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1.
PLoS Comput Biol ; 17(7): e1009180, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34214077

RESUMO

Broad scale remote sensing promises to build forest inventories at unprecedented scales. A crucial step in this process is to associate sensor data into individual crowns. While dozens of crown detection algorithms have been proposed, their performance is typically not compared based on standard data or evaluation metrics. There is a need for a benchmark dataset to minimize differences in reported results as well as support evaluation of algorithms across a broad range of forest types. Combining RGB, LiDAR and hyperspectral sensor data from the USA National Ecological Observatory Network's Airborne Observation Platform with multiple types of evaluation data, we created a benchmark dataset to assess crown detection and delineation methods for canopy trees covering dominant forest types in the United States. This benchmark dataset includes an R package to standardize evaluation metrics and simplify comparisons between methods. The benchmark dataset contains over 6,000 image-annotated crowns, 400 field-annotated crowns, and 3,000 canopy stem points from a wide range of forest types. In addition, we include over 10,000 training crowns for optional use. We discuss the different evaluation data sources and assess the accuracy of the image-annotated crowns by comparing annotations among multiple annotators as well as overlapping field-annotated crowns. We provide an example submission and score for an open-source algorithm that can serve as a baseline for future methods.


Assuntos
Bases de Dados Factuais , Monitoramento Ambiental/métodos , Florestas , Processamento de Imagem Assistida por Computador/métodos , Árvores , Algoritmos , Benchmarking , Ecossistema , Imagem Óptica , Árvores/classificação , Árvores/fisiologia
2.
Pediatr Emerg Care ; 37(6): 296-302, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34038924

RESUMO

OBJECTIVE: To compare radiation doses used for pediatric computed tomography (CT) scans at community-based referring facilities (RF) to those at a designated pediatric trauma center (PTC) to assess the consistency of radiation exposure. METHODS: In this retrospective study, patients 0 to 18 years of age with CT imaging performed either at a RF or at a PTC from January 1, 2015, to January 5, 2016, were identified. Data about patients, CT radiation dose, and characteristics of the RFs were compared. RESULTS: We identified 502 patients (156 RF, 346 PTC) with 281 head CTs (79 RF, 202 PTC) and 86 abdominal/pelvis CTs (28 RF, 58 PTC). The radiation dose (measured in mean dose-length product [DLP] ± 1 standard deviation) was significantly higher for RF scans compared with PTC scans (head, RF DLP = 545 ± 334 vs PTC DLP = 438 ± 186 (P < 0.001); abdomen/pelvis, RF DLP = 279 ± 160 vs PTC DLP = 181 ± 201 [P = 0.027]). There was a nonsignificant trend toward lower head CT radiation dosages at RFs with a dedicated pediatric emergency department compared with RFs without a pediatric emergency department. CONCLUSIONS: Our data suggest that CT scans performed at RFs expose pediatric patients to significantly higher doses of radiation when compared with a PTC. These data support further study to identify factors associated with increased radiation and educational outreach to RFs.


Assuntos
Exposição à Radiação , Centros de Traumatologia , Criança , Humanos , Doses de Radiação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
J Surg Res ; 246: 153-159, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31586889

RESUMO

BACKGROUND: Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). MATERIALS AND METHODS: We performed a retrospective cohort study at two level I pediatric trauma centers. INCLUSION CRITERIA: <15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics. RESULTS: We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82). CONCLUSIONS: Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.


