Predictors of "occult" intra-abdominal injuries in blunt trauma patients.

Science.gov (United States)

Parreira, José Gustavo; Malpaga, Juliano Mangini Dias; Olliari, Camilla Bilac; Perlingeiro, Jacqueline A G; Soldá, Silvia C; Assef, José Cesar

2015-01-01

to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries) or Group 2 (without intra-abdominal injuries). Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting ptrauma mechanism (ptrauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22) and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85). Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

A systematic review of studies identifying predictors of poor return to work outcomes following workplace injury.

Science.gov (United States)

Street, Tamara D; Lacey, Sarah J

2015-06-05

Injuries occurring in the workplace can have serious implications for the health of the individual, the productivity of the employer and the overall economic community. The objective of this paper is to increase the current state of understanding of individual demographic and psychosocial characteristics associated with extended absenteeism from the workforce due to a workplace injury. Studies included in this systematic literature review tracked participants' return to work status over a minimum of three months, identified either demographic, psychosocial or general injury predictors of poor return to work outcomes and included a heterogeneous sample of workplace injuries. Identified predictors of poor return to work outcomes included older age, female gender, divorced marital status, two or more dependent family members, lower education levels, employment variables associated with reduced labour market desirability, severity or sensitive injury locations, negative attitudes and outcome perceptions of the participant. There is a need for clear and consistent definition and measurement of return to work outcomes and a holistic theoretical model integrating injury, psychosocial and demographic predictors of return to work. Through greater understanding of the nature of factors affecting return to work, improved outcomes could be achieved.

Trajectories and Predictors of the Course of Mental Health After Spinal Cord Injury

NARCIS (Netherlands)

van Leeuwen, Christel M.; Hoekstra, Trynke; van Koppenhagen, Casper F.; de Groot, Sonja; Post, Marcel W.

2012-01-01

van Leeuwen CM, Hoekstra T, van Koppenhagen CF, de Groot S, Post MW. Trajectories and predictors of the course of mental health after spinal cord injury. Arch Phys Med Rehabil 2012;93:2170-6. Objective: To study the course and predictors of mental health in the period between the start of active

Potential early predictors for outcomes of experimental hemorrhagic shock induced by uncontrolled internal bleeding in rats.

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Zaid A Abassi

Full Text Available Uncontrolled hemorrhage, resulting from traumatic injuries, continues to be the leading cause of death in civilian and military environments. Hemorrhagic deaths usually occur within the first 6 hours of admission to hospital; therefore, early prehospital identification of patients who are at risk for developing shock may improve survival. The aims of the current study were: 1. To establish and characterize a unique model of uncontrolled internal hemorrhage induced by massive renal injury (MRI, of different degrees (20-35% unilateral nephrectomy in rats, 2. To identify early biomarkers those best predict the outcome of severe internal hemorrhage. For this purpose, male Sprague Dawley rats were anesthetized and cannulas were inserted into the trachea and carotid artery. After abdominal laparotomy, the lower pole of the kidney was excised. During 120 minutes, hematocrit, pO2, pCO2, base excess, potassium, lactate and glucose were measured from blood samples, and mean arterial pressure (MAP was measured through arterial tracing. After 120 minutes, blood loss was determined. Statistical prediction models of mortality and amount of blood loss were performed. In this model, the lowest blood loss and mortality rate were observed in the group with 20% nephrectomy. Escalation of the extent of nephrectomy to 25% and 30% significantly increased blood loss and mortality rate. Two phases of hemodynamic and biochemical response to MRI were noticed: the primary phase, occurring during the first 15 minutes after injury, and the secondary phase, beginning 30 minutes after the induction of bleeding. A Significant correlation between early blood loss and mean arterial pressure (MAP decrements and survival were noted. Our data also indicate that prediction of outcome was attainable in the very early stages of blood loss, over the first 15 minutes after the injury, and that blood loss and MAP were the strongest predictors of mortality.

Predictors of myocardial injury in patients with acute upper gastrointestinal bleeding

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El-Sayed M Farag

2014-03-01

The most significant predictors for myocardial injury in patients with UGIB in descending order were hypertension, cigarette smoking, liver cirrhosis, body mass index > 25 kg/m2, and C-reactive protein level  > 5 mg/dl.

Traumatic brain injury in pediatric age group: Predictors of outcome ...

African Journals Online (AJOL)

Objective: To determine predictors for outcomes of traumatic brain injury (TBI) in infants and children younger than twelve years admitted to our pediatric intensive care units (PICU). Methods: This is a retrospective cohort study from 2004-5, done at the PICU of King Fahad Hofuf Hospital, Eastern Province, Saudi Arabia.

Stress disorder and PTSD after burn injuries: a prospective study of predictors of PTSD at Sina Burn Center, Iran

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Sadeghi-Bazargani H

2011-07-01

Full Text Available Homayoun Sadeghi-Bazargani1, Hemmat Maghsoudi2, Mohsen Soudmand-Niri3, Fatemeh Ranjbar4, Hossein Mashadi-Abdollahi51Neuroscience Research Center, Statistics and Epidemiology Department, School of Health and Nutrition, 2Department of Surgery, 3School of Psychology, 4Department of Psychiatry, 5National Public Health Management Centre, Tabriz University of Medical Sciences, Tabriz, IranBackground: A burn injury can be a traumatic experience with tremendous social, physical, and psychological consequences. The aim of this study was to investigate the existence of post-traumatic stress disorder (PTSD and predictors of PTSD Checklist score initially and 3 months after injury in burns victims admitted to the Sina Burn Center in north-west Iran.Methods: This prospective study examined adult patients aged 16–65 years with unintentional burns. The PTSD Checklist was used to screen for PTSD.Results: Flame burns constituted 49.4% of all burns. Mean PTSD score was 23.8 ± 14.7 early in the hospitalization period and increased to 24.2 ± 14.3, 3 months after the burn injury. Twenty percent of victims 2 weeks into treatment had a positive PTSD screening test, and this figure increased to 31.5% after 3 months. The likelihood of developing a positive PTSD screening test increased significantly after 3 months (P < 0.01. Using multivariate regression analysis, factors independently predicting PTSD score were found to be age, gender, and percentage of total body surface area burned.Conclusion: PTSD was a problem in the population studied and should be managed appropriately after hospital admission due to burn injury. Male gender, younger age, and higher total body surface area burned may predict a higher PTSD score after burn injury. Keywords: post-traumatic stress disorder, burn injury, predictors, Iran

Household related predictors of burn injuries in an Iranian population: a case–control study

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Sadeghi-Bazargani Homayoun

2012-05-01

Full Text Available Abstract Background To prevent burn injuries it is vital to have sound information on predictors of its occurrence in different settings. Ardabil Province is the coldest province of Iran with high burden of burn injuries. The aim of this study was to determine the household related predictors of unintentional burns in Ardabil Province located at North-West of Iran. Methods The study was conducted through a hospital based case–control design. 239 burn victims as well as 246 hospital-based controls were enrolled. Both bivariate and multivariate analysis methods were used. Results Males comprised 55.2% of all the study subjects. Mean age of the participants was 21.8 years (95% CI: 19.17-24.4. The economic ability of the households was associated with risk of burn injuries. Multivariate conditional logistic regression results showed the following variables to be independent factors associated with burn injuries. Using non-conventional pipe-less air heaters instead of conventional piped kerosene- or gas-burning heaters (Odds ratio: 1.98, 95% CI: 1.1-3.6. Common use of picnic gas-stove for cooking at home (odds ratio = 1.6, 95%CI: 1–2.4. Using electric samovars instead of other types of samovars (Odds ratio = 0.3, 95% CI: 0.1-1. Using samovars lacking the national standard authorization mark (Odds ratio = 2.2, 95% CI: 1.4-3.6. Conclusion Using some types of specific heating or cooking appliances, and unsafe use of conventional appliances were major risk predictors of burn injuries in this population.

Complex Foot Injury: Early and Definite Management.

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Schepers, Tim; Rammelt, Stefan

2017-03-01

Complex foot injuries occur infrequently, but are life-changing events. They often present with other injuries as the result of a high-energy trauma. After initial stabilization, early assessment should be regarding salvagability. All treatment strategies are intensive. The initial treatment includes prevention of progression ischemia/necrosis, prevention of infection, and considering salvage or amputation. Definitive treatment for salvage includes anatomic reconstruction with stable internal fixation and early soft tissue coverage followed by aggressive rehabilitation. Prognosis after complex injuries is hard to predict. The various stages of the treatment are reviewed and recommendations are made. Copyright © 2016 Elsevier Inc. All rights reserved.

Urinary Markers of Tubular Injury in Early Diabetic Nephropathy

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Temesgen Fiseha

2016-01-01

Full Text Available Diabetic nephropathy (DN is a common and serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease, and premature mortality. Early and accurate identification of DN is therefore of critical importance to improve patient outcomes. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early DN. Thus, more sensitive and specific markers in addition to albuminuria are needed to predict the early onset and progression of DN. Tubular injury, as shown by the detection of tubular injury markers in the urine, is a critical component of the early course of DN. These urinary tubular markers may increase in diabetic patients, even before diagnosis of microalbuminuria representing early markers of normoalbuminuric DN. In this review we summarized some new and important urinary markers of tubular injury, such as neutrophil gelatinase associated lipocalin (NGAL, kidney injury molecule-1 (KIM-1, liver-type fatty acid binding protein (L-FABP, N-acetyl-beta-glucosaminidase (NAG, alpha-1 microglobulin (A1M, beta 2-microglobulin (B2-M, and retinol binding protein (RBP associated with early DN.

Urinary Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Acute Kidney Injury, Severe Kidney Injury, and the Need for Renal Replacement Therapy in the Intensive Care Unit

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Fatma I. Albeladi

2017-07-01

Full Text Available Background: Recent attempts were made to identify early indicators of acute kidney injury (AKI in order to accelerate treatment and hopefully improve outcomes. This study aims to assess the value of urinary neutrophil gelatinase-associated lipocalin (uNGAL as a predictor of AKI, severe AKI, and the need for renal replacement therapy (RRT. Methods: We conducted a prospective study and included adults admitted to our intensive care unit (ICU at King Abdulaziz University Hospital (KAUH, between May 2012 and June 2013, who had at least 1 major risk factor for AKI. They were followed up throughout their hospital stay to identify which potential characteristics predicted any of the above 3 outcomes. We collected information on patients’ age and gender, the Acute Physiology And Chronic Health Evaluation, version II (APACHE II score, the Sepsis-Related Organ Failure Assessment (SOFA score, serum creatinine and cystatin C levels, and uNGAL. We compared ICU patients who presented with any of the 3 outcomes with others who did not. Results: We included 75 patients, and among those 21 developed AKI, 18 severe AKI, and 17 required RRT. Bivariate analysis revealed intergroup differences for almost all clinical variables (e.g., patients with AKI vs. patients without AKI; while multivariate analysis identified mean arterial pressure as the only predictor for AKI (p < 0.001 and the SOFA score (p = 0.04 as the only predictor for severe AKI. For RRT, day 1 maximum uNGAL was the stronger predictor (p < 0.001 when compared to admission diagnosis (p = 0.014. Day 1 and day 2 maximum uNGAL levels were good and excellent predictors for future RRT, but only fair to good predictors for AKI and severe AKI. Conclusions: Maximum urine levels of uNGAL measured over the first and second 24 h of an ICU admission were highly accurate predictors of the future need for RRT, however less accurate at detecting early and severe AKI.

National trends in occupational injuries before and after 1992 and predictors of workers' compensation costs.

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Bhushan, Abhinav; Leigh, J Paul

2011-01-01

Numbers and costs of occupational injuries and illnesses are significant in terms of morbidity and dollars, yet our understanding of time trends is minimal. We investigated trends and addressed some common hypotheses regarding causes of fluctuations. We pulled data on incidence rates (per 100 full-time employed workers) for injuries and illnesses from the U.S. Bureau of Labor Statistics and on costs and benefits from the National Academy of Social Insurance for 1973 through 2007. Rates reflected all injury and illness cases, lost work-time cases, and cases resulting in at least 31 days away from work. We adjusted dollar costs (premiums) and benefits for inflation and measured them per employed worker. We plotted data in time-trend charts and ran linear regressions. From 1973 to 1991, there was a weak to nonexistent downward trend for injury and illness rates, and rates were strongly and negatively correlated with the unemployment rate. From 1992 to 2007, there were strong, consistent downward trends, but no longer were there statistically significant correlations with unemployment. Significant predictors (and signs) of workers' compensation premiums for 1973-2007 included medical price inflation (positive), number of lost-time injuries (positive), the Dow Jones Industrial Average (negative), and inflation-adjusted interest rate on U.S. Treasury bonds (negative). Dollars of benefits were positively and significantly predicted by medical inflation and number of lost-time cases. For 1992-2007, the Dow Jones variable was the only robust predictor of premiums; the number of injuries was not a significant positive predictor. We had two major conclusions. First, the year 1992 marked a sharp contrast in trends and correlations between unemployment and incidence rates for occupational injuries and illnesses. Second, for the entire time period (1973-2007), insurance carriers' premiums were strongly associated with returns on investments.

Nuclear DNA as Predictor of Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Graft: A Pilot Study.

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Likhvantsev, Valery V; Landoni, Giovanni; Grebenchikov, Oleg A; Skripkin, Yuri V; Zabelina, Tatiana S; Zinovkina, Liudmila A; Prikhodko, Anastasia S; Lomivorotov, Vladimir V; Zinovkin, Roman A

2017-12-01

To measure the release of plasma nuclear deoxyribonucleic acid (DNA) and to assess the relationship between nuclear DNA level and acute kidney injury occurrence in patients undergoing cardiac surgery. Cardiovascular anesthesiology and intensive care unit of a large tertiary-care university hospital. Prospective observational study. Fifty adult patients undergoing cardiac surgery. Nuclear DNA concentration was measured in the plasma. The relationship between the level of nuclear DNA and the incidence of acute kidney injury after coronary artery bypass grafting was investigated. Cardiac surgery leads to significant increase in plasma nuclear DNA with peak levels 12 hours after surgery (median [interquartile range] 7.0 [9.6-22.5] µg/mL). No difference was observed between off-pump and on-pump surgical techniques. Nuclear DNA was the only predictor of acute kidney injury between baseline and early postoperative risk factors. The authors found an increase of nuclear DNA in the plasma of patients who had undergone coronary artery bypass grafting, with a peak after 12 hours and an association of nuclear DNA with postoperative acute kidney injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Early Predictors of Eating Problems in Preadolescence

DEFF Research Database (Denmark)

Munkholm, Anja; Olsen, Else Marie; Rask, Charlotte Ulrikka

2016-01-01

Purpose: The epidemiology of childhood eating problems is far from being fully described. The present study aims to explore early predictors of eating behavior problems in preadolescence. Methods: The study sample comprised 1,939 children from the birth cohort study, the Copenhagen Child Cohort...... interval [CI] = 1.13–6.77; p = .03), with overweight at age 11–12 years and low annual household income as strong explanatory factors (OR = 4.79; 95% CI = 2.81–8.17; p early child...

Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study.

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Buist, Ida; Bredeweg, Steef W; Lemmink, Koen A P M; van Mechelen, Willem; Diercks, Ron L

2010-02-01

The popularity of running is still growing. As participation increases, running-related injuries also increase. Until now, little is known about the predictors for injuries in novice runners. Predictors for running-related injuries (RRIs) will differ between male and female novice runners. Cohort study; Level of evidence, 2. Participants were 532 novice runners (226 men, 306 women) preparing for a recreational 4-mile (6.7-km) running event. After completing a baseline questionnaire and undergoing an orthopaedic examination, they were followed during the training period of 13 weeks. An RRI was defined as any self-reported running-related musculoskeletal pain of the lower extremity or back causing a restriction of running for at least 1 week. Twenty-one percent of the novice runners had at least one RRI during follow-up. The multivariate adjusted Cox regression model for male participants showed that body mass index (BMI) (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.05-1.26), previous injury in the past year (HR, 2.7; 95% CI, 1.36-5.55), and previous participation in sports without axial load (HR, 2.05; 95% CI, 1.03-4.11) were associated with RRI. In female participants, only navicular drop (HR, 0.85; 95% CI, 0.75-0.97) remained a significant predictor for RRI in the multivariate Cox regression modeling. Type A behavior and range of motion (ROM) of the hip and ankle did not affect risk. Male and female novice runners have different risk profiles. Higher BMI, previous injury, and previous sports participation without axial loading are important predictors for RRI in male participants. Further research is needed to detect more predictors for female novice runners.

Complex Foot Injury: Early and Definite Management

NARCIS (Netherlands)

Schepers, Tim; Rammelt, Stefan

2017-01-01

Complex foot injuries occur infrequently, but are life-changing events. They often present with other injuries as the result of a high-energy trauma. After initial stabilization, early assessment should be regarding salvagability. All treatment strategies are intensive. The initial treatment

A Multidisciplinary Evaluation of Traumatic Brain Injury: Early Predictors of Outcome

Science.gov (United States)

2007-04-01

injuries were made. If subjects reported inability to see the palm screen due to eye injuries or lack of eyeglasses /contacts, a second attempt to complete...the medical team was obtained. For subsequent assessments, balance was only evaluated if the subject was cleared for full- weight bearing without... bear or stand [0] b. Yes, quite a bit of pressure [1] c. Yes some, more than usual [2] d. Yes some, but about usual [3] e. Yes, a

Predictors of early stent occlusion among plastic biliary stents.

Science.gov (United States)

Khashab, Mouen A; Kim, Katherine; Hutfless, Susan; Lennon, Anne Marie; Kalloo, Anthony N; Singh, Vikesh K

2012-09-01

A major disadvantage of plastic biliary stents is their short patency rates. The aim of this study was to identify predictors of early stent occlusion among patients receiving conventional plastic biliary stents. Early stent occlusion was defined as worsening cholestatic liver test results of a severity sufficiently significant to warrant ERCP with stent exchange prior to the planned stent exchange, or as symptoms of cholangitis. The association of cumulative stent diameter, demographics, stricture location, procedure indication, Charlson comorbidity index, history of prior early stent occlusion, presence of gallbladder, and performance of sphincteromy with the occurrence of early stent occlusion was studied using logistic regression and multivariate analysis. Our patient cohort comprised 343 patients (mean age 59.3 years) who underwent 561 ERCP procedures with the placement of one or more plastic biliary stents (mean number of stents per procedure 1.2, mean total diameter of stents per procedure 12 Fr). Early stent occlusion occurred in 73 (13 %) procedures. Female gender was protective against early stent occlusion (adjusted OR 0.54, 95 % CI 0.32-0.90, p = 0.02), while hilar stricture location was independently associated with a significantly increased risk of early stent occlusion (adjusted OR 3.41, 95 % CI 1.68-6.90, p = 0.0007). Early occlusion of conventional biliary stents occurred in 13 % of cases. While female gender decreased the risk of early stent occlusion, hilar stricture location was a significant predictor of early stent occlusion. Our results suggest that physicians should consider early elective stent exchange in patients with hilar strictures.

Individual-level predictors of inpatient childhood burn injuries: a case–control study

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Homayoun Sadeghi-Bazargani

2016-03-01

Full Text Available Abstract Background Burn injuries are considered one of the most preventable public health issue among children; however, are a cause of significant morbidity and mortality in Iran. The aim of this study was to assess individual-level predictors of severe burn injuries among children leading to hospitalization, in East Azerbaijan Province, in North-West of Iran. Methods The study was conducted through a hospital based case–control design involving 281 burn victims and 273 hospital-based controls who were frequency matched on age, gender and urbanity. Both bivariate and multivariate methods were used to analyze the data. Results Mean age of the participants was 40.5 months (95 % CI: 37–44 with the majority of burns occurring at ages between 2 months-13.9 years. It was demonstrated that with increase in the caregiver’s age there was a decrease in the odds of burn injuries (OR = 0.94, 95 % CI: 0.92-0.97. According to the multivariate logistic regression there were independent factors associated with burn injuries including childhood ADHD (OR = 2.82, 95 % CI: 1.68 - 4.76, child’s age (OR = 0.73, 95%CI: 0.67 - 0.80, flammability of clothing (OR = 1.60, 95 % CI: 1.12 - 2.28, daily length of watching television (OR = 1.31, 95 % CI: 1.06 - 1.61, playing outdoors (OR = 1.32, 95 % CI: 1.16 - 1.50 and increment in the economic status (OR = 1.37, 95 % CI: 1.18 - 1.60. Conclusion Major risk predictors of burn injuries among the Iranian population included childhood ADHD, child’s age, watching television, playing outdoors, high economic status and flammable clothing.

Prevalence and Predictors of Personality Change After Severe Brain Injury

DEFF Research Database (Denmark)

Norup, Anne; Mortensen, Erik Lykke

2015-01-01

of the Medical Outcomes Study 36-Item Short-Form Health Survey. Results Of the sample, 59.1% experienced personality change after acquired brain injury, and the most dominant changes were observed in the personality traits of neuroticism, extraversion, and conscientiousness. Changes in neuroticism were most......Objectives To investigate the prevalence of personality change after severe brain injury; to identify predictors of personality change; and to investigate whether personality change is associated with distress in family members. Design A longitudinal study of personality change. Setting...... often observed in patients with frontal or temporal lesions. Generally, personality changes in patients were not associated with more distress and lower HRQOL in family members; however, change in patient agreeableness was associated with lower HRQOL on the role limitations-emotional scale. Conclusions...

Relationship between red cell distribution width and early renal injury in patients with gestational diabetes mellitus.

Science.gov (United States)

Cheng, Dong; Zhao, Jiangtao; Jian, Liguo; Ding, Tongbin; Liu, Shichao

2016-09-01

Previous studies found that red cell distribution width was related to adverse cardiovascular events. However, few studies reported the relationship between red cell distribution width and early-stage renal injury in pregnant women with gestational diabetes mellitus. Using a cross-sectional design, 334 pregnant women with gestational diabetes mellitus were enrolled according to the criterion of inclusion and exclusion. Demographic and clinical examination data were collected. Depended on the urine albumin, study population were divided into case group (n = 118) and control group (n = 216). Compared with control group, the case group tend to be higher red cell distribution width level (13.6 ± 0.9 vs.12.5 ± 0.6, p gestational diabetes mellitus patients. The elevated red cell distribution width level might be a predictor of early-stage renal injury in pregnant women with gestational diabetes mellitus. As an easy and routine examination index, red cell distribution width may provide better clinical guidance when combined with other important indices.

Resilience in mathematics after early brain injury: The roles of parental input and early plasticity

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Dana E. Glenn

2018-04-01

Full Text Available Children with early focal unilateral brain injury show remarkable plasticity in language development. However, little is known about how early brain injury influences mathematical learning. Here, we examine early number understanding, comparing cardinal number knowledge of typically developing children (TD and children with pre- and perinatal lesions (BI between 42 and 50 months of age. We also examine how this knowledge relates to the number words children hear from their primary caregivers early in life. We find that children with BI, are, on average, slightly behind TD children in both cardinal number knowledge and later mathematical performance, and show slightly slower learning rates than TD children in cardinal number knowledge during the preschool years. We also find that parents’ “number talk” to their toddlers predicts later mathematical ability for both TD children and children with BI. These findings suggest a relatively optimistic story in which neural plasticity is at play in children’s mathematical development following early brain injury. Further, the effects of early number input suggest that intervening to enrich the number talk that children with BI hear during the preschool years could narrow the math achievement gap. Keywords: Plasticity, Early unilateral brain injury, Mathematical skill, Cardinality, Parent input

Urinary neutrophil gelatinase-associated lipocalin as an early predictor of prolonged intensive care unit stay after cardiac surgery

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Elena Bignami

2012-01-01

Full Text Available Neutrophil gelatinase-associated lipocalin (NGAL is a protein of lipocalin family highly expressed in various pathologic states and is an early biomarker of acute kidney injury in cardiac surgery. We performed an observational study to evaluate the role of NGAL in predicting postoperative intensive care stay in high-risk patients undergoing cardiac surgery. We enrolled 27 consecutive patients who underwent high-risk cardiac surgery with cardiopulmonary bypass. Urinary NGAL (uNGAL was measured before surgery, at intensive care unit (ICU arrival and 24 h later. Univariate and multivariate predictors of ICU stay were performed. uNGAL was 18.0 (8.7-28.1 ng/mL at baseline, 10.7 (4.35-36.0 ng/mL at ICU arrival and 29.6 (9.65-29.5 24 h later. The predictors of prolonged ICU stay at the multivariate analysis were body mass index (BMI, uNGAL 24 h after surgery, and aortic cross-clamp time. The predictors of high uNGAL levels 24 h after at a multivariate analysis were preoperative uNGAL and logistic European System for Cardiac Operative Risk Evaluation. At a multivariate analysis the only independent predictors of prolonged ICU stay were BMI, uNGAL 24 h after surgery and aortic cross-clamp time.

Predictors of seeking financial compensation following motor vehicle trauma: inception cohort with moderate to severe musculoskeletal injuries.

Science.gov (United States)

Murgatroyd, Darnel; Harris, Ian A; Chen, Jian Sheng; Adie, Sam; Mittal, Rajat; Cameron, Ian D

2017-05-02

Compensation related factors have been repeatedly associated with poor recovery following orthopaedic trauma. There is limited research into the factors associated with seeking financial compensation. Further understanding of these factors could facilitate injury recovery by purposeful compensation scheme design. The aim of this study was to investigate the predictors of seeking financial compensation, namely making a claim and seeking legal representation, following motor vehicle related orthopaedic trauma. The study was conducted in New South Wales (NSW), Australia, in motor vehicle crash and workers' compensation schemes. Participants were patients admitted with upper or lower extremity factures following a motor vehicle crash to two trauma hospitals. Data were collected at baseline within two weeks of injury. Participants were followed up at six months. Analysis involved: descriptive statistics for baseline characteristics; comparison of compensable and non-compensable participants with Analysis of Variance (ANOVA) and chi-squared tests; and logistic regression for predictor models. The cohort consisted of 452 participants with a mean age 40 years; 75% male; 74% working pre-injury; 30% in excellent pre-injury health; 56% sustained serious injuries with an Injury Severity Score (ISS) 9-15; 61% had a low-middle range household income; and 35% self-reported at fault in the crash. There was no significant difference in pre-injury/baseline health between compensable and non-compensable participants. Follow up data was available for 301 (67%) participants. The significant predictor of claiming compensation in the adjusted analysis was higher body mass index (BMI) (overweight Odds Ratio [OR] 3.05, 95% Confidence Interval [CI] 1.63-5.68; obese OR 1.63, 95% CI 0.83-3.20). Participants less likely to claim were: involved in a motorcycle crash (OR 0.47, 95% CI 0.28-0.82); socioeconomically less disadvantaged (OR 0.37, 95% CI 0.17-0.82) or least disadvantaged (OR 0.39, 95

The Importance of Early Brain Injury after Subarachnoid Hemorrhage

Science.gov (United States)

Sehba, Fatima A.; Hou, Jack; Pluta, Ryszard M.; Zhang, John H.

2012-01-01

Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency that accounts for 5% of all stroke cases. Individuals affected are typically in the prime of their lives (mean age 50 years). Approximately 12% of patients die before receiving medical attention, 33% within 48 hours and 50% within 30 days of aSAH. Of the survivors 50% suffer from permanent disability with an estimated lifetime cost more than double that of an ischemic stroke. Traditionally, spasm that develops in large cerebral arteries 3-7 days after aneurysm rupture is considered the most important determinant of brain injury and outcome after aSAH. However, recent studies show that prevention of delayed vasospasm does not improve outcome in aSAH patients. This finding has finally brought in focus the influence of early brain injury on outcome of aSAH. A substantial amount of evidence indicates that brain injury begins at the aneurysm rupture, evolves with time and plays an important role in patients’ outcome. In this manuscript we review early brain injury after aSAH. Due to the early nature, most of the information on this injury comes from animals and few only from autopsy of patients who died within days after aSAH. Consequently, we began with a review of animal models of early brain injury, next we review the mechanisms of brain injury according to the sequence of their temporal appearance and finally we discuss the failure of clinical translation of therapies successful in animal models of aSAH. PMID:22414893

Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation

NARCIS (Netherlands)

Verschueren, J. H. M.; Post, M. W. M.; de Groot, S.; van der Woude, L. H. V.; van Asbeck, F. W. A.; Rol, M.

Study design: Multicenter prospective cohort study. Objectives: To determine the occurrence and predictors for pressure ulcers in patients with spinal cord injury (SCI) during primary in-patient rehabilitation. Setting: Eight Dutch rehabilitation centres with specialized SCI units. Methods: The

The Predictors for Maternal Self-efficacy in Early Parenthood

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Elham Azmoude

2015-04-01

Full Text Available Background & aim: Many parents do not believe in their ability to fulfill their parental responsibilities. Parental self-efficacy is crucial to parents’ sense of well-being and is considered a predictor for quality of life. However, evidence is scarce on the factors that influence parents’ perception of efficacy. Therefore, this study aimed to investigate the predictors for parental self-efficacy in the early postpartum period. Methods:This descriptive analytical study was conducted on 150 primiparous women referring to the health care centers of Mashhad during their early postpartum months. For data collection, we used demographic questionnaires, Bates’ Infant Characteristics Questionnaire (ICQ, Scale of Perceived Social Support, Reece’s parent expectations survey (PES, and Edinburgh Postnatal Depression Scale (EPDS. For data analysis, independent T-test, one-way ANOVA, Pearson’s correlation coefficient, and stepwise regression were performed, using SPSS version 16. Results: In this study, a significant association was observed between self-efficacy scores and the parents’ income, educational status, depression, and infant’s gender. Furthermore, there was a significant correlation between self-efficacy scores and infant’s characteristics, mother’s satisfaction with childbirth experience, perceived support from friends, infant’s perceived temperament, infant’s gender, mother’s educational level, and depression, which could predict 26.1% of parental self-efficacy. Conclusion: According to the results of this study, the most significant predictors of maternal self-efficacy during the early postpartum months were maternal depression and educational status, infant’s gender, and infant’s characteristics.

Trajectories in the Course of Life Satisfaction After Spinal Cord Injury : Identification and Predictors

NARCIS (Netherlands)

van Leeuwen, Christel M.; Post, Marcel W.; Hoekstra, Trynke; van der Woude, Lucas H.; de Groot, Sonja; Snoek, Govert J.; Mulder, Dineke G.; Lindeman, Eline

Objective: To identify different life satisfaction trajectories in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge, and to find predictors for distinguishing between trajectories. The hypotheses were that different life satisfaction

Predictors of neonatal outcome in early-onset placental dysfunction

NARCIS (Netherlands)

Baschat, Ahmet A.; Cosmi, Erich; Bilardo, Catarina M.; Wolf, Hans; Berg, Christoph; Rigano, Serena; Germer, Ute; Moyano, Dolores; Turan, Sifa; Hartung, John; Bhide, Amarnath; Müller, Thomas; Bower, Sarah; Nicolaides, Kypros H.; Thilaganathan, Baskaran; Gembruch, Ulrich; Ferrazzi, Enrico; Hecher, Kurt; Galan, Henry L.; Harman, Chris R.

2007-01-01

To identify specific estimates and predictors of neonatal morbidity and mortality in early onset fetal growth restriction due to placental dysfunction. Prospective multicenter study of prenatally diagnosed growth-restricted liveborn neonates of less than 33 weeks of gestational age. Relationships

Early Brain Injury Associated with Systemic Inflammation After Subarachnoid Hemorrhage.

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Savarraj, Jude; Parsha, Kaushik; Hergenroeder, Georgene; Ahn, Sungho; Chang, Tiffany R; Kim, Dong H; Choi, H Alex

2018-04-01

Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) is defined as brain injury occurring within 72 h of aneurysmal rupture. Although EBI is the most significant predictor of outcomes after aSAH, its underlying pathophysiology is not well understood. We hypothesize that EBI after aSAH is associated with an increase in peripheral inflammation measured by cytokine expression levels and changes in associations between cytokines. aSAH patients were enrolled into a prospective observational study and were assessed for markers of EBI: global cerebral edema (GCE), subarachnoid hemorrhage early brain edema score (SEBES), and Hunt-Hess grade. Serum samples collected at ≤ 48 h of admission were analyzed using multiplex bead-based assays to determine levels of 13 pro- and anti-inflammatory cytokines. Pairwise correlation coefficients between cytokines were represented as networks. Cytokine levels and differences in correlation networks were compared between EBI groups. Of the 71 patients enrolled in the study, 17 (24%) subjects had GCE, 31 (44%) subjects had SEBES ≥ 3, and 21 (29%) had HH ≥ 4. IL-6 was elevated in groups with GCE, SEBES ≥ 3, and HH ≥ 4. MIP1β was independently associated with high-grade SEBES. Correlation network analysis suggests higher systematic inflammation in subjects with SEBES ≥ 3. EBI after SAH is associated with increased levels of specific cytokines. Peripheral levels of IL-10, IL-6, and MIP1β may be important markers of EBI. Investigating systematic correlations in addition to expression levels of individual cytokines may offer deeper insight into the underlying mechanisms related to EBI.

Head injury predictors in sports trauma--a state-of-the-art review.

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Fernandes, Fábio A O; de Sousa, Ricardo J Alves

2015-08-01

Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds. © IMechE 2015.

Early Sport Specialization: Effectiveness and Risk of Injury in Professional Baseball Players.

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Wilhelm, Andrew; Choi, Changryol; Deitch, John

2017-09-01

The rate of early sport specialization in professional baseball players is unknown. To report the incidence and age of sport specialization in current professional baseball players and the impact of early specialization on the frequency of serious injuries sustained during the players' careers. We also queried participants about when serious injuries occurred, the players' current position on the field, and their opinions regarding the need for young athletes to specialize early to play at the professional level. Descriptive epidemiological study. A total of 102 current professional baseball players anonymously completed a 7-question written survey. Early sport specialization was defined as "single-sport participation prior to high school." Injury was defined as "a serious injury or surgery that required the player to refrain from sports (baseball) for an entire year." Chi-square tests were used to investigate the risk of injury in those who specialized early in baseball versus those who did not. Independent-sample t tests were used to compare injury rates based on current player position. Fifty (48%) baseball players specialized early. The mean age at initiation of sport specialization was 8.91 years (SD, 3.7 years). Those who specialized early reported more serious injuries (mean, 0.54; SD, 0.838) during their professional baseball career than those who did not (mean, 0.23; SD, 0.425) ( P = .044). Finally, 63.4% of the queried players believed that early sport specialization was not required to play professional baseball. Our study demonstrated a statistically significant higher rate of serious injury during a baseball player's professional career in those players who specialized early. Most current professional baseball players surveyed believed that sport specialization was not required prior to high school to master the skills needed to play at the professional level. Our findings demonstrate an increased incidence of serious injuries in professional baseball

Differential Predictors of Pain and Disability in Patients with Whiplash Injuries

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Michael JL Sullivan

2002-01-01

Full Text Available The psychological predictors of pain and disability were examined in a sample of people who sustained whiplash injuries during rear-end motor vehicle accidents. Sixty-five patients referred to a specialty pain clinic with a diagnosis of whiplash injury completed measures of depression, anxiety, catastrophizing, pain and perceived disability. Regression analysis revealed that psychological variables accounted for 18% of the variance in pain ratings. The magnification subscale of the Pain Catastrophizing Scale was the only variable that contributed significant, unique variance to the prediction of pain. Psychological variables accounted for 37% of the variance in perceived disability scores. In the latter analysis, however, none of the independent variables contributed significant, unique variance to the prediction of perceived disability. Psychological variables accounted for significant variance in disability ratings, even when controlling for pain intensity. Discussion focuses on the need to draw clearer distinctions between determinants of pain and disability, and directions for interventions aimed at minimizing disability following whiplash injury are suggested.

Risk Predictors for Postcontrast Acute Kidney Injury.

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Krause, Trudy Millard; Ukhanova, Maria; Lee Revere, Frances; Finkel, Kevin W

2018-05-22

To evaluate risk predictors of acute kidney injury (AKI) after contrast-media procedures in a broader cohort of patients than previously reported. Comprehensive medical and pharmacy commercial claims data from 2012 to 2014. Claims associated with contrast-media procedures for 2,737,020 persons between January 1, 2012 and November 30, 2014, were reviewed. The overall incidence of AKI after a contrast-media procedure was 0.85%. AKI occurred in 26% of cases that had two or more contrast procedures within 30 days, compared with 9% of non-AKI cases. Although the incidence of postcontrast AKI was low, 10% of patients who developed AKI had a recent previous episode of AKI. In cases when AKI had occurred within 180 days of contrast administration, the odds of subsequent kidney injury was 9.39. Overall, there is a low risk (0.85%) of developing an AKI after a procedure with contrast-media consistent with several recent studies. However, in adults with a recent history of AKI, physicians must consider this history as a risk factor for subsequent AKI. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Emotional and attentional predictors of self-regulation in early childhood

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Stępień-Nycz Małgorzata

2015-09-01

Full Text Available The development of self-regulation in early childhood is related to development of emotional regulation and attention, in particular executive attention (Feldman, 2009; Posner & Rothbart, 1998. As the ability to self-regulate is crucial in life (Casey et al., 2011, it is important to reveal early predictors of self-regulation. The aim of the paper is to present the results of longitudinal studies on the relationships between the functioning of attention, regulation of emotion and later self-regulatory abilities. 310 children were assessed at three time points. At 12 months of age emotional regulation in situation of frustration and attention regulation were assessed. At 18 and 24 months behavioral-emotional regulation in the Snack Delay Task was measured. Additionally parents assessed executive attention using The Early Childhood Behavior Questionnaire when children were 26 months old. Structural equation modelling revealed two different paths to development of self-regulatory abilities at 18 months: emotional (reactive system and emotionalattentional and only one emotional-attentional path at 24 months. The early ability to focus attention and later executive attention functioning revealed to be important predictors of self-regulatory abilities both at 18 and 24 months of age.

Are there clinically useful predictors and early warning signs for pending relapse?

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Gaebel, Wolfgang; Riesbeck, Mathias

2014-02-01

Despite the availability of effective long-term treatment strategies in schizophrenia, relapse is still common. Relapse prevention is one of the major treatment objectives, because relapse represents burden and costs for patients, their environment, and society and seems to increase illness progression at the biological level. Valid predictors for relapse are urgently needed to enable more individualized recommendations and treatment decisions to be made. Mainly recent evidence regarding predictors and early warning signs of relapse in schizophrenia was reviewed. In addition, data from the first-episode (long-term) study (FES; Gaebel et al., 2007, 2011) performed within the German Research Network on Schizophrenia were analyzed. On the basis of FES data, premorbid adjustment, residual symptoms and some side effects are significant predictors. Although a broad spectrum of potential parameters has been investigated in several other studies, only a few and rather general valid predictors were identified consistently. Data of the FES also indicated that predictive power could be enhanced by considering interacting conjunctions, as suggested by the Vulnerability-Stress-Coping model. Prospective studies, however, are rare. In addition, prodromal symptoms as course-related characteristics likewise investigated in the FES add substantially to early recognition of relapse and may serve as early warning signs, but prognosis nevertheless remains a challenge. Comprehensive and well-designed studies are needed to identify and confirm valid predictors for relapse in schizophrenia. In this respect, broadly accepted and specifically defined criteria for relapse would greatly facilitate comparison of results across studies. © 2013 Elsevier B.V. All rights reserved.

NGAL (Neutrophil Gelatinase-associated Lipocalin) is an Early Predictor of Acute Kidney Injury after Cardiac Surgery and Variation of NGAL Values in Homogenous Study Subject.

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Miah, O F; Dowel, F A; Latif, A; Hai, A N; Mahmud, M A; Razzak, M A; Ahammod, T

2018-01-01

Isolated CABG (coronary artery bypass grafting) has the lowest incidence of AKI (Acute Kidney Injury), followed by valvular surgery and then, combined CABG with valvular surgery. Due to the difference in baseline characteristics and in surgery type, the range of incidence is between 8.9 and 39% based on RIFLE (Risk Injury failure loss end stage kidney disease) or AKIN (Acute Kidney Injury Network) criteria. The advent of novel biomarkers of kidney injury has opened a new era of early detection and prognosis prediction for AKI. NGAL is a small molecule of 178 amino acids that belongs to the super family of lipocalins, which are proteins specialized in binding and transporting small hydrophobic molecules. The expression of NGAL raises 1000 fold in humans and rodents in response to renal tubular injury and it appears so rapidly in the urine and serum that it is useful as an early biomarker of renal failure. The role of plasma NGAL to classify AKI severity and predict the need for RRT (renal replacement therapy) after cardiac surgery has been suggested. Although study subjects were more or less from same cohort (All undergone cardiac surgery), previous studies showed that NGAL raised differently in different proportion. NGAL as an early AKI marker has successfully passed through the pre-clinical, assay development and initial clinical testing stages. It is badly need to enter in a consensus about the cutoff value of NGAL which should help the physician about leveling a case as AKI or non AKI and their consequence management.

Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations.

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McNamara, Caitlin; Mironova, Irina; Lehman, Erik; Olympia, Robert P

2017-06-01

Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. We performed a retrospective chart review of pediatric patients (trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness. Copyright © 2016 Elsevier Inc. All rights reserved.

Predictors of early retirement after cancer rehabilitation-a longitudinal study.

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Mehnert, A; Barth, J; Gaspar, M; Leibbrand, B; Kegel, C-D; Bootsveld, W; Friedrich, M; Hartung, T J; Berger, D; Koch, U

2017-09-01

This longitudinal study was designed to assess patients' desire for early retirement and investigate which cancer-related and psychosocial characteristics are associated with early retirement. We assessed 750 cancer patients at the beginning (t 0 ) and end (t 1 ) of, and 12 months after (t 2 ) inpatient cancer rehabilitation. At t 0 , 22% had a desire to retire early. These patients reported significantly longer sick leave periods, less favourable workplace environments, lower work ability, higher psychological distress and lower quality of life than other patients. At t 2 , 12.5% of patients received temporary or permanent early retirement pensions. Of all patients with a desire for early retirement at t 0 , 43% had returned to work at t 2 . This subgroup had a significantly lower physical quality of life than other patients returning to work. The most influential predictors of early retirement were being on sick leave (OR = 6.50, 95% CI = 1.97-21.47) and a desire for early retirement (OR = 5.61, 95% CI = 2.73-11.52). Inverse predictors of early retirement were cancer remission (OR = 0.23, 95% CI = 0.10-0.53), perceived productivity (OR = 0.38, 95% CI = 0.18-0.83), work satisfaction (OR = 0.36, 95% CI = 0.17-0.77) and mental quality of life (OR = 0.94, 95% CI = 0.91-0.98). This underlines the need for cancer-specific multi-professional rehabilitation and occupational therapy programmes. © 2016 John Wiley & Sons Ltd.

Patterns of injury, outcomes, and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients.

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Hwabejire, John O; Kaafarani, Haytham M A; Lee, Jarone; Yeh, Daniel D; Fagenholz, Peter; King, David R; de Moya, Marc A; Velmahos, George C

2014-10-01

With the dramatic growth in the very old population and their concomitant heightened exposure to traumatic injury, the trauma burden among this patient population is estimated to be exponentially increasing. To determine the clinical outcomes and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients (NCTPs). All patients 90 years or older admitted to a level 1 academic trauma center between January 1, 2006, and December 31, 2010, with a primary diagnosis of trauma were included. Standard trauma registry data variables were supplemented by systematic medical record review. Cumulative mortality rates at 1, 3, 6, and 12 months after discharge were investigated using the Social Security Death Index. Univariate and multivariable analyses were performed to identify the predictors of in-hospital and 1-year postdischarge cumulative mortalities. Length of hospital stay, in-hospital mortality, and cumulative mortalities at 1, 3, 6, and 12 months after discharge. Four hundred seventy-four NCTPs were included; 71.7% were female, and a fall was the predominant mechanism of injury (96.4%). The mean patient age was 93 years, the mean Injury Severity Score was 12, and the mean number of comorbidities per patient was 4.4. The in-hospital mortality was 9.5% but cumulatively escalated at 1, 3, 6, and 12 months after discharge to 18.5%, 26.4%, 31.3%, and 40.5%, respectively. Independent predictors of in-hospital mortality were the Injury Severity Score (odds ratio [OR], 1.09; 95% CI, 1.02-1.16; P = .01), mechanical ventilation (OR, 6.23; 95% CI, 1.42-27.27; P = .02), and cervical spine injury (OR, 4.37; 95% CI, 1.41-13.50; P = .01). Independent predictors of cumulative 1-year mortality were head injury (OR, 2.65; 95% CI, 1.24-5.67; P = .03) and length of hospital stay (OR, 1.06; 95% CI, 1.02-1.11; P = .005). Cumulative 1-year mortality in NCTPs with a head injury was 51.1% and increased to 73.2% if the Injury Severity Score was 25 or

Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge.

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Kesinger, Matthew Ryan; Kumar, Raj G; Wagner, Amy K; Puyana, Juan Carlos; Peitzman, Andrew P; Billiar, Timothy R; Sperry, Jason L

2015-02-01

Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI. This study involved data from the merger of an institutional trauma registry and the Traumatic Brain Injury Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale [AIS] score ≥ 4) who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into low (GOSE score GOSE score ≥ 6). Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up (1 year: odds ratio [OR], 6.39; 95% confidence interval [CI], 1.76-23.14; p = 0.005) (2 years: OR, 7.30; 95% CI, 1.87-27.89; p = 0.004) (5-years: OR, 6.89; 95% CI, 1.42-33.39; p = 0.017). Stratifying by GCS score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an independent

Predictors of "occult" intra-abdominal injuries in blunt trauma patients

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José Gustavo Parreira

Full Text Available Objective: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. Methods: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries or Group 2 (without intra-abdominal injuries. Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. Results: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05 lower mean AIS score for the head segment (1.0±1.4 vs. 1.8±1.9, as well as higher mean AIS thorax score (1.6±1.7 vs. 0.9±1.5 and ISS (25.7±14.5 vs. 17,1±13,1. The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3% and in motorcyclists (36.0% (p<0.001. The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64, presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14, run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22 and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85. Conclusion Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury.

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Pacella, Maria L; Hruska, Bryce; George, Richard L; Delahanty, Douglas L

2018-03-01

Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors. Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes. Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f  2  = 0.130; P = .005) and chronic headache related-disability (Cohen's f  2  = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f  2  = 0.105; P = .012) and chronic headache-related disability (Cohen's f  2  = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance). Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with

Resilience in mathematics after early brain injury: The roles of parental input and early plasticity.

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Glenn, Dana E; Demir-Lira, Özlem Ece; Gibson, Dominic J; Congdon, Eliza L; Levine, Susan C

2018-04-01

Children with early focal unilateral brain injury show remarkable plasticity in language development. However, little is known about how early brain injury influences mathematical learning. Here, we examine early number understanding, comparing cardinal number knowledge of typically developing children (TD) and children with pre- and perinatal lesions (BI) between 42 and 50 months of age. We also examine how this knowledge relates to the number words children hear from their primary caregivers early in life. We find that children with BI, are, on average, slightly behind TD children in both cardinal number knowledge and later mathematical performance, and show slightly slower learning rates than TD children in cardinal number knowledge during the preschool years. We also find that parents' "number talk" to their toddlers predicts later mathematical ability for both TD children and children with BI. These findings suggest a relatively optimistic story in which neural plasticity is at play in children's mathematical development following early brain injury. Further, the effects of early number input suggest that intervening to enrich the number talk that children with BI hear during the preschool years could narrow the math achievement gap. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury.

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Hinson, Holly E; Schreiber, Martin A; Laurie, Amber L; Baguley, Ian J; Bourdette, Dennis; Ling, Geoffrey S F

Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH. We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH. PSH was defined as a paroxysm of 3 or more of the following characteristics: (1) tachycardia, (2) tachypnea, (3) hypertension, (4) fever, (5) dystonia (rigidity or decerebrate posturing), and (6) diaphoresis, with no other obvious causation (ie, alcohol withdrawal, sepsis). The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization. Nineteen (11%) of the 167 patients met criteria for PSH. Patients with PSH had a higher 5-day cumulative mCFSS score than those without PSH (median [interquartile range] = 36 [29-42] vs 29 [22-35], P = .01). Of the 4 components of the mCFSS, elevated temperature appeared to be most predictive of the development of PSH, especially during the first 24 hours (odds ratio = 1.95; 95% confidence interval, 1.12-3.40). Early fever after TBI may signal impending autonomic dysfunction.

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

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Algattas, Hanna; Huang, Jason H.

2014-01-01

Traumatic Brain Injury (TBI) affects a large proportion and extensive array of individuals in the population. While precise pathological mechanisms are lacking, the growing base of knowledge concerning TBI has put increased emphasis on its understanding and treatment. Most treatments of TBI are aimed at ameliorating secondary insults arising from the injury; these insults can be characterized with respect to time post-injury, including early, intermediate, and late pathological changes. Early pathological responses are due to energy depletion and cell death secondary to excitotoxicity, the intermediate phase is characterized by neuroinflammation and the late stage by increased susceptibility to seizures and epilepsy. Current treatments of TBI have been tailored to these distinct pathological stages with some overlap. Many prophylactic, pharmacologic, and surgical treatments are used post-TBI to halt the progression of these pathologic reactions. In the present review, we discuss the mechanisms of the pathological hallmarks of TBI and both current and novel treatments which target the respective pathways. PMID:24381049

Predictors of Early versus Later Spelling Development in Danish

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Nielsen, Anne-Mette Veber; Juul, Holger

2016-01-01

The present study examined phoneme awareness, phonological short term memory, letter knowledge, rapid automatized naming (RAN), and visual-verbal paired associate learning (PAL) as longitudinal predictors of spelling skills in an early phase (Grade 2) and a later phase (Grade 5) of development in a sample of 140 children learning to spell in the…

Hospital Acquired Pneumonia is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury up to 5 Years after Discharge

Science.gov (United States)

Kesinger, Matthew R.; Kumar, Raj G.; Wagner, Amy K.; Puyana, Juan C.; Peitzman, Andrew P.; Billiar, Timothy R.; Sperry, Jason L.

2016-01-01

Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSEGOSE≥6). Logistic regression was utilized to determine adjusted odds of LOW-GOSE associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS), ventilation days, and other important confounders. A general estimating equation (GEE) model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. Results A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS. Logistic regression demonstrated that HAP was independently associated with LOW-GOSE scores at follow-up (1year: OR=6.39, 95%CI: 1.76-23.14, p=0.005; 2-years: OR=7.30, 95%CI 1.87-27.89, p=0.004; 5-years: OR=6.89, 95%CI: 1.42-33.39, p=0.017). Stratifying by GCS≤8 and early intubation, HAP remained a significant independent predictor of LOW-GOSE in all strata. In the GEE model, HAP continued to be an independent predictor of LOW-GOSE (OR: 4.59; 95%CI: 1.82-11.60′ p=0.001). Conclusion HAP is independently associated with poor outcomes in severe-TBI extending 5

Early predictors of outcome after mild traumatic brain injury (UPFRONT) : An observational cohort study

NARCIS (Netherlands)

van der Naalt, J.; Timmerman, M.E.; de Koning, M.E.; van der Horn, H.J.; Scheenen, M.E.; Jacobs, B.; Hageman, G.; Yilmaz, T.; Roks, G.; Spikman, J.M.

Background: Mild traumatic brain injury (mTBI) accounts for most cases of TBI, and many patients show incomplete long-term functional recovery. We aimed to create a prognostic model for functional outcome by combining demographics, injury severity, and psychological factors to identify patients at

Effects of early nerve repair on experimental brachial plexus injury in neonatal rats.

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Bourke, Gráinne; McGrath, Aleksandra M; Wiberg, Mikael; Novikov, Lev N

2018-03-01

Obstetrical brachial plexus injury refers to injury observed at the time of delivery, which may lead to major functional impairment in the upper limb. In this study, the neuroprotective effect of early nerve repair following complete brachial plexus injury in neonatal rats was examined. Brachial plexus injury induced 90% loss of spinal motoneurons and 70% decrease in biceps muscle weight at 28 days after injury. Retrograde degeneration in spinal cord was associated with decreased density of dendritic branches and presynaptic boutons and increased density of astrocytes and macrophages/microglial cells. Early repair of the injured brachial plexus significantly delayed retrograde degeneration of spinal motoneurons and reduced the degree of macrophage/microglial reaction but had no effect on muscle atrophy. The results demonstrate that early nerve repair of neonatal brachial plexus injury could promote survival of injured motoneurons and attenuate neuroinflammation in spinal cord.

Predictors of early change in bulimia nervosa after a brief psychoeducational therapy.

Science.gov (United States)

Fernàndez-Aranda, Fernando; Álvarez-Moya, Eva M; Martínez-Viana, Cristina; Sànchez, Isabel; Granero, Roser; Penelo, Eva; Forcano, Laura; Peñas-Lledó, Eva

2009-06-01

We aimed to examine baseline predictors of treatment response in bulimic patients. 241 seeking-treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six-session psychoeducational group. Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family's and patient's concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions.

