bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Body Mass Index and Seatbelt Use on Pediatric Chest and Abdominal Injuries after Motor Vehicle Collisions
Authors: Boserup Brad , Sutherland Mason , Paloka Rinald , McKenney Mark , Elkbuli Adel 
Published: April 2021

Background Motor vehicle collisions (MVCs) are a major cause of pediatric morbidity and mortality. However, the effect of body mass index (BMI) and seatbelt use on thoracic injuries and outcomes in pediatric patients with rib fractures remains unexplored. We aim to assess how seatbelt use and BMI affect thoracic injuries and outcomes in pediatric patients who sustained ≥3 rib fractures following an MVC. Methods The Trauma Quality Improvement Program (TQIP) database (2013-2017) was queried for pediatric patients (8-17 years and >4 feet 9 inches tall) admitted secondary to MVCs, with ≥3 rib fractures and all non-thoracic Abbreviated Injury Scale ≤2. Patients were then divided by Injury Severity Score (ISS) into low (<15) and intermediate-severe (≥15) groups, which were further subdivided according to seatbelt use and BMI. Logistic and linear regression was performed to assess the effects of seatbelt use and BMI on outcomes. Results Seatbelt compliance varied from 39.6 to 50.7%. Belted patients (intermediate-severe ISS) had a reduced hospital length of stay (HLOS), intensive care unit length of stay(ICU-LOS), and mechanical ventilation time but had increased odds of splenic laceration vs. unbelted patients (aOR = 2.46, 95% CI: 1.03-5.93, P = .044). Obese patients (low ISS) had lower incidences of hemothorax, pneumothorax, pulmonary contusion, splenic laceration, and liver injury compared to normal-weight patients. Overweight patients (intermediate-severe ISS) had a significantly reduced ICU-LOS vs. normal-weight patients (β = −.17, 95% CI: -.33,-.01, = .041). Conclusions Seatbelt use may improve outcomes for pediatric MVC patients with ≥3 rib fractures. Higher BMI may be associated with reduced thoracic injury and decreased ICU-LOS. Effective educational initiatives are needed to increase pediatric seatbelt compliance.
Risk of Asymptomatic Gallstones Becoming Symptomatic After Laparoscopic Sleeve Gastrectomy
Authors: Şen Ozan , Türkçapar Ahmet G. 
Published: April 2021

Background Whether concomitant cholecystectomy is needed during laparoscopic sleeve gastrectomy (LSG) in patients with asymptomatic cholelithiasis is controversial. In this study, our aim is to show the follow-up results in patients with asymptomatic cholelithiasis who underwent LSG alone. Methods Patients undergoing primary LSG between March 2018 and September 2020 with asymptomatic gallbladder stones were included in this retrospective study. All patients underwent abdominal ultrasound (US) before surgery. Patients’ demographics and postoperative outcomes were recorded. Results A total of 180 patients underwent primary LSG and completed the 1-year follow-up. The study population consisted of 42 patients (23%) with asymptomatic cholelithiasis. The mean age was 41.1±7.1 years (31-56, 63% female), and mean body mass index (BMI) was 44 ± 6.7 kg/m2. Average BMI decreased to 31.1 ± 4.7 kg/m2 at 6 months and to 27.3 ± 3.6 kg/m2 at 1 year. The average follow-up period was 17 ± 5.7 months (range, 12-28 months). Of the 42 patients, only 1 patient (2.4%) became symptomatic during the follow-up period. Discussion We do not recommend cholecystectomy in patients with asymptomatic gallstones during the same session with LSG. An observational approach should be adopted for these patients.
Extracorporeal Membrane Oxygenation Utilization in Blunt and Penetrating Traumatic Injuries: A Systematic Review
Authors: Ehrlich Haley , Bisbee Charlie , Ali Aleeza , Fanfan Dino , Gill Sabrina , McKenney Mark , Elkbuli Adel 
Published: April 2021

Background Extracorporeal membrane oxygenation (ECMO) has become an increasingly used treatment modality for severe respiratory insufficiency in trauma patients. Examining ECMO use specifically in blunt and penetrating traumas can aid in directing future protocols. We aim to evaluate the outcomes of ECMO use in both blunt and penetrating trauma patients through a systematic review of current literature. Methods An online search of 2 databases (PubMed and Google Scholar) was performed to analyze studies, which evaluated the use of ECMO in blunt and penetrating traumas. Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Grading of Recommendations Assessment, Development and Evaluation guidelines were followed. Data extracted included mechanism of injury, injury severity scores (ISSs), complications, and mortality rates. Results The search demonstrated 9 studies that met our review inclusion criteria. A total of 207 patients were included, of which 64 (30.9%) were non-survivors and 143 (69.1%) were survivors. There was a total of 201 blunt traumas with 61 (30.3%) deaths, whereas penetrating traumas had 2 deaths (33.3%) out of 6 total patients. Complications reported included acute renal failure, hemorrhage at the cannula site, and transient neurological deficits. Most studies found better survival rates and less complications in younger patients and those with lower ISS. Conclusion Expanding the use of ECMO to include blunt and penetrating trauma patients provides the trauma surgeons with another crucial potentially lifesaving tool with an overall survival rate of 70%. Anticipating increased future use of ECMO in blunt and penetrating trauma patients, distinct protocols ought to be instilled to better address the care needed for these critically ill trauma patients.
Telerounding Has Clinical Value and Enables the Busy Surgeon: A Colorectal Surgeon’s Ten-Year Experience
Authors: Nicholson Kristina J. , Rosengart Matthew R. , Watson Andrew R. 
Published: April 2021

