bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Surgical Nurse Self-perceived Competency in Posttraumatic Stress Disorder/Substance Use Disorder Veteran Care in a Non–Veterans Health Administration Setting
Authors: Claus Nancy , Watts Penni , Moss Jacqueline
Published: March 2020

OBJECTIVE

This study evaluated the self-perceived readiness of medical-surgical nurses in a non–Veterans Health Administration (VHA) facility to care for veterans with posttraumatic stress disorder (PTSD) and substance use disorder (SUD).

BACKGROUND

Nurses caring for veterans with PTSD and SUD at facilities other than the VHA should be equipped with the knowledge, skills, and attitudes to provide care for this population.

METHODS

Nurses evaluated their self-perceived knowledge, skills, attitudes, experiences, and perspectives related to caring for veterans.

RESULTS

Nurses overwhelmingly indicated that they had no knowledge of the “Have you served?” campaign, and fewer than half inquired about military status when assessing patients

CONCLUSION

Nurses caring for veterans in non-VHA facilities do not consistently identify veterans or assess for service-related conditions, including PTSD and SUD. Nurses report low skill levels related to identifying, addressing, and referring patients with service-related conditions.
Shock Severity Modifies Associations Between RBC Transfusion in the First 48 Hours of Sepsis Onset and the Duration of Organ Dysfunction in Critically Ill Septic Children*
Authors: Srouji Lara S. , Moore-Clingenpeel Melissa , Hensley Josey , Steele Lisa , Greathouse Kristin , Anglim Larissa , Hanson-Huber Lisa , Nateri Jyotsna , Nicol Kathleen , Hall Mark W. , Ramilo Octavio , Muszynski Jennifer A.
Published: March 2020

Objective:

To test the hypothesis that early RBC transfusion is associated with duration of organ dysfunction in critically ill septic children.

Design:

Secondary analysis of a single-center prospective observational study. Multivariable negative binomial regression was used to determine relationships between RBC transfusion within 48 hours of sepsis onset and number of days in 14 with organ dysfunction, or with multiple organ dysfunction syndrome.

Setting:

A PICU at a quaternary care children’s hospital.

Patients:

Children less than 18 years old with severe sepsis/septic shock by consensus criteria were included. Patients with RBC transfusion prior to sepsis onset and those on extracorporeal membrane oxygenation support within 48 hours of sepsis onset were excluded.

Interventions:

None.

Measurements and Main Results:

Ninety-four patients were included. Median age was 6 years (0–13 yr); 61% were male. Seventy-eight percentage had septic shock, and 41 (44%) were transfused RBC within 48 hours of sepsis onset (early RBC transfusion). On multivariable analyses, early RBC transfusion was independently associated with 44% greater organ dysfunction days (adjusted relative risk, 1.44 [1.04–2.]; p = 0.03), although risk differed by severity of illness (interaction p = 0.004) and by shock severity (interaction p = 0.04 for Vasoactive Inotrope Score and 0.03 for shock index). Relative risks for multiple organ dysfunction syndrome days varied by shock severity (interaction p = 0.008 for Vasoactive Inotrope Score and 0.01 for shock index). Risks associated with early RBC transfusion were highest for the children with the lowest shock severities.

Conclusions:

In agreement with previous studies, early RBC transfusion was independently associated with longer duration of organ dysfunction. Ours is among the first studies to document different transfusion-associated risks based on clinically available measures of shock severity, demonstrating greater transfusion-associated risks in children with less severe shock. Larger multicenter studies to verify these interaction effects are essential to plan much-needed RBC transfusion trials for critically ill septic children.
An Adolescent With Progressive Shortness of Breath
Authors: Szadkowski Adam , Hagen Scott
Published: March 2020

Shortness of breath and wheezing are common presenting signs for children in the emergency department. In adolescence, it is often due to asthma or lower respiratory tract infections. We present a rare pediatric case of an adolescent with biphasic stridor and progressive exercise-induced shortness of breath who was found to have severe idiopathic subglottic stenosis.
Utility of Point-of-Care Ultrasound for the Diagnosis of Hill-Sachs Deformity in the Pediatric Emergency Department
Authors: Solomon Linda , Goldwasser Bernard , Huston Katherine , Meltzer James A.
Published: March 2020

We report a case of a 20-year-old man presenting to our pediatric emergency department with an anterior shoulder dislocation. Point-of-care ultrasound demonstrated a Hill-Sachs deformity. The potential role of ultrasound and the clinical importance of identifying patients with Hill-Sachs deformities are discussed.
Defining Pneumonia Severity in Children
Authors: Dean Preston , Schumacher Daniel , Florin Todd A.
Published: March 2020

Objectives

Although community-acquired pneumonia (CAP) is one of the most common infections in children, no standardized risk classification exists to guide management. The objective of this study was to develop expert consensus for factors associated with various degrees of disease severity in pediatric CAP.

Methods

Using a web-based classical Delphi process, a multidisciplinary panel of 10 childhood pneumonia experts rated the degree of severity (mild, moderate, or severe) of clinical, radiographic, and laboratory factors, as well as outcomes relevant to pediatric pneumonia. Round 1 was open-ended, with panelists freely stating all characteristics they felt determined pneumonia severity. In rounds 2 to 4, panelists used a 9-point Likert scale (1–3, mild; 4–6, moderate; 7–9, severe) to rate severity for each item. Consensus was defined as 70% or greater agreement in ranking mild, moderate, or severe.

