateral slip and hips that further developed a contralateral SCFE, 1-way ANOVA demonstrated a stepwise decrease in epiphyseal cupping and epiphyseal extension ratio in the anterior and superior planes from control hips to contralateral hips without subsequent slip to contralateral hips that developed a SCFE (P<0.01 for each).

Conclusions:

This study provides further evidence that epiphyseal cupping around the metaphysis is associated with decreased likelihood of SCFE and may reflect increased inherent physeal stability. Epiphyseal cupping may represent an adaptive mechanism to stabilize the epiphysis during adolescence at the long-term cost of the eventual development of associated cam-femoroacetabular impingement deformity.

Levels of Evidence:

Level III—prognostic Study.
Monitoring Antiplatelet Aggregation In Vivo and In Vitro by Microtiter Plate Method
Authors: Wu Qiu-Ling , Dong Jun , Zeng Hua-Wu , Lv Chao , Liu Ai-Jun , Zhang Wei-Dong
Published: February 2020

Background:

The current light transmission aggregation method is a recognized conventional method for platelet function evaluation, but it is time-consuming and poor in parallelism and cannot simultaneously monitor multiple inducers at multiple levels. The microtiter plate method has been established because of the high-throughput characteristic, but it needs more practical applications.

Objectives:

To evaluate the microtiter plate method by using aspirin and clopidogrel in vivo and in vitro.

Methods:

In vitro, the platelet aggregations inhibited by aspirin (0.3, 1, 3, 10, 30, 90 μM) and clopidogrel (1, 3, 10, 30, 100, 300 μM) were evaluated with the presence of arachidonic acid (AA) and adenosine diphosphate (ADP) agonists. Using the combination index (CI), the effect of the combination of aspirin and clopidogrel on platelet aggregation was evaluated. In vivo, New Zealand rabbits (n = 18) were randomly divided into 3 groups, aspirin group (5 mg/kg, intragastrical gavage [i.g.]), clopidogrel group (14 mg/kg at the first day, followed by 4 mg/kg, i.g.), and the combination of these two drugs, administered (i.g.) continuously for 7 days. Then, the blood was collected to measure platelet aggregation.

Results:

Different concentrations of AA (12.5, 25, 50, 100 μM) and ADP (1.25, 2.5, 5, 10 μM) could promote platelet aggregation in concentration-dependent manner, and the most stable induction concentrations of AA and ADP were 50 and 5 μM. In vitro, with the above optimized detection system, aspirin and clopidogrel alone or in combination had concentration-dependent antiplatelet aggregation. The combination of aspirin and clopidogrel also showed synergistic inhibition effect within the concentration range studied. In vivo, aspirin and clopidogrel alone or in combination inhibited platelet aggregation induced by multiple concentrations of AA and ADP agonists, and the combined inhibition was more significant during the administration than aspirin or clopidogrel alone.

Conclusions:

The improved microtiter plate method combining the use of multiple levels of multiple agonists avoids the variation of the effective inducer concentrations due to individual different response of platelets to agonists. It may be a potential approach in the detection of platelet aggregation.
Safety, Efficacy and Pharmacokinetics of Anidulafungin in Patients 1 Month to <2 Years of Age With Invasive Candidiasis, Including Candidemia
Authors: Roilides Emmanuel , Carlesse Fabianne , Tawadrous Margaret , Leister-Tebbe Heidi , Conte Umberto , Raber Susan , Swanson Robert , Yan Jean L. , Aram Jalal A. , Queiroz-Telles Flavio ,   on behalf of the Anidulafungin A8851008 Pediatric Study Group
Published: February 2020

Nineteen patients 1 month to <2 years of age with (n = 16) or at high risk of (n = 3) invasive candidiasis received anidulafungin for 5–35 days (3 mg/kg day 1, 1.5 mg/kg daily thereafter) followed by optional fluconazole (NCT00761267). Most treatment-emergent adverse events were mild/moderate, and no treatment-related deaths occurred. End of intravenous therapy global response success rate was 68.8%. Pharmacokinetics were similar to adult patients.
Trends in Utilization of Image Guidance for Hip Joint Injections
Authors: Henne Michelle , Centurion Alejandro , Zeini Ibrahim Mamdouh , Youmans Donald Harrison , Osbahr Daryl Christopher
Published: February 2020

Objective:

This study aims to evaluate trends in utilization of image guidance for intraarticular hip injections and to compare the cost efficiency of ultrasound-, fluoroscopic-, and landmark-guided injections in the management of hip osteoarthritis (OA) and femoroacetabular impingement (FAI).

Design:

Retrospective descriptive epidemiology study.

Setting:

The information was collected from Humana private payer insurance claims database encompassing all practice settings.

Patients or Participants:

A total of 302 855 patients for years 2007 to 2015.

Interventions or Assessment of Risk Factors or Independent Variables:

Primary diagnosis of hip OA or FAI.

