Mean Length Research Articles

Comparative shoot morphology between cultivated Utricularia bremii plants and those growing in natural habitats in the Czech Republic

In summer 2023, the morphometry of large adult plants of Utricularia bremii was studied in an outdoor culture and at three shallow pools in two oligotrophic sand-pits in South Bohemia, Czech Republic, with a focus on shoot length and biomass, shoot branching traits and ecological conditions. Overall, the mean length of main shoots was 34-43 cm (range 23-73 cm) and the shoots bore on average 11-18 branches of three orders. On main shoots, branches were initiated on average every 7.7-9.2 internodes, which indicates a very fast propagation and growth. A new branch is theoretically initiated every ca. 3.3-3.8 days. This study confirms that shallow, well-lit, oligomesotrophic, soft-water sand-pit pools may represent an ecological optimum for this species.

Patterns of Acute Ischemic Stroke Treatment from 2010 to 2020: An Evolving Landscape in Stroke Management Following Thrombectomy Trials.

Population-based studies on stroke can help guide the care of patients with acute ischemic stroke (AIS) by providing health care communities with information regarding the current usage of stroke treatments. It remains unclear how rapidly new techniques, particularly endovascular stroke treatment (EST), are being adopted and whether there is any disparity in their availability. Although studies using the National Inpatient Sample (NIS) have been conducted, updated studies over a longer period may provide further insights. This study aimed to understand patterns of AIS treatment, discharge disposition, in-hospital mortality, and mean length of stay (LOS) for each modality from 2010 to 2020 using the NIS database. This retrospective longitudinal study was conducted using NIS data from 2010 to 2020. Patients were categorized into groups based on whether they received intravenous recombinant tissue plasminogen activator (rt-PA), EST, both rt-PA and EST (combined therapy), or supportive care alone. Demographic, socioeconomic, regional, insurance, and hospital data were also obtained. The primary outcome was the proportion of patients receiving each modality, whereas the secondary outcomes were in-hospital mortality, mean LOS, and discharge disposition. The usage rates increased (p < 0.001) in all groups between 2010 and 2020 (rt-PA: 5.09% to 8.39%, EST: 0.31% to 4.40%, and rt-PA+EST: 0.46% to 1.09%). The highest increase in usage was observed for EST, with a thirteen-fold increase. Mortality decreased from 2010 to 2020 in all groups (rt-PA: 8.45% to 3.54%, EST: 25.22% to 12.50%, and rt-PA+EST: 21.12% in 2010 to 9.30%) (p < 0.001). Combination therapy demonstrated the greatest improvement, with an 11.2% reduction in absolute mortality. Mean LOS was reduced for patients who received rt-PA (6.8 to 4.8 days), EST (9.3 to 8.9 days), and combined therapy (10.0 to 8.3 days) (p < 0.001) over the study period. The proportion of patients discharged to home increased for rt-PA (29.01% to 41.85%), EST (14.13% to 17.70%), and combined therapy (12.89% to 24.29%) (p < 0.001). Overall, stroke treatment usage was higher among the higher income groups, regardless of race. Higher usage was also observed for Whites in the West and Hispanic ethnicities in the South and West. Regardless of income or treatment method, utilization rates were lower for Black patients. Utilization rates were lower for Black patients with Medicare, Medicaid, or self-pay than for White patients. Our study demonstrated that endovascular stroke treatment continues to expand, leading to better outcomes for mortality, LOS, and home discharge. Despite these positive patterns, there are visible inequities across regions, income status, and races.

Lefort 1 Osteotomy Study of Maxillary Bone in Caprine Skull Model: Comparison of Different Osteotomy Techniques (Piezo Versus Lindemann Bur Versus Manual Chisel).

