Ten-year Study Period Research Articles

7 Alcohol Use Acuity and Burn Mortality: A Ten-Year Retrospective Analysis

Abstract Introduction The high incidence of alcohol consumption nationally is linked to increased susceptibility for burn injuries in both cases of acute intoxication as well as chronic misuse. While detection of elevated blood ETOH levels on admission intuitively does not always reflect a patient’s history of use, it does introduce bias and can influence clinical decision-making. Understanding these inherent biases at play, our institution through a retrospective analysis, sought to investigate the differing effects a positive blood alcohol level and true chronic alcohol use disorder had on overall mortality within our burn center. Methods We conducted a retrospective analysis utilizing data from the Institutional Burn Center Registry, which was linked to clinical and administrative records. Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022. We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes. Using logistic regression modeling we evaluated the association between burn mortality and ETOH. Results Over the ten-year study period, a total of 9,955 adult patients were admitted to our burn center. 6,943 tested negative and 541 patients tested positive for blood ETOH on admission. The remaining 2,471 had no test. 567 were determined to have a diagnosis of alcohol use disorder. A positive for ETOH did not have significant impact on mortality (p=0.76) while history of chronic ETOH use had a nearly three-fold increase in odds of mortality (OR 2.58, CI 1.52-4.24, p=0.000) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury. Conclusions Chronic alcoholism has a greater association with mortality than acute alcohol intoxication at our institution. Further, clinicians should exercise caution when presuming alcohol use disorder solely based on a positive test. This highlights the necessity of accurate medical history taking when estimating and counseling patients on mortality risk. Applicability of Research to Practice This emphasizes the pressing need for research into the effects of multiple comorbidities and social determinants on mortality among burn patients. The insights gained have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.

Surgical demands of patients attending an Oral and Maxillofacial Surgery clinic in a Nigerian Hospital

Objectives: Reports on most performed oral and maxillofacial surgical procedures (OMSPs) are scarce globally. This study aimed to determine the pattern of surgical demands of patients attending oral and maxillofacial surgery services at the University of Benin Teaching Hospital, Edo State, Nigeria. Materials and Methods: A retrospective study was conducted on patients managed in the Department of Oral and Maxillofacial Surgery from March 2011 to April 2021. Data were collected from theatre logbooks and case notes of patients who had surgery. The data collected were the age of patients, gender, employment status, educational status, residential distance to the hospital, and type of surgery performed. Descriptive statistics were done using the IBM Statistical Package for the Social Sciences statistics for Windows version 20 (Armonk, NY: IBM Corp) software. Results: A total number of 550 patients were seen in the ten-year study period. The age of the patients ranges between 2 and 97 years. The mean age was 23.5 ± 2.08 years. More than half (55.6%) of the patients were male. The highest (47.1%) number of patients that had OMSP had only primary education, followed by tertiary education (25.1%), secondary (17.8%), and no formal education (10.0%). Cleft lip and palate repairs were the most common surgical demands (34.5%), followed by mandibulectomy, open reduction, and fixation. The least surgical demands were neck dissections (0.36%), and none (0.0%) of the patients had cosmetic surgery. Conclusion: The most common surgical demand by patients was cleft lip and palate repairs, while neck dissection was the least common demand, respectively.

