bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting and Surviving Prolonged Critical Illness After Congenital Heart Surgery
Authors: DeWitt Aaron G. , Rossano Joseph W. , Bailly David K. , Bhat Priya N. , Chanani Nikhil K. , Kirkland Brandon W. , Moga Michael-Alice , Owens Gabe E. , Retzloff Lauren B. , Zhang Wenying , Banerjee Mousumi , Costarino Andrew T. , Bird Geoffrey L. , Gaies Michael
Published: April 2020

Objectives:

Prolonged critical illness after congenital heart surgery disproportionately harms patients and the healthcare system, yet much remains unknown. We aimed to define prolonged critical illness, delineate between nonmodifiable and potentially preventable predictors of prolonged critical illness and prolonged critical illness mortality, and understand the interhospital variation in prolonged critical illness.

Design:

Observational analysis.

Setting:

Pediatric Cardiac Critical Care Consortium clinical registry.

Patients:

All patients, stratified into neonates (≤28 d) and nonneonates (29 d to 18 yr), admitted to the pediatric cardiac ICU after congenital heart surgery at Pediatric Cardiac Critical Care Consortium hospitals.

Interventions:

None.

Measurements and Main Results:

There were 2,419 neonates and 10,687 nonneonates from 22 hospitals. The prolonged critical illness cutoff (90th percentile length of stay) was greater than or equal to 35 and greater than or equal to 10 days for neonates and nonneonates, respectively. Cardiac ICU prolonged critical illness mortality was 24% in neonates and 8% in nonneonates (vs 5% and 0.4%, respectively, in nonprolonged critical illness patients). Multivariable logistic regression identified 10 neonatal and 19 nonneonatal prolonged critical illness predictors within strata and eight predictors of mortality. Only mechanical ventilation days and acute renal failure requiring renal replacement therapy predicted prolonged critical illness and prolonged critical illness mortality in both strata. Approximately 40% of the prolonged critical illness predictors were nonmodifiable (preoperative/patient and operative factors), whereas only one of eight prolonged critical illness mortality predictors was nonmodifiable. The remainders were potentially preventable (postoperative critical care delivery variables and complications). Case-mix–adjusted prolonged critical illness rates were compared across hospitals; six hospitals each had lower- and higher-than-expected prolonged critical illness frequency.

Conclusions:

Although many prolonged critical illness predictors are nonmodifiable, we identified several predictors to target for improvement. Furthermore, we observed that complications and prolonged critical care therapy drive prolonged critical illness mortality. Wide variation of prolonged critical illness frequency suggests that identifying practices at hospitals with lower-than-expected prolonged critical illness could lead to broader quality improvement initiatives.
Attention-Deficit/Hyperactivity Disorder and Outcome After Concussion: A Systematic Review
Authors: Cook Nathan E. , Iaccarino Mary Alexis , Karr Justin E. , Iverson Grant L.
Published: April 2020

Objective:

To synthesize the literature and conduct a gap analysis on the association between attention-deficit/hyperactivity disorder (ADHD) and clinical outcome from sport-related concussion.

Method:

The electronic search for this systematic review (PROSPERO ID: CRD42019128281) was conducted in February 2019 using terms related to concussion, sports/athletics, and predictors/modifiers of outcome to search the PubMed, PsycINFO, MEDLINE, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science databases. Eligible studies evaluated the association between ADHD and outcome from sport-related concussion. Of 4014 studies screened, 359 full-text articles were reviewed, with 14 studies ultimately included, involving 3623 participants (n = 359 [9.9%] with ADHD).

Results:

Study samples were primarily from specialty medical clinics (57.1%) and high school or college athletic groups (28.6%). Only 2 studies reported a statistically significant association between ADHD and worse clinical outcome. Of these, 1 included 13 participants with ADHD and the other included only 8 participants with ADHD. Only 1 previous study in this review was designed specifically to examine ADHD and prolonged concussion recovery, and that study did not report a statistically significant association.

Conclusion:

There is not a clear association between ADHD and worse clinical outcome from concussion. However, eligible studies had limitations in research design, and nearly all studies were underpowered and evaluated the association between ADHD and concussion outcome as a secondary focus rather than the primary research question, precluding definitive conclusions. The association between ADHD and clinical outcomes remains unclear, and future research specifically examining ADHD and concussion recovery is needed.
Assessment of Wellbeing and Anxiety-related Disorders in Those Seeking Rhinoplasty: A Crowdsourcing-based Study
Authors: Shauly Orr , Calvert Jay , Stevens Grant , Rohrich Rod , Villanueva Nate , Gould Daniel J.
Published: April 2020

Background:

Recently, it has been proposed that psychosocial concerns may motivate the demand for aesthetic rhinoplasty. Although successful operations often improve the quality of life and self-esteem symptoms in patients with sound mental health, they may actually result in unsatisfactory outcomes in those patients with significant depression, anxiety, or other severe psychological disorders. The purpose of this study was to assess the incidence of psychological disorders in patients seeking rhinoplasty.