In this study, we aimed to compare the efficiency of different osteotomy techniques for Lefort 1 osteotomy in an experimental caprine skull model. Twelve caprine skulls were used for the study. Skulls were divided into 3 groups: (1) manual chisel group, (2) Lindemann bur group, and (3) piezo osteotomy group. Bilateral osteotomies were performed on each skull. Results were evaluated with three-dimensional computerized tomography scans and macroscopic observations of the mucosal tears and soft tissue. The mean length of the bone gap in the manual, Lindemann, and piezo groups was 4.8 (±0.7), 3.38 (±1.49), and 1.39 (±0.3) mm, respectively (P < 0.05). The mean number of comminuted fractures in the manual, Lindemann, and piezo groups was 5.5 (±1.4), 1.6 (±0.3), and 0.6 (±0.5), respectively (P < 0.05). Mucosal tearing and soft tissue damage based on subjective inspection observations were negligible in the piezo technique. Soft tissue and mucosal damage were observed significantly more in the manual chisel osteotomy method compared with the other 2 techniques. We anticipate that piezo, which has started to be used in new application areas besides rhinoplasty, will continue to be used more widely, especially in reconstructive orthognathic surgery, due to the minimal damage it causes to tissues. With the long-term results, much healthier interpretations can be made.

Resilience and Value: Pediatric Trauma Care in Safety Net Hospitals.

Background: In the setting of limited funding and high expectations for quality care, safety net hospitals play a crucial role in treating pediatric trauma patients. This study aimed to compare outcomes and hospitalization costs of pediatric trauma patients in safety net hospitals across the United States. Methods: The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18years hospitalized for traumatic injury. Patients admitted to safety net hospitals were propensity matched 1:1 to all other patients. The primary outcome was mortality. The secondary outcomes were readmission within 1-year, mean length of stay (LOS), total charges, and total hospitalization costs including readmissions. Results: There were 176,325 patients meeting inclusion criteria, and 30,869 were admitted to safety net hospitals. All safety net patients were successfully matched across predictors, and 61,738 patients were included. The overall mortality rate was 1.4% (n = 834), and the mortality risk was similar in safety net hospitals (OR 1.11 [.96-1.27] P = .15). The overall readmission rate, mean LOS, and mean total cost were similar for safety net hospitals when compared to all hospitals. However, the overall mean total charge was $78,724 (±$224,884) and was lower in safety net hospitals ($76,575 [±$198,342], P = .02). Discussion: Safety net hospitals deliver comparable outcomes as other health care facilities when caring for pediatric trauma patients. Notably, these hospitals appear to undercharge for their services, despite incurring similar costs in the process. These results shed light on the resilience of safety net hospitals in delivering quality and cost-effective care.

The complete anatomy of the iliolumbar artery: a meta-analysis with clinical implications.

The arterial anatomy of the pelvic region is highly variable, and variations in the anatomy of the ILA may often be observed in its point of origin. The main objective of the present meta-analysis was to provide the most up-to-date and evidence-based data regarding the complete anatomy of the iliolumbar artery (ILA. It is hoped that our results may aid in reducing possible complications associated with various procedures performed in the pelvis. To perform this meta-analysis, major online medical databases - PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar - were searched through to find all studies considering the anatomy of the ILA. The pooled prevalence of the ILA originating from the Internal Iliac Artery, in the overall analysis, was found to be 93.62% (95% CI: 82.96-99.63%). Mean diameter of the ILA was found to be 2.67 mm (Standard Error = 0.19 ; Lower Limit = 2.29 ; Upper Limit = 3.05). Mean length of the ILA was established at 12.50 mm (Standard Error = 1.64 ; Lower Limit = 9.28 ; Upper limit = 15.73). The anatomy of the ILA was found to be quite constant, in contrast to what has been discussed in the literature. The said artery originated most frequently from the internal iliac artery (93.62%). Most frequently, this artery originated from the internal iliac artery (observed in approximately 93.62% of cases). Notably, the results of our current meta-analysis indicate that the average distance between the ILA's point of origin, the lower margin of the L5 vertebra, and the bifurcation site of the common iliac artery were 43.20 mm and 28.58 mm, respectively.

Transcription Decisions of Conjoined Independent Clauses Are Equitable Across Dialects but Impact Measurement Outcomes.

