bluuebunny/crossref_metadata_2025 huggingface dataset:
“Death Knell” for Prophylactic Vena Cava Filters? A 20-Year Experience with a Venous Thromboembolism Guideline
Authors: Shenoy Rathna , Cunningham Kyle W. , Ross Samuel Wade , Christmas A. Britton , Thomas Bradley W. , Avery Michael J. , Lessne Mark L. , Prasad Tanushree , Sing Ronald F.
Published: June 2020

The role of prophylactic vena cava filters (pVCFs) in trauma patients remains controversial. After 20 years of data collection and experience, we reviewed our venous thromboembolism guideline for the efficacy of pVCFs in preventing pulmonary embolism (PE). A retrospective cohort study was performed using our Level I trauma center registry from January 1997 thru December 2016. This population was then divided by the presence of pVCFs. Univariate analysis was performed comparing the incidence of PEs, deep vein thrombosis, and mortality between those with and without a pVCF. There were 35,658 patients identified, of whom 2 per cent (n = 847) received pVCFs. The PE rate was 0.4 per cent in both groups. The deep vein thrombosis rate for pVCFs was 3.9 per cent compared with 0.6 per cent in the no-VCF group ( P < 0.0001). Given that there was no difference in the rates of PEs between the cohorts, the subset of patients with a PE were analyzed by their risk factors. Only ventilator days > 3 were associated with a higher risk in the no-pVCF group (0.2 vs 1.5%, P = 0.033). pVCFs did not confer benefit reducing PE rate. In addition, despite their intended purpose, pVCFs cannot eliminate PEs in high-risk trauma patients, suggesting a lack of utility for prophylaxis in this population.
Failure of Nonoperative Management of Splenic Injuries in Trauma Patients on Anticoagulation
Authors: Dougherty Kristen , Collins Jay , Burgess Jessica , Martyak Michael
Published: June 2020

Although nonoperative management or embolization with preservation of splenic tissue is preferable, there is a significant risk of continued bleeding ultimately requiring splenectomy. It has been established that elderly patients on anticoagulation (AC) have an increased risk of splenic injury, but there are little data to show whether AC plays a role in outcomes of splenic injury in the setting of trauma. This is a retrospective cohort study, including 168 adults aged 50 to 79 years who presented as a trauma patient to Sentara Norfolk General Hospital from January 1, 2010, to March 31, 2018. The primary outcome is the management of the splenic injury. Of the 168 patients, 30 were presently taking AC at the time of their injury, and 138 were not taking any AC. These groups were similar in average Injury Severity Score, average grade of splenic injury, and average systolic blood pressure on arrival. However, the groups differed significantly in age and hemoglobin on arrival. We found that patients taking AC at the time of injury underwent splenectomy 23.3 per cent of the time, whereas patients not taking AC underwent splenectomy 11.6 per cent of the time ( P = 0.045). Patients taking AC failed nonoperative management 20 per cent of the time, whereas patients not taking AC failed 0.7 per cent of the time ( P < 0.05). We found that patients taking AC at the time of their traumatic injury were more likely to undergo splenectomy than patients not taking AC. We also found that patients taking AC were more likely to fail nonoperative management.
The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center
Authors: Walker Benjamin S. , Collier Bryan R. , Bower Katie L. , Lollar Daniel I. , Faulks Emily R. , Matos Miguel , Nussbaum Michael S. , Hamill Mark E.
Published: June 2020

The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients. We conducted a retrospective analysis of PIM use in all geriatric patients evaluated at our Level 1 trauma center between 2014 and 2017. Patients were identified from our trauma database. Pre-admission medication use was determined through medication reconciliation from our electronic medical record (EMR). Patients not undergoing medication reconciliation were excluded. After initial analysis, patients were stratified by age into three groups: 65 to 74, 75 to 84, and ≥85 years. Multivariate logistic regression analyses were used to calculate odds ratios of falls for specific PIMs. In all, 2181 patients met the inclusion criteria. Overall, 71.2 per cent of geriatric trauma patients were prescribed at least one PIM—73.1 per cent of falls compared with 68.6 per cent for other mechanisms. Specific PIM use varied by age group. PIMs associated with fall risk in all patients included antipsychotics, benzodiazepines, and diclofenac. For those aged 65 to 74 years, antihistamines, diclofenac, proton pump inhibitors, and promethazine were associated. In those aged 75 to 84 years, alprazolam, antipsychotics, benzodiazepines, cyclobenzaprine, diclofenac, and muscle relaxants were implicated. No significant associations were found for patients aged ≥85 years. PIM use at our trauma center seems to be rampant and well above the national average. Geriatric falls were associated with using ≥1 PIM and multiple specific PIMs implicated. We are designing a targeted educational program for local primary care physicians (PCPs) that will attempt to decrease geriatric PIM use.
Clinically Meaningful Laboratory Protocols Reduce Hospital Charges Based on Institutional and ACS-NSQIP® Risk Calculators in Hepatopancreatobiliary Surgery
Authors: Pickens Ryan C. , King Lacey , Barrier Misty , Tezber Kendra , Sulzer Jesse K. , Cochran Allyson , Lyman William B. , Mcclune Garth , Iannitti David A. , Martinie John B. , Baker Erin H. , Ocuin Lee M. , Hanley Matthew , Vrochides Dionisios
Published: June 2020

