Σάββατο 31 Δεκεμβρίου 2016

Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments

Abstract

Objective

Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (PED)1. Although many professional organizations recommend decreasing use of CT and choosing ultrasound as first line imaging for pediatric appendicitis, significant variability persists in imaging utilization2,3,4.

This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital-level characteristics associated with the likelihood of ultrasound as the first imaging modality.

Methods

This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3-18 years diagnosed with appendicitis from each site was compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental level demographics.

Results

In the diagnostic evaluation of 1090 children with appendicitis, CT scan was performed first for 22.4% of patients, with a range across PEDs of 3.1-83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5-96.9%. The only hospital level factor significantly associated with ultrasound as the first imaging modality was 24-hour availability of in-house ultrasound (OR 29.2, 95% CI 1.2-691.8).

Conclusion

Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24-hour in house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases CT scans. Hospitals aiming to increase the use of ultrasound should consider adding 24-hour in house coverage.

This article is protected by copyright. All rights reserved.



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The PECARN TBI rules do not apply to abusive head trauma

Abstract

The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prediction rules were developed to identify children at very low risk for clinically-important TBIs (ciTBIs), for whom computed tomography (CT) scans can typically be obviated.1 The PECARN prediction rules have been validated in several settings and countries.2-5 The PECARN TBI rules, one developed for children younger than 2 years, and the other for those 2 years and older, rely on accurate patient history and physical examination findings gathered at the time of emergency department (ED) presentation.

This article is protected by copyright. All rights reserved.



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Παρασκευή 30 Δεκεμβρίου 2016

Resident Volunteer Firefighter/EMT - West Thurston Regional Fire Authority

Job Duties as a FF/EMT: respond to and provide various emergency services such as fire suppression, rescue, and emergency medical services. • Transport patients to the hospital • perform Basic Life Support Services • Fire suppression and prevention • Operate power tools and manual tools • Drive and operate Fire/EMS apparatuses such as an aid unit, fire engine, support unit ...

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Fla. EMS supervisor buys crash victim new bicycle

By EMS1 Staff

PINELLAS PARK, Fla. — An EMS supervisor's random act of kindness was recognized by police officers last week.

FOX13News reported that the Pinellas Park Police Department thanked Sunstar EMS Supervisor Josh Brumwell on their Facebook page for going above and beyond the call of duty. Brumwell, who was working a vehicle vs. bicyclist crash at a mall exit, said the bicyclist was not injured in the crash.

However, the man's bike was a total loss. Brumwell said the man broke down, saying the bike was his only means of transportation. Brumwell went to a nearby store and bought the man a new bicycle.

"This was an amazing act of goodwill during the holiday season," the Facebook post said.



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Πέμπτη 29 Δεκεμβρίου 2016

Pediatric dextrose administration tips and tricks

Things you may not have known about Pediatric Dextrose administration?

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Pediatric dextrose administration tips and tricks

Things you may not have known about Pediatric Dextrose administration?

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Pediatric dextrose administration tips and tricks

Things you may not have known about Pediatric Dextrose administration?

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Pediatric dextrose administration tips and tricks

Things you may not have known about Pediatric Dextrose administration?

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Fla. paramedic rescues man, pays for his flight home

By EMS1 Staff

FORT LAUDERDALE, Fla. — A paramedic went above and beyond the call when he took a young drug addict under his wing and paid for his flight home. 

Dusty Rousseau, 36, responded to a call to assist officers with a man who passed out on a sidewalk, reported the Bay Today

“When they woke him up, he was laying on the streets in Fort Lauderdale. Fort Lauderdale sounds beautiful, with Florida and sandy beaches, but where I found him was not the best place,” Rousseau said. 

Rousseau told officers he would escort the man to the hospital, who had relapsed after leaving rehab. After officers told the man, named Ryan, to get up, Rousseau was overcome with emotion.

“That’s where the emotion came for me. I felt bad for the kid right away, he said ‘yes sir,’ he’s not a thug,” Rousseau said. 

The paramedic took the 21-year-old to the hospital, where he asked staff to keep him safe until his 12-hour shift ended. 

“I talked to him for a while, and he’s a good kid who struggled with an addiction, he was dressed well, he spoke well, he was respectful, he had played hockey and grew up in a small town like I did … I thought ‘I’ve got to help this kid,’” Rousseau said. 

When Rousseau returned to the hospital after his shift, he managed to contact Ryan’s father, who lives in Wisconsin. Ryan’s father said he could not afford transportation to get his son home. 

“I talked to his dad on the phone, and his dad wanted nothing more than to get him home for Christmas,” Rousseau said. 

Instead, Rousseau paid for a flight to send Ryan home; he waited with him at the airport. Ryan contacted Rousseau after arriving home, and thanked him for the kind gesture.

“It felt pretty good to send him home for Christmas, he’s doing pretty good right now and I’m trying to keep in touch with him, because he’s a good kid,” Rousseau said. 



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FDNY ambulance hits, kills elderly man

Officials said the ambulance pulled over after the incident and EMS personnel provided aid to the 89-year-old man

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Lessons learned from EMS pioneers

If you've been following EMS Pioneers since its debut in January 2015, you know we've featured senior providers with several decades in EMS. On average, our 14 men and four women were 59 years old with 37 years in the industry. The 13 paramedics and five EMTs interviewed worked in 15 states, eight of which are west of the Mississippi.

Our Pioneers are many things: mothers, fathers, mentors, managers, caregivers, educators and innovators. What they aren't is shy. Getting them to opine and emote about all things EMS was easy; there was no dodging questions or contriving politically-correct answers. That's good news for the rest of us, because as we look back on the first two years of Pioneers, there are plenty of pearls worth remembering.

Lesson 1: The importance of people skills

To be successful in EMS, start with a patient-centric mentality.

Washington paramedic Doug Bair: "One of my heroes, Dr. Gregory Henry, calls emergency medicine 'the occasional application of scientific principles to meet human needs.' What he means is, if you think you'll be saving lives all the time, you're wrong; you're going to be meeting patients' basic needs, whether they're social, psychological or whatever. Occasionally you'll do something medical, but mostly you'll be helping citizens through crises whenever they decide they're having one."

Arkansas paramedic Sharon King: "There are calls where one person clicks and the other doesn't. When you have male and female partners, it broadens the possibilities of someone connecting with the patient."

Kentucky paramedic Carlos Coyle: "Most of our patients don't know how well-trained or highly skilled you are. What they do know is how you responded to their emergency. Did you look professional? Did you give them a pillow and a blanket? Did you treat them and everyone else at the scene with respect? We're the safety net of America. When everything else fails, people call 911 for an ambulance. They need our skills, but even more importantly, they want our compassion."

Lesson 2: The role of educators

When teaching others, be inclusive and realistic.

Minnesota paramedic Roger Swor: "You have to relate to people who are looking to tap into your experience and knowledge. Some skills instructors come across like Marine drill instructors, which causes more stress and makes it even harder for students to remember what they're supposed to do."

Delaware paramedic Barry Eberly: "There seems to be a mindset that succeed or fail, everyone deserves an award, but I think most people who work in medicine know that some are cut out for it and some aren't. Teachers are well-positioned to be part of that decision-making process."

Coyle: "You just never know when you're going to make that connection with someone who's trying to decide on a career path. We have to be seen; we have to tell people what we do because compared to law enforcement and fire, EMS is still very young."

Lesson 3: Patient assessment

In the classroom, EMS is mostly science; in the field it's mostly art.

California paramedic Jim Cuneo: "You have to keep your eyes wide open and make sense of what's going on, to think past what you see and ask really good questions. Mostly, you have to like talking to people."

Vermont AEMT Candy Hall: "Whether you're a nurse, a medic or an EMT, you need information to treat a patient. Being too intense about getting that information can make people feel you're dissing them. Starting with, 'Hi, how are you?' can make a huge difference."

Texas EMT Richard Ponikiewski: "Don't be so gung-ho about doing everything at once. Start with the basics. Understand what's going on before you start pushing drugs."

Coyle: "Sometimes it's not our diagnosis or skill set that makes a difference; it's holding their hand."

Lesson 4: Extreme EMS

"Train wrecks" are uncommon but inevitable.

Cuneo: "It's a challenge to see through the chaos and manage those crazy calls. You never know how you'll do until you're there. You just rely on your training and do the best you can."

Swor: "Emergency shows like Chicago Fire make everything seem so stressful and critical. Everybody's life is on the line all the time. You can't afford to think that way. You have to find a way to keep smiling. Don't get mad when an alarm comes in; bad feelings accumulate over the years and lead to burnout. Enjoy the calls you run. Try to learn from each one."

Ohio paramedic Susie Emmert: "It's exciting when you first get into it, but you have to keep it real. Don't do it for the lights and sirens and don't do it 24/7. Just concentrate on being the best you can be when it's your turn."

Louisiana paramedic Andy Bruch: "You'll have good days and bad days. Most days are good, just like most people in this world are good, but you'll have that one day from hell that will test you and try you and weigh on you heavily. You just have to understand that everything comes in cycles. Don't dwell on it — there are better times ahead."

Lesson 5: Balancing outlook and attitude

Don't let other people's hardships add to your own.

Swor: "Rule number one is people die. Rule number two is medics can't change rule number one."

New York EMT-CC Gary Stehr: "You can't go into EMS half-assed; it's a serious business. You have to be all in. If you don't have the time to do it properly, maybe it's better to wait until you can."

Louisiana paramedic Harry Murphy: "It's difficult to balance home life and the demands some EMS agencies put on you. I used to work 48 hours a week full time, 24 hours part time, then volunteer on top of that. I don't let my work define me anymore. I try to bring my principles and ethics to work and shape the job around that, rather than have the job shape me and my lifestyle. I don't imagine there are too many people on their deathbed who wish they'd spent more time working."

