bluuebunny/crossref_metadata_2025 huggingface dataset:
Urban rooftop-nesting Common Nighthawk chicks tolerate high temperatures by hyperthermia with relatively low rates of evaporative water loss
Authors: Newberry Gretchen N , O′Connor Ryan S , Swanson David L
Published: April 2021

Heat tolerance for many birds under climate and land use change scenarios could be compromised in the future. Common Nighthawks (Chordeiles minor) belong to the Caprimulgiformes, a generally heat-tolerant order, but few studies have assessed heat tolerance in Caprimulgiform chicks, which might be particularly susceptible to heat stress. In the midwestern United States, nighthawks primarily nest on flat graveled rooftops in urban areas, as natural nesting habitats are limited. Urban rooftop-nesting nighthawks are likely exposed to higher environmental temperatures than birds nesting at more thermally buffered natural sites, and evaporative cooling might be impeded by the typically high summer humidity in their Midwest breeding range. This combination of heat and humidity might negatively impact heat tolerance of nighthawk chicks. We exposed 7- to 14-day-old nighthawk chicks (n = 15) from rooftop nests to ambient temperatures (Tas) up to 51°C and at typical summer dew points. Chicks initiated gular flutter at a mean ambient temperature of 42.4 ± 3.4°C (mean ± SE). Evaporative water loss (EWL) rates increased significantly with increasing temperature above 44.0 ± 1.5°C. Chicks showed little evidence of lower and upper bounds of the thermal neutral zone over the range of temperatures (30–44°C) for which we measured oxygen consumption. Body mass loss was significantly positively correlated with temperature during heat exposure trials. Chicks tolerated Tas up to 51°C and body temperatures (Tbs) up to 48°C, which, along with the high temperatures at which gular flutter and high rates of EWL were initiated, suggest that nighthawk chicks are tolerant of high ambient temperatures, even with relatively high humidity. Given the high rates of mass loss and high Tbs at hot ambient temperatures, chick heat tolerance mechanisms could be detrimental for rooftop-nesting nighthawks given projected increasing trends for both heat and humidity in the midwestern United States.
CRISPR screens in plants: approaches, guidelines, and future prospects
Authors: Gaillochet Christophe , Develtere Ward , Jacobs Thomas B
Published: April 2021

Clustered regularly interspaced short palindromic repeat (CRISPR)-associated systems have revolutionized genome engineering by facilitating a wide range of targeted DNA perturbations. These systems have resulted in the development of powerful new screens to test gene functions at the genomic scale. While there is tremendous potential to map and interrogate gene regulatory networks at unprecedented speed and scale using CRISPR screens, their implementation in plants remains in its infancy. Here we discuss the general concepts, tools, and workflows for establishing CRISPR screens in plants and analyze the handful of recent reports describing the use of this strategy to generate mutant knockout collections or to diversify DNA sequences. In addition, we provide insight into how to design CRISPR knockout screens in plants given the current challenges and limitations and examine multiple design options. Finally, we discuss the unique multiplexing capabilities of CRISPR screens to investigate redundant gene functions in highly duplicated plant genomes. Combinatorial mutant screens have the potential to routinely generate higher-order mutant collections and facilitate the characterization of gene networks. By integrating this approach with the numerous genomic profiles that have been generated over the past two decades, the implementation of CRISPR screens offers new opportunities to analyze plant genomes at deeper resolution and will lead to great advances in functional and synthetic biology.
Bimodal cambial activity and false-ring formation in conifers under a monsoon climate
Authors: Morino Kiyomi , Minor Rebecca L , Barron-Gafford Greg A , Brown Peter M , Hughes Malcolm K
Published: April 2021

Tracking wood formation in semiarid regions during the seasonal march of precipitation extremes has two important applications. It can provide (i) insight into the adaptive capacities of trees to drought and (ii) a basis for a richer interpretation of tree-ring data, assisting in a deeper understanding of past and current climate. In the southwestern USA, the anatomical signature of seasonally bimodal precipitation is the ‘false ring’—a band of latewood-like cells in the earlywood. These occur when a particularly deep drought during the early growing season ends abruptly with timely, mid-growing season monsoonal rains. Such conditions presented in southern Arizona in 2014, enabling us to explore false-ring formation in ponderosa pine (Pinus ponderosa Lawson and C. Lawson) and Douglas-fir (Pseudotsuga menziesii Mirb. Franco) in mixed-conifer forest at 2573 m above sea level. We ask: what were the cell-by-cell timings and durations in the phases of wood cell development in 2014? How do these seasonal patterns relate to strongly fluctuating environmental conditions during the growing season? We took weekly microcores from March through November from six ponderosa pine and seven Douglas-fir trees at a well-instrumented flux tower site. Thin sections were prepared, and we counted cells in cambial, expansion, cell wall thickening and mature phases. For ponderosa pine trees forming a false ring, the first impact of intensifying seasonal drought was seen in the enlarging phase and then, almost a month later, in cambial activity. In this species, recovery from drought was associated with recovery first in cambial activity, followed by cell enlargement. This timing raised the possibility that cell division may be affected by atmospheric moisture increases before soil recharge. In both species, the last false-ring cells matured during the summer rainy season. Bimodal cambial activity coincident with moisture availability was observed in both species, whether or not they formed a false ring. This deeper knowledge of the precise timing of both developmental and environmental events should help define mechanistic connections among these factors in creating bimodal growth patterns.
Effectiveness of the Cognitive Restructuring Approach on Irrational Beliefs and Hopelessness in Individuals With a Substance Abuse Disorder: A Randomized Controlled Trial
Authors: Rezaeisharif Ali , Karimi Abdollah , Naeim Mahdi
Published: April 2021

Background:

Nowadays, because of the increasing prevalence of addiction in society, there are many costs involved in treating addicts and returning them to normal lives. This will not be possible except in new and effective ways.