Postoperative laboratory testing is an underrecognized but substantial contributor to health-care costs. We aimed to develop and validate a clinically meaningful laboratory (CML) protocol with individual risk stratification using generalizable and institution-specific predictive analytics to reduce laboratory testing and maximize cost savings for low-risk patients. An institutionally based risk model was developed for pancreaticoduodenectomy and hepatectomy, and an ACS-NSQIP®–based model was developed for distal pancreatectomy. Patients were stratified in each model to the CML by individual risk of major complications, readmission, or death. Clinical outcomes and estimated cost savings were compared with those of a historical cohort with standard of care. Over 34 months, 394 patients stratified to the CML for pancreaticoduodenectomy or hepatectomy saved an estimated $803,391 (44.4%). Over 13 months, 52 patients stratified to the CML for distal pancreatectomy saved an estimated $81,259 (30.5%). Clinical outcomes for 30-day major complications, readmission, and mortality were unchanged after implementation of either model. Predictive analytics can target low-risk patients to reduce laboratory testing and improve cost savings, regardless of whether an institutional or a generalized risk model is implemented. Broader application is important in patient-centered health care and should transition from predictive to prescriptive analytics to guide individual care in real time.
Failure to Rescue: A Quality Improvement Imperative in Achieving Zero Death in Damage Control Laparotomy Patients
Authors: Smith Alison , Ibraheem Kareem , Tatum Danielle , Schroll Rebecca , Guidry Chrissy , Mcgrew Patrick , Mcginness Clifton , Duchesne Juan
Published: June 2020

Failure to rescue (FTR), defined as death after a major complication in surgical patients, is being used to measure outcomes for quality improvement. Major complications frequently occur in patients undergoing damage control laparotomy (DCL). No previous FTR studies have looked specifically into DCL patients. The aim of this study was to examine risk factors of FTR and identify potential areas for targeted quality improvement in DCL patients. A 10-year retrospective review of all consecutive adult trauma patients who underwent DCL at a Level I trauma center was performed. Demographic and clinical variables were examined for association with FTR. Multi-variate regression analysis was performed to identify risk factors of FTR in DCL patients. A total of 199 DCL patients were analyzed. Overall DCL mortality observed was 11.1 per cent (n = 22/199) and overall FTR for the cohort was n = 16/199. FTR represented 72 per cent (n = 16/22) of the total mortality. The significantly increased risk of FTR was associated with older age ( P = 0.027), lower initial Glasgow Coma Scale score ( P = 0.037), more units of packed red blood cells ( P = 0.028), and respiratory complications ( P = 0.035). Renal and infectious complications did not significantly increase the risk of FTR in this population. FTR is an important benchmark of quality for trauma patients. This study elucidates potential initial characteristics and complications related to FTR in DCL patients. Efforts in achieving zero death from FTR can potentially improve overall mortality in this subset of patients. Future quality interventions to help minimize FTR should target these specific areas.
Physiologic Tension: Technique for Measuring and Baseline Values
Authors: Tenzel Paul L. , Bilezikian Jordan , Powers William F. , Hope William W.
Published: June 2020

Tension is one of the most discussed terms related to hernia surgery and repair. Despite the universally accepted opinion that tension and reduction of tension are important concepts in hernia repair, there is very little known about the physiologic tension of the abdominal wall related to ventral hernia repair. The purpose of this project was to attempt to measure physiologic tension in patients without hernia repair and help determine a normal baseline tension. Patients were enrolled in a prospective institutional review board–approved protocol to measure abdominal wall tension from February 2014 to present. Patients undergoing abdominal surgery without hernia repair were included. Demographic information and operative details were documented. Abdominal wall tensions were measured using scales attached to Kocher clamps that are clamped to the fascia and then brought together in the midline. Total tension, surgeon's estimation of tension, and grading of the fascia were recorded. Descriptive statistics were calculated. Eleven patients met the inclusion criteria and had tension measurements performed during surgery. The average age was 58 years, with 55 per cent of them being white and 82 per cent being male, with an average BMI of 27. Operations included exploratory laparotomy for small bowel pathology in six patients, colorectal surgery in three patients, and splenectomy in a trauma patient. Average tension measurements for these patients were 1.9 lbs. Surgeon grading of tension was an average of 2.2 (range, 1–5). Obtaining tension measurements is feasible during abdominal surgery. Physiologic tension seems to be approximately 2 pounds. Further study is needed with a larger sample of patients.
Neuroendocrine Tumors of Meckel's Diverticula: Rare but Fare Well
Authors: De Andrade James P. , Blakely Andrew M. , Nguyen Andrew H. , Ituarte Philip H. G. , Warner Susanne G. , Melstrom Laleh G. , Lee Byrne , Singh Gagandeep
Published: June 2020