Assuntos
Transporte de Pacientes/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Triagem/organização & administração , Ferimentos não Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/organização & administração , Utilização de Instalações e Serviços/normas , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Triagem/normas , Triagem/estatística & dados numéricos , Estados Unidos , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapia
4.
Qual Life Res ; 29(4): 1083-1091, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31853882

RESUMO

AIMS: There is a need for a brief, validated measure of quality of life (QOL) for children to monitor their adjustment to burn injuries. We aimed to apply a Rasch analysis to an existing measure of QOL from the dermatology literature to a clinical sample of pediatric burn patients. METHODS: The Children's Dermatology Life Quality Index (CDLQI) was administered to pediatric burn patients (N = 253) during a standard clinic visit. Rasch analysis was used to examine psychometric properties of this measure with a burn sample. RESULTS: The CDLQI showed an adequate fit to the Rasch model. Test difficulty is .61 logits greater than person ability. Results of item reliability and separation analyses were sufficiently strong and indicated a unidimensional latent trait. Person reliability (.74) and separation analyses (1.64) were moderate. Finally, the CDLQI was able to moderately separate the group of respondents into low and high levels of QOL impairments related to burn injuries. CONCLUSION: The Rasch model demonstrated that the CDLQI is a reliable and valid scale that adequately measures QOL impairments in children following burn injuries.


Assuntos
Queimaduras/psicologia , Psicometria/métodos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Adolescente , Assistência Ambulatorial , Criança , Pré-Escolar , Dermatologia , Família , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
5.
J Pediatr Gastroenterol Nutr ; 68(1): 56-63, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30358741

RESUMO

Biliary atresia (BA) is the most common cause of pediatric end-stage liver disease and the etiology is poorly understood. There is no effective therapy for BA partly due to lack of human BA models. Towards developing in vitro human models of BA, disease-specific induced pluripotent stem cells (iPSCs) from 6 BA patients were generated using non-integrating episomal plasmids. In addition, to determine the functional significance of BA-susceptibility genes identified by genome-wide association studies (GWAS) in biliary development, a genome-editing approach was used to create iPSCs with defined mutations in these GWAS BA loci. Using the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 system, isogenic iPSCs deficient in BA-associated genes (GPC1 and ADD3) were created from healthy iPSCs. Both the BA patient-iPSCs and the knock out (KO) iPSCs were studied for their in vitro biliary differentiation potential. These BA-specific iPSCs demonstrated significantly decreased formation of ductal structures, decreased expression of biliary markers including CK7, EpCAM, SOX9, CK19, AE2, and CFTR and increased fibrosis markers such as alpha smooth muscle actin, Loxl2, and Collagen1 compared to controls. Both the patient- and the KO-iPSCs also showed increased yes-associated protein (YAP, a marker of bile duct proliferation/fibrosis). Collagen and YAP were reduced by treatment with the anti-fibrogenic drug pentoxifylline. In summary, these BA-specific human iPSCs showed deficiency in biliary differentiation along with increased fibrosis, the 2 key disease features of BA. These iPSCs can provide new human BA models for understanding the molecular basis of abnormal biliary development and opportunities to identify drugs that have therapeutic effects on BA.


Assuntos
Atresia Biliar/genética , Células-Tronco Pluripotentes Induzidas/citologia , Diferenciação Celular/genética , Feminino , Loci Gênicos/genética , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Humanos , Lactente , Masculino , Mutação , Pentoxifilina/farmacologia
6.
Hepatology ; 65(5): 1645-1654, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28027587

RESUMO

To evaluate the efficacy of nontransplant surgery for pediatric cholestasis, 58 clinically diagnosed children, including 20 with Alagille syndrome (ALGS), 16 with familial intrahepatic cholestasis-1 (FIC1), 18 with bile salt export pump (BSEP) disease, and 4 others with low γ-glutamyl transpeptidase disease (levels <100 U/L), were identified across 14 Childhood Liver Disease Research Network (ChiLDReN) centers. Data were collected retrospectively from individuals who collectively had 39 partial external biliary diversions (PEBDs), 11 ileal exclusions (IEs), and seven gallbladder-to-colon (GBC) diversions. Serum total bilirubin decreased after PEBD in FIC1 (8.1 ± 4.0 vs. 2.9 ± 4.1 mg/dL, preoperatively vs. 12-24 months postoperatively, respectively; P = 0.02), but not in ALGS or BSEP. Total serum cholesterol decreased after PEBD in ALGS patients (695 ± 465 vs. 457 ± 319 mg/dL, preoperatively vs. 12-24 months postoperatively, respectively; P = 0.0001). Alanine aminotransferase levels increased in ALGS after PEBD (182 ± 70 vs. 260 ± 73 IU/L, preoperatively vs. 24 months; P = 0.03), but not in FIC1 or BSEP. ALGS, FIC1, and BSEP patients experienced less severely scored pruritus after PEBD (ALGS, 100% vs. 9% severe; FIC1, 64% vs. 10%; BSEP, 50% vs. 20%, preoperatively vs. >24 months postoperatively, respectively; P < 0.001). ALGS patients experienced a trend toward greater freedom from xanthomata after PEBD. There was a trend toward decreased pruritus in FIC1 after IE and GBC. Vitamin K supplementation increased in ALGS after PEBD (33% vs. 77%; P = 0.03). Overall, there were 15 major complications after surgery. Twelve patients (3 ALGS, 3 FIC1, and 6 BSEP) subsequently underwent liver transplantation. CONCLUSION: This was a multicenter analysis of nontransplant surgical approaches to intrahepatic cholestasis. Approaches vary, are well tolerated, and generally, although not uniformly, result in improvement of pruritus and cholestasis. (Hepatology 2017;65:1645-1654).


Assuntos
Colestase Intra-Hepática/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Circulação Êntero-Hepática , Adolescente , Criança , Pré-Escolar , Colestase Intra-Hepática/sangue , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
7.
Pediatr Surg Int ; 33(3): 367-376, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28025693

RESUMO

PURPOSE: Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years. METHODS: A prospective, single-blind, parallel group randomized controlled trial was conducted at three clinical sites. Children ≤3 years of age with reducible unilateral or bilateral inguinal hernias were randomized to laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH). The primary outcome was the number of acetaminophen doses. Secondary outcomes included operative time, complications, and parent/caregiver satisfaction scores. RESULTS: Forty-one patients were randomized to unilateral OH (n = 10), unilateral LH (n = 17), bilateral OH (n = 5) and bilateral LH (n = 9). Acetaminophen doses, LOS, complications, and parent/caregiver scores did not differ among groups. Laparoscopic unilateral hernia repair demonstrated shorter operative time, a consistent finding for overall laparoscopic repair in univariate (p = 0.003) and multivariate (p = 0.010) analysis. No cases of testicular atrophy were documented at 2 (SD = 2.7) years. CONCLUSION: Children ≤3 years of age in our cohort safely underwent LH with similar pain scores, complications, and recurrence as OH. Parents and caregivers report high satisfaction with both techniques.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
8.
Pediatr Surg Int ; 31(5): 493-9, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25814003

RESUMO

BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) is a well-established procedure. However, morbidity rate varies widely among institutions, and the incidence of major complications remains unknown. STUDY DESIGN: The American College of Surgeons 2012 National Surgical Quality Improvement Program-Pediatric (NSQIP-P) participant user file was utilized to identify patients who underwent MIRPE at 50 participant institutions. Outcomes of interest were overall 30-day morbidity, hospital readmission, and reoperation. RESULTS: Chest wall repair designated MIRPE accounted for 0.6% (n = 264) of all surgical cases included in the NSQIP-P database in 2012. The median age at surgical repair was 15.2 years. Thoracoscopy was used in 83.7% of cases. No mediastinal injuries or perioperative blood transfusions were identified. The 30-day readmission rate was 3.8%. Three patients (1.1%) required re-operation due to the following complications: superficial site infection, bar displacement and pneumothorax. The overall morbidity was 3.8% with no incidences of mortality. CONCLUSIONS: This analysis of a large prospective multicenter dataset demonstrates that major complications following MIRPE are uncommon in contemporary practice. Wound infection is the most common complication and the main cause of hospital readmission. Targeted quality improvement initiative should be focused on perioperative strategy to further reduce wound occurrences and hospital readmission.


Assuntos
Tórax em Funil/cirurgia , Hospitais Pediátricos/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Tórax em Funil/epidemiologia , Humanos , Lactente , Masculino , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Sociedades Médicas , Toracoscopia , Estados Unidos/epidemiologia
9.
Int J Pediatr Otorhinolaryngol ; 164: 111414, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36527981

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a prevalent cause of disability and death in the pediatric population, often requiring prolonged mechanical ventilation. Patients with significant TBI or intracranial hemorrhage require advanced airway management to protect against aspiration, hypoxia, and hypercarbia, eventually necessitating tracheostomy. While tracheostomy is much less common in children compared to adults, its prevalence among pediatric populations has been steadily increasing. Although early tracheostomy has demonstrated improved outcomes in adult patients, optimal tracheostomy timing in the pediatric population with TBI remains to be definitively established. OBJECTIVE: This retrospective cohort analysis aims to evaluate pediatric TBI patients who undergo tracheostomy and to investigate the impact of tracheostomy timing on outcomes. DESIGN/METHODS: The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), collected between in 2016 and 2019, was queried using International Classification of Disease 10th edition (ICD10) codes for patients with traumatic brain injury who had received a tracheostomy. Baseline demographics, insurance status, and procedural day data were analyzed with univariate and multivariate regression analyses. Propensity score matching was performed to estimate the incidence of medical complications and mortality related to early versus late tracheostomy timing (as defined by median = 9 days). RESULTS: Of the 68,793 patients (mean age = 14, IQR 4-18) who suffered a TBI, 1,956 (2.8%) received a tracheostomy during their hospital stay. TBI patients who were tracheostomized were older (mean age = 16.5 vs 11.4 years), more likely to have injuries classified as severe TBIs and more likely to have accumulated more than one indicator of parenchymal injury as measured by the Composite Stroke Severity Scale (CSSS >1) than non-tracheostomized TBI patients. TBI patients with a tracheostomy were more likely to encounter serious complications such as sepsis, acute kidney injury (AKI), meningitis, or acute respiratory distress syndrome (ARDS). They were also more likely to necessitate an external ventricular drain (EVD) or decompressive hemicraniectomy (DHC) than TBI patients without a tracheostomy. Tracheostomy was also negatively associated with routine discharge. Procedural timing was assessed in 1,867 patients; older children (age >15 years) were more likely to undergo earlier placements (p < 0.001). Propensity score matching (PSM) comparing early versus late placement was completed by controlling for age, gender, and TBI severity. Those who were subjected to late tracheostomy (>9 days) were more likely to face complications such as AKI or deep vein thrombosis (DVT) as well as a host of respiratory conditions such as pulmonary embolism, aspiration pneumonitis, pneumonia, or ARDS. While the timing did not significantly impact mortality across the PSM cohorts, late tracheostomy was associated with increased length of stay (LOS) and ventilator dependence. CONCLUSIONS: Tracheostomy, while necessary for some patients who have sustained a TBI, is itself associated with several risks that should be assessed in context of each individual patient's overall condition. Additionally, the timing of the intervention may significantly impact the trajectory of the patient's recovery. Early intervention may reduce the incidence of serious complications as well as length of stay and dependence on a ventilator and facilitate a timelier recovery.