Objectives:

This study aimed to determine the effectiveness of the cognitive reconstruction approach on irrational beliefs and hopelessness of people with substance abuse disorder.

Methods:

The statistical population of this study includes all people with substance abuse disorder, who were present in addiction treatment camps in Ardabil in 2018, from which 80 eligible people were selected using the available sampling method and Random methods were divided into experimental and control groups (40 people in each group). The experimental group underwent 8 sessions of 90 minutes of cognitive reconstruction intervention. Both groups completed the Ahwaz Irrational Beliefs 4-Factor Questionnaire and the Beck hopelessness test as a pretest and post-test. Data were analyzed using analysis of covariance.

Results:

The results showed that the cognitive reconstruction approach was effective in reducing the irrational beliefs and hopelessness of the subjects in the experimental group (P<0/01).

Conclusions:

On the basis of this study, it can be concluded that cognitive reconstruction intervention can be effective in improving irrational beliefs and reducing hopelessness in people with substance abuse.
Phase I/III Clinical Trial to Evaluate the Safety and Efficacy of a New Botulinum Toxin (HU-014) Versus OnabotulinumtoxinA in Subjects With Moderate-to-Severe Crow's Feet Lines
Authors: Han Hye Sung , Yoo Kwang Ho , Lee Ji Su , Huh Chang-Hun , Kwon Soon-Hyo , Lee Yang Won , Kim Beom Joon
Published: April 2021

BACKGROUND

HU-014, a newly introduced botulinum toxin type A, has not been investigated for its efficacy and safety in crow's feet line (CFL) treatment.

OBJECTIVE

Here, we compared the efficacy and safety of HU-014 and onabotulinumtoxinA in CFL treatment.

METHODS

This was a randomized, double-blind, active drug–controlled, multicenter, 16-week, Phase I/III study designed to determine the noninferiority of HU-014 compared with onabotulinumtoxinA in moderate-to-severe CFL treatment. In the Phase III study, 290 subjects were randomized at a 1:1 ratio to receive a single treatment of HU-014 or onabotulinumtoxinA. The primary endpoint was the proportion of subjects achieving Grade 0 or 1 in the facial wrinkle scale on maximum smile at Week 4.

RESULTS

The primary endpoint was achieved by 72% of the subjects with HU-014 and onabotulinumtoxinA treatments, supporting the noninferiority of HU-014 compared with onabotulinumtoxinA. All secondary efficacy outcomes were achieved by the subjects. The 2 groups showed no significant differences in the safety analysis.

CONCLUSION

HU-014 has noninferior efficacy and safety compared with onabotulinumtoxinA in the treatment of CFL.
Predictive Model for Quality of Life in Patients 1 Year After First Stroke
Authors: Kim Sung Reul , Yoo Sung-Hee , Kim Hye Young , Kim Gye-Gyoung
Published: April 2021

Background

Because the recurrence rate of stroke increases 1 year after its initial occurrence, it is important to predict quality of life at this stage, although most functions are likely recovered.

Objectives

We aimed to construct and verify a model of quality of life in patients 1 year post stroke by considering their characteristics at the time of the stroke based on the Wilson and Cleary model and previous literature.

Methods

Participants comprised 288 patients who had experienced their first ischemic stroke and were enrolled in 3 regional stroke centers in South Korea. Data were analyzed using path analysis to identify a model of patients' quality of life 1 year post stroke.

Results

Age, National Institutes of Health Stroke Scale score, the modified Rankin Scale score, and anxiety had a direct effect on quality of life, whereas type D personality and social support had an indirect effect. Type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety explained 32.9% of the total variance in quality of life.

Conclusions

When predicting quality of life in a patient 1 year after a stroke, it is important to consider variables such as type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety at the time of the first stroke. Interventions to improve the quality of life of patients with stroke should consider these factors.
“No One Told Me About This Part”: What Breastfeeding Women Want and Need to Support Their Physical Health
Authors: Snyder Kailey , Peterson Julie , Bargstadt-Wilson Kari
Published: April 2021

Background:

Breastfeeding women struggle to achieve recommendations of obtaining 150 minutes of moderate activity per week or more. Pelvic floor dysfunction may be hindering postpartum physical activity. However, the severity and type of dysfunction remain poorly understood.

Objective:

This study had the following objectives: (1) to determine the severity of symptoms of pelvic floor dysfunction among breastfeeding women, with a secondary objective (1a) to determine whether this varied on the basis of exclusive breastfeeding versus supplementation of solids foods and/or formula and (2) to determine what breastfeeding women perceive they need in a physical activity intervention and (2a) how their activity levels change from before to after pregnancy.

Study Design:

This was a concurrent embedded mixed-methods cross-sectional survey.

Methods:

A survey consisting of demographic questions, physical activity experiences, the Pelvic Floor Distress Inventory (PFDI-20), and open-ended questions was disseminated to currently breastfeeding mothers.