Transcription of conjoined independent clauses within language samples varies across professionals. Some transcribe these clauses as two separate utterances, whereas others conjoin them within a single utterance. As an inquiry into equitable practice, we examined rates of conjoined independent clauses produced by children and the impact of separating these clauses within utterances on measures of mean length of utterance (MLU) by a child's English dialect, clinical status, and age. The data were archival and included 246 language samples from children classified by their dialect (African American English or Southern White English) and clinical status (developmental language disorder [DLD] or typically developing [TD]), with those in the TD group further classified by their age (4 years [TD4] or 6 years [TD6]). Rates of conjoined independent clauses and the impact of these clauses on MLU varied by clinical status (DLD < TD) and age (TD4 < TD6), but not by dialect. Correlations between the rate of conjoined clauses, MLU, and language test scores were also similar across the two dialects. Transcription decisions regarding conjoined independent clauses within language samples lead to equitable measurement outcomes across dialects of English. Nevertheless, transcribing conjoined independent clauses as two separate utterances reduces one's ability to detect syntactic differences between children with and without DLD and document syntactic growth as children age. https://doi.org/10.23641/asha.25822675.

Sharp needle reconstructs peripheral outflow for patients with malfunctional arteriovenous fistula

Objective To investigate the feasibility and efficacy of combining ultrasound-guided sharp needle technique with percutaneous transluminal angioplasty (PTA) for treating outflow stenosis or dysfunction in arteriovenous fistula (AVF) among hemodialysis patients. Methods From October 2021 to March 2023, patients with occluded or malfunctional fistula veins not amenable to regularly angioplasty were retrospectively enrolled in the study. They underwent ultrasound-guided sharp needle intervention followed by PTA. Data on the location and length between the two veins, technical success, clinical outcomes, and complications were collected. Patency rates post-angioplasty were calculated through Kaplan-Meier analysis. Results A total of 23 patients were included. The mean length of the reconstructed extraluminal segment was 3.18 cm. The sharp needle opening was performed on the basilic vein (60.9%), brachial vein (26.1%), or upper arm cephalic vein (13%) to create outflow channels. Postoperatively, all cases presented with mild subcutaneous hematomas around the tunneling site and minor diffuse bleeding. The immediate patency rate for the internal fistulas was 100%, with 3-month, 6-month, and 12-month patency rates at 91.3%, 78.3%, and 43.5%, respectively. Conclusion Sharp needle technology merged with PTA presents an effective and secure minimally invasive method for reconstructing the outflow tract, offering a new solution for recanalizing high-pressure or occluded fistulas.

Risk of stroke in women using levonorgestrel-releasing intra-uterine device (IUD) for contraception.

Background: The commonly used combined hormonal contraceptives with progestins and ethinylestradiol are associated with an increased risk of ischemic stroke (IS). Progestin-only preparations, including levonorgestrel-releasing intra-uterine devices (LG-IUD), are not associated with an increased risk, and in smaller studies, the risk is even reduced. The risk of intracerebral hemorrhage (ICH) has never been investigated. We studied the risk of IS and ICH in women using LG-IUDs compared to women not using hormonal contraceptives. Methods: In this Danish historical cohort study (2004-2021) we followed non-pregnant women (18-49 years) registering incident IS and ICH in relation to use of LG-IUD/non-use of hormonal contraceptives utilizing Danish high-quality registries with nation-wide coverage. Poisson regression models adjusting for age, ethnicity, education, calendar-year, and medication use for risk factors were applied. Results: A total of 1,681,611 non-pregnant women contributed 11,971,745 person-years (py) of observation. Mean age at inclusion was 30.0 years; mean length of follow-up was 7.1 years; 2916 women (24.4 per 100,000 py) had IS; 367 (3.1 per 100,000 py) had ICH. Of these 364,784 were users of LG-IUD contributing 1,720,311 py to the investigation; mean age at start of usage was 34.6 years. Non-users of hormonal contraceptives contributed 10,251,434 py; mean age at inclusion was 30.0 years. Incidence rate of IS/ICH among LG-IUD users was 19.2/3.0 and among non-users it was 25.2/3.1 per 100,000 py. After adjustment incidence rate ratio for IS was 0.78 (CI: 0.70; 0.88), and for ICH it was 0.94 (CI: 0.69; 1.28). Conclusions:Use of LG-IUD was associated with a 22% lower incidence rate of IS without raising incidence rate of ICH. The finding raises the question of whether levonorgestrel, in addition to its contraceptive properties, could have the potential to prevent IS.

