bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Number of All-Terrain Vehicle-Related Admissions
Authors: Holt Matthew F. , Fortmann Joshua , Testerman George M. 
Published: January 2022

Background All-terrain vehicle (ATV) laws regarding helmet use, alcohol involvement, and roadway riding are poorly enforced or largely ignored. We hypothesized that direct surgeon funding and leadership in injury prevention would decrease ATV crashes. To focus prevention efforts, we reviewed a rural level 1 trauma center 11-year experience with ATV crashes comparing helmeted and unhelmeted rider outcomes. Methods For the latter 6 years of the study period, a trauma surgeon sponsored an injury prevention fund promoting ATV safety using simulators and discussions for area high school students. Helmet use, alcohol avoidance, and safe ATV operating were emphasized. A trauma registry review of ATV admissions from 2009 through 2020 examined demographics, helmet use, and clinical outcomes using chi-square, t-test, and regression analysis. Results Unhelmeted ATV riders suffered more severe head and neck injuries (OR 19, CI 1.5-1.8, P < .001), worse overall Injury Severity Score (ISS), (OR 25, CI 12.1-14.2, P < .001), and higher mortality rates (OR 4.0, CI .02-.05, P < .001). Helmet use corresponded with an average decrease in AIS and increase in GCS status. Although only 15% of riders were helmeted, ATV crash admissions have decreased in the last 5 years ( P < .001). Discussion All-terrain vehicle trauma and mortality is still frequent, especially in unhelmeted riders. The recent decrease in area ATV crashes is encouraging. Trauma surgeons have an opportunity to make a difference in public awareness and education through comprehensive physician-funded and directed injury prevention and research efforts.
Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers
Authors: Lin Nicole , Smiley Abbas , Goud Manoj , Lin Cynthia , Latifi Rifat 
Published: January 2022

Background We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs). Methods A National Inpatient Sample–based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality. Results 70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients ( P < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients ( P < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well. Conclusion Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.
How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?
Authors: Hahn Alexandra , Brown Tommy , Chapman Brett , Marr Alan , Stuke Lance , Greiffenstein Patrick , Schoen Jonathan , Hunt John P. , Smith Alison 
Published: January 2022

Introduction The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. Methods A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. Results A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed ( P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). Discussion During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.
Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids
Authors: Levy Lior , Smiley Abbas , Latifi Rifat 
Published: January 2022

Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.
Prehospital Tourniquet Use Should be a Trauma Team Activation Criterion.
Authors: Coleman Kennith , Grabo Daniel , Wilson Alison , Bardes James 
Published: January 2022

Purpose Prehospital tourniquet application is not a standard trauma team activation (TTA) criterion recommended by the ACS COT. Tourniquet use has seen a resurgence recently with associated risks and benefits of more liberal usage. Our institution added tourniquet application as TTA criterion in January 2019. This study aimed to evaluate the effect this would have on patient care and overtriage. Methods A prospective analysis was conducted for all TTA associated with tourniquets placed during 2019. An overtriage analysis was conducted utilizing a modified Cribari method as described in Resources for the Optimal Care of the Injured Patient, comparing patients that met standard TTA criteria (TTA-S), to those who met criteria due to tourniquet placement (TTA-T). Results During the study, there were 46 TTA with tourniquets. Mean prehospital tourniquet time was 80 minutes. Median ISS was 10, 8 (17%) had an ISS >15. Urgent operative intervention was needed in 74%, with 23% and 21% requiring orthopedic and vascular procedures, respectively. Tourniquets were correctly placed in 80% and clinically appropriate in 57%. Of these subjects, 25 (54%) were TTA-S and 21 TTA-T. Overtriage analysis was performed. Overtriage for TTA-T was 33.3%. Overtriage among TTA-S was 4%. Conclusion Patients with prehospital tourniquets are frequently severely injured. The immediate presence of a trauma surgeon can have significant impacts in these cases. This is particularly important in a rural environment with long tourniquet times. Prehospital tourniquet application as a TTA criteria does not result in excessive overtriage.
Surgical Stabilization of Rib Fractures Improves Outcomes in the Geriatric Patient Population
Authors: Christie Dudley B. , Nowack Timothy E. , Nonnemacher Cory J. , Montgomery Anne , Ashley Dennis W. 
Published: January 2022