Early concern and disregard for others as predictors of antisocial behavior

Science.gov (United States)

Rhee, Soo Hyun; Friedman, Naomi P.; Boeldt, Debra L.; Corley, Robin P.; Hewitt, John. K.; Knafo, Ariel; Lahey, Benjamin B.; Robinson, JoAnn; Van Hulle, Carol A.; Waldman, Irwin D.; Young, Susan E.; Zahn-Waxler, Carolyn

2012-01-01

Background Prediction of antisocial behavior is important given its adverse impact on both the individuals engaging in antisocial behavior and society. Additional research identifying early predictors of future antisocial behavior, or antisocial propensity, is needed. The present study tested the hypothesis that both concern for others and active disregard for others in distress in toddlers and young children predict antisocial behavior during middle childhood and adolescence. Methods A representative sample of same-sex twins (N = 956) recruited in Colorado was examined. Mother-rated and researcher-observed concern and disregard for others assessed at age 14 to 36 months were examined as predictors of parent- (age 4 to 12), teacher- (age 7 to 12), and self-reported (age 17) antisocial behavior. Results Observed disregard for others predicted antisocial behavior assessed by three different informants (parents, teachers, and self), including antisocial behavior assessed 14 years later. It also predicted a higher-order antisocial behavior factor (β = .58, p concern for others. Mother-rated disregard for others predicted parent-reported antisocial behavior. Contrary to predictions, neither mother-rated nor observed concern for others inversely predicted antisocial behavior. Results of twin analyses suggested that the covariation between observed disregard for others and antisocial behavior was due to shared environmental influences. Conclusions Disregard for others in toddlerhood/early childhood is a strong predictor of antisocial behavior in middle childhood and adolescence. The results suggest the potential need for early assessment of disregard for others and the development of potential interventions. PMID:23320806

Informing early intervention: preschool predictors of anxiety disorders in middle childhood.

Directory of Open Access Journals (Sweden)

Jennifer L Hudson

Full Text Available BACKGROUND: To inform early intervention practice, the present research examines how child anxiety, behavioural inhibition, maternal overinvolvement, maternal negativity, mother-child attachment and maternal anxiety, as assessed at age four, predict anxiety at age nine. METHOD: 202 children (102 behaviourally inhibited and 100 behaviourally uninhibited aged 3-4 years were initially recruited and the predictors outlined above were assessed. Diagnostic assessments, using the Anxiety Disorders Interview Schedule, were then conducted five years later. RESULTS: Behavioural inhibition, maternal anxiety, and maternal overinvolvement were significant predictors of clinical anxiety, even after controlling for baseline anxiety (p.1. CONCLUSIONS: Preschool children who show anxiety, are inhibited, have overinvolved mothers and mothers with anxiety disorders are at increased risk for anxiety in middle childhood. These factors can be used to identify suitable participants for early intervention and can be targeted within intervention programs.

Functional Outcomes in Individuals Undergoing Very Early (Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study.

Science.gov (United States)

Mattiassich, Georg; Gollwitzer, Maria; Gaderer, Franz; Blocher, Martina; Osti, Michael; Lill, Markkus; Ortmaier, Reinhold; Haider, Thomas; Hitzl, Wolfgang; Resch, Herbert; Aschauer-Wallner, Stephanie

2017-12-15

Our study aim was to assess the neurological outcomes of surgical decompression and stabilization within 5 and 24 h after injury. We performed a multi-center, retrospective cohort study in adolescents and adults 15-85 years of age presenting cervical spinal cord injury (CSCI) at one of 6 Austrian trauma centers participating in the Austrian Spinal Cord Injury Study (ASCIS). Neurological outcomes were measured using the American Spinal Injury Association Impairment Scale (AIS) grade according to the International Standards For Neurological Classification Of Spinal Cord Injury (ISNCSCI) form after at least 6 months of follow-up (FU). Of the 49 enrolled patients with acute CSCI, 33 underwent surgical decompression within 5 h (mean 3.2 h ± 1.1 h; very early group) after injury, and 16 underwent surgical decompression between 5 and 24 h (mean 8.6 h ± 5.5 h; early group). Significant neurological improvement was observed among the entire study population between the preoperative assessment and the FU. We identified a significant difference in the AIS grade at the last FU between the groups the using Jonckheere-Terpstra test for doubly ordered crosstabs (p = 0.011) and significantly different AIS improvement rates in the early group (Poisson model, p = 0.018). Improvement by one AIS grade was observed in 31% and 42% of the patients in the early and very early groups, respectively (p = 0.54). Improvement by two AIS grades was observed in 31% and 6% of the patients in the early and very early groups, respectively (p = 0.03; relative risk [RR], 5.2; 95% CI, 1.1-35). Improvement by three AIS grades was observed in 6% and 3% of patients in the early and very early groups, respectively (p = 1.0). Decompression of the spinal cord within 24 h after SCI was associated with an improved neurological outcome. No additional neurological benefit was observed in patients who underwent decompression within 5 h of injury.

MRI of perinatal brain injury

Energy Technology Data Exchange (ETDEWEB)

Rutherford, Mary; Allsop, Joanna [Imperial College, Robert Steiner MR Unit, Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Martinez Biarge, Miriam [La Paz University Hospital, Dept of Neonatology, Madrid (Spain); Counsell, Serena [Imperial College, Robert Steiner MR Unit, Neonatal Medicine, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Cowan, Frances [Imperial College, Dept of Paediatrics, Hammersmith Hospital, London (United Kingdom)

2010-06-15

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

MRI of perinatal brain injury

International Nuclear Information System (INIS)

Rutherford, Mary; Allsop, Joanna; Martinez Biarge, Miriam; Counsell, Serena; Cowan, Frances

2010-01-01

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

Psychosocial factors and safety behaviour as predictors of accidental work injuries in farming

DEFF Research Database (Denmark)

Glasscock, David John; Rasmussen, Kurt; Carstensen, Ole

2006-01-01

be a problem faced by farmers, there is a particular need to investigate the associations between farm accidents and work stressors and stress reactions. Using multivariate logistic regression analyses, this study aimed to uncover the best psychosocial predictors of injury, while controlling for exposure-related......, the relation with accidents occurred via an interaction with safety behaviour. The combination of high levels of stress symptoms and poor safety behaviour was associated with a particularly high accident risk.......Farming is one of the most hazardous occupations in terms of the incidence and seriousness of accidental injuries. Research with other occupational groups has drawn attention to the role of psychosocial factors and stress. Such research needs to be extended to agriculture. Since stress may...

Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study

OpenAIRE

Wiseman, Taneal A; Curtis, Kate; Lam, Mary; Foster, Kim

2015-01-01

Background Traumatic injury and mental health disorders are co-associated. Early identification of depression, anxiety and stress following injury, and subsequent preventive intervention, may reduce the long-term symptoms and negative impacts associated with depression and anxiety. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the acute phase of care, and at six months following injury, as well as the ...

Urinary biomarkers TIMP-2 and IGFBP7 early predict acute kidney injury after major surgery.

Directory of Open Access Journals (Sweden)

Ivan Gocze

Full Text Available To assess the ability of the urinary biomarkers IGFBP7 (insulin-like growth factor-binding protein 7 and TIMP-2 (tissue inhibitor of metalloproteinase 2 to early predict acute kidney injury (AKI in high-risk surgical patients.Postoperative AKI is associated with an increase in short and long-term mortality. Using IGFBP7 and TIMP-2 for early detection of cellular kidney injury, thus allowing the early initiation of renal protection measures, may represent a new concept of evaluating renal function.In this prospective study, urinary [TIMP-2]×[IGFBP7] was measured in surgical patients at high risk for AKI. A predefined cut-off value of [TIMP-2]×[IGFBP7] >0.3 was used for assessing diagnostic accuracy. Perioperative characteristics were evaluated, and ROC analyses as well as logistic regression models of risk assessment were calculated with and without a [TIMP-2]×[IGFBP7] test.107 patients were included in the study, of whom 45 (42% developed AKI. The highest median values of biomarker were detected in septic, transplant and patients after hepatic surgery (1.24 vs 0.45 vs 0.47 ng/l²/1000. The area under receiving operating characteristic curve (AUC for the risk of any AKI was 0.85, for early use of RRT 0.83 and for 28-day mortality 0.77. In a multivariable model with established perioperative risk factors, the [TIMP-2]×[IGFBP7] test was the strongest predictor of AKI and significantly improved the risk assessment (p<0.001.Urinary [TIMP-2]×[IGFBP7] test sufficiently detect patients with risk of AKI after major non-cardiac surgery. Due to its rapid responsiveness it extends the time frame for intervention to prevent development of AKI.

Early humoral-mediated graft injuries in ABO-incompatible kidney transplantation in human beings.

Science.gov (United States)

Sekijima, M; Shimizu, A; Ishii, Y; Kudo, S; Horita, S; Nakajima, I; Fuchinoue, S; Teraoka, S

2010-04-01

Acute humoral rejection is the most important risk factor for early graft loss in ABO-incompatible (ABO-i) renal transplantation (RTx) and is present from the early period after RTx. However, the characteristics of early humoral-mediated graft injury are pathologically uncertain. To analyze tissue from 10 protocol graft biopsies performed in 10 patients within 30 days post-RTx to clarify the pathologic features of early humoral-mediated graft injuries in ABO-i RTx. Pathologic findings were examined using light and electron microscopy and immunofluorescence studies for C4d. Protocol biopsies were performed within 30 days after RTx in the absence of an episode of dysfunction (creatinine concentration 1.21-1.81 mg/dL). The immunofluorescence study demonstrated C4d deposition in peritubular and glomerular capillaries. Acute glomerulitis with infiltration of mononuclear cells and neutrophils was observed in 3 patients. Furthermore, glomerulitis was accompanied by endothelial cell injuries, widening of subendothelial spaces with a double-contoured glomerular basement membrane, and mesangiolysis. In ABO-i RTx, early humoral-mediated graft injuries were observed in approximately 30% of patients despite normal graft function. They were characterized by C4d deposition and glomerular capillary injury. These findings suggest that renal glomeruli are the first site of graft injury by anti-A or anti-B blood type antibody with complement activation in ABO-i RTx.

Early inflammatory response in rat brain after peripheral thermal injury.

Science.gov (United States)

Reyes, Raul; Wu, Yimin; Lai, Qin; Mrizek, Michael; Berger, Jamie; Jimenez, David F; Barone, Constance M; Ding, Yuchuan

2006-10-16

Previous studies have shown that the cerebral complications associated with skin burn victims are correlated with brain damage. The aim of this study was to determine whether systemic thermal injury induces inflammatory responses in the brain. Sprague Dawley rats (n=28) were studied in thermal injury and control groups. Animals from the thermal injury (n=14) and control (n=14) group were anesthetized and submerged to the neck vertically in 85 degrees C water for 6 s producing a third degree burn affecting 60-70% of the animal body surface area. The controls were submerged in 37 degrees C water for 6 s. Early expression of tumor necrosis factor-alpha (TNF-alpha), interleukin 1-beta (IL-1beta), and intracellular cell adhesion molecules (ICAM-1) protein levels in serum were determined at 3 (n=7) and 7 h (n=7) by enzyme-linked immunoabsorbent assay (ELISA). mRNA of TNF-alpha, IL-1beta, and ICAM-1 in the brain was measured at the same time points with a real-time reverse transcriptase-polymerase chain reaction (RT-PCR). An equal animal number was used for controls. Systemic inflammatory responses were demonstrated by dramatic up-regulations (5-50 fold) of TNF-alpha, IL-1beta, and ICAM-1 protein level in serum at 7 h after the thermal injury. However, as early as 3 h after peripheral thermal injury, a significant increase (3-15 fold) in mRNA expression of TNF-alpha, IL-1beta and ICAM-1 was observed in brain homogenates, with increased levels remaining at 7 h after injury. This study demonstrated an early inflammatory response in the brain after severe peripheral thermal injury. The cerebral inflammatory reaction was associated with expression of systemic cytokines and an adhesion molecule.

Use of early tactile stimulation in rehabilitation of digital nerve injuries.

Science.gov (United States)

Cheng, A S

2000-01-01

Digital nerves are the most frequently injured peripheral nerve. To improve the recovery of functional sensibility of digital nerve injuries, a prospective randomized controlled study was conducted to see the effect of using early tactile stimulation in rehabilitation of digital nerve injuries. Two specific tactile stimulators were made and prescribed for patients with digital nerve-injury. Twenty-four participants with 32 digital nerve injuries received the prescribed tactile stimulators (experimental group), and another 25 participants with 33 digital nerve injuries received only routine conventional therapy (control group). A significant difference (p sensibility in digital nerve injuries without combined nerve, tendon, and bone injuries.

Predictors of early arrival at the emergency department in acute ischaemic stroke.

LENUS (Irish Health Repository)

Curran, C

2012-01-31

BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

Early Predictors of ASD in Young Children Using a Nationally Representative Data Set

Science.gov (United States)

Jeans, Laurie M.; Santos, Rosa Milagros; Laxman, Daniel J.; McBride, Brent A.; Dyer, W. Justin

2013-01-01

Current clinical diagnosis of Autism Spectrum Disorders (ASD) occurs between 3 and 4 years of age, but increasing evidence indicates that intervention begun earlier may improve outcomes. Using secondary analysis of the Early Childhood Longitudinal Study-Birth Cohort data set, the current study identifies early predictors prior to the diagnosis of…

Early concern and disregard for others as predictors of antisocial behavior.

Science.gov (United States)

Rhee, Soo Hyun; Friedman, Naomi P; Boeldt, Debra L; Corley, Robin P; Hewitt, John K; Knafo, Ariel; Lahey, Benjamin B; Robinson, JoAnn; Van Hulle, Carol A; Waldman, Irwin D; Young, Susan E; Zahn-Waxler, Carolyn

2013-02-01

Prediction of antisocial behavior is important, given its adverse impact on both the individuals engaging in antisocial behavior and society. Additional research identifying early predictors of future antisocial behavior, or antisocial propensity, is needed. The present study tested the hypothesis that both concern for others and active disregard for others in distress in toddlers and young children predict antisocial behavior during middle childhood and adolescence. A representative sample of same-sex twins (N=956) recruited in Colorado was examined. Mother-rated and researcher-observed concern and disregard for others assessed at age 14-36 months were examined as predictors of parent- (age 4-12), teacher- (age 7-12), and self-reported (age 17) antisocial behavior.   Observed disregard for others predicted antisocial behavior assessed by three different informants (parents, teachers, and self), including antisocial behavior assessed 14 years later. It also predicted a higher order antisocial behavior factor (β=.58, pconcern for others. Mother-rated disregard for others predicted parent-reported antisocial behavior. Contrary to predictions, neither mother-rated nor observed concern for others inversely predicted antisocial behavior. RESULTS of twin analyses suggested that the covariation between observed disregard for others and antisocial behavior was due to shared environmental influences. Disregard for others in toddlerhood/early childhood is a strong predictor of antisocial behavior in middle childhood and adolescence. The results suggest the potential need for early assessment of disregard for others and the development of potential interventions. © 2012 The Author. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.

Xenon ventilation-perfusion lung scans. The early diagnosis of inhalation injury

International Nuclear Information System (INIS)

Schall, G.L.; McDonald, H.D.; Carr, L.B.; Capozzi, A.

1978-01-01

The use of xenon Xe-133 ventilation-perfusion lung scans for the early diagnosis of inhalation injury was evaluated in 67 patients with acute thermal burns. Study results were interpreted as normal if there was complete pulmonary clearance of the radioactive gas by 150 seconds. Thirty-two scans were normal, 32 abnormal, and three technically inadequate. There were three true false-positive study results and one false-negative study result. Good correlation was found between the scan results and various historical, physical, and laboratory values currently used to evaluate inhalation injury. The scans appeared to be the most sensitive method for the detection of early involvement, often being abnormal several days before the chest roentgenogram. Xenon lung scanning is a safe, easy, accurate, and sensitive method for the early diagnosis of inhalation injury and has important therapeutic and prognostic implications as well

Predictors of Memory and Processing Speed Dysfunctions after Traumatic Brain Injury

Directory of Open Access Journals (Sweden)

William Winardi

2014-01-01

Full Text Available Background. The aims of this study were to evaluate the predictive value of admission Glasgow Coma Scale (GCS scores, duration of unconsciousness, neurosurgical intervention, and countercoup lesion on the impairment of memory and processing speed functions six months after a traumatic brain injury (TBI based on a structural equation modeling. Methods. Thirty TBI patients recruited from Neurosurgical Department at the Kaohsiung Medical University Hospital were administered the Wechsler Memory Scale-III (WMS-III and the Wechsler Adult Intelligence Scale-III processing speed index to evaluate the memory and processing speed functions. Results. The study showed that GCS scores accounted for 40% of the variance in memory/processing speed. No significant predictive effects were found for the other three variables. GCS classification at the time of TBI seems to correspond moderately to the severity of memory/processing speed dysfunctions. Conclusions. The present study demonstrated that admission GCS score is a robust predictor of memory/processing speed dysfunctions after TBI. The results should be replicated with a large sample of patients with TBI, or be extended by examining other potential clinical predictors.

Mountain time trial in handcycling : exercise intensity and predictors of race time in people with spinal cord injury

NARCIS (Netherlands)

de Groot, Sonja; Postma, Karin; van Vliet, Linda; Timmermans, Remco; Valent, L J M

Study design: Cross-sectional analyses. Objectives: To analyze exercise intensity during a mountain time trial in handcycling and to determine predictors of race time. Setting: Eight Dutch rehabilitation centers and Austrian mountain. Methods: Forty participants with spinal cord injury (SCI; high

Predictors for early introduction of solid food among Danish mothers and infants: an observational study

DEFF Research Database (Denmark)

Kronborg, Hanne; Foverskov, Else; Væth, Michael

2014-01-01

introduced to solid food. Full breastfeeding at five weeks was the most influential predictor for later introduction of solid food (OR = 2.52 CI: 1.93-3.28). Among infant factors male gender, increased gestational age at birth, and higher birth weight were found to be statistically significant predictors......BACKGROUND: Early introduction of complementary feeding may interfere with breastfeeding and the infant's self-controlled appetite resulting in increased growth. The aim of the present study was to investigate predictors for early introduction of solid food. METHODS: In an observational study...... Danish mothers filled in a self-administered questionnaire approximately six months after birth. The questionnaire included questions about factors related to the infant, the mother, attachment and feeding known to influence time for introduction of solid food. The study population consisted of 4503...

Early endoscopic treatment of blunt traumatic pancreatic injury.

Science.gov (United States)

Björnsson, Bergthor; Kullman, Eric; Gasslander, Thomas; Sandström, Per

2015-01-01

Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.

Behavioral, Personality, and Communicative Predictors of Acceptance and Popularity in Early Adolescence

NARCIS (Netherlands)

Wolters, N.; Knoors, H.E.T.; Cillessen, A.H.N.; Verhoeven, L.T.W.

2014-01-01

This study examined the behavioral, personality, and communicative predictors of acceptance and popularity in 608 early adolescents. Data were collected with sociometric methods and ratings in 30 sixth-grade classrooms. Hierarchical regressions were run to predict acceptance and popularity from

External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

NARCIS (Netherlands)

Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base

Predictors for early diagnosis of cerebral palsy from national registry data

DEFF Research Database (Denmark)

Granild-Jensen, Jakob Bie; Rackauskaite, Gija; Flachs, Esben Meulengracht

2015-01-01

AIM: As early intervention is important in cerebral palsy (CP), an early diagnosis is desirable. The aim of this study was to establish the median diagnostic age of CP and to identify predictors of an early diagnosis in a population-based cohort. METHOD: Using the Danish National Cerebral Palsy...... of motor disability, cerebral ultrasonography results, epilepsy, gestational age, and degree of cognitive impairment. RESULTS: We found the overall median corrected diagnostic age of CP to be 11 months. Early diagnosis was associated with the type of CP, presence of epilepsy, a high degree of motor...... disability, and abnormalities in the cerebral ultrasonography. The gestational age was not associated with the diagnostic age. INTERPRETATION: The median diagnostic age implies that half of the Danish children with CP will be able to enter an early intervention program before 1 year of age. A late diagnosis...

Early endoscopic realignment in posterior urethral injuries.

Science.gov (United States)

Shrestha, B; Baidya, J L

2013-01-01

Posterior urethral injury requires meticulous tertiary care and optimum expertise to manage successfully. The aim of our study is to describe our experiences with pelvic injuries involving posterior urethra and their outcome after early endoscopic realignment. A prospective study was carried out in 20 patients with complete posterior urethral rupture, from November 2007 till October 2010. They presented with blunt traumatic pelvic fracture and underwent primary realignment of posterior urethra in our institute. The definitive diagnosis of urethral rupture was made after retrograde urethrography and antegrade urethrography where applicable. The initial management was suprapubic catheter insertion after primary trauma management in casualty. After a week of conservative management with intravenous antibiotics and pain management, patients were subjected to the endoscopic realignment. The follow up period was at least six months. The results were analyzed with SPSS software. After endoscopic realignment, all patients were advised CISC for the initial 3 months. All patients voided well after three months of CISC. However, 12 patients were lost to follow up by the end of 6 postoperative months. Out of eight remaining patients, two had features of restricture and were managed with DVU followed by CISC again. One patient with restricture had some degree of erectile dysfunction who improved significantly after phospodiesterase inhibitors. None of the patients had features of incontinence. Early endoscopic realignment of posterior urethra is a minimally invasive modality in the management of complete posterior urethral injury with low rates of incontinence and impotency.

Early Sport Specialization: Effectiveness and Risk of Injury in Professional Baseball Players

OpenAIRE

Wilhelm, Andrew; Choi, Changryol; Deitch, John

2017-01-01

Background: The rate of early sport specialization in professional baseball players is unknown. Purpose: To report the incidence and age of sport specialization in current professional baseball players and the impact of early specialization on the frequency of serious injuries sustained during the players’ careers. We also queried participants about when serious injuries occurred, the players’ current position on the field, and their opinions regarding the need for young athletes to specializ...

Predictors of excellent early outcome after total hip arthroplasty

Directory of Open Access Journals (Sweden)

Smith George H

2012-03-01

Full Text Available Abstract Background Not all patients gain the same degree of improvement from total hip replacement and the reasons for this are not clear. Many investigators have assessed predictors of general outcome after hip surgery. This study is unique in its quest for the predictors of the best possible early outcome. Methods We prospectively collected data on 1318 total hip replacements. Prior to surgery patient characteristics, demographics and co-morbidities were documented. Hip function and general health was assessed using the Harris Hip score (HHS and the Short-Form 36 respectively. The HHS was repeated at three years. We took a maximal HHS of 100 to represent an excellent outcome (102 patients. Multiple logistic regression analysis was used to identify independent predictors of excellent outcome. Results The two strongest predictive factors in achieving an excellent result were young age and a high pre-operative HHS (p = 0.001. Conclusions It was the young and those less disabled from their arthritis that excelled at three years. When making a decision about the timing of hip arthroplasty surgery it is important to take into account the age and pre-operative function of the patient. Whether these patients continue to excel however will be the basis of future research.

Early predictors of refractory status epilepticus: an international two-center study.

Science.gov (United States)

Sutter, R; Kaplan, P W; Marsch, S; Hammel, E M; Rüegg, S; Ziai, W C

2015-01-01

Status epilepticus (SE) refractory to first- and second-line antiepileptic drugs carries high mortality. Little is known on early prediction of refractory SE (RSE)—an essential tool for planning appropriate therapy. Our aim was to identify and validate independent early RSE predictors in adults. Clinical and laboratory data on consecutive intensive care unit patients with SE from two academic care centers (a derivation data set from a Swiss center and a validation data set from a US center) were assessed. Multivariable analysis was performed with the derivation set to identify RSE predictors at SE onset. Their external validity was evaluated with an independent validation set. Measures of calibration and discrimination were assessed. In all, 302 patients were analyzed (138 with and 164 without RSE), 171 in the derivation data set and 131 in the validation data set. Acute SE etiology, coma/stupor and serum albumin RSE in the derivation data set [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.01-4.07; OR 4.83, 95% CI 2.42-9.68; OR 2.45, 95% CI 1.16-5.16]. The prediction model showed good measures of calibration (Hosmer-Lemesow goodness-of-fit test P = 0.99) and discrimination (area under the receiver operating characteristic curve 0.8) on the derivation data set—results that were similar in the validation data set (Hosmer-Lemeshow P = 0.24; area under the receiver operating characteristic curve 0.73). This study confirms the independent prognostic value of readily available parameters for early RSE prediction. Prospective studies are needed to identify additional robust predictors, which could be added to the proposed model for further optimization towards a reliable prediction scoring system. © 2014 EAN.

Predictors of paediatric injury mortality

African Journals Online (AJOL)

PTS) and Glasgow Coma Score (GCS) were tested against outcome by binary logistic regression analysis. Results. Five hundred and seventy-six children presented with injury during the study period with 22 deaths, giving an injury mortality ...

External validation of the Emergency Trauma Score for early prediction of mortality in trauma patients

NARCIS (Netherlands)

Joosse, Pieter; de Jong, Willem-Jan J.; Reitsma, Johannes B.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel

2014-01-01

The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and

Behavioral, Personality, and Communicative Predictors of Acceptance and Popularity in Early Adolescence

Science.gov (United States)

Wolters, Nina; Knoors, Harry; Cillessen, Antonius H. N.; Verhoeven, Ludo

2014-01-01

This study examined the behavioral, personality, and communicative predictors of acceptance and popularity in 608 early adolescents. Data were collected with sociometric methods and ratings in 30 sixth-grade classrooms. Hierarchical regressions were run to predict acceptance and popularity from prosocial, antisocial, and withdrawn behavior,…

Early surgical managment of penetrating ocular injuries involving the posterior segment.

Science.gov (United States)

Michels, R G

1976-09-01

Pars plana vitrectomy technic can be used in the early management of certain penetrating ocular injuries involving the posterior segment, including selected intraocular foreign bodies. This study reports the results of ten consecutive cases of intraocular foreign bodies in the posterior segment treated by a combination of vitrectomy (including lensectomy when necessary) and foreign-body extraction with forceps. The foreign body was successfully removed in nine of ten eyes, and nine of ten eyes were salvaged. This favorable experience using early vitreous surgery suggests that the vitrectomy technic can be used in other penetrating injuries involving the posterior segment that are not associated with intraocular foreign bodies. Possible indications for early vitrectomy are presented, including cases with a poor prognosis when managed by conventional methods.

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout.

Science.gov (United States)

Fischer, Melanie S; Bhatia, Vickie; Baddeley, Jenna L; Al-Jabari, Rawya; Libet, Julian

2017-07-28

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence-based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the "active" treatment stage after the 3-4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non-Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non-Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment. © 2017 Family Process Institute.

Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury

Science.gov (United States)

Mabray, Marc C.; Whetstone, William D.; Dhall, Sanjay S.; Phillips, David B.; Pan, Jonathan Z.; Manley, Geoffrey T.; Bresnahan, Jacqueline C.; Beattie, Michael S.; Haefeli, Jenny

2016-01-01

Abstract Literature examining magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) has focused on cervical SCI. Reproducible systems have been developed for MRI-based grading; however, it is unclear how they apply to thoracic SCI. Our hypothesis is that MRI measures will group as coherent multivariate principal component (PC) ensembles, and that distinct PCs and individual variables will show discriminant validity for predicting early impairment in thoracic SCI. We undertook a retrospective cohort study of 25 patients with acute thoracic SCI who underwent MRI on admission and had American Spinal Injury Association Impairment Scale (AIS) assessment at hospital discharge. Imaging variables of axial grade, sagittal grade, length of injury, thoracolumbar injury classification system (TLICS), maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were collected. We performed an analytical workflow to detect multivariate PC patterns followed by explicit hypothesis testing to predict AIS at discharge. All imaging variables loaded positively on PC1 (64.3% of variance), which was highly related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively correlated with AIS at discharge with the highest level of correlation for axial grade as assessed with the Brain and Spinal Injury Center (BASIC) score. A multiple variable model identified BASIC as the only statistically significant predictor of AIS at discharge, signifying that BASIC best captured the variance in AIS within our study population. Our study provides evidence of convergent validity, construct validity, and clinical predictive validity for the sampled MRI measures of SCI when applied in acute thoracic and thoracolumbar SCI. PMID:26414451

Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan.

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Mata-Mbemba, Daddy; Mugikura, Shunji; Nakagawa, Atsuhiro; Murata, Takaki; Ishii, Kiyoshi; Li, Li; Takase, Kei; Kushimoto, Shigeki; Takahashi, Shoki

2014-05-01

Computed tomography (CT) plays a crucial role in early assessment of patients with traumatic brain injury (TBI). Marshall and Rotterdam are the mostly used scoring systems, in which CT findings are grouped differently. We sought to determine the scoring system and initial CT findings predicting the death at hospital discharge (early death) in patients with TBI. We included 245 consecutive adult patients with mild-to-severe TBI. Their initial CT and status at hospital discharge (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score was related to early death; compared the two scoring systems' performance in predicting early death, and identified the CT findings that are independent predictors of early death. More deaths occurred among patients with higher Marshall and Rotterdam scores (both P death (Marshall, AUC = 0. 85 vs. Rotterdam, AUC = 0.85). Basal cistern absence (odds ratio [OR] = 771.5, P death. Both Marshall and Rotterdam scoring systems can be used to predict early death in patients with TBI. The performance of the Marshall score is at least equal to that of the Rotterdam score. Thus, although older, the Marshall score remains useful in predicting patients' prognosis. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Early prediction of favourable recovery 6 months after mild traumatic brain injury.

NARCIS (Netherlands)

Stulemeijer, M.; Werf, S.P. van der; Borm, G.F.; Vos, P.E.

2008-01-01

BACKGROUND: Predicting outcome after mild traumatic brain injury (MTBI) is notoriously difficult. Although it is recognised that milder head injuries do not necessarily mean better outcomes, less is known about the factors that do enable early identification of patients who are likely to recover

Management of colonic injuries in the combat theater.

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Cho, S David; Kiraly, Laszlo N; Flaherty, Stephen F; Herzig, Daniel O; Lu, Kim C; Schreiber, Martin A

2010-05-01

Combat injuries are more often associated with blast, penetrating, and high-energy mechanisms than civilian trauma, generating controversy about the management of combat colonic injury. Despite implementation of mandatory colostomy in World War II, recent civilian data suggest that primary repair without diversion is safe and feasible. This study describes the modern management of battle-related colonic injuries and seeks to determine whether management strategy affects early complications. Records from the combat theater (downrange) and tertiary referral center in Germany were retrospectively reviewed from 2005 to 2006. Patient characteristics, management strategy, treatment course, and early complications were recorded. Comparison groups by management strategy were as follows: primary repair, diversion, and damage control. A total of 133 (97% male) patients sustained colonic injuries from penetrating (71%), blunt (5%), and blast (23%) mechanisms. Average injury severity score was 21 and length of stay in the referral center was 7.1 days. Injury distribution was 21% ascending, 21% descending, 15% transverse, 27% sigmoid, and 25% rectum. Downrange complications for primary repair, initial ostomy, and damage control groups were 14%, 15%, and 30%, respectively. On discharge from the center, 62% of patients had undergone a diversion. The complication rate was 18% overall and was unrelated to management strategy (P = .16). Multivariate analysis did not identify independent predictors of complications. Early complications were similar by mechanism, anatomic location, severity of injury, and management strategy. More diversions were performed for rectosigmoid injury. Good surgical judgment allows for low morbidity and supports primary repair in selected cases. Damage control surgery is effective in a multinational theater of operations.

Does linguistic input play the same role in language learning for children with and without early brain injury?

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Rowe, Meredith L; Levine, Susan C; Fisher, Joan A; Goldin-Meadow, Susan

2009-01-01

Children with unilateral pre- or perinatal brain injury (BI) show remarkable plasticity for language learning. Previous work highlights the important role that lesion characteristics play in explaining individual variation in plasticity in the language development of children with BI. The current study examines whether the linguistic input that children with BI receive from their caregivers also contributes to this early plasticity, and whether linguistic input plays a similar role in children with BI as it does in typically developing (TD) children. Growth in vocabulary and syntactic production is modeled for 80 children (53 TD, 27 BI) between 14 and 46 months. Findings indicate that caregiver input is an equally potent predictor of vocabulary growth in children with BI and in TD children. In contrast, input is a more potent predictor of syntactic growth for children with BI than for TD children. Controlling for input, lesion characteristics (lesion size, type, seizure history) also affect the language trajectories of children with BI. Thus, findings illustrate how both variability in the environment (linguistic input) and variability in the organism (lesion characteristics) work together to contribute to plasticity in language learning.

Parent and peer predictors of physical aggression and conflict management in romantic relationships in early adulthood.

Science.gov (United States)

Linder, Jennifer Ruh; Collins, W Andrew

2005-06-01

Violence between romantic partners is widespread, but developmental precursors of perpetration and victimization are little understood. Among participants followed from birth to 23 years of age, familial and extrafamilial childhood and adolescent relationships were examined in connection with couple violence in early adulthood. Predictors included early childhood physical abuse and witnessing of parental partner violence, features of parent-child interactions at the age of 13 years, and close friendship quality at the age of 16 years. Controlling for early familial violence, intrusive or overly familiar behavior in videotaped parent-child collaborations at 13 years of age consistently predicted violence perpetration and victimization in early adulthood. Friendship quality at the age of 16 years contributed over and above familial predictors. Understanding the role of both familial and extrafamilial close relationship precursors may lead to effective strategies for ameliorating the problem of romantic partner violence. 2005 APA, all rights reserved

A subgroup analysis of penetrating injuries to the pancreas: 777 patients from the National Trauma Data Bank, 2010-2014.

Science.gov (United States)

Phillips, Bradley; Turco, Lauren; McDonald, Dan; Mause, Elizabeth; Walters, Ryan W

2018-05-01

This study is the first to analyze penetrating injuries to the pancreas within subgroups of severe traumatic brain injury (TBI), early deaths, and potential survivors. Our objectives were to identify national patterns of injury, predictors of mortality, and to validate the American Association for Surgery of Trauma Organ Injury Scale (AAST-OIS) pancreas injury grades by mortality. Secondary outcomes included hospital and intensive care unit length of stay and days on mechanical ventilation. Using the Abbreviated Injury Scale 2005 and ICD-9-CM E-codes, we identified 777 penetrating pancreatic trauma patients from the National Trauma Data Bank that occurred between 2010 and 2014. Severe TBI was identified by ICD-9-CM diagnosis codes and Glasgow Coma Score (GCS; n = 7), early deaths were those that occurred within 24 h of admission (n = 82), and potential survivors included patients without severe TBI who survived longer than 24 h following admission (n = 690). We estimated multivariable generalized linear mixed models to predict mortality to account for the nesting of potential survivors within trauma centers. Our results indicated that overall mortality decreased from 16.9% to 6.8% after excluding severe TBI and early deaths. Approximately, 11% of patients died within 24 h of admission, of whom 78% died in the first 6 h. Associated injuries to the stomach, liver, and major vasculature occurred in approximately 50% of patients; rates of associated injuries were highest in patients who died within 6 h of admission. In potential survivors, mortality increased by AAST-OIS grade: 3.5% I/II; 8.3% III; 9.6% IV; and 13.8% V. Predictors of mortality with significantly increased odds of death were patients with increasing age, lower admission GCS, higher admission pulse rate, and more severe injuries as indicated by Organ Injury Scale grade. From 777 patients, we identified national patterns of injury, predictors of outcome, and mortality by AAST-OIS grade within

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

Science.gov (United States)

Noyez, L; Biemans, I; Verkroost, M; van Swieten, H

2013-10-01

This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The endpoints of the study were hospital mortality and early mortality. The study population had a mean age of 69.7 ± 10.1 (19-95) years and a mean logistic EuroSCORE risk of 5.1 ± 5.6 (0.88-73.8). Sedentary patients were significantly older (p = 0.001), obese (p = 0.001), had a higher EuroSCORE risk (p = 0.001), and a higher percentage of complications. Hospital mortality (1.1 % versus 0.4 % (p = 0.014)) and early mortality (1.5 % versus 0.6 % (p = 0.006)) were significantly higher in the sedentary group compared with the active group. However, a sedentary lifestyle was not identified as an independent predictor for hospital mortality (p = 0.61) or early mortality (p = 0.70). Sedentary patients were older, obese and had a higher EuroSCORE risk. They had significantly more postoperative complications, higher hospital mortality and early mortality. Despite these results, sedentary behaviour could not be identified as an independent predictor for hospital or early mortality.

Corticobulbar tract changes as predictors of dysarthria in childhood brain injury.

Science.gov (United States)

Liégeois, Frédérique; Tournier, Jacques-Donald; Pigdon, Lauren; Connelly, Alan; Morgan, Angela T

2013-03-05

To identify corticobulbar tract changes that may predict chronic dysarthria in young people who have sustained a traumatic brain injury (TBI) in childhood using diffusion MRI tractography. We collected diffusion-weighted MRI data from 49 participants. We compared 17 young people (mean age 17 years, 10 months; on average 8 years postinjury) with chronic dysarthria who sustained a TBI in childhood (range 3-16 years) with 2 control groups matched for age and sex: 1 group of young people who sustained a traumatic injury but had no subsequent dysarthria (n = 15), and 1 group of typically developing individuals (n = 17). We performed tractography from spherical seed regions within the precentral gyrus white matter to track: 1) the hand-related corticospinal tract; 2) the dorsal corticobulbar tract, thought to correspond to the lips/larynx motor representation; and 3) the ventral corticobulbar tract, corresponding to the tongue representation. Despite widespread white matter damage, radial (perpendicular) diffusivity within the left dorsal corticobulbar tract was the best predictor of the presence of dysarthria after TBI. Diffusion metrics in this tract also predicted speech and oromotor performance across the whole group of TBI participants, with additional significant contributions from ventral speech tract volume in the right hemisphere. An intact left dorsal corticobulbar tract seems crucial to the normal execution of speech long term after acquired injury. Examining the speech-related motor pathways using diffusion-weighted MRI tractography offers a promising prognostic tool for people with acquired, developmental, or degenerative neurologic conditions likely to affect speech.

Prediction of preeclampsia in type 1 diabetes in early pregnancy by clinical predictors

DEFF Research Database (Denmark)

Vestgaard, Marianne; Sommer, Miriam Colstrup; Ringholm, Lene

2018-01-01

PURPOSE: The purpose of this study is to evaluate the prevalence and possible clinical predictors of preeclampsia present in early pregnancy among women with type 1 diabetes. METHODS: A systematic search of PubMed was conducted in April 2017. Inclusion criteria were largely unselected cohort, inc...

Informing early intervention: preschool predictors of anxiety disorders in middle childhood

OpenAIRE

Hudson, J. L.; Dodd, Helen F.

2012-01-01

Background: To inform early intervention practice, the present research examines how child anxiety, behavioural inhibition, maternal overinvolvement, maternal negativity, mother-child attachment and maternal anxiety, as assessed at age four, predict anxiety at age nine.\\ud \\ud Method: 202 children (102 behaviourally inhibited and 100 behaviourally uninhibited) aged 3–4 years were initially recruited and the predictors outlined above were assessed. Diagnostic assessments, using the Anxiety Dis...

Early Childhood Teachers' Psychological Well-Being: Exploring Potential Predictors of Depression, Stress, and Emotional Exhaustion

Science.gov (United States)

Jeon, Lieny; Buettner, Cynthia K.; Grant, Ashley A.

2018-01-01

Research Findings: Early childhood teachers' psychological well-being influences the nurturing and learning classroom climate in early care and education as well as children's development. However, less is known about predictors of teachers' psychological well-being in preschool. The purpose of this study was to explore associations between…

Early Primary Endoscopic Realignment of Posterior Urethral Injury- Evaluation and Follow-Up

Directory of Open Access Journals (Sweden)

Prasad Mylarappa

2013-07-01

Full Text Available Background: The management of complete orpartial posterior urethral disruption is contro-versial and much debate continues regarding theimmediate, early and delayed definitive therapy.Objective: We report our institutional experi-ence and long term result of early endoscopicrealignment of traumatic posterior urethral in-jury. Method and Materials: Between Septem-ber 1996 and March 2012, ninety six men witheither complete (84 or partial (12 posteriorurethral injury secondary to blunt trauma (11or pelvic fractures (85, presented to our insti-tution and these patients underwent immediatesuprapubic cystostomy followed by early pri-mary endoscopic realignment done 3-8 daysafter injury. Result: Seventy four patients(92.5% were continent after catheter removal.Urethral stricture was seen in seventy two pa-tients (90% of which fifty patients (69.4%had simple urethral stricture who were managedby urethral dilatation on outpatient basis. Four-teen patients (19.4% developed short stric-tures which were successfully treated with vi-sual internal urethrotomy. Eight patients(11.1% required anastomotic urethroplasty fordense stricture. Potency was retained in sev-enty five patients (93.75%. Urinary flow mea-surements at follow-up evaluation were satis-factory.Conclusion:Early primary endoscopic realign-ment in our experience reduces time to spon-taneous voiding, decrease the need for majorreconstructive surgery and long term supra pub-lic urinary diversion.

Predictors of Exceptional Longevity: Effects of Early-Life Childhood Conditions, Midlife Environment and Parental Characteristics.

Science.gov (United States)

Gavrilov, Leonid A; Gavrilova, Natalia S

Knowledge of strong predictors of mortality and longevity is very important for actuarial science and practice. Earlier studies found that parental characteristics as well as early-life conditions and midlife environment play a significant role in survival to advanced ages. However, little is known about the simultaneous effects of these three factors on longevity. This ongoing study attempts to fill this gap by comparing centenarians born in the United States in 1890-91 with peers born in the same years who died at age 65. The records for centenarians and controls were taken from computerized family histories, which were then linked to 1900 and 1930 U.S. censuses. As a result of this linkage procedure, 765 records of confirmed centenarians and 783 records of controls were obtained. Analysis with multivariate logistic regression found that parental longevity and some midlife characteristics proved to be significant predictors of longevity while the role of childhood conditions was less important. More centenarians were born in the second half of the year compared to controls, suggesting early origins of longevity. We found the existence of both general and gender-specific predictors of human longevity. General predictors common for men and women are paternal and maternal longevity. Gender-specific predictors of male longevity are the farmer occupation at age 40, Northeastern region of birth in the United States and birth in the second half of year. A gender-specific predictor of female longevity is surprisingly the availability of radio in the household according to the 1930 U.S. census. Given the importance of familial longevity as an independent predictor of survival to advanced ages, we conducted a comparative study of biological and nonbiological relatives of centenarians using a larger sample of 1,945 validated U.S. centenarians born in 1880-95. We found that male gender of centenarian has significant positive effect on survival of adult male relatives

Early detection of crop injury from herbicide glyphosate by leaf biochemical parameter inversion

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Early detection of crop injury from glyphosate is of significant importance in crop management. In this paper, we attempt to detect glyphosate-induced crop injury by PROSPECT (leaf optical PROperty SPECTra model) inversion through leaf hyperspectral reflectance measurements for non-Glyphosate-Resist...

Sway as predictor of injuries in children

DEFF Research Database (Denmark)

Runge, Lisbeth; Kristensen, Peter Lund; Junge, Tina

2014-01-01

). Outcome measures Primary outcome was overuse and traumatic injuries, with special emphasis on ankle and knee sprains. Complaints were registered by SMS-track on a weekly basis, and after a telephone interview, clinicians examined and diagnosed the children with complaints. Injuries were diagnosed using...... ICD-10. Results Injuries: 2276, traumatic injuries: 714, ankle sprains: 164, knee sprains: 42 Preliminary multivariate analysis taking into account competing risk showed significant odds ratios (OR) at test 1; A) 1.003 per cm increase of sway; B) overall traumatic injury OR=3.0, ankle sprain OR=5...

Stages of development and injury patterns in the early years: a population-based analysis

Directory of Open Access Journals (Sweden)

Simpson Kelly

2006-07-01

Full Text Available Abstract Background In Canada, there are many formal public health programs under development that aim to prevent injuries in the early years (e.g. 0–6. There are paradoxically no population-based studies that have examined patterns of injury by developmental stage among these young children. This represents a gap in the Canadian biomedical literature. The current population-based analysis explores external causes and consequences of injuries experienced by young children who present to the emergency department for assessment and treatment. This provides objective evidence about prevention priorities to be considered in anticipatory counseling and public health planning. Methods Four complete years of data (1999–2002; n = 5876 cases were reviewed from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP, an ongoing injury surveillance initiative. Epidemiological analyses were used to characterize injury patterns within and across age groups (0–6 years that corresponded to normative developmental stages. Results The average annual rate of emergency department-attended childhood injury was 107 per 1000 (95% CI 91–123, with boys experiencing higher annual rates of injury than girls (122 vs. 91 per 1000; p Conclusion This population-based injury surveillance analysis provides a strong evidence-base to inform and enhance anticipatory counseling and other public health efforts aimed at the prevention of childhood injury during the early years.

Parent and Peer Predictors of Physical Dating Violence Perpetration in Early Adolescence: Tests of Moderation and Gender Differences

Science.gov (United States)

Miller, Shari; Gorman-Smith, Deborah; Sullivan, Terri; Orpinas, Pamela; Simon, Thomas R.

2009-01-01

This study examined parenting and peer predictors of physical dating violence perpetration during early adolescence and tested moderation among these predictors and gender. Participants were 2,824 ethnically diverse sixth-grade students with a recent boyfriend/girlfriend who was part of a multisite, longitudinal investigation of the development…

Early rise in postoperative creatinine for identification of acute kidney injury after cardiac surgery.

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Karkouti, Keyvan; Rao, Vivek; Chan, Christopher T; Wijeysundera, Duminda N

2017-08-01

Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Treatment strategies are unlikely to prove efficacious unless patients are identified and treated soon after the onset of injury. In this observational study, we determined and validated the ability of an early rise in postoperative serum creatinine to identify patients who suffer AKI during cardiac surgery. The relationship between an early rise in creatinine (immediate postoperative / preoperative creatinine) and AKI (> 50% increase in creatinine by postoperative calendar days 1or 2) was determined by logistic regression modelling. Existing databases were used for model development (n = 4,820; one institution) and validation (n = 6,553; 12 institutions). Acute kidney injury occurred in 9.1% (n = 437) and 9.8% (n = 645) of patients in the development and validation sets, respectively. An early rise in creatinine was related to AKI (P 1.30 (n = 127), the sensitivity, specificity, positive, and negative predictive values for AKI in the development set were 20% (95% CI, 16 to 24), 99% (95% CI, 99 to 99), 68% (95% CI, 59 to 76), and 93% (95% CI, 92 to 93), respectively. In patients undergoing cardiac surgery with cardiopulmonary bypass, an early rise in postoperative creatinine is a useful marker for the early identification of AKI patients. This could allow inclusion of such patients in clinical trials of promising therapeutic strategies that need to be initiated soon after the onset of injury.

Long-term outcome after early repair of iatrogenic bile duct injury

DEFF Research Database (Denmark)

Stilling, Nicolaj M; Fristrup, Claus; Wettergren, André

2015-01-01

BACKGROUND: The aim of this retrospective study was to evaluate the peri-operative and long-term outcome after early repair with a hepaticojejunostomy (HJ). METHODS: Between 1995 and 2010, a nationwide, retrospective multi-centre study was conducted. All iatrogenic bile duct injury (BDI) sustained...... during a cholecystectomy and repaired with HJ in the five Hepato-Pancreatico-Biliary centres in Denmark were included. RESULTS: In total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Post...... with BDI repaired by early HJ we found a considerable risk of long-term complications (e.g. 30% stricture rate) and mortality in both the short- and the long-term perspective....

Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review.

Science.gov (United States)

Hindle, A; de la Piedad Garcia, X; Brennan, L

2017-03-01

This is the first systematic review to synthesize the evidence concerning early post-operative variables predictive of later weight and psychosocial outcomes in bariatric surgery. Eight electronic databases for empirical studies were searched (1954 to 2016). Most of the 39 included studies reported solely on weight outcomes; eating and psychosocial outcomes were less common. A better early weight loss trajectory was the most consistent predictor of more successful medium-term weight outcome (≤24 months); however, its relationship to longer term weight loss maintenance is less certain. Early eating adaptation may be associated with later weight loss, but further research is needed. Evidence is lacking for associations between early adherence or early psychosocial variables and later outcome. In particular, the relationship between early post-operative depression and later weight remains unclear. Little research has considered early prediction of later eating or psychosocial outcomes. Consideration of mediating or moderating relationships is lacking. The body of evidence is limited, and synthesis is hampered by heterogeneity in the type and time at which predictors and outcomes are measured and quality of statistical reporting. Further research on prospective prediction of bariatric surgery outcome is needed to guide early post-operative intervention for those at greatest risk of poor outcomes. © 2017 World Obesity Federation.

Physical Activity-Related Injury Profile in Children and Adolescents According to Their Age, Maturation, and Level of Sports Participation.

Science.gov (United States)

Costa E Silva, Lara; Fragoso, Maria Isabel; Teles, Júlia

Physical activity (PA) is beneficial, enhancing healthy development. However, one-third of school-age children practicing sports regularly suffer from an injury. These injuries are associated with sex, chronological age, and PA level. To identify the importance of age, PA level, and maturity as predictors of injury in Portuguese youth. Descriptive epidemiological study. Level 3. Information about injury and PA level was assessed via 2 questionnaires (LESADO RAPIL II) from 647 subjects aged 10 to 17 years. Maturity offset according to Mirwald (time before or after peak height velocity) and Tanner-Whitehouse III bone age estimates were used to evaluate maturation. Binary logistic regression and gamma regression were used to determine significant predictors of injury and injury rate. Injury occurrence was higher for both sexes in recreational, school, and federated athletes (athletes engaged in sports that are regulated by their respective federations, with formal competition). These injuries also increased with age in boys and in the higher maturity offset group in girls. Injury rate was higher for both sexes in the no sports participation group. Early-maturing girls, with higher bone age and lower maturity offset, showed higher injury rate. Injuries in Portuguese youth were related to PA level, age, and biological maturation. Recreational, school, and federated athletes had more injury ocurrences while subjects with no sports participation had higher injury risk. Older subjects had more injuries. Early-maturing girls that had just passed peak height velocity may be particularly vulnerable to risk of sports injury because of the growing process. Increased knowledge about injury with specific PA exposure data is important to an overall risk management strategy. This study has deepened the association between injury and biological maturation variables.

Evaluation of serum zonulin for use as an early predictor for gestational diabetes.

Science.gov (United States)

Mokkala, K; Tertti, K; Rönnemaa, T; Vahlberg, T; Laitinen, K

2017-03-20

Diet has an important role in regulating intestinal permeability and subsequently the risk for metabolic disorders. In this observational study, we examined whether serum intestinal permeability marker zonulin, could be used as a predictor for gestational diabetes mellitus (GDM). Serum zonulin concentration was measured in early pregnancy in overweight or obese pregnant women (n=88) at risk for developing GDM. Serum zonulin was associated with higher odds of GDM (adjusted OR for 1 ng ml -1 increase in zonulin: 1.08, 95% CI: 1.02-1.15; P=0.009), diagnosed by a 2-h 75-g oral glucose tolerance test at late pregnancy. The optimal cutoff value was 43.3 ng ml -1 , with sensitivity of 88% (95% CI: 71-100%) and specificity of 47% (95% CI: 33-58%). The area under the ROC-curve was 0.67 (95% CI: 0.54-0.81). Our results show an association between increased early-pregnancy serum zonulin concentration and GDM, suggesting zonulin as a possible predictor for GDM.

Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP).

Science.gov (United States)

van Meijel, Els P M; Gigengack, Maj R; Verlinden, Eva; Opmeer, Brent C; Heij, Hugo A; Goslings, J Carel; Bloemers, Frank W; Luitse, Jan S K; Boer, Frits; Grootenhuis, Martha A; Lindauer, Ramón J L

2015-05-12

Children and their parents are at risk of posttraumatic stress disorder (PTSD) following injury due to pediatric accidental trauma. Screening could help predict those at greatest risk and provide an opportunity for monitoring so that early intervention may be provided. The purpose of this study was to evaluate the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP) in a mixed-trauma sample in a non-English speaking country (the Netherlands). Children aged 8-18 and one of their parents were recruited in two academic level I trauma centers. The STEPP was assessed in 161 children (mean age 13.9 years) and 156 parents within one week of the accident. Three months later, clinical diagnoses and symptoms of PTSD were assessed in 147 children and 135 parents. We used the Anxiety Disorders Interview Schedule for DSM-IV - Child and Parent version, the Children's Revised Impact of Event Scale and the Impact of Event Scale-Revised. Receiver Operating Characteristic analyses were performed to estimate the Areas Under the Curve as a measure of performance and to determine the optimal cut-off score in our sample. Sensitivity, specificity, positive and negative predictive values were calculated. The aim was to maximize both sensitivity and negative predictive values. PTSD was diagnosed in 12% of the children; 10% of their parents scored above the cut-off point for PTSD. At the originally recommended cut-off scores (4 for children, 3 for parents), the sensitivity in our sample was 41% for children and 54% for parents. Negative predictive values were 92% for both groups. Adjusting the cut-off scores to 2 improved sensitivity to 82% for children and 92% for parents, with negative predictive values of 92% and 96%, respectively. With adjusted cut-off scores, the STEPP performed well: 82% of the children and 92% of the parents with a subsequent positive diagnosis were identified correctly. Special attention in the screening procedure is required because of a

Executive functions and theory of mind as predictors of social adjustment in childhood traumatic brain injury.

Science.gov (United States)

Robinson, Kristen E; Fountain-Zaragoza, Stephanie; Dennis, Maureen; Taylor, H Gerry; Bigler, Erin D; Rubin, Kenneth; Vannatta, Kathryn; Gerhardt, Cynthia A; Stancin, Terry; Yeates, Keith Owen

2014-11-15

This study examined whether executive function and theory of mind mediate the effects of pediatric traumatic brain injury (TBI) on social adjustment, relative to children with orthopedic injury (OI). Participants included 19 children with severe TBI, 41 children with complicated mild/moderate TBI, and 57 children with OI. They completed measures of executive function, as well as cognitive, affective, and conative theory of mind. Parents provided ratings of children's social adjustment. Children with severe TBI performed more poorly than children with OI on executive function and theory of mind tasks and were rated by parents as having more behavioral symptoms and worse communication and social skills. Executive function and theory of mind were positively correlated with social skills and communication skills, and negatively correlated with behavioral symptoms. In multiple mediator models, theory of mind and executive function were not significant direct predictors of any measure of social adjustment, but mediated the association between injury and adjustment for children with severe TBI. Theory of mind was a significant independent mediator when predicting social skills, but executive function was not. TBI in children, particularly severe injury, is associated with poor social adjustment. The impact of TBI on children's social adjustment is likely mediated by its effects on executive function and theory of mind.