How syntactic complexity indices predict Chinese L2 writing quality: An analysis of unified dependency syntactically-annotated corpus

Previous syntactic complexity (SC) research on L2 Chinese has overlooked a range of Chinese-specific structures and fine-grained indices. This study, utilizing a syntactically annotated Chinese L2 writing corpus, simultaneously employs both large-grained and fine-grained syntactic complexity indices to investigate the relationship between syntactic complexity and writing quality produced by English-speaking Chinese second language (ECSL) learners from macro and micro perspectives. Our findings reveal the following: (a) at a large-grained level of analysis using syntactic complexity indices, the generic syntactic complexity indice (GSC indice) number of T-units per sentence and the Chinese-specific syntactic complexity indice (CSC indice) number of Clauses per topic chain unit account for 14.5% of the total variance in writing scores among ECSL learners; (b) the syntactic diversity model alone accounts for 24.7% of the variance in Chinese writing scores among ECSL learners; (c) the stepwise regression analysis model, which integrates fine-grained SC indices extracted from the syntactically annotated corpus, explains 43.7% of the variance in Chinese writing quality. This model incorporates CSC indices such as average ratio of dependency types per 30 dependency segments, the ratio of adjuncts to sentence end, the ratio of predicate complements, the ratio of numeral adjuncts, the mean length of Topic-Comment-Unit dependency distance, as well as GSC indices like the ratio of main governors, the ratio of attributers, the ratio of coordinating adjuncts, and the ratio of sentential objects. These findings highlight the valuable insights that syntactically annotated fine-grained SC indices offer regarding the writing characteristics of ECSL learners.

Variables that predict hospital stay and the outcome of Fournier gangrene at King Abdulaziz University Hospital: a retrospective study

BackgroundThe aggressive nature of Fournier gangrene and the associated health issues can result in a more complex clinical course and potentially a longer hospital stay. This study aimed to assess factors that affect the length of hospital stay (LHS) and its relation to the outcome of Fournier gangrene patients.MethodsA retrospective study was performed at King Abdulaziz University Hospital (KAUH), Saudi Arabia, on patients diagnosed with Fournier gangrene between 2017 and 2023. Data about length of hospital stay (LHS), age, BMI, clinical and surgical data and outcome was obtained.ResultsThe mean age of the studied patients was 59.23 ± 11.19 years, the mean body mass index (BMI) was 26.69 ± 7.99 kg/m2, and the mean duration of symptoms was 10.27 ± 9.16 days. The most common presenting symptoms were swelling or induration (64%), 88% had comorbidities with diabetes mellitus (DM) (84%), and 76% had uncontrolled DM. of patients, 24% had a poly-microbial infection, with E. coli being the most common (52%). The mean length of hospital stay (LHS) was 54.56 ± 54.57 days, and 24% of patients had an LHS of more than 50 days. Longer LHS (> 50 days) was associated with patients who did not receive a compatible initial antibiotic, whereas shorter LHS was associated with patients who received Impenem or a combination of vancomycin and meropenem as alternative antibiotics following incompatibility. Reconstruction patients had significantly longer LHS and a higher mean temperature. However, none of the studied variables were found to be predictors of long LHS in the multivariate regression analysis.ConclusionKnowledge of the values that predict LHS allows for patient-centered treatment and may be useful in predicting more radical treatments or the need for additional treatment in high-risk patients. Future multicenter prospective studies with larger sample sizes are needed to assess the needed variables and predictors of long LHS.