Results

Panelists identified 318 factors or outcomes in round 1; the panel reached consensus for 286 (90%). The majority of items without consensus straddled levels of severity (eg, mild-moderate). Notable clinical factors with consensus included age, oxygen saturation, age-based respiratory rate, and gestational age. Severity classification consensus was also reached for specific imaging and laboratory findings. Need for and duration of hospitalization, supplemental oxygen/respiratory support, and intravenous fluids/medications were considered important outcomes in classifying severity.

Conclusions

This study presents factors deemed important for risk stratification in pediatric CAP by consensus of a multidisciplinary expert panel. This initial step toward identifying and formalizing severity criteria for CAP informs critical knowledge gaps and can be leveraged in future development of clinically meaningful risk stratification scores.
Effects of Transcutaneous Neuromuscular Electrical Stimulation on Swallowing Disorders
Authors: Sun Yuanyuan , Chen Xiaoyun , Qiao Jianhong , Song Guixiang , Xu Yuedong , Zhang Yan , Xu Dongmei , Gao Wei , Li Yunfeng , Xu Cuiping
Published: March 2020

Objective

The aim of the study was to evaluate the efficacy of transcutaneous neuromuscular electrical stimulation on swallowing disorders.

Design

MEDLINE/PubMed, Embase, CENTRAL, Web of science, and PEDro were searched from their earliest record to August 1, 2019. All randomized controlled trials and quasi-randomized controlled trial were identified, which compared the efficacy of neuromuscular electrical stimulation plus traditional therapy with traditional therapy in swallowing function. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to evaluate the quality of evidence.

Results

Eight randomized controlled trials and three quasi-randomized controlled trials were included. These studies demonstrated a significant, moderate pooled effect size (standard mean difference = 0.62; 95% confidence interval = 0.06 to 1.17). Studies stimulating suprahyoid muscle groups revealed a negative standard mean difference of 0.17 (95% confidence interval = −0.42, 0.08), whereas large effect size was observed in studies stimulating the infrahyoid muscle groups (standard mean difference = 0.89; 95% confidence interval = 0.47 to 1.30) and stimulating the suprahyoid and infrahyoid muscle groups (standard mean difference = 1.4; 95% confidence interval = 1.07 to 1.74). Stimulation lasting 45 mins or less showed a large, significant pooled effect size (standard mean difference = 0.89; 95% confidence interval = 0.58 to 1.20). The quality of evidences was rated as low to very low.

Conclusions

There is no firm evidence to conclude on the efficacy of neuromuscular electrical stimulation on swallowing disorders. Larger-scale and well-designed randomized controlled trials are needed to reach robust conclusions.
Decision-Making in Middle Vault Reconstruction following Dorsal Hump Reduction in Primary Rhinoplasty
Authors: Avashia Yash J. , Marshall Andre P. , Allori Alexander C. , Rohrich Rod J. , Marcus Jeffrey R.
Published: March 2020

Background:

Dorsal hump reduction during open rhinoplasty disrupts the continuity between the upper lateral cartilages and the dorsal septum. Options to reconstitute the midvault include primary closure of the upper lateral cartilages to the dorsal aspect of the septum, placement of spreader grafts, and creation of spreader flaps. The authors sought to clarify from highly experienced rhinoplasty surgeons their decision-making rationale for midvault reconstruction, distilling down the group consensus into algorithmic guidelines.

Methods:

A panel of internationally recognized rhinoplasty surgeons participated in a two-part organized communication method. An introductory summit consisted of open discussions on various topics in midvault reconstruction. The summit transcription was analyzed by thematic content analysis to develop a survey encompassing clinical scenarios for primary rhinoplasty, which was then individually administered to each panelist. Data gathered from both parts were used to generate technical guidelines and a decision-making algorithm.

Results:

The panelists identified the following anatomical features as pertinent to their selection of midvault reconstruction method: size of the dorsal hump reduction, width of the midvault relative to the upper vault, presence of dorsal angulation, and presence of nasal obstructive symptoms. Individual panelist preference was gathered from the 24-scenario survey divided into either cosmetic or functional rhinoplasty cases.

Conclusions:

Management of the midvault after dorsal hump reduction is important to establish proper aesthetic relationships and to provide functional integrity of the internal valve. Our authors present an algorithmic approach to decision-making based on the systematic analysis practiced by senior rhinoplasty surgeons.
“Disbelief and Sadness”: First-Year Health Profession Students’ Perspectives on Medical Errors
Authors: Davis Beth P. , Clevenger Carolyn , Dillard Rebecca , Moulia Danielle , Ander Douglas S.
Published: March 2020

Objectives

The aims of the study were to examine the reactions of first-year health profession students to medical errors and determine whether differences exist between disciplines.

Methods

After viewing the Team STEPPS Program’s Susan Sheridan video that describes two separate medical errors, students from anesthesia assistant, medical imaging, medicine, nursing, physical therapy, and physician assistant programs provided unstructured open responses reflecting on initial impressions of medical errors depicted in the film. Student responses were assessed via inductive coding techniques and thematic analysis and stratified by discipline. Frequencies of key themes were calculated. Descriptive analyses characterized respondents and χ2 tests compared responses between disciplines.