Methods:

A prospective cross-sectional study of 298 random volunteers was conducted, with each participant completing a survey instrument that was administered through an internet crowd-sourcing service (Amazon Mechanical Turk). Participants were asked to complete a 10-item standardized SHNOS scale, and a 26-question PRIME-MD questionnaire in order to assess functional and aesthetic need for rhinoplasty, and the incidence of psychological disorders respectively

Results:

38.95% of female participants reported a willingness to undergo aesthetic rhinoplasty, with a significantly lower number of men reporting the same (27.78%, P = 0.042). Adults between the ages of 18-24 (52.92%) were more willing to undergo aesthetic rhinoplasty, as compared to any other age group (P < 0.01). It was found that 57.84% of patients interested in surgery reported a psychological disorder as determined by the PRIME-MD questionnaire.

Conclusions:

Those suffering from major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder may seek aesthetic rhinoplasty as a solution. It is important that surgeons assess patient mental health prior to treatment in order to avoid unsuccessful outcomes secondary to psychosocial illness.
Crane Principle Revisited
Authors: Kadry Hamed M. , Taha Ahmed A.
Published: April 2020

Background:

Scalp and forehead defects represent one of the most complex defects for reconstruction. The nature of these sites being hair bearing, together with the complicated nature of the injuries, for example, electrical burns and motor vehicle accidents, and of course the aesthetic concern being in the face, all add to the complexity of reconstruction.

Methods:

This is a case series representing the experience of the authors in using the “crane principle” in the reconstruction of various defects in the forehead and the scalp presented to emergency department, Cairo University Hospital, for the period between January 2018 and January 2019.

Results:

Twenty patients, 15 men and 5 women, presented with various soft tissue defects of the forehead and the scalp. The injuries of eighteen patients were due to motor vehicle accidents, and 2 patients had postelectrical burns. Age range was from 20 to 65 years, with a mean follow-up of 8 months. The number of total complications was 5. Three patients had wound dehiscence, and 2 patients had ulceration in the grafts placed at the flap donor site.

Conclusion:

Crane principle represents an adequate reconstruction tool for forehead and scalp defects especially when the access to free flap and more complex reconstruction techniques is not available.
Vascularized, Denervated Muscle Targets: A Novel Approach to Treat and Prevent Symptomatic Neuromas
Authors: Tuffaha Sami H. , Glass Connor , Rosson Gedge , Shores Jaimie , Belzberg Allan , Wong Alison
Published: April 2020

Summary: There are many surgical approaches described to treat and prevent symptomatic neuromas, each of which has significant limitations. Here we describe the rationale and technical approach for a novel method that carries the promise of addressing some of these limitations.
Bifurcation of Patient Reviews: An Analysis of Trends in Online Ratings
Authors: Devgan Lara L. , Klein Elizabeth J. , Fox Stephen , Ozturk Tugce
Published: April 2020

Background:

Online reviews have become increasingly important drivers of healthcare decisions. Data published by the Pew Research Center from 2016 suggest that 84% of adult Americans use online rating sites to search for information about health issues. The authors sought to analyze physician reviews collected from a large online consumer rating site to better understand characteristics that are associated with positive and negative review behavior.

Methods:

Published patient reviews from RealSelf were sampled over a 12-year period (June 2006 to August 2018). SQL, Python, and Python SciPy were used for statistical analysis on 156,965 reviews of 10,376 unique physicians. Python VADER was used to quantify consumer sentiment with review text as input.

Results:

Surgical procedures tended to be higher rated than nonsurgical treatments. The highest-rated procedures were breast augmentation, rejuvenation of the female genitalia, and facelift. The lowest-rated surgical procedures were buttock augmentation, rhinoplasty, and eyelid surgery. The mean physician rating was 4.6, with 87% of reviews being 5-star and 5% being 1-star. Sentiment analysis revealed positive consumer sentiment in 5-star reviews and negative sentiment in 1-star reviews.

Conclusions:

These findings suggest that online reviews of doctors are polarized by extreme ratings. Within the surgical category, significant differences in ratings exist between treatments. Perceived problems with postprocedural care are most associated with negative reviews, whereas satisfaction with a physician’s answers to patient questions is most associated with positive reviews. Polarization of physician reviews may suggest selection bias in reviewer participation.
Coronavirus Disease 2019 State Guidelines on Elective Surgery: Considerations for Plastic and Reconstructive Surgeons
Authors: Sarac Benjamin A. , Schoenbrunner Anna R. , Wilson Stelios C. , Chiu Ernest S. , Janis Jeffrey E.
Published: April 2020

Background:

Vague recommendations regarding elective surgery have been proposed by national organizations in an attempt to conserve personal protective equipment and to protect healthcare workers during the coronavirus disease 2019 pandemic. In response, some states have attempted to provide more clear guidance.

Methods:

An internet search was performed to identify and analyze what guidance each state published through government websites through April 10, 2020.

Results:

Thirty-five states and the District of Columbia published guidance in the form of either a recommendation or a mandate. Procedures relating to cosmetics and malignancy were found to be mentioned in 4 and 12 states, respectively, but ultimately lacked case-specific information.

Conclusions:

Current government and state recommendations do not provide clear guidance on how plastic and reconstructive surgeons should approach elective surgeries. Ultimately, it is the responsibility of all plastic and reconstructive surgeons to operate under appropriate law while individualizing their practices to best suit the needs of their patients while being mindful of resource limitations and exposure risks.
Aberrant lncRNA Profiles Are Associated With Chronic Benzene Poisoning and Acute Myelocytic Leukemia
Authors: Tian Wei , Wang Tong-shuai , Fang Yan , Wu Han-tian , Zheng Guo-qiao , Guo Kong-rong , Huang Ming , Sun Dao-yuan , Xia Zhao-lin
Published: April 2020

Objective:

This study investigates the mechanisms of benzene hematotoxicity.