ОБЕСПЕЧЕНИЕ ПРОДОВОЛЬСТВЕННОЙ БЕЗОПАСНОСТИ ЗА СЧЕТ ИМПОРТОЗАМЕЩЕНИЯ МОЛОКА

The scientific article conducts a theoretical and economic study of the problems of ensuring food security through import substitution, import and export of milk. A review of the scientific literature showed the relevance of the study; many domestic and foreign scientists are directing their scientific interests to the development of an effective mechanism for ensuring the development of agricultural production sectors, and in particular the dairy product complex. In the field of interest of scientists are the problems of ensuring growth in production volumes, the prospects for reducing and completely eliminating the import of milk, as well as the possibility of increasing milk exports in certain regions. For the period from 2013 to 2022, according to official statistics, we observe an increase in milk production volumes, while in 2015 a decrease of 0.4% was detected, and in 2016 by 0.3%. Over the past three years, milk imports do not exceed 18% of the total dairy resource, which indicates food security at the level of 83%. The growth rate of milk exports significantly exceeds the growth rate of its imports; their value has crossed the mark of 114%. It was revealed that the growth of milk volumes was significantly influenced by the annual increase in cow productivity in the ten-year study period; a decrease in milk production volumes was observed in those periods when the number of animals decreased significantly. A slight decrease in milk production volumes in 2015 and 2016 did not have a detrimental effect on milk sales volumes; milk sales volumes, according to official statistics, have been trending upward over the past 10 years.

Epidemiology of aquaporin-4-IgG-positive NMOSD in Sardinia

PurposeThe Italian Island of Sardinia (population, 1,578,146) is recognized for the high risk of multiple sclerosis (MS) but the epidemiological burden of other less common demyelinating diseases of the central nervous system (CNS), such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), is unknown. In this study, we determined the incidence and prevalence of AQP4-IgG+NMOSD in Sardinia over a ten-year study period (2013–2022). MethodsPatients with a diagnosis of AQP4-IgG+NMOSD (per 2015 IPND diagnostic criteria) were retrospectively identified using two sources: (1) Archives of the reference and only laboratory for AQP4-IgG testing in Sardinia; and (2) medical records of the four MS units in the island. Incidence (January 2013–December 2022) and prevalence (December 31, 2022) were calculated. ResultsA total of 45 cases were included: incident, 31; prevalent, 41. The median age (range) at disease presentation was 51 (6–78) years; female/male ratio was 9:1. The crude (95 % CI) incidence and prevalence were 1.9 (1.3–2.7) per million and 2.6 (1.9–3.5) per 100,000, respectively. Prevalence increased from 2013 (1.1 per 100,000) to 2022 (2.6 per 100,000); p = 0.002. After age-standardization to the world, incidence and prevalence (95 % CI) decreased to 1.3 (0.7–2) per million and 1.8 (1.3–2.3) per 100,000, respectively. Coexisting immune-mediated disorders, mostly autoimmune thyroiditis, were reported in 50 % of patients. ConclusionsThe epidemiology of AQP4-IgG+NMOSD in Sardinia is overall in line with other Caucasian populations. The high MS risk in the island seems disease-specific and not associated with an increased risk of other CNS demyelinating disorders, confirming different pathophysiology.

Interactions between sustainable development goals at the district level in Lao PDR

Monitoring the status and evolution of Sustainable Development Goals (SDGs) is typically carried out at the national level. However, significant variation can exist within countries, and this may not be captured by aggregate statistics. Here, we develop a unique dataset representing indicators for three SDGs at a district level for Lao PDR. The indicators comprise prevalence of stunting (SDG 2, Zero hunger), poverty headcount (SDG 1, No Poverty), and share of natural area (SDG 15, Life on land) for two moments in time: 2005 and 2015. In both years, we find considerable variation among district-level outcomes for stunting and poverty. We also find that higher stunting and poverty rates are significantly correlated with higher shares of natural land in both years. This is consistent with the common perception of a trade-off between environmental outcomes and socioeconomic wellbeing. The correlation vanishes, however, when we consider changes in poverty, stunting, and natural area over the ten-year study period. This holds as well when we focus on agricultural land instead of natural areas. We observe that most regions show improvements in both stunting and poverty, albeit not always in a statistically significant sense. This points to synergistic development. Similarly, improvements in both indicators are associated with losses in natural areas in all regions, indicating a trade-off. These results suggest that both trade-offs and synergies between SDGs can arise at the district level, but that context and local conditions likely moderate the strength of these interactions. Our results highlight the importance of quantifying and monitoring sustainable development at the detailed subnational level.

Neonatal bacteraemia in Ireland: A ten-year single-institution retrospective review.

