bluuebunny/crossref_metadata_2025_split huggingface dataset:
Balanced Electrolyte Solutions or Normal Saline? Resuscitative Fluid Administration Practice in Swiss Pediatric Acute Care
Authors: Huber Jasmin L. , Berger Steffen , Löllgen Ruth M. 
Published: May 2019

Introduction
The ideal asanguineous intravenous fluid for volume resuscitation in children is controversially debated and clinical practice guidelines are scarce. Administration of large amounts of normal saline has been associated with complications including hyperchloremic acidosis, dysnatremia, neurologic damage, and fatality.

Aim
We examined the current practice of intravenous fluid and blood product administration in acutely ill and injured children among pediatric acute care physicians in Switzerland.

Methods
For this descriptive, cross-sectional study, pediatric emergency departments, pediatric and neonatal intensive care units were surveyed by means of an online questionnaire.

Results
Sixty of 66 departments and 47 of 87 participants returned the survey. Normal saline (NS) was most commonly administered (n = 42/46, 91.3%) and twice as many times as balanced electrolyte solutions (n = 20/46, 43.5%). The mean fluid volumes ranged from 7.9 to 19.1 mL/kg. Hypertonic saline/NS were selected most often for shock with severe head injury. Half of participants administered colloids (48.9%). Packed red blood cells (97.7%) and fresh frozen plasma (88.4%) were most frequently given blood products.

Conclusion
There is a distinct practice variation in intravenous fluid and blood product administration in children in Switzerland. Although NS is most frequently given, we observed a trend toward the use of balanced electrolyte solutions. Prospective studies are warranted to compare NS with balanced electrolyte solution (BES) in the pediatric acute care setting. We suggest that pediatric fluid administration guidelines and mass transfusion protocols are implemented to standardize this frequent intervention and minimize complications.
Age-Related Changes in Upper Airway Anatomy Via Ultrasonography in Pediatric Patients
Authors: Dalesio Nicholas M. , Wadia Rajeev , Harvey Helen , Ly Olivia , Greenberg Steven A. , Greenberg Robert S. 
Published: May 2019

PurposeUltrasonography is a portable, noninvasive tool that may be used to evaluate the upper airway. The purpose of our study was to present a systematic approach to identify salient features of the pediatric airway and determine whether ultrasonography can identify anatomical changes that occur with growth and development.MethodsWe present a prospective, observational trial where patients included were between 1 day and 10 years of age presenting for elective surgery who had no known history of unfavorable airway pathology. We sequentially obtained 5 ultrasound views under anesthesia: (1) sagittal sternal notch view of the trachea, (2) sagittal longitudinal view of trachea (LT), (3) axial view at the level of the vocal cords (AVC), (4) axial view at the level of the cricoid membrane (AC), and (5) sagittal longitudinal submental space view (SM). A broadband linear array transducer was used to identify airway structures and perform measurements.ResultsEighty-four percent of enrolled patients underwent airway imaging and were analyzed using multiple regression and Spearman correlation (ρ). In view 1, tracheal diameter via sagittal sternal notch view was immeasurable because of air disturbance. In the LT view, the distance from the skin to the cricothyroid membrane (LT1) did not statistically increase with age in days (P= 0.06); however, the distance from the cricoid to thyroid cartilage (LT2) did correlate to age (P< 0.001; 99% confidence interval [CI], 1.8 × 10−5, 7.7 × 10−5; ρ = 0.77,P= 0.001). We found a statistically significant relationship between age and the distance between the anterior and posterior commissures (AVC2;P< 0.001; 99% CI, 1.0 × 10–4, 1.7 × 10–4; ρ = 0.80,P< 0.001), the distance from the skin to the posterior commissure (AVC3;P< 0.001; 99% CI, 9.6 × 10−5, 2.0 × 10–4; ρ = 0.73,P< 0.001), the distance to the cricoid cartilage (AC;P< 0.001; 99% CI, 2.0 × 10−5, 7.7 × 10−5; ρ = 0.66,P< 0.001), and the distance from the tongue base to the soft palate (SM2;P< 0.001; 9% CI, 1.8 × 10–4, 3.9 × 10–4; ρ = 0.85,P< 0.001). There were no significant relationships between age and AVC1 (P= 0.16) and SM1 (P= 0.44).ConclusionsAirway ultrasound is a feasible tool to evaluate the pediatric airway in children younger than 10 years; however, the detection of age-related changes of certain structures is limited to select measurements.
Preventable death and interpersonal violence in the United States: Who can be saved?
Authors: Carmichael Heather , Steward Lauren , Peltz Erik D. , Wright Franklin L. , Velopulos Catherine G. 
Published: May 2019

BACKGROUND
Public health initiatives to reduce mortality from penetrating trauma have largely developed from patterns of injury observed in military casualties, with a focus on hemorrhage control and use of tourniquets. Recent efforts show that injury patterns differ between civilian mass casualty events and combat settings, and no studies characterize wounding patterns in all types of civilian homicide. We hypothesize that many homicide deaths are due to nonsurvivable injuries, and that an effective strategy to reduce mortality must focus on both primary prevention as well as improvement in trauma prehospital care.

METHODS
We analyzed homicides from the National Violent Death Reporting System from 2012 to 2015. We excluded deaths due to poisoning, intentional neglect, or unknown weapon. Deaths were classified as “dead on scene” (DOS), “dead on arrival” (DOA), or “dead at or after hospital” (DAH) if the patient was admitted to a hospital. Injury patterns for penetrating weapons (firearms and sharp instruments) were further categorized.

RESULTS
We included 18,051 homicides, the vast majority of which were due to firearms (n = 12,901 or 71.5%) or sharp instruments (n = 2,265 or 12.5%). The most common injury patterns included wounds to the chest or head, with isolated extremity injuries representing a minority of both firearms deaths (n = 397 of 12,901, 3.1%) and deaths from sharp instruments (n = 50 of 2,265, 2.2%). Furthermore, over half of all deaths occurred prehospital, with only 13.3% of victims admitted prior to death.

CONCLUSION
The vast majority of deaths from interpersonal violence are due to firearm injuries. Few deaths appear to be related to extremity hemorrhage alone, and over half of all fatally injured died at the scene. Strategies to decrease mortality from interpersonal violence must go beyond treating injuries that have already occurred, and must address violence prevention directly.

LEVEL OF EVIDENCE
Epidemiological study, level IV.
Protocols for documentation of electrical injuries for electrical safety inspectors and emergency medical practitioners
Authors: Andrews Christopher J. , Panescu Dorin 
Published: May 2019

BACKGROUND
Electric shocks are common, and victims report difficulty in finding practitioners with knowledge of the injury. Medical Practitioners, especially in private practice, report lack of knowledge of the injury and lack of expertise in assessing and treating the injury. The authors are often requested to suggest investigation protocols, assessment protocols, and treatment protocols, and to provide educational information.

METHODS
The international body establishing electrical standards on the effects of current on the body (International Electrotechnical Commission, Maintenance Team 4 (MT4) of Technical Committee 64 (TC64)) have established protocols for the factors which require documentation and reporting of the injury. This article provides a narrative approach to using these protocols in accord with the standards (IEC 60479). The level of evidence is Level III (US/Canada classification).

TYPE
This article collects together and collates physical and medical aspects of investigating electric shocks, and summarizes those of importance, and which are potentially forgotten. The thoroughness of initial assessment is emphasized.

SUBSTANCE
Summaries are set out to guide first attenders and emergency medical personnel as to findings and observations which must be recorded for later comprehensive medicolegal reporting and which are often overlooked.

CONCLUSION
Wider teaching in the nature of electric shocks will enhance assessment of victims and thorough recording of pertinent information and thus will enhance later medicolegal reporting. Many such factors are initially overlooked and lead to inadequate reporting for forensic purposes.
Motocross versus motorcycle injury patterns: A retrospective National Trauma Databank analysis
Authors: Fierro Nicole , Inaba Kenji , Aiolfi Alberto , Recinos Gustavo , Benjamin Elizabeth , Lam Lydia , Strumwasser Aaron , Demetriades Demitrios 
Published: May 2019

BACKGROUND
Motocross-related injury patterns and outcomes are poorly understood. The purpose of this analysis was to characterize the epidemiology, injury patterns, and outcomes of motocross collisions. These parameters were compared with motorcycle collisions for context.

METHODS
The National Trauma Databank (NTDB) (2007–14) was used to identify and compare injured motorcycle and motocross riders. Variables extracted were demographics, Abbreviated Injury Scale for each body area, Injury Severity Score, and emergency department vital signs. Outcomes included mortality, ventilation days, intensive care unit length of stay, and hospital length of stay.

RESULTS
Of the 5,774,836 NTDB patients, 141,529 were involved in motocross or motorcycle collisions (31,252 motocross and 110,277 motorcycle). Overall, 94.4% were drivers and 87.4% were male. Motocross riders were younger (23 vs. 42, p < 0.001), more likely to use helmets (68.9% vs. 54.1%, p < 0.001), and less likely to have used alcohol (8.4% vs. 23.0%, p < 0.001). Head and chest injuries were less common in motocross patients (28.6% vs. 37.2%, p < 0.001; 25.5% vs. 37.7%, p < 0.001, respectively), as were Injury Severity Score of greater than 15 and Glasgow Coma Scale of less than or equal to 8 (18.2% vs. 28.1%, p < 0.001; 3.7% vs. 7.7%, p < 0.001, respectively). Overall mortality was significantly lower in the motocross group (0.3% vs. 1.4%, p < 0.001). Stepwise logistic regression analysis identified age of older than 60 years, Glasgow Coma Scale of less than or equal to 8, hypotension on admission, head Abbreviated Injury Scale of greater than or equal to 3, and riding a motorcycle, either as a driver or passenger, to be independent predictors of mortality. Subgroup analysis revealed being a motocross driver or passenger to be an independent predictor of improved survival (odds ratio [OR], 0.458; 95% confidence interval [CI], 0.359–0.585; p < 0.001 and OR, 0.127; CI 95%, 0.017–0.944; p = 0.044, respectively). Helmets were protective against mortality for all patients (OR, 0.866; 95% CI, 0.755–0.992; p = 0.039).

CONCLUSION
Motocross and motorcycle collisions are distinct mechanisms of injury. Motocross riders are younger, more likely to wear protective devices, and less likely to use alcohol. Motocross collisions are associated with better outcomes compared with motorcycle collisions. Wearing a helmet is associated with improved survival for all riders.

LEVEL OF EVIDENCE
Retrospective epidemiological study, level IV.
Gunshot wounds to the liver: No longer a mandatory operation
Authors: Schellenberg Morgan , Benjamin Elizabeth , Piccinini Alice , Inaba Kenji , Demetriades Demetrios 
Published: May 2019

BACKGROUND
Selective nonoperative management (SNOM) of gunshot wounds (GSWs) to the liver is a contemporary management strategy that remains controversial. This study examined national trends and outcomes after SNOM versus operative management (OM) of hepatic GSWs.

METHODS
The National Trauma Data Bank was used to identify patients who sustained an isolated GSW to the liver (2007–2014). Patients with emergency department death, transfer, or associated hollow viscus or major abdominal vascular injury were excluded. The defined study groups were SNOM versus OM, with SNOM specified as patients who did not undergo laparotomy within 4 hours of admission. Outcomes included mortality and complications. Logistic regression was used to compare outcomes between groups.

RESULTS
A total of 4,031 patients were included, with 38.8% (n = 1,564) undergoing SNOM and 61.2% (n = 2,467) undergoing OM. The rate of SNOM increased over time, from 34.5% to 41.0% (p = 0.004). By the American Association for the Surgery of Trauma liver injury grade, SNOM was used in 45.0% of grades I and II, 40.6% of grade III, 27.3% of grade IV, and 16.7% of grade V injuries. On regression analysis, SNOM was independently associated with fewer complications (odds ratio [OR], 0.811; p = 0.003) and lower mortality (OR, 0.438; p < 0.001). On subgroup analysis, patients with grade IV injury were most likely to benefit from SNOM with fewer complications (OR, 0.676; p = 0.019) and improved mortality (OR, 0.238; p = 0.002).

CONCLUSION
Selective nonoperative management of GSW to the liver has gained acceptance in the United States. Selective nonoperative management is independently associated with improved survival and decreased complications. In the appropriate clinical scenario, SNOM is a safe and effective method for treating hepatic GSWs.

LEVEL OF EVIDENCE
Therapeutic/care management, level III.
Effect of surgical rib fixation for rib fracture on mortality: A multicenter, propensity score matching analysis
Authors: Shibahashi Keita , Sugiyama Kazuhiro , Okura Yoshihiro , Hamabe Yuichi 
Published: May 2019

BACKGROUND
Rib fracture is a common injury and can be associated with complications and a high mortality rate. There has been growing interest in surgical rib fixation as a treatment for rib fracture. However, results from previous studies are conflicting, and conclusive results regarding the efficacy of surgical rib fixation for rib fracture are lacking. This study aimed to investigate if surgical rib fixation improves prognosis in patients with traumatic rib fractures.

METHODS
Using the Japan Trauma Data Bank, a nationwide trauma registry, we identified patients 18 years or older with rib fracture between 2004 and 2015. The primary outcome was in-hospital mortality. Logistic regression analysis was used to estimate a propensity score to predict reception of surgical rib fixation. We used a 1:4 propensity score matching analysis to compare patients who underwent surgical rib fixation with those who did not.

RESULTS
Overall, 236,698 patients were registered in the database, and 37,571 were eligible for propensity score matching analysis. This analysis included 147 patients who underwent surgical rib fixation and 588 as controls. The in-hospital mortality rate was significantly lower in patients who underwent surgical rib fixation than in those who did not (4.8% vs. 16.2%, respectively; absolute difference: −11.4%; 95% confidence interval: −14.8% to −8.0%).

CONCLUSION
This study showed that surgical fixation may reduce in-hospital mortality in patients with rib fracture. Surgical rib fixation may offer a better modality for the management of selected patients with rib fracture.

LEVEL OF EVIDENCE
Therapeutic, level III.
Self-consistent triple decomposition of the turbulent flow over a backward-facing step under finite amplitude harmonic forcing
Authors: Yim E. , Meliga P. , Gallaire F. 
Published: May 2019

We investigate the saturation of harmonically forced disturbances in the turbulent flow over a backward-facing step subjected to a finite amplitude forcing. The analysis relies on a triple decomposition of the unsteady flow into mean, coherent and incoherent components. The coherent–incoherent interaction is lumped into a Reynolds averaged Navier–Stokes (RANS) eddy viscosity model, and the mean–coherent interaction is analysed via a semi-linear resolvent analysis building on the laminar approach by Mantič-Lugo & Gallaire (2016
J. Fluid Mech.
793
, 777–797. (
doi:10.1017/jfm.2016.109
)). This provides a self-consistent modelling of the interaction between all three components, in the sense that the coherent perturbation structures selected by the resolvent analysis are those whose Reynolds stresses force the mean flow in such a way that the mean flow generates exactly the aforementioned perturbations, while also accounting for the effect of the incoherent scale. The model does not require any input from numerical or experimental data, and accurately predicts the saturation of the forced coherent disturbances, as established from comparison to time-averages of unsteady RANS simulation data.
Identification of two new trichome-specific promoters of Nicotiana tabacum
Authors: Pottier Mathieu , Laterre Raphaëlle , Van Wessem Astrid , Ramirez Aldana M. , Herman Xavier , Boutry Marc , Hachez Charles 
Published: May 2019

AbstractMain conclusion pRbcS-T1 and pMALD1, two new trichome-specific promoters of Nicotiana tabacum, were identified and their strength and specificity were compared to those of previously described promoters in this species.Nicotiana tabacum has emerged as a suitable host for metabolic engineering of terpenoids and derivatives in tall glandular trichomes, which actively synthesize and secrete specialized metabolites. However, implementation of an entire biosynthetic pathway in glandular trichomes requires the identification of trichome-specific promoters to appropriately drive the expression of the transgenes needed to set up the desired pathway. In this context, RT-qPCR analysis was carried out on wild-type N. tabacum plants to compare the expression pattern and gene expression level of NtRbcS-T1 and NtMALD1, two newly identified genes expressed in glandular trichomes, with those of NtCYP71D16, NtCBTS2α, NtCPS2, and NtLTP1, which were reported in the literature to be specifically expressed in glandular trichomes. We show that NtRbcS-T1 and NtMALD1 are specifically expressed in glandular trichomes like NtCYP71D16, NtCBTS2α, and NtCPS2, while NtLTP1 is also expressed in other leaf tissues as well as in the stem. Transcriptional fusions of each of the six promoters to the GUS-VENUS reporter gene were introduced in N. tabacum by Agrobacterium-mediated transformation. Almost all transgenic lines displayed GUS activity in tall glandular trichomes, indicating that the appropriate cis regulatory elements were included in the selected promoter regions. However, unlike for the other promoters, no trichome-specific line was obtained for pNtLTP1:GUS-VENUS, thus in agreement with the RT-qPCR data. These data thus provide two new transcription promoters that could be used in metabolic engineering of glandular trichomes.
High-speed volumetric fluorescein angiography (vFA) by oblique scanning laser ophthalmoscopy in mouse retina
Authors: Song Weiye , Zhou Libo , Yi Ji 
Published: May 2019

AbstractOblique scanning laser ophthalmoscopy (oSLO) is a recently developed technique to provide three-dimensional volumetric fluorescence imaging in retina over a large field of view, without the need for depth sectioning. Here in the paper, we present high-speed volumetric fluorescein angiography (vFA) in mouse retina in vivo by oSLO. By simply using a low-cost industrial CMOS camera, we improved the imaging speed by ~10 times comparing to our previous results, achieving vFA at 2 volumes per second. Enabled by high-speed vFA, we visualized hemodynamics at single capillary level in 3D and provided methods to quantify capillary hematocrit, absolute capillary blood flow speed, and detection of capillary flow stagnancy and stalling. The quantitative metrics for capillary hemodynamics at 3D retinal capillary network can offer valuable insight in vision science and retinal pathologies.
Prevalence of pulmonary tuberculosis among patients presenting with cough of any duration in Addis Ababa, Ethiopia
Authors: Negesse Aynye , Belay Mulugeta , Medhin Girmay , Ayalew Sosina , Mihret Adane , Legesse Mengistu 
Published: May 2019

AbstractBackgroundThe current practice in Ethiopia to diagnose tuberculosis is screening patients with cough for at least two weeks. A health facility based study was conducted to estimate the prevalence of smear and culture positive pulmonary TB among patients presenting with cough ≥2 weeks and <2 weeks in Addis Ababa, Ethiopia.MethodsA cross-sectional study design was used to recruit patients with cough of any duration from four selected health centers in Addis Ababa, between August and December 2016. Sputum samples were collected from patients reporting productive cough of any duration and screened for Pulmonary Tuberculosis (PTB) using smear microscopy and culture methods. Mycobacterium tuberculosis isolates obtained from culture positive samples were characterized using RD9 deletion typing.ResultsMajority (39.7%) of the 725 study participants was in the age range of 20-30 years, and 5.0% were smear positive using smear microscopy. The prevalence of smear positive PTB among patients presented with cough duration of ≥2 weeks was significantly higher compared to those patients presented with cough duration of <2 weeks (10.9% versus 0.7%; χ2=38.98; p=0.001). Using culture method, a total of 86 (11.9%) participants were positive for mycobacteria, and the prevalence (14.6%) of PTB among patients presented with cough duration of ≥2 weeks was not significantly higher compared to prevalence (9.9%) in those patients presented with cough duration of <2 weeks (χ2=3.63; p=0.057). Molecular characterization of 86 culture positive mycobacterial isolates showed that 41 were infected with Mtb; 19(46.3%) from those who had cough duration of <2 weeks and 22(53.7%) from those who had cough duration of ≥2 weeks.ConclusionScreening of PTB using smear microscopy alone and cough duration of at least two weeks would negatively affect early diagnosis and treatment initiation in a considerable number of PTB patients who reports cough duration of <2 weeks with the potential of contributing to the spread of TB. Therefore, screening of patients with cough of any duration using both smear microscopy and culture methods is likely to contribute to the success of any effort towards the control of TB.
Toggling Geobacter sulfurreducens metabolic state reveals hidden behaviour and expanded applicability to sustainable energy applications
Authors: Zarabadi Mir Pouyan , Charette Steve J. , Greener Jesse 
Published: May 2019

AbstractElectroactive biofilms are under intense scrutiny due to their potential to enable new sustainable technologies for energy production and bioremediation. However, severely reduced metabolic activity at low concentrations is a barrier to their implementation. A microfluidic approach was used for real-time respiration experiments on a Geobacter sulfurreducens biofilm to overcome these constraints. Precise changes to solution conditions enabled rapid and reversible switching between biofilm metabolic states, leading to the following discoveries. (i) Flow reactors can maintain biofilm activity at concentrations as low as 15 µM; (ii) a “pseudo-active” metabolic state separates active and inactive states; and (iii) acetate conversion can be as high as 90 percent for active biofilms at the pseudo-activity threshold.