Methods:

We used microarray to detect expression profiles of long non-coding RNAs (lncRNAs) and mRNAs in peripheral lymphocytes from chronic benzene poisoning, acute myelocytic leukemia, and healthy controls. The lncRNAs and mRNAs were validated using real-time quantitative PCR (RT-qPCR). Cytokinesis-block micronucleus assay was used to analyze chromosomal aberration.

Results:

We found 173 upregulated and 258 downregulated lncRNAs, and 695 upregulated and 804 downregulated mRNAs. The lncRNA CUST_40243 and mRNA PDGFC and CDKN1A associated with chronic benzene poisoning. Relevant inflammatory response, hematopoietic cell lineage, and cell cycle may be important pathways for the sifted lncRNAs and mRNAs. Furthermore, micronuclei frequency was significantly higher in off-post chronic benzene poisoning patients.

Conclusions:

Chromosomal aberration induced by benzene exposure is irreversible. The lncRNA CUST_40243 and mRNA PDGFC and CDKN1A are related to chronic benzene poisoning.
Moving Toward Equitable Health Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Education and Training in Physical Therapy Education
Authors: Glick Jared Calvo , Leamy Claire , Hewlett Molsberry Anne , Kerfeld Cheryl Irene
Published: April 2020

Introduction.

Disparities in health and health care experienced by sexual and gender minorities in the United States (US) are well documented, and physical therapists (PTs) play a role in perpetuating them. This study aimed to determine to what degree lesbian, gay, bisexual, transgender, and queer (LGBTQ) health education and training is integrated into physical therapy education curricula. Studies in medicine and nursing have led to increased curricular attention to LGBTQ health topics; yet, similar physical therapy education research has not been published.

Methods.

A link to an anonymous Google Forms survey was emailed to Program Directors (PDs) of US physical therapist education programs accredited by the Commission on Accreditation in Physical Therapy Education for the academic years of 2015–2017. The survey gathered information on the current and optimal number of curricular hours spent on equitable care for LGBTQ patients and perceived barriers to inclusion of LGBTQ curriculum.

Results.

Seventy-two of 229 (31%) programs responded to the survey. Half of the respondents reported inclusion of LGBTQ-related topics in the curriculum. The average number of current hours was 1.43 per year. The average number of optimal hours was 2.82 per year. Eighty-nine percent reported that one or more curricular hours per year should be included. Barriers to LGBTQ health education and training include perceived lack of time and adequate faculty training.

Discussion.

Most PDs believe that more hours should be dedicated to LGBTQ health topics. Open-ended question responses reflect various perspectives held by PDs regarding the importance of including LGBTQ health topics and barriers to inclusion. The development of core competencies may facilitate the inclusion of LGBTQ-specific health education in Doctor of Physical Therapy program curricula.

Conclusion.

Resources to educate faculty and students on LGBTQ health topics are readily available. These topics may be effectively woven into existing curricula, making it an attainable goal to increase the competency of entry-level PTs to assist in meeting the American Physical Therapy Association's mandate to provide nondiscriminatory care.
Right Heart Failure While on Left Ventricular Assist Device Support Is Associated with Primary Graft Dysfunction
Authors: King Phillip M. , Raymer David S. , Shuster Jerrica , Crain Mallory , Bhatia Ankit , Hartupee Justin , Schilling Joel D.
Published: April 2020

Primary graft dysfunction (PGD) is a potentially devastating complication of heart transplantation. Understanding the risk factors for PGD in the modern era of heart transplantation is of vital importance. This study investigated the relationship between post-left ventricular assist device (LVAD) right heart failure (RHF) and transplant outcomes. Patients with durable, continuous-flow LVADs who were transplanted between 2010 and 2016 at Barnes-Jewish Hospital were included in the study. Data collection was performed through retrospective chart review. The primary outcome was the incidence of PGD stratified by pretransplant incidence of RHF while on LVAD support. Among the 141 patients included in the study, 41 developed RHF. In the RHF cohort, 18 patients developed PGD as compared to 14 patients in the group without RHF (44% vs. 14%; p < 0.001). Mortality was significantly higher in the RHF group at 30 days (20% vs. 1%; p < 0.001) and 1 year (22% vs. 6%; p = 0.013). In a multivariable logistic regression model adjusted for confounding variables, RHF was associated with a nearly fourfold increased risk of PGD (odds ratio, 3.91; p = 0.003). The results of this study show that patients supported with LVADs who develop early severe RHF or late RHF are at increased risk of PGD and death following cardiac transplantation.
Clinical efficacy and safety of ketotifen in treating irritable bowel syndrome with diarrhea
Authors: Wang Jing , Wang Yucheng , Zhou Haibin , Gu Weigang , Wang Xia , Yang Jianfeng
Published: April 2020

Objective:

The aim of the study was to investigate the clinical efficacy and safety of ketotifen for the treatment of irritable bowel syndrome with diarrhea (IBS-D).