Results

In a review of 373 student responses (80% response rate), 255 students expressed an emotion-based reply, of which 93.75 were negative with such comments as they felt horrified, appalled, and disappointed by the patient’s experience. Of the 227 students who commented on blame or fault, 70% felt that a system error was at fault, 45% felt that it was the provider and only 1.3% stated that it was the patient’s fault. Of the students who mentioned the context or situation, just more than half felt that the episode was preventable and there was a causal relationship between clinic workers’ actions and the medical error. Finally, a high percentage of students had a solutions-oriented response, noting the importance of teamwork and communication in the avoidance of medical errors.

Conclusions

First-year health profession students responded to medical error with strong emotion and distress. Their responses largely represent an individualistic view of healthcare in both the causes and solutions to medical errors. No differences in response themes were observed by discipline. This study represents our students’ emotional responses to a medical error scenario. The qualitative responses and reactions of students to the Sheridan video offered opportunities to tease out nuances that would otherwise be unavailable in a typical attitudes survey. We noted a individualistic view of healthcare in both the causes and solutions to medical errors. We view these results as an opportunity for interprofessional education in systems-level approaches to improve patient safety. Curricular efforts in interprofessional education, collaborative practice, and patient safety should be driven by these results.
Crohn's Disease Activity Quantified by Iodine Density Obtained From Dual-Energy Computed Tomography Enterography
Authors: Dane Bari , Duenas Sean , Han Joseph , O'Donnell Thomas , Ream Justin , Chang Shannon , Megibow Alec
Published: March 2020

Objective

The objective of this study was to assess if bowel wall iodine density obtained from dual-source, dual-energy computed tomography enterography (DECTE) could be a biomarker of Crohn's disease activity.

Methods

Twenty-two patients with Crohn's disease imaged with DECTE from February 2016 to May 2018 were retrospectively identified by departmental report search. Iodine maps were created with commercial software (Syngovia). Iodine content was normalized to the aorta, and then manual dual-energy region-of-interest cursors were placed over the visibly assessed maximal and minimal iodine density within segments of involved as well as unaffected small bowel. The mixed Hounsfield unit value, maximum iodine density (I
max), and minimum iodine density (I
min) were recorded. The length of affected bowel demonstrating maximum disease activity as a percentage of overall involvement was subjectively assessed. A weighted iodine density (I
weighted) was calculated. The clinical assessment of disease activity using erythrocyte sedimentation rate, C-reactive protein, fecal calprotectin, colonoscopy/endoscopy, and surgery, if available, served as the reference standard. The Crohn's disease activity index was also used as a separate additional reference standard.

Results

Significant heterogeneity within the affected segments was present. The average I
max and I
min of affected bowel was 4.27 ± 1.11 (2.4–7.4) mg/mL and 2.71 ± 0.51 (2.2–3.9) mg/mL, respectively. Iodine density of normal-appearing small bowel was 1.40 ± 0.26 (0.9–1.9) mg/mL. The I
max and I
min of affected bowel differed significantly from normal bowel (P < 0.0001). Mixed Hounsfield unit (101.82 ± 27.5) also statistically differed (46.33 ± 19.62) (P < 0.0001). Using overall clinical assessment as the reference standard, all patients with I
min of greater than 2.6 mg/mL, I
weighted of greater than 3.3 mg/mL, or I
max of greater than 4.7 mg/mL had clinically active disease. Sixteen of 17 patients with I
min of greater than 2.2 mg/mL and 14/15 with I
weighted of greater than 3 mg/mL had clinically active disease. Using Crohn's disease activity index as the reference standard, all patients with I
min of greater than 2.7 mg/mL, I
weighted of greater than 3.6 mg/mL, or I
max of greater than 5.4 mg/mL had clinically active disease. The median effective dose was 4.64 ± 1.68 mSv (range, 2.03–8.12 mSv).

Conclusions

Iodine density obtained from DECTE highlights regions of maximal activity within affected bowel segments. An iodine density of 2 mg/mL appears to be a threshold between normal bowel segments and those with active Crohn's disease. Iodine density measurement thresholds I
min of greater than 2.6 mg/mL, I
weighted of greater than 3.3 mg/mL, and I
max of greater than 4.7 mg/mL correlate with established clinical markers of disease activity, with I
min seemingly most useful in daily clinical practice.
Comparison of Model-Free and Model-Based Dynamic Contrast-Enhanced Magnetic Resonance Imaging Pharmacokinetic Parameters for Predicting Breast Cancers' Response to Neoadjuvant Chemotherapy
Authors: Lv Guangjie , Zhou Yiming , Zheng Dandan , Gao Jiayin , Xu Zhujin , Jiang Lei
Published: March 2020

Objective

To prospectively compare the performance of model-based and model-free dynamic contrast-enhanced (DCE) pharmacokinetic parameters in monitoring breast cancers' early response to neoadjuvant chemotherapy (NACT).

Methods

Sixty patients, with 61 pathology-proven breast cancers, were examined using DCE magnetic resonance imaging before, after the first cycle, and after full cycles of NACT. Both model-based (K
trans and others) and model-free parameters, mainly time-intensity curve (TIC), were measured. According to Miller-Payne grading, patients were divided into response and nonresponse group. Mann-Whitney U test, Fisher exact test, multivariate logistic regression, and receiver operating characteristic curve were used in analysis.