Introduction Rib fractures in the ≥65-year-old population have been shown to strongly influence mortality and pneumonia rates. There is a growing body of evidence demonstrating improvements in the geriatric patient’s survival statistics and respiratory performances after surgical stabilization of rib fractures (SSRF). We have observed a strong survival and complication avoidance trend in geriatric patients who undergo SSRF. The purpose of our study was to evaluate the outcomes of geriatric patients with rib fractures treated with SSRF compared to those who only receive conservative therapies. Methods We performed a retrospective review of our trauma registry analyzing outcomes of patients ≥65 years with rib fractures. Patients admitted from 2015 to 2019 receiving SSRF (RP group) were compared to a nonoperative controls (NO group) admitted during the same time. Bilateral fractures were excluded. Independent variables analyzed = ISS, mortalities, hospital days, ICU days, pleural space complications, and readmissions. Follow-up was 60 days after discharge. Group comparison was performed using Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U tests. Results 257 patients were analyzed: 172 in the NO group with mean age of 75 (65-10) and 85 in the RP group with mean age of 74 (65-96). Mean ISS = 13 (1-38) for the NO group and 20 (9-59) for the RP group ( P < .001). Mean hospital days = 8 (1-39) and 15 (3-49) in NO and RP groups, respectively. Mean ICU days = 10 (1-32) and 8 (1-11) in NO and RP groups, respectively. Deaths, pneumonia, readmissions, and pleural effusions in the NO group were statistically significant ( P < .01). Analysis of complications revealed 4 RP patients (4.7%) with respiratory complications out to 60 days and 65 NO patients (37.8%) ( P < .001). Conclusions Surgical stabilization of rib fractures appears to be associated with a survival advantage and an avoidance of respiratory-related complications in the ≥65-year-old patient population.
Transumbilical Repair for Umbilical Hernia: A New Technique
Authors: Ohba Go , Yamamoto Hiroshi , Minato Masashi , Nakayama Masato , Honda Shohei , Taketomi Akinobu 
Published: January 2022

Although there are many reports on surgical repair for umbilical hernia, there is no standard procedure at present. Since 2012, we have performed surgery with transumbilical repair using an original procedure. With this procedure, a longitudinal incision is made in the umbilicus, and the fascial defect is closed. Excess skin is excised at a fixed length. The fascia and dermis are sutured vertically over a length of 15 mm. A total of 424 patients with pediatric umbilical hernia who underwent this procedure between September 2012 and December 2020 were reviewed. The mean operative duration was 52 minutes. All patients were followed up to 6 months after surgery. Postoperative complications included infection in 15 patients and wound granulation in 5 patients. The morphology of the umbilicus is natural and satisfying. We conclude that this procedure is safe and simple and the results are satisfactory.
Experimental damage tolerance evaluation of thick fabric carbon/epoxy laminates under low-velocity and high-velocity impact and compression-after-impact
Authors: van Hoorn Niels , Kassapoglou Christos , Turteltaub Sergio , van den Brink Wouter 
Published: January 2022