Background Study of telemedicine and telerounding in surgical specialties is limited. The push for telemedicine during the COVID-19 pandemic has challenged the face-to-face rounding paradigm and creates an opportunity for reflection on the benefits of telemedicine, especially for balancing competing corporate and clinical demands. Methods The 117-month video-based inpatient telerounding experience of a colorectal surgeon in an academic medical system was recorded, including patient characteristics, diagnoses, technology, content of telerounding encounters, and logistical considerations. Data were analyzed using descriptive statistics. Results 163 patients were seen in 201 telerounding encounters, primarily for routine postoperative care (90.5%). Most were admitted for inflammatory bowel disease (63.2%). Changes were made to plans of care during 28.9% of encounters, and discharge planning was part of 26.4%. Encounters were conducted primarily from the surgeon’s administrative office (68.7%) or other work-related locations (10.9%), while 6.5% originated from the surgeon’s home. Technologic issues occurred in 5.5% of encounters. 89.1% of patient feedback was positive and none was negative. Conclusion Telerounding is technologically feasible and has clinical value, including for patients with complex surgical problems. Technologic problems are rare and patient satisfaction is high. Surgeons should consider telerounding as a means to balance competing demands.
Relative Humidity Affects Acute Otitis Media Visits of Preschool Children to the Emergency Department
Authors: Jiang Ying-Fang , Luo Wen-Wei , Zhang Xin , Ren Dong-Dong , Huang Yi-Bo 
Published: April 2021

Objective: The associations between climate variables and diseases such as respiratory infections, influenza, pediatric seizure, and gastroenteritis have been long appreciated. Infection is the main reason for acute otitis media (AOM) incidence. However, few previous studies explored the correlation between climatic parameters and AOM infections. The most important meteorological factors, temperature, relative humidity, and fine particulate matter (PM2.5), were included in this study. We studied the relationship between these meteorological factors and the AOM visits. Materials and Methods: It was a retrospective cross-sectional study. A linear correlation and a linear regression model were used to explore the AOM visits and meteorological factors. Results: A total of 7075 emergency department visits for AOM were identified. Relative humidity was found an independent risk factor for the AOM visits in preschool children (regression coefficient = −10.841<0, P = .039 < .05), but not in infants and school-age children. Average temperature and PM2.5 were not correlated with AOM visits. Conclusion: Humidity may have a significant inverse impact on the incidence of AOM in preschool-age children.
Comparative Analysis of Robotic Segmentectomy For Non-Small Cell Lung Cancer: A National Cancer Database Study
Authors: Kodia Karishma , Razi Syed S. , Alnajar Ahmed , Nguyen Dao M. , Villamizar Nestor 
Published: April 2021

Objective The use of segmentectomy for peripheral T ≤2 cm, N0 non-small cell lung cancer (NSCLC) has increased in the last decade. We sought to compare clinical outcomes and overall survival between robotic, video-assisted thoracoscopic surgery (VATS), and open segmentectomy. Methods The National Cancer Database was queried for patients with clinical T ≤2 cm, N0 NSCLC who underwent segmentectomy via robotic, thoracoscopic (VATS), and open approaches (2010 to 2015). Univariate and Cox regression analyses were used to compare surgical approaches and to evaluate predictors of overall survival. Statistical analyses were done using SPSS Version 21.0. Results Segmentectomy was performed in 3,888 patients during the study period with 406 robotic, 1,837 VATS, and 1,645 open patients. VATS and robotic segmentectomy were performed more often at academic or comprehensive community cancer programs as compared to community programs ( P < 0.05). Conversion to open thoracotomy was similar between robotic and VATS groups when stratified by hospital volume. Lymph node yield was significantly higher for robotic (median = 6), compared to VATS (median = 5) or open (median = 4; P < 0.001). Length of stay was decreased for robotic versus open ( P < 0.01). No differences in 30-day readmissions ( P = 0.12) were observed among the 3 modalities. Overall survival was similar among groups ( P = 0.18). Conclusions Robotic segmentectomy provides similar clinical outcomes compared to other standardized approaches for clinical T ≤2 cm, N0 NSCLC. A higher lymph node yield in robotic segmentectomy was not associated with improved survival in this study population.
Sutureless Valve in Repeated Aortic Valve Replacement: Results from an International Prospective Registry
Authors: Glauber Mattia , Kent William D.T. , Asimakopoulos George , Troise Giovanni , Padrò Josep Maria , Royse Alistair , Marnette Jean-Marc , Noirhomme Philippe , Baghai Max , Lewis Michael , Di Bacco Lorenzo , Solinas Marco , Miceli Antonio 
Published: April 2021