Results

After the first cycle, among all the parameters, K
trans and TIC were strongly associated with tumors' early response. There was no significant difference between the areas under receiver operating characteristic curve of K
trans and TIC (0.768, 0.852, respectively).

Conclusions

Model-based and model-free DCE parameters, especially K
trans and TIC, have similar performance in predicting the efficacy of NACT for breast cancers.
Costal Cartilage and Costal Perichondrium Sandwich Graft in Septal Perforation Repair
Authors: Hanci Deniz , Üstün Onur , Yilmazer Ayça Başkadem , Göker Ayşe Enise , Kumral Tolgar Lütfi , Uyar Yavuz
Published: March 2020

Background:

Repair of the septal perforation is a challenging procedure and there are many different surgical techniques. In this study, the authors present a novel method which the authors use costal cartilage and costal perichondrium sandwich graft as an interposition graft with bilateral opposing mucoperichondrial flaps.

Patients and Methods:

Fourteen patients (5 females, 9 males) underwent septal perforation repair. All surgeries were performed through an open approach septoplasty technique. The edges of the perforation were incised to excise the mucosa with a thickness of 2 mm. Bilateral mucoperichondrial flaps were raised. Then costal cartilage and costal perichondrium were harvested from the rib. The cartilage was divided into a smaller piece which is 2 mm thick and 1 cm wider than perforation size. The prepared cartilage was wrapped with perichondrium to obtain a sandwich graft. This sandwich graft was placed between the mucoperichondrial flaps, corresponding to the perforation.

Results:

After 9 months of follow-up, 11 (78%) of the 14 perforations were completely closed. Failure of the repair was observed in 3 patients; 2 of the perforations were medium size and one perforation was large size. No complications occurred.

Conclusion:

Using costal cartilage and costal perichondrium sandwich graft is a novel and useful technique especially in large septal perforations. Considering that septum surgery has an important role in the etiology of septum perforation, this method provides a good graft source for both perforation closure and simultaneous rhinoplasty surgery.
Unusual Mimicker of the Carotid Body Tumor: Synovial Sarcoma of the Carotid Space
Authors: Gozgec Elif , Ogul Hayri
Published: March 2020

Synovial cell sarcomas are malignant tumors originating from pluripotent mesenchymal stem cells, unlike its name. It is a common tumor in the periarticular area, accounting for 8% of all soft tissue sarcomas. Head and neck are among the rarest areas of this tumor. Synovial sarcomas of the head and neck are more aggressive than those seen in other regions and are associated with remarkable mortality and morbidity. Treatment of synovial sarcomas of the head and neck is usually extensive local excision and additional radiation and/or chemotherapy may be performed.
Idiopathic Orbital Inflammation With Superior Rectus and Levator Complex may be Misdiagnosed as Involutional Ptosis
Authors: Kim Seungheon , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun
Published: March 2020

Idiopathic orbital inflammation (IOI) is a benign inflammatory disease usually confined to the orbit. Two middle-aged patients with IOI have been reported who could have been misdiagnosed as involutional ptosis. Two patients presented to the clinic with eyelid ptosis. One patient's erythrocyte sedimentation rate was slightly increased; the other patient's immunoglobulin G4 (IgG4), IgG, and thyroid-stimulating hormone results were higher than the upper limits of normal. The computed tomographic images and orbit magnetic resonance imaging tests showed an inflammatory condition around the droopy eyelids. They were both admitted to the hospital with diagnosis of IOI, and intravenous antibiotic and steroid treatment were administered, which improved their symptoms.
Periorbital Emphysema Presenting With Diplopia After Rhinoplasty
Authors: Lee Ho Yun , Lee Jun , Choi Myoung Su , Kim Su Jin
Published: March 2020

Periorbital emphysema is a well-known but very rare complication after rhinoplasty. Here, we present a case of periorbital emphysema presenting with diplopia and eyeball deviation after rhinoplasty. All symptoms disappeared spontaneously within days, without any complications.
Histone deacetylase 6 inhibition improves survival in a swine model of lethal hemorrhage, polytrauma, and bacteremia
Authors: Biesterveld Ben E. , Wakam Glenn K. , Kemp Michael T. , Williams Aaron M. , Shamshad Alizeh , O'Connell Rachel L. , Siddiqui Ali Z. , Chtraklin Kiril , Bhatti Umar F. , Li Yongqing , Alam Hasan B.
Published: March 2020

BACKGROUND

Trauma is the leading cause of death for young Americans. Nonspecific histone deacetylase inhibitors, such as valproic acid, have been shown to improve survival in preclinical models of lethal trauma, hemorrhage, and sepsis. The doses needed to achieve a survival benefit are higher than Food and Drug Administration–approved doses, and the nonspecificity raises concerns about unintended adverse effects. The isoform-specific histone deacetylase 6 inhibitor, ACY-1083, has been found to be as efficacious as valproic acid in a rodent model of hemorrhagic shock. We hypothesized that ACY-1083 treatment would improve survival in a swine model of lethal hemorrhage, polytrauma, and bacteremia.