RIGHT AXILLARY MINI–THORACOTOMY FOR MINIMALLY INVASIVE MITRAL SURGERY: A 5–YEAR SINGLE–CENTER EXPERIENCE

Abstract Objectives To report early– and long–term outcomes of patients undergoing minimally invasive mitral surgery (MIMS) through right axillary mini–thoracotomy (RAMT) over a 5–year period. Methods From July 2016 to December 2021, a total of 172 patients underwent MIMS through RAMT at “Vito Fazzi” Hospital. Results Mitral valve diseases were degenerative (62.8%), rheumatic (13.9%), functional (13.4%), Barlow (5.2%), and endocarditis (4.7%) mitral disease. Mitral valve repair was performed in 142 patients (82.5%) and 30 (17.5%) had mitral replacement. Repair techniques included neochordae implantation (53.5%), isolated annuloplasty (28.9%), leaflet resection (11.3%), sliding plasty (4.9%) and Alfieri procedure (0.7%). Furthermore, in 29 patients (16,8%) concomitant procedures were associated. All cardiac procedures were performed under direct vision and without using thoracoscopes. Mean length of skin incision under the armpit (fig 1) was 5.7 ± 1.3 cm. Of note, conversion to median sternotomy occurred only in 2 (1.2%) cases. Stroke incidence was 0.9% and in–hospital mortality 0.5%. Overall survival and freedom from reoperation at 5 years were 91.5% and 99.1%, respectively (fig 2). Conclusions RAMT access for MIMS is a safe and reproducible approach associated with low mortality and morbidity, the possibility to perform complex mitral surgery under direct vision, high rate of mitral valve repair, and excellent late results. Importantly, limited skin incision under the armpit provided excellent aesthetic results.

Demographics, psychiatric comorbidities, and hospital outcomes across eating disorder types in adolescents and youth: insights from US hospitals data

ObjectiveThe aim of our study was to delineate the differences in demographics, comorbidities, and hospital outcomes by eating disorder types in adolescents and transitional-age youth (15–26 years), and measure the association with psychiatric comorbidities.MethodsWe conducted a cross-sectional study using the nationwide inpatient sample (2018–2019) and included 7,435 inpatients (age 12–24 years) with a primary diagnosis of eating disorders: anorexia nervosa (AN, 71.7%), bulimia nervosa (BN, 4.7%), avoidant/restrictive food intake disorder (ARFID, 9.5%), and other. We used independent logistic regression models controlled for demographics to evaluate the adjusted odds ratio association of comorbidities with eating disorder types.ResultsThe mean age of BN inpatients was 17.5 years, which was significantly higher compared to the total number of inpatients with eating disorders (15.9 years). Approximately four-fifths of the inpatients with AN and BN were female patients whereas ARFID was seen in a higher proportion of male patients (32.6% vs. 13.7% overall). Anxiety (57.5%) and depressive (47.3%) disorders were prevalent in the total number of inpatients with eating disorders, with suicidal behaviors seen significantly higher in BN (25.7% vs. 12.9% overall). The likelihood of obsessive compulsive–related disorder was higher in all eating disorder types, i.e., AN (OR 2.14), BN (OR 1.79), and ARFID (OR 1.74); however, anxiety (OR 1.52) and neurodevelopmental (OR 1.70) disorders were significantly higher in ARFID. In terms of hospital outcomes, inpatients with ARFID had a longer mean length of stay (13.7 days vs. 8.4 days in BN) and higher mean total charges ($87,747 vs. $44,882 in BN).ConclusionOur findings identify notable demographic and clinical distinctions within inpatients diagnosed with AN, BN, and ARFID. Specifically, inpatients with BN belonging to older age brackets manifest elevated occurrences of depressive disorders and suicidal tendencies. ARFID is linked to prolonged hospitalization and increased costs, underscoring distinctive complexities in care. This highlights the significance of personalized interventions that account for demographic variations and psychiatric comorbidities, aiming to improve outcomes for diverse populations affected by eating disorders.

Assessing the response of marine fish communities to climate change and fishing.