Methods:

A total of 108 enrolled IBS-D patients were randomly divided into a ketotifen group (n = 55) and a control (placebo) group (n = 53). The patients in the ketotifen group received ketotifen tablets (1 mg, oral) two times daily; patients in the control group received oral placebo for 8 weeks. Before and after 8 weeks of treatment, gastrointestinal symptoms, anorectal sensory function and the number and activity status of mast cells were assessed for both groups.

Results:

(1) The overall effective rate of gastrointestinal symptom improvement in the ketotifen group was significantly higher than that in the control group (76.4 vs. 37.7%, P < 0.001). (2) First sensation, defecation urgency and discomfort/pain threshold in the ketotifen group improved significantly after treatment (P < 0.05); no significant changes were observed in the control group (P > 0.05). (3) In the ketotifen group, the number of mast cells in the terminal ileum decreased, and the percentages of degranulated mast cells in the sigmoid colon, ascending colon and terminal ileum decreased significantly after treatment compared with before treatment; these differences were statistically significant (P < 0.01). In the control group, the number of mast cells and the percentages of degranulated mast cells in various sites did not change significantly before and after treatment (P > 0.05). (4) Six patients (10.9%) in the ketotifen group experienced drowsiness and fatigue, but the symptoms disappeared after 1 week of treatment.

Conclusion:

Ketotifen significantly alleviated gastrointestinal symptoms and improved visceral hypersensitivity in patients with IBS-D. The therapeutic effect of ketotifen is related to a reduced number and decreased activity of mast cells in the intestinal mucosa, especially in the terminal ileum.
Effects of prism adaptation on auditory spatial attention in patients with left unilateral spatial neglect: a non-randomized pilot trial
Authors: Matsuo Takashi , Moriuchi Takefumi , Iso Naoki , Hasegawa Takashi , Miyata Hironori , Maruta Michio , Mitsutake Tsubasa , Yamaguchi Yoichi , Tabira Takayuki , Higashi Toshio
Published: April 2020

A short period of adaptation to a prismatic shift of the visual field to the right briefly but significantly improves left unilateral spatial neglect. Additionally, prism adaptation affects multiple modalities, including processes of vision, auditory spatial attention, and sound localization. This non-randomized, single-center, controlled trial aimed to examine the immediate effects of prism adaptation on the sound-localization abilities of patients with left unilateral spatial neglect using a simple source localization test. Subjects were divided by self-allocation into a prism-adaptation group (n = 11) and a control group (n = 12). At baseline, patients with left unilateral spatial neglect showed a rightward deviation tendency in the left space. This tendency to right-sided bias in the left space was attenuated after prism adaptation. However, no changes were observed in the right space of patients with left unilateral spatial neglect after prism adaptation, or in the control group. Our results suggest that prism adaptation improves not only vision and proprioception but also auditory attention in the left space of patients with left unilateral spatial neglect. Our findings demonstrate that a single session of prism adaptation can significantly improve sound localization in patients with left unilateral spatial neglect. However, in this study, it was not possible to accurately determine whether the mechanism was a chronic change in head orientation or a readjustment of the spatial representation of the brain; thus, further studies need to be considered.
Factors Associated With Perceived Job Preparedness Among RNs
Authors: Zahnd Whitney E. , Crouch Elizabeth L. , Probst Janice C. , Hunt McKinney Selina , Abshire Demetrius A. , Eberth Jan M.
Published: April 2020

This article examines perceived job preparedness by demographic and professional characteristics among practicing RNs who completed a national survey. Rural and male nurses felt less prepared for nursing practice and may benefit from tailored educational experiences to improve perceptions of being prepared for the workforce.
The Effect of an Evidence-Based Practice Education and Mentoring Program on Increasing Knowledge, Practice, and Attitudes Toward Evidence-Based Practice in a Rural Critical Access Hospital
Authors: Mudderman Jamie , Nelson-Brantley Heather V. , Wilson-Sands Cathy L. , Brahn Pam , Graves Kristal L.
Published: April 2020

OBJECTIVE

The aim of this study was to determine the effect of an evidence-based practice (EBP) education and mentoring program on the knowledge, practice, and attitudes toward EBP among staff nurses and clinicians in a rural critical access hospital.

BACKGROUND

While rural nurses value EBP, they often have more limited resources to engage in EBP activities compared with urban-based nurses.

METHODS

Direct care nurses and clinicians participated in a 5-month EBP education and mentoring program following the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care. The Evidence-Based Practice Questionnaire was used to assess pretest-posttest knowledge, practice, and attitudes toward EBP.

RESULTS

Knowledge and practice of EBP increased significantly (P = .008 and P = .015, respectively) after the EBP education and mentoring intervention. Attitudes toward EBP also increased, although the increase was not statistically significant (P = .106).