Neonatal sepsis is a catastrophic condition of global concern, with reported mortality rates exceeding 10%. Bloodstream infections are an important cause of sepsis, and epidemiological studies of these infections are crucial for predicting the most common aetiological agents and antimicrobial susceptibility patterns and for developing antimicrobial guidelines. For the ten-year study period from July 2013 to June 2023, all neonatal bacteraemia cases were reviewed prospectively using an enhanced surveillance protocol. The patients were stratified according to their age at the time of blood culture collection: early onset if diagnosed in the first 72 hours of life, and late onset if diagnosed after that time. During the study period, 170 blood cultures were positive from 144 patients, of which 89 specimens from 64 patients represented the growth of significant pathogens. Coagulase-negative staphylococci (CoNS) were the most common pathogens identified (52%, 33/64), followed by Escherichia coli (14%, 9/64), Group B Streptococcus (GBS: 11%, 7/64) and Staphylococcus aureus (11%, 7/64). GBS was more commonly identified in early onset patients, while CoNS were predominantly associated with late onset. The presence of an intravascular catheter, maternal urinary tract infections and the receipt of total parenteral nutrition or transfused blood were identified as significant risk factors. The fatality rate was 8% (5/64). in summary, this study provides a detailed overview of the epidemiology of neonatal bacteraemia in a large teaching hospital in the Midwest of Ireland over a decade.

Urban Streetscape Changes in Portland, Oregon: A Longitudinal Virtual Audit

Streetscape imagery has considerable potential for observing urban change. The literature lacks sufficient longitudinal studies, however, on urban change considering human perception and activities. We conducted a longitudinal virtual audit to observe the change in urban liveliness, human activities, and built environment by examining streetscape imagery taken in the late 2000s and the late 2010s in Portland, Oregon. Eleven untrained crowd workers were recruited to provide liveliness ratings of 24,242 streetscape images for both periods. Tabulation, mapping, and multilevel regression analyses were conducted to observe the distribution, changes in liveliness, and the factors affecting these changes. The results confirmed that the city had become livelier during the ten-year study period, which was spatially associated with the increase in pedestrians and cyclists and particular elements of the built environment, such as mid- and high-rise buildings and sidewalk signs. Although these results were somewhat expected, this study’s value lies in confirming the potential of virtual audits conducted using Google Street View Time Machine for retrospectively examining subjective and objective urban change. Caution should be exercised, though, while interpreting urban change as temporal conditions (e.g., season, weather, and irregular events) can potentially bias the results in longitudinal studies.

Rapid access chest pain clinic; insights from 10 years of an australian experience

Abstract Introduction Rapid Access Chest Pain Clinic (RACPC) has been established in the UK as a safe and cost-effective model for managing low to intermediate Cardiovascular Disease (CVD) risk chest pain patients. In our institute, this service was established in 2012 based on the UK model. Purpose This study aimed to assess the safety, efficacy, and cost-effectiveness of the RACPC at a large metropolitan health service in Australia to inform future models of care. Patients and Methods: We conducted a retrospective analysis of consecutive patients who attended RACPC between 2012 and 2022. Patients aged 25-85 years with low to intermediate CVD risk chest pain and no previously known ischaemic heart disease were included. RACPC staff comprised of a multidisciplinary team of cardiologists, nurse practitioners, and cardiology liaison nurses. The primary outcome was to benchmark our clinic model against national peers. The secondary outcome was to examine the pattern and accuracy of requested cardiac imaging used in RACPC, identify the frequency of incidental findings resulting from imaging and determine the cost-effectiveness of RACPC. Results Over the ten-year study period, a total of 4,194 patients were seen. The median waiting time from referral to consultation was 15.5 days (5 - 21.5). Attendance rates gradually increased from 71% to 95% in the clinic's tenth year of operation. Furthermore, the number of missed appointments and cancellations decreased over the years, reaching 1% and 4%, respectively. A total of 1,758 CT Coronary Angiogram (CTCA); 1,629 functional assessments utilising either Transthoracic Stress Echocardiogram (TSE) or Myocardial Perfusion Scan (MPS), and 174 Invasive Angiography (IA) procedures were requested. 1.2% of the cohort had IA without any prior non-invasive cardiac imaging. CTCA was the most frequently requested modality and resulted in the highest rates of incidental findings (24%) such as pulmonary nodules and vascular anomalies, often leading to further investigations. The rate of non-invasive cardiac imaging resulting in IA for CTCA, TSE and MPS were 7.3%, 2.5%, and 6.4%, respectively. Revascularisation rate for positive IA, CTCA, TSE and MPS were 33.3%, 34.6%, 26.7% and 20% respectively. At our health service, and for the purpose of comparison, we encountered an average of 52 patients/year with low to intermediate CVD risk hospitalised for chest pain assessment with an average length of stay of 2.35 days at a cost of 250,000 Australian Dollars ($4808/patient). Whilst at RACPC, an average of 419 patients/year were seen with a total cost of around 62,400 A$ ($149/patient). Conclusion RACPC is a safe, efficient, and cost-effective model of care, with CTCA being the preferred modality of imaging due to its high diagnostic accuracy, high negative predictive value and high rate of significant incidental findings.