Impact experiments of thick fabric carbon/epoxy laminate specimens, with small thickness ratio, are conducted at distinct energy levels and thicknesses to characterise the damage process. These specimens and loading conditions are representative of a new generation of critical structural components in aviation, such as wing spars, landing gear beams and fittings, that are increasingly being made entirely from composites. The tests address the need to better understand the damage process for specimens with a small thickness ratio since existing experimental impact data for large thickness ratio (thin laminates) may not be directly applicable. Two energy levels, two different fabric layups and two impact methods (drop-weight and gas-cannon) were used. Data from high-speed cameras were processed in a novel way, providing the force during impact. C-scans and micrographs were used to characterise damage. The results show that specimens with a thickness ratio of 5 (20 mm thick) experience more bending compared to specimens with a ratio 2.5 (40 mm thick). For gas-cannon impacts, this results in a higher delaminated area. The drop-weight impacts show almost no differences in damage size for the thickness range analysed. The influence of layup on the global impact response is negligible, but locally it can result in significant variations in dent depth. The dent depth scales linearly with the impact energy and the delaminated area linearly with the impact velocity. There is no clear correlation between the compression-after-impact failure mechanisms and the residual strength. Impact damage, at the current energy levels, showed a minimal reduction of residual strength.
Nano-hybridization effects of nano-silica and nano-graphene platelet on mechanical properties of E-glass/epoxy nanocomposites
Authors: Aydoğuş Osman , Demirci Mehmet Turan 
Published: January 2022

This study reveals the nano-hybridization effects of nano-graphene platelets (NGPs) and nano-silica (SiO2 nanoparticle), having different structural geometries on the mechanical properties, nano and micro-scale failure behaviors, and nanoscale fracture mechanisms of E-glass/epoxy composites. Tensile, three-point bending, and Charpy impact experiments were applied to determine the mechanical behaviors of 0.5 wt.% NGPs, 4 wt.% nano-silica and 0.5 wt.% NGPs + 4 wt.% nano-silica nanohybrid filled E-glass/epoxy and neat E-glass/epoxy composite samples. Failure of composite samples was examined by microscopy and SEM analysis. FTIR analyses were conducted to interpret the chemical and physical interactions between the nanoparticles and epoxy resin. Nano-hybridization exhibited the highest tensile strength and three-point flexural force for the composite samples. However, the NGPs filled nanocomposites also exhibited the best static tensile toughness and impact energy absorption. The experimental data showed that it was statistically significant as a result of the one-way ANOVA analysis. Remarkably, nano-hybridization of nano-silica and NGPs showed different fracture mechanisms at the nano and micro-scales.
Seroprevalence of herpes simplex virus types 1 and 2 and correlates of infection in Jordan
Authors: Swedan Samer F , Darabseh Alia’ 
Published: January 2022

Background Herpes infections are common infections among populations. Herein, a cross-sectional study was used to determine the seroprevalence of herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) IgG antibodies and their association with potential infection risk factors among Jordanians. Methods A total of 759 serum samples were collected (January to February 2020) and analyzed for HSV-1 and HSV-2 IgG antibodies by enzyme-linked immunosorbent assay. Estimates for population seropositivity were determined by weighting the age-specific seroprevalence by the size of the population in each age stratum. Results The population estimate for HSV-1 seroprevalence was 75.3%. After adjustment for possible confounders, regression analysis revealed higher seroprevalence with increase in age ( p < 0.005) and low household income ( p = 0.002). The population estimate for HSV-2 seroprevalence was 2.9%. No significant differences in HSV-2 seroprevalence were observed in association with age, gender, family size, educational level, and socioeconomic status, likely due to low seropositivity. Conclusions Jordanians have high HSV-1 and low HSV-2 seroprevalence. Periodical studies might be needed to evaluate changes in HSV-1 and HSV-2 seroprevalence over time. This study provides essential epidemiological data for Jordan and the Middle East and North Africa region.
‘It’s possibly made us feel a little more alienated’: How people from ethnic minority communities conceptualise COVID-19 and its influence on engagement with testing
Authors: Vandrevala Tushna , Alidu Lailah , Hendy Jane , Shafi Shuja , Ala Aftab 
Published: January 2022