Trajectories of suicide ideation and nonsuicidal self-injury among adolescents in mainland China : Peer predictors, joint development, and risk for suicide attempts

NARCIS (Netherlands)

Giletta, M.; Prinstein, M.J.; Abela, J.R.Z.; Gibb, B.E.; Barrocas, A.L.; Hankin, B.L.

2015-01-01

Objective: This study expanded knowledge about the development of suicide ideation and nonsuicidal self-injury (NSSI) among adolescents by investigating (a) peer experiences as predictors of trajectories of suicide ideation and NSSI, (b) the joint development of suicide ideation and NSSI, and (c)

Early cyclosporin A treatment retards axonal degeneration in an experimental peripheral nerve injection injury model

Directory of Open Access Journals (Sweden)

Ibrahim Erkutlu

2015-01-01

Full Text Available Injury to peripheral nerves during injections of therapeutic agents such as penicillin G potassium is common in developing countries. It has been shown that cyclosporin A, a powerful immunosuppressive agent, can retard Wallerian degeneration after peripheral nerve crush injury. However, few studies are reported on the effects of cyclosporin A on peripheral nerve drug injection injury. This study aimed to assess the time-dependent efficacy of cyclosporine-A as an immunosuppressant therapy in an experimental rat nerve injection injury model established by penicillin G potassium injection. The rats were randomly divided into three groups based on the length of time after nerve injury induced by penicillin G potassium administration (30 minutes, 8 or 24 hours. The compound muscle action potentials were recorded pre-injury, early post-injury (within 1 hour and 4 weeks after injury and compared statistically. Tissue samples were taken from each animal for histological analysis. Compared to the control group, a significant improvement of the compound muscle action potential amplitude value was observed only when cyclosporine-A was administered within 30 minutes of the injection injury (P < 0.05; at 8 or 24 hours after cyclosporine-A administration, compound muscle action potential amplitude was not changed compared with the control group. Thus, early immunosuppressant drug therapy may be a good alternative neuroprotective therapy option in experimental nerve injection injury induced by penicillin G potassium injection.

Work injuries and disability

DEFF Research Database (Denmark)

Tüchsen, Finn; Christensen, Karl Bang; Feveile, Helene

2009-01-01

of 4,217 male and 4,105 female employees from a national survey were followed up for subsequent DPR. RESULTS AND IMPACT ON INDUSTRY AND GOVERNMENT: Having had a work injury was a strong predictor of DPR among men. After control for age, smoking, body mass index, body postures, and physical demands......, the hazard ratio (HR) among those employees who had ever experienced a work injury was 1.80 (95% confidence interval (CI): 1.20-2.68). No association was found among women. SUMMARY: Having had a reportable work injury is a strong predictor of subsequent DPR for men....

Early Predictors of Ten-Year Course in First-Episode Psychosis

DEFF Research Database (Denmark)

Friis, Svein; Melle, Ingrid; Johannessen, Jan Olav

2016-01-01

, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores ≥4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years......, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses. RESULTS: Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow...

Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study.

Science.gov (United States)

Jourdan, C; Bosserelle, V; Azerad, S; Ghout, I; Bayen, E; Aegerter, P; Weiss, J J; Mateo, J; Lescot, T; Vigué, B; Tazarourte, K; Pradat-Diehl, P; Azouvi, P

2013-01-01

To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed. Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI.

Predictors of Exceptional Longevity: Effects of Early-Life and Midlife Conditions, and Familial Longevity.

Science.gov (United States)

Gavrilov, Leonid A; Gavrilova, Natalia S

Knowledge of strong predictors of mortality and longevity is very important for actuarial science and practice. Earlier studies found that parental characteristics as well as early-life conditions and midlife environment play a significant role in survival to advanced ages. However, little is known about the simultaneous effects of these three factors on longevity. This ongoing study attempts to fill this gap by comparing centenarians born in the United States in 1890-1891 with peers born in the same years who died at age 65. The records for centenarians and controls were taken from computerized family histories, which were then linked to 1900 and 1930 U.S. censuses. As a result of this linkage procedure, 765 records of confirmed centenarians and 783 records of controls were obtained. Analysis with multivariate logistic regression found the existence of both general and gender-specific predictors of human longevity. General predictors common for men and women are paternal and maternal longevity. Gender-specific predictors of male longevity are occupation as a farmer at age 40, Northeastern region of birth in the United States, and birth in the second half of year. A gender-specific predictor of female longevity is the availability of radio in the household according to the 1930 U.S. census. Given the importance of familial longevity as an independent predictor of survival to advanced ages, we conducted a comparative study of biological and nonbiological relatives of centenarians using a larger sample of 1,945 validated U.S. centenarians born in 1880-1895. We found that male gender of centenarian has a significant positive effect on survival of adult male relatives (brothers and fathers) but not female blood relatives. Life span of centenarian siblings-in-law is lower compared to life span of centenarian siblings and does not depend on centenarian gender. Wives of male centenarians (who share lifestyle and living conditions) have a significantly better survival

Injuries in Children with Autism Spectrum Disorder: Study to Explore Early Development (SEED)

Science.gov (United States)

DiGuiseppi, Carolyn; Levy, Susan E.; Sabourin, Katherine R.; Soke, Gnakub N.; Rosenberg, Steven; Lee, Li-Ching; Moody, Eric; Schieve, Laura A.

2018-01-01

This study examined caregiver-reported medically-attended injuries among 30-68 month old children with autism spectrum disorder (ASD) compared to general population (POP) and non-ASD developmental disorders (DD) controls in the Study to Explore Early Development. Injuries were common in ASD cases (32.3%) as well as POP (30.2%) and DD (27.8%)…

Patterns and Predictors of Failed and Sustained Return-to-Work in Transport Injury Insurance Claimants.

Science.gov (United States)

Gray, Shannon E; Hassani-Mahmooei, Behrooz; Cameron, Ian D; Kendall, Elizabeth; Kenardy, Justin; Collie, Alex

2018-02-12

Purpose To determine the incidence of employed people who try and fail to return-to-work (RTW) following a transport crash. To identify predictors of RTW failure. A historical cohort study was conducted in the state of Victoria, Australia. People insured through the state-based compulsory third party transport accident compensation scheme were included. Inclusion criteria included date of crash between 2003 and 2012 (inclusive), age 15-70 years at the time of crash, sustained a non-catastrophic injury and received at least 1 day of income replacement. A matrix was created from an administrative payments dataset that mapped their RTW pattern for each day up to 3 years' post-crash. A gap of 7 days of no payment followed by resumption of a payment was considered a RTW failure and was flagged. These event flags were then entered into a regression analysis to determine the odds of having a failed RTW attempt. 17% of individuals had a RTW fail, with males having 20% lower odds of experiencing RTW failure. Those who were younger, had minor injuries (sprains, strains, contusions, abrasions, non-limb fractures), or were from more advantaged socio-economic group, were less likely to experience a RTW failure. Most likely to experience a RTW failure were individuals with whiplash, dislocations or particularly those admitted to hospital. Understanding the causes and predictors of failed RTW can help insurers, employers and health systems identify at-risk individuals. This can enable earlier and more targeted support and more effective employment outcomes.

The scientific foundations and associated injury risks of early soccer specialisation.

Science.gov (United States)

Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A; Myer, Gregory D; Lloyd, Rhodri S

2016-12-01

Early specialisation is characterised by formal participation in a single sport at the exclusion of others. Limited data are available to support this approach in the development of soccer players who attain elite status later in life. Of growing concern is the associated increased risk of injury and suggestions that single sport specialisation is a risk factor independent of age, growth, biological maturation and training volumes. In the United Kingdom, elite soccer organisations have recently adopted an early sport specialisation approach following the introduction of the Elite Player Performance Plan. A key tenet of this programme is increased opportunities for training through a marked rise in the specified on-pitch hours per week. The accumulation of high training hours may be less of a relevant marker for success, and the impact of such a significant increase in training volume for young athletes who are experiencing a range of growth and maturational processes is currently unknown. This critical commentary includes an evidence-based discussion of the effectiveness of early sport specialisation and the potential injury risks associated with such programmes placing a specific focus on elite male youth soccer players. Available data indicate that modifications to the existing Elite Player Performance Plan framework could enhance players' development and reduce injury risk. Proposed alterations include reduced volume of soccer-specific training at key stages of growth and maturation and guidelines for the provision of a greater variety of physical activities that are integrated within other programme components.

Perceived quality of care and outcomes following spinal cord injury: minority status in the context of multiple predictors.

Science.gov (United States)

Johnston, Mark V; Wood, Kenneth; Millis, Scott; Page, Steve; Chen, David

2004-01-01

To determine whether patients with spinal cord injury (SCI) who are members of minority groups experience a disadvantage with regard to quality of care, and investigate predictors of perceived quality of care and indicators of outcome. Correlational analysis of longitudinal data. One hundred and forty-three individuals with SCI in the first year following injury (43.3% tetraplegia, 56.7% paraplegia; 53.6% of total had complete injuries). Hospital and postdischarge (usually outpatient) care at 3 SCI model systems. Perceived quality of acute, rehabilitative, and continuing care rated by patients according to standard format. Objective indicators of amount of care (eg, length of stay [LOS], charges) and outcomes (eg, medical complications, Functional Independence Measure [FIM] scores, a life satisfaction measure [the Diener Scale], and the Craig Handicap and Reporting Technique [CHART; a community participation scale]). Minorities did not report statistically significant differences in perceived quality of care or other indicators (eg, amount of care, medical complications, FIM gain, life satisfaction, and CHART scores) compared with other groups. Severity of injury affected LOS and activity outcomes. Satisfaction with medical care before the injury significantly predicted perceived quality of acute hospital care, inpatient rehabilitation, and continuing care (P satisfaction with previous care can assist in distinguishing satisfaction with current care from pre-existing biases.

Predictors of Cigarette Smoking Initiation in Early, Middle, and Late Adolescence.

Science.gov (United States)

O'Loughlin, Jennifer; O'Loughlin, Erin K; Wellman, Robert J; Sylvestre, Marie-Pierre; Dugas, Erika N; Chagnon, Miguel; Dutczak, Hartley; Laguë, Johanne; McGrath, Jennifer J

2017-09-01

Little is known about age-related differences in risk factors for cigarette smoking initiation. We identified predictors of initiation in early, middle, and late adolescence from among sociodemographic factors, indicators of smoking in the social environment, psychological characteristics, lifestyle indicators, and perceived need for cigarettes. Data were drawn from a longitudinal study of 1,801 children recruited at age 10-11 years from 29 elementary schools in Montreal, Canada. Multivariable logistic regression within a generalized estimating equations framework was used to identify predictors among never smokers across three 2-year windows: age 11-13 years (n = 1,221); age 13-15 years (n = 737); and age 15-17 years (n = 690). Among the 18 risk factors investigated, two differed across age. Friends' smoking, a strong risk factor in early adolescence (odds ratio [95% confidence interval] = 5.78 [3.90-8.58]), lost potency in late adolescence (1.83 [1.31-2.57]). Depressive symptoms, a risk factor in early and middle adolescence (1.60 [1.26-2.02] and 1.92 [1.45-2.54], respectively), were inversely associated in late adolescence (.76 [.58-1.00]). Sex, TV viewing, and weight-related goals were not associated with initiation at any age. All other factors were significant in two or three age groups. Most risk factors for smoking initiation were stable across age. Tobacco control interventions may be robust for risk factors across age groups and may not need adjustment. At all ages, interventions should focus on eliminating smoking in the social environment and on reducing the availability of tobacco products. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Computerized tomography and prognosis in paediatric head injury

International Nuclear Information System (INIS)

Tomberg, T.; Rink, U.; Pikkoja, E.; Tikk, A.

1996-01-01

The authors have analysed the computerized tomography (CT) findings and their correlation with the clinical state, early and late outcome in children and adolescents with head injuries (HI). This study represents clinical and CT data of 82 consecutive HI patients under 18 years of age. Among them 51 (62%) were boys and 31 (38 %) girls. The application of CT to the evaluation of the morphologic manifestations of HI in children has shown some differences in forms and mechanisms of injury and in outcome compared to adults. In the paediatric HI the most frequent finding was diffuse brain swelling with CT evidence of ventricular and cisternal compression or obliteration. Prognostically the most unfavourable findings were shearing injury, intracerebral and subdural haematomas combined with brain swelling and parenchymal damage. According to the Lidcombe impairment scale, outcome from severe paediatric HI was determined in the 3rd and 6th months, one year and 2 years after the injury. The outcome two years after severe HI varied to a great extent and was better in children than in adults. Although there was long-term disruption of the patient's quality of life, our data show that as there are no predictors of individual outcomes in child HI, no child should be excluded from early and long-term rehabilitation. (author)

Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality

Science.gov (United States)

Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L

2014-01-01

Objective: In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka. Subjects and methods: The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed. Results: Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early

Early biomarkers and potential mediators of ventilation-induced lung injury in very preterm lambs

Directory of Open Access Journals (Sweden)

Davis Peter G

2009-03-01

Full Text Available Abstract Background Bronchopulmonary dysplasia (BPD is closely associated with ventilator-induced lung injury (VILI in very preterm infants. The greatest risk of VILI may be in the immediate period after birth, when the lungs are surfactant deficient, still partially filled with liquid and not uniformly aerated. However, there have been very few studies that have examined this immediate post-birth period and identified the initial injury-related pathways that are activated. We aimed to determine if the early response genes; connective tissue growth factor (CTGF, cysteine rich-61 (CYR61 and early growth response 1 (EGR1, were rapidly induced by VILI in preterm lambs and whether ventilation with different tidal volumes caused different inflammatory cytokine and early response gene expression. Methods To identify early markers of VILI, preterm lambs (132 d gestational age; GA, term ~147 d were resuscitated with an injurious ventilation strategy (VT 20 mL/kg for 15 min then gently ventilated (5 mL/kg for 15, 30, 60 or 120 min (n = 4 in each. To determine if early response genes and inflammatory cytokines were differentially regulated by different ventilation strategies, separate groups of preterm lambs (125 d GA; n = 5 in each were ventilated from birth with a VT of 5 (VG5 or 10 mL/kg (VG10 for 135 minutes. Lung gene expression levels were compared to levels prior to ventilation in age-matched control fetuses. Results CTGF, CYR61 and EGR1 lung mRNA levels were increased ~25, 50 and 120-fold respectively (p CTGF, CYR61, EGR1, IL1-β, IL-6 and IL-8 mRNA levels compared to control levels. CTGF, CYR61, IL-6 and IL-8 expression levels were higher in VG10 than VG5 lambs; although only the IL-6 and CYR61 mRNA levels reached significance. Conclusion CTGF, CYR61 and EGR1 may be novel early markers of lung injury and mechanical ventilation from birth using relatively low tidal volumes may be less injurious than using higher tidal volumes.

Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer disease.

Science.gov (United States)

Donovan, Nancy J; Amariglio, Rebecca E; Zoller, Amy S; Rudel, Rebecca K; Gomez-Isla, Teresa; Blacker, Deborah; Hyman, Bradley T; Locascio, Joseph J; Johnson, Keith A; Sperling, Reisa A; Marshall, Gad A; Rentz, Dorene M

2014-12-01

To examine neuropsychiatric and neuropsychological predictors of progression from normal to early clinical stages of Alzheimer disease (AD). From a total sample of 559 older adults from the Massachusetts Alzheimer's Disease Research Center longitudinal cohort, 454 were included in the primary analysis: 283 with clinically normal cognition (CN), 115 with mild cognitive impairment (MCI), and 56 with subjective cognitive concerns (SCC) but no objective impairment, a proposed transitional group between CN and MCI. Two latent cognitive factors (memory-semantic, attention-executive) and two neuropsychiatric factors (affective, psychotic) were derived from the Alzheimer's Disease Centers' Uniform Data Set neuropsychological battery and Neuropsychiatric Inventory brief questionnaire. Factors were analyzed as predictors of time to progression to a worse diagnosis using a Cox proportional hazards regression model with backward elimination. Covariates included baseline diagnosis, gender, age, education, prior depression, antidepressant medication, symptom duration, and interaction terms. Higher/better memory-semantic factor score predicted lower hazard of progression (hazard ratio [HR] = 0.4 for 1 standard deviation [SD] increase, p factor score predicted higher hazard (HR = 1.3 for one SD increase, p = 0.01). No other predictors were significant in adjusted analyses. Using diagnosis as a sole predictor of transition to MCI, the SCC diagnosis carried a fourfold risk of progression compared with CN (HR = 4.1, p factors as significant predictors of more rapid progression from normal to early stages of cognitive decline and highlight the subgroup of cognitively normal elderly with SCC as those with elevated risk of progression to MCI. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Health Visitor's Role in Prediction of Early Childhood Injuries and Failure to Thrive.

Science.gov (United States)

Dean, Janet G.; And Others

1978-01-01

Discusses the role of the health visitor in the prediction of early childhood injuries, abuse, and failure to thrive--based on a three-year study of the relationship between early maternal attitudes and subsequent child health. Journal availability: Pergamon Press Ltd., Headington Hill Hall, Oxford, OX3 OBW England. (DLS)

Parent-child relationships and dyadic friendship experiences as predictors of behavior problems in early adolescence

NARCIS (Netherlands)

Sentse, Miranda; Laird, Robert D.

2010-01-01

This study focused on support and conflict in parent-child relationships and dyadic friendships as predictors of behavior problems in early adolescence (n=182; M age=12.9 years, 51% female, 45% African American, 74% two-parent homes). Support and conflict in one relationship context were

Dynamics and Predictors of Serum TSH and fT4 Reference Limits in Early Pregnancy

DEFF Research Database (Denmark)

Laurberg, Peter; Andersen, Stine Linding; Hindersson, Peter

2016-01-01

CONTEXT: Thyroid hormones are important developmental factors and levels should be adequate both in the pregnant woman and in the fetus. However, there is no consensus on maternal thyroid test reference limits in early pregnancy. OBJECTIVE: Estimation of week-to-week changes in and predictors of ...

FGF-2 induces behavioral recovery after early adolescent injury to the motor cortex of rats.

Science.gov (United States)

Nemati, Farshad; Kolb, Bryan

2011-11-20

Motor cortex injuries in adulthood lead to poor performance in behavioral tasks sensitive to limb movements in the rat. We have shown previously that motor cortex injury on day 10 or day 55 allow significant spontaneous recovery but not injury in early adolescence (postnatal day 35 "P35"). Previous studies have indicated that injection of basic fibroblast growth factor (FGF-2) enhances behavioral recovery after neonatal cortical injury but such effect has not been studied following motor cortex lesions in early adolescence. The present study undertook to investigate the possibility of such behavioral recovery. Rats with unilateral motor cortex lesions were assigned to two groups in which they received FGF-2 or bovine serum albumin (BSA) and were tested in a number of behavioral tests (postural asymmetry, skilled reaching, sunflower seed manipulation, forepaw inhibition in swimming). Golgi-Cox analysis was used to examine the dendritic structure of pyramidal cells in the animals' parietal (layer III) and forelimb (layer V) area of the cortex. The results indicated that rats injected with FGF-2 (but not BSA) showed significant behavioral recovery that was associated with increased dendritic length and spine density. The present study suggests a role for FGF-2 in the recovery of function following injury during early adolescence. Copyright © 2011 Elsevier B.V. All rights reserved.

Serial cranial ultrasonography or early MRI for detecting preterm brain injury?

NARCIS (Netherlands)

Plaisier, Annemarie; Raets, Marlou M A; Ecury-Goossen, Ginette M; Govaert, Paul; Feijen-Roon, Monique; Reiss, Irwin K M; Smit, Liesbeth S; Lequin, Maarten H; Dudink, Jeroen

OBJECTIVE: To investigate detection ability and feasibility of serial cranial ultrasonography (CUS) and early MRI in preterm brain injury. DESIGN: Prospective cohort study. SETTING: Level III neonatal intensive care unit. PATIENTS: 307 infants, born below 29 weeks of gestation. METHODS: Serial CUS

Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients.

Science.gov (United States)

Aveta, Achille; Casati, Paolo

2008-01-01

Facial injuries are often accompanied by soft tissue injuries. The complexity of these injuries is represented by the potential for loss of relationships between the functional and the aesthetic subunits of the head. Most reviews of craniofacial trauma have concentrated on fractures. With this article, we want to emphasize the importance of early aesthetic reconstruction of the face in polytrauma patients. We present 13 patients with soft tissue injuries of the face, treated in our emergency department in the 'day one surgery", without "second look"procedures. The final result always restored a sense of normalcy to the face. The face is the first most visible part of the human anatomy, so, in emergency, surgeons must pay special attention also to the reconstruction of the face, in polytrauma patients.

Chronic consequences of acute injuries: worse survival after discharge.

Science.gov (United States)

Shafi, Shahid; Renfro, Lindsay A; Barnes, Sunni; Rayan, Nadine; Gentilello, Larry M; Fleming, Neil; Ballard, David

2012-09-01

The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score ≥ 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score ≤ 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p > 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictors of long-term mortality given survival to discharge. Log-rank tests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. The survival rate of trauma patients with major injuries remains significantly lower than survival for minor trauma patients and the general population for several months postdischarge. Surveillance for early identification and treatment of

Imbalance of demand and supply for regionalized injury services: a case study in Greece.

Science.gov (United States)

Petridou, E; Gatsoulis, N; Dessypris, N; Skalkidis, Y; Voros, D; Papadimitriou, Y; Trichopoulos, D

2000-04-01

To study regionalized acute injury services on an island with high seasonal fluctuation of the population at risk. Of 9432 individuals with traumatic injuries who contacted the hospital during 1996, 1204 were hospitalized. Information was recorded on several injury-related clinical and sociodemographic variables. Possible residual disabilities, 6 months after the injury, were also assessed. Injury Severity Score (ISS), clinical outcome and duration of hospitalization, odds of transfer to other institutions. Non-residents, whether Greek or foreign nationals are hospitalized for shorter periods. Motor vehicle accident victims are hospitalized on average for 15% longer. Injury victims admitted on a Friday are hospitalized for a longer period. Finally, ISS is a powerful positive predictor of duration of hospitalization. Male injury victims, those injured during late night or early morning and patients injured in July are more likely to be transferred to another institution. Age of the patient and ISS are powerful and independent predictors of an unfavourable outcome. The extra demand created by injured tourists is reflected in the seasonality of admissions for injuries. The district hospital of Kerkyra cannot be considered as deficient in comparison to other district hospitals. Nevertheless, the suboptimal function of the hospital, with respect to injuries, is reflected in the high proportion of injured patients transferred when the injury occurs outside the full working schedule of the hospital. Patients with burns, bone fractures or dislocations and head injuries or concussion are transferred with an overall frequency of about 15%--too high to be compatible with a well functioning secondary care institution.

Physical and biological predictors of radiation-induced whole lung injury: early results of a prospective study

International Nuclear Information System (INIS)

Marks, L.B.; Munley, M.; Bentel, G.; Hollis, D.; Zhou, S.; Jirtle, R.; Kong, F.M.; Scarfone, C.; Antoine, P.; Chew, M.; Tapson, V.; Spencer, D.; Jaszczak, R.; Coleman, E.; Anscher, M.

1996-01-01

Purpose: To develop methods of predicting the pulmonary consequences of thoracic irradiation (RT) by prospectively studying changes in pulmonary function following RT. Methods: 105 patients receiving incidental partial lung irradiation during treatment of tumors in/around the thorax (lung-70, breast-18, lymphoma-4, misc-3) had whole lung function assessed (symptoms and pulmonary function tests [PFTs: FEV1-forced expiratory volume 1 sec; DLCO-diffusion capacity]) before and repeatedly 6-48 months following RT. All had computed tomography-based 3-dimensional (3D) dose calculations with lung density heterogeneity corrections for dose-volume histogram (DVH) and NTCP (normal tissue complication probability) calculations. Functional DVHs (DVfH) based on SPECT (single photon emission computed tomography) lung perfusion scans, and serial transforming growth factor-beta (TGF-β) levels were available in 50 and 30 patients, respectively. The incidence and severity of changes in whole lung function were correlated with clinical, physical and biological factors outlined in the results. Exploratory statistical analyses were preformed using chi-square, logistic regression, and multiple linear regression. Mean pt age=57, range 21-87; sex: 63 F, 42 M; 29 had chemotherapy (CT) before/with RT; Follow-up 6-48 months (mean 15, median 12). Results RT-induced symptoms developed in 26 patients (7-grade I-no intervention; 16 grade II-steroids; 3 grade III-oxygen and steroids). A mixed model based on pre-RT DLCO and CT-based NTCP was strongly predictive for the development of symptoms (p 30 Gy. In patients with 'good' pre-RT PFTs, there may be a relationship between the % reduction in PFT and % lung volume receiving >30 Gy (figure). Conclusion: Whole lung injury (symptoms or PFT changes) appears to be related to a variety of physical, biological and clinical factors. The data suggest that no one variable is likely to be an adequate predictor and that multi-faceted predictive models will be

Changes in the blood-nerve barrier after sciatic nerve cold injury: indications supporting early treatment

Directory of Open Access Journals (Sweden)

Hao Li

2015-01-01

Full Text Available Severe edema in the endoneurium can occur after non-freezing cold injury to the peripheral nerve, which suggests damage to the blood-nerve barrier. To determine the effects of cold injury on the blood-nerve barrier, the sciatic nerve on one side of Wistar rats was treated with low temperatures (3-5°C for 2 hours. The contralateral sciatic nerve was used as a control. We assessed changes in the nerves using Evans blue as a fluid tracer and morphological methods. Excess fluid was found in the endoneurium 1 day after cold injury, though the tight junctions between cells remained closed. From 3 to 5 days after the cold injury, the fluid was still present, but the tight junctions were open. Less tracer leakage was found from 3 to 5 days after the cold injury compared with 1 day after injury. The cold injury resulted in a breakdown of the blood-nerve barrier function, which caused endoneurial edema. However, during the early period, the breakdown of the blood-nerve barrier did not include the opening of tight junctions, but was due to other factors. Excessive fluid volume produced a large increase in the endoneurial fluid pressure, prevented liquid penetration into the endoneurium from the microvasculature. These results suggest that drug treatment to patients with cold injuries should be administered during the early period after injury because it may be more difficult for the drug to reach the injury site through the microcirculation after the tissue fluid pressure becomes elevated.

Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood.

Science.gov (United States)

Ewing-Cobbs, Linda; Prasad, Mary R; Kramer, Larry; Cox, Charles S; Baumgartner, James; Fletcher, Stephen; Mendez, Donna; Barnes, Marcia; Zhang, Xiaoling; Swank, Paul

2006-10-01

Although long-term neurological outcomes after traumatic brain injury (TBI) sustained early in life are generally unfavorable, the effect of TBI on the development of academic competencies is unknown. The present study characterizes intelligence quotient (IQ) and academic outcomes an average of 5.7 years after injury in children who sustained moderate to severe TBI prior to 6 years of age. Twenty-three children who suffered inflicted or noninflicted TBI between the ages of 4 and 71 months were enrolled in a prospective, longitudinal cohort study. Their mean age at injury was 21 months; their mean age at assessment was 89 months. The authors used general linear modeling approaches to compare IQ and standardized academic achievement test scores from the TBI group and a community comparison group (21 children). Children who sustained early TBI scored significantly lower than children in the comparison group on intelligence tests and in the reading, mathematical, and language domains of achievement tests. Forty-eight percent of the TBI group had IQs below the 10th percentile. During the approximately 5-year follow-up period, longitudinal IQ testing revealed continuing deficits and no recovery of function. Both IQ and academic achievement test scores were significantly related to the number of intracranial lesions and the lowest postresuscitation Glasgow Coma Scale score but not to age at the time of injury. Nearly 50% of the TBI group failed a school grade and/or required placement in self-contained special education classrooms; the odds of unfavorable academic performance were 18 times higher for the TBI group than the comparison group. Traumatic brain injury sustained early in life has significant and persistent consequences for the development of intellectual and academic functions and deleterious effects on academic performance.

Comparing Self-Regulatory and Early Academic Skills as Predictors of Later Math, Reading, and Science Elementary School Achievement

Science.gov (United States)

Murrah, William M., III

The achievement score gaps between advantaged and disadvantaged children at school entry is a major problem in education today. Identifying the skills critical for school readiness is an important step in developing interventions aimed at addressing these score gaps. The purpose of this study is to compare a number of school readiness skills with an eye toward finding out which are the best predictors of later academic achievement in math, reading, and science. The predictors were early reading, math, general knowledge, socioemotional skills, and motor skills. Data were obtained from the Early Childhood Longitudinal Study of 1998 (NCES, 1998) database. While controlling for an extensive set of family characteristics, predictions were made across five years - from the end of kindergarten to the end of fifth grade. Consistent with current findings, reading and math skills predicted later achievement. Interestingly, general knowledge, attention, and fine motor skills also proved to be important predictors of later academic achievement, but socioemotional skills were not. The findings were interpreted from a neurobiological perspective involving the development of self-regulation. These school entry skills are used to predict later achievement in reading, math, and science. I argued that in addition to acquiring early academic knowledge, children need to regulate the use of this knowledge to meet academic goals.

Early biomarkers of doxorubicin-induced heart injury in a mouse model

Energy Technology Data Exchange (ETDEWEB)

Desai, Varsha G., E-mail: varsha.desai@fda.hhs.gov [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Kwekel, Joshua C.; Vijay, Vikrant; Moland, Carrie L. [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Herman, Eugene H. [Toxicology and Pharmacology Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, The National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850-9734 (United States); Lee, Taewon [Department of Mathematics, Korea University, Sejong, Chungnam 339-700 (Korea, Republic of); Han, Tao [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Lewis, Sherry M. [Office of Scientific Coordination, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States); Davis, Kelly J.; Muskhelishvili, Levan [Toxicologic Pathology Associates, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Kerr, Susan [Arkansas Heart Hospital, Little Rock, AR 72211 (United States); Fuscoe, James C. [Personalized Medicine Branch, Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 (United States)

2014-12-01

Cardiac troponins, which are used as myocardial injury markers, are released in plasma only after tissue damage has occurred. Therefore, there is a need for identification of biomarkers of earlier events in cardiac injury to limit the extent of damage. To accomplish this, expression profiling of 1179 unique microRNAs (miRNAs) was performed in a chronic cardiotoxicity mouse model developed in our laboratory. Male B6C3F{sub 1} mice were injected intravenously with 3 mg/kg doxorubicin (DOX; an anti-cancer drug), or saline once a week for 2, 3, 4, 6, and 8 weeks, resulting in cumulative DOX doses of 6, 9, 12, 18, and 24 mg/kg, respectively. Mice were euthanized a week after the last dose. Cardiac injury was evidenced in mice exposed to 18 mg/kg and higher cumulative DOX dose whereas examination of hearts by light microscopy revealed cardiac lesions at 24 mg/kg DOX. Also, 24 miRNAs were differentially expressed in mouse hearts, with the expression of 1, 1, 2, 8, and 21 miRNAs altered at 6, 9, 12, 18, and 24 mg/kg DOX, respectively. A pro-apoptotic miR-34a was the only miRNA that was up-regulated at all cumulative DOX doses and showed a significant dose-related response. Up-regulation of miR-34a at 6 mg/kg DOX may suggest apoptosis as an early molecular change in the hearts of DOX-treated mice. At 12 mg/kg DOX, up-regulation of miR-34a was associated with down-regulation of hypertrophy-related miR-150; changes observed before cardiac injury. These findings may lead to the development of biomarkers of earlier events in DOX-induced cardiotoxicity that occur before the release of cardiac troponins. - Highlights: • Upregulation of miR-34a before doxorubicin-induced cardiac tissue injury • Apoptosis might be an early event in mouse heart during doxorubicin treatment. • Expression of miR-150 declined before doxorubicin-induced cardiac tissue injury.

Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

International Nuclear Information System (INIS)

Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

2009-01-01

Aim: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. Methods: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2 x 2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Results: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). Conclusion: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients

Non-invasive detection of the early phase of kidney injury by photoacoustic/computed tomography imaging

Science.gov (United States)

Pan, Wanma; Peng, Wen; Ning, Fengling; Zhang, Yu; Zhang, Yunfei; Wang, Yinhang; Xie, Weiyi; Zhang, Jing; Xin, Hong; Li, Cong; Zhang, Xuemei

2018-06-01

The early diagnosis of kidney diseases, which can remarkably impair the quality of life and are costly, has encountered great difficulties. Therefore, the development of methods for early diagnosis has great clinical significance. In this study, we used an emerging technique of photoacoustic (PA) imaging, which has relatively high spatial resolution and good imaging depth. Two kinds of PA gold nanoparticle (GNP)-based bioprobes were developed based on their superior photo detectability, size controllability and biocompatibility. The kidney injury mouse model was developed by unilateral ureteral obstruction for 96 h and the release of obstruction model). Giving 3.5 and 5.5 nm bioprobes by tail vein injection, we found that the 5.5 nm probe could be detected in the bladder in the model group, but not in the control group. These results were confirmed by computed tomography imaging. Furthermore, the model group did not show changes in the blood biochemical indices (BUN and Scr) and histologic examination. The 5.5 nm GNPs were found to be the critical point for early diagnosis of kidney injury. This new method was faster and more sensitive and accurate for the detection of renal injury, compared with conventional methods, and can be used for the development of a PA GNP-based bioprobe for diagnosing renal injury.

EARLY PREDICTORS OF 30-DAY MORTALITY INNON-ST-ELEVATION ACUTE CORONARY SYNDROME PATIENTS

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Suzana Rožič

2008-09-01

30-day mortality was 4.3 %. Between nonsurvivors and survivors there were significantdifferences in mean age, the incidence of arterial hypertension, positive family history ofcoronary artery disease, in mean admission systolic and diastolic blood pressure, pulse,mean admission troponin T, leukocyte count, CRP, creatinine and the incidence of admission heart failure. Multivariate logistic regression proved that most significant independent early predictor of 30-day mortality was admission heart failure (OR 41.21, 95 %CI 3.50 to 484.66, p = 0.003, followed by admission serum creatinine (OR 0.989, 95 %CI 0.981 to 0.997, p = 0.008 and troponin T (OR 0.263, 95 % CI 0.080 to 0.861.Conclusion Most significant independent predictor of 30-day mortality of patients with non-ST-elevation ACS, being 4.5 %, was heart failure on admission

Early sensitisation and development of allergic airway disease - risk factors and predictors

DEFF Research Database (Denmark)

Halken, Susanne

2003-01-01

The development and phenotypic expression of allergic airway disease depends on a complex interaction between genetic and several environmental factors, such as exposure to food, inhalant allergens and non-specific adjuvant factors (e.g. tobacco smoke, air pollution and infections). The first...... development of allergic disease at birth. Early sensitisation, cow's milk allergy and atopic eczema are predictors for later development of allergic airway disease. Exposure to indoor allergens, especially house dust mite allergens, is a risk factor for sensitisation and development of asthma later...

Efficiency of early application of immunomodulators in combined effect of radiation and thermal injury

International Nuclear Information System (INIS)

Makarov, G.F.

1989-01-01

Medical effect of thymus preparations (thymoline, thymoptine) and levamysole under combined radiation-thermal injury is studied. Experimental results have shown that early application of certain immunostimulators under combined radiation-thermal injury of medium criticality is low-efficient. Their ability to sufficiently increase the antibody synthesis is manifested only under combined action of burns and irradiation in non-lethal doses. 5 refs

Biomarkers of acute kidney injury in neonatal encephalopathy.

LENUS (Irish Health Repository)

Sweetman, D U

2013-03-01

Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.

Twist2 Is Upregulated in Early Stages of Repair Following Acute Kidney Injury

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Elizabeth A. Grunz-Borgmann

2017-02-01

Full Text Available The aging kidney is a marked by a number of structural and functional changes, including an increased susceptibility to acute kidney injury (AKI. Previous studies from our laboratory have shown that aging male Fischer 344 rats (24 month are more susceptible to apoptosis-mediated injury than young counterparts. In the current studies, we examined the initial injury and early recovery phases of mercuric chloride-induced AKI. Interestingly, the aging kidney had decreased serum creatinine compared to young controls 1 day following mercuric chloride injury, but by day 4, serum creatinine was significantly elevated, suggesting that the aging kidney did not recover from injury. This conclusion is supported by the findings that serum creatinine and kidney injury molecule-1 (Kim-1 gene expression remain elevated compared to young controls at 10 days post-injury. To begin to elucidate mechanism(s underlying dysrepair in the aging kidney, we examined the expression of Twist2, a helix-loop-helix transcription factor that may mediate renal fibrosis. Interestingly, Twist2 gene expression was elevated following injury in both young and aged rats, and Twist2 protein expression is elevated by mercuric chloride in vitro.

Evaluation of serum zonulin for use as an early predictor for gestational diabetes

OpenAIRE

Mokkala, K; Tertti, K; R?nnemaa, T; Vahlberg, T; Laitinen, K

2017-01-01

Diet has an important role in regulating intestinal permeability and subsequently the risk for metabolic disorders. In this observational study, we examined whether serum intestinal permeability marker zonulin, could be used as a predictor for gestational diabetes mellitus (GDM). Serum zonulin concentration was measured in early pregnancy in overweight or obese pregnant women (n=88) at risk for developing GDM. Serum zonulin was associated with higher odds of GDM (adjusted OR for 1?ng?ml?1 inc...

Non-suicidal self-injury as a predictor of active and passive suicidal ideation among Iraq/Afghanistan war veterans.

Science.gov (United States)

Kimbrel, Nathan A; Gratz, Kim L; Tull, Matthew T; Morissette, Sandra B; Meyer, Eric C; DeBeer, Bryann B; Silvia, Paul J; Calhoun, Patrick C; Beckham, Jean C

2015-06-30

The present study examined the association between lifetime non-suicidal self-injury (NSSI) and current suicidal ideation among Iraq/Afghanistan veterans. NSSI was positively associated with passive, active, and concurrent active-passive suicidal ideation at the bivariate level. NSSI remained a predictor of active, OR=5.15, and concurrent active-passive suicidal ideation, OR=7.01, when other risk factors were considered. These findings suggest that NSSI may be a particularly useful marker of active suicidal ideation among veterans. Published by Elsevier Ireland Ltd.

Early amplitude‐integrated electroencephalography for monitoring neonates at high risk for brain injury

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Gabriel Fernando Todeschi Variane

2017-09-01

Conclusion: This study supports previous results and demonstrates the utility of amplitude‐integrated electroencephalography for monitoring brain function and predicting early outcome in the studied groups of infants at high risk for brain injury.

Early urinary biomarkers of acute kidney injury in preterm infants.

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Hanna, Mina; Brophy, Patrick D; Giannone, Peter J; Joshi, Mandar S; Bauer, John A; RamachandraRao, Satish

2016-08-01

Acute kidney injury (AKI) in the neonatal intensive care setting is multifactorial and is associated with significant morbidity and mortality. This study evaluates the utility of novel urinary biomarkers to predict the development and/or severity AKI in preterm infants. We performed a case-control study on a prospective cohort of preterm infants (<32 wk), to compare seven urine biomarkers between 25 infants with AKI and 20 infants without AKI. Infants with AKI had significantly higher neutrophil gelatinase-associated lipocalin (NGAL) (median, control (CTRL) vs. AKI; 0.598 vs. 4.24 µg/ml; P < 0.0001). In contrast, urinary epidermal growth factor (EGF) levels were significantly lower in infants who developed AKI compared to controls (median, CTRL vs. AKI; 0.016 vs. 0.006 µg/ml; P < 0.001). The area under the curve (AUC) for NGAL for prediction of stage I AKI on the day prior to AKI diagnosis (day-1) was 0.91, and for the prediction of stage II/III, AKI was 0.92. Similarly, urine EGF was a predictor of renal injury on day -1 (AUC: 0.97 for stage I and 0.86 for stage II/III AKI). Urinary biomarkers may be useful to predict AKI development prior to changes in serum creatinine (SCr) in preterm infants.

EARLY MEDICAL REHABILITATION OF THE PATIENTS WITH SPINAL CORD INJURY

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Aleš Demšar

2003-12-01

Full Text Available Background. Early medical rehabilitation (EMR of the patients with spinal cord injury is discussed in this article.For successful rehabilitation adequate surgical treatment, which enables early verticalisation, is compulsory.Predictable respiratory, vascular, intestinal and urologic complications, contractures and bed sores are described and algorhytms of EMR in the period of spinal shock and after, until transferring the patient to the IRSR, are presented.Respiratory therapy, thromboprophylaxis, kinesiotherapy and functional electrical stimulation as well as the methods of early bladder and bowel control, contractures and bed sores prevention, as procedures of EMR are fully presented.With special importance early verticalisation from the 5th post operative day with help of the tilt table is presented as the key point of EMR.Conclusions. With aggressive EMR the paraplegic patient is able to gain erect posture from the 5th post operative day, sits in a wheel chair from 10th to 14th day and stands in the paralel bar from 15th day on.

Predicting the Transition From Acute Stress Disorder to Posttraumatic Stress Disorder in Children With Severe Injuries.

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Brown, Ruth C; Nugent, Nicole R; Hawn, Sage E; Koenen, Karestan C; Miller, Alisa; Amstadter, Ananda B; Saxe, Glenn

The purpose of this study was to examine predictors of risk for and the transition between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in a longitudinal sample of youth with severe injuries admitted to the hospital. These data would assist with treatment and discharge planning. Youth were assessed for ASD during the initial hospital stay and were followed-up over an 18-month period for PTSD (n = 151). Youth were classified into four groups, including Resilient (ASD-, PTSD-), ASD Only (ASD+, PTSD-), PTSD Only (ASD-, PTSD+), and Chronic (ASD+, PTSD+). Demographic, psychiatric, social context, and injury-related factors were examined as predictors of diagnostic transition. The results of multivariate analysis of variance and pairwise comparisons found that peritraumatic dissociation, gender, and socioeconomic status were significant predictors after controlling for multiple testing. Results suggest that both within-child and contextual factors contribute to the longitudinal response to trauma in children. Clinicians should consider early screening and discharge planning, particularly for children most at risk. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

ANALYSIS OF SERUM URIC ACID LEVELS IN EARLY SECOND TRIMESTER AS AN EARLY PREDICTOR FOR PREECLAMPSIA

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Ratna Bulusu

2017-01-01

Full Text Available BACKGROUND Hypertensive disorders complicate 5-10% of all pregnancies. Screening for these factors in the second trimester of pregnancy will help in early detection of hypertensive disorders of pregnancy, thus enabling. 1. Early identification of patients at risk of developing preeclampsia and eclampsia. 2. Prophylactic medication to prevent hypertension or to reduce its severity. 3. Proper antenatal care. The aim of the study is to study the accuracy of serum uric acid levels in early second trimester (14-20 weeks as early predictor of preeclampsia. MATERIALS AND METHODS 100 pregnant normotensive women between 14-20 weeks gestation with singleton pregnancy irrespective of parity were selected randomly and serum levels of uric acid was estimated. Regular follow up of the cases was done till delivery. Number of cases developing preeclampsia was noted. Results were analysed statistically. RESULTS Out of the 100 patients enrolled in the study, 11 developed preeclampsia while rest 89 remained normotensive. Mean value of uric acid in preeclampsia cases was 6.28±0.86 mg/dL while that in normotensive cases was 3.42±0.94 mg/dL. This result was statistically significant. CONCLUSION Serum uric acid level at 14-20 weeks of gestation was significantly raised in the cases who developed preeclampsia as compared to those who remained normotensive. Hence, serum uric acid estimation at 14-20 weeks of gestation could be used as an effective parameter for predicting preeclampsia.

Analysis of early thrombus dynamics in a humanized mouse laser injury model.

Science.gov (United States)

Wang, Weiwei; Lindsey, John P; Chen, Jianchun; Diacovo, Thomas G; King, Michael R

2014-01-01

Platelet aggregation and thrombus formation at the site of injury is a dynamic process that involves the continuous addition of new platelets as well as thrombus rupture. In the early stages of hemostasis (within minutes after vessel injury) this process can be visualized by transfusing fluorescently labeled human platelets and observing their deposition and detachment. These two counterbalancing events help the developing thrombus reach a steady-state morphology, where it is large enough to cover the injured vessel surface but not too large to form a severe thrombotic occlusion. In this study, the spatial and temporal aspects of early stage thrombus dynamics which result from laser-induced injury on arterioles of cremaster muscle in the humanized mouse were visualized using fluorescent microscopy. It was found that rolling platelets show preference for the upstream region while tethering/detaching platelets were primarily found downstream. It was also determined that the platelet deposition rate is relatively steady, whereas the effective thrombus coverage area does not increase at a constant rate. By introducing a new method to graphically represent the real time in vivo physiological shear stress environment, we conclude that the thrombus continuously changes shape by regional growth and decay, and neither dominates in the high shear stress region.

Treatment-time-dependence models of early and delayed radiation injury in rat small intestine

International Nuclear Information System (INIS)

Denham, James W.; Hauer-Jensen, Martin; Kron, Tomas; Langberg, Carl W.

2000-01-01

Background: The present study modeled data from a large series of experiments originally designed to investigate the influence of time, dose, and fractionation on early and late pathologic endpoints in rat small intestine after localized irradiation. The objective was to obtain satisfactory descriptions of the regenerative response to injury together with the possible relationships between early and late endpoints. Methods: Two- and 26-week pathologic radiation injury data in groups of Sprague-Dawley rats irradiated with 27 different fractionation schedules were modeled using the incomplete repair (IR) version of the linear-quadratic model with or without various time correction models. The following time correction models were tested: (1) No time correction; (2) A simple exponential (SE) regenerative response beginning at an arbitrary time after starting treatment; and (3) A bi-exponential response with its commencement linked to accumulated cellular depletion and fraction size (the 'intelligent response model' [INTR]). Goodness of fit of the various models was assessed by correlating the predicted biological effective dose for each dose group with the observed radiation injury score. Results: (1) The incomplete repair model without time correction did not provide a satisfactory description of either the 2- or 26-week data. (2) The models using SE time correction performed better, providing modest descriptions of the data. (3) The INTR model provided reasonable descriptions of both the 2- and 26-week data, confirming a treatment time dependence of both early and late pathological endpoints. (4) The most satisfactory descriptions of the data by the INTR model were obtained when the regenerative response was assumed to cease 2 weeks after irradiation rather than at the end of irradiation. A fraction-size-dependent delay of the regenerative response was also suggested in the best fitting models. (5) Late endpoints were associated with low-fractionation sensitivity

Donor age is a predictor of early low output after heart transplantation.

Science.gov (United States)

Fujino, Takeo; Kinugawa, Koichiro; Nitta, Daisuke; Imamura, Teruhiko; Maki, Hisataka; Amiya, Eisuke; Hatano, Masaru; Kimura, Mitsutoshi; Kinoshita, Osamu; Nawata, Kan; Komuro, Issei; Ono, Minoru

2016-05-01

Using hearts from marginal donors could be related to increased risk of primary graft dysfunction and poor long-term survival. However, factors associated with delayed myocardial recovery after heart transplantation (HTx) remain unknown. We sought to clarify risk factors that predict early low output after HTx, and investigated whether early low output affects mid-term graft dysfunction. We retrospectively analyzed patients who had undergone HTx at The University of Tokyo Hospital. We defined early low output patients as those whose cardiac index (CI) was early low output group, and the others into early preserved output group. We performed univariable logistic analysis and found that donor age was the only significant factor that predicted early low output (odds ratio 1.107, 95% confidence interval 1.034-1.210, p=0.002). CI of early low output patients gradually increased and it caught up with that of early preserved output patients at 2 weeks after HTx (2.4±0.6 L/min/m(2) in early low output group vs 2.5±0.5 L/min/m(2) in early preserved output group, p=0.684). Plasma B-type natriuretic peptide concentration of early low output patients was higher (1118.5±1250.2 pg/ml vs 526.4±399.5 pg/ml; p=0.033) at 1 week, 703.6±518.4 pg/ml vs 464.6±509.0 pg/ml (p=0.033) at 2 weeks, and 387.7±231.9 pg/ml vs 249.4±209.5 pg/ml (p=0.010) at 4 weeks after HTx, and it came down to that of early preserved output patients at 12 weeks after HTx. Donor age was a predictor of early low output after HTx. We should be careful after HTx from old donors. However, hemodynamic parameters of early low output patients gradually caught up with those of early preserved output patients. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Early rehabilitation and participation in focus - a Danish perspective on patients with severe acquired brain injury

DEFF Research Database (Denmark)

Smidt, Helle Rønn; Pallesen, Hanne; Buhl, Inge

2016-01-01

Early neurorehabilitation is an interdisciplinary field. Thus, in order to eliminate unnecessary barriers for individuals with severe acquired brain injury in early rehabilitation, we need rehabilitation science that supports both quantitative and qualitative research methods. Participation can b...

Predictors of early faculty attrition at one Academic Medical Center.

Science.gov (United States)

Bucklin, Brenda A; Valley, Morgan; Welch, Cheryl; Tran, Zung Vu; Lowenstein, Steven R

2014-02-10

Faculty turnover threatens the research, teaching and clinical missions of medical schools. We measured early attrition among newly-hired medical school faculty and identified personal and institutional factors associated with early attrition. This retrospective cohort study identified faculty hired during the 2005-2006 academic year at one school. Three-year attrition rates were measured. A 40-question electronic survey measured demographics, career satisfaction, faculty responsibilities, institutional/departmental support, and reasons for resignation. Odds ratios (ORs) and 95 percent confidence intervals (95% CI) identified variables associated with early attrition. Of 139 faculty, 34% (95% CI = 26-42%) resigned within three years of hire. Attrition was associated with: perceived failure of the Department Chair to foster a climate of teaching, research, and service (OR = 6.03; 95% CI: 1.84, 19.69), inclusiveness, respect, and open communication (OR = 3.21; 95% CI: 1.04, 9.98). Lack of professional development of the faculty member (OR = 3.84; 95% CI: 1.25, 11.81); institutional recognition and support for excellence in teaching (OR = 2.96; 95% CI: 0.78, 11.19) and clinical care (OR = 3.87; 95% CI: 1.04, 14.41); and >50% of professional time devoted to patient care (OR = 3.93; 95% CI: 1.29, 11.93) predicted attrition. Gender, race, ethnicity, academic degree, department type and tenure status did not predict early attrition. Of still-active faculty, an additional 27 (48.2%, 95% CI: 35.8, 61.0) reported considering resignation within the 5 years. In this pilot study, one-third of new faculty resigned within 3 years of hire. Greater awareness of predictors of early attrition may help schools identify threats to faculty career satisfaction and retention.

Early changes of serum insulin-like growth factor-II (IGF-II) levels in patients with acute brain injury

International Nuclear Information System (INIS)

Liu Cegang; Zhang Xinlu; Tao Jin; Xu Anding; Xu Shanshui; Huang Zhenpeng

2003-01-01

Objective: To investigate the early changes and clinical significance of serum Insulin-like growth factor-II (IGF-II) levels in patients with acute brain injury. Methods: Radioimmunoassay was used for measurement of the serum IGF-II concentration in 30 controls and 29 acute brain injury patients before and after treatment (within 1 day, at 3 and 7 days). Results: The serum IGF-II levels in brain injury patients at 1 day, 3 day 7 days after injury were 0.131 ± 0.047 ng/ml, 0.117 ± 0.046 ng/ml and 0.123 ±0.050 ng/ml respectively and were significantly lower than those in controls 0.44 ± 0.014 ng/ml, p<0.01. Differences among the values of the three days were not significant. Conclusion: IGF-II might play important role in the pathophysiological process of early acute brain injury

Field-expedient screening and injury risk algorithm categories as predictors of noncontact lower extremity injury.

Science.gov (United States)

Lehr, M E; Plisky, P J; Butler, R J; Fink, M L; Kiesel, K B; Underwood, F B

2013-08-01

In athletics, efficient screening tools are sought to curb the rising number of noncontact injuries and associated health care costs. The authors hypothesized that an injury prediction algorithm that incorporates movement screening performance, demographic information, and injury history can accurately categorize risk of noncontact lower extremity (LE) injury. One hundred eighty-three collegiate athletes were screened during the preseason. The test scores and demographic information were entered into an injury prediction algorithm that weighted the evidence-based risk factors. Athletes were then prospectively followed for noncontact LE injury. Subsequent analysis collapsed the groupings into two risk categories: Low (normal and slight) and High (moderate and substantial). Using these groups and noncontact LE injuries, relative risk (RR), sensitivity, specificity, and likelihood ratios were calculated. Forty-two subjects sustained a noncontact LE injury over the course of the study. Athletes identified as High Risk (n = 63) were at a greater risk of noncontact LE injury (27/63) during the season [RR: 3.4 95% confidence interval 2.0 to 6.0]. These results suggest that an injury prediction algorithm composed of performance on efficient, low-cost, field-ready tests can help identify individuals at elevated risk of noncontact LE injury. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Early remodeling of nasal mucosa in rat model after radiation injury

International Nuclear Information System (INIS)

Xiao Mang; Tang Jianguo; Luo Baozhen; Zhao Li'na; Shi Guozhi

2008-01-01

features of remodeling in the rats model of early radiation injury. (authors)

Are the predictors of work absence following a work-related injury similar for musculoskeletal and mental health claims?