Keep reading in 2017 as we profile other EMS pioneers.



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Lessons learned from EMS pioneers

If you've been following EMS Pioneers since its debut in January 2015, you know we've featured senior providers with several decades in EMS. On average, our 14 men and four women were 59 years old with 37 years in the industry. The 13 paramedics and five EMTs interviewed worked in 15 states, eight of which are west of the Mississippi.

Our Pioneers are many things: mothers, fathers, mentors, managers, caregivers, educators and innovators. What they aren't is shy. Getting them to opine and emote about all things EMS was easy; there was no dodging questions or contriving politically-correct answers. That's good news for the rest of us, because as we look back on the first two years of Pioneers, there are plenty of pearls worth remembering.

Lesson 1: The importance of people skills

To be successful in EMS, start with a patient-centric mentality.

Washington paramedic Doug Bair: "One of my heroes, Dr. Gregory Henry, calls emergency medicine 'the occasional application of scientific principles to meet human needs.' What he means is, if you think you'll be saving lives all the time, you're wrong; you're going to be meeting patients' basic needs, whether they're social, psychological or whatever. Occasionally you'll do something medical, but mostly you'll be helping citizens through crises whenever they decide they're having one."

Arkansas paramedic Sharon King: "There are calls where one person clicks and the other doesn't. When you have male and female partners, it broadens the possibilities of someone connecting with the patient."

Kentucky paramedic Carlos Coyle: "Most of our patients don't know how well-trained or highly skilled you are. What they do know is how you responded to their emergency. Did you look professional" Did you give them a pillow and a blanket" Did you treat them and everyone else at the scene with respect" We're the safety net of America. When everything else fails, people call 911 for an ambulance. They need our skills, but even more importantly, they want our compassion."

Lesson 2: The role of educators

When teaching others, be inclusive and realistic.

Minnesota paramedic Roger Swor: "You have to relate to people who are looking to tap into your experience and knowledge. Some skills instructors come across like Marine drill instructors, which causes more stress and makes it even harder for students to remember what they're supposed to do."

Delaware paramedic Barry Eberly: "There seems to be a mindset that succeed or fail, everyone deserves an award, but I think most people who work in medicine know that some are cut out for it and some aren't. Teachers are well-positioned to be part of that decision-making process."

Coyle: "You just never know when you're going to make that connection with someone who's trying to decide on a career path. We have to be seen; we have to tell people what we do because compared to law enforcement and fire, EMS is still very young."

Lesson 3: Patient assessment

In the classroom, EMS is mostly science; in the field it's mostly art.

California paramedic Jim Cuneo: "You have to keep your eyes wide open and make sense of what's going on, to think past what you see and ask really good questions. Mostly, you have to like talking to people."

Vermont AEMT Candy Hall: "Whether you're a nurse, a medic or an EMT, you need information to treat a patient. Being too intense about getting that information can make people feel you're dissing them. Starting with, 'Hi, how are you"' can make a huge difference."

Texas EMT Richard Ponikiewski: "Don't be so gung-ho about doing everything at once. Start with the basics. Understand what's going on before you start pushing drugs."

Coyle: "Sometimes it's not our diagnosis or skill set that makes a difference; it's holding their hand."

Lesson 4: Extreme EMS

"Train wrecks" are uncommon but inevitable.

Cuneo: "It's a challenge to see through the chaos and manage those crazy calls. You never know how you'll do until you're there. You just rely on your training and do the best you can."

Swor: "Emergency shows like Chicago Fire make everything seem so stressful and critical. Everybody's life is on the line all the time. You can't afford to think that way. You have to find a way to keep smiling. Don't get mad when an alarm comes in; bad feelings accumulate over the years and lead to burnout. Enjoy the calls you run. Try to learn from each one."

Ohio paramedic Susie Emmert: "It's exciting when you first get into it, but you have to keep it real. Don't do it for the lights and sirens and don't do it 24/7. Just concentrate on being the best you can be when it's your turn."

Louisiana paramedic Andy Bruch: "You'll have good days and bad days. Most days are good, just like most people in this world are good, but you'll have that one day from hell that will test you and try you and weigh on you heavily. You just have to understand that everything comes in cycles. Don't dwell on it — there are better times ahead."

Lesson 5: Balancing outlook and attitude

Don't let other people's hardships add to your own.

Swor: "Rule number one is people die. Rule number two is medics can't change rule number one."

New York EMT-CC Gary Stehr: "You can't go into EMS half-assed; it's a serious business. You have to be all in. If you don't have the time to do it properly, maybe it's better to wait until you can."

Louisiana paramedic Harry Murphy: "It's difficult to balance home life and the demands some EMS agencies put on you. I used to work 48 hours a week full time, 24 hours part time, then volunteer on top of that. I don't let my work define me anymore. I try to bring my principles and ethics to work and shape the job around that, rather than have the job shape me and my lifestyle. I don't imagine there are too many people on their deathbed who wish they'd spent more time working."

Keep reading in 2017 as we profile other EMS pioneers.



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When a vehicle becomes a weapon: intentional vehicular assaults in Israel

We have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians. We hypothesized that IVA are associated with a specific injury pattern and severity.

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Normal saline as resuscitation fluid in critically ill patients: not dead yet!



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Surface topological differences of phage infected uropathogenic Escherichia coli (UPEC) strains, revealed by atomic force microscopy

Background: Atomic force microscopy (AFM) is an advance microscopic technique that provides three dimensional structures of cell surfaces with high resolution. In the present study AFM was used for comparative analysis of surface topology of phage infected and uninfected Uropathogenic Escherichia coli (UPEC) cells. Two UPEC strains NE and HN were isolated from urine samples of Urinary tract infection patients and their specific narrow host range lytic phages 3S and HNΦ were isolated from the sewage of different areas. Results: On the basis of one step growth curve both phages characterized as short latent period phages with latency period of about 30 min. On AFM analysis significant difference in topology of healthy and infected cells were observed. It was hypothesized that progeny of both lytic phages released out from their respective host cells in different manner. The image of 3S infected UPEC host cells (NE) revealed multiple internal projections which showed progeny phages released out from host cells through these multiple sites. Whereas images of HNΦ infected HN host cells showed central depression which illustrated that new phages released out through single exit point from the middle of cell. Conclusions: These results are significant to extend future studies on isolated phages as an effective tool for phage therapy.

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An adaptive random compressive partial sampling method with TV recovery

Different from standard sampling strategy in compressive sensing (CS), we present a compressive partial sampling framework called adaptive-random sampling and recovery (ASR) for image. It could faithfully recover images by hybridizing random samples with edge-extracted pixels with much lower sampling rate. The new framework preserves edge pixels containing essential information of images, and meanwhile employs the edge-preserving total variation (TV) regularizer. Assisted with the edges, three steps are adopted to recover the high-quality image. First, we extract the edges of a coarse image recovered with completely random measurements in our sampling framework. Then, the TV algorithm in the CS theory is employed for solving the Lagrangian regularization problem. Finally, we refine the coarse image to obtain a high-quality one with both the extracted edges and previous random measurements. Experimental results show that the novel ASR strategy achieves significant performance improvements over the current state-of-the-art schemes.

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Degradation study of lindane by novel strains Kocuria sp. DAB-1Y and Staphylococcus sp. DAB-1W

Background: This study was carried out to isolate and characterize the bacterial strains from lindane-contaminated soil and they were also assessed for their lindane-degrading potential. Methods: In this study the enrichment culture method was used for isolation of  lindane degrading bacterial isolates, in which the mineral salt medium (MSM) supplemented with different concentrations of lindane was used. Further, the screening for the potential lindane degrading isolates was done using the spray plate method and colorimetric dechlorinase enzyme assay. The selected isolates were also studied for their growth response under varying range of temperature, pH, and NaCl. The finally selected isolates DAB-1Y and DAB-1W showing best lindane degradation activity was further subjected to biochemical characterization, microscopy, degradation/kinetic study, and 16S rDNA sequencing. The strain identification were performed using the biochemical characterization, microscopy and the species identifies by 16S rDNA sequence of the two isolates using the standard 16S primers, the 16 S rRNA partial sequence was analyzed through BLAST analysis and phylogenetic tree was generated based on UGPMA clustering method using MEGA7 software. This shows the phylogenetic relationship with the related strains. The two isolates of this study were finally characterized as Kocuria sp. DAB-1Y and Staphylococcus sp. DAB-1W, and their 16S rRNA sequence was submitted to GenBank database with accession numbers, KJ811539 and KX986577, respectively. Results: Out of the 20 isolates, the isolates DAB-1Y and DAB-1W exhibited best lindane-degrading activity of 94 and 98%, respectively, recorded after 8 days of incubation. The optimum growth was observed at temperature 30 °C, pH 7, and 5% NaCl observed for both isolates. Of the four isomers of hexachlorocyclohexane, isomer α and γ were the fastest degrading isomers, which were degraded up to 86 and 94% by isolates DAB-1Y and up to 93 and 98% by DAB-1W, respectively, reported after 8 days incubation. Isomer β was highly recalcitrant in which maximum 35 and 32% lindane degradation was observed even after 28 days incubation by isolates, DAB-1Y and DAB-1W, respectively. At lower lindane concentrations (1–10 mg/L), specific growth rate increased with increase in lindane concentration, maximum being 0.008 and 0.006/day for DAB-1Y and DAB-1W, respectively. The 16 S rRNA partial sequence of isolate DAB-1Y showed similarity with Kocuria sp. by BLAST analysis and was named as Kocuria sp. DAB-1Y and DAB-IW with Staphylococcus sp. DAB-1W. The 16S rDNA sequence of isolate DAB-1Y and DAB-1W was submitted to online at National Centre of Biotechnology Information (NCBI) with GenBank accession numbers, KJ811539 and KX986577, respectively. Conclusions: This study has demonstrated that Kocuria sp. DAB-1Y and Staphylococcus sp. DAB-1W were found efficient in bioremediation of gamma-HCH and can be utilized further for biodegradation of environmental contamination of lindane and can be utilized in bioremediation program.