Objective To report early and midterm results registry of patients undergoing repeated aortic valve replacement (RAVR) with sutureless prostheses from an international prospective registry (SURE-AVR). Methods Between March 2011 and June 2019, 69 patients underwent RAVR with self-expandable sutureless aortic bioprostheses at 22 international cardiac centers. Results Overall mortality was 2.9% with a predicted logistic EuroSCORE II of 10.7%. Indications for RAVR were structural valve dysfunction (84.1%) and infective prosthetic endocarditis (15.9%) and were performed in patients with previously implanted bioprostheses (79.7%), mechanical valves (15.9%), and transcatheter valves (4.3%). Minimally invasive approach was performed in 15.9% of patients. Rate of stroke was 1.4% and rate of early valve-related reintervention was 1.4%. Overall survival rate at 1 and 5 years was 97% and 91%, respectively. No major paravalvular leak occurred. Rate of pacemaker implantation was 5.8% and 0.9% per patient-year early and at follow-up, respectively. The mean transvalvular gradient at 1-year and 5-year follow-up was 10.5 mm Hg and 11.5 mm Hg with a median effective orifice area of 1.8 cm2and 1.8 cm2, respectively. Conclusions RAVR with sutureless valves is a safe and effective approach and provides excellent clinical and hemodynamic results up to 5 years.
The application of an information support robot to reduce agitation in an older adult with Alzheimer’s disease living alone in a community dwelling: a case study
Authors: Mizuno Jumpei , Sadohara Ken , Nihei Misato , Onaka Shinichi , Nishiura Yuko , Inoue Takenobu 
Published: April 2021

Objective/background: Agitation is a common behaviour of Alzheimer’s Disease (AD). Although healing robots have previously been used for alleviating agitation for people with dementia in hospitals and other healthcare facilities, its effects remain unclear whether an information-support robot capable of disseminating information with user needs may have similar effects when it is applied in community dwellings. This study was to investigate the effects of information-support robots for reducing agitation in older people with AD residing alone in community-dwellings. Methods One participant with AD who lived alone in a community-dwelling was recruited. Participant’s frequencies, durations, and time courses of four patterns of agitation at home at baseline and during intervention were analysed. In this study, agitation was defined as: (a) restlessness going to the corridor (RLtoC), (b) restlessness going to the toilet (RLtoT), (c) restlessness going to the entrance (RLtoE), and (d) restlessness going to multiple places (RLtoMP). In the intervention phase, the information-support robot disseminated daily schedule or date information to the participant. Results RLtoC and RLtoMP were significantly reduced in frequency during the intervention. The durations of each episode of RLtoT and RLtoMP in the intervention were slightly reduced than those at the baseline. There were no differences in time courses of episodes of RLtoC and RLtoMP after the intervention. Conclusion This case study showed that information-support robot was useful to alleviate agitation of an older adult with AD living alone in a community-dwelling. Further study is warranted.
Integration of various scales for measurement of insomnia
Authors: Chakrabartty Satyendra Nath 
Published: April 2021

Background Scales for evaluating insomnia differ in number of items, response format, and result in different scores distributions and score ranges and may not facilitate meaningful comparisons. Objectives Transform ordinal item-scores of three scales of insomnia to continuous, equidistant, monotonic, normally distributed scores, avoiding limitations of summative scoring of Likert scales. Methods Equidistant item-scores by weighted sum using data-driven weights to different levels of different items, considering cell frequencies of Item-Levels matrix, followed by normalization and conversion to [1, 10]. Equivalent test-scores (as sum of transformed item- scores) for a pair of scales were found by Normal Probability curves. Empirical illustration given. Results Transformed test-scores are continuous, monotonic and followed Normal distribution with no outliers and tied scores. Such test-scores facilitate ranking, better classification and meaningful comparison of scales of different lengths and formats and finding equivalent score combinations of two scales. For a given value of transformed test-score of a scale, easy alternate method avoiding integration proposed to find equivalent scores of another scales. Equivalent scores of scales help to relate various cut-off scores of different scales and uniformity in interpretations. Integration of various scales of insomnia is achieved by finding one-to-one correspondence among the equivalent score of various scales with correlation over 0.99 Conclusion Resultant test-scores facilitated undertaking analysis in parametric set up. Considering the theoretical advantages including meaningfulness of operations, better comparison, use of such method of transforming scores of Likert items/test is recommended test and items, Future studies were suggested.
Interspecific sensitivity of European amphibians towards two pesticides and comparison to standard test species
Authors: Adams Elena , Leeb Christoph , Roodt Alexis P. , Brühl Carsten A. 
Published: April 2021