Neuroendocrine tumors (NETs) are the most common malignancy arising in Meckel's diverticula (MDs). To date, there are no large series characterizing these tumors. The National Cancer Database was queried for patients with MD NETs (n = 162) from 2004 to 2014. Patient and tumor characteristics as well as outcomes were analyzed. MD NETs were more common in men (72.8%) at a median age of 62 years; 95.1 per cent of patients were white. All patients underwent surgery. Clinical M0 disease was present in 97.4 per cent of patients, and 88.2 per cent of tumors were well differentiated. Lymphovascular invasion was present in 13.2 per cent. Most (60.4%) tumors were less than 10 mm. Lymphadenectomy was performed in 32.9 per cent of patients, with 52.1 per cent of these found to have metastatic lymph node disease. Although most MD NETs are well differentiated, smaller than 10 mm, and do not have lymphovascular invasion, lymph node metastases are commonly found, suggesting that mesenteric lymphadenectomy with adequate resection of the small bowel may be necessary for adequate staging and disease clearance.
Trauma Team Activation at a Level I Trauma Center in Southern California: Time of Day Matters
Authors: Schellenberg Morgan , Inaba Kenji , Love Bryan E. , Warriner Zachary , Forestiere Matthew J. , Benjamin Elizabeth , Lam Lydia , Demetriades Demetrios
Published: June 2020

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.
Cholecystectomy after Endoscopic Papillotomy for Choledocholithiasis in the Elderly—Is It Necessary?
Authors: Zendel Alex , Mor Eyal , Goitein David , Hazzan David , Nissan Aviram , Zippel Douglas
Published: June 2020

Although elective laparoscopic cholecystectomy is the accepted strategy after endoscopic retrograde cholangiopancreatography (ERCP), papillotomy, and common bile duct (CBD) clearance, the decision to perform a cholecystectomy in high-risk elderly comorbid patients remains subjective and is controversial. The aim of this study was to examine the outcome of elderly patients with cholecystectomy deferral after successful initial endoscopic removal of CBD stones. The study examined a retrospective patient database, which included all patients aged >60 years who underwent an ERCP for CBD stones at the Chaim Sheba Medical Center. The study cohort was divided according to whether a subsequent cholecystectomy was performed and also by age 60 to 80 or >80 years. All biliary-related complications were recorded. The primary outcome measures were biliary complications, perioperative and periprocedural mortality, CBD stone recurrence, and the need for future surgical intervention. There were 111 patients (mean age 79.4 ± 9.1 years) who underwent ERCP with follow-up. After excluding 11 patients, 100 patients were left for analysis, 46 of whom underwent a cholecystectomy and 54 were observed without operation. There were significant longer term biliary complications in five of the operated patients (10.9%) and in four of the unoperated cases (7.4%). All biliary-related complications were managed successfully by conservative means except for one fatality in the nonoperated group. Biliary-related complications after successful ERCP for CBD stones were unaffected by surgery but were more commonly observed in older cases. A watch and wait policy may be justified in elderly comorbid patients.
What is the Value of a Burn Surgery Rotation in Surgical Residency?
Authors: Johnson Laura S. , Travis Taryn E. , Shupp Jeffrey W.
Published: June 2020

Declining case volumes on trauma rotations and early specialization of traditional surgical rotations have limited the service lines on which general surgery residents can obtain critical operative and management experience. Meanwhile, a significant portion of residents have no exposure to a burn rotation during their training. A burn rotation may address both of these issues in a meaningful way. Surgical case volumes and burn ICU patient volume were queried for an urban regional verified burn referral center. General surgery program resident case logs were queried for procedures performed during a burn rotation during that same time period. Over a four-year time period, three burn surgeons performed a total of 2374 procedures on burn and wound service patients. In the burn ICU over that same time period, 419 individual critical care patients were managed. Twenty-seven general surgery program residents logged 632 major operations and 67 critical care patients; more than 50 per cent of cases performed were not captured by the Accreditation Council for Graduate Medical Education case log system. A high volume burn service can adequately provide surgical and critical care exposure to junior surgical residents. Accreditation Council for Graduate Medical Education surgical case logs may not fully represent the full scope of exposure sustained on a high-volume burn service.
Feasibility of Thyroid Imaging Reporting and Data System Classification in Predicting Thyroid Malignancy
Authors: Dural Ahmet Cem , Sahbaz Nuri Alper , Akarsu Cevher , Akbulut Sezer , Turkay Rustu , Baytekin Halil Firat , Alis Halil
Published: June 2020