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Wage inequality, skill inequality, and employment: evidence and policy lessons from PIAAC

This paper investigates international differences in wage inequality and skills and whether a compressed wage distribution is associated with high unemployment across core OECD countries. Wage dispersion and wage structure are widely debated among policymakers; compressed wage structure is often perceived as an important cause of high unemployment. Firstly, this paper examines differences in wage dispersion across OECD countries and their link to skill dispersion. Some countries that have more compressed (dispersed) wage structures simultaneously have more compressed (dispersed) skill structures as well, and skill differences explain part of the differences in wage dispersion. However, even when accounted for skills, some countries have a more compressed wage structure, most likely caused by labor market institutions. We do not find an effect of wage compression on the labor market performance in the low-skill sector. Based on the Program for International Assessment of Adult Competencies (PIAAC) survey of adult skills for core OECD countries, this paper cannot confirm the skill compression nor wage compression hypotheses. Rather than insisting on the deregulation of labor market institutions and reductions in public welfare policy as the main policy recommendations to achieve higher employment (and higher wage inequality), policymakers should reconsider aggregate demand deficiency and the variation in macroeconomic policies as potential explanations for the employment differences across countries.JEL Classification: J31, J24, E24

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The legacies of slavery in and out of Africa

The slave trades out of Africa represent one of the most significant forced migration experiences in history. In this paper, I illustrate their long-term consequences on contemporaneous socio-economic outcomes, drawing from my own previous work on the topic and from an extensive review of the available literature. I first consider the influence of the slave trade on the “sending” countries in Africa, with attention to their economic, institutional, demographic, and social implications. Next, I evaluate the consequences of the slave trade on the “receiving” countries in the Americas. Here, I distinguish between the case of Latin America and that of the USA. Overall, I show that the slave trades exert a lasting impact along several contemporaneous socio-economic dimensions and across diverse areas of the world.JEL Classification: J47, J15, O15, N30, P48, Z10

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How Large are Earnings Penalties for Self-Employed and Informal Wage Workers?

This paper examines the earnings penalties and premiums associated with different types of employment in 73 countries. Workers are divided into four categories: non-professional own-account workers, employers and own-account professionals, informal wage employees, and formal wage employees. Approximately half of the workers in low income countries are non-professional own-account workers, and the majority of the rest are informal employees. Fewer than 10 percent are formal employees, and only 2 percent of workers in low income countries are employers or own-account professionals. As per capita gross domestic product increases across countries, there are large net shifts from non-professional own-account work into formal wage employment. Across all regions and income levels, non-professional own-account workers and informal wage employees face an earnings penalty compared with formal wage employees. But in low income countries, this earnings penalty is small, and non-professional own-account workers earn a positive premium relative to all wage employees. Earnings penalties for non-professional own-account workers tend to increase with gross domestic product and are largest for female workers in high income countries. On average, employers and own-account professionals earn a premium compared to employees, although there are important differences across countries and between men and women. In terms of regional differences, earnings premiums for employers and professionals are largest for men in middle income Latin American countries. On the other hand, women employers and professionals do not earn a statistically significant premium compared to employees in any region of the world. These results are consistent with compensating wage differentials and firm quasi-rents playing important roles in explaining cross-country variation in earnings penalties, and raise questions about the extent to which the unskilled self-employed are rationed out of formal wage work in low income countries.JEL Codes: J31, O17.

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Wage rigidities and business cycle fluctuations: a linked employer-employee analysis

This paper analyses wage dynamics in Italy in the last 25 years with a special focus on the recent recession. Despite the rather rigid Italian institutional setting, using linked employer-employee data we find that wage rigidities, albeit always present, have been subdued during the recessionary years. Using complementary data, we verify that, although we only observe daily and not hourly wages, overtime hours are not the main mechanism behind this enhanced wage flexibility. We document the presence of a trade-off between wage and employment adjustments: firms historically displaying higher levels of wage rigidities were less able to modify wages but exhibited higher turnover. A higher share of temporary workers, whose contractual relationship may be costlessly terminated and whose wages are therefore more frequently negotiated, served instead as a significant wage flexibility enhancing margin. More broadly, we find that firms of larger dimension, with a higher share of blue collar workers, or belonging to a sector where bonuses represent a large part of annual earnings were the ones displaying a higher level of wage flexibility.JEL ClassificationJ31, J33

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Gender unemployment gaps in the EU: blame the family

There are considerable differences in gender unemployment gaps across the EU. We use labor force survey data on 21 countries to perform a series of data decompositions and show that the cross-country variation in gender unemployment gaps is primarily driven by the differences in female labor force participation behavior after childbirth, namely, the family leave duration and the subsequent attachment of women to the labor force. Further, in countries where a high share of women permanently withdraw from the labor force after childbirth, the size of gender differences in unemployment strongly correlates with the Eurobarometer measure of perceived overall gender discrimination. Our findings suggest that family leave policies and institutions that facilitate the leave to work transition and the work-family balance are crucial to tackle the gender differences in unemployment in countries where the female unemployment rate exceeds that of men.JEL Classification: J13, J21, J70.

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Τετάρτη 28 Δεκεμβρίου 2016

Prevalence and socio-demographic correlates of physical activity levels among South African adults in Cape Town and Mount Frere communities in 2008-2009

Background: Physical activity has been linked to reduced risk of various cardiometabolic disease, cancer, and premature mortality. We investigated the prevalence and socio-demographic correlates of physical activity among adults in urban and rural communities in South Africa. Methods: This was a cross-sectional survey comprising 1733 adults aged ≥35 years from the Cape Town (urban) and Mount Frere (rural) sites of the Prospective Urban Rural Epidemiology study. Physical activity was assessed using the validated International Physical Activity Questionnaire. Multinomial logistic regressions were used to relate physical activity with socio-demographic characteristics. Results: Overall, 74% of participants engaged in moderate-to-vigorous physical activity. In the adjusted regression models, women were 34% less likely to engage in vigorous physical activity (OR =0.66, 95%-CI = 0.47-0.93). Physical activity decreased with age, varied with marital status, education and occupation, always in differential ways between urban and rural participants (all interactions p ≤ 0.047). For instance, in urban settings, those with secondary education were more likely to engage in moderate physical activity (OR = 2.06, 95%-CI = 1.08-3.92) than those with tertiary education. Single people were more likely to engage in high physical activity (OR = 2.10, 95%-CI = 1.03-4.28) than divorced. Overall, skilled participants were more likely to engage in vigorous physical activity (OR = 2.07, 95%-CI = 1.41-3.05) driven by significant effect in rural area (OR = 2.70, 95%-CI = 1.51-4.83). Urban participants were more likely to engage in moderate physical activity (OR = 1.67, 95%-CI = 1.31-2.13) than rural participants. Conclusions: To prevent chronic diseases among South Africans, attention should be paid to specific policies and interventions aimed at promoting PA among young adults in rural and urban setting, and across the social-economic diversity.

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Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Background: Charcot neuropathic arthropathy (CN) is a chronic, progressive, destructive, non-infectious process that most frequently affects the bone architecture of the foot in patients with sensory neuropathy. We evaluated the outcome of protected weightbearing treatment of CN in unilaterally and bilaterally affected patients and secondarily compared outcomes in protected versus unprotected weightbearing treatment. Methods: Patient records and radiographs from 2002 to 2012 were retrospectively analyzed. Patients with Type 1 or Type 2 diabetes with peripheral neuropathy were included. Exclusion criteria included immunosuppressive or osteoactive medication and the presence of bone tumors. Ninety patients (101 ft), mean age 60.7 ± 10.6 years at first diagnosis of CN, were identified. Protected weightbearing treatment was achieved by total contact cast or custom-made orthosis. Ulcer, infection, CN recurrence, and amputation rates were recorded. Mean follow-up was 48 (range 1–208) months. Results: Per the Eichenholtz classification, 9 ft were prodromal, 61 in stage 1 (development), 21 in stage 2 (coalescence) and 10 in stage 3 (reconstruction). Duration of protected weightbearing was 20 ± 21 weeks and 22 ± 29 weeks in patients with unilateral and bilateral CN, respectively. In bilaterally affected patients, new ulcers developed in 9/22 (41%) feet. In unilaterally affected patients, new ulcers developed in 5/66 (8%) protected weightbearing feet and 4/13 (31%) unprotected, full weightbearing feet (p = 0.036). The ulceration rate was significantly higher in bilaterally versus unilaterally affected patients with a protected weightbearing regimen (p = 0.004). Soft tissue infection occurred in 1/13 (8%) unprotected weightbearing feet and 1/66 (2%) protected weightbearing feet in unilaterally affected patients, and in 1/22 (4%) protected weightbearing feet of bilaterally affected patients. Recurrence and amputation rates were similar across treatment modalities. Conclusions: Bilateral CN results in significantly more ulcers than unilateral CN and leads to slightly higher soft tissue infections. Protected weightbearing in an orthopedic device can reduce the risk for complications in acute CN of the foot and ankle.