METHODS

Swine were subjected to 45% blood volume hemorrhage, brain injury, femur fracture, rectus crush, splenic and liver lacerations, and colon injury. After 1 hour of shock (mean arterial pressure, 30–35 mm Hg), animals were randomized to normal saline resuscitation (control) or normal saline plus ACY-1083 30 mg/kg treatment (n = 5/group). After 3 hours (simulating delayed evacuation), packed red blood cells and antibiotics were administered, the colon injury was repaired, and the abdomen was closed. Animals were then monitored for another 4 hours. Survival was assessed using Kaplan-Meier and log-rank test.

RESULTS

This combination of injuries was lethal. All animals became bacteremic, in addition to the severe hemorrhagic shock. Survival in the control group was 0%, and ACY-1083 treatment increased survival to 80% (p = 0.019). There was no difference in the brain lesion size between the groups.

CONCLUSION

A single dose of ACY-1083 markedly improves survival in an otherwise lethal model of polytrauma, hemorrhagic shock, and bacteremia.
Identifying participants for inclusion in hospital-based violence intervention: An analysis of 18 years of urban firearm recidivism
Authors: Bonne Stephanie , Tufariello Ann , Coles Zachary , Hohl Bernadette , Ostermann Michael , Boxer Paul , Sloan-Power Elizabeth , Gusmano Michael , Glass Nina E. , Kunac Anastasia , Livingston David
Published: March 2020

BACKGROUND

Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria.

METHODS

Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists.

RESULTS

There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone.

CONCLUSION

The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism.

LEVEL OF EVIDENCE

Therapeutic/Care Management level III.
Diagnostic accuracy of different clinical screening criteria for blunt cerebrovascular injuries compared with liberal state of the art computed tomography angiography in major trauma
Authors: Müther Michael , Sporns Peter B. , Hanning Uta , Düsing Helena , Hartensuer René , Raschke Michael , Schwake Michael , Stummer Walter , Glasgow Simon
Published: March 2020

BACKGROUND

Blunt cerebrovascular injuries (BCVI) can significantly impact morbidity and mortality if undetected and, therefore, untreated. Two diagnostic concepts are standard practice in major trauma management: Application of clinical screening criteria (CSC) does or does not recommend consecutive computed tomography angiography (CTA) of head and neck. In contrast, liberal CTA usage integrates into diagnostic protocols for suspected major trauma. First, this study's objective is to assess diagnostic accuracy of different CSC for BCVI in a population of patients diagnosed with BCVI after the use of liberal CTA. Second, anatomical locations and grades of BCVI in CSC false negatives are analyzed.

METHODS

The hospital database at University Hospital Münster was retrospectively searched for BCVI diagnosed in patients with suspicion of major trauma 2008 to 2015. All patients underwent a diagnostic protocol including CTA. No BCVI risk stratification or CSC had been applied beforehand. Three sets of CSC were drawn from current BCVI practice management guidelines and retrospectively applied to the study population. Primary outcome was false-negative recommendation for CTA according to CSC. Secondary outcome measures were stroke, mortality, mechanism of injury, multivessel BCVI, location and grade of BCVI.

RESULTS

From 4,104 patients with suspicion of major trauma, 91 (2.2%) were diagnosed with 126 BCVI through liberal usage of CTA. Sensitivities of different CSC ranged from 57% to 84%. Applying the set of CSC with the highest sensitivity, false-negative BCVIs were found more often in the petrous segment of the carotid artery (p = 0.01) and more false negatives presenting with pseudoaneurysmatic injury were found in the vertebral artery (p = <0.01).

CONCLUSION

This study provides further insight into the common debate of correct assessment of BCVI in trauma patients. Despite following current practice management guidelines, a large number of patients with BCVI would have been missed without liberal CTA usage. Larger-scale observational studies are needed to confirm these results.

LEVEL OF EVIDENCE

Diagnostic study, Level III.
Empirical transfusion strategies for major hemorrhage in trauma patients: A systematic review
Authors: Ritchie Duncan T. , Philbrook Frederick G.A. , Leadbitter Stephen , Kokwe Karin N. , Meehan Ellen , McGeady Martin , Beaton Martin
Published: March 2020

BACKGROUND

Major hemorrhage is a significant cause of mortality and morbidity around the world. There is currently no consensus on the best empirical transfusion strategy. The current National Institute for Clinical Excellence (NICE) guidelines suggest a ratio of 1:1 of red blood cells and plasma. The aim of this study is to compare this to alternative strategies identified through review of the available literature with the objective of identifying the best protocol for mortality outcomes and complication rates.

METHODS

A systematic review of the literature was conducted using four databases. Inclusion and exclusion criteria were applied to produce a suitable list of randomized control trials for review. Critical appraisal of each article was then performed, using a Scottish Intercollegiate Guidelines Network–approved checklist, in duplicate and was subject to further independent scrutiny when required.

RESULTS

Evidence suggests that early administration of cryoprecipitate within the standard practiced major hemorrhage protocol is associated with a lower risk of mortality. Other strategies suggested a negative impact. Complications including incidence of thromboembolic events, multiple organ failure and sepsis as well as length of stay in hospital following activation of the different protocols and overall transfusion requirements were assessed. No clear optimal protocol was identified from our analysis.

CONCLUSION

This project demonstrates that there is no significant clarity regarding morbidity and mortality. As a preliminary recommendation, cryoprecipitate supplementation suggests more favorable mortality over the current protocol. Due to the limited sample populations, we recommend the inclusion of retrospective/prospective cohort studies to bolster the statistical power of any future reviews until randomized control trials of sufficient power are available.