Main Outcome Measures:

Injection type [corticosteroid (CS) or hyaluronic acid (HA)], imaging modality (landmark, ultrasound, or fluoroscopic guidance), and costs.

Results:

Landmark-guided CS and HA injections for the management of hip OA decreased, whereas fluoroscopic and ultrasound guidance increased. Similar trends were demonstrated in the management of FAI using CS. In the management of FAI using HA, landmark- and ultrasound-guided injections decreased and fluoroscopic-guided injections increased. Cost analysis revealed lower reimbursement of landmark and ultrasound guidance compared with fluoroscopic guidance.

Conclusions:

During the study period, there was an increase in the use of image guidance and decline in landmark guidance for the treatment of OA and FAI using CS and HA. Fluoroscopic guidance demonstrated increased reimbursement compared with landmark and fluoroscopic guidance. There is an opportunity to mitigate cost and reduce radiation exposure by using ultrasound-guided injections rather than fluoroscopic guidance.
Iliopsoas Release: A Systematic Review of Clinical Efficacy and Associated Complications
Authors: Longstaffe Robert , Hendrikx Shawn , Naudie Douglas , Willits Kevin , Degen Ryan M.
Published: February 2020

Objective:

To perform a systematic review of the findings of iliopsoas release as it relates to resolution of snapping, improvement of groin pain, and associated complications.

Design:

Systematic review.

Data Sources:

Four electronic databases PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science were searched, identifying all literature pertaining to surgical treatment of a snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis. A total of 818 studies were identified. Two reviewers independently screened the titles, abstracts, and full-text articles for eligibility.

Eligibility Criteria:

All studies published in English that reported on iliopsoas release for snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis reporting outcomes or associated complications were eligible.

Results:

A total of 48 articles were included in this review. Three surgical indications were identified for iliopsoas release, internal snapping hip, labral tear secondary to iliopsoas impingement, and iliopsoas tendinopathy after total hip arthroplasty. Arthroscopic techniques seemed to be superior to open techniques with regards to reoccurrence of snapping (5.1% vs 21.7%) and groin pain relief (89.1% vs 85.6%) with fewer complications (4.2% vs 21.1%) overall.

Conclusions:

Both open and arthroscopic iliopsoas releases have been shown to be successful treatment options regardless of the surgical indications identified in this review. Arthroscopic release demonstrated a decreased failure rate, fewer complications, and improved outcomes when compared with open procedures.
Video Analysis of Acute Injuries in Elite Field Hockey
Authors: Theilen Till-Martin , Mueller-Eising Wiebke , Bettink Peter W. , Rolle Udo
Published: February 2020

Objective:

With this study, we aim to determine the value of video assessment of acute injuries in field hockey.

Design:

Retrospective video analysis for acute injuries.

Setting:

Professional field hockey.

Participants:

Seven women and men's field hockey tournaments (World League, Champions Trophy) in 2015.

Interventions:

Not applicable.

Outcome Measures:

An injury was defined as any new musculoskeletal complaint leading to time stoppage and medical attention. The outcome measures were time at play, location on the pitch, type of injury, injured body part, and injury mechanism.

Results:

A total of 190 injuries occurred in 179 matches (55/73 female and 135/106 male matches). There were 0.75 injuries per match for women [confidence interval (CI, 0.31-1.13)] and 1.27 injuries per match for men (CI, 0.88-1.61). The number of injuries per 1000 player match hours was 34.20 for women (CI, 14.04-51.29) and 57.89 for men (CI, 29.78-73.12). The highest injury frequency occurred within the third quarter and within the circle. Contusion was the most common injury type (90.9% in women and 96.3% in men). The leading causes of injuries were hits by the ball or stick and collisions with another player. The head/face was the most affected body part in both sex groups (32.7% in women and 29.6% in men).

Conclusions:

Video analysis revealed data on injury incidence within the same range of previous reports in elite field hockey. Its advantages, such as slow motion and repetitive play of injury scenes, could contribute valuable information if incorporated into the injury recording process.
Providing a Medical Definition of Concussion: Can a Simple Intervention Improve Self-Reported Concussion History in Youth Athletes?
Authors: Wicklund Alissa , Roy Ashley , Coatsworth J. Douglas
Published: February 2020

Objective:

Providing a medical definition of concussion improves reliability of self-reported history of concussion in adult former athletes. We examine whether providing a medical definition of concussion to youth athletes increases the number of concussions reported, and whether reporting differs by age, sex, or sport type.

Design:

Cross-sectional survey.

Setting:

Concussion specialty clinic.

Participants:

Convenience sample of youth athletes (n = 301; mean age = 15.1 ± 1.6 years) presenting for evaluation of sports-related concussion.

Independent Variables:

Number of concussions reported before and after presentation of the medical definition of concussion (“vignette”).