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Prevalence and socio-demographic correlates of physical activity levels among South African adults in Cape Town and Mount Frere communities in 2008-2009

Background: Physical activity has been linked to reduced risk of various cardiometabolic disease, cancer, and premature mortality. We investigated the prevalence and socio-demographic correlates of physical activity among adults in urban and rural communities in South Africa. Methods: This was a cross-sectional survey comprising 1733 adults aged ≥35 years from the Cape Town (urban) and Mount Frere (rural) sites of the Prospective Urban Rural Epidemiology study. Physical activity was assessed using the validated International Physical Activity Questionnaire. Multinomial logistic regressions were used to relate physical activity with socio-demographic characteristics. Results: Overall, 74% of participants engaged in moderate-to-vigorous physical activity. In the adjusted regression models, women were 34% less likely to engage in vigorous physical activity (OR =0.66, 95%-CI = 0.47-0.93). Physical activity decreased with age, varied with marital status, education and occupation, always in differential ways between urban and rural participants (all interactions p ≤ 0.047). For instance, in urban settings, those with secondary education were more likely to engage in moderate physical activity (OR = 2.06, 95%-CI = 1.08-3.92) than those with tertiary education. Single people were more likely to engage in high physical activity (OR = 2.10, 95%-CI = 1.03-4.28) than divorced. Overall, skilled participants were more likely to engage in vigorous physical activity (OR = 2.07, 95%-CI = 1.41-3.05) driven by significant effect in rural area (OR = 2.70, 95%-CI = 1.51-4.83). Urban participants were more likely to engage in moderate physical activity (OR = 1.67, 95%-CI = 1.31-2.13) than rural participants. Conclusions: To prevent chronic diseases among South Africans, attention should be paid to specific policies and interventions aimed at promoting PA among young adults in rural and urban setting, and across the social-economic diversity.

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ChemEngine: harvesting 3D chemical structures of supplementary data from PDF files

Digital access to chemical journals resulted in a vast array of molecular information that is now available in the supplementary material files in PDF format. However, extracting this molecular information, generally from a PDF document format is a daunting task. Here we present an approach to harvest 3D molecular data from the supporting information of scientific research articles that are normally available from publisher’s resources. In order to demonstrate the feasibility of extracting truly computable molecules from PDF file formats in a fast and efficient manner, we have developed a Java based application, namely ChemEngine. This program recognizes textual patterns from the supplementary data and generates standard molecular structure data (bond matrix, atomic coordinates) that can be subjected to a multitude of computational processes automatically. The methodology has been demonstrated via several case studies on different formats of coordinates data stored in supplementary information files, wherein ChemEngine selectively harvested the atomic coordinates and interpreted them as molecules with high accuracy. The reusability of extracted molecular coordinate data was demonstrated by computing Single Point Energies that were in close agreement with the original computed data provided with the articles. It is envisaged that the methodology will enable large scale conversion of molecular information from supplementary files available in the PDF format into a collection of ready- to- compute molecular data to create an automated workflow for advanced computational processes. Software along with source codes and instructions available at http://ift.tt/2islzYp abstract.

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Inelastic strain rate in the seismogenic layer of Kyushu Island, Japan

Seismic activity is associated with crustal stress relaxation, creating inelastic strain in a medium due to faulting. Inelastic strain affects the stress field around a weak body and causes stress concentration around the body, because the body itself has already released stress. Therefore, the understanding of inelastic deformation is important as it generates earthquakes. We investigated average inelastic strain in a spatial bin of Kyushu Island, Japan, and obtained the inelastic strain rate distribution associated with crustal earthquakes, based on the analysis of fault plane solutions and seismic moments. Large inelastic strains (>10 −7  year −1 ) were found in the Beppu–Shimabara area, located in the center of Kyushu Island. The strain rate tensor was similar to that of the stress tensor except the absolute value in the area, implying that the inelastic strain was controlled by the stress field. The 2016 Kumamoto earthquake sequence (maximum magnitude 7.3) occurred in the Beppu–Shimabara area, with the major earthquakes located around the high inelastic strain rate area. Inelastic strain in the volume released the stress. In addition, the inelastic strain created an increment of stress around the volume. This indicates that the spatial heterogeneity of inelastic strain might concentrate stress.Graphical abstractInelastic strain rate in the seismogenic layer of Kyushu Island, Japan.

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An adaptive random compressive partial sampling method with TV recovery

Different from standard sampling strategy in compressive sensing (CS), we present a compressive partial sampling framework called adaptive-random sampling and recovery (ASR) for image. It could faithfully recover images by hybridizing random samples with edge-extracted pixels with much lower sampling rate. The new framework preserves edge pixels containing essential information of images, and meanwhile employs the edge-preserving total variation (TV) regularizer. Assisted with the edges, three steps are adopted to recover the high-quality image. First, we extract the edges of a coarse image recovered with completely random measurements in our sampling framework. Then, the TV algorithm in the CS theory is employed for solving the Lagrangian regularization problem. Finally, we refine the coarse image to obtain a high-quality one with both the extracted edges and previous random measurements. Experimental results show that the novel ASR strategy achieves significant performance improvements over the current state-of-the-art schemes.

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Degradation study of lindane by novel strains Kocuria sp. DAB-1Y and Staphylococcus sp. DAB-1W

Background: This study was carried out to isolate and characterize the bacterial strains from lindane-contaminated soil and they were also assessed for their lindane-degrading potential. Methods: In this study the enrichment culture method was used for isolation of  lindane degrading bacterial isolates, in which the mineral salt medium (MSM) supplemented with different concentrations of lindane was used. Further, the screening for the potential lindane degrading isolates was done using the spray plate method and colorimetric dechlorinase enzyme assay. The selected isolates were also studied for their growth response under varying range of temperature, pH, and NaCl. The finally selected isolates DAB-1Y and DAB-1W showing best lindane degradation activity was further subjected to biochemical characterization, microscopy, degradation/kinetic study, and 16S rDNA sequencing. The strain identification were performed using the biochemical characterization, microscopy and the species identifies by 16S rDNA sequence of the two isolates using the standard 16S primers, the 16 S rRNA partial sequence was analyzed through BLAST analysis and phylogenetic tree was generated based on UGPMA clustering method using MEGA7 software. This shows the phylogenetic relationship with the related strains. The two isolates of this study were finally characterized as Kocuria sp. DAB-1Y and Staphylococcus sp. DAB-1W, and their 16S rRNA sequence was submitted to GenBank database with accession numbers, KJ811539 and KX986577, respectively. Results: Out of the 20 isolates, the isolates DAB-1Y and DAB-1W exhibited best lindane-degrading activity of 94 and 98%, respectively, recorded after 8 days of incubation. The optimum growth was observed at temperature 30 °C, pH 7, and 5% NaCl observed for both isolates. Of the four isomers of hexachlorocyclohexane, isomer α and γ were the fastest degrading isomers, which were degraded up to 86 and 94% by isolates DAB-1Y and up to 93 and 98% by DAB-1W, respectively, reported after 8 days incubation. Isomer β was highly recalcitrant in which maximum 35 and 32% lindane degradation was observed even after 28 days incubation by isolates, DAB-1Y and DAB-1W, respectively. At lower lindane concentrations (1–10 mg/L), specific growth rate increased with increase in lindane concentration, maximum being 0.008 and 0.006/day for DAB-1Y and DAB-1W, respectively. The 16 S rRNA partial sequence of isolate DAB-1Y showed similarity with Kocuria sp. by BLAST analysis and was named as Kocuria sp. DAB-1Y and DAB-IW with Staphylococcus sp. DAB-1W. The 16S rDNA sequence of isolate DAB-1Y and DAB-1W was submitted to online at National Centre of Biotechnology Information (NCBI) with GenBank accession numbers, KJ811539 and KX986577, respectively. Conclusions: This study has demonstrated that Kocuria sp. DAB-1Y and Staphylococcus sp. DAB-1W were found efficient in bioremediation of gamma-HCH and can be utilized further for biodegradation of environmental contamination of lindane and can be utilized in bioremediation program.

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Non-human primate model of poly-traumatic hemorrhagic shock recapitulates early platelet dysfunction observed following severe injury in humans.

Background: Platelet dysfunction has been described as an early component of trauma induced coagulopathy (TIC). The platelet component of TIC remains to be fully elucidated and translatable animal models are required to facilitate mechanistic investigations. We sought to determine if the early platelet dysfunction described in trauma patients could be recapitulated in an non-human primate (NHP) model of poly-traumatic hemorrhagic shock. Methods: Twenty-four male Rhesus Macaques weighting 7-14 kilograms were subjected to 60 minutes (min) severe pressure-targeted controlled hemorrhagic shock (HS) with and without other injuries. After 60min, resuscitation with 0.9% NaCl and whole blood was initiated. Platelet counts and platelet aggregation assays were performed at baseline (BSLN), end of shock (T=60min, EOS), end of resuscitation (T=180min, EOR), and T=360min on overall cohort. Results are reported as mean+/-standard deviation (SD) or median (interquartile range). Statistical analysis was conducted using Spearmen correlation, one-way ANOVA, two-way RM-ANOVA, paired t-test or Wilcoxon non-parametric test, with p

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Neuro-, Trauma -, or Med/Surg-ICU: Does it matter where polytrauma patients with TBI are admitted? Secondary analysis of AAST-MITC decompressive craniectomy study.

Introduction: Patients with non-traumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without TBI fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. Methods: This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study. Twelve Level 1 trauma centers provided clinical data and head CT scans of patients with Glasgow Coma Scale (GCS) 15) with TBI and isolated TBI patients (other AIS

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A Novel Method of Optimizing Patient and Family Centered Care in the ICU: Family presence on ICU rounds.

Background: Patient and family centered care permeates critical care where there are often multiple teams involved in management. A method of facilitating information sharing to support shared decision-making is essential in appropriately rendering care. This study sought to determine whether incorporating family members on rounds in the ICU improves patient and family knowledge, and whether doing so improves team time management and satisfaction with the process. Methods: A nonrandomized, comparative before and after trial of incorporating family members on rounds (July-December 2009 vs January-July 2010) in a single quarternary center's Surgical ICU assessed: 1) family member knowledge, 2) nurse and physician satisfaction with the intervention, 3) frequency and timing of family meetings, and 4) physician workflow. Results: ICU demographics and utilization was similar between time frames. PRE (n=412 family; 49 nurse) and POST (n=427 family; 47 nurse) surveys were coupled with PRE (n=5) and POST (n=6) physician informal feedback. Family knowledge of the clinical course and plans increased from 146/412 (35.4%) to 374/427 (87.6%; P

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The Mangled Extremity Score and amputation: Time for a revision.

