bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training Emergency Medicine Residents—the Skill of Endotracheal Intubation: Comparison of Human Cadavers vs Mannequins
Authors: Rothstein Josh , Gullo Jennifer , Cuningham Lee , Murphy Peter , Sochor Mark 
Published: July 2014

ABSTRACT

Introduction and objectives
There are multiple approaches to teach residents the skill of endotracheal intubation, including classroom teaching, cadaveric specimens, and simulation mannequins. The hypothesis of our study is training in the technique of intubation is equally mastered (resident confidence and competency) in training on human cadavers or simulation mannequins.

Materials and methods
Emergency medicine interns were asked to voluntarily enroll in the study prior to the beginning of intern year and randomized into two groups. The first group practiced intubation using mannequins. The second group practiced intubation using human cadavers. Both groups were given the same brief introductory lecture on the basics of endotracheal intubation. One week later, all the interns returned and attempted to intubate cadavers and mannequins. Competency assessment was based on the number of successful intubations, number of attempts, and use of adjunctive techniques. Interns were also surveyed after their anesthesia rotation with a Likert scale on confidence of being able to perform intubation.

Results
The overall average number of attempts was 1.67 in the mannequin group and 1.85 in the cadaver group. Mannequin trained interns had a total of 24 poor techniques noted over the 2 years. The cadaver trained group had a total of 35 poor techniques over the 2 years. Adjunct use was nearly identical in the two groups. Intubation success rate during anesthesia rotation and preparation ratings were nearly identical in the two groups. However, the cadaver-trained group reported feeling slightly more confident.

Conclusion
Overall, mannequins require fewer attempts to intubate and being mannequin trained results in fewer attempts. Adjunct use is independent of training type. The mannequintrained group had less episodes of poor technique than the cadaver-trained group. A mannequin training appears to be equivalent or better than cadaveric training for securing an airway, although cadaver trained interns reported slightly more confidence.

How to cite this article
Rothstein J, Gullo J, Cuningham L, Murphy P, Sochor M. Training Emergency Medicine Residents— the Skill of Endotracheal Intubation: Comparison of Human Cadavers vs Mannequins. Panam J Trauma Crit Care Emerg Surg 2014;3(1):8-10.
Epidemiología Del Trauma en Dos Hospitales de Primer Nivel de Atención Del Suroccidente de Colombia. Reporte Preliminar Del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma
Authors: Badiel Marisol , Tejada Jorge W , Aboutanos Michael , Pino Luis F , Mata Lina , Rubiano Jaime , Miñan-Arana Fernando D , Morales Mónica , Vernaza Cristina 
Published: July 2014

RESUMEN

Antecedentes
En Colombia las causas externas y violentas son la primera causa de muerte en menores de 44 años. El propósito de este estudio fue describir mecanismo, severidad y los desenlaces del trauma atendido en dos hospitales de tercer nivel del suroccidente colombiano.

Métodos
Entre Enero-2012 y Agosto-2012 se implementó el Registro Internacional de Trauma de la Sociedad Panamericana de Trauma (ITR-SPT) en dos hospitales civiles Nivel I en Cali, Colombia; uno de ellos de carácter público (PUB) y el otro privado (PRI). El ITR-SPT contiene información sociodemográfica, mecanismo del trauma, etiología, severidad según índice ISS (Injury Severity Score) y el estatus al egreso hospitalario.

Resultados
En el periodo de estudio se registraron 9.927 pacientes; edad promedio de 30 ± 20,2 anos, el 67% fueron hombres. Las tres primeras causas de consulta fueron: caidas (29,7%, n = 2952), heridas penetrantes (19,3%, n = 1916) y accidentes de transito (11,5%, n = 1,142). Segun la severidad del trauma, el 86,4% (n = 8575) ingresaron con ISS <9; el 8% (n = 793) con ISS 9 to 14, y el 5,6% con ISS .15 (PUB 8,6% vs PRI 3,6%). La mortalidad general fue 3,4% (n = 339) [PUB 6,6% (n = 268) vs PRI 1,2% (n = 71), p < 0,001].

Conclusión
En 7 meses, de medición ininterrumpida, en cerca de 10.000 pacientes, se identifica la tendencia real de la atención del trauma en hospitales de primer nivel. Las causas de consulta por trauma fueron similares en los dos hospitales. Parece ser más alta la mortalidad por el impacto de las heridas por armas de fuego en el hospital público luego del ajuste por severidad.