Outcome Measures:

Number of concussions reported after vignette. Paired-sample t test examined for main effect of the vignette on reporting behavior. One-way between-subjects analysis of variance with pairwise comparisons assessed for group differences.

Results:

Thirty percent of youth athletes reported an increase in number of concussions after vignette overall (P < 0.000). There was no significant difference in reporting behavior by age, sex, or sport type.

Conclusions:

Providing the medical definition of concussion, a simple and brief intervention, gives youth athletes context to understand when a concussion has occurred. This results in an increase in the number of concussions reported when gathering a self-reported history. Reporting behavior after a vignette does not differ across sex, sport type, or age of the athlete.
The Influence of Time of Season on Injury Rates and the Epidemiology of Canadian Football Injuries
Authors: Robbins Shawn M. , Bodnar Camille , Donatien Pierre , Mirza Rabia , Zhao Zhen Yuan , Hoeber Shane , Naidu Dhiren , Redelmeier Annabelle , Steele Russell J. , Shrier Ian
Published: February 2020

Objective:

To describe injury rates and injury patterns in the Canadian Football League (CFL) according to time during the season, player position, injury type, and injury location.

Design:

Prospective, cohort study.

Setting and Participants:

Eight seasons from CFL injury surveillance database.

Independent Variables:

Depending on the analysis, time of season (preseason, regular, and playoffs), player position, injury type, and injury location.

Main Outcome Measures:

Medical attention and time-loss injury rates per 100 athletes at risk (AAR), and prevalence of time-loss injuries per week.

Results:

The average game injury rate was 45.2/100 AAR medical attention injuries and 30.7/100 AAR time-loss injuries. Injury rates declined by 1% per week over the season for both medical attention (rate ratio = 0.99) and time-loss (rate ratio = 0.99) injuries, with a substantial decline during the playoffs compared with preseason (rate ratio = 0.70-0.77). The number of ongoing time-loss injuries increased over the course of the regular season. Quarterbacks, offensive backs, and linebackers had the highest game injury rates. Joint/ligament and muscle/tendon injuries were the most common injury types for games and practices, respectively. The lower extremity was the most commonly affected area, specifically the lower leg/ankle/foot and hip/groin/thigh.

Conclusions:

There was a 1% decline in injury rate per week during the season and a 30% decline during the playoffs. The number of ongoing time-loss injuries increased over the regular season. Current results can aid league officials and medical staff in making evidence-based decisions concerning player safety and health.
Identification of Pediatric Sepsis for Epidemiologic Surveillance Using Electronic Clinical Data*
Authors: Weiss Scott L. , Balamuth Fran , Chilutti Marianne , Ramos Mark Jason , McBride Peter , Kelly Nancy-Ann , Payton K. Joy , Fitzgerald Julie C. , Pennington Jeffrey W.
Published: February 2020

Objectives:

A method to identify pediatric sepsis episodes that is not affected by changing diagnosis and claims-based coding practices does not exist. We derived and validated a surveillance algorithm to identify pediatric sepsis using routine clinical data and applied the algorithm to study longitudinal trends in sepsis epidemiology.

Design:

Retrospective observational study.

Setting:

Single academic children’s hospital.

Patients:

All emergency and hospital encounters from January 2011 to January 2019, excluding neonatal ICU and cardiac center.

Exposure:

Sepsis episodes identified by a surveillance algorithm using clinical data to identify infection and concurrent organ dysfunction.

Interventions

None.

Measurements and Main Results:

A surveillance algorithm was derived and validated in separate cohorts with suspected sepsis after clinician-adjudication of final sepsis diagnosis. We then applied the surveillance algorithm to determine longitudinal trends in incidence and mortality of pediatric sepsis over 8 years. Among 93,987 hospital encounters and 1,065 episodes of suspected sepsis in the derivation period, the surveillance algorithm yielded sensitivity 78% (95% CI, 72–84%), specificity 76% (95% CI, 74–79%), positive predictive value 41% (95% CI, 36–46%), and negative predictive value 94% (95% CI, 92–96%). In the validation period, the surveillance algorithm yielded sensitivity 84% (95% CI, 77–92%), specificity of 65% (95% CI, 59–70%), positive predictive value 43% (95% CI, 35–50%), and negative predictive value 93% (95% CI, 90–97%). Notably, most “false-positives” were deemed clinically relevant sepsis cases after manual review. The hospital-wide incidence of sepsis was 0.69% (95% CI, 0.67–0.71%), and the inpatient incidence was 2.8% (95% CI, 2.7–2.9%). Risk-adjusted sepsis incidence, without bias from changing diagnosis or coding practices, increased over time (adjusted incidence rate ratio per year 1.07; 95% CI, 1.06–1.08; p < 0.001). Mortality was 6.7% and did not change over time (adjusted odds ratio per year 0.98; 95% CI, 0.93–1.03; p = 0.38).