Results:

Survey findings conclude that breastfeeding women are primarily sedentary or engage in light physical activity and experience greater symptom severity related to urinary incontinence than anal or pelvic organ prolapse distress. Symptoms are not influenced by breastfeeding exclusivity. Many women are hindered from being active by time constraints associated with feeding their infant. Women would like a combination of in-person/online pelvic floor and general exercise resources.

Conclusion:

A large proportion of breastfeeding women are sedentary or engaging only in light activity. Furthermore, breastfeeding women report urinary incontinence symptoms and these symptoms are not influenced by breastfeeding exclusivity. Breastfeeding women desire increased education and resources to support their physical activity.
Optimizing defibrillation during cardiac arrest
Authors: Babini Giovanni , Ruggeri Laura , Ristagno Giuseppe
Published: April 2021

Purpose of review

Current cardiac arrest guidelines are based on a fixed, time-based defibrillation strategy. Rhythm analysis and shock delivery (if indicated) are repeated every 2 min requiring cyclical interruptions of chest compressions. This approach has several downsides, such as the need to temporarily stop cardiopulmonary resuscitation (CPR) for a variable amount of time, thus reducing myocardial perfusion and decreasing the chance of successful defibrillation. A tailored defibrillation strategy should identify treatment priority for each patient, that is chest compressions (CCS) or defibrillation, minimize CCs interruptions, speed up the delivery of early effective defibrillation and reduce the number of ineffective shocks.

Recent findings

Real-time ECG analysis (using adaptive filters, new algorithms robust to chest compressions artifacts and shock-advisory algorithms) is an effective strategy to correctly identify heart rhythm during CPR and reduce the hands-off time preceding a shock. Similarly, ventricular fibrillation waveform analysis, that is amplitude spectrum area (AMSA) represents a well established approach to reserve defibrillation in patients with high chance of shock success and postpone it when ventricular fibrillation termination is unlikely. Both approaches demonstrated valuable results in improving cardiac arrest outcomes in experimental and observational study.

Real-time ECG analysis and AMSA have the potential to predict ventricular fibrillation termination, return of spontaneous circulation and even survival, with discretely high confidence. Prospective studies are now necessary to validate these new approaches in the clinical scenario.
Effect of Laser-assisted Subepithelial Keratectomy with Mitomycin C on Corneal Optical Density Measured with Confocal Microscopy
Authors: Cañadas Pilar , Garcia-Gonzalez Montserrat , Gros-Otero Juan , Rodriguez-Perez Isabel , Cañones-Zafra Rafael , Teus Miguel A.
Published: April 2021

SIGNIFICANCE

The development of confocal microscopy allows one to obtain high-resolution corneal images like its optical density. Some studies have evaluated the optical density with Scheimpflug cameras in the early post-operative period after photorefractive keratectomy, but no studies have evaluated the long-term evolution of optical density after surface ablation when mitomycin C is used.

PURPOSE

This work aimed to study the changes in corneal optical density measured with confocal microscopy in eyes treated with laser-assisted subepithelial keratectomy (LASEK) and intraoperative mitomycin C (MMC) to correct myopia.

METHODS

A study of 24 consecutive myopic eyes that underwent LASEK with 0.02% MMC and a control group of 24 healthy nontreated eyes was performed. Optical density was measured using the images by the confocal microscopy of the Heidelberg Retina Tomograph II with the Rostock Cornea Module. An analysis of confocal microscopy images was performed using the ImageJ software to obtain the optical density, in gray-scale units (GSU). The optical density of the stromal bed was evaluated 3 months, 15 months, and 3 years after surgery and was compared with the optical density at the equivalent depth of the stroma in controls.

RESULTS

The mean values of optical density for the LASEK group were 81.7 ± 9.7, 78.6 ± 11.7, and 73.6 ± 18.7 GSU at 3 months, 15 months, and 3 years, respectively, and it was 61.8 ± 8.2 GSU for the control group. A statistically higher optical density 3 and 15 months after LASEK with MMC was found compared with controls (P < .001). No significant difference was found in optical density at 3 years post-operatively.

CONCLUSIONS

Our study suggests that, after LASEK with MMC, the anterior corneal stroma has a higher optical density at 3 and 15 months post-operatively, which gradually returns to normal values 3 years after surgery.
FIGO Grade 3 Endometrioid Adenocarcinomas With Diffusely Aberrant β-Catenin Expression: An Aggressive Subset Resembling Cutaneous Pilomatrix Carcinomas
Authors: Weisman Paul , Park Kay J. , Xu Jin
Published: April 2021