How to cite this article
Ordonez C, Rubiano J, Badiel M, Pino LF, Miñan-Arana FD, Tejada JW, Morales M, Puyana JC, Mata L, Aboutanos M, Vernaza C, Ivatury RR. Epidemiología Del Trauma en Dos Hospitales de Primer Nivel de Atención Del Suroccidente de Colombia. Reporte Preliminar Del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma. Panam J Trauma Crit Care Emerg Surg 2014;3(1): 11-15.
Epidemiología de Lesiones Relacionadas con Colisiones de Vehículos Motorizados en dos Centros de Referencia del Suroccidente Colombiano. Reporte del Registro Internacional de Trauma de la Sociedad P
Authors: Badiel Marisol , Aboutanos Michael , Sánchez Álvaro I , Calle-Toro Juan Sebastian , Pino Luis 
Published: July 2014

RESUMEN

Introducción
Dado que las lesiones relacionadas con colisiones de vehículos motorizados son una causa de morbimortalidad prevenible y evitable, generan costos económicos y afectan calidad de vida, se justifica evaluar esta problemática en términos de resultados clínicos. El objetivo de este estudio es caracterizar la población de Cali con lesiones relacionadas con colisiones de vehículos motorizados que fueron atendidos en los servicios de urgencias de dos centros de alta complejidad de la ciudad.

Materiales y métodos
Estudio observacional descriptivo, utilizando un registro de trauma en dos hospitales de alta complejidad de Cali, Colombia.

Resultados
En un periodo de 8 meses 11889 atenciones secundarias a lesiones de causas externas intencionales y no intencionales fueron registradas. Del total de pacientes, 1395 (11,6%) tenían lesión de tránsito, y de estos el 86% (n = 1200) ingresaron con escala de severidad de trauma (ISS) <9. El 48,4% (n = 675) de las atenciones estuvieron relacionadas con el uso de motocicletas, e l 2 6,8% ( n = 3 74), c on u so de b icicletas y 1 0,3% ( n = 1 44) c on v ehículos l ivianos. E l mecanismo de trauma contuso fue el más observado (93,5%, n = 1304). Estratificando los hallazgos por grupos de edad, que la motocicleta es el vehículo más relacionado, excepto en el grupo de edad de 5-14 años. Del total de pacientes, 777 (55,7%) fueron hospitalizados y de ellos 114 (14,7%) requirieron unidad de cuidado intensivo. La mortalidad global fue de 2,7% (53 pacientes).

Conclusiones
En Cali, las personas que sufren más frecuentemente lesiones relacionadas con colisiones de vehículos motorizados son hombres jóvenes, económicamente activos, que usan motocicleta como medio de transporte, con sospecha de ingesta alcohol. Esperamos contribuir con próximas medidas y estudios.

How to cite this article
Calle-Toro JS, Ordonez C, Sánchez ÁI, Sanjuan J, Badiel M, Pino L, Ivatury RR, Aboutanos M. Epidemiología de Lesiones Relacionadas con Colisiones de Vehículos Motorizados en dos Centros de Referencia del Suroccidente Colombiano. Reporte del Registro Internacional de Trauma de la Sociedad P. Panam J Trauma Crit Care Emerg Surg 2014;3(1):16-22.
Trends in Neurosurgical Management of Traumatic Brain Injury in Colombia
Authors: Puyana Juan Carlos , Moscote Luis Rafael , Lugo Claudia Marcela Restrepo , Castellar Sandra , Alcala Gabriel , Rubiano Andres Mariano 
Published: July 2014

ABSTRACT

Introduction
Traumatic brain injury (TBI) is a public health problem with higher impact in low and middle income countries. Surgical management of TBI in Colombia is a common intervention performed by neurosurgeons but there is little knowledge about their preferences and trends during the care.

Materials and methods
We designed a 19 questions survey based on previous studies in high income settings. Through the Colombian Association of Neurosurgery website contact list, we submit the survey to 324 registered neurosurgeons. Statistical analysis was performed using frequencies of nominal and quantitative data.

Results
The response number was 47 (14.8%). Around 97.8% were males and 66% have more than 5 years in practice. Thirty percent operate between 50 and 100 cases of TBI and 65.9% work in at least two facilities. The 95.74% consider that trauma surgery is not well paid by the system. Only 12.5% of the neurosurgeons are more devoted to neurotrauma and 20.8% are practicing more spine surgery. The 36.1% will choose not to do trauma neurosurgery if they have the opportunity. Resources for emergency craniotomies in their facilities were considered adequate by 93.6% of the responders.