Science.gov (United States)

Smith, Peter M; Black, Oliver; Keegel, Tessa; Collie, Alex

2014-03-01

To examine if the factors associated with days of absence following a work-related injury are similar for mental health versus musculoskeletal (MSK) conditions. A secondary analysis of wage replacement workers' compensation claims in the state of Victoria, Australia. We examined the relationship between individual, injury, occupational and workplace variables with days of wage replacement over the 2-year period following first day of absence from work separately for mental health claims and MSK claims using negative binomial regression models. Mental health conditions were associated with a greater number of days of absence over the 2 years following first incapacity compared to MSK conditions. Differences were observed in employment, injury and industry variables on absence from work for mental claims compared to MSK claims. Working in the agriculture, forestry, fishing and mining industries and employment with a small organisation were more strongly associated with the number of days of wage-replacement among MSK compared to mental health claims, and working in the public administration and safety, or education and training industries or being employed in a position with high time pressure were associated with greater days of wage-replacement among mental health compared to MSK claims. Predictors of days away from work in the 2 years following an injury differ for mental health versus MSK claims. Given the increasing number of mental health claims in Australia more research is required to understand differences in return-to-work for this group of claimants compared to those with physical injuries.

Predictors of early return to work after a coronary artery bypass graft surgery (CABG

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Ramin Mehrdad

2016-12-01

Full Text Available Objectives: Identifying factors predictive of early return to work in patients who underwent a coronary artery bypass graft surgery (CABG. Material and Methods: Two hundred twenty-six working patients who volunteered and underwent a primary coronary artery bypass surgery between September 2013 and May 2014 were selected for the study and followed up for 6 months. Predictors of early return to work (RTW (within 2 months were analyzed from variables in a prospectively collected database and the 36-Item Short Form Health Survey (SF-36 questionnaire carried out in the hospital and rehabilitation center as well as from the follow-up performed via the phone. Results: One hundred and two (45.1% and 155 (68.9% patients returned to work within 2 and 3 months after the surgery, respectively. Furthermore, 196 patients (87.1% returned to work within 6 months after the surgery. In the univariate analysis, demographic or socioeconomic factors (such as age, level of education, income, occupational factors (such as occupation type, working hours per week, duration of the preoperative absence from work, psychological factors (such as a patient’s concern about adverse health effects of RTW, feeling depressed, a patient’s attitude towards his/her ability to RTW and a patient’s perception of his/her job stress level and medical factors (such as serum troponin T and creatine kinase MB (CKMB level, pump time in surgery, co-surgery and dyslipidemia history had a statistically significant correlation with early return to work. The patients who early returned to work had significantly higher scores in 3 domains on the SF-36 questionnaire (used for assessing the patients’ quality of life, compared to those who did not return to work early (including physical functioning, role limitations due to physical health and pain. Conclusions: In the present study we identified 4 new medical factors that could be used as predictors of early return to work after CABG. These

Homotopic Language Reorganization in the Right Hemisphere after Early Left Hemisphere Injury

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Tivarus, Madalina E.; Starling, Sarah J.; Newport, Elissa L.; Langfitt, John T.

2012-01-01

To determine the areas involved in reorganization of language to the right hemisphere after early left hemisphere injury, we compared fMRI activation patterns during four production and comprehension tasks in post-surgical epilepsy patients with either left (LH) or right hemisphere (RH) speech dominance (determined by Wada testing) and healthy…

Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.

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Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Boix, Ricardo; Lopez-Perez, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

2012-09-01

To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4). Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.

Predictors of Hypopituitarism in Patients with Traumatic Brain Injury.

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Silva, Paula P B; Bhatnagar, Saurabha; Herman, Seth D; Zafonte, Ross; Klibanski, Anne; Miller, Karen K; Tritos, Nicholas A

2015-11-15

Hypopituitarism may often occur in association with traumatic brain injury (TBI). Identification of reliable predictors of pituitary dysfunction is of importance in order to establish a rational testing approach. We searched the records of patients with TBI, who underwent neuroendocrine evaluation in our institution between 2007 and 2013. One hundred sixty-six adults (70% men) with TBI (median age: 41.6 years; range: 18-76) were evaluated at a median interval of 40.4 months (0.2-430.4).Of these, 31% had ≥1 pituitary deficiency, including 29% of patients with mild TBI and 35% with moderate/severe TBI. Growth hormone deficiency was the most common deficiency (21%); when body mass index (BMI)-dependent cutpoints were used, this was reduced to 15%. Central hypoadrenalism occurred in10%, who were more likely to have suffered a motor vehicle accident (MVA, p = 0.04), experienced post-traumatic seizures (p = 0.04), demonstrated any intracranial hemorrhage (p = 0.05), petechial brain hemorrhages (p = 0.017), or focal cortical parenchymal contusions (p = 0.02). Central hypothyroidism occurred in 8% and central hypogonadism in 12%; the latter subgroup had higher BMI (p = 0.03), were less likely to be working after TBI (p = 0.002), and had lower Global Assessment of Functioning (GAF) scores (p = 0.03). Central diabetes insipidus (DI) occurred in 6%, who were more likely to have experienced MVA (p hypopituitarism.

Predictors of Renal Replacement Therapy in Acute Kidney Injury

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Michael J. Koziolek

2012-09-01

Full Text Available Backgrounds: Criteria that may guide early renal replacement therapy (RRT initiation in patients with acute kidney injury (AKI currently do not exist. Methods: In 120 consecutive patients with AKI, clinical and laboratory data were analyzed on admittance. The prognostic power of those parameters which were significantly different between the two groups was analyzed by receiver operator characteristic curves and by leave-1-out cross validation. Results: Six parameters (urine albumin, plasma creatinine, blood urea nitrogen, daily urine output, fluid balance and plasma sodium were combined in a logistic regression model that estimates the probability that a particular patient will need RRT. Additionally, a second model without daily urine output was established. Both models yielded a higher accuracy (89 and 88% correct classification rate, respectively than the best single parameter, cystatin C (correct classification rate 74%. Conclusions: The combined models may help to better predict the necessity of RRT using clinical and routine laboratory data in patients with AKI.

Social Environmental Moderators of Long-term Functional Outcomes of Early Childhood Brain Injury.

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Wade, Shari L; Zhang, Nanhua; Yeates, Keith Owen; Stancin, Terry; Taylor, H Gerry

2016-04-01

Pediatric traumatic brain injury (TBI) contributes to impairments in behavior and academic performance. However, the long-term effects of early childhood TBI on functioning across settings remain poorly understood. To examine the long-term functional outcomes of early childhood TBI relative to early childhood orthopedic injuries (OIs). We also examine the moderating role of the social environment as defined by parent report and observational measures of family functioning, parenting practices, and home environment. A prospective, longitudinal, observational cohort study conducted at each child's home, school, and hospital, including 3 children's hospitals and 1 general hospital in the Midwest. Patients were enrolled in the initial study between January 2003 and October 2006. Follow-ups were completed between January 2010 and April 2015. Fifty-eight children who sustained a TBI (67% of original enrolled cohort) and 72 children who sustained an OI (61% of the original enrolled cohort) were prospectively followed up from shortly after injury (between the ages of 3 and 7 years at enrollment) to an average of 6.7 years after injury, with assessments occurring at multiple points. Long-term functional outcomes in everyday settings, as assessed through the Child and Adolescent Functional Assessment Scale (CAFAS). Of the 130 children included, the median age for those with OIs was 11.72 years and 11.97, 12.21, and 11.72 years for those with complicated mild, moderate, and severe TBIs, respectively. Children with moderate and severe TBI were rated as having more functional impairments in multiple domains than those with OIs (P authoritarian (mean CAFAS of 56.45, 41.80, 54.90, and 17.12 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 39.33; P parenting or with fewer home resources (mean CAFAS of 69.57, 47.45, 49.00, and 23.81 for severe TBI, moderate TBI, complicated mild TBI, and OI

Early versus Late Decompression for Traumatic Spinal Cord Injuries; a Systematic Review and Meta-analysis

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Mahmoud Yousefifard

2017-01-01

Full Text Available Introduction: Despite the vast number of surveys, no consensus has been reached on the optimum timing of spinal decompression surgery. This systematic review and meta-analysis aimed to compare the effects of early and late spinal decompression surgery on neurologic improvement and post-surgical complications in patients with traumatic spinal cord injuries.Methods: Two independent reviewers carried out an extended search in electronic databases. Data of neurological outcome and post-surgery complication were extracted. Finally, pooled relative risk (RR with a 95% confidence interval (CI was reported for comparing of efficacy of early and late surgical decompression.Results: Eventually 22 studies were included. The pooled RR was 0.77 (95% CI: 0.68-0.89 for at least one grade neurological improvement, and 0.84 (95% CI: 0.77-0.92 for at least two grade improvement. Pooled RR for surgical decompression performed within 12 hours after the injury was 0.26 (95% CI: 0.13-0.52; p<0.001, while it was 0.75 (95% CI: 0.63-0.90; p=0.002 when the procedure was performed within 24 hours, and 0.93 (95% CI: 0.76-1.14; p=0.48 when it was carried out in the first 72 hours after the injury. Surgical decompression performed within 24 hours after injury was found to be associated with significantly lower rates of post-surgical complications (RR=0.77; 95% CI: 0.68-0.86; p<0.001.Conclusion: The findings of this study indicate that early spinal decompression surgery can improve neurologic recovery and is associated with less post-surgical complications. The optimum efficacy is observed when the procedure is performed within 12 hours of the injury.

Predictors of Early Rebleeding after Endoscopic Therapy in Patients with Nonvariceal Upper Gastrointestinal Bleeding Secondary to High-Risk Lesions

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Davide Maggio

2013-01-01

Full Text Available BACKGROUND: In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB exhibiting high-risk stigmata (HRS having undergone endoscopic hemostasis are lacking.

Predictors of clinical complications in patients with spinomedullary injury

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Dionei Freitas De Morais

2014-01-01

Full Text Available Objective: To analyze individuals with spinal cord injury who developed secondary clinical complications, and the variables that can influence the prognosis. Methods: A prospective study of 321 patients with spinal cord injury. The variables were collected: age, sex, cause of the accident, anatomical distribution, neurological status, associated injuries, in-hospital complications, and mortality only in patients who developed complications. Results: A total of 72 patients were analyzed (85% male with a mean age of 44.72±19.19 years. The individuals with spinal cord injury who developed clinical complications were mostly male, over 50 years of age, and the main cause was accidental falls. These patients had longer hospitalization times and a higher risk of progressing to death. Pneumonia was the main clinical complication. With regard to the variables that can influence the prognosis of these patients, it was observed that spinal cord injury to the cervical segment with syndromic quadriplegia, and neurological status ASIA-A, have a higher risk of developing pneumonia, the most common complication, as well as increased mortality. Conclusion: Clinical complications secondary to spinal cord injury are influenced by demographic factors, as well as characteristics of the injury contributing to an increase in mortality.

Perceived exercise self-efficacy as a predictor of exercise behavior in individuals aging with spinal cord injury.

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Kroll, Thilo; Kratz, Anna; Kehn, Matthew; Jensen, Mark P; Groah, Suzanne; Ljungberg, Inger H; Molton, Ivan R; Bombardier, Charles

2012-08-01

The purpose of this study was to test the hypothesized association between exercise self-efficacy and exercise behavior, controlling for demographic variables and clinical characteristics, in a sample of individuals with spinal cord injuries. A cross-sectional national survey of 612 community-dwelling adults with spinal cord injury in the United States ranging from 18 to 89 yrs of age was conducted. Sample consisted of 63.1% men with a mean (SD) duration of 15.8 (12.79) yrs postinjury; 86.3% reported using a wheelchair. Self-efficacy was the only independent variable that consistently predicted all four exercise outcomes. Self-efficacy beliefs were significantly related to frequency and intensity of resistance training (R(2) change = 0.08 and 0.03, respectively; P exercise frequency and intensity (R(2) change = 0.01 and 0.03, respectively; P exercise. Self-efficacy beliefs play an important role as predictors of exercise. Variations in exercise intensity along the age continuum have implications for exercise prescription and composition. Future research should replicate findings with objective activity measures.

Predictors of satisfactory improvements in pain for patients with early rheumatoid arthritis in a treat-to-target study.

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Ten Klooster, Peter M; Vonkeman, Harald E; Oude Voshaar, Martijn A H; Siemons, Liseth; van Riel, Piet L C M; van de Laar, Mart A F J

2015-06-01

The aim of this study was to identify baseline predictors of achieving patient-perceived satisfactory improvement (PPSI) in pain after 6 months of treat to target in patients with early RA. Baseline and 6 month data were used from patients included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Simple and multivariable logistic regression analyses were used to identify significant predictors of achieving an absolute improvement of 30 mm or a relative improvement of 50% on a visual analogue scale for pain. At 6 months, 125 of 209 patients (59.8%) achieved an absolute PPSI and 130 patients (62.2%) achieved a relative PPSI in pain. Controlling for baseline pain, having symmetrical arthritis was the strongest independent predictor of achieving an absolute [odds ratio (OR) 3.17, P = 0.03] or relative (OR 3.44, P = 0.01) PPSI. Additionally, anti-CCP positivity (OR 2.04, P = 0.04) and having ≤12 tender joints (OR 0.29, P = 0.01) were predictive of achieving a relative PPSI. The total explained variance of baseline predictors was 30% for absolute and 18% for relative improvements, respectively. Symmetrical joint involvement, anti-CCP positivity and fewer tender joints at baseline are prognostic signs for achieving satisfactory improvement in pain after 6 months of treat to target in patients with early RA. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Mothers report more child-rearing disagreements following early brain injury than do fathers.

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Bendikas, Emily A; Wade, Shari L; Cassedy, Amy; Taylor, H Gerry; Yeates, Keith Owen

2011-11-01

To investigate differences between mother's and father's perceptions of marital relationship quality, child rearing disagreements, and family functioning over the initial 18 months following traumatic brain injury (TBI) in early childhood relative to an orthopedic-injury comparison group. Participants included 147 parent-dyads of children with TBI (n = 53) and orthopedic injuries (OI; n = 94) who were between the ages of 3 and 7 years at injury. Family functioning, marital quality, and child-rearing disagreements were assessed shortly after injury and at 6, 12, and 18-month follow-ups, with ratings at the initial assessment completed to reflect preinjury functioning. Mixed model analyses were used to examine mother and father's reports of family functioning, marital quality, and child-rearing disagreements over time as a function of injury severity and parent gender. We found a significant Group x Gender interaction for ratings of love and parenting disagreements. As hypothesized, mothers of children with severe TBI rated the relationship as significantly less loving than did their partners, and mothers of children with both moderate and severe TBI endorsed more parenting disagreements than did their partners. However, fathers reported higher levels of family dysfunction than their partners, regardless of injury type or severity. Implications for treatment based on differences in mothers' and fathers' perceptions of family and marital functioning, and future directions for research, are discussed.

Predictors of intramedullary lesion expansion rate on MR images of patients with subaxial spinal cord injury.

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Le, Elizabeth; Aarabi, Bizhan; Hersh, David S; Shanmuganathan, Kathirkamanthan; Diaz, Cara; Massetti, Jennifer; Akhtar-Danesh, Noori

2015-06-01

.05), ASIA motor score (p < 0.05), and time to decompression (p < 0.05) were all predictors of lesion expansion. In multiple regression analysis, however, the sole determinant of IML expansion was AIS grade (p < 0.005). CONCLUSIONS After traumatic subaxial cervical spine or spinal cord injury, patients with motor-complete injury (AIS Grade A or B) had a significantly higher rate of IML expansion than those with motor-incomplete injury (AIS Grade C or D).

Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study.

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Jørgensen, Vivien; Butler Forslund, Emelie; Opheim, Arve; Franzén, Erika; Wahman, Kerstin; Hultling, Claes; Seiger, Åke; Ståhle, Agneta; Stanghelle, Johan K; Roaldsen, Kirsti S

2017-04-01

What is the 1-year incidence of falls and injurious falls in a representative cohort of community-dwelling ambulatory individuals with chronic spinal cord injury? What are the predictors of recurrent falls (more than two/year) and injurious falls in this population? One-year longitudinal observational multi-centre study. A representative sample of 68 (of 73 included) community-dwelling ambulatory individuals with traumatic SCI attending regular follow-up programs at rehabilitation centres. Primary outcome measures were incidence and predictors of recurrent falls (more than two/year) and injurious falls reported every 2 weeks for 1year. A total of 48% of participants reported recurrent falls. Of the 272 reported falls, 41% were injurious. Serious injuries were experienced by 4% of participants, all of whom were women. Multivariate logistic regression analysis showed that recurrent falls in the previous year (OR=111, 95% CI=8.6 to 1425), fear of falling (OR=6.1, 95% CI=1.43 to 26) and longer time taken to walk 10m (OR=1.3, 95% CI=1.0 to 1.7) were predictors of recurrent falls. Fear of falling (OR=4.3, 95% CI=1.3 to 14) and recurrent falls in the previous year (OR=4.2, 95% CI=1.2 to 14) were predictors of injurious falls. Ambulatory individuals have a high risk of falling and of fall-related injuries. Fall history, fear of falling and walking speed could predict recurrent falls and injurious falls. Further studies with larger samples are needed to validate these findings. [Jørgensen V, Butler Forslund E, Opheim A, Franzén E, Wahman K, Hultling C, Seiger Å, Ståhle A, Stanghelle JK, Roaldsen KS (2017) Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study. Journal of Physiotherapy 63: 108-113]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Effect of early rehabilitation training on oxygen free radical generation and nerve injury in patients with cerebral hemorrhage

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Zhao-Shu Liu

2017-08-01

Full Text Available Objective: To study the effect of early rehabilitation training combined with edaravone on oxygen free radical generation and nerve injury in patients with cerebral hemorrhage. Methods: A total of 56 patients with acute cerebral hemorrhage who were treated in Zigong Third People’s Hospital between July 2014 and March 2017 were selected and randomly divided into early rehabilitation group and routine rehabilitation group, the early rehabilitation group began the rehabilitation training 2 d after cerebral hemorrhage condition was stabilized, and routine rehabilitation group began the rehabilitation training 14 d after cerebral hemorrhage. Serum contents of oxygen free radicals, nerve injury markers and neurotrophic molecules were detected 28 d and 56 d after cerebral hemorrhage. Results: 28 d and 56 d after cerebral hemorrhage, serum MDA, AOPP, 8-OHdG, GFAP, NSE, Tf, Ft and S100B levels of early rehabilitation group were significantly lower than those of routine rehabilitation group while BDNF, NGF, NTF-α and IGF-I levels were significantly higher than those of routine rehabilitation group. Conclusion: Early rehabilitation training combined with edaravone for cerebral hemorrhage can inhibit the oxygen free radical generation, reduce the degree of nerve injury and improve the neurotrophic state.

Relations between Parenting and Externalizing and Internalizing Problem Behaviour in Early Adolescence: Child Behaviour as Moderator and Predictor

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Reitz, E.; Dekovic, M.; Meijer, A. M.

2006-01-01

In this longitudinal study we investigated relations between parenting and externalizing and internalizing problem behaviour during early adolescence. First, we examined parenting effects on problem behaviour, including child behaviour as a moderator. Second, we examined child behaviour as predictor of parenting, also including moderator effects.…

Predictors of satisfactory improvements in pain for patients with early rheumatoid arthritis in a treat-to-target study

NARCIS (Netherlands)

Klooster, P.M. ten; Vonkeman, H.E.; Voshaar, M.A.; Siemons, L.; Riel, P.L.C.M. van; Laar, M.A.F.J. van de

2015-01-01

OBJECTIVE: The aim of this study was to identify baseline predictors of achieving patient-perceived satisfactory improvement (PPSI) in pain after 6 months of treat to target in patients with early RA. METHODS: Baseline and 6 month data were used from patients included in the Dutch Rheumatoid

Social Environmental Moderators of Long-term Functional Outcomes of Early Childhood Brain Injury

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Wade, Shari L.; Zhang, Nanhua; Yeates, Keith Owen; Stancin, Terry; Taylor, H. Gerry

2017-01-01

IMPORTANCE Pediatric traumatic brain injury (TBI) contributes to impairments in behavior and academic performance. However, the long-term effects of early childhood TBI on functioning across settings remain poorly understood. OBJECTIVE To examine the long-term functional outcomes of early childhood TBI relative to early childhood orthopedic injuries (OIs). We also examine the moderating role of the social environment as defined by parent report and observational measures of family functioning, parenting practices, and home environment. DESIGN, SETTING, AND PARTICIPANTS A prospective, longitudinal, observational cohort study conducted at each child’s home, school, and hospital, including 3 children’s hospitals and 1 general hospital in the Midwest. Patients were enrolled in the initial study between January 2003 and October 2006. Follow-ups were completed between January 2010 and April 2015. Fifty-eight children who sustained a TBI (67%of original enrolled cohort) and 72 children who sustained an OI (61% of the original enrolled cohort) were prospectively followed up from shortly after injury (between the ages of 3 and 7 years at enrollment) to an average of 6.7 years after injury, with assessments occurring at multiple points. MAIN OUTCOMES AND MEASURES Long-term functional outcomes in everyday settings, as assessed through the Child and Adolescent Functional Assessment Scale (CAFAS). RESULTS Of the 130 children included, the median age for those with OIs was 11.72 years and 11.97, 12.21, and 11.72 years for those with complicated mild, moderate, and severe TBIs, respectively. Children with moderate and severe TBI were rated as having more functional impairments in multiple domains than those with OIs (P authoritarian (mean CAFAS of 56.45, 41.80, 54.90, and 17.12 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 39.33; P < .001], moderate TBI and OI [difference = 24

Talent predictors

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Raquel Lorenzo

2007-07-01

Full Text Available The knowledge of talent predictors is the initial point for building diagnosis and encouragement procedures in this field. The meaning of word predictor is to anticipate the future, to divine. Early prediction of high performance is complex problem no resolute by the science yet. There are many discrepancies about what measure and how to do. The article analyze the art state in this problematic because the excellence is determined by the interaction between internal and environmental factors.

Potential Predictors of Injury Among Pre-Professional Ballet and Contemporary Dancers.

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Yau, Rebecca K; Golightly, Yvonne M; Richardson, David B; Runfola, Cristin D; Waller, Anna E; Marshall, Stephen W

2017-06-15

Injuries occur frequently among ballet and contemporary dancers. However, limited literature exists on injuries to pre-professional dancers in the USA. The goals of this study were to 1. provide a descriptive epidemiology of the incidence of musculoskeletal injuries in an adolescent and young adult dance population and 2. identify parsimonious regression models that could be potentially used to predict injury incidence. The study was based at the University of North Carolina School of the Arts (UNCSA) from Fall 2009 to Spring 2015. An injury was defined as any event that caused a dancer to be seen at the UNCSA Student Health Services and caused the dancer to modify or curtail dance activity for at least 1 day. Injury rate ratios (IRRs) were calculated using negative binomial generalized estimating equations. Models predicting injury rates were built using forward selection, stratified by sex. Among 480 dancers, 1,014 injuries were sustained. Most injuries were to the lower extremity and the result of overuse. There were differences in upper extremity, lower extremity, and traumatic injury rates by demographic subgroups. Among females, the most parsimonious predictive model for injury rates included a self-reported history of depression, age at time of injury, and number of injuries sustained at UNCSA prior to the semester of current injury. Among males, the most parsimonious model was a univariate model with family history of alcohol or drug problems. Strategies for traumatic injury prevention among dancers should be both sex- and style-specific. No differences were observed in overuse injury rates by sex or style, suggesting that generic overuse prevention strategies may not need to be guided by these factors. It is concluded that strategies can be implemented to reduce and mitigate the consequences of injuries if not the injuries themselves.

Poisson regression approach for modeling fatal injury rates amongst Malaysian workers

International Nuclear Information System (INIS)

Kamarulzaman Ibrahim; Heng Khai Theng

2005-01-01

Many safety studies are based on the analysis carried out on injury surveillance data. The injury surveillance data gathered for the analysis include information on number of employees at risk of injury in each of several strata where the strata are defined in terms of a series of important predictor variables. Further insight into the relationship between fatal injury rates and predictor variables may be obtained by the poisson regression approach. Poisson regression is widely used in analyzing count data. In this study, poisson regression is used to model the relationship between fatal injury rates and predictor variables which are year (1995-2002), gender, recording system and industry type. Data for the analysis were obtained from PERKESO and Jabatan Perangkaan Malaysia. It is found that the assumption that the data follow poisson distribution has been violated. After correction for the problem of over dispersion, the predictor variables that are found to be significant in the model are gender, system of recording, industry type, two interaction effects (interaction between recording system and industry type and between year and industry type). Introduction Regression analysis is one of the most popular

I-FABP as biomarker for the early diagnosis of acute mesenteric ischemia and resultant lung injury.

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Rachel G Khadaroo

Full Text Available Acute mesenteric ischemia (AMI is a life-threatening condition that can result in multiple organ injury and death. A timely diagnosis and treatment would have a significant impact on the morbidity and mortality in high-risk patient population. The purpose of this study was to investigate if intestinal fatty acid binding protein (I-FABP and α-defensins can be used as biomarkers for early AMI and resultant lung injury. C57BL/6 mice were subjected to intestinal ischemia by occlusion of the superior mesenteric artery. A time course of intestinal ischemia from 0.5 to 3 h was performed and followed by reperfusion for 2 h. Additional mice were treated with N-acetyl-cysteine (NAC at 300 mg/kg given intraperitoneally prior to reperfusion. AMI resulted in severe intestinal injury characterized by neutrophil infiltrate, myeloperoxidase (MPO levels, cytokine/chemokine levels, and tissue histopathology. Pathologic signs of ischemia were evident at 1 h, and by 3 h of ischemia, the full thickness of the intestine mucosa had areas of coagulative necrosis. It was noted that the levels of α-defensins in intestinal tissue peaked at 1 h and I-FABP in plasma peaked at 3 h after AMI. Intestinal ischemia also resulted in lung injury in a time-dependent manner. Pretreatment with NAC decreased the levels of intestinal α-defensins and plasma I-FABP, as well as lung MPO and cytokines. In summary, the concentrations of intestinal α-defensins and plasma I-FABP predicted intestinal ischemia prior to pathological evidence of ischemia and I-FABP directly correlated with resultant lung injury. The antioxidant NAC reduced intestinal and lung injury induced by AMI, suggesting a role for oxidants in the mechanism for distant organ injury. I-FABP and α-defensins are promising biomarkers, and may guide the treatment with antioxidant in early intestinal and distal organ injury.

Proximal Tubular Injury in Medullary Rays Is an Early Sign of Acute Tacrolimus Nephrotoxicity

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Diane Cosner

2015-01-01

Full Text Available Tacrolimus (FK506 is one of the principal immunosuppressive agents used after solid organ transplantations to prevent allograft rejection. Chronic renal injury induced by tacrolimus is characterized by linear fibrosis in the medullary rays; however, the early morphologic findings of acute tacrolimus nephrotoxicity are not well characterized. Kidney injury molecule-1 (KIM-1 is a specific injury biomarker that has been proven to be useful in the diagnosis of mild to severe acute tubular injury on renal biopsies. This study was motivated by a patient with acute kidney injury associated with elevated serum tacrolimus levels in whom KIM-1 staining was present only in proximal tubules located in the medullary rays in the setting of otherwise normal light, immunofluorescent, and electron microscopy. We subsequently evaluated KIM-1 expression in 45 protocol and 39 indicated renal transplant biopsies to determine whether higher serum levels of tacrolimus were associated with acute segment specific injury to the proximal tubule, as reflected by KIM-1 staining in the proximal tubules of the cortical medullary rays. The data suggest that tacrolimus toxicity preferentially affects proximal tubules in medullary rays and that this targeted injury is a precursor lesion for the linear fibrosis seen in chronic tacrolimus toxicity.

Psychological predictors of injuries in circus artists: an exploratory study.

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Shrier, Ian; Hallé, Madeleine

2011-04-01

To explore the relationship between potential psychological risk factors and injury risk in circus artists. Historical cohort study. Cirque du Soleil training programme. Forty-seven circus artists training to become Cirque du Soleil artists. Artists completed the validated REST-Q questionnaire (19 domains) during their first 2 weeks of training. Injury risk ratio. Of the five a priori exposures of interest, injury, emotional exhaustion, self-efficacy and fatigue were associated with an increase in injury risk (risk ratios between 1.8 and 2.8), but Conflicts/Pressure was not (risk ratio=0.8). Of the several specific psychological aspects that are considered risk factors for injury, low self-efficacy had the strongest relationship. Most of the strong psychological risk factors for injuries previously identified in athletes also appear to be risk factors in circus artists.

Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study.

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Wiseman, Taneal A; Curtis, Kate; Lam, Mary; Foster, Kim

2015-03-28

Traumatic injury and mental health disorders are co-associated. Early identification of depression, anxiety and stress following injury, and subsequent preventive intervention, may reduce the long-term symptoms and negative impacts associated with depression and anxiety. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the acute phase of care, and at six months following injury, as well as the effectiveness of an in-hospital screening tool. This descriptive longitudinal study of trauma patients was conducted at a Level 1 Metropolitan Trauma Centre in Australia over 14 months. Participants were interviewed using the Depression Anxiety Stress Scale short-form version (DASS-21) during hospital admission then at 3 and 6 months after injury. Descriptive statistics were performed to evaluate participant characteristics and incidence of depression, anxiety and stress. Correlations and logistic regression were conducted to investigate the ability of the DASS-21 to predict symptoms of depression, anxiety and stress and to investigate factors associated with depression, anxiety and stress 6 months after injury. 201 participants ranging in age (18-94 years) and injury severity participated in the baseline interview and 109 completed all 3 interviews over 6 months. Over half (54%) reported above normal scores for depression, anxiety and/or stress in at least one of the 3 time points. Intensive care unit admission and high levels of depression, anxiety and stress at 3 months post injury were predictors for high levels of depression, anxiety and stress at 6 months. Low scores for depression, anxiety and stress during admission were correlated with low scores for depression, anxiety and stress at 3 and 6 months. Depression, anxiety and stress in patients hospitalised following injury is common and should be anticipated in patients who have had an intensive care admission. Screening at 3

A structural equation model of turnover for a longitudinal survey among early career registered nurses.

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Brewer, Carol S; Chao, Ying-Yu; Colder, Craig R; Kovner, Christine T; Chacko, Thomas P

2015-11-01

Key predictors of early career nurses' turnover are job satisfaction, organizational commitment, job search, intent to stay, and shock (back injuries) based on the literature review and our previous research. Existing research has often omitted one of these key predictors. The purpose of this study in a sample of early career nurses was to compare predictors of turnover to nurses' actual turnover at two time points in their careers. A multi-state longitudinal panel survey of early career nurses was used to compare a turnover model across two time periods. The sample has been surveyed five times. The sample was selected using a two-stage sample of registered nurses nested in 51 metropolitan areas and nine non-metropolitan, rural areas in 34 states and the District of Columbia. The associations between key predictors of turnover were tested using structural equation modeling and data from the earliest and latest panels in our study. We used predictors from the respondents who replied to the Wave-1 survey in 2006 and their turnover status from Wave 2 in 2007 (N=2386). We compared these results to the remaining respondents' predictors from Wave 4 in 2011 and their turnover status in Wave 5 in 2013 (N=1073). We tested and found no effect for missingness from Wave 1-5 and little evidence of attrition bias. Strong support was found for the relationships hypothesized among job satisfaction, organizational commitment, intent to stay, and turnover, with some support for shock and search in the Wave 1-2 sample. However, for Wave 4-5 sample (n=1073), none of the paths through search were significant, nor was the path from shock to turnover. Nurses in the second analysis who had matured longer in their career did not have a significant response to search or shock (back injuries), which may indicate how easily experienced registered nurses find new jobs and/or accommodation to jobs requiring significant physicality. Nurse turnover is a major concern for healthcare organizations

Mobile health technology transforms injury severity scoring in South Africa.

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Spence, Richard Trafford; Zargaran, Eiman; Hameed, S Morad; Navsaria, Pradeep; Nicol, Andrew

2016-08-01

The burden of data collection associated with injury severity scoring has limited its application in areas of the world with the highest incidence of trauma. Since January 2014, electronic records (electronic Trauma Health Records [eTHRs]) replaced all handwritten records at the Groote Schuur Hospital Trauma Unit in South Africa. Data fields required for Glasgow Coma Scale, Revised Trauma Score, Kampala Trauma Score, Injury Severity Score (ISS), and Trauma Score-Injury Severity Score calculations are now prospectively collected. Fifteen months after implementation of eTHR, the injury severity scores were compared as predictors of mortality on three accounts: (1) ability to discriminate (area under receiver operating curve, ROC); (2) ability to calibrate (observed versus expected ratio, O/E); and (3) feasibility of data collection (rate of missing data). A total of 7460 admissions were recorded by eTHR from April 1, 2014 to July 7, 2015, including 770 severely injured patients (ISS > 15) and 950 operations. The mean age was 33.3 y (range 13-94), 77.6% were male, and the mechanism of injury was penetrating in 39.3% of cases. The cohort experienced a mortality rate of 2.5%. Patient reserve predictors required by the scores were 98.7% complete, physiological injury predictors were 95.1% complete, and anatomic injury predictors were 86.9% complete. The discrimination and calibration of Trauma Score-Injury Severity Score was superior for all admissions (ROC 0.9591 and O/E 1.01) and operatively managed patients (ROC 0.8427 and O/E 0.79). In the severely injured cohort, the discriminatory ability of Revised Trauma Score was superior (ROC 0.8315), but no score provided adequate calibration. Emerging mobile health technology enables reliable and sustainable injury severity scoring in a high-volume trauma center in South Africa. Copyright © 2016 Elsevier Inc. All rights reserved.

Early endocrine alterations reflect prolonged stress and relate to one year functional outcome in patients with severe brain injury

DEFF Research Database (Denmark)

Marina, Djordje; Klose, Marianne; Nordenbo, Annette

2015-01-01

OBJECTIVE: Severe brain injury poses a risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective was to assess the pattern and prevalence...

Kindergarten risk factors, cognitive factors, and teacher judgments as predictors of early reading in Dutch.

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Gijsel, Martine A R; Bosman, Anna M T; Verhoeven, Ludo

2006-01-01

This study focused on the predictive value of risk factors, cognitive factors, and teachers' judgments in a sample of 462 kindergartners for their early reading skills and reading failure at the beginning of Grade 1. With respect to risk factors, enrollment in speech-language therapy, history of dyslexia or speech-language problems in the family, and the role of gender were considered. None of these risk factors were significantly related to reading performance. Cognitive factors in this study included letter knowledge, rapid naming ability, and nonword repetition skills. Of these skills, letter knowledge seemed to have the highest correlation with reading. Kindergarten teachers' judgments, including a task assignment scale and teachers' predictions, demonstrated a significant relationship with reading. Finally, to judge whether these predictors could identify reading disabilities, the discriminatory power of all predictors was assessed and appeared to be insufficient. Implications for screening purposes are discussed.

Association of Lectin Pathway Protein Levels and Genetic Variants Early after Injury with Outcomes after Severe Traumatic Brain Injury: A Prospective Cohort Study.

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Osthoff, Michael; Walder, Bernhard; Delhumeau, Cécile; Trendelenburg, Marten; Turck, Natacha

2017-09-01

The lectin pathway of the complement system has been implicated in secondary ischemic/inflammatory injury after traumatic brain injury (TBI). However, previous experimental studies have yielded conflicting results, and human studies are scarce. In this exploratory study, we investigated associations of several lectin pathway proteins early after injury and single-nucleotide polymorphisms (SNP) with outcomes after severe TBI (mortality at 14 days [primary outcome] and consciousness assessed with the Glasgow Coma Scale [GCS] at 14 days, disability assessed with the Glasgow Outcome Scale Extended [GOSE] at 90 days). Forty-four patients with severe TBI were included. Plasma levels of lectin pathway proteins were sampled at 6, 12, 24, and 48 h after injury and eight mannose-binding lectin (MBL) and ficolin (FCN)2 SNPs were analyzed by enzyme-linked immunosorbent assay (ELISA) and genotyping, respectively. Plasma protein levels were stable with only a slight increase in mannose-binding protein-associated serine protease (MASP)-2 and FCN2 levels after 48 h (p GOSE 1-4) at 90 days (p GOSE score < 4 at 90 days after adjustment (odds ratio 3.46 [95% confidence interval 1.12-10.68] per 100 ng/mL increase, p = 0.03). No association was observed between the lectin pathway of the complement system and 14 day mortality or 14 day consciousness. However, higher plasma FCN2, FCN3, and, in particular, MASP-2 levels early after injury were associated with an unfavorable outcome at 90 days (death, vegetative state, and severe disability) which may be related to an increased activation of the lectin pathway.

THE EFFECTS OF AN EARLY RETURN TO TRAINING ON THE BONE-TENDON JUNCTION POST-ACUTE MICRO-INJURY HEALING

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Lin Wang

2012-06-01

Full Text Available Bone-tendon junction (BTJ overuse injuries are common athletic and occupational problems. BTJ injuries may sometimes be caused by resuming training too early after injury. To study the effects of post-injury resuming training within 48 hours on the acute injury healing process, as it is often the case for athletes. Twelve mature female rabbits were assigned to one of the following groups: acute injury (AI, n = 6, post-injury early return to training (PIERT, n = 6 and normal control (CON, n = 6. Tissue specimens were harvested at week 4. The radiological and histological characteristics of the AI and PIERT groups were compared among the groups. The trabecular thickness of the PIERT group was significantly different from those of the AI and CON group. A histological evaluation revealed poor collagen fibre alignment, extensive scar tissue and lowered cell density in the AI and PIERT groups compared with the CON group, but no significant differences were observed between the AI group and the PIERT group. The fibrocartilage zone and proteoglycan area in the PIERT group were significantly different from those in AI group. No differences were observed in the Total VOI volume (TV, Object volume (OBV, Percent object volume (BV/TV and trabecular number (Tb.N among the AI, PIERT and CON groups. In conclusion, a repeatable animal model of bone-tendon junction acute micro-damage by puncture was established. Resuming training in 48 hours did not significantly deteriorate the BTJ injury healing, but improved bone remodelling and increased fibrocartilage zone thickness

Predictors of residual flow in embolized intracranial ruptured aneurysms at early follow-up.

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Serafin, Zbigniew; Strześniewski, Piotr; Beuth, Wojciech

2014-01-01

The possibility of recanalization and the need for retreatment are the most important drawbacks of intracranial aneurysm embolization. The purpose of the study was to prospectively analyze the results of early follow-up angiography of embolized ruptured aneurysms in an attempt to determine factors predicting the presence of residual flow. Evaluation included 72 patients with 72 aneurysms, which were followed-up 3 months after the treatment. Analysis of residual flow predictors included: age and gender, clinical state in Hunt-Hess scale, aneurysm localization, aneurysm three dimensions and volume, neck width, sac-to-neck ratio, initial result of embolization, number of coils used and the use of hydrogel coils and stents. Mean sac diameter was 6.5±3.9 mm, and mean neck width was 2.9±1.4 mm. Follow-up angiography presented residual flow in 26 aneurysms (36.1%): class 2 in 8 aneurysms (11.1%), and class 3 in 18 cases (25.0%). Stable aneurysm filling was observed in 45 cases (62.5%), progression of residual flow in 25 cases (34.7%), and regression in 2 cases (2.8%). According to ROC analysis independent predictors of residual flow were aneurysm neck diameter (AUC 0.857, 95% CI: 0.755-0.928, p<0.0001) and sac-to-neck ratio (AUC 0.817, 95% CI: 0.708-0.898, p<0.0001). Cut-off point of the ROC curve was established at 2.8 mm for neck diameter, and 1.73 for sac-to-neck ratio. Aneurysm neck diameter and sac-to-neck ratio are independently related to the residual flow in embolized ruptured aneurysms at early follow-up.

Prospective outcomes of injury study.

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Derrett, S; Langley, J; Hokowhitu, B; Ameratunga, S; Hansen, P; Davie, G; Wyeth, E; Lilley, R

2009-10-01

In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ's unique macro-social factors, such as NZ's no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC). (1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Māori and 15 other New Zealanders, 6 and 12 months after injury. Four geographical regions within NZ. Prospective cohort study with telephone interviews 1, 4 and 12 months after injury. 2500 people (including 460 Māori), aged 18-64 years, randomly selected from ACC's entitlement claims register (people likely to be off work for at least 1 week or equivalent). Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors. Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs. Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.

Early cranial ultrasound changes as predictors of outcome during first year of life in term infants with perinatal asphyxia.

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Boo, N Y; Chandran, V; Zulfiqar, M A; Zamratol, S M; Nyein, M K; Haliza, M S; Lye, M S

2000-08-01

To identify the types of early cranial ultrasound changes that were significant predictors of adverse outcome during the first year of life in asphyxiated term infants. This was a prospective cohort study. Shortly after birth, cranial ultrasonography was carried out via the anterior fontanelles of 70 normal control infants and 104 asphyxiated infants with a history of fetal distress and Apgar scores of less than 6 at 1 and 5 min of life, or requiring endotracheal intubation and manual intermittent positive pressure ventilation for at least 5 min after birth. Neurodevelopmental assessment was carried out on the survivors at 1 year of age. Abnormal cranial ultrasound changes were detected in a significantly higher proportion (79.8%, or n = 83) of asphyxiated infants than controls (39.5%, or n = 30) (P < 0.0001). However, logistic regression analysis showed that only three factors were significantly associated with adverse outcome at 1 year of life among the asphyxiated infants. These were: (i) decreasing birthweight (for every additional gram of increase in birthweight, adjusted odds ratio (OR) = 0.999, 95% confidence interval (CI) 0.998, 1.000; P = 0.047); (ii) a history of receiving ventilatory support during the neonatal period (adjusted OR = 8.3; 95%CI 2.4, 28.9; P = 0.0009); and (iii) hypoxic-ischaemic encephalopathy stage 2 or 3 (adjusted OR = 5.8; 95%CI 1.8, 18.6; P = 0.003). None of the early cranial ultrasound changes was a significant predictor. Early cranial ultrasound findings, although common in asphyxiated infants, were not significant predictors of adverse outcome during the first year of life in asphyxiated term infants.

Personality variables as predictors of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life: a one-year prospective study.

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Hyphantis, Thomas; Paika, Vassiliki; Almyroudi, Augoustina; Kampletsas, Eleftherios O; Pavlidis, Nicholas

2011-05-01

We aimed to assess the course of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life (HRQOL) and to identify relevant clinical and psychological predictors during a one-year period. Of the 144 early non-metastatic colorectal cancer patients initially assessed for psychological distress symptoms (SCL-90-R), HRQOL (WHOQOL-BREF), sense of coherence (SOC), defense mechanisms (LSI) and hostility (HDHQ), 84 (58.3%) completed the one-year follow-up. Mean (SD) age was 65.1 (9.8) years and 67.4% were male. Mean (SD) disease duration was 1.7 (2.2) years, with 49.3% being diagnosed within the last six months. In 75.0% the site was at colon and in 25.0% at rectum; 2.1% had stage I, 59.0% stage II and 38.9% stage III disease. Paranoid ideation, psychoticism, interpersonal sensitivity, anxiety and depressive symptoms increased significantly over the one-year period of the study and most of the HRQOL components were significantly decreased over the same period. Men were at greater risk for further developing depressive symptomatology. Low SOC was independent predictor of depression, while hostility independently predicted anxiety, interpersonal sensitivity and psychoticism symptoms. General psychological distress and low SOC were independent predictors of HRQOL, while repression was also an independent predictor of Physical HRQOL. In early non-metastatic colorectal cancer patients, psychological distress symptoms are increased and HRQOL is decreased over one-year period. Symptoms of psychological distress are strong predictors of HRQOL, while personality variables can also predict psychological distress symptoms' increase and HRQOL decrease over time, and this could be relevant to psychological interventions. Copyright © 2010 Elsevier Inc. All rights reserved.

Narrative discourse in children with early focal brain injury.

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Reilly, J S; Bates, E A; Marchman, V A

1998-02-15

Children with early brain damage, unlike adult stroke victims, often go on to develop nearly normal language. However, the route and extent of their linguistic development are still unclear, as is the relationship between lesion site and patterns of delay and recovery. Here we address these questions by examining narratives from children with early brain damage. Thirty children (ages 3:7-10:10) with pre- or perinatal unilateral focal brain damage and their matched controls participated in a storytelling task. Analyses focused on linguistic proficiency and narrative competence. Overall, children with brain damage scored significantly lower than their age-matched controls on both linguistic (morphological and syntactic) indices and those targeting broader narrative qualities. Rather than indicating that children with brain damage fully catch up, these data suggest that deficits in linguistic abilities reassert themselves as children face new linguistic challenges. Interestingly, after age 5, site of lesion does not appear to be a significant factor and the delays we have witnessed do not map onto the lesion profiles observed in adults with analogous brain injuries.

Circulating Extracellular Vesicles Contain miRNAs and are Released as Early Biomarkers for Cardiac Injury

NARCIS (Netherlands)

Deddens, Janine C; Vrijsen, Krijn R; Colijn, Johanna M; Oerlemans, Marish; Metz, Corina H G; van der Vlist, Els J; Nolte-'t Hoen, Esther N M; den Ouden, Krista; Jansen of Lorkeers, SJ; van der Spoel, TIG; Koudstaal, Stefan; Arkesteijn, Ger J; Wauben, Marca H M; van Laake, Linda W; Doevendans, Pieter A; Chamuleau, Steven A J; Sluijter, Joost P G

2016-01-01

Plasma-circulating microRNAs have been implicated as novel early biomarkers for myocardial infarction (MI) due to their high specificity for cardiac injury. For swift clinical translation of this potential biomarker, it is important to understand their temporal and spatial characteristics upon MI.

Magnetic resonance imaging versus transcranial ultrasound in early identification of cerebral injuries in neonatal encephalopathy

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Eman A.Sh. Genedi

2016-03-01

Conclusion: TCUS is an effective screening tool in detecting the etiology of NE in suspected cases; it is sometimes crucial in critically sick neonates; however, early MRI is mandatory as it can detect precisely the extent of brain injury compared with TCUS alone.

Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part II: Specific injuries and ED management.

Science.gov (United States)

Rothrock, S G; Green, S M; Morgan, R

2000-06-01

Evaluation of children with suspected abdominal trauma could be a difficult task. Unique anatomic and physiologic features render vital sign assessment and the physical examination less useful than in the adult population. Awareness of injury patterns and associations will improve the early diagnosis of abdominal trauma. Clinicians must have a complete understanding of common and atypical presentations of children with significant abdominal injuries. Knowledge of the utility and limitations of available laboratory and radiologic adjuncts will assist in accurately identifying abdominal injury. While other obvious injuries (eg, facial, cranial, and extremity trauma) can distract physicians from less obvious abdominal trauma, an algorithmic approach to evaluating and managing children with multisystem trauma will improve overall care and help to identify and treat abdominal injuries in a timely fashion. Finally, physicians must be aware of the capabilities of their own facility to handle pediatric trauma. Protocols must be in place for expediting the transfer of children who require a higher level of care. Knowledge of each of these areas will help to improve the overall care and outcome of children with abdominal trauma.

Anti-α4 antibody treatment blocks virus traffic to the brain and gut early, and stabilizes CNS injury late in infection.

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Jennifer H Campbell

2014-12-01

Full Text Available Four SIV-infected monkeys with high plasma virus and CNS injury were treated with an anti-α4 blocking antibody (natalizumab once a week for three weeks beginning on 28 days post-infection (late. Infection in the brain and gut were quantified, and neuronal injury in the CNS was assessed by MR spectroscopy, and compared to controls with AIDS and SIV encephalitis. Treatment resulted in stabilization of ongoing neuronal injury (NAA/Cr by 1H MRS, and decreased numbers of monocytes/macrophages and productive infection (SIV p28+, RNA+ in brain and gut. Antibody treatment of six SIV infected monkeys at the time of infection (early for 3 weeks blocked monocyte/macrophage traffic and infection in the CNS, and significantly decreased leukocyte traffic and infection in the gut. SIV - RNA and p28 was absent in the CNS and the gut. SIV DNA was undetectable in brains of five of six early treated macaques, but proviral DNA in guts of treated and control animals was equivalent. Early treated animals had low-to-no plasma LPS and sCD163. These results support the notion that monocyte/macrophage traffic late in infection drives neuronal injury and maintains CNS viral reservoirs and lesions. Leukocyte traffic early in infection seeds the CNS with virus and contributes to productive infection in the gut. Leukocyte traffic early contributes to gut pathology, bacterial translocation, and activation of innate immunity.

Anti-α4 antibody treatment blocks virus traffic to the brain and gut early, and stabilizes CNS injury late in infection.

Science.gov (United States)

Campbell, Jennifer H; Ratai, Eva-Maria; Autissier, Patrick; Nolan, David J; Tse, Samantha; Miller, Andrew D; González, R Gilberto; Salemi, Marco; Burdo, Tricia H; Williams, Kenneth C

2014-12-01

Four SIV-infected monkeys with high plasma virus and CNS injury were treated with an anti-α4 blocking antibody (natalizumab) once a week for three weeks beginning on 28 days post-infection (late). Infection in the brain and gut were quantified, and neuronal injury in the CNS was assessed by MR spectroscopy, and compared to controls with AIDS and SIV encephalitis. Treatment resulted in stabilization of ongoing neuronal injury (NAA/Cr by 1H MRS), and decreased numbers of monocytes/macrophages and productive infection (SIV p28+, RNA+) in brain and gut. Antibody treatment of six SIV infected monkeys at the time of infection (early) for 3 weeks blocked monocyte/macrophage traffic and infection in the CNS, and significantly decreased leukocyte traffic and infection in the gut. SIV - RNA and p28 was absent in the CNS and the gut. SIV DNA was undetectable in brains of five of six early treated macaques, but proviral DNA in guts of treated and control animals was equivalent. Early treated animals had low-to-no plasma LPS and sCD163. These results support the notion that monocyte/macrophage traffic late in infection drives neuronal injury and maintains CNS viral reservoirs and lesions. Leukocyte traffic early in infection seeds the CNS with virus and contributes to productive infection in the gut. Leukocyte traffic early contributes to gut pathology, bacterial translocation, and activation of innate immunity.

The family environment predicts long-term academic achievement and classroom behavior following traumatic brain injury in early childhood.

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Durber, Chelsea M; Yeates, Keith Owen; Taylor, H Gerry; Walz, Nicolay Chertkoff; Stancin, Terry; Wade, Shari L

2017-07-01

This study examined how the family environment predicts long-term academic and behavioral functioning in school following traumatic brain injury (TBI) in early childhood. Using a concurrent cohort, prospective design, 15 children with severe TBI, 39 with moderate TBI, and 70 with orthopedic injury (OI) who were injured when they were 3-7 years of age were compared on tests of academic achievement and parent and teacher ratings of school performance and behavior on average 6.83 years postinjury. Soon after injury and at the longer term follow-up, families completed measures of parental psychological distress, family functioning, and quality of the home environment. Hierarchical linear regression analyses examined group differences in academic outcomes and their associations with measures of the early and later family environment. The severe TBI group, but not the moderate TBI group, performed worse than did the OI group on all achievement tests, parent ratings of academic performance, and teacher ratings of internalizing problems. Higher quality early and late home environments predicted stronger academic skills and better classroom behavior for children with both TBI and OI. The early family environment more consistently predicted academic achievement, whereas the later family environment more consistently predicted classroom functioning. The quality of the home environment predicted academic outcomes more strongly than did parental psychological distress or family functioning. TBI in early childhood has long-term consequences for academic achievement and school performance and behavior. Higher quality early and later home environments predict better school outcomes for both children with TBI and children with OI. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Cognitive appraisals of alcohol use in early adolescence: Psychosocial predictors and reciprocal associations with alcohol use.

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Colder, Craig R; Read, Jennifer P; Wieczorek, William F; Eiden, Rina D; Lengua, Liliana J; Hawk, Larry W; Trucco, Elisa M; Lopez-Vergara, Hector I

2017-04-01

Early adolescence is a dynamic period for the development of alcohol appraisals (expected outcomes of drinking and subjective evaluations of expected outcomes), yet the literature provides a limited understanding of psychosocial factors that shape these appraisals during this period. This study took a comprehensive view of alcohol appraisals and considered positive and negative alcohol outcome expectancies, as well as subjective evaluations of expected outcomes. Developmental-ecological theory guided examination of individual, peer, family, and neighborhood predictors of cognitive appraisals of alcohol and use. A community sample of 378 adolescents (mean age 11.5 years at Wave 1, 52% female) was assessed annually for 4 years. Longitudinal path analysis suggested that the most robust predictors of alcohol appraisals were peer norms. Furthermore, perceived likelihood of positive and negative alcohol outcomes prospectively predicted increases in drinking. There was limited support for appraisals operating as mediators of psychosocial risk and protective factors.

Incidence and predictors of onboard injuries among Sri Lankan flight attendants

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Agampodi Thilini C

2009-07-01

Full Text Available Abstract Background Occupational injuries among flight attendants have not been given appropriate attention in Sri Lanka. The purpose of this study was to estimate the incidence of onboard injury among Sri Lankan flight attendants and to describe the determinants of onboard injury. Methods A descriptive cross-sectional study was carried out among Sri Lankan flight attendants. All flight attendants undergoing their annual health and first aid training were invited to participate. Flight attendants who flew continuously for a six-month period prior to data collection were included in the study sample. Recall history of injuries for a period of six months was recorded. Results The study sample consisted of 98 (30.4% male and 224 (69.6% female flight attendants. The mean age of the study sample was 31 years (SD = 8 and the average duration of service was 10 years (SD = 7. A total of 100 onboard falls, slips or trips in the previous six months were reported by 52 (16.1% respondents. Of the total sample, 128 (39.8% cabin crew members reported an injury in the six months preceding the study. This represents a total injury incidence of 795 per 1000 person per year. The leading causes of injury was pulling, pushing or lifting (60.2%. The commonest type of injuries were strains and sprains (52.3%. Turbulence related injuries were reported by 38 (29.7% flight attendants. The upper limbs (44.5% and the back (32% were the commonest sites affected. After controlling for other factors, female flight attendants had 2.9 times higher risk (95% CI 1.2–7.2 of sustaining and injury than males. Irrespective of sex, body weight less than 56 kilograms (OR 2.9, 95% CI 1.4–5.8 and less than seven years of on board experience (OR 10.5, 95% CI 3.6–31.0 were associated with higher risk of injury. Conclusion Work related injury is a major occupational hazard to flight attendants. Appropriate preventive strategies are required to minimize them.