Globally, marine fish communities are being altered by climate change and human disturbances. We examined data on global marine fish communities to assess changes in community-weighted mean temperature affinity (i.e., mean temperatures within geographic ranges), maximum length, and trophic levels, which, respectively, represent the physiological, morphological, and trophic characteristics of marine fish communities. Then, we explored the influence of climate change and fishing on these characteristics because of their long-term role in shaping fish communities, especially their interactive effects. We employed spatial linear mixed models to investigate their impacts on community-weighted mean trait values and on abundance of different fish lengths and trophic groups. Globally, we observed an initial increasing trend in the temperature affinity of marine fish communities, whereas the weighted mean length and trophic levels of fish communities showed a declining trend. However, these shift trends were not significant, likely due to the large variation in midlatitude communities. Fishing pressure increased fish communities' temperature affinity in regions experiencing climate warming. Furthermore, climate warming was associated with an increase in weighted mean length and trophic levels of fish communities. Low climate baseline temperature appeared to mitigate the effect of climate warming on temperature affinity and trophic levels. The effect of climate warming on the relative abundance of different trophic classes and size classes both exhibited a nonlinear pattern. The small and relatively large fish species may benefit from climate warming, whereas the medium and largest size groups may be disadvantaged. Our results highlight the urgency of establishing stepping-stone marine protected areas to facilitate the migration of fishes to habitats in a warming ocean. Moreover, reducing human disturbance is crucial to mitigate rapid tropicalization, particularly in vulnerable temperate regions.

Better outcomes using suture button compared to screw fixation in talofibular syndesmotic injuries of the ankle: a level I evidence-based meta-analysis.

The present meta-analysis evaluated current level I clinical trials which compared the use of a suture button (SB) versus syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. It was hypothesised that SB might achieve better PROMs along with a lower rate of complications. This study was conducted according to the 2020 PRISMA statement. In August 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed. All the randomised controlled trials (RCTs) which compared SB versus SS fixation for syndesmosis injuries of the ankle were accessed. Data concerning the American Orthopaedic Foot & Ankle Society (AOFAS), and Olerud-Molander score (OMS) were collected at baseline and at last follow-up. Data on implant failure, implant removal, and joint malreduction were also retrieved. Data from seven RCTs (490 patients) were collected. 33% (161 of 490) were women. The mean length of the follow-up was 30.8 ± 27.4months. The mean age of the patients was 41.1 ± 4.1years. Between the two groups (SB and SS), comparability was found in the mean age, and men:women ratio. The SS group evidenced lower OMS (P = 0.0006) and lower AOFAS (P = 0.03). The SS group evidenced a greater rate of implant failure (P = 0.0003), implant removal (P = 0.0005), and malreduction (P = 0.04). Suture button fixation might perform better than the syndesmotic screw fixation in syndesmotic injuries of the ankle.

Surgical treatment of Nutcracker Syndrome

The objective of this paper is to report early and mid-term outcomes of the surgical treatment Nutcracker Syndrome (NCS) in a single-center prospective study. Between January 2019 and September 2023, five patients with symptomatic NCS were treated at our center using left renal vein caudal transposition on the inferior vena cava, conducted through a midline incision of approximately 12 cm and a transperitoneal technique. Patient characteristics, presentation, length of hospital stay, and complications were analyzed. All diagnoses were established after clinical evaluation, ultrasound scanning, and radiological investigations, which confirmed left renal vein compression between the aorta and the Superior Mesenteric Artery (SMA). The average operating time was 159 minutes, with an average blood loss of 205 mL. There was no need for blood transfusions. Intensive care stay was not required and there were no early complications. The mean length of stay was 3.5 days. At a mean follow-up of 18.8 months, one patient reported persistent hematuria, and therefore underwent a secondary procedure, which incorporated patch venoplasty using the great saphenous vein. In our experience, left renal vein transposition appears to be a safe and effective procedure for the surgical management of severe NCS.