In this study, we aimed to evaluate the diagnostic value of thyroid imaging reporting and data system (TIRADS) in the estimation of malignancy and assess the concordance between TIRADS and the histopathology results of the postoperative specimens. Consecutive ultrasound imaging records of patients with multinodular goiter from January 2010 to December 2017 who underwent surgery were retrospectively reviewed. The risk of malignancy of each TIRADS category was determined, and correlation with pathology was assessed. The patients with malignant cytology findings (Bethesda 6) who were categorized TIRADS 6 were excluded from the study. The positive and negative predictive values, sensitivity, specificity, and accuracy of the TIRADS classification were calculated on a 2 x 2 table with their own formulas. A total of 1457 patients were evaluated, and 1122 of these were included in the study. The risk of malignancy for nodules evaluated as TIRADS 2 was 0.6 per cent, TIRADS 3 was 13.1 per cent, TIRADS 4a was 20 per cent, TIRADS 4b was 61.1 per cent, TIRADS 4c was 85.7 per cent, and TIRADS 5 was 93.3 per cent. The positive predictive value of TIRADS classification was found to be 43.4 per cent, negative predictive value was found to be 90.7 per cent, sensitivity was found to be 78 per cent, specificity was found to be 68.4 per cent, and accuracy was found to be 70.7 per cent for our institution. The TIRADS classification based on suspicious ultrasound findings is reliable in predicting thyroid malignancy and can be routinely used in daily practice.
Findings on Colonoscopy after Diverticulitis: A Multicenter Review
Authors: Studniarek Adam , Kochar Kunal , Warner Christina , Eftaiha Saleh , Naffouj Sandra , Borsuk Daniel J. , Mellgren Anders , Park John J. , Cintron Jose , Harrison Jacqueline
Published: June 2020

Diverticular disease is a common problem where patients with diverticulosis have a 1–4 per cent risk of acute diverticulitis. Current guidelines recommend a colonoscopy after.the resolution of acute diverticulitis. The aim of this study was to evaluate the yield of significant findings on colonoscopy after an episode of diverticulitis. This is a retrospective analysis of patients who underwent colonoscopy after an episode of diverticulitis between November 2005 and August 2017 at three major teaching hospitals. Advanced adenomas were defined as adenomas ≥1 cm, serrated adenomas, and tubulovillous or villous adenomas. A total of 584 patients (298 males; 51%) underwent colonoscopy for a history of diverticulitis after resolution of acute symptoms. Colonoscopy was complete in 488 patients (84%). Among these 488 patients, 446 had diverticular disease, 31 had advanced adenomas, and four had adenocarcinomas. Colonoscopies were incomplete in 96 patients (16%). Forty-six of those patients underwent surgery. The overall incidence of advanced adenomas and adenocarcinomas was 32 (5.4%) and nine (1.5%), respectively. In our study, the prevalence of advanced adenomas and adenocarcinomas was relatively high compared with the average risk individuals. Our findings support that patients after an episode of diverticulitis should continue to get a colonoscopy.
Opioid Prescribing and Use After Pediatric Umbilical Hernia Repair
Authors: Lee Matthew L. , Camp Lauren B. , Raval Mehul V. , Huang Eunice Y.
Published: June 2020

Background

Opioid overuse is a concern in adult and pediatric populations. Physician education may improve appropriate opioid prescribing and patient instruction for use. Prescribing and use of opioid for pain control after pediatric umbilical hernia repair (UH) before and after surgeon education was evaluated. This is a substudy of a multi-institutional study assessing prescribing practice before and after surgeon education. This study further assessed patient prescription filling pattern and parent report of pain control.

Methods

A retrospective study was performed evaluating children who underwent UH 6 months before and after an educational presentation on opioid use. Prescriptions, prescription fills, patient medication use, and pain control effectiveness were assessed. Adverse events were collected.

Results

There were 78 subjects in the pre- and 99 in the posteducation group. Opioid prescribed changed from 98.7% to 61.6% ( P < .0001), and nonopioid prescriptions increased following education ( P = .0063). The number of opioid prescriptions filled decreased ( P = .0296). There were limited data on opioid doses used and quality of pain control, but the posteducation group showed good pain control. There was no difference in adverse events.

Discussion

Surgeon education on current opioid epidemic and strategies for opioid stewardship improves opioid prescribing and use without adversely impacting pain control or clinical outcome.
Getting a Better Grip: A Novel Modification to the Dual Snare Technique for Removing Long Esophageal Foreign Bodies
Authors: Judge Joshua , Le Anh , Wecowski Jacek
Published: June 2020

Foreign body ingestion is a common indication for general surgery consultation in the emergency setting. We report a case of large esophageal foreign body ingestion involving a metallic butter knife lodged at the gastroesophageal junction that required endoscopic removal. Furthermore, we report a novel modification to the dual snare technique of retrieval incorporating a snare placed through a nasogastric tube to facilitate introduction and manipulation of the second snare.
A First Report: Two Cases of Survival and Full Recovery After Blunt Cardiac Rupture Requiring Emergency Department Thoracotomy
Authors: Weber Courtney , Farrah Jason , Garcia Alejandro , Ang Darwin
Published: June 2020

Blunt traumatic cardiac rupture is an uncommon event in trauma and survival is rare. While multiple isolated accounts of repair of blunt cardiac rupture have been reported in the literature, there is not a single report of survival from right ventricular rupture following an emergency department thoracotomy (EDT). We report 2 cases where patients have survived such injuries and have made a full recovery. These patients are from a single institution who lost pulses on arrival to the emergency department; then underwent EDT with relief of cardiac tamponade with hemorrhage control by temporary closure, and subsequent definitive repair of right ventricular rupture in the operating room. Both were multiply injured and survived to discharge without neurologic sequelae and have made a full recovery back to their baseline function. This setting may represent an important use of EDT among blunt trauma patients, where time to survival and recovery may dependent on the speed of hemorrhage control and return of cardiac activity.
Governing Collaborative Value Creation in the Context of Grand Challenges: A Case Study of a Cross-Sectoral Collaboration in the Textile Industry
Authors: DiVito Lori , van Wijk Jakomijn , Wakkee Ingrid
Published: June 2020