Vitamin D Deficiency Prevalence and Predictors in Early Pregnancy among Arab Women

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Sara Al-Musharaf

2018-04-01

Full Text Available Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1st trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OHD levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OHD levels <50 nmol/L were considered vitamin D deficient. The majority of participants (n = 468 (81% were vitamin D deficient. High levels of indoor activity, whole body clothing, multiparity, total cholesterol/HDL ratio(>3.5, low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs (95% confidence interval of 25.4 (5.5–117.3, 17.8 (2.3–138.5, 4.0 (1.7–9.5, 3.3 (1.4–7.9, 2.8 (1.2–6.4, and 2.0 (1.1–3.5, respectively. Factors like increased physical activity, sun exposure at noon, sunrise or sunset, high educational status, and residence in North Riyadh were protective against vitamin D deficiency with ORs 0.2 (0.1–0.5; 0.2 (0.1–0.6; 0.3 (0.1–0.9; and 0.4 (0.2–0.8, respectively. All ORs were adjusted for age, BMI, sun exposure, parity, summer season, vitamin D intake, multivitamin intake, physical activity, education, employment, living in the north, and coverage with clothing. In conclusion, the prevalence of vitamin D deficiency among Saudi women during early pregnancy was high (81%. Timely detection and appropriate supplementation with adequate amounts of vitamin D should reduce the risks of vitamin D deficiency and its complications during pregnancy.

Neurocognitive Models of Medical Decision-Making Capacity in Traumatic Brain Injury Across Injury Severity.

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Triebel, Kristen L; Novack, Thomas A; Kennedy, Richard; Martin, Roy C; Dreer, Laura E; Raman, Rema; Marson, Daniel C

2016-01-01

To identify neurocognitive predictors of medical decision-making capacity (MDC) in participants with mild and moderate/severe traumatic brain injury (TBI). Academic medical center. Sixty adult controls and 104 adults with TBI (49 mild, 55 moderate/severe) evaluated within 6 weeks of injury. Prospective cross-sectional study. Participants completed the Capacity to Consent to Treatment Instrument to assess MDC and a neuropsychological test battery. We used factor analysis to reduce the battery test measures into 4 cognitive composite scores (verbal memory, verbal fluency, academic skills, and processing speed/executive function). We identified cognitive predictors of the 3 most clinically relevant Capacity to Consent to Treatment Instrument consent standards (appreciation, reasoning, and understanding). In controls, academic skills (word reading, arithmetic) and verbal memory predicted understanding; verbal fluency predicted reasoning; and no predictors emerged for appreciation. In the mild TBI group, verbal memory predicted understanding and reasoning, whereas academic skills predicted appreciation. In the moderate/severe TBI group, verbal memory and academic skills predicted understanding; academic skills predicted reasoning; and academic skills and verbal fluency predicted appreciation. Verbal memory was a predictor of MDC in controls and persons with mild and moderate/severe TBI. In clinical practice, impaired verbal memory could serve as a "red flag" for diminished consent capacity in persons with recent TBI.

Head injury as a PTSD predictor among Oklahoma City bombing survivors.

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Walilko, Timothy; North, Carol; Young, Lee Ann; Lux, Warren E; Warden, Deborah L; Jaffee, Michael S; Moore, David F

2009-12-01

The aim of the Oklahoma City (OKC) bombing retrospective review was to investigate the relationship between physical injury, environmental contributors, and psychiatric disorders such as posttraumatic stress disorder (PTSD) in an event-based, matched design study focused on injury. The 182 selected participants were a random subset of the 1,092 direct survivors from the OKC bombing. Only 124 of these 182 cases had a full complement of medical/clinical data in the OKC database. These 124 cases were assessed to explore relationships among PTSD diagnoses, levels of blast exposure, and physical injuries. Associations among variables were statistically tested using contingency analysis and logistic regression. Comparison of the PTSD cases to symptoms/diagnoses reported in the medical records reveals a statistically significant association between PTSD and head/brain injuries associated with head acceleration. PTSD was not highly correlated with other injuries. Although blast pressure and impulse were highly correlated with head injuries, the correlation with PTSD was not statistically significant. Thus, a correlation between blast pressure and PTSD may exist, but higher fidelity pressure calculations are required to elucidate this potential relationship. This study provides clear evidence that head injury is associated with subsequent PTSD, giving caregivers' information on what physical injuries may suggest the development of psychologic disorders to aid them in developing a profile for the identification of future survivors of terrorist attacks and Warfighters with brain injuries and potential PTSD.

Exploring predictors of scientific performance with decision tree analysis: The case of research excellence in early career mathematics

Energy Technology Data Exchange (ETDEWEB)

Lindahl, J.

2016-07-01

The purpose of this study was (1) to introduce the exploratory method of decision tree analysis as a complementary alternative to current confirmatory methods used in scientometric prediction studies of research performance; and (2) as an illustrative case, to explore predictors of future research excellence at the individual level among 493 early career mathematicians in the sub-field of number theory between 1999 and 2010. A conceptual introduction to decision tree analysis is provided including an overview of the main steps of the tree-building algorithm and the statistical method of cross-validation used to evaluate the performance of decision tree models. A decision tree analysis of 493 mathematicians was conducted to find useful predictors and important relationships between variables in the context of predicting research excellence. The results suggest that the number of prestige journal publications and a topically diverse output are important predictors of future research excellence. Researchers with no prestige journal publications are very unlikely to produce excellent research. Limitations of decision three analysis are discussed. (Author)

Early vasopressor use following traumatic injury

DEFF Research Database (Denmark)

Hylands, Mathieu; Toma, Augustin; Beaudoin, Nicolas

2017-01-01

OBJECTIVES: Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids. This systema......OBJECTIVES: Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids...... trials are currently ongoing. No study measured long-term quality of life or cognitive function. CONCLUSIONS: Existing data on the effects of vasopressors following traumatic injury are of very low quality according to the Grading of Recommendations, Assessment, Development and Evaluation methodology...

Early Predictors of High School Mathematics Achievement

Science.gov (United States)

Siegler, Robert S.; Duncan, Greg J.; Davis-Kean, Pamela E.; Duckworth, Kathryn; Claessens, Amy; Engel, Mimi; Susperreguy, Maria Ines; Meichu, Chen

2012-01-01

Identifying the types of mathematics content knowledge that are most predictive of students' long-term learning is essential for improving both theories of mathematical development and mathematics education. To identify these types of knowledge, we examined long-term predictors of high school students' knowledge of algebra and overall mathematics…

Suprathreshold Heat Pain Response Predicts Activity-Related Pain, but Not Rest-Related Pain, in an Exercise-Induced Injury Model

Science.gov (United States)

Coronado, Rogelio A.; Simon, Corey B.; Valencia, Carolina; Parr, Jeffrey J.; Borsa, Paul A.; George, Steven Z.

2014-01-01

Exercise-induced injury models are advantageous for studying pain since the onset of pain is controlled and both pre-injury and post-injury factors can be utilized as explanatory variables or predictors. In these studies, rest-related pain is often considered the primary dependent variable or outcome, as opposed to a measure of activity-related pain. Additionally, few studies include pain sensitivity measures as predictors. In this study, we examined the influence of pre-injury and post-injury factors, including pain sensitivity, for induced rest and activity-related pain following exercise induced muscle injury. The overall goal of this investigation was to determine if there were convergent or divergent predictors of rest and activity-related pain. One hundred forty-three participants provided demographic, psychological, and pain sensitivity information and underwent a standard fatigue trial of resistance exercise to induce injury of the dominant shoulder. Pain at rest and during active and resisted shoulder motion were measured at 48- and 96-hours post-injury. Separate hierarchical models were generated for assessing the influence of pre-injury and post-injury factors on 48- and 96-hour rest-related and activity-related pain. Overall, we did not find a universal predictor of pain across all models. However, pre-injury and post-injury suprathreshold heat pain response (SHPR), a pain sensitivity measure, was a consistent predictor of activity-related pain, even after controlling for known psychological factors. These results suggest there is differential prediction of pain. A measure of pain sensitivity such as SHPR appears more influential for activity-related pain, but not rest-related pain, and may reflect different underlying processes involved during pain appraisal. PMID:25265560

Early childhood predictors of age of initiation to use of cannabis: a birth prospective study.

Science.gov (United States)

Hayatbakhsh, Reza; Williams, Gail M; Bor, William; Najman, Jake M

2013-05-01

Early age of cannabis use predicts subsequent illicit drug abuse and other psychosocial problems. Identification of factors associated with early cannabis use may contribute to the development of preventive interventions. This study aimed to examine the early life predictors of age of initiation to cannabis. Data were from Mater Hospital and University of Queensland Study of Pregnancy, a population-based prospective birth cohort study. Participants were a cohort of 3488 young adults who self-reported frequency and age of onset of cannabis use at the 21 year follow up. Of 3488 young adults, 48.9% (51.8% men and 46.4% women) reported having ever used cannabis. For those who had ever used cannabis, age of onset had mean and median of 15.8 and 16.0 years, respectively. In multivariate analysis child's gender, change in maternal marital status, quality of marital relationship, maternal cigarette smoking and alcohol consumption and maternal depression when the child was 5 years statistically significantly predicted age of initiation to cannabis use. The present study explores the impact of early childhood factors associated with age of onset of cannabis use. It is suggested that the family environment within which children are reared, including factors such as parents' marital circumstances, has a major influence on initiation to cannabis use in adolescence. Research is needed to disentangle the pathways of association between these early life factors and early initiation to use of cannabis. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Obesity as a Possible Risk Factor for Lost-time Injury in Registered Nurses: A Literature Review

Directory of Open Access Journals (Sweden)

Gillian Jordan

2015-03-01

Full Text Available Time-loss injuries are still a major occurrence in Canada, injuring thousands of Canadian workers each year. With obesity rates on the rise across the country, as well as around the world, it is important that the possible effects of obesity in the workplace be fully understood, especially those effects linked to lost-time injuries. The aim of this paper was to evaluate predictors of workplace lost-time injuries and how they may be related to obesity or high body mass index by examining factors associated with lost-time injuries in the health care sector, a well-studied industry with the highest number of reported time loss injuries in Canada. A literature review focusing on lost-time injuries in Registered Nurses (RNs was conducted using the keywords and terms: lost time injury, workers' compensation, occupational injury, workplace injury, injury, injuries, work, workplace, occupational, nurse, registered nurse, RN, health care, predictors, risk factors, risk, risks, cause, causes, obese, obesity, and body mass index. Data on predictors or factors associated with lost-time injuries in RNs were gathered and organized using Loisel's Work Disability Prevention Management Model and extrapolated upon using existing literature surrounding obesity in the Canadian workplace.

The first concussion crisis: head injury and evidence in early American football.

Science.gov (United States)

Harrison, Emily A

2014-05-01

In the early 21st century, sports concussion has become a prominent public health problem, popularly labeled "The Concussion Crisis." Football-related concussion contributes much of the epidemiological burden and inspires much of the public awareness. Though often cast as a recent phenomenon, the crisis in fact began more than a century ago, as concussions were identified among footballers in the game's first decades. This early concussion crisis subsided-allowing the problem to proliferate-because work was done by football's supporters to reshape public acceptance of risk. They appealed to an American culture that permitted violence, shifted attention to reforms addressing more visible injuries, and legitimized football within morally reputable institutions. Meanwhile, changing demands on the medical profession made practitioners reluctant to take a definitive stance. Drawing on scientific journals, public newspapers, and personal letters of players and coaches, this history of the early crisis raises critical questions about solutions being negotiated at present.

Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury Than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball.

Science.gov (United States)

Camp, Christopher L; Zajac, John M; Pearson, David B; Sinatro, Alec M; Spiker, Andrea M; Werner, Brian C; Altchek, David W; Coleman, Struan H; Dines, Joshua S

2017-09-01

The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2) describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury. Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. All noncontact shoulder and elbow injuries were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified. A total of 53 shoulder (n = 25) and elbow (n = 28) injuries occurred during 132 pitcher seasons (n = 81 pitchers). The most significant categorical risk factor associated with increased elbow injury rates was the presence of a shoulder flexion deficit >5° (odds ratio [OR] 2.83; P = .042). For continuous variables, the risk of elbow injury increased by 7% for each degree of increased shoulder ER deficit (OR 1.07; P = .030) and 9% for each degree of decreased shoulder flexion (OR 1.09; P = .017). None of the measures significantly correlated with shoulder injuries. Preseason shoulder ER and flexion deficits are independent risk factors for the development of elbow injuries during the upcoming season. Although prior work has supported the importance of reducing glenohumeral internal rotation deficits in pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of

Early predictors of narcotics-dependent patients in the emergency department

Directory of Open Access Journals (Sweden)

Wei-Che Lee

2013-06-01

Full Text Available It is not unusual that narcotics-dependent patients fulfill their medical requirements in the emergency department (ED. The behavior of these patients varies, and their manifestations and predictors are still not fully studied. We performed this retrospective study by prospectively collecting data on patients with suspected drug dependence who were undiagnosed at first and then treated for some kind of reported pain at the ED. Patients who were confirmed to have narcotics dependence were compared with control patients in a ratio of 1:3 matching for age, gender, disease, and clinical diagnoses. From January 2006 to October 2009, 26 of 223 patients treated for pain were found to be drug dependent (12 males and 14 females. The average dose of narcotics used was higher than the control group [3.23 ± 1.14 vs. 1.12 ± 0.36, p < 0.001, confidence interval (CI: 1.648–2.583]. Numbers of patients making unscheduled returns to the ED within 24 hours were significant [24/26 vs. 8/78, p ≤ 0.001, odds ratio (OR 105.00, 95% CI 20.834–529.175]. In addition, patients showing aggressive attitudes were significant (17/26 vs. 2/78, p < 0.001, OR 71.78, 95% CI 14.206–362.663. In the case group, six of them told the physician that they were allergic to medicines other than the particular one they wanted, and three of the six presented injuries that were reported to be in the same (or repeated place for unscheduled returns, which were not found in the control group. In this study, some behaviors were commonly observed in the at-risk group. These patients were prone to manifest some types of symptoms and behaviors, such as uncontrolled pain with three doses of analgesics, aggressive attitude, returning to the ED within 24 hours with the complaint of the same severe pain, repeating the same injury, claiming allergy to other analgesics, and asking for certain analgesics. All these behaviors should alert the physician to suspect a drug-seeking problem.

Early monitoring of PtiO2, PtiCO2, pH and brain temperat ure in patients with brain injuries and the clinical significanc e

Institute of Scientific and Technical Information of China (English)

无

2001-01-01

Objective:　To explore the regulation of early br ain tissue metabolic changing after brain injuries and the clinical significance . 　　Methods:　There were 17 patients with brain injuries. Early dire ct monitoring of PtiO2, PtiCO2, pH and brain temperature, dynami c observation of the relation between various parameters and clinics after brai n injuries were performed. 　　Results:　Early changes of PtiO2, PtiCO2 and pH we re closely correlated with outcome. The death rate obviously increased when P tiO2 was continuously lower than 9 mm?Hg within 24 hours after injuries. Secondary brain injury prolonged and aggravated brain tissue metabolic disturban ce. When intracerebral pressure was over 30 mm?Hg PtiO2 began to de crea se. The brain temperature in brain death patients was evidently lower than axill ary temperature. 　　Conclusions:　The direct monitoring of PtiO2, PtiC O2, pH and brain temperature is safe and accurate and can find early anoxia da mage to brain tissue and provide reliable basis for clinical therapy. It ha s an instructive significance in selecting and studying a new treatment method i n brain injuries. And it can be taken as a criterion in clinical judging brain d eaths.

Vocabulary, syntax, and narrative development in typically developing children and children with early unilateral brain injury: Early parental talk about the there-and-then matters

Science.gov (United States)

Demir, Özlem Ece; Rowe, Meredith L.; Heller, Gabriella; Goldin-Meadow, Susan; Levine, Susan C.

2014-01-01

This study examines the role of a particular kind of linguistic input––talk about the past and future, pretend, and explanations, that is, talk that is decontextualized––in the development of vocabulary, syntax, and narrative skill in typically developing (TD) children and children with pre- or perinatal brain injury (BI). Decontextualized talk has been shown to be particularly effective in predicting children’s language skills, but it is not clear why. We first explored the nature of parent decontextualized talk and found it to be linguistically richer than contextualized talk in parents of both TD and BI children. We then found, again for both groups, that parent decontextualized talk at child age 30 months was a significant predictor of child vocabulary, syntax, and narrative performance at kindergarten, above and beyond the child’s own early language skills, parent contextualized talk and demographic factors. Decontextualized talk played a larger role in predicting kindergarten syntax and narrative outcomes for children with lower syntax and narrative skill at 30 months, and also a larger role in predicting kindergarten narrative outcomes for children with BI than for TD children. The difference between the two groups stemmed primarily from the fact that children with BI had lower narrative (but not vocabulary or syntax) scores than TD children. When the two groups were matched in terms of narrative skill at kindergarten, the impact that decontextualized talk had on narrative skill did not differ for children with BI and for TD children. Decontextualized talk is thus a strong predictor of later language skill for all children, but may be particularly potent for children at the lower-end of the distribution for language skill. The findings also suggest that variability in the language development of children with BI is influenced not only by the biological characteristics of their lesions, but also by the language input they receive. PMID:25621756

Early Gelatinase Activity Is Not a Determinant of Long-Term Recovery after Traumatic Brain Injury in the Immature Mouse.

Directory of Open Access Journals (Sweden)

Bridgette D Semple

Full Text Available The gelatinases, matrix metalloproteinases (MMP-2 and MMP-9, are thought to be key mediators of secondary damage in adult animal models of brain injury. Moreover, an acute increase in these proteases in plasma and brain extracellular fluid of adult patients with moderate-to-severe traumatic brain injuries (TBIs is associated with poorer clinical outcomes and mortality. Nonetheless, their involvement after TBI in the pediatric brain remains understudied. Using a murine model of TBI at postnatal day 21 (p21, approximating a toddler-aged child, we saw upregulation of active and pro-MMP-9 and MMP-2 by gelatin zymography at 48 h post-injury. We therefore investigated the role of gelatinases on long-term structural and behavioral outcomes after injury after acute inhibition with a selective gelatinase inhibitor, p-OH SB-3CT. After systemic administration, p-OH SB-3CT crossed the blood-brain barrier at therapeutically-relevant concentrations. TBI at p21 induced hyperactivity, deficits in spatial learning and memory, and reduced sociability when mice were assessed at adulthood, alongside pronounced tissue loss in key neuroanatomical regions. Acute and short-term post-injury treatment with p-OH SB-3CT did not ameliorate these long-term behavioral, cognitive, or neuropathological deficits as compared to vehicle-treated controls, suggesting that these deficits were independent of MMP-9 and MMP-2 upregulation. These findings emphasize the vulnerability of the immature brain to the consequences of traumatic injuries. However, early upregulation of gelatinases do not appear to be key determinants of long-term recovery after an early-life injury.

Early Gelatinase Activity Is Not a Determinant of Long-Term Recovery after Traumatic Brain Injury in the Immature Mouse

Science.gov (United States)

Semple, Bridgette D.; Noble-Haeusslein, Linda J.; Gooyit, Major; Tercovich, Kayleen G.; Peng, Zhihong; Nguyen, Trung T.; Schroeder, Valerie A.; Suckow, Mark A.; Chang, Mayland; Raber, Jacob; Trivedi, Alpa

2015-01-01

The gelatinases, matrix metalloproteinases (MMP)-2 and MMP-9, are thought to be key mediators of secondary damage in adult animal models of brain injury. Moreover, an acute increase in these proteases in plasma and brain extracellular fluid of adult patients with moderate-to-severe traumatic brain injuries (TBIs) is associated with poorer clinical outcomes and mortality. Nonetheless, their involvement after TBI in the pediatric brain remains understudied. Using a murine model of TBI at postnatal day 21 (p21), approximating a toddler-aged child, we saw upregulation of active and pro-MMP-9 and MMP-2 by gelatin zymography at 48 h post-injury. We therefore investigated the role of gelatinases on long-term structural and behavioral outcomes after injury after acute inhibition with a selective gelatinase inhibitor, p-OH SB-3CT. After systemic administration, p-OH SB-3CT crossed the blood-brain barrier at therapeutically-relevant concentrations. TBI at p21 induced hyperactivity, deficits in spatial learning and memory, and reduced sociability when mice were assessed at adulthood, alongside pronounced tissue loss in key neuroanatomical regions. Acute and short-term post-injury treatment with p-OH SB-3CT did not ameliorate these long-term behavioral, cognitive, or neuropathological deficits as compared to vehicle-treated controls, suggesting that these deficits were independent of MMP-9 and MMP-2 upregulation. These findings emphasize the vulnerability of the immature brain to the consequences of traumatic injuries. However, early upregulation of gelatinases do not appear to be key determinants of long-term recovery after an early-life injury. PMID:26588471

Occurrence and severity of agitated behavior after severe traumatic brain injury

DEFF Research Database (Denmark)

Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W

2013-01-01

To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS).......To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS)....

Using Dynamic Response Index (DRI) as a spinal injury predictor

CSIR Research Space (South Africa)

Ahmed, Rayeesa

2014-09-01

Full Text Available , moments and accelerations on an occupant are measured using an Anthropomorphic Testing Device (ATD). These measurements are then correlated to injury criteria which determine the probability of injury. Seats are typically evaluated in terms of probability...

Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis

DEFF Research Database (Denmark)

Dombernowsky, Tilde; Kristensen, Marlene Østermark; Rysgaard, Sisse

2016-01-01

: Retrospective cohort study including 359 patients admitted with acute pancreatitis. Information was gathered from electronic patient records. We defined respiratory failure based on the modified Marshall scoring system in the revised Atlanta criteria. Predictors of respiratory failure were evaluated......, or pneumonia may develop respiratory failure, suggests that acute lung injury, possibly associated with systemic inflammation, may be important.......BACKGROUND: The incidence of respiratory failure and other respiratory complications in the early phase of acute pancreatitis (AP) is not well investigated. OBJECTIVE: To evaluate the incidence and risk factors of respiratory failure, and its impact on mortality in the early phase AP. METHODS...

Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial

NARCIS (Netherlands)

Levitsky, Adrian; Brismar, Kerstin; Hafström, Ingiäld; Hambardzumyan, Karen; Lourdudoss, Cecilia; van Vollenhoven, Ronald F.; Saevarsdottir, Saedis

2017-01-01

The aim of this paper was to analyse the impact of obesity, in addition to known predictors, on disease outcome in early rheumatoid arthritis (RA). Body mass index (BMI) was available in 260 patients from the Swedish pharmacotherapy trial (SWEFOT). Differences in disease activity (DAS28), functional

Injuries in martial arts: a comparison of five styles.

Science.gov (United States)

Zetaruk, M N; Violán, M A; Zurakowski, D; Micheli, L J

2005-01-01

To compare five martial arts with respect to injury outcomes. A one year retrospective cohort was studied using an injury survey. Data on 263 martial arts participants (Shotokan karate, n = 114; aikido, n = 47; tae kwon do, n = 49; kung fu, n = 39; tai chi, n = 14) were analysed. Predictor variables included age, sex, training frequency (3 h/week), experience (or=3 years), and martial art style. Outcome measures were injuries requiring time off from training, major injuries (>or=7 days off), multiple injuries (>or=3), body region, and type of injury. Logistic regression was used to determine odds ratios (OR) and confidence intervals (CI). Fisher's exact test was used for comparisons between styles, with a Bonferroni correction for multiple comparisons. The rate of injuries, expressed as percentage of participants sustaining an injury that required time off training a year, varied according to style: 59% tae kwon do, 51% aikido, 38% kung fu, 30% karate, and 14% tai chi. There was a threefold increased risk of injury and multiple injury in tae kwon do than karate (por=18 years of age were at greater risk of injury than younger ones (p3 h/week was also a significant predictor of injury (pkarate, the risks of head/neck injury, upper extremity injury, and soft tissue injury were all higher in aikido (pinjuries were higher in tae kwon do (pkarate. Different martial arts have significantly different types and distribution of injuries. Martial arts appear to be safe for young athletes, particularly those at beginner or intermediate levels.

Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study.

Science.gov (United States)

Spittal, Matthew J; Grant, Genevieve; O'Donnell, Meaghan; McFarlane, Alexander C; Studdert, David M

2018-04-28

We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury. Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury. Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia. 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers' compensation scheme. 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey. Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R 2 =0.37) and calibration. The disability risk score had a score range of 0-180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0-220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes. The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions. © Article author(s) (or their employer

93 Aetiological spectrum, injury characteristics and treatment ...

African Journals Online (AJOL)

Abstract: Head injury is considered as a major health problem that is a ... Road traffic accidents (RTAs) were the most common cause of injury accounting for .... Student t-test was used to test for significance of associations between the predictor and ..... Mwang'ombe, N.J. & Kiboi, J. (2001) Factors influencing the outcome of ...

Running injuries - changing trends and demographics.

Science.gov (United States)

Fields, Karl B

2011-01-01

Running injuries are common. Recently the demographic has changed, in that most runners in road races are older and injuries now include those more common in master runners. In particular, Achilles/calf injuries, iliotibial band injury, meniscus injury, and muscle injuries to the hamstrings and quadriceps represent higher percentages of the overall injury mix in recent epidemiologic studies compared with earlier ones. Evidence suggests that running mileage and previous injury are important predictors of running injury. Evidence-based research now helps guide the treatment of iliotibial band, patellofemoral syndrome, and Achilles tendinopathy. The use of topical nitroglycerin in tendinopathy and orthotics for the treatment of patellofemoral syndrome has moderate to strong evidence. Thus, more current knowledge about the changing demographics of runners and the application of research to guide treatment and, eventually, prevent running injury offers hope that clinicians can help reduce the high morbidity associated with long-distance running.

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence.

Science.gov (United States)

Jordan, Jennifer; McIntosh, Virginia V W; Carter, Frances A; Joyce, Peter R; Frampton, Christopher M A; Luty, Suzanne E; McKenzie, Janice M; Carter, Janet D; Bulik, Cynthia M

2017-08-01

Failure to complete treatment for anorexia nervosa (AN) is- common, clinically concerning but difficult to predict. This study examines whether therapy-related factors (patient-rated pretreatment credibility and early therapeutic alliance) predict subsequent premature termination of treatment (PTT) alongside self-transcendence (a previously identified clinical predictor) in women with AN. 56 women aged 17-40 years participating in a randomized outpatient psychotherapy trial for AN. Treatment completion was defined as attending 15/20 planned sessions. Measures were the Treatment Credibility, Temperament and Character Inventory, Vanderbilt Therapeutic Alliance Scale and the Vanderbilt Psychotherapy Process Scale. Statistics were univariate tests, correlations, and logistic regression. Treatment credibility and certain early patient and therapist alliance/process subscales predicted PTT. Lower self-transcendence and lower early process accounted for 33% of the variance in predicting PTT. Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes. © 2017 Wiley Periodicals, Inc.

Predictors of treatment failure among pulmonary tuberculosis ...

African Journals Online (AJOL)

Introduction: Early identification of Tuberculosis (TB) treatment failure using cost effective means is urgently needed in developing nations. The study set out to describe affordable predictors of TB treatment failure in an African setting. Objective: To determine the predictors of treatment failure among patients with sputum ...

Early detection of consciousness in patients with acute severe traumatic brain injury.

Science.gov (United States)

Edlow, Brian L; Chatelle, Camille; Spencer, Camille A; Chu, Catherine J; Bodien, Yelena G; O'Connor, Kathryn L; Hirschberg, Ronald E; Hochberg, Leigh R; Giacino, Joseph T; Rosenthal, Eric S; Wu, Ona

2017-09-01

See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit. We prospectively enrolled 16 patients admitted to the intensive care unit for acute severe traumatic brain injury to test two hypotheses: (i) in patients who lack behavioural evidence of language expression and comprehension, functional magnetic resonance imaging and electroencephalography detect command-following during a motor imagery task (i.e. cognitive motor dissociation) and association cortex responses during language and music stimuli (i.e. higher-order cortex motor dissociation); and (ii) early responses to these paradigms are associated with better 6-month outcomes on the Glasgow Outcome Scale-Extended. Patients underwent functional magnetic resonance imaging on post-injury Day 9.2 ± 5.0 and electroencephalography on Day 9.8 ± 4.6. At the time of imaging, behavioural evaluation with the Coma Recovery Scale-Revised indicated coma (n = 2), vegetative state (n = 3), minimally conscious state without language (n = 3), minimally conscious state with language (n = 4) or post-traumatic confusional state (n = 4). Cognitive motor dissociation was identified in four patients, including three whose behavioural diagnosis suggested a vegetative state. Higher-order cortex motor dissociation was identified in two additional patients. Complete absence of responses to language, music and motor imagery was only observed in coma patients. In patients with behavioural evidence

Anaemia worsens early functional outcome after traumatic brain injury: a preliminary study.

Science.gov (United States)

Litofsky, N Scott; Miller, Douglas C; Chen, Zhenzhou; Simonyi, Agnes; Klakotskaia, Diana; Giritharan, Andrew; Feng, Qi; McConnell, Diane; Cui, Jiankun; Gu, Zezong

2018-01-01

To determine early effects on outcome from traumatic brain injury (TBI) induced by controlled cortical impact (CCI) associated with anaemia in mice. Outcome from TBI with concomitant anaemia would be worse than TBI without anaemia. CCI was induced with electromagnetic impaction in four groups of C57BL/6J mice: sham, sham+anaemia; TBI; and TBI+anaemia. Anaemia was created by withdrawal of 30% of calculated intravascular blood volume and saline replacement of equal volume. Functional outcome was assessed by beam-walking test and open field test (after pre-injury training) on post-injury days 3 and 7. After functional assessment, brains removed from sacrificed animals were pathological reviewed with haematoxylin and eosin, cresyl violet, Luxol Fast Blue, and IBA-1 immunostains. Beam-walking was similar between animals with TBI and TBI+anaemia (p = 0.9). In open field test, animals with TBI+anaemia walked less distance than TBI alone or sham animals on days 3 (p < 0.001) and 7 (p < 0.05), indicating less exploratory and locomotion behaviours. No specific pathologic differences could be identified. Anaemia associated with TBI from CCI is associated with worse outcome as measured by less distance travelled in the open field test at three days than if anaemia is not present.

Life expectancy in elderly patients following burns injury.

Science.gov (United States)

Sepehripour, Sarvnaz; Duggineni, Sirisha; Shahsavari, Somaya; Dheansa, Baljit

2018-05-18

Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival. Retrospective data collection from patients aged 75 with burns injuries, treated and discharged at Queen Victoria Hospital. The Clinical Frailty Scale (Rockwood et al., 2005) was used to calculate frailty at the time of admission. The expected mortality age (life expectancy) of deceased patients was obtained from two survival predictors. The data shows a statistically significant correlation between frailty score and complications and a statistically significant correlation between total body surface area percentage and complications. No significant difference was found between expected and observed age of death or life expectancy amongst the deceased (p value of 0.109). Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population. Copyright © 2018 Elsevier Ltd. All rights reserved.

Predictors of early postpartum mental distress in mothers with midwifery home care--results from a nested case-control study.

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Staehelin, Katharina; Kurth, Elisabeth; Schindler, Christian; Schmid, Monika; Zemp Stutz, Elisabeth

2013-08-27

The prevalence of early postpartum mental health conditions is high. Midwives and other health professionals visiting women at home may identify mothers at risk. This seems crucial given decreasing trends of length of hospital stay after childbirth. This study aimed to identify predictors of maternal mental distress in a midwifery home care setting. Using the statistical database of independent midwives' services in Switzerland in 2007, we conducted a matched nested case-control study. Out of a source population of 34,295 mothers with midwifery home care in the first ten days after childbirth, 935 mothers with maternal distress and 3,645 controls, matched by midwife, were included. We analysed whether socio-demographic, maternal and neonatal factors predict maternal mental distress by multivariable conditional logistic regression analysis. Infant crying problems and not living with a partner were the strongest predictors for maternal distress, whereas higher parity was the most protective factor. Significantly elevated risks were also found for older age, lower educational levels, breast/breastfeeding problems, infant weight gain concerns, neonatal pathologies and use of midwifery care during pregnancy. A lower likelihood for maternal distress was seen for non-Swiss nationality, full-time employment before birth, intention to return to work after birth and midwife-led birth. The study informs on predictors of maternal mental distress identified in a home care setting in the early postpartum period. Midwives and other health care professionals should pay particular attention to mothers of excessively crying infants, single mothers and primipara, and assess the need for support of these mothers.

Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature.

NARCIS (Netherlands)

Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

2009-01-01

AIM: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. METHODS: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers

Neonatal encephalopathic cerebral injury in South India assessed by perinatal magnetic resonance biomarkers and early childhood neurodevelopmental outcome.

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Peter J Lally

Full Text Available Although brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such injury in low- and middle-income countries. Such injury accounts for an estimated 1 million neonatal deaths per year. We used magnetic resonance (MR biomarkers to characterise perinatal brain injury, and examined early childhood outcomes in South India.We recruited consecutive term or near term infants with evidence of perinatal asphyxia and a Thompson encephalopathy score ≥6 within 6 h of birth, over 6 months. We performed conventional MR imaging, diffusion tensor MR imaging and thalamic proton MR spectroscopy within 3 weeks of birth. We computed group-wise differences in white matter fractional anisotropy (FA using tract based spatial statistics. We allocated Sarnat encephalopathy stage aged 3 days, and evaluated neurodevelopmental outcomes aged 3½ years using Bayley III.Of the 54 neonates recruited, Sarnat staging was mild in 30 (56%; moderate in 15 (28% and severe in 6 (11%, with no encephalopathy in 3 (6%. Six infants died. Of the 48 survivors, 44 had images available for analysis. In these infants, imaging indicated perinatal rather than established antenatal origins to injury. Abnormalities were frequently observed in white matter (n = 40, 91% and cortex (n = 31, 70% while only 12 (27% had abnormal basal ganglia/thalami. Reduced white matter FA was associated with Sarnat stage, deep grey nuclear injury, and MR spectroscopy N-acetylaspartate/choline, but not early Thompson scores. Outcome data were obtained in 44 infants (81% with 38 (79% survivors examined aged 3½ years; of these, 16 (42% had adverse neurodevelopmental outcomes.No infants had evidence for established brain lesions, suggesting potentially treatable perinatal origins. White matter injury was more common than deep brain nuclei injury. Our results support the need for rigorous evaluation of the efficacy of rescue hypothermic

Antiangiogenic Treatment Diminishes Renal Injury and Dysfunction via Regulation of Local AKT in Early Experimental Diabetes

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Bai, Xiaoyan; Li, Xiao; Tian, Jianwei; Zhou, Zhanmei

2014-01-01

In view of increased vascular endothelial growth factor-A (VEGF-A) expression and renal dysfunction in early diabetes, we designed a study to test whether VEGF-A inhibition can prevent early renal injury and dysfunction. We investigated the relationship and mechanism between VEGF-A and AKT regulation. In vitro, VEGF-A small interfering RNA (siRNA) and AKT inhibitor MK-2206 were employed to podocytes and NRK-52 cells cultured in high glucose (30 mM). In vivo, the antiangiogenic drug endostatin...

Penetrating injuries to the duodenum: An analysis of 879 patients from the National Trauma Data Bank, 2010 to 2014.

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Phillips, Bradley; Turco, Lauren; McDonald, Dan; Mause, Alison; Walters, Ryan W

2017-11-01

Despite wide belief that the duodenal Organ Injury Scale has been validated, this has not been reported in the published literature. Based on clinical experience, we hypothesize that the American Association for Surgery of Trauma Organ Injury Scale (AAST-OIS) for duodenal injuries can independently predict mortality. Our objectives were threefold: (1) describe the national profile of penetrating duodenal injuries, (2) identify predictors of morbidity and mortality, and (3) validate the duodenum AAST-OIS as a statistically significant predictor of mortality. Using the Abbreviated Injury Scale 2005 and International Classification of Diseases-9th Rev.-Clinical Modification (ICD-9-CM) E-codes, we identified 879 penetrating duodenal trauma patients from the National Trauma Data Bank between 2010 and 2014. We controlled patient-level covariates of age, biological sex, systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, pulse, Injury Severity Score (ISS), and Organ Injury Scale (OIS) grade. We estimated multivariable generalized linear mixed models to account for the nesting of patients within trauma centers. Our results indicated an overall mortality rate of 14.4%. Approximately 10% of patients died within 24 hours of admission, of whom 76% died in the first 6 hours. Patients averaged approximately five associated injuries, 45% of which involved the liver and colon. Statistically significant independent predictors of mortality were firearm mechanism, SBP, GCS, pulse, ISS, and AAST-OIS grade. Specifically, odds of death were decreased with 10 mm Hg higher admission SBP (13% decreased odds), one point higher GCS (14.4%), 10-beat lower pulse (8.2%), and 10-point lower ISS (51.0%). This study is the first to report the national profile of penetrating duodenal injuries. Using the National Trauma Data Bank, we identified patterns of injury, predictors of outcome, and validated the AAST-OIS for duodenal injuries as a statistically significant predictor of morbidity

Community integration 2 years after moderate and severe traumatic brain injury.

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Sandhaug, Maria; Andelic, Nada; Langhammer, Birgitta; Mygland, Aase

2015-01-01

The aim of this study was to examine community integration by the Community Integration Questionnaire (CIQ) 2 years after injury in a divided TBI sample of moderately and severely injured patients. The second aim was to identify social-demographic, injury-related and rehabilitation associated predictors of CIQ. A cohort study. Outpatient follow-up. Fifty-seven patients with moderate (n = 21) or severe (n = 36) TBI were examined with the Community Integration Questionnaire (CIQ) at 2 years after injury. Possible predictors were analysed in a regression model using CIQ total score at 2 years as the outcome measure. The Community Integration Questionnaire. At 2 years follow-up, there was significant difference between the moderately and severely injured patients in the productivity scores (p productivity level than the severely injured patients. Marital status, injury severity and rehabilitation after injury were associated with community integration 2 years after TBI.

Impact of location on outcome after penetrating colon injuries.

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Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Zarzaur, Ben L; Shahan, Charles P; Parks, Nancy A; Fabian, Timothy C; Croce, Martin A

2012-12-01

Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. Four hundred sixty-nine patients were identified: 314 (67%) underwent primary repair and 155 (33%) underwent resection. Most injuries involved the transverse colon (39%), followed by the ascending colon (26%), the descending colon (21%), and the sigmoid colon (14%). Overall, there were 13 suture line failures (3%) and 72 abscesses (15%). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily

Stressful Life Events and Predictors of Post-traumatic Growth among High-Risk Early Emerging Adults.

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Arpawong, Thalida E; Rohrbach, Louise A; Milam, Joel E; Unger, Jennifer B; Land, Helen; Sun, Ping; Spruijt-Metz, Donna; Sussman, Steve

2016-01-01

Stressful life events (SLEs) may elicit positive psychosocial change among youth, referred to as Post-traumatic Growth (PTG). We assessed types of SLEs experienced, degree to which participants reported PTG, and variables predicting PTG across 24 months among a sample of high risk, ethnically diverse early emerging adults. Participants were recruited from alternative high schools ( n = 564; mean age=16.8; 65% Hispanic). Multi-level regression models were constructed to examine the impact of environmental (SLE quantity, severity) and personal factors (hedonic ability, perceived stress, developmental stage, future time orientation) on a composite score of PTG. The majority of participants reported positive changes resulted from their most life-altering SLE of the past two years. Predictors of PTG included fewer SLEs, less general stress, having a future time perspective, and greater identification with the developmental stage of Emerging Adulthood. Findings suggest intervention targets to foster positive adaptation among early emerging adults who experience frequent SLEs.

Long-term classroom functioning and its association with neuropsychological and academic performance following traumatic brain injury during early childhood.

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Treble-Barna, Amery; Schultz, Hanna; Minich, Nori; Taylor, H Gerry; Yeates, Keith Owen; Stancin, Terry; Wade, Shari L

2017-07-01

The present study utilized ecobehavioral assessment to examine classroom functioning several years following early childhood traumatic brain injury (TBI) or orthopedic injury (OI) and its association with injury factors, neuropsychological abilities, and academic performance. Participants included 39 children with moderate to severe TBI and 51 children with OI sustained between ages 3 and 7 years. At 7.2 (± 1.3) years post injury, ecobehavioral assessment was used to examine classroom functioning. Additional outcomes included neuropsychological tests, parent and teacher ratings of dysexecutive behavior, and teacher ratings of academic performance. Groups were compared on measures controlling for demographic characteristics, and associations among outcomes were examined using linear regression. Children with TBI showed lower academic engagement relative to children with OI, as well as more frequent individual teacher attention for children with more severe injuries. For children with TBI, difficulties in classroom functioning were associated with lower cognitive flexibility and higher parent and teacher ratings of dysexecutive behavior. Lower scores on a test of fluid reasoning and a greater frequency of individual teacher attention were also associated with lower academic performance in children with TBI. Difficulties in classroom functioning are evident several years after early childhood TBI and were associated with greater injury severity, neuropsychological weaknesses, and poorer academic performance. Children with impaired cognitive flexibility and fluid reasoning skills were at greatest risk for these difficulties and associated weaknesses in academic performance. Instructional interactions may be a potential target for intervention to promote academic progress in at-risk children. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The Clinical Significance of the MIF Homolog D-Dopachrome Tautomerase (MIF-2) and its Circulating Receptor (sCD74) in Burn Injury

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Kim, Bong-Sung; Stoppe, Christian; Grieb, Gerrit; Leng, Lin; Sauler, Maor; Assis, David; Simons, David; Boecker, Arne Hendrick; Schulte, Wibke; Piecychna, Marta; Hager, Stephan; Bernhagen, Jürgen; Pallua, Norbert; Bucala, Richard

2016-01-01

Background We reported earlier that the cytokine macrophage migration inhibitory factor (MIF) is a potential biomarker in burn injury. In the present study, we investigated the clinical significance in severely burned patients of expression levels the newly discovered MIF family member D-dopachrome tautomerase (DDT or MIF-2) and their common soluble receptor CD74 (sCD74). Methods DDT and sCD74 serum levels were measured 20 severely burned patients and 20 controls. Serum levels were correlated to the abbreviated burn severity index (ABSI) and TBSA followed by receiver operating characteristic (ROC) analysis. Data were supported by gene expression dataset analysis of 31 burn patients and 28 healthy controls. Results CD74 and DDT were increased in burn patients. Furthermore, CD74 and DDT also were elevated in septic non-survivors when compared to survivors. Serum levels of DDT showed a positive correlation with the ABSI and TBSA in the early stage after burn injury, and the predictive character of DDT was strongest at 24 hrs. Serum levels of CD74 only correlated with the ABSI five days post-injury. Conclusions DDT may assist in the monitoring of clinical outcome and prediction of sepsis during the early post-burn period. sCD74 and MIF, by contrast, have limited value as an early predictor of death due to their delayed response to burn injury. PMID:27209369

Predictors of early breastfeeding initiation among mothers of children under 24 months of age in rural part of West Ethiopia.

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Hailemariam, Tsedeke Wolde; Adeba, Emiru; Sufa, Alem

2015-10-21

The World Health Organization recommends initiation of breastfeeding within the first hour after childbirth. In developing countries alone, early initiation of breastfeeding could save as many as 1.45 million lives each year by reducing deaths mainly due to diarrheal disorders and lower respiratory tract infections in children. The current study aimed to determine the rate and the predictors of breastfeeding initiation in East Wollega Zones of West Ethiopia. A community-based, cross-sectional study was conducted from April to May 2014 among 594 mothers who had children less than 24 months. Multi stage cluster sampling method was used to select the study population. Eligible mothers were invited to interview using pretested questionnaires to gather data regarding sociodemographics, health-related variables, breastfeeding initiation, and current breastfeeding practices. A multivariable logistic regression analysis was used to identify independent predictors of early initiation of breastfeeding after controlling for confounding variables. A sample of 593 mothers was included in the study. Breastfeeding was initiated by 83.1 % of mothers within the first hour of childbirth. Being a housewife (AOR (95 % CI) = 2.48 (1.54- 3.99)) and infant received colostrum (AOR (95 % CI) =2.22 (1.08-4.55)) were significant positive predictors for early breastfeeding initiation as revealed by logistic regression. The multivariable logistic regression analysis showed that the mothers who had no radio and/or TV in the household (AOR (95 % CI = 0.55 (0.35-0.88)), were not exposure to health information (AOR (95 % CI) = 0.44 (0.25-0.75)), and infants were provided with prelacteal feeds (AOR (95 % CI)=0.30 (0.14-0.65)) were less likely to initiate breastfeeding. The rate of timely initiation of breastfeeding was high. Breastfeeding promotion program is essential to encourage the practice of timely initiation of breastfeeding, and reduce the practice of providing prelacteal

Pain Catastrophizing Correlates with Early Mild Traumatic Brain Injury Outcome

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Geneviève Chaput

2016-01-01

Full Text Available Background. Identifying which patients are most likely to be at risk of chronic pain and other postconcussion symptoms following mild traumatic brain injury (MTBI is a difficult clinical challenge. Objectives. To examine the relationship between pain catastrophizing, defined as the exaggerated negative appraisal of a pain experience, and early MTBI outcome. Methods. This cross-sectional design included 58 patients diagnosed with a MTBI. In addition to medical chart review, postconcussion symptoms were assessed by self-report at 1 month (Time 1 and 8 weeks (Time 2 after MTBI. Pain severity, psychological distress, level of functionality, and pain catastrophizing were measured by self-report at Time 2. Results. The pain catastrophizing subscales of rumination, magnification, and helplessness were significantly correlated with pain severity (r=.31 to .44, number of postconcussion symptoms reported (r=.35 to .45, psychological distress (r=.57 to .67, and level of functionality (r=-.43 to -.29. Pain catastrophizing scores were significantly higher for patients deemed to be at high risk of postconcussion syndrome (6 or more symptoms reported at both Time 1 and Time 2. Conclusions. Higher levels of pain catastrophizing were related to adverse early MTBI outcomes. The early detection of pain catastrophizing may facilitate goal-oriented interventions to prevent or minimize the development of chronic pain and other postconcussion symptoms.

Preventing occupational injury among police officers: does motivation matter?

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Chan, D K C; Webb, D; Ryan, R M; Tang, T C W; Yang, S X; Ntoumanis, N; Hagger, M S

2017-08-01

Injury prevention is an important issue for police officers, but the effectiveness of prevention initiatives is dependent on officers' motivation toward, and adherence to, recommended health and safety guidelines. To understand effects of police officers' motivation to prevent occupational injury on beliefs about safety and adherence to injury prevention behaviours. Full-time police officers completed a survey comprising validated psychometric scales to assess autonomous, controlled and amotivated forms of motivation (Treatment Self-Regulation Questionnaire), behavioural adherence (Self-reported Treatment Adherence Scale) and beliefs (Safety Attitude Questionnaire) with respect to injury prevention behaviours. There were 207 participants; response rate was 87%. Hierarchical multiple regression analyses demonstrated that autonomous motivation was positively related to behavioural adherence, commitment to safety and prioritizing injury prevention. Controlled motivation was a positive predictor of safety communication barriers. Amotivation was positively associated with fatalism regarding injury prevention, safety violation and worry. These findings are consistent with the tenets of self-determination theory in that autonomous motivation was a positive predictor of adaptive safety beliefs and adherence to injury prevention behaviours. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury.

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Hilton, G; Unsworth, C A; Murphy, G C; Browne, M; Olver, J

2017-08-01

Longitudinal cohort design. First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time. Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS). People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics. Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (ρ=0.692), and reduced anxiety (ρ=-0.522), depression (ρ=-0.643) and pain (ρ=-0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point. EIVR shows promise in delivering similar return

Psychosocial safety climate, emotional exhaustion, and work injuries in healthcare workplaces.

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Zadow, Amy Jane; Dollard, Maureen Frances; Mclinton, Sarven Savia; Lawrence, Peter; Tuckey, Michelle Rae

2017-12-01

Preventing work injuries requires a clear understanding of how they occur, how they are recorded, and the accuracy of injury surveillance. Our innovation was to examine how psychosocial safety climate (PSC) influences the development of reported and unreported physical and psychological workplace injuries beyond (physical) safety climate, via the erosion of psychological health (emotional exhaustion). Self-report data (T2, 2013) from 214 hospital employees (18 teams) were linked at the team level to the hospital workplace injury register (T1, 2012; T2, 2013; and T3, 2014). Concordance between survey-reported and registered injury rates was low (36%), indicating that many injuries go unreported. Safety climate was the strongest predictor of T2 registered injury rates (controlling for T1); PSC and emotional exhaustion also played a role. Emotional exhaustion was the strongest predictor of survey-reported total injuries and underreporting. Multilevel analysis showed that low PSC, emanating from senior managers and transmitted through teams, was the origin of psychological health erosion (i.e., low emotional exhaustion), which culminated in greater self-reported work injuries and injury underreporting (both physical and psychological). These results underscore the need to consider, in theory and practice, a dual physical-psychosocial safety explanation of injury events and a psychosocial explanation of injury underreporting. Copyright © 2017 John Wiley & Sons, Ltd.

Urine Biochemistry in the Early Postoperative Period after Cardiac Surgery: Role in Acute Kidney Injury Monitoring

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Alexandre Toledo Maciel

2013-01-01

Full Text Available We have recently suggested that sequential urine electrolyte measurement in critically ill patients may be useful in monitoring kidney function. Cardiac surgery is one of the leading causes of acute kidney injury (AKI in the intensive care unit (ICU. In this paper, we describe the sequential behavior of urine electrolytes in three patients in the early (first 60 hours postoperative period after cardiac surgery according to AKI status: no AKI, transient AKI, and persistent AKI. We have found that the patient with no AKI had stable and high concentrations of sodium (NaU and chloride (ClU in sequential spot samples of urine. AKI development was characterized in the other two patients by decreases in NaU and ClU, which have started early after ICU admission. Transient AKI was marked by also transient and less severe decreases in NaU and ClU. Persistent AKI was marked by the less favorable clinical course with abrupt and prolonged declines in NaU and ClU values. These electrolytes in urine had a behavior like a “mirror image” in comparison with that of serum creatinine. We suggest that sequential urine electrolytes are useful in monitoring acute kidney injury development in the early postoperative period after cardiac surgery.

Testing Students’ Entrepreneurial Self-Efficacy as an Early Predictor of Entrepreneurial Activities. Evidence From the SEAS Project

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Krzysztof Zięba

2018-01-01

Full Text Available Over the last forty years, since Bandura (1977 introduced the concept of selfefcacy, there have been a constantly growing number of research publicatons using this concept. Its early development resulted in the creaton of a new construct of entrepreneurial self-efcacy (ESE proposed for the frst tme by (Chen et al. 1998. Since then, many different groups of research concerning ESE have emerged - one of them is the study of ESE of students. With regard to this partcular group, a recent tendency to study ESE in a pre-post setng can be notced i.a. Karlsson, Moberg (2013, Shinnar, Hsu, Powell (2014, Ismail, Zain, Zulihar (2015. Due to the increasing interest in entrepreneurial self-efcacy research and the need to fll the gap in the literature with regard to European post-communist countries (and partcularly – Poland (Drnovsek, Wincent, Cardon, 2010, in this paper we present a brief overview of ESE research and pose the queston whether ESE of Polish students can serve as an early predictor of their subsequent entrepreneurial actvites, potentally leading them to nascent entrepreneurship. The research material was collected from the SEAS (Survey on Entrepreneurial Attudes of Students Project carried out at the Faculty of Management and Economics, Gdańsk University of Technology. The research sample was composed of 72 students - ESE was measured in a pre-post setng using a single item based on a fve-point Likert scale. One of the research conclusions is that ESE manifested by student-beginners seems to influence their later entrepreneurial behavior in a statstcally signifcant way - potentally making ESE a valuable early predictor of future entrepreneurial actvites. In the concluding part of the study, limitatons are discussed and future study developments are indicated.

Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery?

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Leppäniemi, Ari K; Mentula, Panu J; Streng, Mari H; Koivikko, Mika P; Handolin, Lauri E

2011-12-01

Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Initial management was nonoperative in 94 blunt trauma patients with 8 failures. Uni- and multivariate analyses were used to calculate predictor odds ratios (OR) with 95% confidence intervals (CI). Factors associated with early laparotomy in blunt trauma included shock on admission, associated grade IV-V splenic injury, grade IV-V head injury, and grade V liver injury. Only shock was an independent predictor (OR, 26.1; 95% CI, 8.9-77.1; P < 0.001). The presence of a grade IV-V splenic injury predicted damage control strategy (OR infinite; P = 0.021). Failed nonoperative management was associated with grade IV-V splenic injury (OR, 14.00; 95% CI, 1.67-117.55), and shock (OR, 6.82; 95% CI, 1.49-31.29). The hospital mortality rate was 15%; 8 of 21 deaths were liver-related. Shock (OR, 9.3; 95% CI, 2.4-35.8; P = 0.001) and severe head injury (OR, 9.25; 95% CI, 3.0-28.9; P = 0.000) were independent predictors for mortality. In patients with severe liver injury, associated severe splenic injury favors early laparotomy and damage control strategy. Patients who arrive in shock or have an associated severe splenic injury should not be managed nonoperatively. In addition to severe head injury, uncontrollable bleeding from the liver injury is still a major cause of early death.

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease.

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Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-07-28

To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California.