Uterine endometrioid adenocarcinomas are known for their morphologic plasticity. In addition to a multiplicity of metaplasias, uterine endometrioid adenocarcinomas may also undergo high-grade divergent differentiation in the form of high-grade neuroendocrine carcinoma, neuroectodermal differentiation or carcinosarcoma; others may dedifferentiate completely. Here we describe 5 cases of uterine endometrioid adenocarcinomas with high-grade divergent differentiation showing a striking morphologic and immunophenotypic resemblance to cutaneous pilomatrix carcinoma. Specifically, the high-grade component in all cases exhibited solid, basaloid morphology with conspicuous tumor cell necrosis and the presence of shadow cells, accompanied by diffusely aberrant (nuclear and cytoplasmic) β-catenin expression as well as variably diffuse CDX2 expression. In addition, the high-grade component in all cases showed loss of ER and PAX8 expression, retained MMR expression, wild-type p53 expression, patchy p16 expression, and diffusely positive cytokeratin expression (AE1/AE3 and CK7); at least focal neuroendocrine marker expression was present in all cases. CK20 was negative in all cases, with the exception of very focal staining in a single case (2% of tumor cells). All 5 of our tumors had at least a focal conventional FIGO grade 1 component. In all 4 cases tested, the low-grade component retained both PAX8 and ER expression and had, at best, focally aberrant β-catenin expression. Two of our cases had molecular analysis performed and both harbored mutations in exon 3 of CTNNB1 as expected; molecular analysis also revealed that both cases lacked POLE or TP53 mutations and showed no microsatellite instability. The tumors in this series were uniformly aggressive. Four of the 5 patients in our cohort had available follow-up information; of these, 3/4 died of their disease within 14 mo of diagnosis and the fourth patient had distant metastatic disease at presentation and is alive with disease 1 mo following diagnosis. The 1 patient without follow-up information also had distant metastatic disease at presentation and was lost to follow-up 17 mo later. The cases described in this series (1) represent a highly aggressive CTNNB1-mutated subset of the “no specific molecular profile” category of endometrioid adenocarcinomas; (2) illustrate a form of high-grade divergent differentiation resembling cutaneous pilomatrix carcinoma already described in carcinomas at other anatomic sites; and (3) underscore the difficulty in recognizing this phenotype at distant metastatic sites, which are frequent even at the time of presentation, given the consistent loss of ER and PAX8 expression and concurrent CDX2 expression.
Community Health Improvement Plans: An Analysis of Approaches Used by Local Health Departments
Authors: Carroll Leslie D. , Wetherill Marianna S. , Teasdale Thomas A. , Salvatore Alicia L.
Published: April 2021

Context:

The Public Health Accreditation Board requires accredited local health departments (LHDs) to complete community health improvement plans (CHIPs). Evidence suggests that participatory planning frameworks, cross-sector collaboration, social determinants of health (SDOHs), and steering organizations are integral to effective public health planning. However, little is known about the degree to which LHDs incorporate these aspects during the CHIP process.

Objectives:

To describe the use of planning methods, SDOHs, cross-sector partnerships, and steering organizations during the CHIP development process among nationally accredited LHDs and to identify whether LHD jurisdictional size or region is associated with differences in use.

Design:

The most recent CHIPs from 93% of all nationally accredited LHDs (n = 195) were qualitatively reviewed and numerically coded for each of the planning components to calculate frequency and degree of use. Differences in use of each component by LHDs' jurisdictional size and region were tested using the chi-square test.

Main Outcome Measure:

Use of CHIP planning frameworks, SDOH inclusion, cross-sector partnerships, and steering organizations.

Results:

One-half of LHDs (53%) reported use of Mobilizing for Action through Planning and Partnerships, but nearly one-fourth of LHDs did not use any planning framework. LHDs with a large jurisdictional size (>500 000) were significantly more likely to include SDOHs to a high degree than LHDs with mid- (100 000-499 999) to small- (<99 999) jurisdictional size (P < .01). Similarly, large LHDs were more likely to include cross-sector partners except for the category community members, which were rarely (10%) included. Mid-sized LHDs were more likely to lead the CHIP steering committee (61%) than small (29%) and large (9%) LHDs (P < .01). Differences in use of the 4 components by region were less significant.

Conclusions:

Jurisdictional size, rather than region, was more strongly associated with LHD approaches to CHIP development. More studies are needed to determine how differences influence CHIP implementation and impact.
The Governance of Helmet Safety to Prevent Traumatic Brain Injury in the Caribbean
Authors: Rolle Myron L. , Garba Deen L. , Wesley Alexander , Teasley Damian E. , Warner Tyler , Odewade Niyi , Ekedede Magnus
Published: April 2021

Background:

The Caribbean is a unique region of islands and cays home to nearly 43 million people. A significant challenge facing this population is the burden of traumatic brain injury, which disproportionately affects younger individuals and carries a significant economic burden. A preventive measure to reduce this burden is consistent wearing of helmets. This study aims to assess TBI prevention through helmet safety in Caribbean nations in order to demonstrate the regional impact of public health solutions.

Methods:

We assess the member states of the Caribbean Community (CARICOM) and sought to evaluate CARICOM nations' TBI prevention through helmet safety with relation to public health, policy, laws, infrastructure, and regulations. We produced the Rolle Scoring System (RSS) to ascertain the influence of governance around helmet safety for TBI prevention. The RSS aims to provide a quantifiable method of how well a CARICOM nation is performing in efforts to reduce TBI. The RSS is broken down into 2 categories, with scores ranging from 1 (worst) to 5 (best). The range of possible scores a CARICOM nation could receive was 8 to 40.

Results:

Fourteen CARICOM nations were ultimately incorporated into our analysis. From the initial cohort, 3 were removed. These nations were Anguilla, Saint Kitts & Nevis, and Montserrat. We analyzed values derived from the RSS, finding a mean Rolle score of 22. We further subdivided the nations into low Rolle score (8-24) and high Rolle score (>24). Trinidad and Tobago had the highest Rolle score at 29. Haiti was found to have the lowest Rolle score at 8.