LEVEL OF EVIDENCE

Systematic review, Level III.
Universal background checks for handgun purchases can reduce homicide rates of African Americans
Authors: Kaufman Elinore J. , Morrison Christopher N. , Olson Erik J. , Humphreys David K. , Wiebe Douglas J. , Martin Niels D. , Sims Carrie A. , Hoofnagle Mark H. , Schwab C. William , Reilly Patrick M. , Seamon Mark J.
Published: March 2020

BACKGROUND

Federal law requires background checks for firearms purchased from licensed dealers, but states can extend requirements to private sales of handguns and purchases at gun shows (universal background checks for handguns [UBC-HG]). Although firearm homicide disproportionately affects African Americans, little is known about how UBG-HG impacts African Americans. We hypothesized that implementation of UBC-HG would reduce rates of firearm homicide of African Americans.

METHODS

We collected Centers for Disease Control firearm homicide counts for African American and white populations in the 50 states, 1999 to 2017. Laws were drawn from the State Firearm Laws Database. The exposure and outcome of interest were UBC-HG adoption and firearm homicide. We included non-Hispanic African American and non-Hispanic white populations. We used Poisson regression to perform a differences-in-differences analysis. A categorical variable for state accounted for time-stable state characteristics. We controlled for year to account for trends over time unrelated to policy. We controlled for state-specific, time-variable factors, including median household income, population younger than 25 years or 65 years or older, alcohol consumption, and count of firearm laws (UBC-HG excluded). Standard errors were adjusted for clustering at the state level.

RESULTS

The firearm homicide rate among whites was 1.8 per 100,000 (interquartile range, 1.2–2.7) ranging from 1.4 in 2011 to 1.8 in 2016. The firearm homicide rate was 15.6 per 100,000 (interquartile range, 11.6–21.0) among African Americans, ranging from 14.0 in 2009 to 19.6 in 2017. While no significant difference in firearm homicides among whites (incidence rate ratio, 0.93; 95% confidence interval, 0.73–1.20) was appreciated, the passage of UBC-HG was associated with an 19% decrease in African Americans firearm homicides (incidence rate ratio, 0.81; 95% confidence interval, 0.70–0.94; p = 0.006).

CONCLUSION

Implementing UBC-HG was associated with decreased firearm homicides among African Americans—the population most at risk. Expanding UBC-HG may be an effective approach to reducing racial disparities in firearm homicides.

LEVEL OF EVIDENCE

Epidemiological, level III.
Challenges in the veterinary microbiology diagnostic laboratory: a novel Acinetobacter species as presumptive cause for feline unilateral conjunctivitis
Authors: Vale Ana P. , Leggett Bernadette , Smyth David , Leonard Finola
Published: March 2020

The present study highlights challenges in the veterinary microbiology diagnostic laboratory in the identification of bacteria responsible for infections in veterinary settings, particularly when evidence-based data is lacking. A 1.8-year-old neutered male domestic cat (FIV/FeLV negative) was presented to a veterinary practice in April 2016 with a history of left unilateral mild conjunctivitis that was empirically treated with fusidic acid and chloramphenicol. In January 2017, the same animal was presented with chronic left unilateral conjunctivitis and an eye swab was submitted for microbiological culture and susceptibility testing. Significant growth was not detected in two samples tested. Finally, in February 2017 another eye swab produced a slow growing pure culture identified by VITEK 2 as

Neisseria cinerea

(94 % confidence). Given the morphology and multidrug resistance profile of the isolate a 16S rRNA PCR was performed for definitive identification. The nucleotide sequence of the PCR amplicon was 99 % homologous to

Acinetobacter equi

sp. nov. strain 114. Veterinary microbiology diagnostic laboratories play an important role worldwide, not only in preserving animal health and welfare but also in controlling the spread of zoonotic pathogens. The lack of evidence-based information on the ocular microbiome of healthy cats and the complexity of bacterial ecosystems renders the interpretation of results difficult. A further problem for both the laboratory and the clinician is the lack of interpretive criteria for antibiotic susceptibility test results for some types of infections in animals (including those caused by

Acinetobacter

) and the complete unavailability of criteria for topical antibiotic preparations.
Vagococcus xieshaowenii sp. nov., isolated from snow finch (Montifringilla taczanowskii) cloacal content
Authors: Ge Yajun , Yang Jing , Lai Xin-He , Zhang Gui , Jin Dong , Lu Shan , Wang Bin , Huang Yuyuan , Huang Ying , Ren Zhihong , Zhang Xiaoyan , Xu Jianguo
Published: March 2020

A Gram-stain-positive, coccus-shaped, non-motile bacterium, designated CF-49T, was isolated from the cloacal content of a snow finch, which was incidentally captured in a plateau pika burrow on the Qinghai–Tibet Plateau, PR China. Analysis of the 16S rRNA gene sequence showed that strain CF-49T was closely related to