Background: The Mangled Extremity Severity Score (MESS) was developed 25 years ago in an attempt to utilize the extent of skeletal and soft tissue injury, limb ischemia, shock, and age to predict the need for amputation after extremity injury. Subsequently, there have been mixed reviews as to the utility of this score. We hypothesized that the MESS, when applied to a data set collected prospectively in modern times, would not correlate with the need for amputation. Methods: We applied the MESS to patient data collected in the American Association for the Surgery of Trauma PROspective Vascular Injury Treatment (PROOVIT) registry. This registry contains prospectively collected demographic, diagnostic, treatment, and outcome data. Results: Between 2013 and 2015, 230 patients with lower extremity arterial injuries were entered into the PROOVIT registry. The majority were male with a mean age of 34 years (range 4-92) and a blunt mechanism of injury at a rate of 47.4%. A MESS of 8 or greater was associated with a longer stay in the hospital (median 22.5 (15, 29) vs 12 (6, 21), p=0.006) and ICU (median 6 (2, 13) vs 3 (1, 6), p=0.03). 81.3% of limbs were ultimately salvaged (median MESS 4 (3, 5)) and 18.7% required primary or secondary amputation (median MESS 6 (4, 8), p

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Modeling Acinetobacter baumannii wound infections: The critical role of iron.

Background: Acinetobacter baumannii has emerged as an increasingly important and successful opportunistic human pathogen due to its ability to withstand harsh environmental conditions, its characteristic virulence factors and quick adaptability to stress. Methods: We developed a clinically relevant murine model of A. baumannii traumatic wound infection to determine the effect of local wound environment on A. baumannii virulence. Mice underwent rectus muscle crush injury combined with ischemia created by epigastric vessel ligation, followed by A. baumannii inoculation. Reiterative experiments were performed using 1) a mutant deficient in the production of the siderophore acinetobactin, or 2) iron supplementation of the wound milieu. Mice were euthanized 7 days later and rectus muscle analyzed for signs of clinical infection, HIF1[alpha] accumulation, bacterial abundance and colony morphotype. To determine the effect of wound milieu on bacterial virulence, the Galleria mellonella infection model was utilized. Results: The combination of rectus muscle injury with ischemia and A. baumannii inoculation resulted in 100% incidence of clinical wound infection that was significantly higher compared to other groups (n=15/group, p

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Combat amputees' health-related quality of life and psychological outcomes: A brief report from the Wounded Warrior Recovery Project.

BACKGROUND: This study extends what is known about long-term health-related quality of life (HrQoL) and other psychosocial outcomes (i.e., depression, posttraumatic stress disorder [PTSD]) among US military combat amputees serving in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. METHODS: A total of 63 combat amputees were identified from the Wounded Warrior Recovery Project (WWRP), a study assessing long-term self-reported HrQoL and psychological outcomes among those wounded during military service. Another 477 service members from the WWRP were identified as a comparison group (i.e., nonamputees with moderate to severe extremity injuries). RESULTS: After adjusting for age, time since injury, overall injury severity, and traumatic brain injury, amputees had poorer functional HrQoL than those in the nonamputee comparison group overall and in the specific area related to performance of usual activities, and, to some degree, chronic and acute symptoms, and mobility/self-care. On the other hand, depression and PTSD symptoms were not different for the two groups. CONCLUSIONS: Results suggest that when assessed over 5 years postinjury, on average, amputees have unique physical and functional limitations, yet do not report greater depression or PTSD symptoms than others seriously injured in combat. It may be that state-of-the-art integrated amputee care that includes support networks and emphasis on adjustment and psychological health may increase successful coping and adjustment, at least to a level that is on par with other types of serious combat injury. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III. (C) 2016 Lippincott Williams & Wilkins, Inc.

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Severe injuries associated with skiing and snowboarding: A national trauma data bank study.

Background: Injuries following skiing and snowboarding accidents lead to an estimated 7,000 hospital admissions annually and present a significant burden to the health care system. The epidemiology, injury patterns, hospital resource utilization, and outcomes associated with these severe injuries need further characterization. Methods: The National Trauma Data Bank was queried for the period 2007-2014 for admissions with injury severity score (ISS) >15 and ICD-9 codes 885.3 (fall from skis, n=1,353) and 885.4 (fall from snowboard, n=1,216). Demographics, emergency department data, diagnosis and procedure codes, and outcomes were abstracted from the database. Results: Severe (ISS > 15) ski- and snowboard-associated injuries differed with respect to age distribution (median age [IQR]: 38 [19-59] for skiers and 20 [16-25] for snowboarders, p

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Stapled versus handsewn: A prospective emergency surgery study (SHAPES). An American Association for the Surgery of Trauma multi-institutional study.

Background: Data from the trauma patient population suggests handsewn anastomoses (HS) are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study is to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. Methods: The study was sponsored by the AAST Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from 7/22/2013-12/31/2015. Patients were grouped by HS / ST anastomoses and variables were collected. The primary outcome was anastomotic failure. Similar to other studies, anastomotic failure was evaluated at the anastomosis level. Multivariable logistic regression was performed controlling for age and risk factors for anastomotic failure. Results: Fifteen institutions enrolled a total of 595 patients with 649 anastomoses (253 HS & 396 ST). Mean age was 61-years, 51% were male, 7% overall mortality. Age and sex were the same between groups. The overall anastomotic failure rate was 12.5%. The HS group had higher lactate, lower albumin, and were more likely to be on vasopressors. Hospital and ICU days, as well as mortality, were greater in the HS group. Anastomotic failure rates and operative time were equivalent for HS and ST. On multivariate regression, the presence of contamination at initial resection (OR 1.965; 95% CI 1.183-3.264) and the patient being managed with open abdomen (OR 2.529; 95% CI 1.492-4.286) were independently associated with anastomotic failure, while the type of anastomosis was not. Conclusions: EGS patients requiring bowel resection and anastomosis are at high risk for anastomotic failure. The current study illustrates an apparent bias among acute care surgeons to perform HS techniques in higher risk patients. Despite the individualized application of technique for differing patient populations, the risk of anastomotic failure was equivalent when comparing HS and ST anastomoses. LEVEL OF EVIDENCE: II STUDY TYPE: Therapeutic (C) 2016 Lippincott Williams & Wilkins, Inc.

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Enteral nutrition in traumatic brain injury.

No abstract available

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Traumatic colon injury in damage control laparotomy - A multicenter trial: Is it safe to do a delayed anastomosis?.

Background: Delayed colonic anastomosis after damage control laparotomy (DCL) is an alternative to colostomies during a single laparotomy (SL) in high-risk patients. However, literature suggests increased colonic leak rates up to 27% with DCL, and various reported risk factors. We evaluated our regional experience to determine if delayed colonic anastomosis was associated with worse outcomes. Methods: A multi-center retrospective cohort study was performed across three Level I Trauma Centers encompassing traumatic colon injuries from January 2006 through June 2014. Patients with rectal injuries or mortality within 24 hours were excluded. Patient and injury characteristics, complications, and interventions were compared between SL and DCL groups. Regional readmission data were utilized to capture complications within 6 months of index trauma. Results: Of 267 patients, 69% had penetrating injuries, 21% underwent DCL, and the mortality rate was 4.9%. Overall, 176 received primary repair (26 in DCL), 90 had resection and anastomosis (28 in DCL), and 26 had a stoma created (10 end colostomies and 2 loop ileostomies in DCL). Thirty-five of 56 DCL patients had definitive colonic repair subsequent to their index operation. DCL patients were more likely to be hypotensive; require more resuscitation; and suffer acute kidney injury, pneumonia, adult respiratory distress syndrome, and death. Five enteric leaks (1.9%) and 3 enterocutaneous fistulas (ECF, 1.1%) were identified, proportionately distributed between DCL and SL (p=1.00, p=0.51). No difference was seen in intraperitoneal abscesses (p=0.13) or surgical site infections (SSI, p=0.70) between cohorts. Among SL patients, pancreas injuries portended an increased risk of intraperitoneal abscesses (p=0.0002), as did liver injuries in DCL patients (p=0.06). Conclusions: DCL was not associated with increased enteric leaks, ECF, SSI, or intraperitoneal abscesses despite nearly two-thirds having delayed repair. Despite this being a multicenter study, it is underpowered, and a prospective trial would better demonstrate risks of DCL in colon trauma. Level of Evidence: Therapeutic study, level III. (C) 2016 Lippincott Williams & Wilkins, Inc.

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Resuscitative endovascular balloon occlusion of the aorta in trauma patients in youth.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has received increasing attention for critically uncontrolled hemorrhagic shock. However, the efficacy of REBOA in patients in youth is unknown. Objectives: The aim of this study was to evaluate the mortality and characteristics of patients of age

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Temporary arterial shunts in damage control: Experience and outcomes.