CONCLUSIONS

Education and mentoring of healthcare clinicians in rural settings are crucial to the translation of evidence-based research into practice to improve patient outcomes.
The Underuse of STI Prevention Counseling in Primary Care
Authors: Diamond Victoria , Harman Jeffrey , Gerend Mary A.
Published: April 2020

Although sexually transmitted infection (STI) rates are increasing in the United States, prevention efforts remain limited. This study examined how often STI prevention counseling is given during primary care office visits using nationally representative data. Sexually transmitted infection prevention counseling occurred in 0.6% of visits and differences by patient race and physician specialty were observed.
Comparison of Immunohistochemistry for PRAME With Cytogenetic Test Results in the Evaluation of Challenging Melanocytic Tumors
Authors: Lezcano Cecilia , Jungbluth Achim A. , Busam Klaus J.
Published: April 2020

PRAME (PReferentially expressed Antigen in MElanoma) is a melanoma-associated antigen. Although diffuse immunoreactivity for PRAME is found in most primary cutaneous melanomas, melanocytic nevi express PRAME usually only in a subpopulation of tumor cells or not at all. Hence, testing for PRAME expression has the potential to provide useful information for the assessment for diagnostically ambiguous melanocytic neoplasms. Many of the latter tumors are currently studied by cytogenetic methods for ancillary evidence in support of or against a diagnosis of melanoma. In this study we analyzed 110 diagnostically problematic melanocytic tumors comparing results for PRAME immunohistochemistry (IHC) with those from fluorescence in situ hybridization and/or single nucleotide polymorphism-array, and each with the final diagnostic interpretation. In 90% of cases there was concordance between PRAME IHC and cytogenetic tests results, and in 92.7% concordance between PRAME IHC and the final diagnosis. The high concordance between PRAME IHC and cytogenetic test results as well as the final diagnosis supports the use of PRAME IHC as an ancillary test in the evaluation of ambiguous primary cutaneous melanocytic neoplasms, especially given its practical advantage of lower cost and faster turnaround over cytogenetic or gene expression studies. However, our results indicate that PRAME IHC and cytogenetic tests for melanocytic tumors are not entirely interchangeable and on occasion each type of test may yield false-negative or false-positive results.
Comparison of Systemic EBV-positive T-Cell and NK-Cell Lymphoproliferative Diseases of Childhood Based on Classification Evolution
Authors: Chen Zihang , Wang Mi , Guan Pujun , Zhao Sha , Zhang Wenyan , Gao Limin , Tang Yuan , Li Li , Liu Weiping
Published: April 2020

Systemic Epstein-Barr virus–positive T-cell and natural killer (NK)-cell lymphoproliferative diseases of childhood are a group of lethal diseases mostly affecting children and young adults. The Ohshima Grading System and the 2017 World Health Organization (WHO) classification have been used for classifying this spectrum, but these systems have not been validated externally and compared. Therefore, we examined 36 cases of systemic Epstein-Barr virus–positive T-cell and NK-cell lymphoproliferative diseases of childhood with long-term follow-up, from Southwest China, to systematically summarize the clinicopathologic features and to validate and compare the Ohshima Grading System and the 2017 WHO classification in discrimination ability, predictive accuracy, concordance indices, and explained variation. Clinically, our cohort showed severe manifestations and poor prognoses. Morphologically, the hematopoietic and lymphoid specimens showed proliferation of small-sized to medium-sized bland-looking lymphocytes that might mask disease severity, whereas other extranodal lesions showed a disorganized to obliterated architecture infiltrated by medium-sized to large-sized, subtle to obvious atypical cells, which may mimic extranodal NK/T-cell lymphoma. Immunophenotypically, our cases mainly originate from CD8+ αβ T cells. Therefore, clinical and pathologic features should be equally considered to avoid missed diagnosis or misdiagnosis. In addition, the 2017 WHO classification shows a flexible grasp of pathologic features, thus classifying some cases (polymorphic and monoclonal cases with fulminant course) more reasonably; thereby, it showed statistically improved results compared with the Ohshima Grading System. However, underestimating the risk of some polyclonal cases and imprecisely discriminating monoclonal cases at diagnosis are common dilemmas in both systems. Therefore, the construction of a comprehensive grading algorithm for improved prognostic value and precise diagnosis requires additional studies.
Evaluation of Preparedness and Recovery Needs of Private Well Users After the Great Louisiana Flood of 2016
Authors: Gilliland Aubrey E. , Pieper Kelsey J. , Straif-Bourgeois Susanne , Rhoads William J. , Dai Dongjuan , Edwards Marc , Brisolara Kari , Olexia Darcie , Katner Adrienne
Published: April 2020

Context:

The August 2016 Louisiana flood marked the second 500-year flood in the state in 1 year.

Objective:

The aim of this study was to identify private well user needs in the aftermath of the flood and to develop disaster planning and recovery recommendations for flood-prone well-reliant communities.

Design:

A descriptive cross-sectional study was conducted to collect information from a convenience sample of flood-impacted well users via surveys and water sampling kits, which were distributed to well users 9 to 11 weeks after floodwaters receded (n = 106).

Setting:

Surveys and kits were distributed at roadside flood response and recovery stations set up by local churches in French Settlement, Livingston Parish, Louisiana, an area at the epicenter of the flood-impacted area.

Participants:

Subjects were included if they self-reported having a flood-impacted well.

Main Outcome Measures:

Surveys collected information to characterize knowledge gaps, risk perceptions, flood impacts, resource accessibility, and well maintenance barriers. Well water tests evaluated total coliform and Escherichia coli.

Results:

Among those in low-risk flood zones (n = 22), 27% were in areas designated as having flooded. Among flood-impacted wells that were shock chlorinated after the flood (n = 16), 31.3% tested positive for total coliform and 12.5% for E coli. Only 26% of respondents received well-related information after the disaster.