Abstract
Background
Although debates about the assessment of potential effects of pesticides on amphibians are ongoing, amphibians are not yet considered in the current EU environmental risk assessment of pesticides. Instead, the risk assessment of potential effects on aquatic amphibian life stages relies on use of data of surrogate species like the standard temperate fish species rainbow trout (Oncorhynchus mykiss). This assumption is mainly based on the comparison to amphibian species not native to Europe such as the aquatic African clawed frog (Xenopus laevis). It remains unclear whether these surrogate species cover semi-aquatic Central European amphibian sensitivities. Therefore, we assessed the acute sensitivity of aquatic stages of eight European amphibian species native in Germany (Bufo bufo, Bufotes viridis, Epidalea calamita, Hyla arborea, Pelobates fuscus, Pelophylax sp., Rana dalmatina, R. temporaria) towards commercial formulations of the fungicide folpet (Folpan® 500 SC, Adama) and the insecticide indoxacarb (Avaunt® EC, Cheminova). The determined acute sensitivities (median lethal concentration, LC50) were included in species sensitivity distributions and compared to experimentally determined LC50 values of X. laevis and literature values of O. mykiss.

Results
The results showed that native amphibian sensitivities differed between the tested pesticides with a factor of 5 and 11. Depending on the pesticide, X. laevis was five and nine times more tolerant than the most sensitive native amphibian species. Comparing literature values of O. mykiss to the experimentally determined sensitivities of the native amphibian species showed that the O. mykiss sensitivity was in the same range as for the tested amphibians for the formulation Folpan® 500 SC. The comparison of sensitivities towards the formulation Avaunt® EC showed an eight times lower sensitivity of O. mykiss than the most sensitive amphibian species.

Conclusions
A risk assessment using the 96-h LC50 values for fish covers the risk for the assessed aquatic stages of European amphibians after the application of the recommended uncertainty factor of 100 and thus may be adequate for lower tier risk assessment of the studied pesticides. If aquatic amphibian testing will be required for pesticide risk assessment nevertheless, acute tests with the model organism X. laevis and the application of an appropriate uncertainty factor might be a promising approach.
Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery
Authors: Lind Caroline , Olsen Karina , Angelsen Nina K. , Krefting Einar A. , Fossen Kristian , Gravningen Kirsten , Depoorter Eliza , Vandamme Peter , Bertelsen Geir 
Published: April 2021

Abstract
Background
Postoperative endophthalmitis is a rare but dreaded complication of intraocular surgery and often results in severe visual impairment or blindness. The present study describes the clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery.

Methods
Among 290 patients who underwent uneventful phacoemulsification cataract surgery at one outpatient clinic between January 4th and 28th 2019, 6 cases developed Burkholderia contaminans endophthalmitis. Clinical data were collected by retrospective review of patient records. Microbiological samples from vitreous aspirates, intraocular lenses (IOL) and lens capsules were cultured, and recA and draft whole genome sequences analysed.

Results
The recA sequences of all Burkholderia contaminans isolates and the allelic profile of the isolates were identical. All cases had a similar clinical presentation with rapid development of endophthalmitis symptoms with variable time to onset. The mean time to admission was 34 days (12–112 days). All cases had a seemingly favourable response to intravitreal antibiotics. However, acute recurrences occurred after long time periods (12–71 days). The cases experienced between 0 and 3 recurrences. Due to persistent infection, the cases received between 5 and 15 treatments (mean 7.8) including IOL and lens capsule explantation in 5 of 6 cases. Burkholderia contaminans was detected in all explanted lens capsules. The final corrected distance visual acuity (CDVA, Snellen chart) was between 0.8 and 1.2 and all cases had final CDVA ≥0.8.

Conclusions
A persistent and intensive treatment approach including total lens capsule and IOL explantation is recommended for Burkholderia contaminans endophthalmitis following cataract surgery and may lead to a favourable visual result.
Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes
Authors: Kilpatrick Kelley , Tchouaket Eric , Fernandez Nicolas , Jabbour Mira , Dubois Carl-Ardy , Paquette Lysane , Landry Véronique , Gauthier Nathalie , Beaulieu Marie-Dominique 
Published: April 2021

AbstractBackgroundNurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs.MethodsA cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes.ResultsPatients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes.ConclusionsThis study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.