Objectives The cultural beliefs, practices and experiences of ethnic minority groups, alongside structural inequalities and the political economy play a critical, but overlooked role in health promotion. This study aimed to understand how ethnic minority groups in the United Kingdom conceptualised COVID-19 and how this influenced engagement in testing. Method Black (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members were purposefully recruited from across the UK. Fifty-seven semi-structured interviews were conducted and analysed using principles of grounded theory. Results We found that people of Black and South Asian ethnicity conceptualised COVID-19 as a disease that makes them visible to others outside their community and was seen as having more severe risk and suffering worse consequences, resulting in fear, stigmatisation and alienation. Views about COVID-19 were embedded in cultural beliefs, relating to culturally specific ideas around disease, such as ill-health being God’s will. Challenges brought about by the pandemic were conceptualised as one of many struggles, with the saliency of the virus contextualised against life experiences. These themes and others influenced engagement with COVID-19 testing. Testing was less about accessing timely and effective treatment for themselves and more about acting to protect the family and community. Testing symbolised a loss of income, anxiety and isolation, accentuated by issues of mistrust of the system and not being valued, or being treated unfairly. Conclusion Health communications should focus on counterbalancing the mistrust, alienation and stigmatisation that act as barriers to testing, with trust built using local credible sources.
The intergenerational transmission of maternal adverse childhood experiences on offspring’s psychiatric disorder and the mediating role of maternal depression: Results from a cross sectional study
Authors: Kang Na Ri , Kwack Young Sook , Song Jung-Kook , Kim Moon-Doo , Park Joon Hyuk , Kim Bung-Nyun , Moon Duk-Soo 
Published: January 2022

Maternal adverse childhood experiences (ACEs) may negatively affect the mental health and development of their offspring. The purpose of this study was to investigate the association of maternal ACE and offspring’s psychiatric disorder and the mediating effect of maternal depression. The subjects included 463 mothers (42.78 ± 5.68 years) and their offspring aged 6–18 years (13.26 ± 3.90 years). Mothers reported their ACE before age 18 and completed the Beck Depression Inventory-II and Diagnostic Predictive Scales (DPS), a screening tool for offspring’s psychiatric disorder. 35.42% of subjects had at least one ACE, and 11.0% reported three or more ACEs. Higher maternal ACE scores were associated with a significantly higher prevalence of offspring’s psychiatric disorders ( p < 0.001). Household dysfunction of maternal ACE (OR = 2.263, p < 0.001) is significantly associated with offspring’s psychiatric disorder. In the mediation model in which the household dysfunction affects the number of offspring’s psychiatric disorders, the partial mediation model through maternal depression was significant. The mother’s experience of household dysfunction before the age of 18 has a significant impact on her offspring’s psychiatric disorder and supported significant mediation through maternal depression. Further research is needed to determine the mechanisms of intergenerational transmission of ACE and offspring’s psychopathology.
Deformation analysis of axially loaded weak PVC-fiber reinforced polymer confined concrete column-strong reinforced concrete beam joints reinforced with core steel tube
Authors: Yu Feng , Zou Qiye , Fang Yuan , Li Dongang , Bu Shuangshuang 
Published: January 2022

This paper presents an experimental study on 11 weak PVC-FRP Confined Concrete (PFCC) Column-strong Reinforced Concrete beam joints reinforced with Core Steel Tube (CST) subjected to axial load. The influences of the joint height, joint stirrup ratio, Carbon Fiber Reinforced Polymer (CFRP) strips spacing, steel ratio and CST length on the failure mode, ultimate strength, and strain behavior of specimens are analyzed and discussed. Test results indicate that the failure mode of specimens is distinguished by the cracking of PVC tube, fracture of CFRP strips, yielding of stirrups, and longitudinal steel bars in the PFCC columns. Both the longitudinal steel bars and CST yield at the joint area, while there is no obvious damage on the joint. The ultimate stress of specimens decreases with the increment of CFRP strips spacing, while the other studied variables have little impact on the ultimate stress. As the CFRP strips spacing increases, the ultimate strain of specimens decreases, and the strain development accelerates. Considering the effect of joint dimension, a modified prediction model for the stress–strain relationship of axially loaded weak PFCC column-strong RC beam joints reinforced with CST is proposed and verified with good accuracy.