Conclusions:

Results highlight critical needs for disaster planning and well user education in flood-prone areas, changes to flood risk maps, and concerns with the efficacy of disinfection strategies. Information and resources needs for flood-impacted well users are presented and recommendations on how to improve flood preparedness and recovery are made.
Validation of Appropriate Use Criteria for Coronary Computed Tomographic Angiography for Chest Pain Evaluation in a Tertiary Care Emergency Room
Authors: Teressa Getu , Manjur Jahan , Ciuffo Marissa , Noack Pamela , Radulescu Vlad A. , Kanagaraj Gautham , Ahuja Ankur , Malaney Roshini , Poon Michael
Published: April 2020

Purpose:

Appropriate use criteria (AUC) defines the appropriateness of imaging procedures for specific clinical scenarios to promote evidence-based utilization and improve cost-effective care. The goal of this study was to assess the diagnostic yield and downstream health care resource utilization according to the AUC categorization for coronary computed tomography angiography (CCTA) in emergency department (ED) patients presenting with chest pain.

Materials and Methods:

A total of 789 consecutive patients in the ED with chest pain and no known coronary artery disease (CAD) who underwent CCTA were classified as appropriate, uncertain, or inappropriate use according to the 2010 AUC. We abstracted index and 30-day data from the electronic medical record to determine diagnostic yield (rate of obstructive CAD and revascularization) and health care resource utilization (downstream stress test and 30-d hospital return rate).

Results:

Rates of appropriate, uncertain, and inappropriate utilization were 48.4%, 48.8%, and 2.8%. Among appropriate, uncertain, and inappropriate classifications, rates of obstructive CAD were 9%, 8%, and 32% (P=0.002); rates of revascularization were 3%, 1%, and 36% (P<0.001); downstream stress test utilization rates were 5% versus 5% versus 14% (P=0.17), and 30-day hospital return rates were 6% versus 6% versus 5% (P>0.99), respectively.

Conclusions:

Appropriate and uncertain uses were associated with low diagnostic yield compared with inappropriate use; however, our findings do not demonstrate differences between appropriate use categories with respect to downstream health care resource utilization. Further studies are needed to define the role of AUC for CCTA in the ED setting.
Is magnetic resonance imaging becoming the new computed tomography for cervical spine clearance? Trends in magnetic resonance imaging utilization at a Level I trauma center
Authors: Huang Raymond , Ryu Robert C. , Kim Terrence T. , Alban Rodrigo F. , Margulies Daniel R. , Ley Eric J. , Barmparas Galinos
Published: April 2020

BACKGROUND

Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center.

METHODS

All blunt trauma patients undergoing a computed tomography (CT) of the C-spine between January 2009 and December 2018 were reviewed. The CT and MRI results, demographics, clinical presentation, subspecialty consultations, and interventions were recorded. The MRI results were considered clinically significant if they resulted in cervical thoracic orthosis/halo placement or surgical intervention. Linear regression models were utilized to identify trends.

RESULTS

There were 9,101 patients that underwent a CT of the C-spine, with 513 (5.6%) being positive for an acute injury. MRI was obtained for 375 (4.1%) of patients. A linear increase in the proportion of patients undergoing an MRI was noted, from 0.9% in 2009 to 5.6% in 2018 (p < 0.01). Of the 513 patients with a positive CT, 290 (56.5%) had an MRI. In 40 (13.8%) of them, the CT demonstrated a minor injury. Clinically significant MRI findings were noted only in two (5.0%) of the 40 patients, and both had a neurologic deficit on initial examination. Of the 8,588 patients with a negative CT, 85 (1.0%) underwent an MRI. Of those, 9 (10.6%) had a clinically significant MRI with all but one presenting with a neurological deficit.

CONCLUSION

MRI is increasingly utilized for C-spine clearance following blunt trauma. MRI was exceedingly unlikely to demonstrate a clinically significant finding in the absence of a neurological deficit, when the CT was negative or included minor injuries. Trauma centers are encouraged to constantly evaluate their own practices and intervene with education and collaboration to limit the excessive use of unnecessary resources.

LEVEL OF EVIDENCE

Therapeutic/Care Management Study, Level III or IV. Diagnostic test, level IV.
Reperfusion repercussions: A review of the metabolic derangements following resuscitative endovascular balloon occlusion of the aorta
Authors: Abid Mustafa , Neff Lucas P. , Russo Rachel M. , Hoareau Guillaume , Williams Timothy K. , Grayson J. Kevin , DuBose Joseph J. , Lendrum Robbie , Johnson M. Austin
Published: April 2020

BACKGROUND

Current resuscitative endovascular balloon occlusion of the aorta (REBOA) literature focuses on improving outcomes through careful patient selection, diligent catheter placement, and expeditious definitive hemorrhage control. However, the detection and treatment of post-REBOA ischemia-reperfusion injury (IRI) remains an area for potential improvement. Herein, we provide a review of the metabolic derangements that we have encountered while managing post-REBOA IRI in past swine experiments. We also provide data-driven clinical recommendations to facilitate resuscitation post-REBOA deflation that may be translatable to humans.

METHODS

We retrospectively reviewed the laboratory data from 25 swine across three varying hemorrhagic shock models that were subjected to complete REBOA of either 45 minutes, 60 minutes, or 90 minutes. In each model the balloon was deflated gradually following definitive hemorrhage control. Animals were then subjected to whole blood transfusion and critical care with frequent electrolyte monitoring and treatment of derangements as necessary.