Background: Arterial shunting is a well-described method to control hemorrhage and rapidly re-establish flow, but optimal shunt dwell times remain controversial. We hypothesized that prolonged shunt dwell times of >6 hours are related to adverse outcomes after major arterial injury. Methods: A review (2005-2013) of all patients with arterial shunts placed after traumatic injury at our urban Level-I trauma center was undertaken. Patients who expired prior to shunt removal (n=7) were excluded. Shunt complications were defined as dislodgement, thrombosis and distal ischemia. Patients were compared on the basis of shunt complications with respect to clinical parameters. Results: The 42 patients who underwent arterial shunting after major vascular injury were primarily young (median 26 years, [IQR 22-31]) males (97.6%), severely injured (ISS 17.5 [14-29], shunted vessel AIS 4 [3-4]) by gunshot (85.7%) requiring neck/torso (33.3%), upper (19.1%) or lower (47.6%) extremity shunts. Thirty-five patients survived until shunt removal and 5/35 (14.3%) developed shunt complications. Demographics and clinical characteristics were compared between those with shunt dwell times 6 hours (n=16). While patients appeared to have a greater injury burden overall in the >6 hours group, there were no statistical differences between groups with respect to age, gender, initial SBP or hemodynamics during the shunt dwell period, use of vasopressors, AIS of the shunted vessel, ISS or outcomes including limb amputation or mortality. No patients (0/19) with shunt dwell times 6 hours developed shunt complications (p=0.05). Conclusions: In this civilian series, 14% of patients with arterial shunts developed shunt complications. Our data suggests that limiting shunt dwell times to

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Extra-Corporeal Membrane Oxygenation (ECMO) following traumatic injury.

Background: The use of ECMO for acute respiratory failure following injury is controversial and poorly described. Methods: We reviewed our single-center experience with use of ECMO from January 2006 to November 2015 at a Level 1 primary adult resource center for trauma to determine the association of in-hospital mortality with patient demographics and clinical variables. Results: 46 patients were treated with ECMO. Patients requiring venoarterial ECMO (n=7) were excluded. Thirty-nine (85%) were cannulated for venovenous ECMO. Of these, (44%) patients survived to discharge. Median age was 28 years. Survivors had a lower BMI and PaCO2 at time of cannulation. Non-survivors were more severely injured (median ISS 41 vs. 25, p=0.03), had a lower arterial pH on arrival, and a shorter length of stay (11 vs. 41 days, p=0.006). Neither mechanism of injury nor indication for ECMO were associated with mortality. 41% developed at least one ECMO-related complication, but this was not associated with mortality. 94% of survivors were anticoagulated with heparin vs. 55% of non-survivors (p=0.01). Median ISS and presence of TBI were not significantly different between survivors and non-survivors who were anticoagulated. Conclusions: The use of venovenous ECMO for acute lung injury following trauma should be considered in special patient populations. Ability to tolerate systemic anticoagulation was associated with improved survival. Level of Evidence: Prognostic and epidemiologic study, level III (C) 2016 Lippincott Williams & Wilkins, Inc.

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Re: Enteral nutrition in traumatic brain injury.

No abstract available

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The Coalition for National Trauma Research (CNTR) Supports the Call for a National Trauma Research Action Plan.

No abstract available

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Analysis of aeromedical retrieval coverage using elliptical isochrones: An evaluation of helicopter fleet size configurations in Scotland.

Background: Trauma systems in remote and rural regions often rely on helicopter emergency medical services to facilitate access to definitive care. The siting of such resources is key, but often relies on simplistic modelling of coverage, using circular isochrones. Scotland is in the process of implementing a national trauma network, and there have been calls for an expansion of aeromedical retrieval capacity. The aim of this study was to analyse population and area coverage of the current retrieval service configuration, with three aircraft, and a configuration with an additional helicopter, in the North East of Scotland, using a novel methodology. Both overall coverage and coverage by physician-staffed aircraft, with enhanced clinical capability, were analysed. Methods: Geographical analysis, based on calculation of elliptical isochrones, which consider the "open-jaw" configuration of many retrieval flights. Helicopters are not always based at hospitals. We modelled coverage based on different outbound and inbound flights. Areally-referenced population data were obtained from the Scottish Government. Results: The current helicopter network configuration provides 94.2% population coverage and 59.0% area coverage. The addition of a fourth helicopter would marginally increase population coverage to 94.4%, and area coverage to 59.1%. However, when considering only physician-manned aircraft, the current configuration provides only 71.7% population coverage and 29.4% area coverage, which would be increased to 91.1% and 51.2% respectively with a second aircraft. Conclusions: Scotland's current helicopter network configuration provides good population coverage for retrievals to major trauma centers, which would only be increased minimally by the addition of a fourth aircraft in the North East. The coverage provided by the single physician-staffed aircraft is more limited, however, and would be increased considerably by a second physician-staffed aircraft in the North East. Elliptical isochrones provide a useful means of modelling "open-jaw" retrieval missions, and provide a more realistic estimate of coverage. Level of Evidence: Level IV Study type: Epidemiological study (C) 2016 Lippincott Williams & Wilkins, Inc.

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Paramedic - Sign on Bonus & Relocation assistance available! - REMSA

If you are currently a nationally registered (NREMT) Paramedic or about to graduate a Paramedic program and would like to work for an exciting fast paced, family oriented company we’re looking for you! Many of our Paramedics go on to enhance their careers within our organization as Tactical Medics, Search/Rescue, Instructors, Community Health Paramedics, and Critical Care Flight Medics.

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Transitional cell carcinoma with extension of the renal vein and IVC tumor thrombus: report of three cases and literature review

Background: Transitional cell carcinoma (TCC) originating from the renal pelvis with a venous tumor thrombus is a rare entity. However, clinicians should be aware of it because of its high malignancy and poor prognosis.Case presentationHere, we report three cases of pathologically confirmed TCC originating from the renal pelvis with extension into the renal vein or inferior vena cava (IVC). Of these patients, two are males and one is female (58~73 years old). Their main symptom is flank pain; besides, gross hematuria and weight loss is observed in one of the patients. Computed tomography (CT) scan of the first patient revealed multiple space-occupying lesions in the left renal pelvis and left medium and lower ureter with a tumor thrombus in the left renal vein. CT scan of the second patient revealed a right renal mass and extension into the IVC. Abdominal magnetic resonance imaging (MRI) of the third patient showed a soft tissue mass in the region of the left renal sinus, and the signal of the soft tissue was observed in the left renal vein. The preoperative diagnoses of the first and third patient were TCC, while the second patient was renal cell carcinoma (RCC). Two patients with the preoperative diagnosis of TCC underwent laparoscopic radical nephroureterectomy with thrombectomy, and the other patient underwent radical nephrectomy with thrombectomy. The surgeries were successful. Although two of our patients underwent chemotherapy and radiotherapy, they died 2 and 19 months after the surgery, respectively. The other patient refused any adjuvant therapy and died 3 months after the operation. Conclusions: Compared to the extension of RCC to the renal vein or IVC, extension of TCC to the renal vein or IVC is rare. TCC with a venous tumor thrombus is often misdiagnosed as RCC. However, a correct preoperative or intraoperative diagnosis is of great importance to decide surgical strategy. Laparoscopic radical nephroureterectomy with thrombectomy may be a safe and feasible operative method in treatment of TCC with a renal vein thrombus. The prognosis of such cases is poor even if chemotherapy and radiotherapy are scheduled.

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Transitional cell carcinoma with extension of the renal vein and IVC tumor thrombus: report of three cases and literature review

Background: Transitional cell carcinoma (TCC) originating from the renal pelvis with a venous tumor thrombus is a rare entity. However, clinicians should be aware of it because of its high malignancy and poor prognosis.Case presentationHere, we report three cases of pathologically confirmed TCC originating from the renal pelvis with extension into the renal vein or inferior vena cava (IVC). Of these patients, two are males and one is female (58~73 years old). Their main symptom is flank pain; besides, gross hematuria and weight loss is observed in one of the patients. Computed tomography (CT) scan of the first patient revealed multiple space-occupying lesions in the left renal pelvis and left medium and lower ureter with a tumor thrombus in the left renal vein. CT scan of the second patient revealed a right renal mass and extension into the IVC. Abdominal magnetic resonance imaging (MRI) of the third patient showed a soft tissue mass in the region of the left renal sinus, and the signal of the soft tissue was observed in the left renal vein. The preoperative diagnoses of the first and third patient were TCC, while the second patient was renal cell carcinoma (RCC). Two patients with the preoperative diagnosis of TCC underwent laparoscopic radical nephroureterectomy with thrombectomy, and the other patient underwent radical nephrectomy with thrombectomy. The surgeries were successful. Although two of our patients underwent chemotherapy and radiotherapy, they died 2 and 19 months after the surgery, respectively. The other patient refused any adjuvant therapy and died 3 months after the operation. Conclusions: Compared to the extension of RCC to the renal vein or IVC, extension of TCC to the renal vein or IVC is rare. TCC with a venous tumor thrombus is often misdiagnosed as RCC. However, a correct preoperative or intraoperative diagnosis is of great importance to decide surgical strategy. Laparoscopic radical nephroureterectomy with thrombectomy may be a safe and feasible operative method in treatment of TCC with a renal vein thrombus. The prognosis of such cases is poor even if chemotherapy and radiotherapy are scheduled.

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EMCrit 189 – End of Year Grab Bag

KAWASE-HASUI-QUIET-ELEGANCE-1.jpg?resize

A brain dump at the end of 2016

EMCrit by Scott Weingart.



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Toronto paramedic delivers 3 babies in 3 weeks

By EMS1 Staff

TORONTO — For a Toronto paramedic, three may be his lucky number. 

George Christidis, 53, said in the last three weeks he’s delivered three babies, a streak Toronto Paramedics Service called “really unheard of and a first in recent memory.”

Christidis, a 28-year veteran, said he’s delivered around 20 babies throughout his career. 

“We would deliver between 40 and 60 babies a year, about once a week,” Kim McKinnon, the service’s spokesperson, said. “So he [Christidis] has delivered more than his share out of 1,000 paramedics.”

Christidis recalled one delivery in which he responded to a woman going into labor at her home. Since there was no time to transport the woman to the hospital, Christidis delivered the baby there. 

“Any deliveries that I’ve encountered in the field, everybody’s a little bit nervous. Because they go ‘Are we going to make it to the hospital,’ and at some point I think they realize, ‘I’m not going to make it to the hospital.’ So I think there is some tension there,” Christidis told the Toronto Sun

When asked about his most recent streak, Christidis said, “I’ve honestly never had this many in such a short time. I guess the baby gods were smiling on me.”



