BACKGROUNDChildren who present to emergency departments (EDs) for care are frequently advised to follow up with their primary care providers (PCPs) after discharge; little is known about whether PCPs ...agree that follow-up advised by EDs is appropriate for their patients.
OBJECTIVESThe aims of this study were to determine PCP preferences for follow-up recommendations given to their pediatric patients at the time of ED visits and to compare these preferences to reported emergency medicine provider (EMP) practice.
METHODSThis was an online survey of PCPs and EMPs in a regional health system assessing preferred timing for ED follow-up recommendations for 15 common pediatric conditions and whether the follow-up should be definite or contingent.
RESULTSNinety PCPs and 36 EMPs responded to the survey. In patients with community-acquired pneumonia, probability of recommending follow-up after 5 or more days was 33% in PCPs and 8% in EMPs (P = 0.001). In all conditions with significant differences, PCPs favored longer follow-up. In upper respiratory tract infection and acute otitis media, PCPs had a higher probability than EMPs of selecting as-needed versus definite follow-up (P = 0.0002 and P = 0.01, respectively). In asthma, concussion, and pneumonia, PCPs had a significantly lower probability of selecting as-needed follow-up than EMPs.
CONCLUSIONSIn this regional survey, PCPs preferred longer times between ED visit and follow-up than EMPs for a number of conditions. Differences were also found in preference for as-needed or definite follow-up, varying by condition. These discrepancies could result in overuse or underuse of clinic resources, suggesting a possible quality improvement target for emergency medicine practice.
The rice stink bug, Oebalus pugnax (F.), is a key pest of heading rice, Oryza sativa L. (Poales: Poaceae), in the southern United States. Sweep net sampling is the recommended method for sampling ...rice stink bug in rice, but there currently exists no specific recommendation for sweep length, and a large amount of variation likely exists amongst samplers. The objectives of this study were to determine the role that sweep length plays in sampling accuracy and determine the feasibility of using sweep lengths smaller than 180°. When monitoring sweep lengths by consultants, producers, and researchers, a large amount of variation in sweep length and a significant linear relationship between sweep length and rice stink bug catch per 10 sweeps was observed. Sweep length was then controlled at three levels (0.8, 1.8, and 3.5 m) and a change from 0.8 to 1.8 m in sweep length led to an increase on average of 2.28 rice stink bugs per 10 sweeps. These data suggest knowledge of sweep length is vital, and paired with large amounts of observed variation in sweep length, recommending a specific sweep length is ideal. Using Taylor's values, it was determined that 1.8 m sweeps resulted in density estimates that were as reliable as 3.5 m (180°) sweeps, suggesting a longer sweep length was not necessary. A 1.8 m sweep length recommendation would create an easier sampling regimen that is still reliable, which could lead to more accurate action threshold decisions being made for rice stink bug if it increases adoption in consultants and producers.
Objective
To compare the prognostic value of admission hematologic parameters serum/plasma iron, red blood cell distribution width (RDW), and nucleated red blood cells (nRBCs) in dogs presenting with ...acute traumatic injury.
Design
Retrospective observational study (2009‐2015).
Setting
University teaching hospital.
Animals
One hundred and twenty‐nine clinical dogs presenting within 24 hours of acute traumatic injury.
Interventions
None.
Measurements and Main Results
One hundred and twenty‐nine dogs met the inclusion criteria and 109 (84.5%) survived, while 20 (15.5%) died or were euthanized in hospital. Patients with blunt force trauma comprised 79.8% of the patient population; dogs with penetrating trauma comprised 20.2% of cases. Hypoferremia occurred in all nonsurvivors, and the median serum/plasma iron concentration was significantly lower in nonsurvivors than survivors (P = 0.028). Normal or increased serum/plasma iron had 100% specificity and 100% positive predictive value for survival. Red blood cell distribution width was not significantly different between groups (P = 0.417). The presence of nRBCs was significantly associated with nonsurvival (P = 0.030), although the absolute nRBC concentrations were not significantly different (P = 0.070). A multiple logistic regression model found age, type of injury, presence of nRBCs, and serum/plasma iron to be independent predictors of survival with an area under the receiver operator characteristic curve of 0.813.
Conclusions
The presence of nRBCs and low serum/plasma iron are associated with mortality in patients with acute trauma; however, red blood cell distribution width was not associated with survival. Absence of hypoferremia was highly associated with a favorable prognosis in this patient population. These parameters may warrant inclusion in trauma scoring systems.
The eating behavior of children is important to maintain a healthy weight. This current study explored the differences in children's eating behaviors and their relation to weight status and maternal ...education level, using the child eating behavior questionnaire (CEBQ).
The study recruited 169 participants aged between six and ten years. Multinomial logistic regression was conducted to examine the association between the CEBQ factors and children's body weight status. The association between the CEBQ scores and maternal educational levels was examined using a one-way analysis of variance (ANOVA).
The multinomial logistic regression findings indicate that children in the obese group exhibited a significant increase in food responsiveness, enjoyment of food, emotional overeating, and a decrease in satiety responsiveness compared to normal weight children. The one-way ANOVA showed a significant difference in subscales under the food approach (food responsiveness, desire to drink, emotional overeating) and food avoidance (satiety responsiveness) based upon the child's weight status. The three subscales under the food approach category were significantly dependent upon the maternal education but did not have a significant association with food avoidance.
The results suggest that the increase in food responsiveness and emotional overeating in obese children is influenced by maternal education.
To estimate possible differences in skeletal asymmetry between patients with skeletal Class I and skeletal Class II relationships.
Cone beam computed tomography (CBCT) images were examined from 70 ...consecutive patients who presented for orthodontic care and fit the inclusion criteria. Asymmetry was quantified using an asymmetry index developed by Katsumata et al. Anatomic landmarks were defined and reference planes were established to determine the asymmetry of the landmarks using a constructed coordinate plane system. Thirty randomly selected patients were reanalyzed to assess the reliability of the method.
Statistical analysis did not find any significant relationship between asymmetry and A-P skeletal relationship for any of the landmarks. Asymmetry index scores were reproducible within a certain range of agreement for each landmark.
Based on this study, the discrepant jaw growth resulting in a Class II skeletal pattern results in no more skeletal asymmetry than Class I skeletal patterns.
Objective measures of adherence to high-frequency chest wall compression (HFCWC), a form of airway clearance therapy for patients with cystic fibrosis, are lacking. We used a novel electronic ...monitoring device integrated into an HFCWC vest to measure adherence compared with self-reported adherence. We determined factors that influenced adherence and how adherence correlated with baseline pulmonary function and pulmonary exacerbations.
Data were collected by direct measurement of date, time of day, and duration of HFCWC use to determine the number of daily treatments and daily duration of treatments. Chart review provided prescribed airway clearance therapy treatment and demographic and clinical information. Subject and caregiver report of the daily number of airway clearance therapy treatments was obtained by telephone interviews. Analysis used 2-sample and paired
test, analysis of variance, and linear regression.
Average adherence was 69%. Adherence was highest in children (82%,
= .02) and those receiving assistance with treatment (82%,
< .001). Subjects overestimated therapy duration from a mean ± SD of 127 ± 169% by adults to 19.2 ± 26.3% by parents or guardians of children. Average adherence decreased with increasing prescribed therapy time (
= .02). Average daily therapy time and adherence had significant positive associations with baseline FEV
percent of predicted (
= .02 and
= .02, respectively) and negative associations with pulmonary exacerbations during the pre-study period and at baseline (
= .044 and
= .02, respectively).
Greater adherence to HFCWC measured directly by a novel recorder was associated with better baseline pulmonary function and fewer exacerbations in the pre-study and baseline period. Adherence decreased with age and prescribed therapy time and increased with therapy assistance. Self-report overestimation is large and thus not an accurate measure of adherence.
In the processing of uranium ores, the uranium is recovered from mill leach solutions by precipitation as yellow cake concentrates. Among the different existing processes, the continuous ...precipitation with hydrogen peroxide in a fluidized bed leads to high-quality solid particles. This paper deals with the determination of the crystal growth mechanism and the kinetic parameters. An experimental study is performed in a stirred batch reactor over a wide range of experimental conditions. The experimental method adapted to the uranium peroxide crystal growth study consists of following hydrogen ion concentration. In order to determine the kinetic parameters, a solubility model has been developed and the calculation of the supersaturation ratio is developed in this article. The deviation from ideality is taken into account and the activity coefficients are calculated by the Specific Interaction Theory. This article gives the results obtained for the uranium peroxide solubility, the supersaturation ratio calculation and crystal growth kinetic law. The treatment of the experimental data shows that the crystal growth rate corresponds to the dislocation mechanism.
A thermodynamic study and a method to determine the crystal growth mechanism and kinetics by recording the pH decrease are described.
The 2013-2016 West African Ebola virus disease epidemic was unprecedented in terms of the number of cases and survivors. Prior to this epidemic there was limited data available on the persistence of ...Ebola virus in survivors' body fluids and the potential risk of transmission, including sexual transmission.
Given the urgent need to determine the persistence of Ebola virus in survivors' body fluids, an observational cohort study was designed and implemented during the epidemic response operation in Sierra Leone. This publication describes study implementation methodology and the key lessons learned. Challenges encountered during implementation included unforeseen duration of follow-up, complexity of interpreting and communicating laboratory results to survivors, and the urgency of translating research findings into public health practice. Strong community engagement helped rapidly implement the study during the epidemic. The study was conducted in two phases. The first phase was initiated within five months of initial protocol discussions and assessed persistence of Ebola virus in semen of 100 adult men. The second phase assessed the persistence of virus in multiple body fluids (semen or vaginal fluid, menstrual blood, breast milk, and urine, rectal fluid, sweat, saliva, tears), of 120 men and 120 women.
Data from this study informed national and global guidelines in real time and demonstrated the need to implement semen testing programs among Ebola virus disease survivors. The lessons learned and study tools developed accelerated the implementation of such programs in Ebola virus disease affected countries, and also informed studies examining persistence of Zika virus. Research is a vital component of the public health response to an epidemic of a poorly characterized disease. Adequate resources should be rapidly made available to answer critical research questions, in order to better inform response efforts.
OBJECTIVE
We assessed the impact of acid suppression therapy (i.e., ranitidine or proton pump inhibitors) on iron supplementation and its ability to maintain or alter laboratory values that are ...commonly associated with anemia.
METHODS
This was a prospective, observational trial. The primary outcome was changes in serum iron levels from baseline. Secondary outcomes were changes in hemoglobin (Hgb) and hematocrit (Hct), transfusions, and maintenance of an alkalotic gastric pH.
RESULTS
Thirty-four patients (mean 24 ± 43 months) met inclusion criteria. The serum iron levels increased to 50.9 ± 24.6 mcg/dL by day 3. The mean difference from baseline was 1.5 mcg/dL (95% CI, 1.14–1.98, p = 0.0056). Gastric pH increased to 4.68 ± 1.49 on day 5. The mean Hgb and Hct increased on day 5 to 10 ± 1.06 g/dL and 29.6% ± 3.27%, respectively. The mean difference of Hgb was 1.15 g/dL (95% CI, 0.51–1.78, p = 0.0009). The mean difference of Hct was 3.04% (95% CI, 1.11–4.97, p = 0.0032).
CONCLUSIONS
The use of antacids along with oral ferrous sulfate supplementation did not affect the absorption of iron. Serum iron, Hgb, and Hct all showed statistically significant increases despite combined antacid and iron therapy. Thus, despite use of antacids, combination use showed increases in iron absorption.
Abstract Objective To evaluate the validity of 2 brief instruments to estimate fruit and vegetable (FV) intake among third-grade children. Methods Children from an elementary school and a community ...center (n = 107) completed 2 retrospective questions for FV intake (fruit and vegetable questionnaire FVQ) and a food record (A Day in the Life Questionnaire DILQ) to estimate FV intake. Agreement between intake based on these instruments and 3 24-hour dietary recalls was determined. Results Disattenuated Pearson correlation coefficients ranged from 0.40 to 0.69 for FV intake; however, the low reliability of multiple 24-hour recalls may have inflated the strength of the correlations. Altman-Bland difference plots suggested that the FVQ overestimated FV intake whereas the DILQ overestimated fruit and underestimated vegetable intake. Limits of agreement were wide for both tools, indicating poor overall agreement. Conclusions and Implications The FVQ and DILQ were not valid instruments to evaluate FV consumption under current study conditions. Other assessment methods and instruments should be considered for young children.
PDF