Utilization of Health Services Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic.

Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years before until five years after diagnosis in the specialist Rural and Remote Memory Clinic (RRMC). Clinical and administrative health data of RRMC patients were linked. Annual health service utilization of the cohort (N = 436) was analyzed for 416 patients pre-index (57.5% female, mean age 71.2 years) and 419 post-index (56.3% female, mean age 70.8 years). Approximately 40% of memory clinic diagnoses were Alzheimer's disease (AD), 20% non-AD dementia, and 40% mild or subjective cognitive impairment or other condition. Post-index, 188 patients (44.9%) moved to permanent long-term care and were retained in the sample; 121 patients died (28.9%) and were removed yearly. Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all p <.001). The highest proportion of patients hospitalized was observed one year pre-index, the highest average number of specialist visits was observed one year post-index, and both demonstrated a significant decreasing trend in the five-year post-index period (p = .037). A pattern of increasing FP visits and drug prescriptions over an extended period before and after diagnosis in a specialist rural and remote memory clinic highlights a need to support FPs in post-diagnostic management. Further research of longitudinal patterns in health service utilization is merited.

China nationwide landscape of 16 types inherited metabolic disorders: a retrospective analysis on 372,255 clinical cases

BackgroundInherited metabolic disorders (IMDs) usually occurs at young age and hence it severely threatening the health and life of young people. While so far there lacks a comprehensive study which can reveals China’s nationwide landscape of IMDs. This study aimed to evaluate IMDs incidence and regional distributions in China at a national and province level to guide clinicians and policy makers.MethodsThe retrospective study conducted from January 2012 to March 2021, we analyzed and characterized 372255 cases’ clinical test information and diagnostic data from KingMed Diagnostics Laboratory. The samples were from 32 provincial regions of China, the urine organic acids were detected by gas chromatography-mass spectrometry (GC–MS), amino acids and acylcarnitines in dried blood spots were detected by liquid chromatography-tandem mass spectrometry (LC–MS/MS). We did a statistical analysis of the distribution of the 16 most common IMDs in amino acid disorders and organic acidemias, and then paid special attention to analyze the age and regional distributions of different IMDs. The statistical analyses and visualization analysis were performed with the programming language R (version 4.2.1).ResultsThere were 4911 positive cases diagnosed, which was 1.32% of the total sample during the ten-year study period. Most diseases tended to occur at ages younger than 18 year-old. The Ornithine Transcarbamylase Deficiency tended to progress on male infants who were less than 28 days old. While the peak of the positive case number of Citrin Deficiency disease (CD) was at 1–6 months. Different IMDs’ had different distribution patterns in China’s provinces. Methylmalonic Acidemias and Hyperphenylalaninemia had an imbalanced distribution pattern in China and its positive rate was significantly higher in North China than South China. Conversely, the positive rate of CD was significantly higher in South China than North China.ConclusionsResults of this work, such as the differences in distribution pattern of different diseases in terms of age, region, etc. provide important insights and references for clinicians, researchers and healthcare policy makers. The policy makers could optimize the better health screening programs for covering children and infants in specific ages and regions based on our findings.

Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients

ObjectiveWeighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication.MethodsAll patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed.Results585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001).ConclusionThe lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.

Human tolerance to extreme heat: evidence from a desert climate population.

Ambient temperatures exceeding 40 °C are projected to become common in many temperate climatic zones due to global warming. Therefore, understanding the health effects of continuous exposure to high ambient temperatures on populations living in hot climatic regions can help identify the limits of human tolerance. We studied the relationship between ambient temperature and non-accidental mortality in the hot desert city of Mecca, Saudi Arabia, between 2006 and 2015. We used a distributed lag nonlinear model to estimate the mortality-temperature association over 25 days of lag. We determined the minimum mortality temperature (MMT) and the deaths that are attributable to heat and cold. We analyzed 37,178 non-accidental deaths reported in the ten-year study period among Mecca residents. The median average daily temperature was 32 °C (19-42 °C) during the same study period. We observed a U-shaped relationship between daily temperature and mortality with an MMT of 31.8 °C. The total temperature-attributable mortality of Mecca residents was 6.9% (-3.2; 14.8) without reaching statistical significance. However, extreme heat, higher than 38 °C, was significantly associated with increased risk of mortality. The lag structure effect of the temperature showed an immediate impact, followed by a decline in mortality over many days of heat. No effect of cold on mortality was observed. High ambient temperatures are projected to become future norms in temperate climates. Studying populations familiar with desert climates for generations with access to air-conditioning would inform on the mitigation measures to protect other populations from heat and on the limits of human tolerance to extreme temperatures. We studied the relationship between ambient temperature and all-cause mortality in the hot desert city of Mecca. We found that Mecca population is adapted to high temperatures, although there was a limit to tolerance to extreme heat. This implies that mitigation measures should be directed to accelerate individual adaptation to heat and societal reorganization.

Years of life lost due to unintentional drug overdose among perinatal individuals in the United States

BackgroundThe United States has one of the highest maternal mortality rates of developing countries, but the contribution of perinatal drug overdose is not known. Communities of color also have higher rates of maternal morbidity and mortality when compared to White communities, however the contribution due to overdose has not yet been examined in this population. ObjectivesTo quantify the years of life lost due to unintentional overdose in perinatal individuals from 2010 to 2019 and assess for disparity by race.Study Design: This was a cross-sectional retrospective study with summary-level mortality statistics for the years 2010–2019 obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) mortality file. A total of 1,586 individuals of childbearing age (15–44 years) who died during pregnancy or six weeks postpartum (perinatal) from unintentional overdose in the United States from January 1, 2010 to December 31, 2019 were included. Total years of life lost (YLL) was calculated and summated for White, Black, Hispanic, Asian/Pacific Islander, and American Indian/Native Alaska women. Additionally, the top three overall causes of death were also identified for women in this age group for comparison. ResultsUnintentional drug overdose accounted for 1,586 deaths and 83,969.78 YLL in perinatal individuals from 2010 to 2019 in the United States. Perinatal American Indian/Native American individuals had a disproportionate amount of YLL when compared to other ethnic groups, with 2.39% of YLL due to overdose, while only making up 0.80% of the population. During the last two years of the study, only American Indian/Native American and Black individuals had increased rates of mortality when compared to other races. During the ten-year study period, when including the top three causes of mortality, unintentional drug overdoses made up 11.98% of the YLL overall and 46.39% of accidents. For the years 2016–2019, YLL due to unintentional overdose was the third leading cause of YLL overall for this population. ConclusionsUnintentional drug overdose is a leading cause of death for perinatal individuals in the United States, claiming nearly 84,000 years of life over a ten-year period. When examining by race, American Indian/Native American women are most disproportionately affected.