Indications and Short-Term Outcomes of Conventional Mechanical Ventilation in a Neonatal Intensive Care Unit of a Tertiary Care Hospital in a Developing Country

Background: Mechanical ventilation is an advanced intervention employed in neonatal intensive care units (NICUs) to assist neonates who require external ventilation for adequate gas exchange, while minimizing associated complications. Understanding the indications and short-term outcomes of mechanical ventilation is crucial for improving neonatal care, especially in developing countries with limited resources. Objective: To examine the indications and short-term outcomes of conventional mechanical ventilation in a neonatal intensive care unit of a tertiary care hospital in a developing country. Methods: This descriptive cross-sectional study was conducted from July 2022 to February 2023 in the Department of Paediatrics at Combined Military Hospital, Kharian. The study included 227 pediatric patients admitted to the NICU for mechanical ventilation, selected via consecutive non-probability sampling. Written informed consent was obtained from parents or guardians. Data collected included neonatal and pregnancy parameters, primary indication for mechanical ventilation, duration of mechanical ventilation, and length of hospital stay. Patients were monitored for complications such as pneumothorax, sepsis, and ventilator-associated pneumonia. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0. Quantitative variables were expressed as mean ± standard deviation or median and interquartile range, while qualitative variables were presented as frequencies and percentages. Comparisons were made using the Chi-square test, Fisher's exact test, independent samples t-test, or Mann-Whitney U test as appropriate, with a p-value of ≤0.05 considered significant. Results: The study included 128 males (56.4%) and 99 females (43.6%). The mean gestational age at birth was 36.4 ± 1.5 weeks, and the mean birth weight was 2994.1 ± 450.1 grams. Common indications for mechanical ventilation included pneumonia (26.4%), respiratory distress syndrome (24.7%), and sepsis (18.5%). The mean duration of mechanical ventilation was 7.1 ± 2.5 days, and the mean length of hospital stay was 13.4 ± 6.0 days. Complications were observed in 29.5% of patients, with ventilator-associated pneumonia (18.1%) being the most common, followed by sepsis (9.7%) and pneumothorax (5.3%). The overall mortality rate was 18.5%. Significant associations were found between mortality and duration of mechanical ventilation (p&lt;0.001), occurrence of complications (p&lt;0.001), and requirement for re-intubation (p&lt;0.001). Conclusion: The study highlights the significant association between prolonged mechanical ventilation, the development of complications, and increased mortality in neonates. Effective strategies to prevent and manage complications, as well as to limit the duration of mechanical ventilation, are essential to improve neonatal outcomes in resource-limited settings.

Association of Admission Temperature and Outcome among Neonates with Sepsis in a Tertiary Care Hospital

Background: Neonatal sepsis is a leading cause of mortality in the neonatal period, particularly in low- and middle-income countries. Temperature at admission may provide valuable prognostic information for managing critically ill neonates. Objective: This study aimed to determine the association between admission temperature and outcomes in neonates with sepsis, including mortality rates, length of hospital stay, and the requirement for intensive interventions. Methods: This descriptive cross-sectional study was conducted from July 2022 to February 2023 in the Department of Paediatrics, Combined Military Hospital, Kharian. A total of 170 neonates diagnosed with sepsis were enrolled using non-probability, consecutive sampling. Informed, written consent was obtained from parents or guardians. Temperature was recorded at admission using a mercury thermometer in the axilla. Hypothermia was defined as a body temperature &lt;36.5°C, hyperthermia as &gt;37.5°C, and normothermia as 36.5-37.5°C. Blood and urine samples were collected for culture. Data were analyzed using SPSS version 25. Quantitative variables were expressed as mean ± standard deviation or median with interquartile range, and qualitative variables as frequencies and percentages. Comparisons were made using Chi-square, Fisher’s exact test, ANOVA, and independent samples t-test, with a significance level of p ≤ 0.05. Results: Of the 170 neonates, 94 (55.3%) were male and 76 (44.7%) were female. Hypothermia was present in 50 (29.4%) neonates, normothermia in 35 (20.6%), and hyperthermia in 85 (50.0%). Blood culture positivity was highest in hyperthermic neonates (61.2%), followed by hypothermic (36.0%) and normothermic (17.1%) neonates (p &lt; 0.001). The mean length of hospital stay was 13.1 ± 4.1 days for hyperthermic neonates, 9.1 ± 2.3 days for hypothermic, and 6.3 ± 2.9 days for normothermic neonates (p &lt; 0.001). Mortality rates were 31.8% for hyperthermic neonates, 14.0% for hypothermic, and 5.7% for normothermic (p = 0.002). Conclusion: Admission temperature in neonates with sepsis is significantly associated with clinical outcomes. Hyperthermic neonates have higher mortality rates, increased blood culture positivity, and longer hospital stays compared to normothermic and hypothermic neonates. Measuring body temperature at admission can aid in risk stratification and management decisions.