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Video: EMS1’s Greg Friese on ambulance theft, security

KXAN interview discussed the growing trend and importance of ambulance security nationwide

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EMCrit 189 – End of Year Grab Bag

KAWASE-HASUI-QUIET-ELEGANCE-1.jpg?resize

A brain dump at the end of 2016

EMCrit by Scott Weingart.



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Analysis of molecular networks and targets mining of Chinese herbal medicines on anti-aging

Background: Many kidney-tonifying Chinese herbal medicines exert effects on anti-aging by comprehensive interactions of multiple targets. However, the interactions of multi-targets targeted by effective ingredients of kidney-tonifying Chinese herbal medicines are unknown. In this study, to explore the systems pharmacology mechanisms of kidney-tonifying Chinese medicines on anti-aging, we establish the molecular networks with the interactions of multi-targets, analyze bio-functions and pathways with IPA, and calculated the mutual interaction pairs of targets (target pairs) with data mining, respectively. Methods: Kidney-tonifying Chinese medicines with anti-aging effects were screened from the Chinese Pharmacopoeia and the literatures. Target proteins of these herbal medicines were obtained from bioinformatics databases. Comparisons of molecular networks, bio-functions and pathways given by Ingenuity Pathway Analysis system showed the similarities and the differences between kidney Yin-tonifying herbal medicines and kidney Yang-tonifying herbal medicines. Target pairs with high correlation related to anti-aging were also discovered by data mining algorithm. And regulatory networks of targets were built based on the target pairs. Results: Twenty-eight kidney-tonifying herbal medicines with anti-aging effects and 717 related target proteins were collected. The main bio-functions that all targets enriched in were “Cell Death and Survival”, “Free Radical Scavenging” and “Cellular Movement”, etc. The results of comparison analysis showed that kidney Yin-tonifying herbal medicines focused more on “Cancer related signaling”, “Apoptosis related signaling” and “Cardiovascular related signaling”. And kidney Yang-tonifying herbal medicines focused more on “Cellular stress and injury related signaling” and “Cellular growth, proliferation and development related signaling”. Moreover, the results of regulatory network showed that the anti-aging related target pairs with high correlated degrees of Kidney Yin-tonifying herbal medicines included TNF-PTGS2, TNF-CASP3, PTGS2-CASP3, CASP3-NOS2 and TNF-NOS2, and that of kidney Yang-tonifying herbal medicines included REAL-TNF, REAL-NFKBIA, REAL-JUN, PTGS2-SOD1 and TNF-IL6. Conclusions: In this study, we achieved some important targets, target pairs and regulatory networks with bioinformatics and data mining, to discuss the systems pharmacology mechanisms of kidney-tonifying herbal medicines acting on anti-aging. Mutual target pairs related to anti-aging found in this study included TNF-PTGS2, TNF-CASP3, PTGS2-CASP3, CASP3-NOS2, TNF-NOS2, REAL-TNF, REAL-NFKBIA, REAL-JUN, PTGS2-SOD1 and TNF-IL6. Target pairs and regulatory networks of targets could reflect more potential interactions between targets and comprehensive effects on anti-aging. Compared with the existing researches, it was found that the kidney-tonifying herbal medicines may exert anti-aging effects in multiple pathways in this study.

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Kinematic and spatiotemporal assessment of habituation to treadmill walking in Labrador retrievers

Background: This study investigated differences in kinematic and spatiotemporal variables in Labrador retrievers during introduction to treadmill walking, with the aim to determine the time required for them to become habituated. Twenty-five healthy, treadmill-naive Labrador retrievers participated in the study. The total angular displacement of the carpus, elbow, tarsus and stifle, as well as stride time and stance duration were calculated from the 3-D tracking of skin mounted reflective markers recorded with 6 infrared light emitting video cameras at 240 Hz. The measurements were done at two walking speeds, 0.78 and 0.96 m/s, in six sessions on the treadmill during two consecutive days. Results: With a 1–2 min acclimatization period following each treadmill speed change, mean values of the study variables were significantly different from the last training session mainly in the first session on the first day. However, between-stride variability was significantly larger for at least one variable even in the fourth session for the slower walking speed, and in the fifth session for the higher walking speed. Conclusions: The results show the importance of proper pre-training of dogs in locomotion studies at walk using a treadmill, and the need to consider not only variable mean values but also between-stride variability, in order to ensure that dogs are sufficiently accustomed to allow collection of reliable data.

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Pathological fractures in predicting clinical outcomes for patients with osteosarcoma

Background: Studies reported contradictory results for the prognostic significance of a pathological fracture in osteosarcoma patients. The aim of this study is to report the outcomes for a cohort of patients with osteosarcoma who presented with and without pathological fractures and to identify the prognostic importance of pathological fracture in predicting outcomes and influences on survival. Methods: Data of patients with osteosarcoma were retrospectively reviewed. Between March 1992 and June 2014, a total of 268 patients with osteosarcoma were included in this analysis, of whom 34 (12.7%) with fractures at diagnosis or sustained after chemotherapy and 234 (87.3%) without fracture. All patients were treated with approaches that integrated chemotherapy and surgical resections to maximal extent of all sites whenever feasible. The association between potential prognostic factors and survival for these patients were analyzed and compared. Results: No significant difference was observed in overall survival, progression free survival, and disease free survival between osteosarcoma patients with pathological fractures and without fracture. The patients without fracture had a 5-year survival of 50% and 10-year survival of 21%, in contrast to 37% (5-year) and 22% (10-year) in patients with fractures. Lung metastasis was the significant predictor for the presence of fractures. Advanced stage (III) of tumor, lung metastasis, poor response to chemotherapy, and local recurrence were associated increased risk for death in all osteosarcoma patients. Conclusion: Pathological fracture is not a predictor of worse survival in this study. Further studies with matched cases are needed to confirm our observations.

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Gene regulatory network inference using PLS-based methods

Background: Inferring the topology of gene regulatory networks (GRNs) from microarray gene expression data has many potential applications, such as identifying candidate drug targets and providing valuable insights into the biological processes. It remains a challenge due to the fact that the data is noisy and high dimensional, and there exists a large number of potential interactions. Results: We introduce an ensemble gene regulatory network inference method PLSNET, which decomposes the GRN inference problem with p genes into p subproblems and solves each of the subproblems by using Partial least squares (PLS) based feature selection algorithm. Then, a statistical technique is used to refine the predictions in our method. The proposed method was evaluated on the DREAM4 and DREAM5 benchmark datasets and achieved higher accuracy than the winners of those competitions and other state-of-the-art GRN inference methods. Conclusions: Superior accuracy achieved on different benchmark datasets, including both in silico and in vivo networks, shows that PLSNET reaches state-of-the-art performance.

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Serum biomarkers and changes in clinical/MRI evidence of golimumab-treated patients with ankylosing spondylitis: results of the randomized, placebo-controlled GO-RAISE study

Background: In the present study, we evaluated relationships between serum biomarkers and clinical/magnetic resonance imaging (MRI) findings in golimumab-treated patients with ankylosing spondylitis. Methods: In the GO-RAISE study, 356 patients with ankylosing spondylitis randomly received either placebo (n = 78) or golimumab 50 mg or 100 mg (n = 278) injections every 4 weeks through week 24 (placebo-controlled); patients continuing GO-RAISE received golimumab through week 252. Up to 139/125 patients had sera collected for biomarkers/serial spine MRI scans (sagittal plane, 1.5-T scanner). Two blinded readers employed modified ankylosing spondylitis spine magnetic resonance imaging score for activity (ASspiMRI-a) and ankylosing spondylitis spine magnetic resonance imaging score for chronicity. Spearman correlations (r s ) were assessed between serum biomarkers (n = 73) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive-protein (CRP)-based Ankylosing Spondylitis Disease Activity Score (ASDAS), modified Stokes Ankylosing Spondylitis Spine Score (mSASSS), and ASspiMRI scores. Serum biomarkers predicting postbaseline spinal fatty lesion development and inflammation were analyzed by logistic regression. Results: Significant, moderately strong correlations were observed between baseline inflammatory markers interleukin (IL)-6, intracellular adhesion molecule-1, complement component 3 (C3), CRP, haptoglobin, and serum amyloid-P and baseline ASDAS (r s  = 0.39–0.66, p ≤ 0.01). Only baseline leptin significantly correlated with ASDAS improvement at week 104 (r s  = 0.55, p = 0.040), and only baseline IL-6 significantly predicted mSASSS week 104 change (β = 0.236, SE = 0.073, p = 0.002, model R 2  = 0.093). By logistic regression, baseline leptin, C3, and tissue inhibitor of metalloproteinase (TIMP)-1 correlated with new fatty lesions per spinal MRI at week 14 and week 104 (both p < 0.01). Changes in serum C3 levels at week 4 (r s  = 0.55, p = 0.001) and week 14 (r s  = 0.49, p = 0.040) significantly correlated with BASDAI improvement at week 14. Baseline IL-6 and TIMP-1 (r s  = −0.63, −0.67; p < 0.05) and reductions at week 4 in IL-6 (r s  = 0.61, p < 0.05) and C3 (r s  = 0.72; p < 0.05) significantly correlated with week 14 ASspiMRI-a improvement. Conclusions: Extensive serum biomarker multiparametric analyses in golimumab-treated patients with ankylosing spondylitis demonstrated few correlations with disease activity or MRI changes; IL-6 weakly correlated with radiographic progression.Trial registrationClinicalTrials.gov identifier: NCT00265083. Registered on 12 December 2005.