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Erhardt, Taryn; Rice, Thomas; Troszak, Lara; Zhu, Motao

2016-01-01

The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death. Copyright © 2015 Elsevier Ltd. All rights reserved.

Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries

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Hanifah J

2015-11-01

Full Text Available High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.

Kidney Disease and the Nexus of Chronic Kidney Disease and Acute Kidney Injury: The Role of Novel Biomarkers as Early and Accurate Diagnostics.

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Yerramilli, Murthy; Farace, Giosi; Quinn, John; Yerramilli, Maha

2016-11-01

Chronic kidney disease (CKD) and acute kidney injury (AKI) are interconnected and the presence of one is a risk for the other. CKD is an important predictor of AKI after exposure to nephrotoxic drugs or major surgery, whereas persistent or repetitive injury could result in the progression of CKD. This brings new perspectives to the diagnosis and monitoring of kidney diseases highlighting the need for a panel of kidney-specific biomarkers that reflect functional as well as structural damage and recovery, predict potential risk and provide prognosis. This article discusses the kidney-specific biomarkers, symmetric dimethylarginine (SDMA), clusterin, cystatin B, and inosine. Copyright © 2016 Elsevier Inc. All rights reserved.

Early application of tail nerve electrical stimulation-induced walking training promotes locomotor recovery in rats with spinal cord injury.

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Zhang, S-X; Huang, F; Gates, M; Shen, X; Holmberg, E G

2016-11-01

This is a randomized controlled prospective trial with two parallel groups. The objective of this study was to determine whether early application of tail nerve electrical stimulation (TANES)-induced walking training can improve the locomotor function. This study was conducted in SCS Research Center in Colorado, USA. A contusion injury to spinal cord T10 was produced using the New York University impactor device with a 25 -mm height setting in female, adult Long-Evans rats. Injured rats were randomly divided into two groups (n=12 per group). One group was subjected to TANES-induced walking training 2 weeks post injury, and the other group, as control, received no TANES-induced walking training. Restorations of behavior and conduction were assessed using the Basso, Beattie and Bresnahan open-field rating scale, horizontal ladder rung walking test and electrophysiological test (Hoffmann reflex). Early application of TANES-induced walking training significantly improved the recovery of locomotor function and benefited the restoration of Hoffmann reflex. TANES-induced walking training is a useful method to promote locomotor recovery in rats with spinal cord injury.

Brain injury and altered brain growth in preterm infants: predictors and prognosis.

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Kidokoro, Hiroyuki; Anderson, Peter J; Doyle, Lex W; Woodward, Lianne J; Neil, Jeffrey J; Inder, Terrie E

2014-08-01

To define the nature and frequency of brain injury and brain growth impairment in very preterm (VPT) infants by using MRI at term-equivalent age and to relate these findings to perinatal risk factors and 2-year neurodevelopmental outcomes. MRI scans at term-equivalent age from 3 VPT cohorts (n = 325) were reviewed. The severity of brain injury, including periventricular leukomalacia and intraventricular and cerebellar hemorrhage, was graded. Brain growth was assessed by using measures of biparietal width (BPW) and interhemispheric distance. Neurodevelopmental outcome at age 2 years was assessed across all cohorts (n = 297) by using the Bayley Scales of Infant Development, Second Edition (BSID-II) or Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), and evaluation for cerebral palsy. Of 325 infants, 107 (33%) had some grade of brain injury and 33 (10%) had severe injury. Severe brain injury was more common in infants with lower Apgar scores, necrotizing enterocolitis, inotropic support, and patent ductus arteriosus. Severe brain injury was associated with delayed cognitive and motor development and cerebral palsy. Decreased BPW was related to lower gestational age, inotropic support, patent ductus arteriosus, necrotizing enterocolitis, prolonged parenteral nutrition, and oxygen at 36 weeks and was associated with delayed cognitive development. In contrast, increased interhemispheric distance was related to male gender, dexamethasone use, and severe brain injury. It was also associated with reduced cognitive development, independent of BPW. At term-equivalent age, VPT infants showed both brain injury and impaired brain growth on MRI. Severe brain injury and impaired brain growth patterns were independently associated with perinatal risk factors and delayed cognitive development. Copyright © 2014 by the American Academy of Pediatrics.

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients.

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Shingai, N; Morito, T; Najima, Y; Kobayashi, T; Doki, N; Kakihana, K; Ohashi, K; Ando, M

2015-12-01

Acute kidney injury (AKI) following stem-cell transplantation (SCT) contributes to a poor prognosis, yet its impact may vary depending on the timing of AKI onset. A prospective cohort study was performed to understand the significance of the onset timing in 103 allogeneic SCT (allo-SCT) recipients. AKI prior to stem-cell engraftment was defined as early AKI and subsequently occurring AKI as late AKI. Propensity score (PS) for early AKI was calculated using a logistic regression model to reduce confounding effects related to differences in clinical background between the early and late AKI groups. The cumulative incidences of early and late AKI were 22.3% and 54.9%, respectively. Non-relapse mortality (NRM) was 39.1% and 7.0%, and overall survival (OS) was 56.5% and 90.9% in early and late AKI at 100 days after AKI, respectively (PSCT was 41.5% and 19.1% in early and late AKI, respectively (P=0.048). Logistic regression analysis adjusted for the PS showed that early AKI was significantly associated with OS (odds ratio (95% confidence interval); 4.63 (1.15-21.4), P=0.031) but with neither NRM (1.25 (0.28-5.33), P=0.766) nor CKD (1.85 (0.41-8.60), P=0.422). In conclusion, early AKI may portend a poor survival for allo-SCT recipients.

Deceleration during 'real life' motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?

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Hartwig Erich

2009-03-01

Full Text Available Abstract Background The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents. Methods ΔV was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF. Results In our study, 32 (56% subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44% patients complained of neck pain: 8 (14% were classified as QTF grade I, 6 (10% as QTF grade II, and 11 (19% as QTF grade IV. Only a slight correlation (r = 0.55 was found between the reported pain and ΔV. No relevant correlation was found between ΔV and the neck disability index (r = 0.46 and between ΔV and the QTF grade (r = 0.45 for any of the collision types. There was no ΔV threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury. Conclusion The results of this study indicate that ΔV is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs after motor vehicle accidents. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.

Clinical predictors of in-hospital death and early surgery for infective endocarditis: results of CArdiac Disease REgistration (CADRE), a nation-wide survey in Japan.

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Ohara, Takahiro; Nakatani, Satoshi; Kokubo, Yoshihiro; Yamamoto, Haruko; Mitsutake, Kotaro; Hanai, Sotaro

2013-09-10

The benefit of early surgery for IE is yet to be determined in non-Western countries. We conducted this study to evaluate the role of early surgery in infective endocarditis (IE) in Japan. IE admissions in Japan were prospectively registered using a nation-wide WEB-based registration system (CArdiac Disease REgistration, CADRE). The impact of early surgery on in-hospital mortality was assessed in native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Risk factors for in-hospital death were assessed by multiple logistic regression analysis. The propensity score for early surgery was calculated to adjust the impact of early surgery. From September 2006 to May 2009, 348 NVE and 81 PVE were registered. In NVE, early surgery was preferable in every quartile stratified with the propensity score and the summary odds ratio (OR) and 95% confidence interval (CI) was 0.12 (0.05-0.31). The predictors of in-hospital death were Staphylococcus aureus infection (OR 3.5, 95% CI 1.26-9.7), heart failure (OR 6.74, 95% CI 2.43-18.7) and early surgery (OR 0.07, 95% CI 0.03-0.2). In PVE, the predictors of in-hospital death were age (OR 1.09, 95% CI 1.01-1.18), S. aureus infection (OR 5.8, 95% CI 1.4-24.01) and heart failure (OR 7.44, 95% CI 1.81-30.67), whereas early surgery was not (OR 0.51, 95% CI 0.12-2.16). Early surgery for NVE is associated with improved survival in a wide range of clinical subgroups in Japan. In PVE a survival benefit of early surgery is not clear. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Prediction of driving capacity after traumatic brain injury: a systematic review.

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Ortoleva, Claudia; Brugger, Camille; Van der Linden, Martial; Walder, Bernhard

2012-01-01

To review the current evidence on predictors for the ability to return to driving after traumatic brain injury. Systematic searches were conducted in MEDLINE, PsycINFO, EMBASE, and CINAHL up to March 1, 2010. Studies were rigorously rated for their methodological content and quality and standardized data were extracted from eligible studies. We screened 2341 articles, of which 7 satisfied our inclusion criteria. Five studies were of limited quality because of undefined, unrepresentative samples and/or absence of blinding. Studies mentioned 38 candidate predictors and tested 37. The candidate predictors most frequently mentioned were "selective attention" and "divided attention" in 4/7 studies, and "executive functions" and "processing speed," both in 3/7 studies. No association with driving was observed for 19 candidate predictors. Eighteen candidate predictors from 3 domains were associated with driving capacity: patient and trauma characteristics, neuropsychological assessments, and general assessments; 10 candidate predictors were tested in only one study and 8 in more than one study. The results of associations were contradictory for all but one: time between trauma and driving evaluation. There is no sound basis at present for predicting driving capacity after traumatic brain injury because most studies have methodological limitations.

Statistical process control: A feasibility study of the application of time-series measurement in early neurorehabilitation after acquired brain injury.

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Markovic, Gabriela; Schult, Marie-Louise; Bartfai, Aniko; Elg, Mattias

2017-01-31

Progress in early cognitive recovery after acquired brain injury is uneven and unpredictable, and thus the evaluation of rehabilitation is complex. The use of time-series measurements is susceptible to statistical change due to process variation. To evaluate the feasibility of using a time-series method, statistical process control, in early cognitive rehabilitation. Participants were 27 patients with acquired brain injury undergoing interdisciplinary rehabilitation of attention within 4 months post-injury. The outcome measure, the Paced Auditory Serial Addition Test, was analysed using statistical process control. Statistical process control identifies if and when change occurs in the process according to 3 patterns: rapid, steady or stationary performers. The statistical process control method was adjusted, in terms of constructing the baseline and the total number of measurement points, in order to measure a process in change. Statistical process control methodology is feasible for use in early cognitive rehabilitation, since it provides information about change in a process, thus enabling adjustment of the individual treatment response. Together with the results indicating discernible subgroups that respond differently to rehabilitation, statistical process control could be a valid tool in clinical decision-making. This study is a starting-point in understanding the rehabilitation process using a real-time-measurements approach.

Biochemical and Radiobiological Factors in the Early Detection of Radiation Injury in Mammals

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Cole, L. J. [Life Sciences Division, Stanford Research Institute, Menlo Park, CA (United States)

1971-03-15

In considering the body of radiobiological knowledge upon which the present possibilities for the development of an objective quantitative laboratory procedure for early detection of radiation injury depend, it is evident that there are at least three general categories of radiation effects which are relevant to this objective: (1) Products of the enzymatic-chemical breakdown of macromolecules, and lysis of killed or dying cells from radiosensitive tissues, for example deoxypolynucleotides from lymphoid tissues and bone marrow; (2) Radiation-induced inhibition of synthesis of deoxyribonucleic acid (DNA) and/or other macromolecules, eliciting alterations in tissue and blood concentrations and pool size of metabolic intermediates in the synthesis, for example, deoxycytidine; (3) Radiation-induced alterations, suppression, or cessation of specialized cell function; of particular interest here is the immunological functions of lymphocytes, including those in the circulating blood. For rodents, the exquisite radiosensitivity of bone-marrow-stem cells as well as of lymphocytes has been precisely measured by modern cellular radiobiological techniques: the colony-forming technique of Till and McCulloch, yielding a D{sub 0} for bone-marrow cells of about 80 R; and the graft-versus-host reactivity of transplanted lymphocytes yielding a similar D{sub 0} value. In our own hands, a modified colony-formation technique for dog bone-marrow cells irradiated in.vitro and in vivo give D{sub 0} values of {approx}100 R. Thus, on the basis of radiation sensitivity and the time-relationships for interphase cell death for lymphocytes, it appears that this cell class is probably the best ''candidate'' source for an early radiation-injury detection system. However,- the important report by Zicha and Buric indicates that extrapolation of biochemical data on radiation dosimetry from rodents to man is not necessarily feasible, at least in the. case of the urinary excretion of deoxycytidine

Development and delivery of a physiotherapy intervention for the early management of whiplash injuries: the Managing Injuries of Neck Trial (MINT) Intervention.

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Williamson, Esther; Williams, Mark; Hansen, Zara; Joseph, Stephen; Lamb, Sarah E

2009-03-01

This paper describes the development and implementation of a physiotherapy intervention for a large multicentred randomised controlled trial of the early management of whiplash injuries in a National Health Service setting. Participants were eligible if they were classified as having whiplash-associated disorder grades I to III and self-referred for treatment within 6 weeks of injury. The intervention development was informed through a variety of methods including the current evidence base, published guidelines, clinician opinion, a pilot study and expert opinion. The intervention was targeted at known, potentially modifiable risk factors for poor recovery, and utilised manual therapy, exercises and psychological strategies. The treatment was individually tailored, with a maximum of six treatments allowed within the trial protocol over an 8-week period. The intervention was delivered to 300 participants. The amount and types of treatments delivered are described.

Early Autologous Cranioplasty after Decompressive Hemi-Craniectomy for Severe Traumatic Brain Injury

International Nuclear Information System (INIS)

Qasmi, S. A.; Ghaffar, A.; Hussain, Z.; Mushtaq, J.

2015-01-01

Objective: To evaluate the outcome of early replacement of autologous bone flap for decompressive hemicraniectomy in severe traumatic brain injury patients. Methods: The observational cross-sectional prospective study was conducted at the Neurosurgical Unit of the Combined Military Hospital, Rawalpindi, Pakistan, from July 2011, to June 2014, and comprised patients who underwent cranioplasty after decompressive hemicraniectomy for trauma. Patients over 20 years of age and of either gender were included. Cranioplasty was timed in all these patients using native bone flap preserved in the abdominal wall after decompressive craniectomy. Parameters recorded were mortality, wound infection, subdural collection, wound dehiscence, ventriculomegaly, bone resorption, cosmetic deformity and neurological outcome. SPSS 17 was used for data analysis. Results: Of the 30 patients in the study, 28(93.3 percent) were males. The overall mean age was age 32.03±8.01 years (range: 20-48 years). Mean cranioplasty time was 66.2±11.50 days (range: 44-89 days). Major infection necessitating bone flap removal was found in 1(3.33 percent) patient, while minor scalp wound infections, treated with antibiotics and dressings were found in 2(6.66 percent). Cosmetic18 deformity was seen in 3(10 percent). Improved neurological outcome was noted in 21(70 percent) patients; 6(20 percent) survived with a moderate to severe disability and 3(10 percent) remained in a vegetative state. No mortality was found after the procedure. Conclusion: Early autologous bone replacement for decompressive hemicraniectomy in severe traumatic brain injury patients offered cost-effective, acceptable surgical and improve dneurological outcome. (author)

Interpersonal Stressors and Resources as Predictors of Parental Adaptation Following Pediatric Traumatic Injury

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Wade, Shari L.; Stancin, Terry; Taylor, H. Gerry; Drotar, Dennis; Yeates, Keith Owen; Minish, Nori M.

2004-01-01

The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the…

Ultrasonographic findings of early abortion: suggested predictors

International Nuclear Information System (INIS)

Jun, Soon Ae; Ahn, Myoung Ock; Cha, Kwang Yul; Lee, Young Doo

1992-01-01

To investigate predictable ultrasonographic findings of early abortion. To investigate objective rules for the screening of abortion. Ultrasonographic examination of 111 early pregnancies between the sixth and ninth week in women who had regular 28 day menstrual cycles was performed. Ultrasonographic measurements of the gestational sac, crown rump length and fetal heart rate were performed using a linear array real time transducer with doppler ultrasonogram. All measurements of 17 early abortions were compared to those of 94 normal pregnancies. Most of early aborted pregnancies were classified correctly by discriminant analysis with G-SAC and CRL (G-SAC=0.5 CRL + 15, sensitivity 76.5%, specificity 96.8%). With the addition of FHR, 94.1% of early abortions could be predicted. In conclusion, ultrasonographic findings of early intrauterine growth retardation, small gestational sac and bradycardia can be predictable signs suggestive of poor prognosis of early pregnancies

Serum cystatin C level is associated with locomotive syndrome risk and can be an early predictor in community-living people: The Yakumo study.

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Tanaka, Satoshi; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Morozumi, Masayoshi; Machino, Masaaki; Ota, Kyotaro; Seki, Taisuke; Suzuki, Koji; Nishida, Yoshihiro; Ishiguro, Naoki; Hasegawa, Yukiharu; Imagama, Shiro

2018-03-02

The locomotive syndrome (LS) risk has been recently proposed as a criterion for evaluating physical ability. Serum cystatin C level is an early renal function marker and a cardiovascular disease predictor. This study aimed to evaluate the relationship between serum cystatin C level and LS risk. We enrolled 54 participants and conducted the two-step test, stand-up test, 25-question geriatric locomotive function scale, LS risk test, Timed Up and Go test, back muscle strength, grip strength, blood test and serum cystatin C level measurement. A comparative study was conducted in participants with and without LS risk and in subgroups aged C level in subgroups aged C level for LS risk was 0.824. The serum cystatin C level is significantly related to LS risk and can be an early predictor. In middle-aged and elderly people with high serum cystatin C levels, it is strongly recommended to enforce LS risk test and intervention.

Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?

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Antonacci, Nicola; Di Saverio, Salomone; Ciaroni, Valentina; Biscardi, Andrea; Giugni, Aimone; Cancellieri, Francesco; Coniglio, Carlo; Cavallo, Piergiorgio; Giorgini, Eleonora; Baldoni, Franco; Gordini, Giovanni; Tugnoli, Gregorio

2011-03-01

Abdominal trauma rarely causes injuries involving the duodenum and pancreas. Associated injuries occur in 46% of all pancreatic injuries. The morbidity and mortality of pancreaticoduodenal injuries remain high. The present study is a retrospective review of our experience from 1989 to 2008 in the surgical treatment of traumatic pancreaticoduodenal injuries. Mortality, morbidity, prognostic factors, and the value of surgical techniques were analyzed. In our level I Trauma Center, between 1989 and 2008, 55 patients had a pancreaticoduodenal injury. In 68.5% of cases pancreatic injuries were found, 20.4% had duodenal injury, and 11.1% suffered combined pancreaticoduodenal injuries; 85.3% of the patients had blunt abdominal trauma, while 14.9% had penetrating injuries. We treated 78.1% of the patients with external drainage and/or simple suture; distal pancreatectomy was performed in 9% of cases and duodenal resection with anastomosis (3.7%) and diversion procedures (3.7%) were performed in an equal number of patients. Age, American Association for the Surgery of Trauma (AAST) grade, organ involved, hemodynamic status, intraoperative cardiac arrest, and operative time remained strongly predictive of mortality on multivariate analysis. The AAST grade represented, on multivariate analysis, the only independent prognostic factor predictive of overall morbidity. In the past decade we have used feeding jejunostomy more frequently, with a reduction of mortality and operating time, due also to a better approach from a dedicated trauma team. Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures.

Predictors of driving safety in early Alzheimer disease.

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Dawson, J D; Anderson, S W; Uc, E Y; Dastrup, E; Rizzo, M

2009-02-10

To measure the association of cognition, visual perception, and motor function with driving safety in Alzheimer disease (AD). Forty drivers with probable early AD (mean Mini-Mental State Examination score 26.5) and 115 elderly drivers without neurologic disease underwent a battery of cognitive, visual, and motor tests, and drove a standardized 35-mile route in urban and rural settings in an instrumented vehicle. A composite cognitive score (COGSTAT) was calculated for each subject based on eight neuropsychological tests. Driving safety errors were noted and classified by a driving expert based on video review. Drivers with AD committed an average of 42.0 safety errors/drive (SD = 12.8), compared to an average of 33.2 (SD = 12.2) for drivers without AD (p < 0.0001); the most common errors were lane violations. Increased age was predictive of errors, with a mean of 2.3 more errors per drive observed for each 5-year age increment. After adjustment for age and gender, COGSTAT was a significant predictor of safety errors in subjects with AD, with a 4.1 increase in safety errors observed for a 1 SD decrease in cognitive function. Significant increases in safety errors were also found in subjects with AD with poorer scores on Benton Visual Retention Test, Complex Figure Test-Copy, Trail Making Subtest-A, and the Functional Reach Test. Drivers with Alzheimer disease (AD) exhibit a range of performance on tests of cognition, vision, and motor skills. Since these tests provide additional predictive value of driving performance beyond diagnosis alone, clinicians may use these tests to help predict whether a patient with AD can safely operate a motor vehicle.

Serum cystatin C as an earlier predictor of acute kidney injury than serum creatinine in preterm neonates with respiratory distress syndrome

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Noha Ahmed Abdelaal

2017-01-01

Full Text Available In this study, we aimed to evaluate serum cystatin C (sCysC as an early predictor of acute kidney injury (AKI in preterm neonates with respiratory distress syndrome (RDS. Sixty preterm neonates diagnosed with RDS and 40 healthy controls (28–36 weeks admitted to the neonatal Intensive Care Unit were investigated. AKI was defined on the 3rd day of life (DOL-3 as an increase in serum creatinine (sCr of >0.3 mg/dL from baseline (the lowest previous sCr. sCysC levels were measured on DOL-1, -3 and -7. Of the 60 neonates with RDS, 24 (40% developed AKI. Five patients (79.17% were classified as AKI Network (AKIN-1 and 19 patients (20.83%, as AKIN-2. At DOL-3, the mean sCysC values were significantly higher among neonates with RDS and AKI (1.68 ± 0.37 compared with controls (0.79 ± 0.83 and those with RDS and no AKI (0.85 ± 0.20 (P <0.001. sCysC levels significantly increased among neonates with AKI from DOL-3 to DOL-7 (P = 0.002. The sCr values showed no significant difference between those with RDS with AKI, RDS, and no AKI or control groups at DOL-1 and -3. Only as late as DOL-7, the mean values of sCr were higher among neonates with AKI compared with no AKI and controls (P <0.001. The receiver operating characteristic curves area under the curve was 0.97 for predicting the development of AKI within 72 h (P = 0.001. With the best cutoff value of ≥1.28 mg/L, the sensitivity and specificity of sCysC for detecting AKI within 72 h were 100 and 83.3%, respectively. In conclusion, sCysC is an early marker for AKI in neonates with RDS.

Early predictors of first-year academic success at university : Pre-university effort, pre-university self-efficacy, and pre-university reasons for attending university

NARCIS (Netherlands)

van Herpen, Sanne G.A.; Meeuwisse, Marieke; Hofman, W. H.Adriaan; Severiens, Sabine E.; Arends, Lidia R.

Given the large number of dropouts in the 1st year at university, it is important to identify early predictors of 1st-year academic success. The present study (n = 453 first-year students) contributes to literature on the transition from secondary to higher education by investigating how the

Determinants of physical activity among people with spinal cord injury: a test of social cognitive theory.

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Ginis, Kathleen A Martin; Latimer, Amy E; Arbour-Nicitopoulos, Kelly P; Bassett, Rebecca L; Wolfe, Dalton L; Hanna, Steven E

2011-08-01

Little theory-based research has focused on understanding and increasing physical activity among people with physical disabilities. Testing a social cognitive theory-based model of determinants is important for identifying variables to target in physical activity-enhancing interventions. The aim of this study is to examine Social Cognitive Theory variables as predictors of physical activity among people living with spinal cord injury. Structural equation modeling was used to test a model of Social Cognitive Theory predictors of physical activity (n=160). The model explained 39% of the variance in physical activity. Self-regulation was the only significant, direct predictor. Self-regulatory efficacy and outcome expectations had indirect effects, mediated by self-regulation. Social Cognitive Theory is useful for predicting physical activity in people with spinal cord injury. Self-regulation is the most potent Social Cognitive Theory predictor of physical activity in people with spinal cord injury. Self-regulation and its determinants should be targeted in physical activity-enhancing interventions.

Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

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Machado Cristiano V

2011-06-01

Full Text Available Abstract Background Left ventricular ejection fraction (LVEF has been considered a major determinant of early outcome in acute myocardial infarction (AMI. Myocardial performance index (MPI has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF specifically in patients with a first isolated ST-elevation AMI. Methods Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. Results Early in-hospital CHF occurred in 29 (31% of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p Conclusion For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.

Poor anaerobic power/capability and static balance predicted prospective musculoskeletal injuries among Soldiers of the 101st Airborne (Air Assault) Division.

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Nagai, Takashi; Lovalekar, Mita; Wohleber, Meleesa F; Perlsweig, Katherine A; Wirt, Michael D; Beals, Kim

2017-11-01

Musculoskeletal injuries have negatively impacted tactical readiness. The identification of prospective and modifiable risk factors of preventable musculoskeletal injuries can guide specific injury prevention strategies for Soldiers and health care providers. To analyze physiological and neuromuscular characteristics as predictors of preventable musculoskeletal injuries. Prospective-cohort study. A total of 491 Soldiers were enrolled and participated in the baseline laboratory testing, including body composition, aerobic capacity, anaerobic power/capacity, muscular strength, flexibility, static balance, and landing biomechanics. After reviewing their medical charts, 275 male Soldiers who met the criteria were divided into two groups: with injuries (INJ) and no injuries (NOI). Simple and multiple logistic regression analyses were used to calculate the odds ratio (OR) and significant predictors of musculoskeletal injuries (pmodel included the static balance with eyes-closed and peak anaerobic power as predictors of future injuries (p<0.001). The current results highlighted the importance of anaerobic power/capacity and static balance. High intensity training and balance exercise should be incorporated in their physical training as countermeasures. Copyright © 2017 Sports Medicine Australia. All rights reserved.

Predictors of axillary lymph node metastases in women with early breast cancer in Singapore.

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Tan, L G L; Tan, Y Y; Heng, D; Chan, M Y

2005-12-01

The presence of axillary lymph node metastases is an important prognostic factor in breast cancer. Sentinel lymph node biopsy (SLNB) is an emerging method for the staging of the axilla. It is hoped that with SLNB, the morbidity from axillary lymph node dissection (ALND) can be avoided without compromising the staging and management of early breast cancer. However, only patients found to be SLNB negative benefit from this procedure, as those with positive SLNB may still require ALND. Our objective is to study the various clinico-pathological factors to find predictive factors for axillary lymph node involvement in early breast cancer. It is hoped that with these factors, we will be better able to identify groups of patients most likely to benefit from SLNB. A retrospective study of 380 early breast cancer cases (stage T1 and T2, N0, N1, M0) in women treated in the Department of General Surgery, Tan Tock Seng Hospital, between January 1999 and August 2002, was conducted. Incidence of nodal metastases was correlated with clinico-pathological factors, and analysed by univariate and multivariate analyses. Approximately 35 percent of the 380 cases of early breast cancer had nodal metastases. Multivariate analyses revealed four independent predictors of node positivity: tumour size (p-value equals 0.0001), presence of lymphovascular invasion (p-value is less than 0.0001), tumours with histology other than invasive ductal or lobular carcinoma (p-value equals 0.04), and presence of progesterone receptors (p-value equals 0.05). We have found independent preoperative predictive factors in our local population for the presence of nodal metastases. This information can aid patient selection for SLNB and improve patient counselling.

Early Detection of Poor Outcome after Mild Traumatic Brain Injury: Predictive Factors Using a Multidimensional Approach a Pilot Study

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Sophie Caplain

2017-12-01

Full Text Available Mild traumatic brain injury (MTBI is a common condition within the general population, usually with good clinical outcome. However, in 10–25% of cases, a post-concussive syndrome (PCS occurs. Identifying early prognostic factors for the development of PCS can ensure widespread clinical and economic benefits. The aim of this study was to demonstrate the potential value of a comprehensive neuropsychological evaluation to identify early prognostic factors following MTBI. We performed a multi-center open, prospective, longitudinal study that included 72 MTBI patients and 42 healthy volunteers matched for age, gender, and socioeconomic status. MTBI patients were evaluated 8–21 days after injury, and 6 months thereafter, with a full neurological and psychological examination and brain MRI. At 6 months follow-up, MTBI patients were categorized into two subgroups according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV as having either favorable or unfavorable evolution (UE, corresponding to the presence of major or mild neurocognitive disorder due to traumatic brain injury. Univariate and multivariate logistical regression analysis demonstrated the importance of patient complaints, quality of life, and cognition in the outcome of MTBI patients, but only 6/23 UE patients were detected early via the multivariate logistic regression model. Using several variables from each of these three categories of variables, we built a model that assigns a score to each patient presuming the possibility of UE. Statistical analyses showed this last model to be reliable and sensitive, allowing early identification of patients at risk of developing PCS with 95.7% sensitivity and 77.6% specificity.

Predictors and incidence of posttraumatic seizures in children and adolescents after brain injury

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Athanasios K. Petridis

2012-06-01

Full Text Available The present study evaluates the incidence of early and late seizures after head injury in patients under 18 years old. Factors correlating with a high risk of developing posttraumatic seizures were identified. Such risk factors were the severity of the head trauma and a Glasgow Coma Scale of 3-8. In contrast to many studies, we observed that the incidence of posttraumatic seizures was significantly higher in patients older than 12 years old (12-16 and 12-18. Most of the late seizures were paroxysmal electroencephalography (EEG discharges diagnosed on a snapshot-EEG during the follow-up examination of the patients without clinical symptoms. We suppose that EEG-examination in head injured children is important to identify patients with epileptic potentials without clinical symptoms. Epileptic patterns of the EEG could worsen the diagnosis and clinical outcome of the children in accordance to studies performed in the adult population.

Risk factors for musculoskeletal injuries among Greek Army officer cadets undergoing Basic Combat Training.

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Havenetidis, Konstantinos; Paxinos, Thrasivoulos

2011-10-01

Predictors of work-related injuries were assessed using data from a group of Greek Army officer cadets. Cadets (n = 253) were monitored by physicians for musculoskeletal injuries resulting through a 7-week Basic Combat Training (BCT) period. Potential predictors of musculoskeletal injuries (Cadets' entry number, body mass index [BMI], body fat percentage [BFP], gender, age, sport experience, and nationality) were modeled via univariate and multivariate logistic regressions. Using odds ratio (OR) and confidence interval (CI), it was shown that older age (OR = 0.73; 95% CI = 0.56-0.96), female gender (OR = 0.13; 95% CI = 0.02-0.81), high BFP (OR = 1.21; 95% CI = 1.07-1.37), and Greek nationality (OR = 0.22; 95% CI = 0.07-0.69) were all associated with musculoskeletal injuries. These factors, except for gender, were also related to overuse injuries. During BCT, adiposity expressed as BFP and not as BMI can predict the magnitude and type (acute-overuse) of musculoskeletal injuries in Greek cadets.

Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries

Directory of Open Access Journals (Sweden)

Björkman Anders

2010-07-01

Full Text Available Abstract Background As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries. Methods Seven consecutive male patients (median age 33; range 15-61 with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI, computed tomography myelography (CT-M or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value. Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of the clinical findings and the radiological findings were estimated. Results The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76 compared with only fair (К = 0.34 for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87. Conclusions The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.

Effect of ozone oxidative preconditioning in preventing early radiation-induced lung injury in rats

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Bakkal, B.H. [Department of Radiation Oncology, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak (Turkey); Gultekin, F.A. [Department of General Surgery, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak (Turkey); Guven, B. [Department of Biochemistry, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak (Turkey); Turkcu, U.O. [Mugla School of Health Sciences, Mugla Sitki Kocman University, Mugla (Turkey); Bektas, S. [Department of Pathology, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak (Turkey); Can, M. [Department of Biochemistry, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak (Turkey)

2013-09-27

Ionizing radiation causes its biological effects mainly through oxidative damage induced by reactive oxygen species. Previous studies showed that ozone oxidative preconditioning attenuated pathophysiological events mediated by reactive oxygen species. As inhalation of ozone induces lung injury, the aim of this study was to examine whether ozone oxidative preconditioning potentiates or attenuates the effects of irradiation on the lung. Rats were subjected to total body irradiation, with or without treatment with ozone oxidative preconditioning (0.72 mg/kg). Serum proinflammatory cytokine levels, oxidative damage markers, and histopathological analysis were compared at 6 and 72 h after total body irradiation. Irradiation significantly increased lung malondialdehyde levels as an end-product of lipoperoxidation. Irradiation also significantly decreased lung superoxide dismutase activity, which is an indicator of the generation of oxidative stress and an early protective response to oxidative damage. Ozone oxidative preconditioning plus irradiation significantly decreased malondialdehyde levels and increased the activity of superoxide dismutase, which might indicate protection of the lung from radiation-induced lung injury. Serum tumor necrosis factor alpha and interleukin-1 beta levels, which increased significantly following total body irradiation, were decreased with ozone oxidative preconditioning. Moreover, ozone oxidative preconditioning was able to ameliorate radiation-induced lung injury assessed by histopathological evaluation. In conclusion, ozone oxidative preconditioning, repeated low-dose intraperitoneal administration of ozone, did not exacerbate radiation-induced lung injury, and, on the contrary, it provided protection against radiation-induced lung damage.

Effect of ozone oxidative preconditioning in preventing early radiation-induced lung injury in rats

International Nuclear Information System (INIS)

Bakkal, B.H.; Gultekin, F.A.; Guven, B.; Turkcu, U.O.; Bektas, S.; Can, M.

2013-01-01

Ionizing radiation causes its biological effects mainly through oxidative damage induced by reactive oxygen species. Previous studies showed that ozone oxidative preconditioning attenuated pathophysiological events mediated by reactive oxygen species. As inhalation of ozone induces lung injury, the aim of this study was to examine whether ozone oxidative preconditioning potentiates or attenuates the effects of irradiation on the lung. Rats were subjected to total body irradiation, with or without treatment with ozone oxidative preconditioning (0.72 mg/kg). Serum proinflammatory cytokine levels, oxidative damage markers, and histopathological analysis were compared at 6 and 72 h after total body irradiation. Irradiation significantly increased lung malondialdehyde levels as an end-product of lipoperoxidation. Irradiation also significantly decreased lung superoxide dismutase activity, which is an indicator of the generation of oxidative stress and an early protective response to oxidative damage. Ozone oxidative preconditioning plus irradiation significantly decreased malondialdehyde levels and increased the activity of superoxide dismutase, which might indicate protection of the lung from radiation-induced lung injury. Serum tumor necrosis factor alpha and interleukin-1 beta levels, which increased significantly following total body irradiation, were decreased with ozone oxidative preconditioning. Moreover, ozone oxidative preconditioning was able to ameliorate radiation-induced lung injury assessed by histopathological evaluation. In conclusion, ozone oxidative preconditioning, repeated low-dose intraperitoneal administration of ozone, did not exacerbate radiation-induced lung injury, and, on the contrary, it provided protection against radiation-induced lung damage

Nurses' knowledge to identify early acute kidney injury.

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Nascimento, Roseli Aparecida Matheus do; Assunção, Murillo Santucci Cesar; Silva, João Manoel; Amendola, Cristina Prata; Carvalho, Taysa Martindo de; Lima, Emerson Quintino; Lobo, Suzana Margareth Ajeje

2016-01-01

To evaluate the knowledgeof nurses on early identification of acute kidney injury (AKI) in intensive care, emergency and hospitalization units. A prospective multi-center study was conducted with 216 nurses, using a questionnaire with 10 questions related to AKI prevention, diagnosis, and treatment. 57.2% of nurses were unable to identify AKI clinical manifestations, 54.6% did not have knowledge of AKI incidence in patients admitted to the ICU, 87.0% of the nurses did not know how to answer as regards the AKI mortality rate in patients admitted to the ICU, 67.1% answered incorrectly that slight increases in serum creatinine do not have an impact on mortality, 66.8% answered incorrectly to the question on AKI prevention measures, 60.4% answered correctly that loop diuretics for preventing AKI is not recommended, 77.6% answered correctly that AKI does not characterize the need for hemodialysis, and 92.5% said they had no knowledge of the Acute Kidney Injury Networkclassification. Nurses do not have enough knowledge to identify early AKI, demonstrating the importance of qualification programs in this field of knowledge. Avaliar o conhecimento do enfermeiro na identificação precoce da Injúria Renal Aguda (IRA) em Unidade de Terapia Intensiva, Unidade de Internação e Emergência. Estudo multicêntrico, prospectivo.Participaram do estudo 216 enfermeiros,por meio de questionário com 10 questões relacionadas à prevenção, ao diagnóstico e ao tratamento da IRA. 57,2% não souberam identificar as manifestações clínicas da IRA, 54,6% não têm conhecimento da incidência de IRA em pacientes internados na UTI, 87,0% dos enfermeiros não souberam responder ao índice de mortalidade de IRA em pacientes internados na UTI, 67,1% responderam incorretamente que aumentos discretos da creatinina sérica não têm impacto na mortalidade, 66,8% responderam incorretamente à questão sobre as medidas de prevenção da IRA, 60,4% acertaram quando responderam que não �

Post-dexamethasone Cortisol, Self-inflicted Injury, and Suicidal Ideation among Depressed Adolescent Girls

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Beauchaine, Theodore P.; Crowell, Sheila E.; Hsiao, Ray C.

2014-01-01

Although the dexamethasone suppression test (DST) has limited use as a marker of depression given inadequate sensitivity and specificity, it marks prospective risk for suicide among adults. However, few studies have examined associations between the DST, suicidal ideation, and self-inflicted injury (SII) among adolescents, even though SII is the single best predictor of eventual suicide. We evaluated the DST as a correlate of suicidal ideation and retrospective reports of self-inflicted injury (SII) among adolescent girls, ages 13–17, with histories of depression (n=28) or depression/self-harm (n=29). Lower post-DST cortisol was associated with suicidal ideation and SII, over-and-above parent-reports and combined parent-/self-reports of internalizing and externalizing behavior. These findings are consistent with recent acquired capacity models of stress-related psychopathology in which hypothalamic-pituitary adrenal (HPA) axis function is altered through epigenetic/allostatic mechanisms among vulnerable individuals who incur adversity early in life. PMID:25208812

MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances

International Nuclear Information System (INIS)

Twomey, Eilish; Ryan, Stephanie; Twomey, Anne; Murphy, John; Donoghue, Veronica B.

2010-01-01

Morbidity attributable to hypoxic-ischaemic injury (HIE) in the perinatal period remains problematic, and timely and accurate assessment of the degree of injury is required for clinical management and prognosis. Conventional MR sequences typically appear normal in the first 48 h post HIE. While diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps register the injury earlier, perhaps within the first 24 h, it has been suggested that there may be a propensity at that early stage to underestimate the lesion severity or extent. To assess whether MR imaging that included DWI, measured ADC values and T1- and T2-weighted sequences ultimately correlated with either neurodevelopmental outcome or with late MR imaging at 2 years of age. In addition, we wished to compare the performance of MR imaging with cranial US imaging. All infants presenting with HIE who had an MRI within 10 days of life were eligible for enrollment and subsequently underwent a full neurodevelopmental assessment at 2 years of age. All children underwent repeat MRI at this time. All neonates had at least one cranial US study. The US findings were categorized as normal, abnormalities confined to the cerebral cortex and subcortical white matter, isolated central grey matter hyperechogenicity, and central hyperechogenicity combined with cerebral cortical/subcortical changes. All MRI studies were retrospectively reviewed by three radiologists. The patterns of injury on the early DWI and ADC maps and early T1- and T2-W studies were recorded as diffuse, central, watershed or atypical. The patterns of signal abnormality were assessed using a scoring system that yielded four separate scores [basal ganglia (BG), watershed (W), BG/W and summation (S)] for the three sets of images, a total of 12 scores in all. The appearance of the posterior limb of the internal capsule (PLIC) on T1-W inversion recovery sequences and of the corpus callosum on all sequences was also documented. After

MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances

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Twomey, Eilish; Ryan, Stephanie [Children' s University Hospital, Department of Radiology, Dublin (Ireland); Twomey, Anne; Murphy, John [National Maternity Hospital, Department of Neonatology, Dublin (Ireland); Donoghue, Veronica B. [National Maternity Hospital, Department of Radiology, Dublin (Ireland); Children' s University Hospital, Department of Radiology, Dublin (Ireland)

2010-09-15

Morbidity attributable to hypoxic-ischaemic injury (HIE) in the perinatal period remains problematic, and timely and accurate assessment of the degree of injury is required for clinical management and prognosis. Conventional MR sequences typically appear normal in the first 48 h post HIE. While diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps register the injury earlier, perhaps within the first 24 h, it has been suggested that there may be a propensity at that early stage to underestimate the lesion severity or extent. To assess whether MR imaging that included DWI, measured ADC values and T1- and T2-weighted sequences ultimately correlated with either neurodevelopmental outcome or with late MR imaging at 2 years of age. In addition, we wished to compare the performance of MR imaging with cranial US imaging. All infants presenting with HIE who had an MRI within 10 days of life were eligible for enrollment and subsequently underwent a full neurodevelopmental assessment at 2 years of age. All children underwent repeat MRI at this time. All neonates had at least one cranial US study. The US findings were categorized as normal, abnormalities confined to the cerebral cortex and subcortical white matter, isolated central grey matter hyperechogenicity, and central hyperechogenicity combined with cerebral cortical/subcortical changes. All MRI studies were retrospectively reviewed by three radiologists. The patterns of injury on the early DWI and ADC maps and early T1- and T2-W studies were recorded as diffuse, central, watershed or atypical. The patterns of signal abnormality were assessed using a scoring system that yielded four separate scores [basal ganglia (BG), watershed (W), BG/W and summation (S)] for the three sets of images, a total of 12 scores in all. The appearance of the posterior limb of the internal capsule (PLIC) on T1-W inversion recovery sequences and of the corpus callosum on all sequences was also documented. After

Early elective colostomy following spinal cord injury.

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Boucher, Michelle

Elective colostomy is an accepted method of bowel management for patients who have had a spinal cord injury (SCI). Approximately 2.4% of patients with SCI have a colostomy, and traditionally it is performed as a last resort several years after injury, and only if bowel complications persist when all other methods have failed. This is despite evidence that patients find a colostomy easier to manage and frequently report wishing it had been performed earlier. It was noticed in the author's spinal unit that increasing numbers of patients were requesting colostomy formation during inpatient rehabilitation following SCI. No supporting literature was found for this; it appears to be an emerging and untested practice. This article explores colostomy formation as a method of bowel management in patients with SCI, considers the optimal time for colostomy formation after injury and examines issues for health professionals.

Hyperspectral Imaging as an Early Biomarker for Radiation Exposure and Microcirculatory Damage

Directory of Open Access Journals (Sweden)

Michael S. Chin

2015-10-01

Full Text Available BACKGROUND: Radiation exposure can lead to detrimental effects in skin microcirculation. The precise relationship between radiation dose received and its effect on cutaneous perfusion still remains controversial. Previously, we have shown that hyperspectral imaging (HSI is able to demonstrate long-term reductions in cutaneous perfusion secondary to chronic microvascular injury. This study characterizes the changes in skin microcirculation in response to varying doses of ionizing radiation and investigates these microcirculatory changes as a possible early non-invasive biomarker that may correlate with the extent of long-term microvascular damage.METHODS: Immunocompetent hairless mice (n=66 were exposed to single fractions of superficial beta-irradiation in doses of 0, 5, 10, 20, 35, or 50 Gy. A HSI device was utilized to measure deoxygenated hemoglobin levels in irradiated and control areas. HSI measurements were performed at baseline before radiation exposure and for the first three days post-irradiation. Maximum macroscopic skin reactions were graded, and histological assessment of cutaneous microvascular densities at four weeks post-irradiation was performed in harvested tissue by CD31 immunohistochemistry.RESULTS: CD31 immunohistochemistry demonstrated a significant correlation (r=0.90, p<0.0001 between dose and vessel density reduction at four weeks. Using HSI analysis, early changes in deoxygenated hemoglobin levels were observed during the first three days post-irradiation in all groups. These deoxygenated hemoglobin changes varied proportionally with dose (r=0.98, p<0.0001 and skin reactions (r=0.98, p<0.0001. There was a highly significant correlation (r= 0.91, p<0.0001 between these early changes in deoxygenated hemoglobin and late vascular injury severity assessed at the end of four weeks.CONCLUSIONS: Radiation dose is directly correlated with cutaneous microvascular injury severity at four weeks in our model. Early post

Delayed Traumatic Intracranial Haemorrhage and Progressive Traumatic Brain Injury in a Major Referral Centre Based in a Developing Country

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Jeng, Toh Charng; Haspani, Mohd Saffari Mohd; Adnan, Johari Siregar; Naing, Nyi Nyi

2008-01-01

A repeat Computer Tomographic (CT) brain after 24–48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS). Most of the time the prognosis of any intervention may be too late especially in hospitals with high patient-to-doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred, as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain was studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorised into patient factors, CT brain findings and laboratory investigations. The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, 81.5% were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, 9.9% of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p<0.001), platelet count (p=0.011) and time interval between trauma and first CT brain (p=0.022). In the PTBI group, 42.0% of the patients were found to have new changes (new clot occurrence, old clot expansion and oedema) in the repeat CT brain. Univariate statistical analysis revealed that age (p=0.03), race (p=0.035), types of

Sociodemographic and Perinatal Predictors of Early Pregnancy Per- and Polyfluoroalkyl Substance (PFAS) Concentrations.

Science.gov (United States)

Sagiv, Sharon K; Rifas-Shiman, Sheryl L; Webster, Thomas F; Mora, Ana Maria; Harris, Maria H; Calafat, Antonia M; Ye, Xiaoyun; Gillman, Matthew W; Oken, Emily

2015-10-06

Per- and polyfluoroalkyl substances (PFASs), used in food packaging and stain-resistant coatings, are suspected developmental toxicants that are ubiquitous and persistent in the environment. We measured plasma PFAS concentrations during early pregnancy (median = 9.7 weeks gestation) among 1645 women in the Boston-area Project Viva cohort, recruited during 1999-2002. We used multivariable linear regression to estimate associations of sociodemographic and perinatal predictors, including measures of pregnancy physiology (albumin, glomerular filtration rate (GFR)), with log-transformed plasma PFAS concentrations. Geometric mean concentrations for the four main PFASs, perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexanesulfonate (PFHxS) and perfluorononanoate (PFNA) were 25.4, 5.7, 2.5, and 0.6 ng/mL, respectively, comparable with general U.S. population concentrations during those years. Higher early pregnancy PFAS concentrations were associated with younger age (except PFNA), less educational attainment, nulliparity, no history of breastfeeding and higher prepregnancy body mass index in adjusted models. In addition, lower GFR was associated with 3-4% higher PFAS concentrations and higher albumin was associated with 4-6% higher PFAS concentrations. Our results show associations consistent (parity and breastfeeding) and less consistent (age and education) with previous studies. We also report associations with GFR and albumin, which were strongly related to PFAS concentrations and thus could confound estimates of PFAS-outcome associations in epidemiologic studies.

Effects of anodal transcranial direct current stimulation (tDCS) on behavioral and spatial memory during the early stage of traumatic brain injury in the rats.

Science.gov (United States)

Yoon, Kyung Jae; Lee, Yong-Taek; Chae, Seoung Wan; Park, Chae Ri; Kim, Dae Yul

2016-03-15

Transcranial direct current stimulation (tDCS) is a noninvasive technique to modulate the neural membrane potential. Its effects in the early stage of traumatic brain injury (TBI) have rarely been investigated. This study assessed the effects of anodal tDCS on behavioral and spatial memory in a rat model of traumatic brain injury. Thirty six rats underwent lateral fluid percussion and were then randomly assigned to one of three groups: control (n=12), five-day tDCS over peri-lesional cortex at one (1W, n=12), or two (2W, n=12) weeks post-injury. The Barnes maze (BM) and Rotarod (RR) tests were evaluated in a blind manner on day 1, week 3 and week 5 post-injury. After three weeks, both the 1W and 2W groups showed significant improvements in the BM ratio (PtDCS ameliorated behavioral and spatial memory function in the early phase after TBI when it is delivered two weeks post-injury. Earlier stimulation (one week post-injury) improves spatial memory only. However, the beneficial effects did not persist after cessation of the anodal stimulation. Copyright © 2016 Elsevier B.V. All rights reserved.

Early detection of skeletal muscle injury by assay of creatine kinase MM isoforms in serum after acute exercise

DEFF Research Database (Denmark)

Apple, F. S.; Hellsten, Ylva; Clarkson, P. M.

1988-01-01

We could detect skeletal muscle injury early after an acute exercise bout by measuring creatine kinase (CK, EC 2.7.3.2) MM isoforms in serum. Eleven men performed 120 alternating-arm, eccentric (muscle lengthening) biceps contractions with the intensity of each contraction being 110% of maximal...

The health profile of professional soccer players: future opportunities for injury prevention.

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Volpi, Piero; Taioli, Emanuela

2012-12-01

Injuries are a major adverse event during a soccer player's career; they require medical and surgical treatment and rehabilitation and thus may interrupt the player's activity, often with severe physical and psychological sequel. Specialists have tried to identify the risk factors for injuries, in an attempt to discover predictors that could be prevented and or eliminated before the injury occurs, but the results are scarce. This article reviews the epidemiology of the frequency and occurrence of injuries in Italian soccer players, reports a list of preventable risk factors that are associated with injuries, and identifies preventable risk factors. We have identified personal factors (age, previous traumatic events, physical and biological characteristics of the player, life style habits such as smoking, alcohol, and diet, changes in physical-athletic aspects of the players, such as increased muscle strength, and use of medications) as possible risk factors for injuries. However, environmental factors such as changes in training techniques, field composition, and shoes structure may also have a major influence. This summary indicates that appropriate preventive measures can be undertaken to prevent injuries in professional soccer players. Professionals who are in close contacts with the players should be informed of the predictors of injuries and should be trained to intervene and plan appropriate preventive measures.

Caring for a family member with a traumatic brain injury.

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Knight, R G; Devereux, R; Godfrey, H P

1998-06-01

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers' ratings of their satisfaction with their ability to cope with the work of caregiving. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.

Statistical considerations in the development of injury risk functions.

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McMurry, Timothy L; Poplin, Gerald S

2015-01-01

We address 4 frequently misunderstood and important statistical ideas in the construction of injury risk functions. These include the similarities of survival analysis and logistic regression, the correct scale on which to construct pointwise confidence intervals for injury risk, the ability to discern which form of injury risk function is optimal, and the handling of repeated tests on the same subject. The statistical models are explored through simulation and examination of the underlying mathematics. We provide recommendations for the statistically valid construction and correct interpretation of single-predictor injury risk functions. This article aims to provide useful and understandable statistical guidance to improve the practice in constructing injury risk functions.

Symptomatic hypoglycemia causing brain injury in a term breast fed newborn following early discharge.

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Marwah, Ashish; Gathwala, Geeta

2011-12-01

Cerebral metabolism and functioning depends upon an adequate blood glucose supply which provides for majority of the brain's energy requirement. Studies from the past have shown that neonatal hypoglycemia is associated with acute and long term neurological sequelae. Early discharge without adequately established breast feeding may lead to feeding problems, post discharge hypoglycemia and its associated neurological complications. The authors describe one such case of an exclusively breast fed term newborn who presented on day 3 with symptomatic hypoglycemia and associated neurological injury.

Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.

Science.gov (United States)

Wellsandt, Elizabeth; Gardinier, Emily S; Manal, Kurt; Axe, Michael J; Buchanan, Thomas S; Snyder-Mackler, Lynn

2016-01-01

Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb

Employment Trajectories After Spinal Cord Injury : Results From a 5-Year Prospective Cohort Study

NARCIS (Netherlands)

Ferdiana, Astri; Post, Marcel W.; Hoekstra, Trynke; van der Woude, Luccas H.; van der Klink, Jac J.; Bultmann, Ute

Objectives: To identify different employment trajectories in individuals with spinal cord injury (SCI) after discharge from initial rehabilitation and to determine predictors of different trajectories from demographic, injury, functional, and psychological characteristics. Design: Prospective cohort

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

Science.gov (United States)

Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-01-01

AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn’s disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients. PMID:19630105

Early Predictors of First-Year Academic Success at University: Pre-University Effort, Pre-University Self-Efficacy, and Pre-University Reasons for Attending University

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van Herpen, Sanne G. A.; Meeuwisse, Marieke; Hofman, W. H. Adriaan; Severiens, Sabine E.; Arends, Lidia R.

2017-01-01

Given the large number of dropouts in the 1st year at university, it is important to identify early predictors of 1st-year academic success. The present study (n = 453 first-year students) contributes to literature on the transition from secondary to higher education by investigating how the non-cognitive factors "pre-university" effort…

Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review

Science.gov (United States)

2004-01-01

Introduction Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients. Methods The following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay. Results Of 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean ± standard error: 9.6 ± 1.2 days versus 18.7 ± 1.3 days; P tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 ± 1.2 days versus 4.9 ± 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of

Early-onset Infectious Complications among Penetrating and Severe Closed Traumatic Brain Injury in Active Duty Deployed during OIF and OEF, 2008-2013

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2015-02-01

seizures, hydrocephalus, cerebral spinal fluid (CSF) leaks, infections inside the skull, vascular injuries, and cranial nerve injuries. 9-11 The...the form of early in-theater cranial decompression, followed by aggressive critical care management. 8 Medical advances, in addition to improved body...p = 0.66). However, closed TBI patients were significantly more likely than penetrating TBI patients to have anoxic brain damage (coma, stupor

Predictors of early infection in cerebral ischemic stroke.