RESULTS

Plasma lactate peaked and pH nadired long after balloon deflation in all swine in the 45-minute, 60-minute, and 90-minute occlusion models (onset of peak lactate, 32.9 ± 6.35 minutes, 38.8 ± 10.55 minutes, and 49.5 ± 6.5 minutes; pH nadir, 4.3 ± 0.72 minutes, 26.9 ± 12.32 minutes, and 42 ± 7.45 minutes after balloon deflation in the 45-, 60-, and 90-minute occlusion models, respectively). All models displayed persistent hypoglycemia for more than an hour following reperfusion (92.1 ± 105.5 minutes, 125 ± 114.9 minutes, and 96 ± 97.8 minutes after balloon deflation in the 45-, 60-, and 90-minute occlusion groups, respectively). Hypocalcemia and hyperkalemia occurred in all three groups, with some animals requiring treatment more than an hour after reperfusion.

CONCLUSION

Metabolic derangements resulting from REBOA use are common and may worsen long after reperfusion despite resuscitation. Vigilance is required to detect and proactively manage REBOA-associated IRI. Maintaining a readily available “deflation kit” of pharmacological agents needed to treat common post-REBOA electrolyte abnormalities may facilitate management.

LEVEL OF EVIDENCE

Level V.
The Influence of Body Mass Index on Characteristics of Falls in the Malaysian Elders Longitudinal Research Study
Authors: Kioh Sheng Hui , Mat Sumaiyah , Myint Phyo Kyaw , Ai-Vyrn Chin , Kamaruzzaman Shahrul Bahyah , Hairi Noran N. , Cumming Robert , Tan Maw Pin
Published: April 2020

Aim:

To compare and contrast falls characteristics between older adults with body mass index of 25.0 kg/m2 or greater and less than 25.0 kg/m2 and to further identify potential underlying mechanisms if differences existed.

Subjects and Methods:

This was a cross-sectional study using data from fallers identified during the first wave of the Malaysian Elders Longitudinal Research study. Basic demographics, falls characteristics, fear of falling, medical comorbidities, and lifestyle factors were obtained during a home-based computer-assisted interview, while anthropometric measurements, body composition, and physical performance were collected during the hospital-based health check.

Results:

Of the 302 individuals with 1 or more falls in the previous 12 months, mean age (SD) = 69.6 (7.7) years, 152 individuals (50.3%) were in the body mass index of 25.0 group or greater. Fallers with body mass index of 25.0 or greater were more likely to have fallen in the bedroom and on the stairs (adjusted odds ratio = 2.50; 95% confidence interval, 1.10-5.73) and less likely to fall in the afternoon (adjusted odds ratio = 0.47; 95% confidence interval, 0.26-0.83) after adjustment for potential confounders.

Conclusions:

Our study suggests that mechanisms of falls may differ in those with excess body weight, who may benefit from specific targeted fall prevention programmes.
Lower Extremity Functional Strength and Walking Speed in Older Adults Living in a Senior Housing Facility
Authors: Sebastião Emerson , Pak Joshua , Fuerniss Karisa , Siqueira Vitor Antonio Assis Alves , Benner David , Gurjão André Luiz Demantova
Published: April 2020

There is growing interest of researchers in physical performance tests such as walking speed (WS) in the older adult population. This study examined the association between lower extremity functional strength (LEFS) and WS, accounting for potential confounders, and the extent to which LEFS significantly predicts WS in 72 older adults living in a senior housing facility. Participants completed LEFS and WS measures. We observed strong associations between LEFS and WS, and a significant regression equation was found with LEFS and height emerging as significant predictors of WS. This suggests that an equation using LEFS and height could be used as a surrogate to predict WS in this age group.
Investigation of the Relationship Between Activity Performance, Frequency of Fall, and Pain in Elderly People Living at Home
Authors: Cetin Sebahat Yaprak , Calik Bilge Basakci
Published: April 2020

Objective:

The aim of this study was to determine the occupational performance of the elderly individuals living at home and to investigate the relationship between this performance and the frequency of fall and pain.

Methods:

A total of 120 elderly individuals with a mean age of 71.86 ± 5.69 years were included in the study. The Canadian Occupational Performance Measure was used to determine occupational performance. The frequency of falls has been recorded as none, 1, and more than 1 over the last 1 year. Visual analog scale (resting-activity) was used to evaluate the pain.

Results:

There was a moderately significant relationship between the performance and satisfaction scores of the elderly individuals and VAS values and the frequency of fall (P < .05).

Conclusion:

According to the results of our study, it is thought that the participation of the elderly individuals will be increased by relieving the pain in the home-based rehabilitation program to be prepared for the elderly individuals and reducing or preventing the falls.
Mobility Improvement and Rehospitalization Risk Following Discharge From Skilled Nursing Facility
Authors: Walser Ronald F. , Sorrells Robert , Crawford Benjamin , Rhodes Diana , Chyn Eric , Longbottom Thomas , Barton Olivia
Published: April 2020