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China’s community-based strategy of universal preconception care in rural areas at a population level using a novel risk classification system for stratifying couples´ preconception health status

Background: Preconception care (PCC) is recommended for optimizing a woman’s health prior to pregnancy to minimize the risk of adverse pregnancy and birth outcomes. We aimed to evaluate the impact of strategy and a novel risk classification model of China´s “National Preconception Health Care Project” (NPHCP) in identifying risk factors and stratifying couples’ preconception health status. Methods: We performed a secondary analysis of data collected by NPHCP during April 2010 to December 2012 in 220 selected counties in China. All couples enrolled in the project accepted free preconception health examination, risk evaluation, health education and medical advice. Risk factors were categorized into five preconception risk classes based on their amenability to prevention and treatment: A-avoidable risk factors, B- benefiting from targeted medical intervention, C-controllable but requiring close monitoring and treatment during pregnancy, D-diagnosable prenatally but not modifiable preconceptionally, X-pregnancy not advisable. Information on each couple´s socio-demographic and health status was recorded and further analyzed. Results: Among the 2,142,849 couples who were enrolled to this study, the majority (92.36%) were from rural areas with low education levels (89.2% women and 88.3% men had education below university level). A total of 1463266 (68.29%) couples had one or more preconception risk factors mainly of category A, B and C, among which 46.25% were women and 51.92% were men. Category A risk factors were more common among men compared with women (38.13% versus 11.24%; P = 0.000). Conclusions: This project provided new insights into preconception health of Chinese couples of reproductive age. More than half of the male partners planning to father a child, were exposed to risk factors during the preconception period, suggesting that an integrated approach to PCC including both women and men is justified. Stratification based on the new risk classification model demonstrated that a majority of the risk factors are avoidable, or preventable by medical intervention. Therefore, universal free PCC can be expected to improve pregnancy outcomes in rural China.

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Assessing key cost drivers associated with caring for chronic kidney disease patients

Background: To examine key factors influencing chronic kidney disease (CKD) patients’ total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality. Methods: Using the 2002–2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records—79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant. Covariate information included region, demographic, co-morbid conditions and types of services. We used descriptive methods and multivariate generalized linear models to understand the impact of cost drivers. We compared actual and predicted CKD cost of care data using a hold-out sample of nine, randomly selected patients to validate the models. Results: Total costs were significantly affected by treatment type, with dialysis being significantly higher than non-dialysis and transplant groups. Costs were highest in the West region of the U.S. Average costs for patients with public insurance were significantly higher than patients with private insurance (p < .0743), and likewise, for patients with co-morbid conditions over those without co-morbid conditions (p < .001). Conclusions: Managing CKD patients both before and after the onset of dialysis treatment and managing co-morbid conditions in individuals with CKD are potential sources of substantial cost savings in the care of CKD patients. Comparing total costs pre and post the United States Affordable Care Act could provide invaluable insights into managing the cost-quality tradeoff in CKD care.

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Expansion of the molecular and morphological diversity of Acanthamoebidae (Centramoebida, Amoebozoa) and identification of a novel life cycle type within the group

Background: Acanthamoebidae is a “family” level amoebozoan group composed of the genera Acanthamoeba, Protacanthamoeba, and very recently Luapeleamoeba. This clade of amoebozoans has received considerable attention from the broader scientific community as Acanthamoeba spp. represent both model organisms and human pathogens. While the classical composition of the group (Acanthamoeba + Protacanthamoeba) has been well accepted due to the morphological and ultrastructural similarities of its members, the Acanthamoebidae has never been highly statistically supported in single gene phylogenetic reconstructions of Amoebozoa either by maximum likelihood (ML) or Bayesian analyses. Results: Here we show using a phylogenomic approach that the Acanthamoebidae is a fully supported monophyletic group within Amoebozoa with both ML and Bayesian analyses. We also expand the known range of morphological and life cycle diversity found in the Acanthamoebidae by demonstrating that the amoebozoans “Protostelium” arachisporum, Dracoamoeba jormungandri n. g. n. sp., and Vacuolamoeba acanthoformis n.g. n.sp., belong within the group. We also found that “Protostelium” pyriformis is clearly a species of Acanthamoeba making it the first reported sporocarpic member of the genus, that is, an amoeba that individually forms a walled, dormant propagule elevated by a non-cellular stalk. Our phylogenetic analyses recover a fully supported Acanthamoebidae composed of five genera. Two of these genera (Acanthamoeba and Luapeleameoba) have members that are sporocarpic. Conclusions: Our results provide high statistical support for an Acanthamoebidae that is composed of five distinct genera. This study increases the known morphological diversity of this group and shows that species of Acanthamoeba can include spore-bearing stages. This further illustrates the widespread nature of spore-bearing stages across the tree of Amoebozoa.ReviewersThis article was reviewed by Drs. Eugene Koonin, Purificacion Lopez-Garcia and Sandra Baldauf. Sandra Baldauf was nominated by Purificacion Lopez-Garcia, an Editorial Board member.

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Normal saline as resuscitation fluid in critically ill patients: not dead yet!

No description available

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Analysis of molecular networks and targets mining of Chinese herbal medicines on anti-aging

Background: Many kidney-tonifying Chinese herbal medicines exert effects on anti-aging by comprehensive interactions of multiple targets. However, the interactions of multi-targets targeted by effective ingredients of kidney-tonifying Chinese herbal medicines are unknown. In this study, to explore the systems pharmacology mechanisms of kidney-tonifying Chinese medicines on anti-aging, we establish the molecular networks with the interactions of multi-targets, analyze bio-functions and pathways with IPA, and calculated the mutual interaction pairs of targets (target pairs) with data mining, respectively. Methods: Kidney-tonifying Chinese medicines with anti-aging effects were screened from the Chinese Pharmacopoeia and the literatures. Target proteins of these herbal medicines were obtained from bioinformatics databases. Comparisons of molecular networks, bio-functions and pathways given by Ingenuity Pathway Analysis system showed the similarities and the differences between kidney Yin-tonifying herbal medicines and kidney Yang-tonifying herbal medicines. Target pairs with high correlation related to anti-aging were also discovered by data mining algorithm. And regulatory networks of targets were built based on the target pairs. Results: Twenty-eight kidney-tonifying herbal medicines with anti-aging effects and 717 related target proteins were collected. The main bio-functions that all targets enriched in were “Cell Death and Survival”, “Free Radical Scavenging” and “Cellular Movement”, etc. The results of comparison analysis showed that kidney Yin-tonifying herbal medicines focused more on “Cancer related signaling”, “Apoptosis related signaling” and “Cardiovascular related signaling”. And kidney Yang-tonifying herbal medicines focused more on “Cellular stress and injury related signaling” and “Cellular growth, proliferation and development related signaling”. Moreover, the results of regulatory network showed that the anti-aging related target pairs with high correlated degrees of Kidney Yin-tonifying herbal medicines included TNF-PTGS2, TNF-CASP3, PTGS2-CASP3, CASP3-NOS2 and TNF-NOS2, and that of kidney Yang-tonifying herbal medicines included REAL-TNF, REAL-NFKBIA, REAL-JUN, PTGS2-SOD1 and TNF-IL6. Conclusions: In this study, we achieved some important targets, target pairs and regulatory networks with bioinformatics and data mining, to discuss the systems pharmacology mechanisms of kidney-tonifying herbal medicines acting on anti-aging. Mutual target pairs related to anti-aging found in this study included TNF-PTGS2, TNF-CASP3, PTGS2-CASP3, CASP3-NOS2, TNF-NOS2, REAL-TNF, REAL-NFKBIA, REAL-JUN, PTGS2-SOD1 and TNF-IL6. Target pairs and regulatory networks of targets could reflect more potential interactions between targets and comprehensive effects on anti-aging. Compared with the existing researches, it was found that the kidney-tonifying herbal medicines may exert anti-aging effects in multiple pathways in this study.

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Gene regulatory network inference using PLS-based methods

Background: Inferring the topology of gene regulatory networks (GRNs) from microarray gene expression data has many potential applications, such as identifying candidate drug targets and providing valuable insights into the biological processes. It remains a challenge due to the fact that the data is noisy and high dimensional, and there exists a large number of potential interactions. Results: We introduce an ensemble gene regulatory network inference method PLSNET, which decomposes the GRN inference problem with p genes into p subproblems and solves each of the subproblems by using Partial least squares (PLS) based feature selection algorithm. Then, a statistical technique is used to refine the predictions in our method. The proposed method was evaluated on the DREAM4 and DREAM5 benchmark datasets and achieved higher accuracy than the winners of those competitions and other state-of-the-art GRN inference methods. Conclusions: Superior accuracy achieved on different benchmark datasets, including both in silico and in vivo networks, shows that PLSNET reaches state-of-the-art performance.

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Can longitudinal generalized estimating equation models distinguish network influence and homophily? An agent-based modeling approach to measurement characteristics

Background: Connected individuals (or nodes) in a network are more likely to be similar than two randomly selected nodes due to homophily and/or network influence. Distinguishing between these two influences is an important goal in network analysis, and generalized estimating equation (GEE) analyses of longitudinal dyadic network data are an attractive approach. It is not known to what extent such regressions can accurately extract underlying data generating processes. Therefore our primary objective is to determine to what extent, and under what conditions, does the GEE-approach recreate the actual dynamics in an agent-based model. Methods: We generated simulated cohorts with pre-specified network characteristics and attachments in both static and dynamic networks, and we varied the presence of homophily and network influence. We then used statistical regression and examined the GEE model performance in each cohort to determine whether the model was able to detect the presence of homophily and network influence. Results: In cohorts with both static and dynamic networks, we find that the GEE models have excellent sensitivity and reasonable specificity for determining the presence or absence of network influence, but little ability to distinguish whether or not homophily is present. Conclusions: The GEE models are a valuable tool to examine for the presence of network influence in longitudinal data, but are quite limited with respect to homophily.

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