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Ashour, Wmr; Al-Anwar, A D; Kamel, A E; Aidaros, M A

2016-01-01

Infection is the most common complication of stroke. To determine the risk factors and predictors of post-stroke infection (PSI), which developed within 7 days from the onset of acute ischemic stroke. The study included 60 ischemic stroke patients admitted in the Neurology Department of Zagazig University, Egypt, who were subdivided into: [Non Stroke Associated Infection group (nSAI); 30 patients having stroke without any criteria of infection within 7 days from the onset and Stroke Associated Infection group (SAI); 30 patients having stroke with respiratory tract infection (RTI) or urinary tract infection within 7 days], in addition to 30 healthy sex and age-matching subjects as control. All the patients had a detailed history taking, thorough clinical general and neurological examination, laboratory tests (Urine analysis & urine culture, blood sugar, lipid profile and serum tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-10), a chest radiography to assess RTI and brain computed tomography (CT) to exclude the hemorrhagic stroke and to confirm the ischemic stroke. SAI patients were found to be significantly older with higher baseline blood glucose level. Also the number of patients with tube feeding, lower conscious level, more stroke severity and more large size infarcts were significantly higher in SAI patients. There was a significant elevation in the IL-10, a significant decrease in the TNF-α and a significant decrease in the TNF-α/ IL-10 ratio, in the SAI group. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and size of infarct area > 3.5 cm3 were found to be the independent predictors of PSI. Patients with older age, tube feeding, lower conscious level, worse baseline stroke severity, large cerebral infarcts in CT scan, and increased IL-10 serum level were more susceptible to infection. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and the size of infarct area > 3.5 cm3 were the independent predictors of PSI.

Early magnetic resonance detection of cortical necrosis and acute network injury associated with neonatal and infantile cerebral infarction.

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Okabe, Tetsuhiko; Aida, Noriko; Niwa, Tetsu; Nozawa, Kumiko; Shibasaki, Jun; Osaka, Hitoshi

2014-05-01

Knowledge of MRI findings in pediatric cerebral infarction is limited. To determine whether cortical necrosis and network injury appear in the acute phase in post-stroke children and to identify anatomical location of acute network injury and the ages at which these phenomena are seen. Images from 12 children (age range: 0-9 years; neonates [acute middle cerebral artery (MCA) cortical infarction were retrospectively analyzed. Cortical necrosis was defined as hyperintense cortical lesions on T1-weighted imaging that lacked evidence of hemorrhage. Acute network injury was defined as hyperintense lesions on diffusion-weighted imaging that were not in the MCA territory and had fiber connections with the affected cerebral cortex. MRI was performed within the first week after disease onset. Cortical necrosis was only found in three neonates. Acute network injury was seen in the corticospinal tract (CST), thalamus and corpus callosum. Acute network injury along the CST was found in five neonates and one 7-month-old infant. Acute network injury was evident in the thalamus of four neonates and two infants (ages 4 and 7 months) and in the corpus callosum of five neonates and two infants (ages 4 and 7 months). The entire thalamus was involved in three children when infarction of MCA was complete. In acute MCA cortical infarction, MRI findings indicating cortical necrosis or acute network injury was frequently found in neonates and early infants. Response to injury in a developing brain may be faster than that in a mature one.

Popularity as a predictor of early alcohol use and moderator of other risk processes.

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Guyll, Max; Madon, Stephanie; Spoth, Richard; Lannin, Daniel G

2014-11-01

This study tested the relationship between popularity and early adolescent alcohol use and examined whether popularity moderated the influence of several risk processes. Longitudinal data provided by 1,196 youth (590 girls) were analyzed to assess main and interactive effects of popularity, friends' alcohol use attitudes, own alcohol use attitude, risk taking, and aggressive-disruptive behavior on changes in alcohol use during seventh grade. When we controlled for demographic variables and baseline alcohol use, popularity and the other predictors of interest exhibited linear main effects on alcohol use, with popularity and the attitude variables also demonstrating curvilinear relationships. Further analysis indicated that popularity moderated the effect of aggressive-disruptive behavior, the latter being associated with greater alcohol use among more popular adolescents. Additional moderation results revealed that friends' favorable attitudes toward alcohol use also potentiated aggressive-disruptive behavior's relationship with alcohol use and that male youth were more likely than female youth to use alcohol, but only among low risk takers. Popular youth may attempt to maintain status through early alcohol use, and their social competencies may facilitate risk processes associated with aggressive-disruptive behavior. Findings suggest the utility of providing universal prevention at developmentally crucial times to address substance use overall, and particularly to decrease early use among popular youth, which may serve to slow the growth of substance use in the larger cohort. Although aggressive-disruptive youth who are popular seem to be at particular risk, they may resist traditional interventions, indicating the potential value of less obvious intervention strategies.

Does tinnitus, hearing asymmetry, or hearing loss predispose to occupational injury risk?

Science.gov (United States)

Cantley, Linda F; Galusha, Deron; Cullen, Mark R; Dixon-Ernst, Christine; Tessier-Sherman, Baylah; Slade, Martin D; Rabinowitz, Peter M; Neitzel, Richard L

2015-02-01

To determine the relative contributions of tinnitus, asymmetrical hearing loss, low frequency hearing loss (pure tone average of 0.5, 1, 2, 3 kHz; PTA.5123), or high frequency hearing loss (pure tone average of 4, 6 kHz; PTA46), to acute injury risk among a cohort of production and maintenance workers at six aluminum manufacturing plants, adjusting for ambient noise exposure and other recognized predictors of injury risk. Retrospective analysis. The study considered 9920 workers employed during 2003 to 2008. The cohort consisted of 8818 workers (89%) whose complete records were available. Adjusting for noise exposure and other recognized injury predictors, a 25% increased acute injury risk was observed among workers with a history of tinnitus in conjunction with high-frequency hearing loss (PTA46). Low frequency hearing loss may be associated with minor, yet less serious, injury risk. We did not find evidence that asymmetry contributes to injury risk. These results provide evidence that tinnitus, combined with high-frequency hearing loss, may pose an important safety threat to workers, especially those who work in high-noise exposed environments. These at risk workers may require careful examination of their communication and hearing protection needs.

Non-suicidal self-injury among children with hearing loss and intellectual disability.

Science.gov (United States)

Akram, Bushra; Tariq, Amina; Rafi, Zeeshan

2017-10-01

To find the prevalence and to identify the predictors of non-suicidal self-injury among school-going children.. This cross-sectional study was conducted at the University of Gujrat, Gujrat Pakistan, from September 2015 to October 2016, and comprised children with intellectual disability and hearing loss. Participants were recruited from schools for special children located in Gujranwala, Jhelum and Gujrat. Multistage stratified sampling technique was used. Of the 325 children, 178(50.4%) had intellectual disability and 175(49.6%) had hearing loss. Findings indicated that the prevalence of self-injurious behaviour was higher in children with intellectual disability 48(27%) compared to their counterparts with hearing loss 3(2%). Neural network, when administered on whole data set, indicated type of disability 0.474(100%), education/training 0.99(20.9%) and access of counselling 0.114(24%) as important predictors of non-suicidal self-injury in both groups. On the other hand, the degree of disability (hearing loss 0.42[100%]; intellectual disability 0.32[100%]), education/ training (hearing loss 0.18[43%]; intellectual disability 0.27[84.5%]) and access of counselling (hearing loss 0.175[41.8%]; intellectual disability 0.256[78.7%]) were important predictors of non-suicidal self-injury among the participants, when neural network was run on the split files on the basis of disability. The prevalence of non-suicidal self-injury among children with intellectual disability was higher as compared to those with hearing loss.

Neural predictors of sensorimotor adaptation rate and savings.

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Cassady, Kaitlin; Ruitenberg, Marit; Koppelmans, Vincent; Reuter-Lorenz, Patricia; De Dios, Yiri; Gadd, Nichole; Wood, Scott; Riascos Castenada, Roy; Kofman, Igor; Bloomberg, Jacob; Mulavara, Ajitkumar; Seidler, Rachael

2018-04-01

In this study, we investigate whether individual variability in the rate of visuomotor adaptation and multiday savings is associated with differences in regional gray matter volume and resting-state functional connectivity. Thirty-four participants performed a manual adaptation task during two separate test sessions, on average 9 days apart. Functional connectivity strength between sensorimotor, dorsal cingulate, and temporoparietal regions of the brain was found to predict the rate of learning during the early phase of the adaptation task. In contrast, default mode network connectivity strength was found to predict both the rate of learning during the late adaptation phase and savings. As for structural predictors, greater gray matter volume in temporoparietal and occipital regions predicted faster early learning, whereas greater gray matter volume in superior posterior regions of the cerebellum predicted faster late learning. These findings suggest that the offline neural predictors of early adaptation may facilitate the cognitive aspects of sensorimotor adaptation, supported by the involvement of temporoparietal and cingulate networks. The offline neural predictors of late adaptation and savings, including the default mode network and the cerebellum, likely support the storage and modification of newly acquired sensorimotor representations. © 2017 Wiley Periodicals, Inc.

Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

Directory of Open Access Journals (Sweden)

Copin Jean-Christophe

2012-12-01

Full Text Available Abstract Background The relationship between severe traumatic brain injury (TBI and blood levels of matrix metalloproteinase-9 (MMP-9 or cellular fibronectin (c-Fn has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU length of stay (LOS of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE at 3 months. Methods Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS, as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. Results There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02 or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01. A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02. No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. Conclusions Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months.

Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

Science.gov (United States)

2012-01-01

Background The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months. Methods Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. Results There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. Conclusions Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months. PMID:23249478

Caregiver ratings of long-term executive dysfunction and attention problems after early childhood traumatic brain injury: family functioning is important.

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Kurowski, Brad G; Taylor, H Gerry; Yeates, Keith Owen; Walz, Nicolay C; Stancin, Terry; Wade, Shari L

2011-09-01

To evaluate the relationship of family and parenting factors to long-term executive dysfunction and attention problems after early childhood traumatic brain injury (TBI). We hypothesized that the magnitude of executive dysfunction and attention problems would be moderated by family and parenting factors. A multicenter, prospective cohort study that included an orthopedic injury (OI) reference group. Three tertiary academic children's hospital medical centers and one general medical center. Children, ages 3-7 years, hospitalized for OI, moderate TBI, or severe TBI. METHODS AND OUTCOME MEASUREMENTS: Parental ratings of family functioning and parenting styles were obtained 18 months after the injury occurred. The main outcome measurements, which were parental ratings of children's executive function and attention, were performed at least 24 months after the injury occurred (mean, 39 months; range, 25-63 months). Group comparisons were conducted with use of t-tests, χ(2) analysis, analysis of variance, and Pearson and Spearman correlations. Regression analysis was used to examine associations of the outcomes with family functioning and parenting styles and to test moderating effects of these factors on group differences. Participants with severe TBI demonstrated increased executive dysfunction and attention problems compared with those who sustained moderate TBI or OI. Lower levels of family dysfunction were associated with better executive function and attention across groups but did not moderate group differences. However, attention deficits after severe TBI were exacerbated under conditions of more permissive parenting relative to attention deficits after OIs. Executive function and attention problems persisted on a long-term basis (>24 months) after early childhood TBI, and positive global family functioning and nonpermissive parenting were associated with better outcomes. Better characterization of the optimal family environment for recovery from early childhood

Plasma NGAL predicts early acute kidney injury no earlier than s-creatinine or cystatin C in severely burned patients.

Science.gov (United States)

Rakkolainen, Ilmari; Vuola, Jyrki

2016-03-01

Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker used in acute kidney injury (AKI) diagnostics. Studies on burn patients have highlighted it as a promising biomarker for early detection of AKI. This study was designed to discover whether plasma NGAL is as a biomarker superior to serum creatinine and cystatin C in detecting AKI in severely burned patients. Nineteen subjects were enrolled from March 2013 to September 2014 in the Helsinki Burn Centre. Serum creatinine, cystatin C, and plasma NGAL were collected from the patients at admission and every 12h during the first 48h and thereafter daily until seven days following admission. AKI was defined by acute kidney injury network criteria. Nine (47%) developed AKI during their intensive care unit stay and two (11%) underwent renal replacement therapy. All biomarkers were significantly higher in the AKI group but serum creatinine- and cystatin C values reacted more rapidly to changes in kidney function than did plasma NGAL. Plasma NGAL tended to rise on average 72h±29h (95% CI) later in patients with early AKI than did serum creatinine. Area-under-the-curve values calculated for each biomarker were 0.92 for serum creatinine, 0.87 for cystatin C, and 0.62 for plasma NGAL predicting AKI by the receiver-operating-characteristic method. This study demonstrated serum creatinine and cystatin C as faster and more reliable biomarkers than plasma NGAL in detecting early AKI within one week of injury in patients with severe burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Acute lung injury induces cardiovascular dysfunction

DEFF Research Database (Denmark)

Suda, Koichi; Tsuruta, Masashi; Eom, Jihyoun

2011-01-01

Acute lung injury (ALI) is associated with systemic inflammation and cardiovascular dysfunction. IL-6 is a biomarker of this systemic response and a predictor of cardiovascular events, but its possible causal role is uncertain. Inhaled corticosteroids and long-acting β2 agonists (ICS/LABA) down-r...

The early IL-6 and IL-10 response in trauma is correlated with injury severity and mortality

DEFF Research Database (Denmark)

Stensballe, J; Christiansen, M; Tønnesen, E

2009-01-01

BACKGROUND: Trauma has previously been shown to influence interleukin (IL)-6 and IL-10 levels, but the association of injury severity and mortality with IL-6 and IL-10 responses in the early phase of accidental trauma remains to be investigated. We wished to describe serum levels of IL-6 and IL-10...... in the first 24 h after trauma and to assess the relationship with severity of injury and mortality. METHODS: Prospective, descriptive cohort study in a Level 1 trauma centre, Copenhagen, Denmark. We included 265 consecutive adult trauma patients admitted directly from the accident scene during an 18-month...... period. Serum levels of IL-6 and IL-10 were measured upon arrival and at 6, 12, and 24 h after admittance using an enzyme-linked immunosorbent assay. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS) and levels of IL-6 and IL-10. Analysis of variance was used...

Fall predictors in older cancer patients: a multicenter prospective study.

Science.gov (United States)

Vande Walle, Nathalie; Kenis, Cindy; Heeren, Pieter; Van Puyvelde, Katrien; Decoster, Lore; Beyer, Ingo; Conings, Godelieve; Flamaing, Johan; Lobelle, Jean-Pierre; Wildiers, Hans; Milisen, Koen

2014-12-15

In the older population falls are a common problem and a major cause of morbidity, mortality and functional decline. The etiology is often multifactorial making the identification of fall predictors essential for preventive measures. Despite this knowledge, data on falls within the older cancer population are limited. The objective of this study was to evaluate the occurrence of falls within 2 to 3 months after cancer treatment decision and to identify predictors of falls (≥1 fall) during follow-up. Older patients (70 years or more) with a cancer treatment decision were included. At baseline, all patients underwent geriatric screening (G8 and Flemish Triage Risk Screening Tool), followed by a geriatric assessment including living situation, activities of daily living (ADL), instrumental activities of daily living (IADL), fall history in the past 12 months, fatigue, cognition, depression, nutrition, comorbidities and polypharmacy. Questionnaires were used to collect follow-up (2-3 months) data. Univariate and multivariate analyses were performed to identify predictors for falls (≥1 fall) during follow-up. At baseline, 295 (31.5%) of 937 included patients reported at least one fall in the past 12 months with 88 patients (29.5%) sustaining a major injury. During follow-up (2-3 months), 142 (17.6%) patients fell, of whom 51.4% fell recurrently and 17.6% reported a major injury. Baseline fall history in the past 12 months (OR = 3.926), fatigue (OR = 0.380), ADL dependency (OR = 0.492), geriatric risk profile by G8 (OR = 0.471) and living alone (OR = 1.631) were independent predictors of falls (≥1 fall) within 2-3 months after cancer treatment decision. Falls are a serious problem among older cancer patients. Geriatric screening and assessment data can identify patients at risk for a fall. A patient with risk factors associated with falls should undergo further evaluation and intervention to prevent potentially injurious fall incidents.

Change in contrast enhancement of HCC on 1-month follow-up CT after local radiotherapy: An early predictor of final treatment response

International Nuclear Information System (INIS)

Kim, Eun Young; Choi, Dongil; Lim, Do Hoon; Lee, Won Jae; Yoo, Byung Chul; Paik, Seung Woon

2009-01-01

Background: The purpose of this study was to evaluate the change in contrast enhancement of HCC on 1-month follow-up CT after local radiotherapy (RT) as an early predictor of final treatment response. Materials: Fifty patients who underwent local RT for HCCs had both pre-RT and post-RT CT scans including 1-month follow-up CT. We assessed the final treatment response by using the change in maximal tumor size on 6-12-month follow-up CT scan after RT. We also evaluated the change in tumor enhancement between pre-RT and 1-month follow-up CT scans. Results: A final treatment response was achieved in 27 (54%) of 50 patients, who showed either a complete response (n = 11) or a partial response (n = 16). Compared with non-responsive patients (n = 23), responsive patients showed a significant decrease in tumor enhancement on 1-month follow-up CT after RT in both objective and subjective analyses (each P < 0.001). Conclusion: The change in contrast enhancement of HCC seen on the 1-month follow-up CT in patients after local RT may be used as an early predictor of final treatment response.

Clinical effect of vitamin A palmitate eye gel on early ocular surface reconstruction after thermal or chemical injuries

Directory of Open Access Journals (Sweden)

Fen-Dui Zhang

2015-11-01

Full Text Available AIM: To evaluate the clinical effect of vitamin A palmitate eye gel on early ocular surface reconstruction after thermal or chemical injuries. METHODS: Seventy-eight cases with thermal or chemical injuries to eyes were selected and divided into two groups by randomized, double-blind, positive drug parallel controlled method: group A(40 cases were treated with vitamin A palmitate eye geland group B \\〖38 cases were treated with basic fibroblast growth factor(bFGF\\〗. The bFGF and vitamin A palmitate eye gel were used 4 times a day. The treatment course was 14d. Restoration of epithelial defect, Schirmer's test values, tear break-up time(BUT, and subjective assessment of symptoms and signs were observed on D1, D3, D5, D7, D10 and D14.RESULTS: In group A, 31 cases were cured, 5 cases were effective, with the cure rate of 76% and efficiency 90%. In group B, 32 cases were cured, 3 cases were effective, with the cure rate of 84% and efficiency 92%. There were no significant differences between the two groups(P>0.05. However, there were significant differences on the results of Schirmer's test and BUT(PPCONCLUSION: Vitamin A palmitate eye gel is valuable and safe on early ocular surface reconstruction of the eyes suffered from thermal or chemical injuries.

Minocycline Protects Against NLRP3 Inflammasome-Induced Inflammation and P53-Associated Apoptosis in Early Brain Injury After Subarachnoid Hemorrhage.

Science.gov (United States)

Li, Jianru; Chen, Jingsen; Mo, Hangbo; Chen, Jingyin; Qian, Cong; Yan, Feng; Gu, Chi; Hu, Qiang; Wang, Lin; Chen, Gao

2016-05-01

Minocycline has beneficial effects in early brain injury (EBI) following subarachnoid hemorrhage (SAH); however, the molecular mechanisms underlying these effects have not been clearly identified. This study was undertaken to determine the influence of minocycline on inflammation and neural apoptosis and the possible mechanisms of these effects in early brain injury following subarachnoid hemorrhage. SAH was induced by the filament perforation model of SAH in male Sprague-Dawley rats. Minocycline or vehicle was given via an intraperitoneal injection 1 h after SAH induction. Minocycline treatment markedly attenuated brain edema secondary to blood-brain barrier (BBB) dysfunction by inhibiting NLRP3 inflammasome activation, which controls the maturation and release of pro-inflammatory cytokines, especially interleukin-1β (IL-1β). Minocycline treatment also markedly reduced the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)-positive cells. To further identify the potential mechanisms, we demonstrated that minocycline increased Bcl2 expression and reduced the protein expression of P53, Bax, and cleaved caspase-3. In addition, minocycline reduced the cortical levels of reactive oxygen species (ROS), which are closely related to both NLRP3 inflammasome and P53 expression. Minocycline protects against NLRP3 inflammasome-induced inflammation and P53-associated apoptosis in early brain injury following SAH. Minocycline's anti-inflammatory and anti-apoptotic effect may involve the reduction of ROS. Minocycline treatment may exhibit important clinical potentials in the management of SAH.

A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury

DEFF Research Database (Denmark)

Karvellas, Constantine J; Farhat, Maha R; Sajjad, Imran

2011-01-01

Introduction: Our aim was to investigate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods: Systematic review and meta-analysis were used in this study. PUBMED, EMBASE, SCOPUS, Web ...

Mild traumatic brain injury and fatigue: a prospective longitudinal study.

Science.gov (United States)

Norrie, Joan; Heitger, Marcus; Leathem, Janet; Anderson, Tim; Jones, Richard; Flett, Ross

2010-01-01

To examine fatigue prevalence, severity, predictors and co-variates over 6 months post-mild traumatic brain injury (MTBI). Longitudinal prospective study including 263 adults with MTBI. Participants completed the Fatigue Severity Scale (FSS), Rivermead Post-concussion Symptoms Questionnaire (RPSQ), Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 Health Survey-Version 2 (SF-36v2). Complete data were available for 159 participants. Key measures; prevalence--RPSQ Item 6: severity--FSS. The effect of time on fatigue prevalence and severity was examined using ANOVA. Multiple regression analysis identified statistically significant covariates. Post-MTBI fatigue prevalence was 68%, 38% and 34% at 1 week, 3 and 6 months, respectively. There was a strong effect for time over the first 3 months and moderate-to-high correlations between fatigue prevalence and severity. Early fatigue strongly predicted later fatigue; depression, but not anxiety was a predictor. Fatigue was seen as laziness by family or friends in 30% of cases. Post-MTBI fatigue is a persistent post-concussion symptom, exacerbated by depression but not anxiety. It diminishes in the first 3 months and then becomes relatively stable, suggesting the optimum intervention placement is at 3 months or more post-MTBI.

Proinflammatory adipokine leptin mediates disinfection byproduct bromodichloromethane-induced early steatohepatitic injury in obesity

International Nuclear Information System (INIS)

Das, Suvarthi; Kumar, Ashutosh; Seth, Ratanesh Kumar; Tokar, Erik J.; Kadiiska, Maria B.; Waalkes, Michael P.; Mason, Ronald P.; Chatterjee, Saurabh

2013-01-01

Today's developed world faces a major public health challenge in the rise in the obese population and the increased incidence in fatty liver disease. There is a strong association among diet induced obesity, fatty liver disease and development of nonalcoholic steatohepatitis but the environmental link to disease progression remains unclear. Here we demonstrate that in obesity, early steatohepatitic lesions induced by the water disinfection byproduct bromodichloromethane are mediated by increased oxidative stress and leptin which act in synchrony to potentiate disease progression. Low acute exposure to bromodichloromethane (BDCM), in diet-induced obesity produced oxidative stress as shown by increased lipid peroxidation, protein free radical and nitrotyrosine formation and elevated leptin levels. Exposed obese mice showed histopathological signs of early steatohepatitic injury and necrosis. Spontaneous knockout mice for leptin or systemic leptin receptor knockout mice had significantly decreased oxidative stress and TNF-α levels. Co-incubation of leptin and BDCM caused Kupffer cell activation as shown by increased MCP-1 release and NADPH oxidase membrane assembly, a phenomenon that was decreased in Kupffer cells isolated from leptin receptor knockout mice. In obese mice that were BDCM-exposed, livers showed a significant increase in Kupffer cell activation marker CD68 and, increased necrosis as assessed by levels of isocitrate dehydrogenase, events that were decreased in the absence of leptin or its receptor. In conclusion, our results show that exposure to the disinfection byproduct BDCM in diet-induced obesity augments steatohepatitic injury by potentiating the effects of leptin on oxidative stress, Kupffer cell activation and cell death in the liver. - Highlights: ► BDCM acute exposure sensitizes liver to increased free radical stress in obesity. ► BDCM-induced higher leptin contributes to early steatohepatitic lesions. ► Increased leptin mediates protein

Proinflammatory adipokine leptin mediates disinfection byproduct bromodichloromethane-induced early steatohepatitic injury in obesity

Energy Technology Data Exchange (ETDEWEB)

Das, Suvarthi [Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208 (United States); Kumar, Ashutosh [Free Radical Metabolism Group, Laboratory of Toxicology and Pharmacology, Research Triangle Park, NC 27709 (United States); Seth, Ratanesh Kumar [Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208 (United States); Tokar, Erik J. [Inorganic Toxicology Group, National Toxicology Program Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709 (United States); Kadiiska, Maria B. [Free Radical Metabolism Group, Laboratory of Toxicology and Pharmacology, Research Triangle Park, NC 27709 (United States); Waalkes, Michael P. [Inorganic Toxicology Group, National Toxicology Program Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709 (United States); Mason, Ronald P. [Free Radical Metabolism Group, Laboratory of Toxicology and Pharmacology, Research Triangle Park, NC 27709 (United States); Chatterjee, Saurabh, E-mail: schatt@mailbox.sc.edu [Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208 (United States)

2013-06-15

Today's developed world faces a major public health challenge in the rise in the obese population and the increased incidence in fatty liver disease. There is a strong association among diet induced obesity, fatty liver disease and development of nonalcoholic steatohepatitis but the environmental link to disease progression remains unclear. Here we demonstrate that in obesity, early steatohepatitic lesions induced by the water disinfection byproduct bromodichloromethane are mediated by increased oxidative stress and leptin which act in synchrony to potentiate disease progression. Low acute exposure to bromodichloromethane (BDCM), in diet-induced obesity produced oxidative stress as shown by increased lipid peroxidation, protein free radical and nitrotyrosine formation and elevated leptin levels. Exposed obese mice showed histopathological signs of early steatohepatitic injury and necrosis. Spontaneous knockout mice for leptin or systemic leptin receptor knockout mice had significantly decreased oxidative stress and TNF-α levels. Co-incubation of leptin and BDCM caused Kupffer cell activation as shown by increased MCP-1 release and NADPH oxidase membrane assembly, a phenomenon that was decreased in Kupffer cells isolated from leptin receptor knockout mice. In obese mice that were BDCM-exposed, livers showed a significant increase in Kupffer cell activation marker CD68 and, increased necrosis as assessed by levels of isocitrate dehydrogenase, events that were decreased in the absence of leptin or its receptor. In conclusion, our results show that exposure to the disinfection byproduct BDCM in diet-induced obesity augments steatohepatitic injury by potentiating the effects of leptin on oxidative stress, Kupffer cell activation and cell death in the liver. - Highlights: ► BDCM acute exposure sensitizes liver to increased free radical stress in obesity. ► BDCM-induced higher leptin contributes to early steatohepatitic lesions. ► Increased leptin mediates

The burden and management of self-inflicted injuries at a tertiary ...

African Journals Online (AJOL)

The mortality rate was 22.8%. Late presentation (>24 hour), severe injuries (KTS II ≤ 6) and presence of surgical site infections were the main predictors of mortality (p<0.001). Conclusion: Self-inflicted injuries are an emerging but neglected public health problem in Mwanza, Tanzania and contribute to unacceptably high ...

Cannabis use in persons with traumatic spinal cord injury in Denmark

DEFF Research Database (Denmark)

Andresen, Sven R; Biering-Sørensen, Fin; Hagen, Ellen Merete

2017-01-01

OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. DESIGN: Cross-sectional survey in Denmark. METHODS: A 35-item questionnaire was sent to 1,101 pati......OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. DESIGN: Cross-sectional survey in Denmark. METHODS: A 35-item questionnaire was sent to 1......,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012. RESULTS: A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before...... their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas...

Predictors of Outcome following Acquired Brain Injury in Children

Science.gov (United States)

Johnson, Abigail R.; DeMatt, Ellen; Salorio, Cynthia F.

2009-01-01

Acquired brain injury (ABI) in children and adolescents can result from multiple causes, including trauma, central nervous system infections, noninfectious disorders (epilepsy, hypoxia/ischemia, genetic/metabolic disorders), tumors, and vascular abnormalities. Prediction of outcomes is important, to target interventions, allocate resources,…

Predictors of nurses' experience of verbal abuse by nurse colleagues.

Science.gov (United States)

Keller, Ronald; Krainovich-Miller, Barbara; Budin, Wendy; Djukic, Maja

Between 45% and 94% of registered nurses (RNs) experience verbal abuse, which is associated with physical and psychological harm. Although several studies examined predictors of RNs' verbal abuse, none examined predictors of RNs' experiences of verbal abuse by RN colleagues. To examine individual, workplace, dispositional, contextual, and interpersonal predictors of RNs' reported experiences of verbal abuse from RN colleagues. In this secondary analysis, a cross-sectional design with multiple linear regression analysis was used to examine the effect of 23 predictors on verbal abuse by RN colleagues in a sample of 1,208 early career RNs. Selected variables in the empirical intragroup conflict model explained 23.8% of variance in RNs' experiences of verbal abuse by RN colleagues. A number of previously unstudied factors were identified that organizational leaders can monitor and develop or modify policies to prevent early career RNs' experiences of verbal abuse by RN colleagues. Copyright © 2017 Elsevier Inc. All rights reserved.

Temperamental predictors of subjective well-being from early adolescence to mid-life: The role of temporal and energetic regulation.

Science.gov (United States)

Bojanowska, Agnieszka; Zalewska, Anna M

2017-02-14

We investigated links between temperament traits described in Strelau's Regulative Theory of Temperament (Emotional Reactivity, Briskness, Activity, Endurance, Perseveration and Sensory Sensitivity) and subjective well-being (SWB)-Positive Affect, Negative Affect and Life Satisfaction as conceptualised by Diener. Participants representing early (n = 166) and late adolescence (n = 199), early (n = 195) and mid-adulthood (n = 156) filled out Formal Characteristics of Behaviour-Temperament Inventory, Positive and Negative Affect Schedule and Satisfaction with Life Scale. Results showed that higher Briskness, Endurance, Activity, lower Perseveration and Emotional Reactivity corresponded with higher SWB. They predicted 16% of affective components' and 7% of satisfaction variance. Each well-being component had a unique set of predictors; however, predictors of affective components varied across age groups. Higher Positive Affect was predicted by traits responsible for energetic regulation (higher Endurance and Activity and lower Emotional Reactivity) and by higher Perseveration, but their role (excluding Emotional Reactivity) was age-dependent. Higher Negative Affect was predicted by higher Emotional Reactivity and dimensions expressing temporal characteristics, lower Briskness and higher Perseveration (Perseveration was not significant among younger adolescents). Higher Satisfaction was steadily predicted by lower Emotional Reactivity and higher Activity. To conclude, the functions of temperament traits are mostly in line with theoretical expectations, but more complex than indicated by previous research. © 2017 The Authors. International Journal of Psychology published by John Wiley & Sons Ltd on behalf of International Union of Psychological Science.

Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury

DEFF Research Database (Denmark)

Sommer, Jens Bak; Norup, Anne; Poulsen, Ingrid

2013-01-01

Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub-acute re......Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub......-acute rehabilitation in the Eastern part of Denmark during a 5-year period from 2005 to 2009. Methods: Level of consciousness was assessed consecutively during rehabilitation and at 1 year post-trauma. Severity of traumatic brain injury was classified according to duration of post-traumatic amnesia. The cognitive...... subscale of Functional Independence MeasureTM (Cog-FIM) was used to assess cognitive activity limitations. Multivariate logistic regression analyses were performed to identify predictors of an independent level of functioning. Results: The majority of patients progressed to a post-confusional level...

Temporal Profile of Microtubule-Associated Protein 2: A Novel Indicator of Diffuse Brain Injury Severity and Early Mortality after Brain Trauma.

Science.gov (United States)

Papa, Linda; Robicsek, Steven A; Brophy, Gretchen M; Wang, Kevin K W; Hannay, H Julia; Heaton, Shelley; Schmalfuss, Ilona; Gabrielli, Andrea; Hayes, Ronald L; Robertson, Claudia S

2018-01-01

This study compared cerebrospinal fluid (CSF) levels of microtubule-associated protein 2 (MAP-2) from adult patients with severe traumatic brain injury (TBI) with uninjured controls over 10 days, and examined the relationship between MAP-2 concentrations and acute clinical and radiologic measures of injury severity along with mortality at 2 weeks and over 6 months. This prospective study, conducted at two Level 1 trauma centers, enrolled adults with severe TBI (Glasgow Coma Scale [GCS] score ≤8) requiring a ventriculostomy, as well as controls. Ventricular CSF was sampled from each patient at 6, 12, 24, 48, 72, 96, 120, 144, 168, 192, 216, and 240 h following TBI and analyzed via enzyme-linked immunosorbent assay for MAP-2 (ng/mL). Injury severity was assessed by the GCS score, Marshall Classification on computed tomography (CT), Rotterdam CT score, and mortality. There were 151 patients enrolled-130 TBI and 21 control patients. MAP-2 was detectable within 6 h of injury and was significantly elevated compared with controls (p < 0.001) at each time-point. MAP-2 was highest within 72 h of injury and decreased gradually over 10 days. The area under the receiver operating characteristic curve for deciphering TBI versus controls at the earliest time-point CSF was obtained was 0.96 (95% CI 0.93-0.99) and for the maximal 24-h level was 0.98 (95% CI 0.97-1.00). The area under the curve for initial MAP-2 levels predicting 2-week mortality was 0.80 at 6 h, 0.81 at 12 h, 0.75 at 18 h, 0.75 at 24 h, and 0.80 at 48 h. Those with Diffuse Injury III-IV had much higher initial (p = 0.033) and maximal (p = 0.003) MAP-2 levels than those with Diffuse Injury I-II. There was a graded increase in the overall levels and peaks of MAP-2 as the degree of diffuse injury increased within the first 120 h post-injury. These data suggest that early levels of MAP-2 reflect severity of diffuse brain injury and predict 2-week mortality in TBI patients. These

Employee resistance and injury during commercial robberies.

Science.gov (United States)

Jones, Jennifer; Casteel, Carri; Peek-Asa, Corinne

2015-05-01

To examine the association between employee resistance and injury and examine whether type or location of property stolen was associated with employee resistance during commercial robberies in a large metropolitan city. Robbery data were abstracted from police crime reports between 2008 and 2012. Log binomial regression models were used to identify predictors of employee resistance and to evaluate the association between employee resistance and injury. Employees resisted a robber in nearly half of all robbery events. Active employee resistance was significantly associated with employee injury (Adj PR: 1.49, 95% confidence interval, 1.34 to 1.65). Goods being stolen were associated with active employee resistance and employee injury, whereas cash only being stolen was inversely associated with employee injury. Results suggest that employee training in nonresistance can be an important strategy in protecting employees working with the exchange of cash and goods.

Early Adolescent Sexual Activity: A Developmental Study.

Science.gov (United States)

Whitbeck, Les B.; Yoder, Kevin A.; Hoyt, Dan R.; Conger, Rand D.

1999-01-01

Examines predictors of early sexual intercourse for a sample of 457 adolescents in grades 8 through 10, from two-parent and single-mother families. Significant decreases were noted in the effect of mother monitoring by 10th grade. The primary predictors of early intercourse were age, opportunity (steady relationship), sexually permissive attitude,…

Internet-based early intervention to prevent posttraumatic stress disorder in injury patients: randomized controlled trial.

Science.gov (United States)

Mouthaan, Joanne; Sijbrandij, Marit; de Vries, Giel-Jan; Reitsma, Johannes B; van de Schoot, Rens; Goslings, J Carel; Luitse, Jan S K; Bakker, Fred C; Gersons, Berthold P R; Olff, Miranda

2013-08-13

Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients. Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale-Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented. The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (PInternet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high

Predictors of response to neuroleptic treatment in schizophrenia.

Science.gov (United States)

Stern, R G; Kahn, R S; Davidson, M

1993-06-01

Baseline symptom severity, early reduction in symptom severity, initial subjective response to neuroleptic treatment, the degree of brain atrophy, and early changes in pHVA levels appear to predict treatment outcome in schizophrenic patients. Computerized EEG results, neuropsychological and neurophysiologic tests, and baseline pHVA concentrations require further examination. Only a limited proportion of variance in treatment response, however, could be explained by either of the nine predictors alone or combined. Therefore, further research is necessary to discover yet unidentified determinants of treatment response. Future studies should test the validity and reliability of these five promising predictors in large groups of male and female patients, employ high standards for assessment reliability of clinical parameters, and use absolute rating scores on psychopathology as well as functional scales for the definition of good and poor treatment response. Furthermore, the statistical approach for data analysis should take in consideration the need for appropriate corrections when multiple correlations are performed and should test the extent to which these predictors are interdependent.

Relationship between trauma-induced coagulopathy and progressive hemorrhagic injury in patients with traumatic brain injury

Institute of Scientific and Technical Information of China (English)

Jia Liu; Heng-Li Tian

2016-01-01

Progressive hemorrhagic injury (PHI) can be divided into coagulopathy-related PHI and normal coagulation PHI.Coagulation disorders after traumatic brain injuries can be included in trauma-induced coagulopathy (TIC).Some studies showed that TIC is associated with PHI and increases the rates of disability and mortality.In this review,we discussed some mechanisms in TIC,which is of great importance in the development of PHI,including tissue factor (TF) hypothesis,protein C pathway and thrombocytopenia.The main mechanism in the relation of TIC to PHI is hypocoagulability.We also reviewed some coagulopathy parameters and proposed some possible risk factors,predictors and therapies.

Early magnetic resonance detection of cortical necrosis and acute network injury associated with neonatal and infantile cerebral infarction

Energy Technology Data Exchange (ETDEWEB)

Okabe, Tetsuhiko; Aida, Noriko; Nozawa, Kumiko [Kanagawa Children' s Medical Center, Department of Radiology, Yokohama (Japan); Niwa, Tetsu [Kanagawa Children' s Medical Center, Department of Radiology, Yokohama (Japan); Tokai University School of Medicine, Department of Radiology, Isehara (Japan); Shibasaki, Jun [Kanagawa Children' s Medical Center, Department of Neonatology, Yokohama (Japan); Osaka, Hitoshi [Kanagawa Children' s Medical Center, Department of Neurology, Yokohama (Japan)

2014-05-15

Knowledge of MRI findings in pediatric cerebral infarction is limited. To determine whether cortical necrosis and network injury appear in the acute phase in post-stroke children and to identify anatomical location of acute network injury and the ages at which these phenomena are seen. Images from 12 children (age range: 0-9 years; neonates [<1 month], n=5; infants [1 month-12 months], n=3; others [≥1 year], n=4) with acute middle cerebral artery (MCA) cortical infarction were retrospectively analyzed. Cortical necrosis was defined as hyperintense cortical lesions on T1-weighted imaging that lacked evidence of hemorrhage. Acute network injury was defined as hyperintense lesions on diffusion-weighted imaging that were not in the MCA territory and had fiber connections with the affected cerebral cortex. MRI was performed within the first week after disease onset. Cortical necrosis was only found in three neonates. Acute network injury was seen in the corticospinal tract (CST), thalamus and corpus callosum. Acute network injury along the CST was found in five neonates and one 7-month-old infant. Acute network injury was evident in the thalamus of four neonates and two infants (ages 4 and 7 months) and in the corpus callosum of five neonates and two infants (ages 4 and 7 months). The entire thalamus was involved in three children when infarction of MCA was complete. In acute MCA cortical infarction, MRI findings indicating cortical necrosis or acute network injury was frequently found in neonates and early infants. Response to injury in a developing brain may be faster than that in a mature one. (orig.)

Early magnetic resonance detection of cortical necrosis and acute network injury associated with neonatal and infantile cerebral infarction

International Nuclear Information System (INIS)

Okabe, Tetsuhiko; Aida, Noriko; Nozawa, Kumiko; Niwa, Tetsu; Shibasaki, Jun; Osaka, Hitoshi

2014-01-01

Knowledge of MRI findings in pediatric cerebral infarction is limited. To determine whether cortical necrosis and network injury appear in the acute phase in post-stroke children and to identify anatomical location of acute network injury and the ages at which these phenomena are seen. Images from 12 children (age range: 0-9 years; neonates [<1 month], n=5; infants [1 month-12 months], n=3; others [≥1 year], n=4) with acute middle cerebral artery (MCA) cortical infarction were retrospectively analyzed. Cortical necrosis was defined as hyperintense cortical lesions on T1-weighted imaging that lacked evidence of hemorrhage. Acute network injury was defined as hyperintense lesions on diffusion-weighted imaging that were not in the MCA territory and had fiber connections with the affected cerebral cortex. MRI was performed within the first week after disease onset. Cortical necrosis was only found in three neonates. Acute network injury was seen in the corticospinal tract (CST), thalamus and corpus callosum. Acute network injury along the CST was found in five neonates and one 7-month-old infant. Acute network injury was evident in the thalamus of four neonates and two infants (ages 4 and 7 months) and in the corpus callosum of five neonates and two infants (ages 4 and 7 months). The entire thalamus was involved in three children when infarction of MCA was complete. In acute MCA cortical infarction, MRI findings indicating cortical necrosis or acute network injury was frequently found in neonates and early infants. Response to injury in a developing brain may be faster than that in a mature one. (orig.)

Surviving severe traumatic brain injury in Denmark

DEFF Research Database (Denmark)

Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter

2015-01-01

PURPOSE: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). PATIENTS AND METHODS: Patients surviving severe TBI were identified from...... severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. CONCLUSION: The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark...

Efficacy of Early Surgery for Neurological Improvement in Spinal Cord Injury without Radiographic Evidence of Trauma in the Elderly.

Science.gov (United States)

Inoue, Tomoo; Suzuki, Shinsuke; Endo, Toshiki; Uenohara, Hiroshi; Tominaga, Teiji

2017-09-01

The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (24 hours postinjury) surgery in patients with SCIWORET aged ≥65 years. We identified patients aged ≥65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of >50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmer-Lemeshow test. Eighty patients aged ≥65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25-13.20), with excellent calibration (Hosmer-Lemeshow, P = 0.857). The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET. Copyright © 2017 Elsevier Inc. All rights reserved.

Self-injury, converting emotional distress into physical pain

DEFF Research Database (Denmark)

Møhl, Bo; Rubæk, Lotte

2017-01-01

Self-inflicted pain by cutting, hitting or burning oneself has become a common way to regulate emotions and to serve as coping strategy. 21.5-32% of adolescents in non-clinical populations have a history of non-suicidal self-injury. Non-suicidal self-injury has a momentarily relieving effect and ...... and is an important predictor of suicidal behaviour; even superficial self-injury should be taken seriously. There is an urgent need for organized treatment programmes for young people who self-harm.......Self-inflicted pain by cutting, hitting or burning oneself has become a common way to regulate emotions and to serve as coping strategy. 21.5-32% of adolescents in non-clinical populations have a history of non-suicidal self-injury. Non-suicidal self-injury has a momentarily relieving effect...

Trauma: Spinal Cord Injury.

Science.gov (United States)

Eckert, Matthew J; Martin, Matthew J

2017-10-01

Injuries to the spinal column and spinal cord frequently occur after high-energy mechanisms of injury, or with lower-energy mechanisms, in select patient populations like the elderly. A focused yet complete neurologic examination during the initial evaluation will guide subsequent diagnostic procedures and early supportive measures to help prevent further injury. For patients with injury to bone and/or ligaments, the initial focus should be spinal immobilization and prevention of inducing injury to the spinal cord. Spinal cord injury is associated with numerous life-threatening complications during the acute and long-term phases of care that all acute care surgeons must recognize. Published by Elsevier Inc.

SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

Science.gov (United States)

Gregoric, Pavle; Pavle, Gregoric; Sijacki, Ana; Ana, Sijacki; Stankovic, Sanja; Sanja, Stankovic; Radenkovic, Dejan; Dejan, Radenkovic; Ivancevic, Nenad; Nenad, Ivancevic; Karamarkovic, Aleksandar; Aleksandar, Karamarkovic; Popovic, Nada; Nada, Popovic; Karadzic, Borivoje; Borivoje, Karadzic; Stijak, Lazar; Stefanovic, Branislav; Branislav, Stefanovic; Milosevic, Zoran; Zoran, Milosević; Bajec, Djordje; Djordje, Bajec

2010-01-01

Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.

The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury.

Science.gov (United States)

Forslund, Marit V; Roe, Cecilie; Perrin, Paul B; Sigurdardottir, Solrun; Lu, Juan; Berntsen, Svein; Andelic, Nada

2017-01-01

To assess longitudinal trajectories of overall disability after moderate-to-severe traumatic brain injury (TBI) and to examine whether those trajectories could be predicted by socio-demographic and injury characteristics. Demographics and injury characteristics of 105 individuals with moderate-to-severe TBI were extracted from medical records. At the 1-, 2-, and 5-year follow-ups, TBI-related disability was assessed by the GOSE. A hierarchical linear model (HLM) was used to examine functional outcomes up to 5 years following injury and whether those outcomes could be predicted by: time, gender, age, relationship, education, employment pre-injury, occupation, GCS, cause of injury, length of post-traumatic amnesia (PTA), CT findings and injury severity score, as well as the interactions between each of these predictors and time. Higher GOSE trajectories (lower disability) were predicted by younger age at injury and shorter PTA, as well as by the interaction terms of time*PTA and time*employment. Those who had been employed at injury decreased in disability over time, while those who had been unemployed increased in disability. The study results support the view that individual factors generally outweigh injury-related factors as predictors of disability after TBI, except for PTA.

Posttraumatic growth within the first three months after accidental injury in China: the role of self-disclosure, cognitive processing, and psychosocial resources.

Science.gov (United States)

Dong, Chaoqun; Gong, Shumei; Jiang, Liping; Deng, Guanghui; Liu, Xiaohong

2015-01-01

The primary goals of this study, were to identify the posttraumatic growth (PTG) level of accidentally injured Chinese patients shortly after an accident occurred and to determine whether cognitive processing, self-disclosure, and psychosocial resources predicted PTG. A total of 232 patients were recruited from two public hospitals in Shanghai within the first three months of an accidental injury. Patients completed self-report questionnaires to assess severity of injury, cognitive processing, self-disclosure, psychosocial resources, and PTG. Patients reported a mid-low level of PTG (M = 50.38, SD = 18.12) in the short length of time post-injury. Hierarchical regression analysis indicated that subjective accident severity, deliberate rumination, perceived social support, and attitude towards disclosure were strong predictors of PTG. A moderating role of self-disclosure between intrusive rumination and PTG was identified. These findings support an interaction effect of rumination and self-disclosure on PTG and have implications for early intervention of accidentally injured patients.

Employment Outcome Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study.

Science.gov (United States)

Grauwmeijer, Erik; Heijenbrok-Kal, Majanka H; Haitsma, Ian K; Ribbers, Gerard M

2017-09-01

The objective of this prospective cohort study was to evaluate the probability of employment and predictors of employment in patients with moderate- to- severe traumatic brain injury (TBI) over 10-year follow-up. One hundred nine patients (18-67 years) were included with follow-up measurements 3, 6, 12, 18, 24, and 36 months and 10 years post-TBI. Potential predictors of employment probability included patient characteristics, injury severity factors, functional outcome measured at discharge from the hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), Functional Independence Measure (FIM), and the Functional Assessment Measure (FAM). Forty-eight patients (42%) completed the 10-year follow-up. Three months post-TBI, 12% were employed, which gradually, but significantly, increased to 57% after 2-years follow-up (p employed persons had less-severe TBI, shorter length of hospital stay (LOS), and higher scores on the GOS, BI, FIM, and FAM at hospital discharge than unemployed persons. No significant differences in age, sex, educational level, living with partner/family or not, pre-injury employment, professional category, psychiatric symptoms, or discharge destination were found. Longitudinal multivariable analysis showed that time, pre-injury employment, FAM, and LOS were independent predictors of employment probability. We concluded that employment probability 10 years after moderate or severe TBI is related to injury severity and pre-injury employment. Future studies on vocational rehabilitation should focus on modifiable factors and take into consideration the effects of national legislation and national labor market forces.

Gender and injuries predict stimulant medication

DEFF Research Database (Denmark)

Dalsgaard, Søren; Leckman, James F.; Nielsen, Helena Skyt

2014-01-01

Objective: The purpose of this article was to examine whether injuries in early childhood and gender predict prescriptions of stimulant medication in three groups of children: With attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other psychiatric disorders (OPD...... follow-up of all cases. We found that the number of injuries prior to diagnosis was associated with initiation of stimulant treatment in all three groups of patients. In addition, male gender predicted treatment with ADHD medications. Our results suggest that the number of injuries early in life prior...

Self-injurious behavior in anorexia nervosa.

Science.gov (United States)

Favaro, A; Santonastaso, P

2000-08-01

Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa

Probable reasons for the lower effectiveness of remedies for early treatment of acute radiation sickness accompanied by combination of radiation and thermal injuries

International Nuclear Information System (INIS)

Budagov, R.S.; Ul'yanova, L.P.

2001-01-01

Mechanism underlying a lower effectiveness of remedies for early treatment of acute radiation sickness in the case of combined radiation and thermal injuries are studied. Experiments were carried out on mice. Animals had been subjected to either a 3B degree thermal burn covering 10% of the body surface or a single whole body gamma-irradiation of 7 Gy dose or a combined injury (radiation exposure + burn), and changes of the blood serum level of interleukin-6 (IL-6) were investigated by means of ELISA kits. Modifying influence of remedies for early therapy (a synthetic analogue of dicorynomycolate trehalose and a preparation based on killed Lacobacillus acidophilus) on the endogenous serum level of IL-6 and on the 30-day survival was evaluated. In accordance with the degree and duration of increased levels of IL-6 in blood serum, the investigated groups of animals were ranged as follows: combined action > burn only > irradiation only. L. acidophilus based preparation rendered a transient modifying action on the IL-6 level at the combined injury and contributed to increasing the 30-day survival. Lower effectiveness of remedies for early treatment of acute radiation sickness may be associated with too excessive levels of IL-6 in the blood serum [ru

Influence of Dopamine-Related Genes on Neurobehavioral Recovery after Traumatic Brain Injury during Early Childhood.

Science.gov (United States)

Treble-Barna, Amery; Wade, Shari L; Martin, Lisa J; Pilipenko, Valentina; Yeates, Keith Owen; Taylor, H Gerry; Kurowski, Brad G

2017-06-01

The present study examined the association of dopamine-related genes with short- and long-term neurobehavioral recovery, as well as neurobehavioral recovery trajectories over time, in children who had sustained early childhood traumatic brain injuries (TBI) relative to children who had sustained orthopedic injuries (OI). Participants were recruited from a prospective, longitudinal study evaluating outcomes of children who sustained a TBI (n = 68) or OI (n = 72) between the ages of 3 and 7 years. Parents completed ratings of child executive function and behavior at the immediate post-acute period (0-3 months after injury); 6, 12, and 18 months after injury; and an average of 3.5 and 7 years after injury. Thirty-two single nucleotide polymorphisms (SNPs) in dopamine-related genes (dopamine receptor D2 [DRD2], solute carrier family 6 member 3 [SLC6A3], solute carrier family 18 member A2 [SLC18A2], catechol-o-methyltransferase [COMT], and ankyrin repeat and kinase domain containing 1 [ANKK1]) were examined in association with short- and long-term executive function and behavioral adjustment, as well as their trajectories over time. After controlling for premorbid child functioning, genetic variation within the SLC6A3 (rs464049 and rs460000) gene was differentially associated with neurobehavioral recovery trajectories over time following TBI relative to OI, with rs464049 surviving multiple testing corrections. In addition, genetic variation within the ANKK1 (rs1800497 and rs2734849) and SLC6A3 (rs464049, rs460000, and rs1042098) genes was differentially associated with short- and long-term neurobehavioral recovery following TBI, with rs460000 and rs464049 surviving multiple testing corrections. The findings provide preliminary evidence that genetic variation in genes involved in DRD2 expression and density (ANKK1) and dopamine transport (SLC6A3) plays a role in neurobehavioral recovery following pediatric TBI.

Early nerve repair in traumatic brachial plexus injuries in adults: treatment algorithm and first experiences.

Science.gov (United States)

Pondaag, Willem; van Driest, Finn Y; Groen, Justus L; Malessy, Martijn J A

2018-01-26

OBJECTIVE The object of this study was to assess the advantages and disadvantages of early nerve repair within 2 weeks following adult traumatic brachial plexus injury (ATBPI). METHODS From 2009 onwards, the authors have strived to repair as early as possible extended C-5 to C-8 or T-1 lesions or complete loss of C-5 to C-6 or C-7 function in patients in whom there was clinical and radiological suspicion of root avulsion. Among a group of 36 patients surgically treated in the period between 2009 and 2011, surgical findings in those who had undergone treatment within 2 weeks after trauma were retrospectively compared with results in those who had undergone delayed treatment. The result of biceps muscle reanimation was the primary outcome measure. RESULTS Five of the 36 patients were referred within 2 weeks after trauma and were eligible for early surgery. Nerve ruptures and/or avulsions were found in all early cases of surgery. The advantages of early surgery are as follows: no scar formation, easy anatomical identification, and gap length reduction. Disadvantages include less-clear demarcation of vital nerve tissue and unfamiliarity with the interpretation of frozen-section examination findings. All 5 early-treatment patients recovered a biceps force rated Medical Research Council grade 4. CONCLUSIONS Preliminary results of nerve repair within 2 weeks of ATBPI are encouraging, and the benefits outweigh the drawbacks. The authors propose a decision algorithm to select patients eligible for early surgery. Referral standards for patients with ATBPI must be adapted to enable early surgery.

Fatigue in adults with traumatic brain injury

DEFF Research Database (Denmark)

Mollayeva, Tatyana; Kendzerska, Tetyana; Mollayeva, Shirin

2013-01-01

BACKGROUND: Despite strong indications that fatigue is the most common and debilitating symptom after traumatic brain injury, little is known about its frequency, natural history, or relation to other factors. The current protocol outlines a strategy for a systematic review that will identify......, assess, and critically appraise studies that assessed predictors for fatigue and the consequences of fatigue on at least two separate time points following traumatic brain injury. METHODS/DESIGN: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO will be systematically...... searched for relevant peer-reviewed studies. Reference lists of eligible papers will also be searched. All English language studies with a longitudinal design that focus on fatigue in adults with primary-impact traumatic brain injury will be included. Studies on fatigue following brain injury due...