Integrating random forest and synthetic aperture radar improves the estimation and monitoring of woody cover in indigenous forests of South Africa

Woody canopy cover (CC) is important for characterising terrestrial ecosystems and understanding vegetation dynamics. The lack of accurate calibration and validation datasets for reliable modelling of CC in the indigenous forests in South Africa contributes to uncertainties in carbon stock estimates and limits our understanding of how they might influence long-term climate change. The aim of this study was to develop a method for monitoring CC in the Dukuduku indigenous forest in South Africa. Advanced Land Observing Satellite (ALOS) Phased Arrayed L-band Synthetic Aperture Radar (PALSAR) global mosaics of 2008, 2015, and 2018, polarimetric features, and Grey Level Co-occurrence Matrix (GLCMs) were used. Machine learning models Random Forest (RF) vs Support Vector Machines (SVM) were developed and calibrated using Collect Earth Online (CEO) data, a free and open-access land monitoring tool developed by the Food and Agriculture Organisation (FAO). The addition of GLCMs produced the highest accuracy in 2008, R2 (RMSE) = 0.39 (36.04%), and in 2015, R2 (RMSE) = 0.51 (27.82%), and in 2018, only SAR variables gave the highest accuracy R2 (RMSE) = 0.55 (29.50). The best-performing models for 2008, 2015, and 2018 were based on RF. During the ten-year study period, shrubland and wooded grassland had the highest transition, at 6% and 13%, respectively. The observed changes in the different canopies provide valuable insights into the vegetation dynamics of the Dukuduku indigenous forest. The modelling results suggest that the CEO calibration data can be improved by integrating airborne LiDAR data.

A 10-year microbiological study of Pseudomonas aeruginosa strains revealed the circulation of populations resistant to both carbapenems and quaternary ammonium compounds

Pseudomonas aeruginosa is one of the leading causes of healthcare-associated infections. For this study, the susceptibility profiles to antipseudomonal antibiotics and a quaternary ammonium compound, didecyldimethylammonium chloride (DDAC), widely used as a disinfectant, were established for 180 selected human and environmental hospital strains isolated between 2011 and 2020. Furthermore, a genomic study determined resistome and clonal putative relatedness for 77 of them. During the ten-year study period, it was estimated that 9.5% of patients’ strains were resistant to carbapenems, 11.9% were multidrug-resistant (MDR), and 0.7% were extensively drug-resistant (XDR). Decreased susceptibility (DS) to DDAC was observed for 28.0% of strains, a phenotype significantly associated with MDR/XDR profiles and from hospital environmental samples (p < 0.0001). According to genomic analyses, the P. aeruginosa population unsusceptible to carbapenems and/or to DDAC was diverse but mainly belonged to top ten high-risk clones described worldwide by del Barrio-Tofiño et al. The carbapenem resistance appeared mainly due to the production of the VIM-2 carbapenemase (39.3%) and DS to DDAC mediated by MexAB-OprM pump efflux overexpression. This study highlights the diversity of MDR/XDR populations of P. aeruginosa which are unsusceptible to compounds that are widely used in medicine and hospital disinfection and are probably distributed in hospitals worldwide.

Characterization of MRI White Matter Signal Abnormalities in the Pediatric Population.