The aim of this study is to understand how governance mechanisms in cross-sector collaborations (CSCs) for sustainability affect value creation and capture and subsequently the survival of this organizational form. Drawing on a longitudinal, participatory, single-case study of collaborative action in the textile industry, we identify three governance mechanisms—safeguarding, bundling and connecting—that coevolve with the rising and waning of collaborative tensions and the shifting levels of action in the CSC we studied. These mechanisms aided value creation and helped facilitate private value capture. We integrate these insights into a process model that visualizes the interplay between governance mechanisms of tensions and systems of value creation and capture in CSCs for sustainability. Our study contributes to the cross-sector collaboration literature by providing a dynamic and nuanced understanding of how governance mechanisms influence outcomes in CSCs for sustainability. We also add to the business model for sustainability literature by theorizing the value creation and capture system of collaborative rather than individual organizations. Our findings have important implications for policymakers who fund collaborative organizations and practitioners who manage or participate in them.
Prototypical career paths in urban, suburban, and rural locations in the United States
Authors: Setor Tenace , Joseph Damien
Published: June 2020

Career paths are formed over time from interactions between individuals, organizations, and labor markets within and across geographic locations. What are the prototypical career paths thus formed? Who are the likely incumbents of these career paths? What are the consequences of pursuing these career paths? This study combines micro-level perspectives on personal agency and macro-level institutional factors to explain how careers unfold over time and space. The juxtaposition of micro- and macro-level factors contributes to career research and practice, which have traditionally examined careers as movements across organizations and occupations over time, but almost exclusively within specific geographic locations. We make a significant contribution to theory and practice by analyzing sequences of jobs and residence locations for 2836 individuals drawn from the National Longitudinal Survey of Youth 1979. The analyses reveal eight prototypical career paths, some commonly found across geographic locations and others idiosyncratic to specific geographic locations. The profiles of the career path incumbents vary regarding gender, ethnicity, and education attainment. We find that the objective career success associated with prototypical career paths is more a function of human capital accumulation and career choices than geographic locations. We close by discussing our findings’ implications for career research and practice.
Drug Promotion in India Since 2000: Problems Remain
Authors: Lexchin Joel
Published: June 2020

Pharmaceutical companies engage heavily in promoting their products worldwide, and India is no exception. This article begins with an analysis of the therapeutic value of medications on the Indian market because, by definition, if a drug has no therapeutic value or has a negative benefit-to-harm ratio, then any promotion of that drug is inappropriate. It then examines 2 Indian case studies: drug promotion in Mumbai and the misuse of the World Health Organization logo in promotion. Next it describes specific types of promotion: advertisements in medical journals, brochures, and pamphlets; the actions of sales representatives; and the content of continuing medical education courses and medical conferences. The next sections examine medical students’ and trainees’ exposure to promotion and their attitudes about promotion; the attitudes of doctors about their interactions with the pharmaceutical industry; and whether promotion has an influence on prescribing. The article concludes with a critique of the existing industry, professional, and government regulatory regimes in India.
“He Was a Good Boy”: The Caribbean Black Mothers’ Experience of Coping and Grief With the Homicide of Their Sons in Trinidad
Authors: Huggins Camille , Hinkson Glenda , Charles Keevin
Published: June 2020

There is little research on Caribbean Black mothers coping with the homicide of their sons. This phenomenological study examines mothers’ grief and coping after the homicide of their male child on the small island state of Trinidad, where people are close knit and socially interconnected. In-depth interviews of 10 mothers who suffered the loss of their sons within a 10-year period were conducted and four themes emerged: normalizing the child against stigma, spirituality and meaning making, concealment and suppression of emotions, and collective support. Results highlighted the immense grief mothers are still struggling with, due to lack of closure with their son’s murder case and the stigma associated with homicide. Additional supports are needed to help mothers with the grieving process.
Shear performance of single-keyed dry joints between reactive power concrete and high strength concrete in push-off tests
Authors: Feng Jiahui , Liang Weibin , Jiang Haibo , Huang Chengwang , Zhang Jingyuan
Published: June 2020

Shear key joints are commonly used in constructions of precast concrete segmental bridges. Most researches focused on shear performance of the dry joints with the identical-strength concrete, leaving a research gap on that of composite joints between different concrete segments. This research aims to investigate shear behavior of shear key joint between reactive powder concrete and high strength concrete. Totally 12 specimens of single-keyed dry joint were tested, with the parameters of concrete compressive strength, steel fibers, and confining stress. The experimental results indicated that shear failure was observed, but crushing phenomenon occasionally occurred in composite joints in testing, which was confirmed by stress distribution from numerical simulation. In terms of shear capacity of composite joint, peak shear loads of reactive powder concrete specimens without steel fibers were enhanced by 10%–12% as increasing of concrete compressive strength, while those with steel fibers achieved 22%–25% enhancement. Nevertheless, a slight reduction of normalized shear strength was obtained because of its lower volume fraction of coarse aggregate. In numerical simulation, as increasing the concrete compressive strength of convex part, peak shear load was enhanced, but the increment rate of peak shear load decreased. Shear design formulae underestimated shear capacity of reactive powder concrete specimens with steel fibers, but the models proposed by Buyukozturk and Rombach gave accurate predictions on those without steel fibers.
Acute infectious purpura fulminans: a case series from India
Authors: Abdul Kalam Sumayya , Carey Ronald AB , Antony John , Abraham OC
Published: June 2020