Vagococcus elongatus

CCUG 51432T (96.5 % similarity),

Vagococcus fluvialis

NCFB 2497T (96.0 %) and

Vagococcus lutrae

CCUG 39187T (95.9 %), whereas the similarity to another isolate (CF-210) was 99.9 %. Strains CF-49T and CF-210 grew optimally at 37 °C and pH 7.0 and in the presence of 0.5 % (w/v) NaCl. Acid was produced from N-acetylglucosamine, cellobiose, d-fructose, d-glucose, d-mannose, d-mannitol, maltose, d-ribose and salicin. The cell-wall peptidoglycan type was A4α (l-Lys–d-Asp). The major cellular fatty acids (>10 %) were C16 : 0 (35.6 %), C14 : 0 (17.3 %), C18 : 1 ω9c (16.2 %) and C16 : 1 ω9c (10.6 %). The predominant respiratory quinone was menaquinone MK-7 (68.8 %). The G+C content of the genomic DNA was 35.9 mol%. Digital DNA–DNA hybridization of strain CF-49T with

V. fluvialis

DSM 5731T,

V. elongatus

CCUG 51432Tand

V. lutrae

CCUG 39187T resulted in relatedness values of 21.4, 23.3 and 24.6 %, respectively. Based on results from polyphasic analyses, our two isolates are proposed to represent a novel species in the genus

Vagococcus

, with the name Vagococcus xieshaowenii. The type strain is CF-49T (=CGMCC 1.6436T=GDMCC 1.1588T=JCM 33477T).
Multi-city modeling of epidemics using spatial networks: Application to 2019-nCov (COVID-19) coronavirus in India
Authors: Pujari Bhalchandra S. , Shekatkar Snehal
Published: March 2020

The ongoing pandemic of 2019-nCov (COVID-19) coronavirus has made reliable epidemiological modeling an urgent necessity. Unfortunately, most of the existing models are either too fine-grained to be efficient or too coarse-grained to be reliable. Here we propose a computationally efficient hybrid approach that uses SIR model for individual cities which are in turn coupled via empirical transportation networks that facilitate migration among them. The treatment presented here differs from existing models in two crucial ways: first, self-consistent determination of coupling parameters so as to maintain the populations of individual cities, and second, the incorporation of distance dependent temporal delays in migration. We apply our model to Indian aviation as well as railway networks taking into account populations of more than 300 cities. Our results project that through the domestic transportation, the significant population is poised to be exposed within 90 days of the onset of epidemic. Thus, serious supervision of domestic transport networks is warranted even after restricting international migration.
Demographic science aids in understanding the spread and fatality rates of COVID-19
Authors: Dowd Jennifer Beam , Andriano Liliana , Rotondi Valentina , Brazel David M. , Block Per , Ding Xuejie , Liu Yan , Mills Melinda C.
Published: March 2020

Governments around the world must rapidly mobilize and make difficult policy decisions to mitigate the COVID-19 pandemic. Because deaths have been concentrated at older ages, we highlight the important role of demography, particularly how the age structure of a population may help explain differences in fatality rates across countries and how transmission unfolds. We examine the role of age structure in deaths thus far in Italy and South Korea and illustrate how the pandemic could unfold in populations with similar population sizes but different age structures, showing a dramatically higher burden of mortality in countries with older versus younger populations. This powerful interaction of demography and current age-specific mortality for COVID-19 suggests that social distancing and other policies to slow transmission should consider both the age composition of local and national contexts as well as the social connectedness of older and younger generations. We also call for countries to provide case and fatality data disaggregated by age and sex to improve real-time targeted nowcasting.
Evaluation of Nucleocapsid and Spike Protein-based ELISAs for detecting antibodies against SARS-CoV-2
Authors: Liu Wanbing , Liu Lei , Kou Guomei , Zheng Yaqiong , Ding Yinjuan , Ni Wenxu , Wang Qiongshu , Tan Li , Wu Wanlei , Tang Shi , Xiong Zhou , Zheng Shangen
Published: March 2020

Background

At present, PCR-based nucleic acid detection cannot meet the demands for coronavirus infectious disease (COVID-19) diagnosis.

Methods

214 confirmed COVID-19 patients who were hospitalized in the General Hospital of Central Theater Command of the People’s Liberation Army between January 18 and February 26, 2020, were recruited. Two Enzyme-Linked Immunosorbent Assay (ELISA) kits based on recombinant SARS-CoV-2 nucleocapsid protein (rN) and spike protein (rS) were used for detecting IgM and IgG antibodies, and their diagnostic feasibility was evaluated.

Results

Among the 214 patients, 146 (68.2%) and 150 (70.1%) were successfully diagnosed with the rN-based IgM and IgG ELISAs, respectively; 165 (77.1%) and 159 (74.3%) were successfully diagnosed with the rS-based IgM and IgG ELISAs, respectively. The positive rates of the rN-based and rS-based ELISAs for antibody (IgM and/or IgG) detection were 80.4% and 82.2%, respectively. The sensitivity of the rS-based ELISA for IgM detection was significantly higher than that of the rN-based ELISA. We observed an increase in the positive rate for IgM and IgG with an increasing number of days post-disease onset (d.p.o.), but the positive rate of IgM dropped after 35 d.p.o. The positive rate of rN-based and rS-based IgM and IgG ELISAs was less than 60% during the early stage of the illness 0-10 d.p.o., and that of IgM and IgG was obviously increased after 10 d.p.o.