(1) Background and Purpose: The aim of this study was to retrospectively characterize WMSAs in an unselected patient cohort at a large pediatric neuroimaging facility, in order to learn more about the spectrum of the underlying disorders encountered in everyday clinical practice. (2) Materials and Methods: Radiology reports of 5166 consecutive patients with standard brain MRI (2006-2018) were searched for predefined keywords describing WMSAs. A neuroradiology specialist enrolled patients with WMSAs following a structured approach. Imaging characteristics, etiology (autoimmune disorders, non-genetic hypoxic and ischemic insults, traumatic white matter injuries, no final diagnosis due to insufficient clinical information, "non-specific" WMSAs, infectious white matter damage, leukodystrophies, toxic white matter injuries, inborn errors of metabolism, and white matter damage caused by tumor infiltration/cancer-like disease), and age/gender distribution were evaluated. (3) Results: Overall, WMSAs were found in 3.4% of pediatric patients scanned at our and referring hospitals within the ten-year study period. The majority were found in the supratentorial region only (87%) and were non-enhancing (78% of CE-MRI). WMSAs caused by autoimmune disorders formed the largest group (23%), followed by "non-specific" WMSAs (18%), as well as non-genetic hypoxic and ischemic insults (17%). The majority were therefore acquired as opposed to inherited. Etiology-based classification of WMSAs was affected by age but not by gender. In 17% of the study population, a definite diagnosis could not be established due to insufficient clinical information (mostly external radiology consults). (4) Conclusions: An "integrated diagnosis" that combines baseline demographics, including patient age as an important factor, clinical characteristics, and additional diagnostic workup with imaging patterns can be made in the majority of cases.

Epidemiology of syphilis in the Nepean and Blue Mountains Local Health District between 1 October 2009 and 30 September 2019.

Syphilis is a nationally notifiable sexually transmitted infection (STI). Rates of syphilis notifications have been on the increase in Australia. Given these increases, we wanted to study the epidemiological trends of syphilis notifications in the Nepean Blue Mountain Local Health District (NBMLHD) over a ten-year period across different healthcare settings. All syphilis notifications in residents in the NBMLHD in the ten-year period between 1 October 2009 and 30 September 2019 were included in the study. Separate analyses were performed for all syphilis notifications, as well as for infectious syphilis and for syphilis acquired > 2 years ago or of unknown duration. We described age distribution and demographic profile and risk factors of all syphilis notifications. Notification trends were studied and crude incidence rates were calculated. Notifications were stratified by stage of syphilis, sex, and geographical location. In the study duration, a total of 342 notifications of syphilis were received. Of these, 187 were infectious syphilis and 155 were related to infections acquired > 2 years ago and/or of unknown duration. The majority of notifications were in men: 281 (82%). Overall, syphilis notifications increased over the ten-year study period. The crude incidence rates for infectious syphilis were significantly higher in the second five-year period overall (7.78/100,000 population per year compared to 5.28/100,000 population per year; incidence rate ratio (IRR): 1.47; 95% confidence interval (95% CI): 1.10-1.97; p < 0.01), as well as for males (14.44/100,000 population per year compared to 9.7/100,000 population per year; IRR: 1.49; 95% CI: 1.09-2.03; p < 0.01). There were significant increases in syphilis notifications in males < 35 years of age, from 39 such notifications in the first five-year period (27.5% of all syphilis notifications in this period) to 83 notifications in the second five-year period (42.1% of all notifications in this period), p < 0.05. In keeping with national trends, notifications in our study increased. Significant increases were noted in notifications among males under 35 years of age. This supports the continued investment in sexual health promotion activities aimed at young sexually active men. Expansion of screening activities to include women and older people would help detect any increase in cases in these groups. Increase in engagement with general practitioners will support them to provide opportunistic STI screens to sexually-active attendees. National screening recommendations remain applicable to this population.

Retrospective Analysis of 101 Canine Lymphoma Cases Diagnosed in Surgical biopsies in Latvia (2011–2020)