Acute infectious purpura fulminans is a serious, potentially fatal condition. We present a case series of 11 patients from March 2005 to March 2017, whose clinical symptoms were fever (100%), confusion (63.6%) and headache (55%), and whose common laboratory abnormalities were thrombocytopenia (100%), elevated alkaline phosphatase (70%) and anaemia (63.6%). Three patients (27%) developed gangrene and two presented in shock. Only one grew Neisseria meningitidis in cerebrospinal fluid (CSF) culture and another confirmed by latex agglutination and polymerase chain reaction in CSF. Five others had serology confirmed spotted fever rickettsioses (SFG). All received broad spectrum antibiotics; in 9/11 patients, this included doxycycline or azithromycin. The mean hospital stay was 10.2 days and overall mortality was 18.2%.
Swimming With the Bicheno “Coffee Club”: The Textured World of Wild Swimming
Authors: Gould Shane , McLachlan Fiona , McDonald Brent
Published: June 2020

Wild swimming is currently experiencing a surge in popularity as people avowedly attempt to reconnect with the natural world. Previous research has positioned wild swimming as a solitary pursuit whereby individuals retreat from society to connect with or overcome nature and better themselves. This article draws on an ethnographic examination of a wild swimming group in Australia and reveals that while being in nature and personal fulfillment are key motivations for these wild swimmers, it is the social interactions that facilitate a deep engagement with their local “bluespace.” We argue that rather than swimming away from the world, by “wayfaring” together these swimmers become connected to their environment, and each other, simultaneously. Such findings indicate potential social, health, and environmental benefits of collective wild swimming.
Sensing Water: Uncovering Health and Well-Being in the Sea and Surf
Authors: Britton Easkey , Foley Ronan
Published: June 2020

This article considers how different recreational users engage with and utilize blue spaces as health-enabling. Informed by empirical and participatory fieldwork with surfing and sea swimming groups, we explore embodied and emotional experiences while researching directly within blue space. Given a focus on health and well-being, we identify different dimensions of how surfers and swimmers narrate those experiences while directly immersed in water during a sport/recreational activity. Such questions resonate with geographical thinking around phenomenology, active relational geographies, embodiment, emotion, and sport and leisure practice. We use a broad health promotion or enabling spaces approach to capture different emotional and embodied accounts of immersions in blue space, recognizing that this capture is emergent in and from place.
An investigation of the validity of a speaking assessment for adolescent English language learners
Authors: Huang Becky H. , Bailey Alison L. , Sass Daniel A. , Shawn Chang Yung-hsiang
Published: June 2020

Given the increasing emphasis of communicative competence in English as a foreign language (EFL) contexts and the lack of validation research on speaking assessments for adolescent EFL learners, in the current study we examined the validity of the TOEFL Junior® speaking test, a relatively new speaking assessment developed by Educational Testing Service. We utilized Messick’s integrative view of construct validity (1996) and Kane’s interpretation argument framework (Kane, 2013), and focused on two sources of validity evidence: internal structure and external relations to other variables (AERA, APA, and NCME, 2014). We used a cross-sectional design with 252 seventh-to-ninth graders in Taiwan, which aligns with the spectrum of the TOEFL Junior®’s target age group. All adolescent participants took the TOEFL Junior® speaking test and two researcher-developed speaking tests. They also completed a survey reporting their history of English learning experiences from kindergarten to present and evaluating their own English language skills. Adolescent participants’ teachers provided evaluations of participants’ English language skills. Results from correlational tests and confirmatory factor analysis showed robust evidence for the test’s internal structure. Correlation and multiple regression models also demonstrated strong positive relationships between TOEFL Junior® test scores and external variables, providing evidence for TOEFL Junior®’s construct validity.
Reversal of neurovascular coupling in the default mode network: Evidence from hypoxia
Authors: Rossetti Gabriella MK , d’Avossa Giovanni , Rogan Matthew , Macdonald Jamie H , Oliver Samuel J , Mullins Paul G
Published: June 2020