Conclusion:

Several Caribbean nations have demonstrated leadership pertaining to TBI prevention through helmet safety. The regional momentum of helmet safety in the Caribbean can serve as a model for other geographical regional blocs that share interests and culture to consider comprehensive approaches to public health challenges.
Pulmonary Artery Size Measurements: A Comparison Study Between Electrocardiogram-Gated and Nonelectrocardiogram-Gated Computed Tomography
Authors: Li Danyan , Tang Xin , Zhu Yinsu , Wei Yongyue , Mu Dan
Published: April 2021

Objectives

The aim of this study was to determine the difference and correlation in pulmonary artery (PA) size when measured from the electrocardiogram (ECG)–gated computed tomography (CT) and non–ECG-gated CT.

Methods

In the retrospective study, 279 patients who underwent both ECG-gated CT and non–ECG-gated CT were enrolled. Maximum and minimum diameters of main pulmonary artery (MPA), right pulmonary artery (RPA), and ascending aorta (AAO) were measured, whereas mean diameters of MPA and RPA were obtained. The same PA size parameters were also measured on non–ECG-gated CT.

Results

There was a significant difference in maximum and minimum PA diameters between ECG-gated CT and non-ECG-gated CT, whereas mean PA diameters showed no statistically difference. The PA parameters showed a strong positive correlation between these 2 examinations.

Conclusions

The PA size was different between ECG-gated CT and non–ECG-gated CT, whereas the PA size parameters on non–ECG-gated CT could be used to predict those with ECG-gated CT, which allow for confident prediction of pulmonary hypertension and guide further surgical intervention.
Validation of Second-Generation Motion-Correction Software for Computed Tomography Coronary Angiography With Novel Quantitative Approach
Authors: Goldberg Ari , Adams William H. , Thomsen Brian , Ashraf Usman , Vasilopoulos Vasilios
Published: April 2021

Introduction

Computed tomography of the coronary arteries (CTCA) is an important diagnostic tool. However, motion degradation is sometimes a challenge to interpretation and quantification, particularly with elevated heart rates. Here, a novel quantitative method is presented as part of an evaluation of one particular motion correction algorithm.

Methods

Computed tomography of the coronary arteries scans from 49 patients, with heart rates of >70 bpm, were identified with motion artifacts in multiple coronary segments. At these foci (196), an objective measure of motion degradation, defined here by cross-section eccentricity, was determined before and after image processing with second-generation GE SnapShot Freeze software (SSF-2.0). In addition, a subjective scoring was applied by an expert cardiothoracic radiologist both before and after processing.

Results

An overall decrease in vessel eccentricity strongly correlated (P < 0.001) with processing of the images by motion-correction software. A concurrent overall increase in subjective vessel clarity correlated (P < 0.001) with application of the software as well.

Conclusions

A novel quantitative method (and subjective analysis) for evaluation of CTCA motion has been described and applied to validation of SSF-2.0 motion-correction software. Both the technique and software demonstrate promise for robust clinical utility in CTCA evaluation.
Optimizing Identification of Power Injectable Ports on the Scout Images for Multidetector Computed Tomography Procedures
Authors: Schwartz Fides R. , Iliffe Kevin S. , Somers Andrew , Stone Brittney , Jaffe Tracy A. , Solomon Justin , Hurwitz Koweek Lynne M.
Published: April 2021

Objective

The objective of this study was to assess the impact of tube voltage and image display on the identification of power ports features on anterior-posterior scout images to inform optimal workflow for multidetector computed tomography (MDCT) examinations.

Materials and Methods

Four ports, representing variable material composition (titanium/silicone), shapes, and computed tomography (CT) markings, were imaged on an adult anthropomorphic chest phantom using a dual-source MDCT at variable peak tube voltages (80, 100, 120, 150, and Sn150 kVp). Images were reviewed at variable image display setting by 5 blinded readers to assess port features of material composition, shape, and text markings as well as overall preferred image quality.

Results

Material composition was correctly identified for all ports by all readers across all kilovoltage-peak settings. The identification by shape was more reliable than CT markers for all but one of the ports. CT marker identification was up to 80% for titanium ports at window level settings optimized for metal (window width, 200; window center, −150) and at a soft tissue setting (window width, 400; window center, 40) for silicone ports. Interreader agreement for best image quality per kilovoltage-peak setting was moderate to substantial for 3 ports (k = 0.5–0.62) but only fair for 1 port (k = 0.27). The highest overall rank for image quality was given unanimously to Sn150 kVp for imaging titanium ports and 100 kVp for silicone ports.

Conclusions

Power port identification on MDCT scout images can be optimized with modification of MDCT scout acquisition and display settings based on the main port material.
Magnetic Resonance Imaging Evaluation of Ectopic Pregnancy: A Value-Added Review
Authors: Gopireddy Dheeraj Reddy , Le Rebecca , Virarkar Mayur Kundan , Freels Parker D. , Hubickey Joana , Kee-Sampson Joanna , Lall Chandana
Published: April 2021