Secondary production of the central rangeland region of the United States.

Rangelands are the dominant land use across a broad swath of central North America where they span a wide gradient, from <350 to >900 mm, in mean annual precipitation. Substantial efforts have examined temporal and spatial variation in aboveground net primary production (ANPP) to precipitation (PPT) across this gradient. In contrast, net secondary productivity (NSP, e.g., primary consumer production) has not been evaluated analogously. However, livestock production, which is a form of NSP or primary consumer production supported by primary production, is the dominant non-cultivated land use and an integral economic driver in these regions. Here, we used long-term (mean length = 19 years) ANPP and NSP data from six research sites across the Central Great Plains with a history of a conservative stocking to determine resource (i.e., PPT)-productivity relationships, NSP sensitivities to dry-year precipitation, and regional trophic efficiencies (e.g., NSP:ANPP ratio). PPT-ANPP relationships were linear for both temporal (site-based) and spatial (among site) gradients. The spatial PPT-NSP model revealed that PPT mediated a saturating relationship for NSP as sites became more mesic, a finding that contrasts with many plant-based PPT-ANPP relationships. A saturating response to high growing-season precipitation suggests biogeochemical rather than vegetation growth constraints may govern NSP (i.e., large herbivore production). Differential sensitivity in NSP to dry years demonstrated that the primary consumer production response heightened as sites became more xeric. Although sensitivity generally decreased with increasing precipitation as predicted from known PPT-ANPP relationships, evidence suggests that the dominant species' identity and traits influenced secondary production efficiency. Non-native northern mixed-grass prairie was outperformed by native Central Great Plains rangeland in sensitivity to dry years and efficiency in converting ANPP to NSP. A more comprehensive understanding of the mechanisms leading to differences in producer and consumer responses will require multisite experiments to assess biotic and abiotic determinants of multi-trophic level efficiency and sensitivity.

Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study.

Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar. This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations. The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709). Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.

Association of Morphology of Lenticulostriate Arteries and Proximal Plaque Characteristics With Single Subcortical Infarction: A Whole-Brain High-Resolution Vessel Wall Imaging Study.

We aimed to investigate the association of characteristics of lenticulostriate artery (LSA) morphology and parental atheromatous disease (PAD) with single subcortical infarction (SSI) and to explore whether the LSA morphology is correlated with proximal plaque features in asymptomatic PAD. Patients with acute SSI were prospectively enrolled and classified as large- and small-SSI groups. The clinical data and imaging features of LSA morphology (branches, length, dilation, and tortuosity) and middle cerebral artery plaques (normalized wall index, remodeling index, enhancement degree, and hyperintense plaques) were evaluated. Logistic regression was performed to determine the association of large SSIs with morphologic features of LSAs and plaques. The Spearman correlation between the morphologic characteristics of LSAs and plaque features in asymptomatic PAD was analyzed. Of the 121 patients recruited with symptomatic PAD, 102 had coexisting asymptomatic contralateral PAD. The mean length of LSAs (odds ratio, 0.84 [95% CI, 0.73-0.95]; P=0.007), mean tortuosity of LSAs (odds ratio, 1.13 [95% CI, 1.05-1.22]; P=0.002), dilated LSAs (odds ratio, 22.59 [95% CI, 2.46-207.74]; P=0.006), and normalized wall index (odds ratio, 1.08 [95% CI, 1.01-1.15]; P=0.022) were significantly associated with large SSIs. Moreover, the normalized wall index was negatively correlated with the mean length of LSAs (r=-0.348, P<0.001), and the remodeling index was negatively correlated with the mean tortuosity of LSAs (r=-0.348, P<0.001) in asymptomatic PAD. Our findings suggest that mean length of LSAs, mean tortuosity of LSAs, dilated LSAs, and normalized wall index are associated with large SSIs. Moreover, plaque features in asymptomatic PAD are correlated with morphologic features of LSAs.