Local changes in cerebral blood flow are thought to match changes in neuronal activity, a phenomenon termed neurovascular coupling. Hypoxia increases global resting cerebral blood flow, but regional cerebral blood flow (rCBF) changes are non-uniform. Hypoxia decreases baseline rCBF to the default mode network (DMN), which could reflect either decreased neuronal activity or altered neurovascular coupling. To distinguish between these hypotheses, we characterized the effects of hypoxia on baseline rCBF, task performance, and the hemodynamic (BOLD) response to task activity. During hypoxia, baseline CBF increased across most of the brain, but decreased in DMN regions. Performance on memory recall and motion detection tasks was not diminished, suggesting task-relevant neuronal activity was unaffected. Hypoxia reversed both positive and negative task-evoked BOLD responses in the DMN, suggesting hypoxia reverses neurovascular coupling in the DMN of healthy adults. The reversal of the BOLD response was specific to the DMN. Hypoxia produced modest increases in activations in the visual attention network (VAN) during the motion detection task, and had no effect on activations in the visual cortex during visual stimulation. This regional specificity may be particularly pertinent to clinical populations characterized by hypoxemia and may enhance understanding of regional specificity in neurodegenerative disease pathology.
Patterns of Anemia in Married Women and Their Children in Cambodia: A Synthetic Cohort Analysis
Authors: I’Aronu Ngozi J. , Onyeneho Nkechi G. , Ozumba Benjamin C. , Subramanian S.V.
Published: June 2020

Aim

To explore the prevalence of anemia in three cohorts of women, namely, married yet to be mothers, married and are mothers, and currently pregnant, to ascertain the patterns in anemia in women.

Methods

We analyzed a sample of 130,965 married women from four Demographic Health Surveys: 2000, 2005, 2009 and 2015. The primary focus for the analysis was married women aged 15 to 49 years. In the absence of a longitudinal data that followed the same women over the periods, a synthetic cohort of the women of that age-group was constructed to get women aged 15 to 64 years over the four surveys. Women who were aged 15 to 19 years in 2000 were the same as those 30 to 34 years in 2015, while those aged 45 to 49 years in 2000 were the same as 60 to 64 years in 2015.

Results

Logistic regression revealed that young mothers were significantly more infected ( p < .001). Pregnancy affected anemia in the women ( p < .001). Being younger and richer were associated with odds ratios of 0.599 (95% confidence interval, CI: [0.560, 0.640]) and 0.765 (95% CI: [0.726, 0.807]) for anemia, respectively. Being pregnant had odds ratio of 1.642 (95% CI: [1.439, 1.872]) for anemia.

Conclusion

Public health strategies should target social deprivation at the household level while addressing maternal health issues. An analysis of data on unmarried women and their children is recommended.
Influence of menstrual status and pathological type on the apparent diffusion coefficient in cervical cancer: a primary study
Authors: Dong Yue , Dong Rui Tong , Zhang Xiao Miao , Song Qing Ling , Yu Tao , Hong Luo Ya
Published: June 2020

Background

Apparent diffusion coefficient (ADC) value is an important quantitative parameter in the research of cervical cancer, affected by some factors.

Purpose

To investigate the effect of pathological type and menstrual status on the ADC value of cervical cancer.

Material and Methods

A total of 352 individuals with pathologically confirmed cervical cancer between January 2015 to December 2017 were retrospectively enrolled in this study, including 317 cases with squamous cell carcinomas (SCC) and 35 cases with adenocarcinomas (AC); 177 patients were non-menopausal and 175 were menopausal. All patients underwent a routine 3.0-T magnetic resonance imaging (MRI) scan and diffusion-weighted imaging (DWI) examination using b-values of 0, 800, and 1000 s/mm2. Three parameters including mean ADC (ADCmean), maximum ADC (ADCmax), and minimum ADC (ADCmin) of cervical cancer lesions were measured and retrospectively analyzed. Independent samples t-test was used to compare the difference of ADC values in different menstrual status and pathological types.

Results

In all menopausal and non-menopausal patients, the ADCmean and ADCmin values of SCC were lower than those of AC ( P<0.05), the ADCmax of two pathological types showed no statistical difference ( P > 0.05). In menopausal patients, the ADCmean, ADCmax, and ADCmin values of SCC were not statistically different compared with those of AC ( P > 0.05). The ADCmean, ADCmax, and ADCmin values of different pathological types cervical cancers in non-menopausal patients were all higher than those in menopausal patients ( P<0.05).

Conclusion

The ADC values of the cervical cancers were different in different pathological types and were also affected by menstrual status.
Radiomics of apparent diffusion coefficient maps to predict histologic grade in squamous cell carcinoma of the oral tongue and floor of mouth: a preliminary study
Authors: Ren Jiliang , Qi Meng , Yuan Ying , Tao Xiaofeng
Published: June 2020

Background

Histologic grade assessment plays an important part in the clinical decision making and prognostic evaluation of squamous cell carcinoma (SCC) of the oral tongue and floor of mouth (FOM).

Purpose

To assess the value of apparent diffusion coefficient (ADC)-based radiomics in discriminating between low- and high-grade SCC of the oral tongue and FOM.

Material and Methods

We included data from 88 patients (training cohort: n = 59; testing cohort: n = 29) who underwent diffusion-weighted imaging with a 3.0-T magnetic resonance imaging scanner before treatment. A total of 526 radiomics features were extracted from ADC maps to construct a radiomics signature with least absolute shrinkage and selection operator logistic regression. Receiver operating characteristic curves and areas under the curve (AUCs) were used to evaluate the performance of radiomic signature.