Abstract Lymphoma is a malignant tumor commonly diagnosed in dogs representing 7–24% of all canine tumors. There has been no previous studies focused on characterization of canine lymphoma cases in Latvia. The goals of this retrospective study were to determine prevalence and characteristics of lymphoma cases among biopsy submissions to a private veterinary pathology service that receives approximately 80% of all biopsy submission in Latvia and to compare this data with published canine lymphoma reviews. Data were retrieved to select records from Latvian dogs diagnosed with lymphoma between 2011 and 2020, determining characteristics of dogs and types of lymphoma based on anatomic distribution and cellular morphology. In a ten-year study period, diagnosis of lymphoma constituted 1–4% of surgical biopsy submissions each year without upwards trend. Affected dogs were middle age (median 8 years; range 2–13), with a slight male predominance (58%). The majority of dogs (19%) were mixed breed. Top 3 affected dog breeds were Rottweiler, American Staffordshire terrier and French bulldog with 6–7 cases in each breed. Multicentric form of lymphoma predominated (55%) followed by alimentary and mucocutaneous lymphoma (21% and 14%, respectively). Within multicentric form of lymphoma two thirds were intermediate to large cell lymphomas. Included in this group would be diffuse large B cell lymphomas, the most common subtype of canine lymphomas; however, lack of immunohistochemical testing precluded complete lymphoma classification according to WHO guidelines. Results of this study correlate well with the previously published results and provide important information to Latvian small animal veterinarians and pathologists.

Shifting practice in pediatric prescription opioid use in the emergency department for fractures

ObjectivesJudicious opioid use is important for balancing patient comfort and safety. Although opioid use is well studied in adult populations, pediatric opioid prescription practices are less understood and there are very few guidelines regarding its usage. The purpose of this study was to investigate pediatric opioid prescription trends by emergency medicine physicians over the last ten years, including assessing proxies for the adequacy of pain control and risk of any opioid-related adverse events including overdose. MethodsA retrospective analysis was performed of all patients age 0 to 18 who presented to an urban county hospital emergency department (ED) between 2007 and 2017 for acute fracture care. Data collected included age, opioids given in the ED, opioid prescriptions from the ED, adverse events, and secondary opioid prescriptions. Opioid prescription quantities were assessed in morphine equivalents (Meqs). ResultsOut of 4713 patients diagnosed with acute fracture, opioid prescriptions from the ED were given to 1772 patients (37.6%), with a mean quantity of 107.0 Meqs (SD = 69.1). Over the ten-year period studied, prescription rates declined from 54.8% in 2007 to 13.6% in 2017. Although 201 (4.3%) fracture patients had a second fracture-related ED visit, only 27 visits (0.57%) were for inadequate pain control, with no significant differences in year-to-year analysis. During the ten-year study period, there were zero opioid overdoses reported among pediatric fracture patients. ConclusionsA major shift has occurred in the last ten years, as emergency medicine physicians now favor non-opioid pain management regimens over opioids for the majority of pediatric fracture patients. There was no increase in the rate of inadequate pain control requiring a return to the ED, even as opioid prescription rates declined during the study period.

Impact of urbanization and stormwater infrastructure on ephemeral channel transmission loss in a semiarid watershed

Study regionMontoyas watershed in central New Mexico, a rapidly urbanizing basin characteristic for the semiarid Southwestern United States. The 142 km2 watershed drains to the Rio Grande. Study focusThis study evaluated the impacts of urbanization and stormwater infrastructure on ephemeral channel transmission loss (TL), an important source of groundwater recharge in dryland basins. A hydrologic model (HEC-HMS) was built for the watershed and calibrated based on seven years of precipitation and discharge data. The model was then used to simulate the individual and combined impacts of land use change (urbanization) and stormwater infrastructure (ponds, channel lining) on runoff and transmission losses over a ten-year period based on observed storm events. New hydrological insights for the regionResults show high inter-annual runoff variability with the two wettest years contributing 44–59% of the 10-year total, and dry years resulting in nearly no flow. Both runoff and TL increased with urbanization. Assuming natural ephemeral channels, TL comprised 64–81% of runoff reaching the basin outlet and 7–10% of domestic water use in the basin, depending on urbanization scenario. Stormwater detention ponds had minimal impact on TL; however, lining the lower 5, 10 and 15 km of ephemeral streams reduced TL by 31%, 55% and 73% over the ten-year study period. Results indicate that preservation of ephemeral channels, in particular permeable channel beds, should be considered a viable strategy for managed aquifer recharge in urbanizing areas.