The primary objectives of this research were to pilot the use of a new pain and mobility outcome measure, the Pain and Mobility Index (PMI), and to assess its convergent validity with the Short Physical Performance Battery (SPPB). Twenty-eight subjects were divided into nonhospitalized and hospitalized groups. The number of subjects needed for future research using the PMI to assess for rehospitalization risk is at least 124. Discharge SPPB and PMI scores showed a good correlation, and there was a significant difference in bed mobility scores and SPPB scores between the nonhospitalized and hospitalized groups.
Interfering with influenza: nonlinear coupling of reactive and static mitigation strategies
Authors: Zachreson Cameron , Fair Kristopher M. , Harding Nathan , Prokopenko Mikhail
Published: April 2020

When new, highly infectious strains of influenza emerge, global pandemics can occur before an effective vaccine is developed. Without a strain-specific vaccine, pandemics can only be mitigated by employing combinations of low-efficacy pre-pandemic vaccines and reactive response measures that are carried out as the pandemic unfolds. Unfortunately, the application of reactive interventions can lead to unintended consequences that may exacerbate unpredictable spreading dynamics and cause more drawn-out epidemics. Here, we employ a detailed model of pandemic influenza in Australia to simulate the combination of pre-pandemic vaccination and reactive antiviral prophylaxis. This study focuses on population-level coupling effects between the respective methods, and the associated spatio-temporal fluctuations in pandemic dynamics produced by reactive strategies. Our results show that combining strategies can produce either mutual improvement of performance or interference that reduces the effectiveness of each strategy when they are used together. We demonstrate that these coupling effects between intervention strategies are extremely sensitive to delay times, compliance rates and the type of contact targeting used to administer prophylaxis.
Efficient manipulation and generation of Kirchhoff polynomials for the analysis of non-equilibrium biochemical reaction networks
Authors: Yordanov Pencho , Stelling Jörg
Published: April 2020

Kirchhoff polynomials are central for deriving symbolic steady-state expressions of models whose dynamics are governed by linear diffusion on graphs. In biology, such models have been unified under a common linear framework subsuming studies across areas such as enzyme kinetics, G-protein coupled receptors, ion channels and gene regulation. Due to ‘history dependence’ away from thermodynamic equilibrium, these models suffer from a (super) exponential growth in the size of their symbolic steady-state expressions and, respectively, Kirchhoff polynomials. This algebraic explosion has limited applications of the linear framework. However, recent results on the graph-based prime factorization of Kirchhoff polynomials may help subdue the combinatorial complexity. By prime decomposing the graphs contained in an expression of Kirchhoff polynomials and identifying the graphs giving rise to equal polynomials, we formulate a coarse-grained variant of the expression suitable for symbolic simplification. We devise criteria to efficiently test the equality of Kirchhoff polynomials and propose two heuristic algorithms to explicitly generate individual Kirchhoff polynomials in a compressed form; they are inspired by algebraic simplifications but operate on the corresponding graphs. We illustrate the practicality of the developed theory and algorithms for a diverse set of graphs of different sizes and for non-equilibrium gene regulation analyses.
Scientific elite revisited: patterns of productivity, collaboration, authorship and impact
Authors: Li Jichao , Yin Yian , Fortunato Santo , Wang Dashun
Published: April 2020

Throughout history, a relatively small number of individuals have made a profound and lasting impact on science and society. Despite long-standing, multi-disciplinary interests in understanding careers of elite scientists, there have been limited attempts for a quantitative, career-level analysis. Here, we leverage a comprehensive dataset we assembled, allowing us to trace the entire career histories of nearly all Nobel laureates in physics, chemistry, and physiology or medicine over the past century. We find that, although Nobel laureates were energetic producers from the outset, producing works that garner unusually high impact, their careers before winning the prize follow relatively similar patterns to those of ordinary scientists, being characterized by hot streaks and increasing reliance on collaborations. We also uncovered notable variations along their careers, often associated with the Nobel Prize, including shifting coauthorship structure in the prize-winning work, and a significant but temporary dip in the impact of work they produce after winning the Nobel Prize. Together, these results document quantitative patterns governing the careers of scientific elites, offering an empirical basis for a deeper understanding of the hallmarks of exceptional careers in science.
Efficient vasculature investment in tissues can be determined without global information
Authors: Duran-Nebreda Salva , Johnston Iain G. , Bassel George W.
Published: April 2020

Cells are the fundamental building blocks of organs and tissues. Information and mass flow through cellular contacts in these structures is vital for the orchestration of organ function. Constraints imposed by packing and cell immobility limit intercellular communication, particularly as organs and organisms scale up to greater sizes. In order to transcend transport limitations, delivery systems including vascular and respiratory systems evolved to facilitate the movement of matter and information. The construction of these delivery systems has an associated cost, as vascular elements do not perform the metabolic functions of the organs they are part of. This study investigates a fundamental trade-off in vascularization in multicellular tissues: the reduction of path lengths for communication versus the cost associated with producing vasculature. Biologically realistic generative models, using multicellular templates of different dimensionalities, revealed a limited advantage to the vascularization of two-dimensional tissues. Strikingly, scale-free improvements in transport efficiency can be achieved even in the absence of global knowledge of tissue organization. A point of diminishing returns in the investment of additional vascular tissue to the increased reduction of path length in 2.5- and three-dimensional tissues was identified. Applying this theory to experimentally determined biological tissue structures, we show the possibility of a co-dependency between the method used to limit path length and the organization of cells it acts upon. These results provide insight as to why tissues are or are not vascularized in nature, the robustness of developmental generative mechanisms and the extent to which vasculature is advantageous in the support of organ function.