The immunological consequences of injury.

LENUS (Irish Health Repository)

Ni Choileain, N

2012-02-03

Immediate and early trauma death rates are determined by "first hits" such as hypoxia, hypotension and organ injury, while late mortality correlates closely with "second hits" such as infection. An imbalance between the early systemic inflammatory response (SIRS), and the later compensatory counter-inflammatory response (CARS), is considered to be responsible for much post-traumatic morbidity and mortality. From a clinical perspective, this remains a significant healthcare problem, which has stimulated decades of experimental and clinical research aimed at understanding the functional effects of injury on the immune system. This review describes the impact of injury on the innate and adaptive immune systems. Though it is worth noting that the features of the immune response to injury overlap in many areas with immune dysregulation in sepsis, we attempt here to elucidate the mechanism by which injury predisposes to infection rather than to describe the alterations in host immunity consequent to established sepsis.

Early treatment with lyophilized plasma protects the brain in a large animal model of combined traumatic brain injury and hemorrhagic shock

DEFF Research Database (Denmark)

Imam, Ayesha M; Jin, Guang; Sillesen, Martin

2013-01-01

Combination of traumatic brain injury (TBI) and hemorrhagic shock (HS) can result in significant morbidity and mortality. We have previously shown that early administration of fresh frozen plasma (FFP) in a large animal model of TBI and HS reduces the size of the brain lesion as well as the assoc...... as the associated edema. However, FFP is a perishable product that is not well suited for use in the austere prehospital settings. In this study, we tested whether a shelf-stable, low-volume, lyophilized plasma (LSP) product was as effective as FFP.......Combination of traumatic brain injury (TBI) and hemorrhagic shock (HS) can result in significant morbidity and mortality. We have previously shown that early administration of fresh frozen plasma (FFP) in a large animal model of TBI and HS reduces the size of the brain lesion as well...

Early Onset of Drug and Polysubstance Use as Predictors of Injection Drug Use Among Adult Drug Users

Science.gov (United States)

Trenz, Rebecca C.; Scherer, Michael; Harrell, Paul; Zur, Julia; Sinha, Ashish; Latimer, William

2012-01-01

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore Maryland. The present study used a subset (N = 651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ2 = 19.71, p < .01), cigarette (χ2 = 11.05, p < .01), marijuana (χ2 = 10.83, p < .01), and polysubstance use (χ2 = 23.48, p < .01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR = 1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR = 1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR = 2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset alcohol and polysubstance use is an important risk factor for IDU in adulthood. PMID:22172686

Fat intake and injury in female runners.

Science.gov (United States)

Gerlach, Kristen E; Burton, Harold W; Dorn, Joan M; Leddy, John J; Horvath, Peter J

2008-01-03

Our purpose was to determine the relationship between energy intake, energy availability, dietary fat and lower extremity injury in adult female runners. We hypothesized that runners who develop overuse running-related injuries have lower energy intakes, lower energy availability and lower fat intake compared to non-injured runners. Eighty-six female subjects, running a minimum of 20 miles/week, completed a food frequency questionnaire and informed us about injury incidence over the next year. Injured runners had significantly lower intakes of total fat (63 +/- 20 vs. 80 +/- 50 g/d) and percentage of kilocalories from fat (27 +/- 5 vs. 30 +/- 8 %) compared with non-injured runners. A logistic regression analysis found that fat intake was the best dietary predictor, correctly identifying 64% of future injuries. Lower energy intake and lower energy availability approached, but did not reach, a significant association with overuse injury in this study. Fat intake is likely associated with injury risk in female runners. By documenting these associations, better strategies can be developed to reduce running injuries in women.

Permanent hypopituitarism is rare after structural traumatic brain injury in early childhood.

Science.gov (United States)

Heather, Natasha L; Jefferies, Craig; Hofman, Paul L; Derraik, José G B; Brennan, Christine; Kelly, Patrick; Hamill, James K M; Jones, Rhys G; Rowe, Deborah L; Cutfield, Wayne S

2012-02-01

We sought to determine the incidence of permanent hypopituitarism in a potentially high-risk group: young children after structural traumatic brain injury (TBI). We conducted a cross-sectional study with longitudinal follow-up. Dynamic tests of pituitary function (GH and ACTH) were performed in all subjects and potential abnormalities critically evaluated. Puberty was clinically staged; baseline thyroid function, prolactin, IGF-I, serum sodium, and osmolality were compared with age-matched data. Diagnosis of GH deficiency was based on an integrated assessment of stimulated GH peak (hypopituitarism were recorded. Permanent hypopituitarism is rare after both inflicted and accidental structural TBI in early childhood. Precocious puberty was the only pituitary hormone abnormality found, but the prevalence did not exceed that of the normal population.

Human neural stem cells differentiate and promote locomotor recovery in an early chronic spinal cord injury NOD-scid mouse model.

Directory of Open Access Journals (Sweden)

Desirée L Salazar

2010-08-01

Full Text Available Traumatic spinal cord injury (SCI results in partial or complete paralysis and is characterized by a loss of neurons and oligodendrocytes, axonal injury, and demyelination/dysmyelination of spared axons. Approximately 1,250,000 individuals have chronic SCI in the U.S.; therefore treatment in the chronic stages is highly clinically relevant. Human neural stem cells (hCNS-SCns were prospectively isolated based on fluorescence-activated cell sorting for a CD133(+ and CD24(-/lo population from fetal brain, grown as neurospheres, and lineage restricted to generate neurons, oligodendrocytes and astrocytes. hCNS-SCns have recently been transplanted sub-acutely following spinal cord injury and found to promote improved locomotor recovery. We tested the ability of hCNS-SCns transplanted 30 days post SCI to survive, differentiate, migrate, and promote improved locomotor recovery.hCNS-SCns were transplanted into immunodeficient NOD-scid mice 30 days post spinal cord contusion injury. hCNS-SCns transplanted mice demonstrated significantly improved locomotor recovery compared to vehicle controls using open field locomotor testing and CatWalk gait analysis. Transplanted hCNS-SCns exhibited long-term engraftment, migration, limited proliferation, and differentiation predominantly to oligodendrocytes and neurons. Astrocytic differentiation was rare and mice did not exhibit mechanical allodynia. Furthermore, differentiated hCNS-SCns integrated with the host as demonstrated by co-localization of human cytoplasm with discrete staining for the paranodal marker contactin-associated protein.The results suggest that hCNS-SCns are capable of surviving, differentiating, and promoting improved locomotor recovery when transplanted into an early chronic injury microenvironment. These data suggest that hCNS-SCns transplantation has efficacy in an early chronic SCI setting and thus expands the "window of opportunity" for intervention.

Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries.

Science.gov (United States)

Sullivan, Michael J L; Thibault, Pascal; Simmonds, Maureen J; Milioto, Maria; Cantin, André-Philippe; Velly, Ana M

2009-10-01

The present study assessed the role of pain and pain-related psychological variables in the persistence of post-traumatic stress symptoms following whiplash injury. Individuals (N=112) with whiplash injuries who had been admitted to a standardized multidisciplinary rehabilitation program were asked to complete measures of pain, post-traumatic stress symptoms, physical function and pain-related psychological variables at three different points during their treatment program. The findings are consistent with previous research showing that indicators of injury severity such as pain, reduced function and disability, and scores on pain-related psychological were associated with more severe post-traumatic stress symptoms in individuals with whiplash injuries. Contrary to expectations, indicators of pain severity did not contribute to the persistence of post-traumatic stress symptoms. Univariate analyses revealed that self-reported disability, pain catastrophizing and perceived injustice were significant determinants of the persistence of post-traumatic stress symptoms. In multivariate analyses, only perceived injustice emerged as a unique predictor of the persistence of post-traumatic stress symptoms. The results suggest that early adequate management of pain symptoms and disability consequent to whiplash injury might reduce the severity of post-traumatic stress symptoms. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of post-traumatic stress symptoms consequent to whiplash injury.

Tracheobronchial injuries in blunt chest trauma

Directory of Open Access Journals (Sweden)

vahid Montazeri

2004-01-01

Full Text Available Introduction: Tracheobronchial injuries are uncommon but potentially fatal complication of blunt thoracic trauma harboring a high morbidity and mortality if not diagnosed early . A recent series gleaning cases from four major Trauma Center in Los Angeles nine cases in a seven- year period , but the incidence of these injuries has been increasing recently. This has been attributed to improvement in hospital care and advanced Trauma Centers and earlier diagnosis of such injuries. Disruption of tight main bronchus is more common, such injuries are often associated with rib or clavicular fractures. Findings: Clinical and paraclinical data gathered from records of three patients referred with tracheobronchial injuries during the recent ten years have been reviewed .These include clinical manifestations, diagnostic findings, treatment modality and clinical course. The outcome has been satisfactory in all three patients who have undergone operation 2-5 hours after sustaining the injury. We have not had any mortality. Conclusion: These results are similar to those of other series emphasizing over early diagnosis and treatment of such injuries .

Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis

Directory of Open Access Journals (Sweden)

Maria Carmo Pereira Nunes

2018-03-01

Full Text Available Background: The early identification of patients at risk of complications of infective endocarditis (IE using parameters obtained as part of routine practice is essential for guiding clinical decision-making. This study aimed to identify a parameter at hospital admission that predicts the outcome, adding value to other well-known factors of a poor prognosis in IE. Methods: Two hundred and three patients with IE were included in this study. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed at hospital admission. The endpoint was in-hospital mortality. Results: The mean age of the patients was 48.2 ± 16.6 years; 62% were male and 38% had rheumatic heart disease. During treatment, cardiac surgery was performed in 111 patients (55%, and the overall in-hospital mortality rate was 32%. In the multivariable analysis, the independent predictors of death were age (odds ratio (OR 1.07, 95% confidence interval (CI 1.02–1.13, C-reactive protein (CRP at hospital admission (OR 1.12, 95% CI 1.04–1.21, length of the vegetation at diagnosis (OR 1.15, 95% CI 1.03–1.28, development of heart failure (OR 6.43, 95% CI 2.14–19.33, and embolic events during antimicrobial therapy (OR 12.14, 95% CI 2.11–71.89. Conclusions: An elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy. Keywords: Infective endocarditis, C-reactive protein, Echocardiography, Mortality

Statistical Evaluation of Causal Factors Associated with Astronaut Shoulder Injury in Space Suits.

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Anderson, Allison P; Newman, Dava J; Welsch, Roy E

2015-07-01

Shoulder injuries due to working inside the space suit are some of the most serious and debilitating injuries astronauts encounter. Space suit injuries occur primarily in the Neutral Buoyancy Laboratory (NBL) underwater training facility due to accumulated musculoskeletal stress. We quantitatively explored the underlying causal mechanisms of injury. Logistic regression was used to identify relevant space suit components, training environment variables, and anthropometric dimensions related to an increased propensity for space-suited injury. Two groups of subjects were analyzed: those whose reported shoulder incident is attributable to the NBL or working in the space suit, and those whose shoulder incidence began in active duty, meaning working in the suit could be a contributing factor. For both groups, percent of training performed in the space suit planar hard upper torso (HUT) was the most important predictor variable for injury. Frequency of training and recovery between training were also significant metrics. The most relevant anthropometric dimensions were bideltoid breadth, expanded chest depth, and shoulder circumference. Finally, record of previous injury was found to be a relevant predictor for subsequent injury. The first statistical model correctly identifies 39% of injured subjects, while the second model correctly identifies 68% of injured subjects. A review of the literature suggests this is the first work to quantitatively evaluate the hypothesized causal mechanisms of all space-suited shoulder injuries. Although limited in predictive capability, each of the identified variables can be monitored and modified operationally to reduce future impacts on an astronaut's health.

Medical and psychosocial predictors of caregiver distress and perceived burden following traumatic brain injury.

Science.gov (United States)

Davis, Lynne C; Sander, Angelle M; Struchen, Margaret A; Sherer, Mark; Nakase-Richardson, Risa; Malec, James F

2009-01-01

To determine whether caregivers' medical and psychiatric histories, coping style, and social support predict global distress and perceived burden. Correlational, cohort study. A total of 114 caregivers of persons with moderate to severe traumatic brain injury, assessed 1 year postinjury. Ratings of caregivers' medical and psychiatric history; Disability Rating Scale; Ways of Coping Questionnaire; Multidimensional Scale of Perceived Social Support; Brief Symptom Inventory; and Modified Caregiver Appraisal Scale. Caregivers' medical and psychiatric histories predicted global distress, after accounting for education, sex, income, and relationship, as well as disability of the person with injury. Increased use of escape-avoidance as a coping strategy was related to increased distress. Perceived burden was predicted by disability in the person with injury, use of escape-avoidance, and perceived social support. Caregivers' preinjury functioning is more predictive of global distress, whereas the functioning of the person with injury is more predictive of injury-related burden. Caregivers' medical and psychiatric histories are important considerations when targeting interventions; global stress management strategies may be as important as assisting with injury-related issues.

Expectancies for Social Support and Negative Mood Regulation Mediate the Relationship between Childhood Maltreatment and Self-Injury

Directory of Open Access Journals (Sweden)

Fiona Tresno

2016-07-01

Full Text Available Nonsuicidal self-injury (NSSI is common among young people. A majority of individuals who injure themselves do so to alleviate negative affect, as most self-injurers report difficulties with mood regulation. Trauma in childhood is an important risk factor that may cause individuals to develop poor interpersonal relations and impaired emotion-regulation, leading to the use of non-adaptive coping strategies such as NSSI. This study examined factors contributing to self-injury, focusing on the link from childhood maltreatment, through mood regulation expectancies and expectancies for social support (father, mother, and friends, to self-injury. Understanding how these variables relate to NSSI is crucial for early identification of individuals at risk of NSSI. Participants were 377 Japanese university students. Lifetime prevalence of self-injury was 20% among the sample. Results showed childhood maltreatment is a strong predictor that increases the risk for NSSI. However, expectancies for social support and mood regulation seem to be potential protective factors. Mood regulation expectancies mediate the relationship between childhood maltreatment and self-injury. In addition, expectancies for social support were indirectly linked with NSSI through negative mood regulation expectancies. It appears that perceived support from father and friends increases one's confidence in regulating difficult emotions, which in turn reduces risk for NSSI. Results suggest that strong expectancies for social support, especially from friends, increase one's confidence in regulating emotion, which contributes as a protective factor against self-injury.

Hamstring injuries: prevention and treatment—an update

Science.gov (United States)

Brukner, Peter

2015-01-01

Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. We now know that not all hamstring injuries are the same and that certain types of injuries require prolonged rehabilitation and return to play. The slow stretch type of injury and injuries involving the central tendon both require longer times to return to play. A number of factors have been proposed as being indicators of time taken to return to play, but the evidence for these is conflicting. Recurrence rates remain high and it is now thought that strength deficits may be an important factor. Strengthening exercise should be performed with the hamstrings in a lengthened position. There is conflicting evidence regarding the efficacy of platelet-rich plasma injection in the treatment of hamstring injuries so at this stage we cannot advise their use. Various tests have been proposed as predictors of hamstring injury and the use of the Nordboard is an interesting addition to the testing process. Prevention of these injuries is the ultimate aim and there is increasing evidence that Nordic hamstring exercises are effective in reducing the incidence. PMID:26105015

Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambézia, Mozambique.

Science.gov (United States)

Cook, Rebecca E; Ciampa, Philip J; Sidat, Mohsin; Blevins, Meridith; Burlison, Janeen; Davidson, Mario A; Arroz, Jorge A; Vergara, Alfredo E; Vermund, Sten H; Moon, Troy D

2011-04-01

A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambézia Province, Mozambique. We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up. Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for early infant diagnosis were larger household size (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09-1.53), independent maternal source of income (OR, 10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR, 2.14; 95% CI, 1.01-4.51), and maternal receipt of antiretroviral therapy (OR, 3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range, 2-7); 16% of the tested infants were infected. Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of antiretroviral therapy has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care.

Change in interstitial fluid pressure measurements in carcinoma of the uterine cervix as an early predictor of radioresponsiveness

International Nuclear Information System (INIS)

Karasek, Kristina; Faul, Clare; Znati, Cindy

1996-01-01

Purpose/Objective: Interstitial fluid pressure (IFP) has been found to be elevated in cervical carcinomas. This study sought to evaluate IFP as a potential early measure of tumor response to radiation therapy. Identification of poor responders early in the course of treatment may allow the clinician to modify the treatment strategy early in the course of therapy. Materials and Methods: IFP was measured using the wick-in-needle technique in 42 patients undergoing definitive radiotherapy for carcinoma of the cervix. Measurements were taken before and after external beam radiation treatment (EBRT) in 25, after intracavitary treatment (ICT) in 7, and after both EBRT and ICT in 10 patients. An additional 10 patients had weekly measurements during radiotherapy. Tumor stage, size, hemoglobin, and clinical response were assessed and correlated with IFP readings. Results: All initial IFP readings were elevated. The extent of elevation did not correlate with outcome (p=0.76) or stage (p=0.6). Smaller tumors had a higher initial IFP (p=0.02). Tumor response correlated with change in IFP readings (p=0.01), tumor size (0.04), hemoglobin (p=0.01), and stage (0.04). On multivariate analysis, change in IFP remained an independent predictor of response. The IFP change from pretreatment to post-EBRT was - 13±3 in complete responders versus 4±11 and 18±10 in the partial and nonresponders respectively (p=0.01). In those with post-ICT readings, the change was -18±4 in complete responders versus 54±18 in the partial responders (p=0.01). In 10 patients undergoing weekly measurement, 8 complete responders had decreasing IFP measurements. An average fall of 51.6% was seen in five patients at < 1620cGy despite little or no change in tumor size, and by 2700cGy (average decrease 31%) in the remaining 3 complete responders. Nonresponders had either no change or an increase in IFP throughout EBRT. Conclusion: IFP is elevated in tumors of the uterine cervix. Decreasing IFP measurement

Interdisciplinary facilitation of the minimal participation of patients with severe brain injury in early rehabilitation

DEFF Research Database (Denmark)

Pallesen, Hanne; Buhl, Inge

2016-01-01

ABSTRACT Aim: The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions. Methodology...... of hospital charts and memos. The data were analyzed using a four-step phenomenological analysis and NVivo 10. Major findings: Participation comes into play in various practices around the patient. Three main themes seem to be important: (1) The dynamic interplay of the multidisciplinary team as an element...

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.

Science.gov (United States)

Taw, Benedict B T; Lam, Alan C S; Ho, Faith L Y; Hung, K N; Lui, W M; Leung, Gilberto K K

2012-07-01

Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery. Copyright © 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

[Evaluation of diffuse cerebral atrophy in patients with a history of traumatic brain injury and its relation to cognitive deterioration].

Science.gov (United States)

Narberhaus, A; Segarra-Castells, M D; Verger-Maestre, K; Serra-Grabulosa, J M; Salgado-Pineda, P; Bartomeus-Jené, F; Mercader-Sobrequés, J M

Diffuse damage secondary to traumatic brain injury (TBI) can be studied through volumetric analysis of several structures that are sensible to this kind of injury, such as corpus callosum, ventricular system, hippocampus, basal ganglia and the volume of cerebrospinal fluid spaces. Our aim is to describe how closed head injury (CHI) occurred in early years produce diffuse damage, and how this damage affects general cognitive functioning at long term. Initially the group of subjects was composed of 27 head injured children and adolescents following paediatric moderate to severe TBI. From this initial group we selected 15 patients without focal lesion, or in case of having suffered focal lesion, this was smaller than 2,600 mm3. These subjects were assessed by means of volumetric analysis of cerebrospinal fluid spaces, corpus callosum, hippocampus and caudate nucleus, comparing the results with a matched control group. We calculated the degree of general cognitive ability of these subjects through tests of intellectual, memory, frontal lobe and motor speed functioning. This study demonstrates that early CHI produce a volume decrease in all measured structures. Corpus callosum atrophy is the factor that better explains general cognitive impairment. Diffuse damage secondary to moderate to severe peadiatric TBI has long term effects on several cerebral structures and on cognitive performance. Corpus callosum atrophy is the best predictor for general cognitive impairment, compared with other affected structures.

Early discharge following birth

DEFF Research Database (Denmark)

Nilsson, Ingrid M. S.; Kronborg, Hanne; Knight, Christopher H.

2017-01-01

.26–0.48) and primiparous compared to multiparous had an OR of 0.22 (CI 0.17–0.29) for early discharge. Other predictors for early discharge were: no induction of labour, no epidural painkiller, bleeding less than 500 ml during delivery, higher gestational age, early expected discharge and positive breastfeeding experience...

Testing an equifinality model of nonsuicidal self-injury among early adolescent girls

Science.gov (United States)

KEENAN, KATE; HIPWELL, ALISON E.; STEPP, STEPHANIE D.; WROBLEWSKI, KRISTEN

2015-01-01

Nonsuicidal self-injury (NSSI) is a common behavior among females that has been shown to confer risk for continued self-injury and suicidal attempts. NSSI can be viewed conceptually as behavior that is pathognomonic with aggression and/or depression. Empirical research on concurrent correlates supports this concept: numerous and diverse factors are shown to be significantly associated with self-harm, including depression, emotion dysregulation, impulsivity, and aggression and other conduct problems, as well as environmental stressors such as bullying, harsh parenting, and negative life events. In the present study, we test hypotheses regarding developmental precursors (measured from ages 8 to 12 years) to NSSI in young adolescent girls (ages 13–14 years), specifically whether aggression, depression, and environmental stressors distinguish girls with and without self-harm, and whether there is evidence for multiple developmental pathways to NSSI. Data were derived from the longitudinal Pittsburgh Girls Study. In this community sample of girls, the prevalence of NSSI at ages 13 or 14 years of age was 6.0%. Initial levels in dimensions measured within the depression, aggression, and environmental stressor domains accounted for variance in NSSI in early adolescence. Changes over time in relational aggression and assertiveness were also significantly associated with risk for NSSI. To a large extent, adolescent NSSI was predicted by psychological deficits and stress exposure that began early in childhood. Risk indices were calculated using the 85th or 15th percentile. Close to 80% of girls who engaged in NSSI during adolescence were identified by at least one risk domain in childhood. A sizable proportion of adolescent girls who later engaged in NSSI had childhood risk scores in all three domains; the remaining girls with adolescent NSSI were relatively evenly distributed across the other risk domain profiles. The observation that multiple pathways to NSSI exist

Psychosocial recovery after serious injury

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Meaghan O'Donnell

2014-12-01

Full Text Available Background: The 2010 iteration of the Global Burden of Disease statistics (Murray et al., 2012 points to the growing impact of injury and highlights the mounting burden of psychiatric disorder. It is essential to examine the intersection between these two contributors to disease burden. Methods: The Australian Injury Vulnerability Study collected data of over 1,000 injury patients from their initial hospitalization to 6 years post-injury. Structured clinical interviews were used to diagnose psychiatric disorder and self-report measures for disability and symptom severity. Results: A wide range of psychiatric disorders developed following injury, which included posttraumatic stress disorder, agoraphobia, depression, and substance use disorders (Bryant, O'Donnell, Creamer, Silove, & McFarlane, 2010. Although prevalence rates for these disorders were generally consistent over time, examination of trajectory data showed that different people had the disorders at different times. Importantly, the data showed that early anxiety, depression, and PTSD symptoms played a significant role in the development of long term disability after injury (Carty, O'Donnell, Evans, Kazantzis, & Creamer, 2011; O'Donnell et al., 2013. Conclusions: These data support the view that transdiagnostic models for early intervention may be required to address the complex psychiatric disorder trajectories that develop after injury.

The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

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Haghbayan, Hourmazd; Boutin, Amélie; Laflamme, Mathieu; Lauzier, François; Shemilt, Michèle; Moore, Lynne; Zarychanski, Ryan; Douville, Vincent; Fergusson, Dean; Turgeon, Alexis F

2017-12-01

Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury. MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015. Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale. Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation. We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias. MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well

Predictors of Early Termination in a University Counseling Training Clinic

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Lampropoulos, Georgios K.; Schneider, Mercedes K.; Spengler, Paul M.

2009-01-01

Despite the existence of counseling dropout research, there are limited predictive data for counseling in training clinics. Potential predictor variables were investigated in this archival study of 380 client files in a university counseling training clinic. Multinomial logistic regression, predictive discriminant analysis, and classification and…

Diabetic retinopathy: A predictor of coronary artery disease

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Fawzia El Demerdash

2012-06-01

Conclusion: Diabetic retinopathy is a good predictor of coronary artery disease that exceeds the conventional risk factors. Diabetics with retinopathy would benefit from early coronary angiography and diabetic retinocoronary clinics are warranted.

Prevalence and Risk Factors for Early Seizure in Patients with Traumatic Brain Injury: Analysis from National Trauma Data Bank.

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Majidi, Shahram; Makke, Yamane; Ewida, Amr; Sianati, Bahareh; Qureshi, Adnan I; Koubeissi, Mohamad Z

2017-08-01

Traumatic brain injury (TBI) is a well-known risk factor for seizures. We aimed to identify the frequency and risk factors for seizure occurrence during hospitalization for TBI. We used ICD-9-CM codes to identify patients 18 years of age or older from the National Trauma Data Bank who were admitted with TBI. We also used ICD-9-CM codes to identify the subset who had seizures during hospitalization. Patient demographics, comorbidities, Glasgow Coma Scale (GCS) score, Injury Severity Score Abbreviated Injury Scale (ISSAIS), in-hospital complications, and discharge disposition were compared in the seizure group (SG) and no-seizure group (NSG). A total of 1559 patients had in-hospital seizures, comprising 0.4% of all patients admitted with TBI. The mean age of SG was 3 years older than NSG [51 vs. 48; p < 0.0001]. African-American ethnicity (20 vs. 12%, p < 0.0001) and moderate TBI (8 vs. 4%, p < 0.0001) were more common in SG. History of alcohol dependence was more common in the SG (25 vs. 11%, p < 0.0001). Fall was the most common mechanism of injury in SG (56 vs. 36% in NSG; p < 0.0001). Subdural hematoma was more common in SG (31 vs. 21%, p < 0.0001). SG had higher rates of pneumonia, ARDS, acute kidney injury, and increased ICP. The average length of hospital stay was significantly higher in SG (10 vs. 6 days, p < 0.0001), and these patients had higher rate of discharge to nursing facility (32 vs. 25%, p < 0.0001). In-hospital seizures occur in 0.4% of all TBI patients. Although infrequent, seizure occurrence is associated with higher rates of hospital complications such as pneumonia and ARDS and is an independent predictor of longer hospital stay and worse hospital outcome.

CT-based injury classification

International Nuclear Information System (INIS)

Mirvis, S.E.; Whitley, N.O.; Vainright, J.; Gens, D.

1988-01-01

Review of preoperative abdominal CT scans obtained in adults after blunt trauma during a 2.5-year period demonstrated isolated or predominant liver injury in 35 patients and splenic injury in 33 patients. CT-based injury scores, consisting of five levels of hepatic injury and four levels of splenic injury, were correlated with clinical outcome and surgical findings. Hepatic injury grades I-III, present in 33 of 35 patients, were associated with successful nonsurgical management in 27 (82%) or with findings at celiotomy not requiring surgical intervention in four (12%). Higher grades of splenic injury generally required early operative intervention, but eight (36%) of 22 patients with initial grade III or IV injury were managed without surgery, while four (36%) of 11 patients with grade I or II injury required delayed celiotomy and splenectomy (three patients) or emergent rehospitalization (one patient). CT-based injury classification is useful in guiding the nonoperative management of blunt hepatic injury in hemodynamically stable adults but appears to be less reliable in predicting the outcome of blunt splenic injury

Frailty as a Predictor of Acute Kidney Injury in Hospitalized Elderly Patients: A Single Center, Retrospective Cohort Study.

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Seon Ha Baek

Full Text Available Elderly patients have an increased risk for acute kidney injury (AKI. However, few studies have reported on predictors for AKI in geriatric patients. Therefore, we aimed at determining the effect of frailty as a predictor of AKI.We retrospectively enrolled 533 hospitalized elderly patients (aged ≥ 65 years who had their creatinine levels measured (≥ 1 measurement during admission for a period of 1 year (2013 and conducted a comprehensive geriatric assessment (CGA within 1 year before the index hospitalization. We examined five variables (activity of daily living [ADL] and instrumental ADL dependence, dementia, nutrition, and polypharmacy from CGA. We categorized the patients into 3 groups according to the tertile of aggregate frailty scores: Group 1, score 1-2; Group 2, score 3-4; Group 3, score 5-8.Fifty-four patients (10.1% developed AKI (median duration, 4 days. The frailest group (Group 3 showed an increased risk of AKI as compared to Group 1, (hazard ratio [HR] = 3.536, P = 0.002. We found that discriminatory accuracy for AKI improved with the addition of the tertile of aggregate frailty score to covariates (area under the receiver operator characteristics curves [AUROC] 0.641, AUROC 0.739, P = 0.004. Forty-six patients (8.6% were transferred to nursing facilities and 477 patients (89.5% were discharged home. The overall 90-day and 1-year mortality for elderly inpatients were 7.9% and 26.3%. The frailest group also demonstrated an increased risk of discharge to nursing facilities, and 90-day and 1-year mortality as compared to Group 1, independent of AKI severity (nursing facilities: odd ratio = 4.843, P = 0.002; 90-day mortality: HR = 6.555, P = 0.002; 1-year mortality: HR = 3.249, P = 0.001.We found that frailty may independently predict the development of AKI and adverse outcomes in geriatric inpatients.

Early Specialization in Youth Sport: A Biomechanical Perspective

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Mattson, Jeffrey M.; Richards, Jim

2010-01-01

This article examines, from a biomechanical perspective, three issues related to early specialization: overuse injuries, the developmental aspects, and the performance aspects. It concludes that "there is no evidence that early specialization causes overuse injuries or hinders growth and maturation." At the same time, early specialization has…

Predictors of Early Community Involvement: Advancing the Self and Caring for Others.

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Lawford, Heather L; Ramey, Heather L

2017-03-01

Recent research on community involvement points to the importance of both agentic (advancing the self) and communal motives (serving others) as key predictors, though few studies have examined both simultaneously. At the same time, research has identified generativity, defined as concern for future generations as a legacy of the self, as particularly relevant for community involvement. Moreover, generativity involves both agentic and communal motives, meaning that advancing personal goals and caring for others are integrated in this construct. Therefore, the purpose of this study was to examine how individual differences in attributes pertaining to self and to others-specifically, self-esteem, initiative, and empathy-related to both generativity and community involvement. A sample of adolescents (N = 160; 64% female, M age  = 17) and a sample of young adults (N = 237; 84% female, M age  = 20) completed a survey including measures of community involvement and generativity. Generative concern fully mediated the associations between individual differences (self-esteem, initiative, and empathy) and community involvement, suggesting that the early generativity has a role in fostering capacities and contribution in youth. These developmental indicators pertaining to self and others link to actions that benefit the community through a desire to benefit future generations. © Society for Community Research and Action 2017.

Family adaptation 18 months after traumatic brain injury in early childhood.

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Stancin, Terry; Wade, Shari L; Walz, Nicolay C; Yeates, Keith Owen; Taylor, H Gerry

2010-05-01

The purpose of this study was to examine family adaptation to a traumatic brain injury (TBI) in young children during the first 18-month postinjury, when compared with children who had an orthopedic injury. A concurrent cohort/prospective research design was used with repeated assessments of children aged 3 to 6 years with TBI or orthopedic injury requiring hospitalization and their families. Shortly after injury and at 6-, 12-, and 18-month postinjury, parents of 99 children with TBI (20 severe, 64 moderate, 15 mild) and 117 with orthopedic injury completed standardized assessments of family functioning, parental distress and coping, injury-related burden, and noninjury-related parent stressors and resources. Mixed models analyses examined group differences in parental burden and distress adjusted for race and social demographic factors. Both moderate and severe TBI were associated with higher levels of injury-related stress than orthopedic injury, with stress levels diminishing over time in all groups. Severe TBI was also associated with greater psychological distress on the Brief Symptom Inventory but not with more depressive symptoms. Family functioning and social resources moderated the relationship of TBI severity to injury-related burden and caregiver distress, respectively. Lower child adaptive skills were associated with poorer family outcome but group differences remained even when controlling for this effect. Severe TBI in young children has adverse consequences for parents and families during the first 18-month postinjury. The consequences lessen over time for many families and vary as a function of social resources.

Decreased respiratory system compliance on the sixth day of mechanical ventilation is a predictor of death in patients with established acute lung injury

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Matthay Michael A

2011-04-01

Full Text Available Abstract Background Multiple studies have identified single variables or composite scores that help risk stratify patients at the time of acute lung injury (ALI diagnosis. However, few studies have addressed the important question of how changes in pulmonary physiologic variables might predict mortality in patients during the subacute or chronic phases of ALI. We studied pulmonary physiologic variables, including respiratory system compliance, P/F ratio and oxygenation index, in a cohort of patients with ALI who survived more than 6 days of mechanical ventilation to see if changes in these variables were predictive of death and whether they are informative about the pathophysiology of subacute ALI. Methods Ninety-three patients with ALI who were mechanically ventilated for more than 6 days were enrolled in this prospective cohort study. Patients were enrolled at two medical centers in the US, a county hospital and a large academic center. Bivariate analyses were used to identify pulmonary physiologic predictors of death during the first 6 days of mechanical ventilation. Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model. Results The overall mortality was 35%. In multivariate analysis, the PaO2/FiO2 (OR 2.09, p th day of acute lung injury. In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p Conclusions A low respiratory system compliance on day 6 or a decrease in the respiratory system compliance between the 1st and 6th day of mechanical ventilation were associated with increased mortality in multivariate analysis of this cohort of patients with ALI. We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

Motor impairment factors related to brain injury timing in early hemiparesis. Part I: expression of upper-extremity weakness.

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Sukal-Moulton, Theresa; Krosschell, Kristin J; Gaebler-Spira, Deborah J; Dewald, Julius P A

2014-01-01

Extensive neuromotor development occurs early in human life, but the time that a brain injury occurs during development has not been rigorously studied when quantifying motor impairments. This study investigated the impact of timing of brain injury on the magnitude and distribution of weakness in the paretic arm of individuals with childhood-onset hemiparesis. A total of 24 individuals with hemiparesis were divided into time periods of injury before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), or after 6 months of age (POST-natal, n = 8). They, along with 8 typically developing peers, participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks using a multiple-degree-of-freedom load cell to quantify torques in 10 directions. A mixed-model ANOVA was used to determine the effect of group and task on a calculated relative weakness ratio between arms. There was a significant effect of both time of injury group (P < .001) and joint torque direction (P < .001) on the relative weakness of the paretic arm. Distal joints were more affected compared with proximal joints, especially in the POST-natal group. The distribution of weakness provides evidence for the relative preservation of ipsilateral corticospinal motor pathways to the paretic limb in those individuals injured earlier, whereas those who sustained later injury may rely more on indirect ipsilateral corticobulbospinal projections during the generation of torques with the paretic arm.

Motor impairment factors related to brain injury timing in early hemiparesis Part I: expression of upper extremity weakness

Science.gov (United States)

Sukal-Moulton, Theresa; Krosschell, Kristin J.; Gaebler-Spira, Deborah J.; Dewald, Julius P.A.

2014-01-01

Background Extensive neuromotor development occurs early in human life, but the time that a brain injury occurs during development has not been rigorously studied when quantifying motor impairments. Objective This study investigated the impact of timing of brain injury on magnitude and distribution of weakness in the paretic arm of individuals with childhood-onset hemiparesis. Methods Twenty-four individuals with hemiparesis were divided into time periods of injury before birth (PRE-natal, n=8), around the time of birth (PERI-natal, n=8) or after 6 months of age (POST-natal, n=8). They, along with 8 typically developing peers, participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks using a multiple degree-of-freedom load cell to quantify torques in 10 directions. A mixed model ANOVA was used to determine the effect of group and task on a calculated relative weakness ratio between arms. Results There was a significant effect of both time of injury group (p<0.001) and joint torque direction (p<0.001) on the relative weakness of the paretic arm. Distal joints were more affected compared to proximal joints, especially in the POST-natal group. Conclusions The distribution of weakness provides evidence for the relative preservation of ipsilateral corticospinal motor pathways to the paretic limb in those individuals injured earlier, while those who sustained later injury may rely more on indirect ipsilateral cortico-bulbospinal projections during the generation of torques with the paretic arm. PMID:24009182

Protective effect of calcium dobesilate combined with benazepril therapy on renal injury in patients with early diabetic nephropathy and the possible molecular mechanisms

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Ling Zhang

2017-06-01

Full Text Available Objective: To explore the protective effect of calcium dobesilate combined with benazepril therapy on renal injury in patients with early diabetic nephropathy and the possible molecular mechanisms. Methods: A total of 50 patients with early diabetic nephropathy treated in our hospital between May 2012 and January 2016 were collected, and according to the random number table, the patients were divided into observation group (n=25 and control group (n=25. On the basis of conventional treatment, control group of patients received benazepril therapy, observation group of patients received calcium dobesilate combined with benazepril therapy, and the treatment lasted for 3 months. Before and after treatment, automatic biochemical analyzer was used to detect the levels of renal injury indexes in peripheral blood, RIA method was used to detect the levels of renal injury indexes in urine, ELISA method was used to detect the levels of renal fibrosis indexes and Western-blot method was used to detect the protein expression of TGF-β1/BMP-7 and Smad signaling pathway molecules in renal tissue. Results: Before treatment, differences in renal injury index levels, renal fibrosis index levels and signaling pathway molecule protein expression were not statistically significant between two groups of patients. After treatment, BUN, SCr and β-TP levels in the peripheral blood as well as KIM-1 level in urine of observation group were lower than those of control group; renal fibrosis indexes TGF-β1, CTGF, TIMP-1, LN and HA levels in serum of observation group were lower than those of control group; TGF-β1 and Smad2/3 protein expression in renal tissue of observation group were lower than those of control group while Smad7 and BMP-7 protein expression were higher than those of control group. Conclusion: Calcium dobesilate combined with benazepril therapy can reduce the renal injury and inhibit the fibrosis process in patients with early diabetic nephropathy, and it

Three phase bone scan in sports injuries

International Nuclear Information System (INIS)

Chauhan, M.S.; Chowhan, M.

2007-01-01

Full text: Sports injuries are common in individual who participate in sports and exercise related activities. In majority of sports related injuries such as stress fracture, periosteitits, acute stress reaction of bone, the radiological investigations are usually normal in early stages. These injuries can lead to serious complications if not detected early and managed properly. This study was jointly carried out in premier medical institutes. All patients were referred from premier sports institute of the country and also by orthopedic surgeons. All patients were subjected for relevant radiological investigations and 3 phase bone scan. Total number of cases included in this study was 70 (N=70) among which bone scan was positive for stress fracture in 45 patients and shin splint was detected in 15 patients and avulsion injury seen in 3 patients. However, only one patient showed features of avulsion injury in X ray and in 1 patient X-ray was inconclusive. Conclusion:-The study shows that 3 phase bone scan is the most sensitive and relatively an inexpensive study. Bone scan has the ability for early detection of sports injuries and provide physiological information and evaluate multiple sites in single examination.SPECT study will help in the diagnostic specificity. (author)

Cost prediction following traumatic brain injury: model development and validation.

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Spitz, Gershon; McKenzie, Dean; Attwood, David; Ponsford, Jennie L

2016-02-01

The ability to predict costs following a traumatic brain injury (TBI) would assist in planning treatment and support services by healthcare providers, insurers and other agencies. The objective of the current study was to develop predictive models of hospital, medical, paramedical, and long-term care (LTC) costs for the first 10 years following a TBI. The sample comprised 798 participants with TBI, the majority of whom were male and aged between 15 and 34 at time of injury. Costing information was obtained for hospital, medical, paramedical, and LTC costs up to 10 years postinjury. Demographic and injury-severity variables were collected at the time of admission to the rehabilitation hospital. Duration of PTA was the most important single predictor for each cost type. The final models predicted 44% of hospital costs, 26% of medical costs, 23% of paramedical costs, and 34% of LTC costs. Greater costs were incurred, depending on cost type, for individuals with longer PTA duration, obtaining a limb or chest injury, a lower GCS score, older age at injury, not being married or defacto prior to injury, living in metropolitan areas, and those reporting premorbid excessive or problem alcohol use. This study has provided a comprehensive analysis of factors predicting various types of costs following TBI, with the combination of injury-related and demographic variables predicting 23-44% of costs. PTA duration was the strongest predictor across all cost categories. These factors may be used for the planning and case management of individuals following TBI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome.

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Skandsen, Toril; Kvistad, Kjell Arne; Solheim, Ole; Strand, Ingrid Haavde; Folvik, Mari; Vik, Anne

2010-09-01

In this prospective cohort study the authors examined patients with moderate to severe head injuries using MR imaging in the early phase. The objective was to explore the occurrence of diffuse axonal injury (DAI) and determine whether DAI was related to level of consciousness and patient outcome. One hundred and fifty-nine patients (age range 5-65 years) with traumatic brain injury, who survived the acute phase, and who had a Glasgow Coma Scale (GCS) score of 3-13 were admitted between October 2004 and August 2008. Of these 159 patients, 106 were examined using MR imaging within 4 weeks postinjury. Patients were classified into 1 of 3 stages of DAI: Stage 1, in which lesions were confined to the lobar white matter; Stage 2, in which there were callosal lesions; and Stage 3, in which lesions occurred in the dorsolateral brainstem. The outcome measure used 12 months postinjury was the Glasgow Outcome Scale-Extended (GOSE). Diffuse axonal injury was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS score was significantly lower in patients with "pure DAI" (median GCS Score 9) than in patients without DAI (median GCS Score 12; p GOSE score of 7, and patients without DAI had a median GOSE score of 8 (p = 0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; p < 0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). Diffuse axonal injury was found in almost three-quarters of the patients with moderate and severe head injury who survived the acute phase. Diffuse axonal injury influenced the level of consciousness, and only in patients with DAI was GCS score related to outcome. Finally, DAI was a negative prognostic sign only when located in the brainstem.

Relatives of patients with severe brain injury

DEFF Research Database (Denmark)

Norup, Anne; Petersen, Janne; Lykke Mortensen, Erik

2015-01-01

PRIMARY OBJECTIVE: To investigate trajectories and predictors of trajectories of anxiety and depression in relatives of patients with a severe brain injury during the first year after injury. RESEARCH DESIGN: A prospective longitudinal study with four repeated measurements. SUBJECTS: Ninety...... relatives of patients with severe brain injury. METHODS: The relatives were assessed on the anxiety and depression scales from the Symptom Checklist-90-Revised and latent variable growth curve models were used to model the trajectories. The effects of patient's age, patient's Glasgow Coma Score, level...... should focus not only on specific deficits in the patient, but also on how the emotional state and well-being of the relatives evolve, while trying to adjust and cope with a new life-situation....

Gender, age and ethnicity influence on pain levels and analgesic use in the acute whiplash injury.

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Koren, L; Peled, E; Trogan, R; Norman, D; Berkovich, Y; Israelit, S

2015-06-01

Initial pain level in the acute whiplash injury is the most consistent predictor of transformation to a chronic pain syndrome. The risk factors for those early pain levels were, to our knowledge, scarcely evaluate to this date. We set to evaluate whether gender, age or ethnicity comprise a risk factor for those initial pain levels. Further, gender, age and ethnicity have been shown to be bias factors in pain management. We investigated if gender, age or ethnicity are bias factor in pain management in the face of a standardized pain treatment protocol in the acute whiplash injury. We reviewed 2,538 patients with acute whiplash injury that were treated at our emergency department (ED). Gender, age and ethnicity were investigated as risk factors for elevated visual analog scale (VAS) scores. Those factors were also investigated as bias in pain medication administration in the face of a standardized analgesic protocol. Women had significantly higher VAS scores (p = 0.009). Age and ethnicity did not influence pain levels. There was no influence of gender or age on pain medication administration. The Jewish patients (the majority in Israel) were administered fewer pain medication (p whiplash injury. Age and ethnicity have less impact on those pain levels. A pain management protocol might reduce bias in pain management in the acute whiplash injury in the ED. The Jewish population tends to be less receptive to pain medication administration.

Fat intake and injury in female runners

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Leddy John J

2008-01-01

Full Text Available Abstract Background Our purpose was to determine the relationship between energy intake, energy availability, dietary fat and lower extremity injury in adult female runners. We hypothesized that runners who develop overuse running-related injuries have lower energy intakes, lower energy availability and lower fat intake compared to non-injured runners. Methods Eighty-six female subjects, running a minimum of 20 miles/week, completed a food frequency questionnaire and informed us about injury incidence over the next year. Results Injured runners had significantly lower intakes of total fat (63 ± 20 vs. 80 ± 50 g/d and percentage of kilocalories from fat (27 ± 5 vs. 30 ± 8 % compared with non-injured runners. A logistic regression analysis found that fat intake was the best dietary predictor, correctly identifying 64% of future injuries. Lower energy intake and lower energy availability approached, but did not reach, a significant association with overuse injury in this study. Conclusion Fat intake is likely associated with injury risk in female runners. By documenting these associations, better strategies can be developed to reduce running injuries in women.

Early lymphocyte recovery as a predictor of outcome, including relapse, after hematopoieticstem cell transplantation

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Juliane Morando

2012-01-01

Full Text Available BACKGROUND: Despite advances in the treatment of acute leukemia, many patients need to undergo hematopoietic stem cell transplantation. Recent studies show that early lymphocyte recovery may be a predictor of relapse and survival in these patients. OBJECTIVE: To analyze the influence of lymphocyte recovery on Days +30 and +100 post-transplant on the occurrence of relapse and survival. METHODS: A descriptive, retrospective study was performed of 137 under 21-year-old patients who were submitted to hematopoietic stem cell transplantation for acute leukemia between 1995 and 2008. A lymphocyte count 0.3 x 10(9/L were considered adequate. Lymphocyte recovery was also analyzed on Day +100 with < 0.75 x 10(9/Land < 0.75 x 10(9/L being considered inadequate and adequate lymphocyte recovery, respectively. RESULTS: There was no significant difference in the occurrence of relapse between patients with inadequate and adequate lymphocyte recovery on Day +30 post-transplant. However, the transplant-related mortality was significantly higher in patients with inadequate recovery on Day +30. Patients with inadequate lymphocyte recovery on Day +30 had worse overall survival and relapse-free survival than patients with adequate recovery. There was no significant difference in the occurrence of infections and acute or chronic graft-versus-host disease. Patients with inadequate lymphocyte recovery on Day +100 had worse overall survival and relapse-free survival and a higher cumulative incidence of relapse. CONCLUSION: The evaluation of lymphocyte recovery on Day +30 is not a good predictor of relapse after transplant however patients with inadequate lymphocyte recovery had worse overall survival and relapse-free survival. Inadequate lymphocyte recovery on Day +100 is correlated with higher cumulative relapse as well as lower overall survival and relapse-free survival.

Early predictors of high school mathematics achievement.

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Siegler, Robert S; Duncan, Greg J; Davis-Kean, Pamela E; Duckworth, Kathryn; Claessens, Amy; Engel, Mimi; Susperreguy, Maria Ines; Chen, Meichu

2012-07-01

Identifying the types of mathematics content knowledge that are most predictive of students' long-term learning is essential for improving both theories of mathematical development and mathematics education. To identify these types of knowledge, we examined long-term predictors of high school students' knowledge of algebra and overall mathematics achievement. Analyses of large, nationally representative, longitudinal data sets from the United States and the United Kingdom revealed that elementary school students' knowledge of fractions and of division uniquely predicts those students' knowledge of algebra and overall mathematics achievement in high school, 5 or 6 years later, even after statistically controlling for other types of mathematical knowledge, general intellectual ability, working memory, and family income and education. Implications of these findings for understanding and improving mathematics learning are discussed.

Family Adaptation 18 Months After Traumatic Brain Injury in Early Childhood

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Stancin, Terry; Wade, Shari L.; Walz, Nicolay C.; Yeates, Keith Owen; Taylor, H. Gerry

2014-01-01

Objective The purpose of this study was to examine family adaptation to a traumatic brain injury (TBI) in young children during the first 18-month postinjury, when compared with children who had an orthopedic injury. Methods A concurrent cohort/prospective research design was used with repeated assessments of children aged 3 to 6 years with TBI or orthopedic injury requiring hospitalization and their families. Shortly after injury and at 6-, 12-, and 18-month postinjury, parents of 99 children with TBI (20 severe, 64 moderate, 15 mild) and 117 with orthopedic injury completed standardized assessments of family functioning, parental distress and coping, injury-related burden, and noninjury-related parent stressors and resources. Mixed models analyses examined group differences in parental burden and distress adjusted for race and social demographic factors. Results Both moderate and severe TBI were associated with higher levels of injury-related stress than orthopedic injury, with stress levels diminishing over time in all groups. Severe TBI was also associated with greater psychological distress on the Brief Symptom Inventory but not with more depressive symptoms. Family functioning and social resources moderated the relationship of TBI severity to injury-related burden and caregiver distress, respectively. Lower child adaptive skills were associated with poorer family outcome but group differences remained even when controlling for this effect. Conclusions Severe TBI in young children has adverse consequences for parents and families during the first 18-month postinjury. The consequences lessen over time for many families and vary as a function of social resources. PMID:20431399

Variability and predictors of serum perfluoroalkyl substance concentrations during pregnancy and early childhood.

Science.gov (United States)

Kingsley, Samantha L; Eliot, Melissa N; Kelsey, Karl T; Calafat, Antonia M; Ehrlich, Shelley; Lanphear, Bruce P; Chen, Aimin; Braun, Joseph M

2018-08-01

Exposure to poly- and perfluoroalkyl substances (PFAS), ubiquitous and persistent environmental contaminants, could be associated with adverse health outcomes, but there are limited longitudinal data assessing patterns and predictors of exposure during childhood. We quantified concentrations of eight different PFAS in sera collected from women during pregnancy and children at delivery and ages 3 and 8 years in 367 mother-child pairs enrolled in a prospective cohort from 2003 to 2006. In general, median childhood PFAS concentrations increased from birth to age 3 and then decreased by age 8. Maternal serum PFAS concentrations during pregnancy were strongly correlated with cord serum concentrations (0.76 PFAS concentrations, including income, race, and parity. In children, serum PFAS concentrations were associated with maternal age at delivery, race, parity, and child age. Breastfeeding duration was positively associated with childhood PFAS concentrations at ages 3 and 8 years. In addition, stain repellant use was associated with higher perfluorooctanoic acid and perfluorohexane sulfonic acid concentrations at age 8 years. Serum PFAS concentrations are higher during early childhood, a potentially sensitive period of development, and were highest among breastfed children. Copyright © 2018 Elsevier Inc. All rights reserved.

The association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition.

Science.gov (United States)

Gabbe, B J; Bailey, M; Cook, J L; Makdissi, M; Scase, E; Ames, N; Wood, T; McNeil, J J; Orchard, J W

2010-09-01

To establish the relationship between the history of hip and groin injuries in elite junior football players prior to elite club recruitment and the incidence of hip and groin injuries during their elite career. Retrospective cohort study. Analysis of existing data. 500 Australian Football League (AFL) players drafted from 1999 to 2006 with complete draft medical assessment data. Previous history of hip/groin injury, anthropometric and demographic information. The number of hip/groin injuries resulting in > or =1 missed AFL game. Data for 500 players were available for analysis. 86 (17%) players reported a hip/groin injury in their junior football years. 159 (32%) players sustained a hip/groin injury in the AFL. Players who reported a previous hip or groin injury at the draft medical assessment demonstrated a rate of hip/groin injury in the AFL >6 times higher (IRR 6.24, 95% CI 4.43 to 8.77) than players without a pre-AFL hip or groin injury history. This study demonstrated that a hip or groin injury sustained during junior football years is a significant predictor of missed game time at the elite level due to hip/groin injury. The elite junior football period should be targeted for research to investigate and identify modifiable risk factors for the development of hip/groin injuries.

Proliferation during early phases of bronchiolar repair in neonatal rabbits following lung injury by 4-ipomeanol

International Nuclear Information System (INIS)

Smiley-Jewell, Suzette M.; Plopper, Charles G.

2003-01-01

Nonciliated bronchiolar (Clara cells) are progenitor cells during development. During differentiation, they are more susceptible to injury by environmental toxicants metabolized by the cytochrome P450 monooxygenase system, and injury results in altered bronchiolar repair and development. Squamous cells and abnormal cuboidal epithelium persist into early adulthood. The hypothesis tested in this study was that the failure of bronchiolar epithelium to repair normally in neonates following injury is due to an inhibition of proliferation. A model of differential repair in rabbit kits was used. Proliferation was followed for 1 week post injury in rabbit kits treated with a single dose of the P450-mediated cytotoxicant 4-ipomeanol (IPO) at 7 days old (repair abnormal) and compared to rabbits treated with a single dose of IPO at 21 days old (repair normal). Proliferation was measured by the nuclear incorporation of 5-chloro-2'-deoxyuridine (CldU) within epithelium at the target site (terminal bronchiole). The repair pattern between the two age groups was histologically defined. There was no difference in the CdlU labeling index during the week of repair between the two age groups, even though the bronchiolar epithelium did not return to normal in the animals treated at 7 days old. In summary, proliferation (through S-phase) is not inhibited during repair in neonatal rabbits treated with IPO at 7 days old compared to animals treated at 21 days old, and we conclude that other factors may be responsible for the altered repair in the young neonates injured by a P450-mediated cytotoxicant

The patient–body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment