Abstract Background Disasters occur randomly and can severely tax the health care delivery system of affected and surrounding regions. A significant proportion of disaster survivors are children, who ...have unique medical, psychosocial, and logistical needs after a mass casualty event. Children are often transported to specialty centers after disasters for a higher level of pediatric care, but this can also lead to separation of these survivors from their families. In a recent theoretical article, we showed that the availability of a pediatric trauma center after a mass casualty event would decrease the time needed to definitively treat the pediatric survivor cohort and decrease pediatric mortality. However, we also found that if the pediatric center was too slow in admitting and discharging patients, these benefits were at risk of being lost as children became “trapped” in the slow center. We hypothesized that this effect could result in further increased mortality and greater costs. Methods Here, we expand on these ideas to test this hypothesis via mathematical simulation. We examine how a delay in discharge of part of the pediatric cohort is predicted to affect mortality and the cost of inpatient care in the setting of our model. Results We find that mortality would increase slightly (from 14.2%–16.1%), and the cost of inpatient care increases dramatically (by a factor of 21) if children are discharged at rates consistent with reported delays to reunification after a disaster from the literature. Conclusions Our results argue for the ongoing improvement of identification technology and logistics for rapid reunification of pediatric survivors with their families after mass casualty events.
Abstract Introduction The diagnosis and assessment of apical periodontitis by traditional periapical radiographs can be challenging and might yield false-negative results. The aim of this study was ...to determine whether interleukin-1beta (IL-1β) and dentin sialoprotein (DSP) in gingival crevicular fluid (GCF) can be used as biological markers for apical periodontitis. Methods Forty healthy patients with teeth diagnosed with apical periodontitis of pulpal origin were included in the study. GCF samples were obtained from the diseased tooth and from a healthy contralateral control tooth. Total protein concentration in each sample was determined by using the Bio-Rad protein assay. Enzyme-linked immunosorbent assay was used to analyze the concentration of IL-1β and DSP in the samples. Results Protein content of the GCF was statistically significantly higher in the disease group compared with the control group. The levels of IL-1β and DSP were not statistically different between disease and control groups. Conclusions Although this study was unable to demonstrate a significantly higher level of IL-1β or DSP in the GCF of teeth with apical periodontitis, the observed presence of a significantly higher level of total protein in the GCF of diseased teeth suggests the possible role of total protein level as a marker for periapical disease.
Epidermal Growth Factor (EGF) reduces necrotizing enterocolitis (NEC). However, its high cost virtually prohibits clinical use. To reduce cost, soybean expressing human EGF was developed. Here we ...report effectiveness of soybean-derived EGF in experimental NEC.
Newborn rats were subjected to the NEC-inducing regimen of formula feeding and hypoxia. Formula was supplemented with extract from EGF-expressing or empty soybeans. NEC pathology was determined microscopically. Localization of tight junction proteins JAM-A and ZO-1 was examined by immunofluorescence and levels of mucosal COX-2 and iNOS mRNAs by real time PCR.
Soybean extract amounts corresponding to 150μg/kg/day EGF caused considerable mortality, whereas those corresponding to 75μg/kg/day EGF were well tolerated. There was no significant difference in NEC scores between animals fed plain formula and formula supplemented with empty soybean extract. Soybean-EGF-supplemented formula at 75μg/kg/day EGF significantly decreased NEC, attenuated dissociation of JAM-A and ZO-1 proteins from tight junctions, and reduced intestinal expression of COX-2 and iNOS mRNAs.
Supplementation with soybean-expressed EGF significantly decreased NEC in the rat model. Soybean-expressed EGF may provide an economical solution for EGF administration and prophylaxis of clinical NEC.
The concept of transfer of learning holds that previous practice or experience in one task or domain will enable successful performance in another related task or domain. In contrast, specificity of ...learning holds that previous practice or experience in one task or domain does not transfer to other related tasks or domains. The aim of the current study is to examine whether decision-making skill transfers between sports that share similar elements, or whether it is specific to a sport. Participants (
n
= 205) completed a video-based temporal occlusion decision-making test in which they were required to decide on which action to execute across a series of 4 versus 4 soccer game situations. A sport engagement questionnaire was used to identify 106 soccer players, 43 other invasion sport players and 58 other sport players. Positive transfer of decision-making skill occurred between soccer and other invasion sports, which are related and have similar elements, but not from volleyball, supporting the concept of transfer of learning.
