External validation of a pediatric decision rule for blunt abdominal trauma

INTRODUCTION

Blunt traumatic injuries are a leading cause of morbidity and mortality in the pediatric population. Contrast-enhanced multidetector computed tomography is the best imaging tool for screening patients at risk of blunt abdominal injury. The Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule was derived to identify patients at low risk for significant abdominal injury who do not require imaging.

METHODS

We conducted a retrospective review of pediatric patients with blunt trauma to validate the PECARN rule in a non-pediatric specialized hospital from February 3, 2013, through December 31, 2019. We excluded those with penetrating or mild isolated head injury. The PECARN decision rule was retrospectively applied for the presence of a therapeutic intervention, defined as a laparotomy, angiographic embolization, blood transfusion, or administration of intravenous fluids for pancreatic or gastrointestinal injury. Sensitivity and specificity analysis were conducted along with the negative and positive predictive values.

RESULTS

A total of 794 patients were included in the final analysis; 23 patients met the primary outcome for an acute intervention. The PECARN clinical decision rule (CDR) had a sensitivity of 91.3%, a negative predictive value of 99.5, and a negative likelihood ration of 0.16.

CONCLUSION

In a non-pediatric specialty hospital, the PECARN blunt abdominal CDR performed with comparable sensitivity and negative predictive value to the derivation and external validation study performed at specialized children's hospitals.

Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users

Introduction

Case management is an effective, short-term means to reduce emergency department (ED) visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS), accrued costs, and utilization of diagnostic tests.

Methods

The study consisted of a retrospective chart review of ED and inpatient visits in our hospital's ED case management program, comparing patient visits made in the one year prior to enrollment in the program, to the visits made in the one year after enrollment in the program. We examined the LOS, use of diagnostic testing, and monetary charges incurred by these patients one year prior and one year after enrollment into case management.

Results

The study consisted of 158 patients in case management. Comparing the one year prior to enrollment to the one year after enrollment, ED visits decreased by 49%, inpatient admissions decreased by 39%, the use of computed tomography imaging decreased 41%, the use of ultrasound imaging decreased 52%, and the use of radiographs decreased 38%. LOS in the ED and for inpatient admissions decreased by 39%, reducing total LOS for these patients by 178 days. ED and hospital charges incurred by these patients decreased by 5.8 million dollars, a 41% reduction. All differences were statistically significant.

Conclusion

Case management for frequent users of the ED is an effective method to reduce patient visits, the use of diagnostic testing, length of stay, and cost within our institution.

Charge transfer emission of ytterbium-doped oxyborates

The ultraviolet spectroscopic properties of trivalent ytterbium have been studied at low temperature in one borate and two oxyborates in the ternary diagram Li(2)O-Y(2)O(3)-B(2)O(3). The UV luminescence was detected in the two ytterbium-doped oxyborates. The evolution of these emissions was studied as a function of the temperature. A determination of the configurational coordinate diagrams based on the Struck and Fonger model is proposed to calculate the position in energy of the charge transfer band afforded by the simulation of spectral distribution of these excitation and emission bands. The strong correlation between the luminescent properties and the environments of the rare earth is pointed out.

Thiazolinium and imidazolium chiral ionic liquids derived from natural amino acid derivatives

Starting from commercially available amino acid derivatives, two novel families of chiral ionic liquids having either a thiazolinium or an imidazolium cation were prepared by simple and straightforward procedures in good overall yields. The properties of these new salts can be finely tuned by careful selection of the anion and the cation.

Photodarkening and photobleaching of an ytterbium-doped silica double-clad LMA fiber

We studied the temporal evolution of the photodarkening effect in an Yb-doped silica LMA fiber. The absorption spectra exhibit an increase in absorption in the visible and in the near infrared spectral range when the fiber is exposed to pump light around 980 nm. We show the influence of the photodarkening on the cw lasing properties of the fiber, and demonstrate photobleaching of the same fiber by exposure to UV light at 355 nm. The corresponding absorption spectra and lasing performances are shown and are entirely comparable to those of a new fiber.

Mitochondrial gene expression and respiratory enzyme activities in cardiac diseases

Respiratory enzyme activities and steady-state level of two mitochondrial-encoded transcripts were quantified in heart muscle biopsies from patients suffering various types of cardiomyopathies unrelated to mitochondrial primary disorders. We have found that although the mitochondrial DNA copy number and the concentration of COI and ND4 transcripts remain fairly constant, there is an important increase (up to 6-fold) in respiratory enzyme activities affecting to several oxidative phosphorylation complexes. Idiopathic dilated cardiomyopathy shows the greatest increase, followed by ischemic heart and ventricular hypertrophy due to aortic stenosis. The results suggest an energetic compensatory mechanism in the heart muscle, in the absence of mitochondrial proliferation or activation of mitochondrial gene expression.

A comparison of the performance of male and female CBD distributors in Peru

This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.