Conclusions:

An algorithm using routine clinical data provided an objective, efficient, and reliable method for pediatric sepsis surveillance. An increased sepsis incidence and stable mortality, free from influence of changes in diagnosis or billing practices, were evident.
Outcomes of Acute Inpatient Rehabilitation After Ventricular Assist Device Placement
Authors: Johnson Shelby E. , Del Fabro A. Sophia , Reeves Ronald K.
Published: February 2020

Objective

The aim of the study was to compare outcomes of inpatient rehabilitation after ventricular assist device placement with outcomes for other cardiac diagnoses.

Design

This was a retrospective review of the electronic health records of 265 patients admitted to inpatient rehabilitation: 166 patients were admitted after ventricular assist device placement and 99 were admitted for other cardiac disease. Data collected included functional independence measure score on admission and discharge, dates of admission and discharge, and disposition.

Results

Patients admitted after ventricular assist device placement had a mean functional independence measure gain of 25.7 and length of stay of 8.7 days. Patients admitted for other cardiac diagnoses had a mean functional independence measure gain of 25.9 and length of stay of 9.4 days. These differences were not statistically significant. Change in functional independence measure from admission to discharge was statistically significant within each group (P < 0.001). Most patients were discharged home, and the proportions who returned to acute care or home were not different between groups.

Conclusions

Both the ventricular assist device and nonventricular assist device groups had significant and equivalent improvements in functional outcomes after inpatient rehabilitation. This study found that ventricular assist device patients benefit from inpatient rehabilitation with similar disposition rates as patients with other cardiac diagnoses. Inpatient rehabilitation is the appropriate setting for this group.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Describe the role of rehabilitation in the care of individuals after ventricular assist device (VAD) placement; (2) Compare the outcomes of inpatient rehabilitation for individuals after VAD placement to those admitted for other cardiac reasons; and (3) Recognize potential complications that may occur during the course of a VAD patient’s inpatient rehabilitation stay.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Performance of Computed Tomographic Pulmonary Angiography Compared With Standard Chest Computed Tomography for Identification of Solid Organ, Serosal, and Nodal Findings
Authors: Anderson John F. , Raptis Constantine , Bhalla Sanjeev
Published: February 2020

Purpose:

Computed tomographic pulmonary angiography (CTPA) is the test of choice for patients with acute chest pain and suspected pulmonary embolism (PE). This examination is excellent for the diagnosis of PE and can also often identify alternative diagnoses. The early phase of contrast, however, may not allow for optimal evaluation of lymph nodes, serosal surfaces, and solid organs, leading to the nonvisualization of important findings and the potential for missed diagnoses. The purpose of this study was to determine the frequency of relevant findings only identified on standard portal venous phase CT compared with CTPA.

Materials and Methods:

The reports for all patients in the previous 10 years who underwent both standard CT and CTPA within 7 days, for a total of 675 pairs of scans, were tabulated according to the presence of PE, serosal abnormalities, solid organ abnormalities, and lymphadenopathy. All findings were categorized as present on both scans, standard CT only, or CTPA only. The scans were manually evaluated to exclude findings that were new or resolved on the second study or outside the field of view on one of the studies.

Results:

Significantly more PEs were identified only on CTPA examinations. However, significantly more pleural, peritoneal, and solid organ abnormalities, and abnormal mediastinal and abdominal lymph nodes were identified on standard CT only. There was no significant difference in the identification of pericardial abnormalities or abnormal hilar lymph nodes between the two scans.

Conclusions:

Many serosal abnormalities, solid organ abnormalities, and lymphadenopathy were only reported on standard portal venous phase CT compared with CTPA.
Preresection Stained Glue Injection to Localize Pulmonary Small Nodules and Ground-glass Opacities
Authors: Wang Jian , Gao Li-Bin , Zhang Hong , Wang Jian , Liu Liang , Shi Wan-Yin
Published: February 2020

Objective:

We sought to introduce a localization procedure (methylene blue-stained N-butyl cyanoacrylate and N-octyl cyanoacrylate glue) in localizing pulmonary small nodules and ground-glass opacities before thoracoscopic resection, and to evaluate its efficacy.

Methods:

A total of 20 patients with pulmonary small nodules and/or ground-glass opacities, who underwent video-assisted thoracoscopic surgery from August 1, 2017 to March 1 2018, were included in the study.

Results:

A total of 24 lesions in 20 patients underwent blue-stained glue localization. The success rate of localization was 100%, with a mean dose of 0.04±0.01 mL blue dye and 1 mL glue used for each lesion. The average time for the whole localization procedure was 15.4±6.3 minutes. All lesions were intraoperatively localized by visual inspection in combination with palpation. The complications related to the localization procedure included mild pneumothorax occurring in 9 patients and minor pulmonary hematoma in 4 patients. No pain or distress was reported.