Ectopic pregnancy (EP) is a known cause of maternal mortality and may be misdiagnosed in up to 50% of pregnant female individuals (Ann Emerg Med. 1996;28(1):10–17). Magnetic resonance imaging, with its superior soft tissue resolution, is a valuable alternative diagnostic modality to diagnose EP when transvaginal ultrasound results are inconclusive. Although an extrauterine gestational sac is the most specific finding, there are other key MRI findings that can aid in diagnosing EP. As availability of MRI access in the emergency department setting increases across the nation, its utility in women with a positive pregnancy test has also increased. Specific MRI findings that are diagnostic of EP include absence of intrauterine pregnancy, adnexal mass separate from the ovary, and hemoperitoneum. In addition, intrauterine ectopic locations, especially intramural, cornual, and cervical pregnancies, can be diagnosed with increased accuracy with the help of MRI. Magnetic resonance imaging is also useful in excluding potential mimics of EP, including adnexal cysts, ovarian neoplasms, and fibroids. In summary, providing an accurate diagnosis and determining the precise location of an EP, which is supported by the use of MRI, is imperative for guiding a patient's treatment to prevent a potentially fatal outcome.
Computed Tomography–Derived Fractional Flow Reserve in Patients With Chronic Coronary Syndrome: A Real-World Cohort Study
Authors: Kvist Thomas Vedel , Nørgaard Bjarne Linde , Bøtker Hans Erik , Mathiassen Ole Norling , Grove Erik Lerkevang , Parner Erik , Jensen Jesper Møller
Published: April 2021

Objective

This study aimed to investigate the outcome of computed tomography (CT) angiography with optional CT-derived fractional flow reserve (FFRCT) of intermediate-range coronary artery disease in non-emergent patients referred on a suspicion of chronic coronary syndrome.

Methods

Patients were classified as high risk and low-intermediate risk according to the presence of typical angina or either atypical or nonangina chest pain. Outcome was assessed as the cumulative incidence proportion of a composite end point of unstable angina pectoris, unplanned revascularization, nonfatal myocardial infarction, and all-cause mortality.

Results

The study included 743 patients. Mean follow-up was 2.2 (range, 0.1–2.5) years. Low-intermediate–risk and high-risk patients who had invasive coronary angiography deferred had comparable proportions of adverse events (1.4% vs 2.6% [P = 0.27]). Adverse events in high-risk patients with FFRCT >0.80 was 3.3% versus 1.4% in patients where no additional testing was performed (P = 0.79).

Conclusions

Computed tomography–derived fractional flow reserve >0.8 conveys an excellent prognosis. Computed tomography angiography with optional FFRCT allows for the safe cancellation of invasive coronary angiography in high-risk patients.
Verification of Duodenobiliary Reflux With SPECT/CT Imaging
Authors: Zhao Meixin , Zhang Weifang
Published: April 2021

Duodenobiliary reflux is believed to be 1 of the causes of recurrent bacterial cholangitis. We reported a 65-year-old woman with intermittent epigastric pain for 20 years. She was diagnosed with cholelithiasis in the past, and she still had recurrent abdominal pain after the stone was removed. The patient was suspected of having duodenobiliary reflux and received duodenobiliary reflux imaging. After oral administration of 700 mL water containing 5 mCi 99mTc-DTPA, SPECT/CT images of the abdomen were acquired. Abnormal radioactivity was seen in the common bile duct, indicating the presence of duodenobiliary reflux.
Auditory and Visual Stimulation for Abdominal Postoperative Patients Experiencing Enhanced Recovery After Surgery (ERAS)
Authors: Lu Juanjuan , Tao Pengxian , Li Huixia , Wu Guangli , Wang Caijuan , Zhang Juan , Dou Xinman , Han Zhijian , Chen Hao
Published: April 2021

The Enhanced Recovery After Surgery program can reduce postoperative complications, hospital stay, and overall costs in patients, although the evidence for physical intervention with patients is still lacking. This study provides visual and auditory physical interventions to patients in order to explore the effects of Enhanced Recovery After Surgery following abdominal surgery. The study group consisted of patients who had undergone laparoscopic cholecystectomy, radical resection of gastric cancer, or radical resection of colon cancer; we randomly divided them into a control group and a visual and auditory intervention group. We then monitored the bowel sound frequency and time of the first anal self-exsufflation for both groups after surgery. We found that compared with the control group, patients who had undergone laparoscopic cholecystectomy and radical gastrectomy who received auditory intervention had increased bowel sound frequency and a shorter time until first anal self-exsufflation. In addition, patients with colon cancer who received both auditory and visual stimulation had increased bowel sounds and shorter time until the first anal self-exsufflation. These results suggest that visual and auditory interventions significantly improve patients' gastrointestinal function, shorten the hospitalization period, and reduce complications after operation.
Use of Patient Abdominal Compression Device Reduces Staff Musculoskeletal Pain Associated With Supporting Colonoscopy
Authors: Crockett Seth , Dellon Evan S. , Biggers Larissa , Ernst Donna A.
Published: April 2021

Work-related musculoskeletal disorders occur frequently among the endoscopy staff, and patient-handling duties involved with colonoscopy—applying manual pressure and repositioning patients—are particularly physically demanding. This study explored whether the use of a lower abdominal compression device (ColoWrap), previously shown to reduce the need for manual pressure and patient repositioning, would diminish the frequency of staff-reported musculoskeletal pain. A randomized, blinded, sham-controlled clinical trial was performed at the University of North Carolina Hospitals. Three hundred fifty patients had either ColoWrap or a sham device applied before colonoscopy. The primary outcome was the frequency of staff-reported musculoskeletal pain after assisting with colonoscopy. In the intention-to-treat analysis, which included procedures in which ColoWrap was removed, there was no statistical difference in the frequency of staff-reported pain in the control versus ColoWrap arm (4.6% vs. 3.4% of procedures, p = .59). However, when ColoWrap was used as directed (e.g., remained in place for the duration of the procedure), the frequency of staff-reported musculoskeletal pain was significantly reduced (4.6% vs. 0.7% of procedures, p = 0.04). Use of ColoWrap as directed was also found to be independently associated with reduced odds of staff-reported pain relative to the sham arm (OR = 0.12; 95% CI [0.02, 0.95]). When used as directed, ColoWrap reduced the frequency of musculoskeletal pain experienced related to assisting with colonoscopy and may reduce the risk of musculoskeletal disorders and injuries among the endoscopy staff.
Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy
Authors: Zhang Yuanyuan , Ding Caiyan , Li Jing , Hu Xianyu , Wang Yifan , Tang Wei
Published: April 2021