Some pasture species are rich in phytochemicals, able to improve milk yield and quality and to reduce the environmental impacts of livestock farming. The phytochemicals interact with the different ...gene networks within the animal, such as nuclear factor erythroid 2-related factor 2 (NRF2), but their overall impact on animal health remains to be fully understood. The objective of this study was to identify the effects of pasture Legumes and non-leguminous Forbs containing high bioactive compounds on metabolism and activity of the liver, antioxidant response, kidney function, and inflammation of dairy cows using a large array of blood parameters associated with metabolism and the innate immune system. For this purpose, 26 parameters and the concentration of certain bioactive compounds were assessed in blood plasma, collected from the Jersey cows grazing either Grass, Legume, or Forb-based pastures. In addition, serum collected from all the cows was utilized to detect the changes in NRF2 activation in bovine mammary alveolar cells (MACT) and hepatocytes. Compared with Grass, the cows that grazed both Forb and Legume pastures had lower β-hydroxybutyric acid (BHB) and creatinine and larger vitamin E and the ferric reducing ability of the plasma, supporting an improved antioxidative status for these animals. Compared with both Grass and Legume, the cows that graze Forb pasture had lower urea and urea to creatinine ratio, and lower creatinine, indicating a better kidney function. The cows grazing Legume pasture had greater hematocrit, bilirubin, cholesterol, albumin, β-carotene, retinol, and thiol groups but lower ceruloplasmin, paraoxonase, and myeloperoxidase (MPO) than those grazed Grass and Forb pastures, indicating a positive effect of Legume pasture on the liver, oxidative stress, and red blood cells. The plasma of cows in the various pastures was enriched with various isoflavonoids, especially the cows grazed on Forb and Legume pastures, which likely contributed to improving the antioxidative status of those cows. However, this effect was likely not due to the higher activation of NRF2. Overall, these results indicate that Forb and Legume pastures rich in secondary metabolites do not strongly affect the metabolism but can improve the status of the liver and the kidney and improve the efficiency of N utilization and antioxidant response, compared with the Grass pasture.
Neuromuscular training protocols that include both plyometrics and dynamic balance exercises can significantly improve biomechanics and neuromuscular performance and reduce anterior cruciate ligament ...injury risk in female athletes. The purpose of this study was to compare the effects of plyometrics (PLYO) versus dynamic stabilization and balance training (BAL) on power, balance, strength, and landing force in female athletes. Either PLYO or BAL were included as a component of a dynamic neuromuscular training regimen that reduced measures related to ACL injury and increased measures of performance. Nineteen high school female athletes participated in training 3 times a week for 7 weeks. The PLYO (n = 8) group did not receive any dynamic balance exercises and the BAL (n = 11) group did not receive any maximum effort jumps during training. Pretraining vs. posttraining measures of impact force and standard deviation of center of pressure (COP) were recorded during a single leg hop and hold. Subjects were also tested for training effects in strength (isokinetic and isoinertial) and power (vertical jump). The percent change from pretest to posttest in vertical ground reaction force was significantly different between the BAL and PLYO groups on the dominant side (p < 0.05). Both groups decreased their standard deviation of center of pressure (COP) during hop landings in the medial/lateral direction on their dominant side, which equalized pretested side to side differences. Both groups increased hamstrings strength and vertical jump. The results of this study suggest that both PLYO and BAL training are effective at increasing measures of neuromuscular power and control. A combination of PLYO and BAL training may further maximize the effectiveness of preseason training for female athletes.
Female athletes who are at increased risk for anterior cruciate ligament (ACL) injury demonstrate biomechanical differences between limbs during athletic tasks that may persist following anterior ...cruciate ligament reconstruction (ACLR). This may limit an athlete's potential for safe return to sports competition. The purpose of this study was to determine if female athletes demonstrate lower limb asymmetries in landing and takeoff force following ACLR and clearance for return to competitive sports participation. We hypothesized that females following ACLR would demonstrate side-to-side differences in landing and jumping kinetics after their return to sport (2+ years) that would not be observed in a group of healthy female controls.
Case control study.
The Sports Medicine Biodynamics Center at Cincinnati Children's Hospital Medical Center.
Fourteen female athletes at a mean of 27 months following ACLR and 18 healthy female athletes participated in the study.
All subjects executed a drop vertical jump (DVJ) task onto 2 force plates. Vertical ground reaction force (VGRF) was measured during landing and takeoff and was used to calculate landing phase loading rates. A 2-way analysis of variance was used to determine differences between the involved, uninvolved, and control limbs.