Conclusions:

Blue-stained glue injection is technically feasible and safe to localize pulmonary small nodules and ground-glass opacities before thoracoscopic resection.
Laparoscopic Versus Robotic-assisted Suturing Performance Among Novice Surgeons: A Blinded, Cross-Over Study
Authors: Møller Sofie G. , Dohrn Niclas , Brisling Steffen K. , Larsen Jens C.R. , Klein Mads
Published: February 2020

Robotic-assisted laparoscopy (RAL) presents several advantages over 3-dimensional conventional laparoscopy (3D-CL) that may facilitate laparoscopic suturing especially with novice surgeons. This study compares novice surgeons’ suturing performance by 3D-CL and RAL using Objective Structured Assessment of Technical Skill (OSATS), an objective, validated scoring tool. Twenty-two surgeons with no robotic experience completed a standardized suturing task in an experimental setup by both 3D-CL and RAL in a randomized, cross-over design. Two experienced surgeons blindly assessed their performance using OSATS. Median (interquartile range) OSATS scores for 3D-CL and RAL were, respectively, 22.8 (17.4 to 25.8) versus 25.0 (21.9 to 26.5), P=0.032. There was no association between laparoscopic experience and robotic-assisted suturing performance. Thus, this study is, to our knowledge, the first to compare novice surgeons’ suturing performance by 3D-CL and RAL using an objective, validated scoring tool and to show better suturing performance when assisted by the robot regardless of experience level.
Mortality review of US Special Operations Command battle-injured fatalities
Authors: Mazuchowski Edward L. , Kotwal Russ S. , Janak Jud C. , Howard Jeffrey T. , Harcke Howard T. , Montgomery Harold R. , Butler Frank K. , Holcomb John B. , Eastridge Brian J. , Gurney Jennifer M. , Shackelford Stacy A.
Published: February 2020

BACKGROUND

Comprehensive analyses of battle-injured fatalities, incorporating a multidisciplinary process with a standardized lexicon, is necessary to elucidate opportunities for improvement (OFIs) to increase survivability.

METHODS

A mortality review was conducted on United States Special Operations Command battle-injured fatalities who died from September 11, 2001, to September 10, 2018. Fatalities were analyzed by demographics, operational posture, mechanism of injury, cause of death, mechanism of death (MOD), classification of death, and injury severity. Injury survivability was determined by a subject matter expert panel and compared with injury patterns among Department of Defense Trauma Registry survivors. Death preventability and OFI were determined for fatalities with potentially survivable or survivable (PS-S) injuries using tactical data and documented medical interventions.

RESULTS

Of 369 United States Special Operations Command battle-injured fatalities (median age, 29 years; male, 98.6%), most were killed in action (89.4%) and more than half died from injuries sustained during mounted operations (52.3%). The cause of death was blast injury (45.0%), gunshot wound (39.8%), and multiple/blunt force injury (15.2%). The leading MOD was catastrophic tissue destruction (73.7%). Most fatalities sustained nonsurvivable injuries (74.3%). For fatalities with PS-S injuries, most had hemorrhage as a component of MOD (88.4%); however, the MOD was multifactorial in the majority of these fatalities (58.9%). Only 5.4% of all fatalities and 21.1% of fatalities with PS-S injuries had comparable injury patterns among survivors. Accounting for tactical situation, a minority of deaths were potentially preventable (5.7%) and a few preventable (1.1%). Time to surgery (93.7%) and prehospital blood transfusion (89.5%) were the leading OFI for PS-S fatalities. Most fatalities with PS-S injuries requiring blood (83.5%) also had an additional prehospital OFI.

CONCLUSION

Comprehensive mortality reviews of battlefield fatalities can identify OFI in combat casualty care and prevention. Standardized lexicon is essential for translation to civilian trauma systems.

LEVEL OF EVIDENCE

Epidemiological, level IV.
Rats with prenatal dexamethasone exposure and postnatal high-fat diet exhibited insulin resistance, and spatial learning and memory impairment: effects of enriched environment
Authors: Hsu Mei-Hsin , Sheen Jiunn-Ming , Chen Yu-Chieh , Yu Hong-Ren , Tain You-Lin , Huang Li-Tung
Published: February 2020

This study aimed to examine the combined effects of prenatal glucocorticoid exposure and a postnatal high-fat diet (HFD) on offspring brain development and metabolic disturbance. Besides, the effects of an enriched environment were assessed. Pregnant Sprague–Dawley rats were administered vehicle or dexamethasone between gestation days 14 and 21. Male offspring was then weaned onto either a standard chow or HFD. An enriched environment was implemented between postnatal days 22 and 180 in a subset of rats with prenatal dexamethasone and a postnatal HFD. Adult male offspring with prenatal exposure to dexamethasone and a postnatal HFD showed obesity, increased systolic blood pressure, peripheral and central insulin resistance, and spatial learning and memory impairment detected by Morris water maze. An enriched environment displayed beneficial effects in reducing body weight, decreasing systolic blood pressure, reducing insulin resistance, ameliorating brain molecular alterations, and alleviating spatial deficit in rats with prenatal dexamethasone and a postnatal HFD. In conclusion, adult male offspring with prenatal dexamethasone exposure and a postnatal HFD showed obesity, increased systolic blood pressure, peripheral and central insulin resistance, and spatial learning and memory impairment. In addition, an enriched environment had beneficial effects in this context.
Neurochemical characterization of mouse dorsal root ganglion neurons expressing organic cation transporter 2
Authors: Matsui Toshiyasu , Nakata Takahiro , Kurohmaru Masamichi , Kobayashi Yasushi
Published: February 2020

Organic cation transporters (OCTs) are poly-specific carriers for endogenous and exogenous cationic compounds. These are widely distributed in the nervous system and mediate neuronal activities. As antineoplastic cationic drugs accumulate in the dorsal root ganglion (DRG), OCT function has been studied mainly in cultured DRG neurons. However, the histological distribution of OCTs in the DRG is unclear. This study investigated the localization of OCT2 (a member of OCTs) in mouse DRG neurons and determined their histochemical properties. OCT2 expression was found in about 20% of DRG neurons, which were small to medium size. OCT2-expressing neurons were labeled with markers for peptidergic nociceptive (substance P or calcitonin gene-related peptide) and tactile/proprioceptive (neurofilament 200 or tropomyosin receptor kinase B or C) neurons. OCT2 was also expressed in cholinergic DRG neurons identified by choline acetyltransferase promoter-derived Cre expression. In the spinal dorsal horn, OCT2 was distributed in superficial to deep laminae. OCT2 immunoreactivity was punctate in appearance and localized in the nerve terminals of sensory afferents with labeling of neurochemical markers. Our findings suggest that OCT2 as a low-affinity, high-capacity carrier may take up substrates including cationic neurotransmitters and drugs from the extracellular space around cell bodies in DRG neurons.
X-ray fluorescence detection for serial macromolecular crystallography using a JUNGFRAU pixel detector
Authors: Martiel Isabelle , Mozzanica Aldo , Opara Nadia L. , Panepucci Ezequiel , Leonarski Filip , Redford Sophie , Mohacsi Istvan , Guzenko Vitaliy , Ozerov Dmitry , Padeste Celestino , Schmitt Bernd , Pedrini Bill , Wang Meitian
Published: February 2020

Detection of heavy elements, such as metals, in macromolecular crystallography (MX) samples by X-ray fluorescence is a function traditionally covered at synchrotron MX beamlines by silicon drift detectors, which cannot be used at X-ray free-electron lasers because of the very short duration of the X-ray pulses. Here it is shown that the hybrid pixel charge-integrating detector JUNGFRAU can fulfill this function when operating in a low-flux regime. The feasibility of precise position determination of micrometre-sized metal marks is also demonstrated, to be used as fiducials for offline prelocation in serial crystallography experiments, based on the specific fluorescence signal measured with JUNGFRAU, both at the synchrotron and at SwissFEL. Finally, the measurement of elemental absorption edges at a synchrotron beamline using JUNGFRAU is also demonstrated.
Beyond supervisors’ support: influencing (international) technical training transfer
Authors: Richter Svenja , Kauffeld Simone
Published: February 2020

Purpose

This paper aims to provide an understanding of influencing motivation and volition in the transfer of learning within the context of technical training in different countries by controlling predictors.

Design/methodology/approach

In six countries, employees from one automotive company’s service centres were asked to complete two online questionnaires after a blended learning training program with technical content (t1: 7 to 12 days after the training, t2: 5 to 7 weeks after). In total, 441 technical staff members participated.

Findings

Results suggest that motivation and volition mediate the effects of peer support, content validity and supervisor support on training transfer after a technical training. The outcomes show that peer support has an important influence on motivation and that national culture is less important than company culture.

Research limitations/implications

The results should be tested further in different trainings, companies and countries.

Originality/value

This is one of the first international studies to confirm peer support and content validity as predictors for motivation to transfer after technical training. It is also the first instance of exploring possible mediation by motivation and volition on peer support and content validity after technical training in an intercultural context.
Compliance behaviour from the holistic human nature perspective
Authors: Fidiana Fidiana
Published: February 2020

Purpose

Previous studies on tax compliance have not internally failed to consider why individuals avoid tax payments. The purpose of this paper is to explore the compliance behaviour of Indonesian taxpayers from holistic human nature perspectives including their rational, social and spiritual values.

Design/methodology/approach

This paper adopts the tabayyun approach, an interpretive conceptualised methodology using Islamic knowledge to explore taxpayers' rational, social and spiritual realities.