Conclusion
Caring for patients with neurotrauma is not an attractive option for some practicing neurosurgeons in Colombia. Traumatic brain injury cases are frequent in daily practice but some neurosurgeons prefer not to do trauma surgery if they have the option. Institutions have basic resources to perform trauma neurosurgery but the surgery is not well paid by the health system according to the neurosurgeons perspective.

How to cite this article
Moscote LR, Lugo CMR, Castellar S, Alcala G, Puyana JC, Rubiano AM. Trends in Neurosurgical Management of Traumatic Brain Injury in Colombia. Panam J Trauma Crit Care Emerg Surg 2014;3(1):23-28.
The Burden of Trauma in Kosova: A Post Card Report from Prishtina
Authors: Latifi Rifat , Mora Fransisco , Lenjani Basri , Osmani Kalterina L , Beqiri Lirije , Hoxha Zana , Hajdari Fatmir 
Published: July 2014

ABSTRACT

Introduction
Kosova, an independent country since 2008 in Southern Europe, has experienced increased urbanization and development. Despite this young country's advances, its healthcare infrastructure has progressed at a much slower rate and limitations are particularly notable in trauma care. This combination has made trauma a major public health issue in Kosova. The University Clinic Center of Kosova (UCCK) in Prishtina is the only tertiary center that serves the entire country.

Materials and methods
A retrospective review of data collected from a combination of local sources, as there is no one agency or department that has all the data. These sources include: (1) the emergency department (ED) of UCCK (data from 2007-2012), admissions hospital data from UCCK (2004- 2009), and motor vehicle collisions (MVC) data provided by the Prishtina police department (2008-2012). However, the main source of patients data analyzed in this study was provided from the ED. Throughout this study rate calculations are based on the population of Prishtina (198,330 inhabitants as reported in the last national census).

Results
Twenty-four thousand one hundred and ninety-nine trauma patients were treated at UCCK ED between 2007 and 2012, of which 93.5% were blunt trauma and 6.3% penetrating trauma. There were 285 fatalities with a mortality rate varying between 16.6 and 37.3 for 100,000 inhabitants. UCCK in-patient data from 2004 to 2009 reported 193 fatalities due to MVC, with a mortality rate between 10.08 and 23.1 per 100,000 inhabitants. Prishtina police reported 214 MVC-related deaths on the streets of Prishtina, with a mortality injury rate between 16.13 and 27.22 per 100,000 inhabitants from 2008 to 2012. However, combined mortality data for 2009 yields an MVC mortality rate of 61 per 100,000 inhabitants, the highest in the world.

Conclusion
Trauma burden remains a substantial public problem in Kosova, and needs to be addressed acutely. Furthermore, there is urgent need for a nationwide trauma registry, in order for policymakers to be able to recognize the gravity of the situation and to design and implement appropriate interventions and allocate already limited funding.

How to cite this article
Mora F, Lenjani B, Osmani KL, Beqiri L, Hoxha Z, Hajdari F, Latifi R. The Burden of Trauma in Kosova: A Post Card Report from Prishtina. Panam J Trauma Crit Care Emerg Surg 2014;3(1):29-32.
Unusual Occurrence of Inguinal Hernia in Raw Area Postdebridement for Fournier Gangrene
Authors: Patel Rajesh , Paryani Jeetendar , Rathod Gunvant , Makwana Rakesh , Gadani Ravi 
Published: July 2014

ABSTRACT
Fournier gangrene (FG) is an idiopathic spreading necrosis of the scrotum surrounding perineum which may even spread to anterior abdominal wall. The development and fast progression of gangrene can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible.
Management of the condition includes initial resuscitation, combined with broad spectrum intravenous (IV) antibiotics and aggressive debridement, followed by dressing and local management. Once the bed of the wound is prepared, the wound may be covered with split thickness grafts or testicular repositions.
Fournier gangrene is rare but life-threatening disease. Nonetheless, occurrence of another surgically correctable emergency in the same patient can complicate the course of disease and alter the management strategy. The identification and management of such a condition in an open wound pose a diagnostic and therapeutic challenge.
Here, we would like to describe the case, we encountered in our ward (Civil Hospital, Ahmedabad), which developed hernia postdebridement for FG. It presented as swelling in the raw area. The diagnosis was confirmed by investigations and managed with herniorrhaphy as the wound was contaminated. Daily dressing was continued for the raw area. The raw area developed healthy granulation tissue and there were no complications related to hernia surgery during the postoperative course. Patient then underwent testis reposition in the thigh pouch as well as coverage of raw area with split thickness graft. The uptake was healthy, and patient was discharged without any complication.

How to cite this article
Paryani J, Rathod G, Makwana R, Gadani R, Patel R. Unusual Occurrence of Inguinal Hernia in Raw Area Postdebridement for Fournier Gangrene. J Trauma Crit Care Emerg Surg 2014;3(1):33-36.
Necrotizing Fasciitis of the Abdominal Wall in a Patient with Diverticulitis
Authors: Shah Shinil K , Walker Peter A , Jacquez Ricardo A , Fischer Uwe M , Yaakovian Michael D 
Published: July 2014

ABSTRACT
Intra-abdominal infections, such as diverticulitis causing necrotizing fasciitis of the abdominal wall or extremities, are extremely rare and carry a high mortality rate. We present the case of a 52-year-old man with multiple medical comorbidities and diverticulitis who presented to our service with necrotizing fasciitis of the left lateral and posterior abdominal wall. The relevant literature is discussed.

How to cite this article
Jacquez RA, Fischer UM, Yaakovian MD, Walker PA, Shah SK. Necrotizing Fasciitis of the Abdominal Wall in a Patient with Diverticulitis. J Trauma Crit Care Emerg Surg 2014;3(1):37-38.
Pneumoperitoneum Secondary to Emphysematous Cholecystitis: An Unusual Presentation
Authors: Singh Shailender , Surendra KL 
Published: July 2014

ABSTRACT
We herein report a case of emphysematous cholecystitis (EC) causing pneumoperitoneum with gross ascites, which is a very rare entity. A 64-year-old diabetic man was admitted with diffuse abdominal pain, abdominal distension and fever of 1 week duration. On examination, patient was febrile (38.7oC) and abdominal guarding noted. Laboratory investigations revealed total leukocyte count of 16000/ƒÊl with 90% neutrophils, total bilirubin level of 2 mg/dl (direct 0.60 mg/dl). In erect X-ray abdomen, there was no significant finding. Ultrasonography (USG) abdomen showed cholelithiasis with thickened edematous gallbladder (GB) wall and few reflective echoes in GB fossa. Computed tomography (CT) axial sections revealed the presence of small stones in the gallbladder neck and small amount of intraluminal as well as intramural air. Tiny pockets of free intraperitoneal air was also noted. On intravenous (IV) contrast, there was minimal wall enhancement. Preoperative diagnosis of emphysematous cholecystitis with pneumoperitoneum was made and the same was confirmed in the intraoperative findings. Patient underwent emergency exploratory laparotomy with cholecystectomy and was given required medical management, the postoperative course was uneventful.

How to cite this article
Singh S, Surendra KL. Pneumoperitoneum Secondary to Emphysematous Cholecystitis: An Unusual Presentation. Panam J Trauma Crit Care Emerg Surg 2014;3(1):39-41.
USPTO Guidance On Patentable Subject Matter: Impediment to Biotech Innovation?
Authors: Brougher Joanna T. , Fazzolare David A. 
Published: July 2014

In June 2013, the U.S. Supreme Court issued a unanimous decision upending more than three decades worth of established patent practice when it ruled that isolated gene sequences are no longer patentable subject matter under 35 U.S.C. Section 101.While many practitioners in the field believed that the USPTO would interpret the decision narrowly, the USPTO actually expanded the scope of the decision when it issued its guidelines for determining whether an invention satisfies Section 101. The guidelines were met with intense backlash with many arguing that they unnecessarily expanded the scope of the Supreme Court cases in a way that could unduly restrict the scope of patentable subject matter, weaken the U.S. patent system, and create a disincentive to innovation. By undermining patentable subject matter in this way, the guidelines may end up harming not only the companies that patent medical innovations, but also the patients who need medical care.Â This article examines the guidelines and their impact on various technologies.
The carbon budget in the northern Adriatic Sea, a winter case study
Authors: Catalano G. , Azzaro M. , Bastianini M. , Bellucci L. G. , Bernardi Aubry F. , Bianchi F. , Burca M. , Cantoni C. , Caruso G. , Casotti R. , Cozzi S. , Del Negro P. , Fonda Umani S. , Giani M. , Giuliani S. , Kovacevic V. , La Ferla R. , Langone L. , Luchetta A. , Monticelli L. S. , Piacentino S. , Pugnetti A. , Ravaioli M. , Socal G. , Spagnoli F. , Ursella L. 
Published: July 2014