Females who had undergone ACLR demonstrated increased VGRF (P = 0.001) and loading rate (P < 0.001) on the uninvolved limb during landing when compared with the involved limb and the control group. During takeoff, the involved limb showed significantly less ability to generate force (P = 0.03) than the uninvolved limb and the control limbs.
Female athletes who have undergone ACLR and returned to sport may continue to demonstrate biomechanical limb asymmetries 2 years or more after reconstruction that can be identified during landing.
PurposeIn response to external conditions, organizations yearn to gain a competitive edge during unremitting change. Recognizing the importance of managing change, researchers have aggressively ...investigated organizational change at the macro level. This research, however, argues that an employee's ability to cope with change is a function of both micro (individual) and macro (contextual) factors.Design/methodology/approachThe survey data were collected at an organization that was undergoing a significant internal change. Correlational and structural equation modeling techniques were used for data analysis.FindingsThe results suggest that individual differences (intolerance for ambiguity) and contextual factors (LMX, TMX receipts and TMX contributions) are important factors for understanding the ability to manage organizational change effectively. Additionally, it is argued that contextual factors not only have direct effects on coping with change but indirect effects through perceptions of work group effectiveness. Our results indicate that both micro and macro factors are important for understanding the ability to cope with and manage change.Research limitations/implicationsThe research leaves open some interesting questions around the role of contextual factors in coping with change, in addition to the interaction with individual differences.Practical implicationsMost sources discuss change as focused at the organizational level. Managers will be well served to understand that the degree to which employees cope effectively with change will be partly determined by the interaction of individual differences and the organizational and team level context.Originality/valueThis research extends our understanding of the relationship between social exchange relationships and how individuals cope with change in organizations and the mechanism by which that occurs.
The vast majority of advanced numerical ocean models in use today, while performing extremely well, especially for certain classes of problem, do not necessarily take full advantage of current trends ...in numerical analysis and scientific computing. Here, a three-dimensional finite-element model is presented for use in oceanic simulations. The main aim is to fully exploit the use of unstructured meshes in both the horizontal and vertical directions, in order to conform well to topography and coastlines, and also to enable the straightforward use of dynamic variable mesh resolution reflecting fluid flow. In addition, the model should be accurate and efficient under typical oceanographic conditions, and not make the hydrostatic approximation. For simplicity here however the model does assume the presence of a rigid lid. To cope with inherent instabilities present in finite-element simulations of incompressible flow, caused by the Lagrange multiplier role that pressure plays in satisfying incompressibility, a mixed formulation for representing velocity and pressure is employed. Additionally, instabilities occurring due to the advection-dominated nature of the flow are dealt with using linear Petrov-Galerkin methods. In the course of this work a different type of instability has also been observed, which has some similarities with the sigma coordinate pressure gradient problem. The instability results from the mixed nature of the finite-element formulation and consequent poor satisfaction of hydrostatic balance, which in turn manifests itself in errors and spurious velocities on distorted meshes, such as those typical over topography. A satisfactory solution to this problem is presented that involves a splitting of pressure and allows efficient computations, whether the flow be close to or far from a state of hydrostatic balance.
Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived ...as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community.
We retrospectively queried a level 1 trauma registry for pediatric (0-18 y) MVC patients from October 2013 to December 2018. Demographic and clinical variables were recorded. Data regarding appropriate restraint use by age group were examined.
Four hundred thirty-four cases of pediatric MVC were identified. Overall, 53% were improperly restrained or unrestrained. Sixty-two percent of car seat age and 51% of booster age children were improperly restrained or unrestrained altogether. Fifty-nine percent of back seat riding, seatbelt age were improperly restrained/unrestrained, with 26% riding in the front. Fifty-one percent of seatbelt-only adolescents were not belted. Black, non-Hispanic children were more often improperly restrained/unrestrained compared to Hispanics (63% versus 48%, P = 0.001). Improperly restrained/unrestrained children had higher injury severity (10% versus 4% Injury Severity Score > 25, P = 0.021), require operative/interventional radiology (33% versus 19%, P = 0.001), and be discharged to rehabilitation or skilled nursing facility (5.2% versus 1.5%, P = 0.033). Mortality in adolescents was higher among those unrestrained (5.2% versus 0.8%, P = 0.034).
Although efforts to improve adherence to restraint regulations have greatly increased in the last decade, more than half of children in MVC are still improperly restrained. Injury prevention services and community outreach is essential to educate the most vulnerable populations, especially those with infants and toddlers, on adequate motor vehicle safety measures in our community.
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