Findings

Tax compliance is influenced by holistic factors: personal economic rational, social consensus and spiritual beliefs. Rational taxpayers distrust tax authority and see tax payments as an economic decision (i.e. costs and benefits) that reduces/increases wealth. So, they tend to avoid or reconfigure payments. Opposite to economic rationally is the societal pressure upon taxpayers to converge to being an acceptable citizen with legitimate businesses. Under this view, no mistrust against tax authority exists. As for the spiritual factor, tax payments are seen as religious duties like zakat that ought to be paid for achieving spiritual alleviation.

Research limitations/implications

Due to the research approach, this study results may lack generalisation. Future research can expand broader understanding of religious belief in corporation with compliance behaviour.

Practical implications

In the tax policy context, this study recommends to take into consideration religious levy being included in the tax system. This study also argues substituting tax with zakat. In Indonesia, religious levy takes more essential roles in the spiritual domain rather than economical domain.

Social implications

It is difficult to expect tax compliance to be an internal compliance because the source of the command is of an external origin. It is considered as a new concept of wealth distribution that comes from an internal attribute. For states that have religious population as Indonesia, religious values become communal bonds that more dominantly form self-identity at both physical and mental levels. Hence, it is very essential for the state to consider the inclusion of religious values or teachings to the regulation, if the state wants such regulation to be adhered significantly by people. The collection instrument whose bonds originated in religious moral/spiritual values can raise the awareness and compliance voluntarily because the command source is internal and autonomous.

Originality/value

This study fills the gaps in the taxation literature by incorporating a spiritual perspective, instead of rational and social domains.
‘It's like sludge green’: young people's perceptions of standardized tobacco packaging in the UK
Authors: MacGregor Andy , Delaney Hannah , Amos Amanda , Stead Martine , Eadie Douglas , Pearce Jamie , Ozakinci Gozde , Haw Sally
Published: February 2020

Background and Aims

Standardized tobacco packaging was introduced in the United Kingdom in May 2016, together with larger graphic warnings. This study explored young Scottish people's awareness of and perceptions about standardized tobacco packaging in the United Kingdom.

Design

Qualitative study using 16 focus groups conducted February–March 2017.

Setting

Four schools in Scotland based in areas of differing socio‐economic status (high versus medium/low) and two levels of urbanity (large urban versus small town/other urban).

Participants

Eighty‐two S2 (13–14 years) and S4 (15–16 years) students who were smokers or at‐risk non‐smokers.

Measurements

Focus groups explored perceptions of standardized packaging and health warnings. The qualitative data underwent thematic analysis.

Findings

Views about standardized packaging were generally negative. Packs were described as being unattractive, drab and less appealing than non‐standardized versions. The new health warnings generated negative affective, often aversive, responses. These varied depending on the image's perceived ‘gruesomeness’ and authenticity. Most participants thought that the impact would be greatest on young non/occasional smokers. There were divergent views about whether established smokers would be affected.

Conclusions

The introduction of standardized tobacco packaging and new larger graphic health warnings in the United Kingdom seems have reduced the perceived attractiveness of cigarette packs among young people in the United Kingdom who smoke or are at elevated risk of becoming smokers, disrupting positive brand imagery (the brand heuristic), increasing the salience of health warnings and contributing to denormalizing smoking.
City checking: Piloting the UK's first community‐based drug safety testing (drug checking) service in 2 city centres
Authors: Measham Fiona
Published: February 2020

Aims

To explore the feasibility of delivering community‐based drug safety testing (drug checking), to trial service design characteristics and to compare with festival‐based testing.

Methods

In total, 171 substances of concern were submitted on 5 dates at 3 venues in 2 UK cities and tested using up to 6 analytical techniques. Test results and harm reduction advice were distributed directly to over 200 service users through 144 tailored healthcare consultations, to stakeholders, and through early warning systems, media and social media alerts.

Results

The 171 samples were submitted and identified as MDMA (43.3%), cocaine (12.9%), ketamine (12.9%), various psychedelics submitted by students, and heroin and a synthetic cannabinoid submitted by rough sleeping communities, with 76% of samples' test results as expected. The 144 primary service users identified as 91.7% white, 68.1% male, with an average age of 26.7 years. Reported harm reduction intentions included alerting friends and acquaintances (37.5%), being more careful mixing that substance (35.4%), lowered dosage (27.8%), disposal of further substances (6.9%) and additionally 2.8% handed over further substances for verified destruction.

Conclusion

Community‐based drug safety testing (drug checking) was piloted for the first time in the UK—within a drugs service, a community centre and a church—with consideration given to meso‐level operational feasibility and micro‐level behavioural outcomes. Service design characteristics such as venue, day of week, prior publicity, service provider, and direct and indirect dissemination of results all may impact on outcomes. Future studies should consider cost–benefit analyses of community and event‐based testing and context‐appropriate macro, meso and micro‐level evaluations.
Are apoptosis‐determining techniques useful to establish an early diagnosis of acute graft‐vs‐host disease in pediatric patients under treatment with multiple drugs?
Authors: Morán‐Villaseñor Edna , Serrano‐Pacheco Cecilia , Orozco‐Covarrubias Luz , Murata Chiharu , Rodríguez‐Jurado Rodolfo , Olaya‐Vargas Alberto , Saez‐de‐Ocariz Marimar
Published: February 2020

Background

There are no pathognomonic histopathological features to distinguish acute graft‐vs‐host disease (aGVHD) from skin drug reactions (SDRs) in pediatric patients with multiple drug regimens that have received blood transfusions and/or transplants. We aimed to determine if the addition of apoptosis markers is helpful to distinguish aGVHD from SDRs in these patients.

Methods

Skin biopsy specimens from patients with a clinical diagnosis of aGVHD or SDRs were evaluated for the presence of apoptotic bodies, satellitosis, interface damage, vasculitis, and inflammatory infiltrate on H&E stain. Information was completed with apoptotic markers (transferase‐mediated dUTP nick end‐labeling [TUNEL], bcl‐2, and caspase‐3).

Results

The skin biopsy specimens of 32 patients with aGVHD and 11 with SDRs were included for study. Only the number of apoptotic keratinocytes per 10 high‐power fields (hpf) showed a significant difference between both groups (P = 0.02); the presence of ≥4 apoptotic keratinocytes per 10 hpf was identified as the optimal cut‐off point to discriminate aGVHD from SDRs. No SDRs cases had follicular apoptotic cells. TUNEL, bcl‐2, and caspase‐3 determination showed no difference between both groups.

Conclusions

The presence of ≥4 apoptotic keratinocytes per 10 hpf (in aGVHD) and the absence of follicular apoptotic cells (in SDRs) might be a useful marker to distinguish between them.
Emergence stages of permanent teeth in twins: A comparative study
Authors: Oz Esra , Kırzıoglu Zuhal
Published: February 2020

Background

The relative effects of genetic factors on the timing of tooth eruption can be demonstrated through twin studies; however, twin studies on the eruption time of permanent teeth were limited.

Aim

To compare the emergence stages of permanent teeth in twins and non‐twin children.

Design

A total of 480 patients aged from 5.0 to 13.11 years who attended to the Department of Pediatric Dentistry for any dental reason were included in the study. Twins were compared with the control group in terms of the emergence stages for all permanent teeth.

Results

At the age of 5 years, girls in the control group showed statistically significant differences related to the central incisors, the first molars in the mandibular dentition and the first molars in the maxillary dentition, showing more advanced emergence stages. In the 6‐ to 8‐ and 12‐ to 13‐year‐old age groups, no gender‐related differences in emergence stages were observed. Gestation age was found to have a statistically significant effect on the emergence stages of permanent teeth. There were no statistically significant differences between birthweights and tooth emergence stages in twins.

Conclusion

Longitudinal studies are needed to determine whether there is a strong genetic effect on emergence stages of permanent teeth in twins.
A novel sleep stage scoring system: Combining expert‐based features with the generalized linear model
Authors: Gunnarsdottir Kristin M. , Gamaldo Charlene , Salas Rachel Marie , Ewen Joshua B. , Allen Richard P. , Hu Katherine , Sarma Sridevi V.
Published: February 2020

In this study, we aim to automate the sleep stage scoring process of overnight polysomnography (PSG) data while adhering to expert‐based rules. We developed a sleep stage scoring algorithm utilizing the generalized linear modelling (GLM) framework and extracted features from electroencephalogram (EEG), electromyography (EMG) and electrooculogram (EOG) signals based on predefined rules of the American Academy of Sleep Medicine (AASM) Manual for Scoring Sleep. Specifically, features were computed in 30‐s epochs in the time and frequency domains of the signals and were then used to model the probability of an epoch being in each of five sleep stages: N3, N2, N1, REM or Wake. Finally, each epoch was assigned to a sleep stage based on model predictions. The algorithm was trained and tested on PSG data from 38 healthy individuals with no reported sleep disturbances. The overall scoring accuracy reached on the test set was 81.50 ± 1.14% (Cohen's kappa, ). The test set results were highly comparable to the training set, indicating robustness of the algorithm. Furthermore, our algorithm was compared to three well‐known commercialized sleep‐staging tools and achieved higher accuracies than all of them. Our results suggest that automatic classification is highly consistent with visual scoring. We conclude that our algorithm can reproduce the judgement of a scoring expert and is also highly interpretable. This tool can assist visual scorers to speed up their process (from hours to minutes) and provides a method for a more robust, quantitative, reproducible and cost‐effective PSG evaluation, supporting assessment of sleep and sleep disorders.