Conclusions

ELISA has a high sensitivity, especially for the detection of serum samples from patients after 10 d.p.o, it can be an important supplementary method for COVID-19 diagnosis.
Assessment of menstrual hygiene practice and associated factor among High school female students in Harari Region, Eastern Ethiopia 2019
Authors: Alemayehu Astawus , Ahmed Abdi , Abdalla Maruf
Published: March 2020

Background

Menstruation is a visible manifestation of cyclic uterine bleeding as a result of the interaction of different hormones. During menstruation, girls face gender problems. These are, early marriage, premature childbirth, higher infant mortality and potential vaginal infections resulting in infertility.

Objective

To assess the level of menstrual hygiene practice and associated factors among high school female students in Harari Region Eastern, Ethiopia, 2019.

Study Design and Method

A cross-sectional quantitative study was employed from April 02-05/2019. A minimum sample size of 301 Data was collected using a self-administered structured questionnaire. Descriptive and analytical facts were applied. Bivariate analysis and multivariate regression model were used. P-value <= 0.05 was declared as statistical significance

Result

According to study 168(55.8%) had good practiced the rest had no. students who have no pocket money from family(AOR 0.36:95% CI,0.309,0.989) was 64% less likely poor practiced than students who have permanent pocket money, students who have no educated father(AOR 0.39:95% CI, 0.180,0.872) was 61% less likely poor practiced than who have educated father and students who had not Freely discuss with parents(AOR 0.45:95% CI,0.22,0.903) was 55% less likely poor practiced than who had Freely discuss with parents.

Conclusion

Majority of female students in Harar region had good knowledge about menstrual hygiene practice. good menstrual hygiene practice was more among students who live in the urban than students who live in the rural area; students who have permanent pocket money from family than students who have no permanent pocket money from family.
Hundreds of severe pediatric COVID-19 infections in Wuhan prior to the lockdown
Authors: Du Zhanwei , Nugent Ciara , Cowling Benjamin John , Meyers Lauren Ancel
Published: March 2020

Before January 22, 2020, only one pediatric case of COVID-19 was reported in mainland China1,2. However, a retrospective surveillance study3 identified six children who had been hospitalized for COVID-19 in one of three central Wuhan hospitals between January 7th and January 15th. Given that Wuhan has over 395 other hospitals, there may have been far more severe pediatric cases than reported.
Bio-upcycling of polyethylene terephthalate
Authors: Tiso Till , Narancic Tanja , Wei Ren , Pollet Eric , Beagan Niall , Schröder Katja , Honak Annett , Jiang Mengying , Kenny Shane T. , Wierckx Nick , Perrin Rémi , Avérous Luc , Zimmermann Wolfgang , O’Connor Kevin , Blank Lars M.
Published: March 2020

Over 359 million tons of plastics were produced worldwide in 2018, with significant growth expected in the near future, resulting in the global challenge of end-of-life management. The recent identification of enzymes that degrade plastics previously considered non-biodegradable opens up opportunities to steer the plastic recycling industry into the realm of biotechnology. Here, we present the sequential conversion of polyethylene terephthalate (PET) into two types of bioplastics: a medium chain-length polyhydroxyalkanoate (PHA) and a novel bio-based poly(amide urethane) (bio-PU). PET films were hydrolyzed by a thermostable polyester hydrolase yielding 100% terephthalate and ethylene glycol. A terephthalate-degradingPseudomonaswas evolved to also metabolize ethylene glycol and subsequently produced PHA. The strain was further modified to secrete hydroxyalkanoyloxy-alkanoates (HAAs), which were used as monomers for the chemo-catalytic synthesis of bio-PU. In short, we present a novel value-chain for PET upcycling, adding technological flexibility to the global challenge of end-of-life management of plastics.

Graphical abstract
Analysis of genetic signatures of tumor microenvironment yields insight into mechanisms of resistance to immunotherapy
Authors: Wang Ben , Liu Mengmeng , Ran Zhujie , Li Xin , Li Jie , Ou Yunsheng
Published: March 2020

Background

Therapeutic intervention targeting immune cells have led to remarkable improvements in clinical outcomes of tumor patients. However, responses are not universal. The inflamed tumor microenvironment has been reported to correlate with response in tumor patients. However, due to the lack of appropriate experimental methods, the reason why the immunotherapeutic resistance still existed on the inflamed tumor microenvironment remains unclear.

Materials and methods

Here, based on integrated single-cell RNA sequencing technology, we classified tumor microenvironment into inflamed immunotherapeutic responsive and inflamed non-responsive. Then, phenotype-specific genes were identified to show mechanistic differences between distant TME phenotypes. Finally, we screened for some potential favorable TME phenotypes transformation drugs to aid current immunotherapy.

Results

Multiple signaling pathways were phenotypes-specific dysregulated. For example, Interleukin signaling pathways including IL-4 and IL-13 were activated in inflamed TME across multiple tumor types. PPAR signaling pathways and multiple epigenetic pathways were respectively inhibited and activated in inflamed immunotherapeutic non-responsive TME, suggesting a potential mechanism of immunotherapeutic resistance and target for therapy. We also identified some genetic markers of inflamed non-responsive or responsive TME, some of which have shown its potentials to enhance the efficacy of current immunotherapy.

Conclusion

These results may contribute to the mechanistic understanding of immunotherapeutic resistance and guide rational therapeutic combinations of distant targeted chemotherapy agents with immunotherapy.