This meta-analysis aimed to evaluate the impact of prepackaged low-residue diet (PLRD) on bowel preparation for colonoscopy. We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases from inception to August 2020. Randomized controlled trials (RCTs) comparing PLRD with clear liquid diet (CLD) or self-prepared LRD were considered for inclusion. The analysis calculated the odds ratio (OR) for the rate of adequate bowel preparation, patient tolerance, willingness to repeat bowel preparation, tolerability of bowel preparation, and overall adverse effects. Five RCTs published between 2006 and 2019 (N = 561) were included in our meta-analysis. Compared with the traditional CLD or self-prepared LRD, PLRD showed significantly higher rates of adequate bowel preparation (OR, 2.16; 95% confidence interval [CI], 1.18–3.98; p = .01), patient tolerance (OR, 1.99; 95% CI, 1.30–3.07; p = .002), and willingness to repeat the bowel preparation (OR, 1.68; 95% CI, 1.05–2.70; p = .03), with no differences in adverse events (OR, 0.93; 95% CI, 0.59–1.46; p = .75). Prepackaged low-residue diet improved bowel preparation quality, patient tolerance, and willingness to repeat bowel preparations. Importantly, PLRD does not increase the incidence of adverse events. This suggests that it is effective and safe to use PLRD for bowel preparation before colonoscopy.
A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries
Authors: Biffl Walter L. , Zhao Frank Z. , Morse Bryan , McNutt Michelle , Lees Jason , Byerly Saskya , Weaver Jessica , Callcut Rachael , Ball Chad G. , Nahmias Jeffry , West Michaela , Jurkovich Gregory J. , Todd Samuel Rob , Bala Miklosh , Spalding Chance , Kornblith Lucy , Castelo Matthew , Schaffer Kathryn B. , Moore Ernest E. ,   the WTA Multicenter Trials Group on Pancreatic Injuries
Published: April 2021

BACKGROUND

Outcomes following pancreatic trauma have not improved significantly over the past two decades. A 2013 Western Trauma Association algorithm highlighted emerging data that might improve the diagnosis and management of high-grade pancreatic injuries (HGPIs; grades III–V). We hypothesized that the use of magnetic resonance cholangiopancreatography, pancreatic duct stenting, operative drainage versus resection, and nonoperative management of HGPIs increased over time.

METHODS

Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018 was performed. Data were analyzed by grade and time period (PRE, 2010–2013; POST, 2014–2018) using various statistical tests where appropriate.

RESULTS

Thirty-two centers reported data on 515 HGPI patients. A total of 270 (53%) had penetrating trauma, and 58% went directly to the operating room without imaging. Eighty-nine (17%) died within 24 hours. Management and outcomes of 426 24-hour survivors were evaluated. Agreement between computed tomography and operating room grading was 38%. Magnetic resonance cholangiopancreatography use doubled in grade IV/V injuries over time but was still low.

Overall HGPI treatment and outcomes did not change over time. Resection was performed in 78% of grade III injuries and remained stable over time, while resection of grade IV/V injuries trended downward (56% to 39%, p = 0.11). Pancreas-related complications (PRCs) occurred more frequently in grade IV/V injuries managed with drainage versus resection (61% vs. 32%, p = 0.0051), but there was no difference in PRCs for grade III injuries between resection and drainage.

Pancreatectomy closure had no impact on PRCs. Pancreatic duct stenting increased over time in grade IV/V injuries, with 76% used to treat PRCs.

CONCLUSION

Intraoperative and computed tomography grading are different in the majority of HGPI cases. Resection is still used for most patients with grade III injuries; however, drainage may be a noninferior alternative. Drainage trended upward for grade IV/V injuries, but the higher rate of PRCs calls for caution in this practice.

LEVEL OF EVIDENCE

Retrospective diagnostic/therapeutic study, level III
Half of geriatric trauma patients have significant ocular disease: Findings of a novel trauma provider eye examination for vision screening
Authors: Bardes James M. , Grabo Daniel J. , Donovan James , Albuquerque Alexander , Coleman Kennith Conley , Wen Sijin , Wilson Alison , Nguyen John , Bardes Allison
Published: April 2021

BACKGROUND

Geriatric ground level fall is a common admission diagnosis for trauma centers in the United States. Visual health has been linked to fall risk reduction in older adult but is rarely fully evaluated during a trauma admission. Using a commercial application and a questionnaire, we developed and tested a trauma provider eye examination (TPEE) to screen visual health. This study used the TPEE to (1) evaluate the prevalence of undiagnosed or undertreated visual disease in geriatric trauma patients and (2) determine the feasibility and reliability of the TPEE to screen for vision disease.