Results

Five features were selected to construct the radiomics signature for predicting histologic grade. The ADC-based radiomics signature performed well for discriminating between low- and high-grade tumors, with AUCs of 0.83 in both cohorts. Based on the cut-off value of the training cohort, the radiomics signature achieved accuracies of 0.78 and 0.79, sensitivities of 0.65 and 0.71, and specificities of 0.85 and 0.82 in the training and testing cohorts, respectively.

Conclusion

ADC-based radiomics can be a useful and promising non-invasive method for predicting histologic grade of SCC of the oral tongue and FOM.
Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study
Authors: Podgórska Joanna , Pasicz Katarzyna , Zagórowicz Edyta , Mróz Andrzej , Gołębiewski Bogumił , Kuś Piotr , Jasieniak Jakub , Skrzyński Witold , Wieszczy Paulina , Kukołowicz Paweł , Cieszanowski Andrzej
Published: June 2020

Background

A non-invasive tool for the assessment of ulcerative colitis (UC) activity is needed for treatment control.

Purpose

To determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in UC.

Material and Methods

In this prospective study, 20 adult patients underwent 3.0-T magnetic resonance imaging (MRI) IVIM diffusion-weighted imaging (DWI) with 10 b-values (0–900 s/mm2) 0–6 days after biopsies entailing colonoscopy. The inflammatory activity of large bowel segments was graded on endoscopy with Mayo score and on pathology with a six‑grade classification system. IVIM‑derived parameters (f, D, and D*) calculated from regions of interest placed within the bowel wall were correlated with both scores (56 and 34 bowel segments, respectively). Radiologists were blinded to endoscopy and pathology results. A T-test and Wilcoxon rank sum test was used in comparisons and receiver operating characteristic curve analysis was performed.

Results

Statistically significant differences were found between histopathologically inactive or mild activity and moderate to severe activity in f (respectively: mean = 0.19 and mean = 0.28, P = 0.024; area under the curve [AUC] = 0.723, sensitivity 0.82, specificity 0.59, accuracy 0.67 for a 0.185 cut-off value) and D (mean = 1.34 × 10−3mm2/s and mean = 1.07 × 10−3mm2/s, P = 0.0083; AUC = 0.735, sensitivity 0.91, specificity 0.54, accuracy 0.66 for cut-off value 1.24 × 10−3mm2/s). No significant difference in D* was noted. No significant correlation between Mayo endoscopic subscore, and f, D, nor D* was found.

Conclusion

IVIM perfusion fraction correlates with UC activity and might represent emerging tool in assessment of inflammatory activity.
Diagnosis of Collagen Type III Glomerulopathy Using Picrosirius Red and PASH/Masson’s Trichrome Stain
Authors: Davis Katelin L. , Burnum Anne L. , Beck Jessica A. , Kirejczyk Shannon G. M. , Miller Margaret A. , Sola Mario F. , Brown Cathy A.
Published: June 2020

Canine collagen type III glomerulopathy (Col3GP) is a rare juvenile nephropathy in which irregular type III collagen fibrils and fibronectin accumulate in glomerular capillary walls and the mesangium. Necropsy findings were reviewed from 5 puppies diagnosed with Col3GP at 6 to 18 weeks of age. Histologically, with hematoxylin and eosin stain, the glomerular capillary walls and mesangium were diffusely and globally expanded by homogeneous pale eosinophilic material. Ultrastructurally, the subendothelial zone and mesangium were expanded by fibronectin and cross-banded collagen type III fibrils, diagnostic of Col3GP. Two additional stains were employed to identify the material within glomeruli as fibrillar collagen using light microscopy. In all 5 cases, the material was red with picrosirius red and birefringent under polarized light, and was blue with periodic acid-Schiff/hematoxylin/trichrome (PASH/TRI), thereby identifying it as fibrillar collagen. Based on these unique staining characteristics with picrosirius red and PASH/TRI, Col3GP may be reliably diagnosed with light microscopy alone.
Dimensions of Electronic Fraud and Governance of Trust in Nigeria’s Cashless Ecosystem
Authors: Tade Oludayo , Adeniyi Oluwatosin
Published: June 2020

A negative outcome of the nascent cashless policy in Nigeria has been persistent electronic banking fraud (e-fraud). Fraud occurrence in any financial space indicates insecurity and loopholes being exploited by fraudsters. This underscores the importance of trust governance in electronic banking and its centrality in a transiting cashless economy like Nigeria. Against this background, we investigated e-banking fraud and the role trust governance plays in both the adoption and refusal to migrate and use electronic banking in Nigeria. Using qualitative methods (in-depth and key informant interviews) of data collection, 30 participants were purposively selected and in some instances reached through the snowball and referral methods. Findings showed internal, external, and collaborative dimensions of e-fraud. Experiences of fraud reportedly affected adoption and migration of bank customers to e-banking platforms. Although weak governance mechanism was reported, banks nonetheless are embracing security mechanisms such as sending SCAM alert messages to customers, while shaming and sack of compromised staff were employed as within-bank measures to secure the confidence of customers in the evolving financial ecosystem.