AbstractThis paper presents a winter carbon budget for the northern Adriatic Sea, obtained through direct measurements during two multidisciplinary cruises and literature data. A box model approach was adopted to integrate estimates of stocks and fluxes of carbon species over the total area. The oligotrophy at the basin scale and the start of primary productivity well before the onset of spring stratification were observed. In winter, the system underwent a complete reset, as the mixing of water masses erased any signal of previous hypoxia or anoxia episodes. The northern Adriatic Sea was phosphorus depleted with respect to C and N availability. This fact confirms the importance of mixing with deep‐sea water for P supply to biological processes on the whole. Despite the abundant prokaryotic biomass, the microbial food web was less efficient in organic C production than phytoplankton. In the upper layer, the carbon produced by primary production exceeded the fraction respired by planktonic community smaller than 200 µm. On the contrary, respiration processes prevailed in the water column below the pycnocline. The carbon budget also proved that the northern Adriatic Sea can be an effective sink for atmospheric CO2 throughout the entire winter season.
Modeling hydrologic and ecologic responses using a new eco‐hydrological model for identification of droughts
Authors: Sawada Yohei , Koike Toshio , Jaranilla‐Sanchez Patricia Ann 
Published: July 2014

AbstractDrought severely damages water and agricultural resources, and both hydrological and ecological responses are important for its understanding. First, precipitation deficit induces soil moisture deficiency and high plant water stress causing agricultural droughts. Second, hydrological drought characterized by deficit of river discharge and groundwater follows agricultural drought. However, contributions of vegetation dynamics to these processes at basin scale have not been quantified. To address this issue, we develop an eco‐hydrological model that can calculate river discharge, groundwater, energy flux, and vegetation dynamics as diagnostic variables at basin scale within a distributed hydrological modeling framework. The model is applied to drought analysis in the Medjerda River basin. From model inputs and outputs, we calculate drought indices for different drought types. The model shows reliable accuracy in reproducing observed river discharge in long‐term (19 year) simulation. Moreover, the drought index calculated from the model‐estimated annual peak of leaf area index correlates well (correlation coefficient r = 0.89) with the drought index from nationwide annual crop production, which demonstrates that the modeled leaf area index is capable of representing agricultural droughts related to historical food shortages. We show that vegetation dynamics have a more rapid response to meteorological droughts than river discharge and groundwater dynamics in the Medjerda basin because vegetation dynamics are sensitive to soil moisture in surface layers, whereas soil moisture in deeper layers strongly contributes to streamflow and groundwater level. Our modeling framework can contribute to analyze drought progress, although analyses for other climate conditions are needed.
Environmental determinants of tropical forest and savanna distribution: A quantitative model evaluation and its implication
Authors: Zeng Zhenzhong , Chen Anping , Piao Shilong , Rabin Sam , Shen Zehao 
Published: July 2014

AbstractThe distributions of tropical ecosystems are rapidly being altered by climate change and anthropogenic activities. One possible trend—the loss of tropical forests and replacement by savannas—could result in significant shifts in ecosystem services and biodiversity loss. However, the influence and the relative importance of environmental factors in regulating the distribution of tropical forest and savanna biomes are still poorly understood, which makes it difficult to predict future tropical forest and savanna distributions in the context of climate change. Here we use boosted regression trees to quantitatively evaluate the importance of environmental predictors—mainly climatic, edaphic, and fire factors—for the tropical forest‐savanna distribution at a mesoscale across the tropics (between 15°N and 35°S). Our results demonstrate that climate alone can explain most of the distribution of tropical forest and savanna at the scale considered; dry season average precipitation is the single most important determinant across tropical Asia‐Australia, Africa, and South America. Given the strong tendency of increased seasonality and decreased dry season precipitation predicted by global climate models, we estimate that about 28% of what is now tropical forest would likely be lost to savanna by the late 21st century under the future scenario considered. This study highlights the importance of climate seasonality and interannual variability in predicting the distribution of tropical forest and savanna, supporting the climate as the primary driver in the savanna biogeography.