METHODS

This prospective study included patients older than 60 years evaluated by the trauma service from June 2019 to May 2020. Patients with ocular or globe trauma were excluded. The primary outcome was significant abnormal vision (SAV) found using the TPEE. Ophthalmology performed a dilated examination as the criterion standard for comparison. We assessed the feasibility and reliability of the TPEE. Fisher’s exact test and logistic model were used in the data analysis.

RESULTS

Enrollment concluded with 96 patients. Mean age was 75 years, and fall (79%) was the most common mechanism of injury. Significant abnormal vision was common: undiagnosed disease was found in 39% and undertreated in 14%. Trauma provider examination was 94% sensitive and 92% specific for SAV cases. Congruence between TPEE and ophthalmology examination was highest in pupil examination (86%), visual fields (58%), and Amsler grid (52%). Multivariate analysis found that a combination of an abnormal Amsler test and abnormal visual field defect was significantly associated with SAV (odds ratio, 4.1; p = 0.03).

CONCLUSION

Trauma provider eye examination screening can identify patients with visual deficits. Given the association between visual deficits and fall risk, older adults may benefit from such a screening or a formal ophthalmology referral.

LEVEL OF EVIDENCE

Therapeutic/Care Management, level II.
Characteristics of burn casualties treated at role 2 in Afghanistan
Authors: Suresh Mithun R. , Staudt Amanda M. , Trevino Jennifer D. , Valdez-Delgado Krystal K. , VanFosson Christopher A. , Rizzo Julie A.
Published: April 2021

BACKGROUND

Role 2 medical treatment facilities (MTFs) are frequently located in austere settings and have limited resources. A dedicated assessment of burn casualties treated at this level of care has not been performed. Therefore, the objective of this study was to characterize burn casualties presenting to role 2 MTFs in Afghanistan, along with the procedures they required, complications, and mortality to begin understanding the resources consumed by their care.

METHODS

We identified burn casualties from the Department of Defense Trauma Registry (DODTR). The inclusion criteria were (1) experienced burn injuries in Afghanistan between October 2005 and April 2018 and (2) had documentation of treatment at role 2 in the DODTR. We excluded casualties with only first-degree burns, not otherwise specified burns, or only corneal burns. Casualty demographics, injury characteristics, procedures, and outcomes were reported.

RESULTS

We identified 453 burn casualties with a median (interquartile range) Injury Severity Score of 10 (4–22) and percent total body surface area burned of 11 (5–30). There were 123 casualties (27.2%) with inhalation injury, and the casualties experienced 3,343 additional traumatic injuries and needed 2,530 procedures. Casualties with documentation of resuscitation information received a median (interquartile range) of 1.9 (0.7–3.7) L of crystalloid fluids. Complications were documented in 53 casualties (11.7%). Final mortality was reported in 36 casualties (8.0%), and mortality at role 2 MTFs was reported in 7 casualties (1.5%).

CONCLUSION

Burn casualties had many injuries and needed many procedures, including those related to airway management, resuscitation, and wound care. Given the urgency of these procedures, ensuring that there is enough equipment and supplies will be important in the future. Although infrequent, some casualties experienced complications. Factors that may influence resuscitation include injury severity, concomitant traumatic injuries, and available supplies. Obtaining more contextual information on the patient care environment will be useful going forward.

LEVEL OF EVIDENCE

Epidemiological, level III
Traffic stops do not prevent traffic deaths
Authors: Sarode Anuja L. , Ho Vanessa P. , Chen Lin , Bachman Katelynn C. , Linden Philip A. , Lasinski Alaina M. , Moorman Matthew L. , Towe Christopher W.
Published: April 2021

OBJECTIVES

Amid growing calls for police reform, it is imperative to reassess whether police actions designed to improve public safety are associated with injury prevention. This study aims to examine the relationship between the police traffic stops (PTSs) and motor vehicle crash (MVC) deaths at the state level. We hypothesize that increased PTSs would be associated with reduced MVC deaths.

METHODS

We retrospectively analyzed PTSs and MVC deaths at the state level from 2004 to 2016. Police traffic stops data were from 33 state patrols from the Stanford Open Policing Project. The MVC deaths data were collected from the National Highway Traffic Safety Administration. The vehicle miles traveled data were from the Federal Highway Administration Office of Highway Policy Information. All data were adjusted per 100 million vehicle miles traveled (100MVMT) and were analyzed as state-level time series cross-sectional data. The dependent variable was MVC deaths per 100MVMT, and the independent variable was number of PTSs per 100MVMT. We performed panel data analysis accounting for random and fixed state effects and changes over time.

RESULTS

Thirty-three state patrols with 235 combined years were analyzed, with a total of 161,153,248 PTSs. The PTS rate varied by state and year. Nebraska had the highest PTS rate (3,637/100MVMT in 2004), while Arizona had the lowest (0.17/100MVMT in 2009). Motor vehicle crash deaths varied by state and year, with the highest death rate occurring in South Carolina in 2005 (2.2/100MVMT) and the lowest in Rhode Island in 2015 (0.57/100MVMT). After accounting for year and state-level variability, no association was found between PTS and the MVC death rates.

CONCLUSION

State patrol traffic stops are not associated with reduced MVC deaths. Strategies to reduce death from MVC should consider alternative strategies, such as motor vehicle modifications, community-based safety initiatives, improved access to health care, or prioritizing trauma system.

LEVEL OF EVIDENCE

Retrospective epidemiological study, level IV.