Assuntos
Lesões Encefálicas Traumáticas , Traqueostomia , Adulto , Humanos , Criança , Adolescente , Traqueostomia/efeitos adversos , Estudos Retrospectivos , Lesões Encefálicas Traumáticas/cirurgia , Tempo de Internação , Respiração Artificial
10.
J Neurosurg Pediatr ; 31(5): 417-422, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-36787133

RESUMO

OBJECTIVE: Traumatic brain injuries (TBIs) play a significant role in pediatric mortality and morbidity. Decompressive hemicraniectomy (DHC) is a treatment option for severe pediatric TBI (pTBI) not amenable to medical management of intracranial pressure. Posttraumatic hydrocephalus (PTH) is a known sequela of DHC that may lead to further injury and decreased capacity for recovery if not identified and treated. The goal of this study was to characterize risk factors for PTH after DHC in patients with pTBI by using the Kids' Inpatient Database (KID). METHODS: The records collected in the KID from 2016 to 2019 were queried for patients with TBI using International Classification of Diseases, 10th Revision codes. Data defining demographics, complications, procedures, and outcomes were extracted. Multivariate regression was used to identify risk factors associated with PTH. The authors also investigated length of stay and hospital charges. RESULTS: Of 68,793 patients with pTBI, 848 (1.2%) patients underwent DHC. Prolonged mechanical ventilation (PMV) was required in 475 (56.0%) patients with pTBI undergoing DHC. Three hundred (35.4%) patients received an external ventricular drain (EVD) prior to DHC. PTH was seen in 105 (12.4%), and 50 (5.9%) received a ventriculoperitoneal shunt. DHC before hospital day 2 was negatively associated with PTH (OR 0.464, 95% CI 0.267-0.804; p = 0.006), whereas PMV (OR 2.204, 95% CI 1.344-3.615; p = 0.002) and EVD placement prior to DHC (OR 6.362, 95% CI 3.667-11.037; p < 0.001) were positively associated with PTH. PMV (OR 7.919, 95% CI 2.793-22.454; p < 0.001), TBI with subdural hematoma (OR 2.606, 95% CI 1.119-6.072; p = 0.026), and EVD placement prior to DHC (OR 4.575, 95% CI 2.253-9.291; p < 0.001) were independent predictors of ventriculoperitoneal shunt insertion. The mean length of stay and total hospital charges were significantly increased in patients with PMV and in those with PTH. CONCLUSIONS: PMV, presence of subdural hematoma, and EVD placement prior to DHC are risk factors for PTH in patients with pTBI who underwent DHC. Higher healthcare resource utilization was seen in patients with PTH. Identifying risk factors for PTH may improve early diagnosis and efficient resource utilization.


Assuntos
Lesões Encefálicas Traumáticas , Craniectomia Descompressiva , Hidrocefalia , Humanos , Criança , Lesões Encefálicas Traumáticas/complicações , Hidrocefalia/cirurgia , Fatores de Risco , Derivação Ventriculoperitoneal/efeitos adversos , Hematoma Subdural/etiologia , Craniectomia Descompressiva/efeitos adversos , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia
11.
PeerJ ; 11: e16578, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38144190

RESUMO

Data on individual tree crowns from remote sensing have the potential to advance forest ecology by providing information about forest composition and structure with a continuous spatial coverage over large spatial extents. Classifying individual trees to their taxonomic species over large regions from remote sensing data is challenging. Methods to classify individual species are often accurate for common species, but perform poorly for less common species and when applied to new sites. We ran a data science competition to help identify effective methods for the task of classification of individual crowns to species identity. The competition included data from three sites to assess each methods' ability to generalize patterns across two sites simultaneously and apply methods to an untrained site. Three different metrics were used to assess and compare model performance. Six teams participated, representing four countries and nine individuals. The highest performing method from a previous competition in 2017 was applied and used as a baseline to understand advancements and changes in successful methods. The best species classification method was based on a two-stage fully connected neural network that significantly outperformed the baseline random forest and gradient boosting ensemble methods. All methods generalized well by showing relatively strong performance on the trained sites (accuracy = 0.46-0.55, macro F1 = 0.09-0.32, cross entropy loss = 2.4-9.2), but generally failed to transfer effectively to the untrained site (accuracy = 0.07-0.32, macro F1 = 0.02-0.18, cross entropy loss = 2.8-16.3). Classification performance was influenced by the number of samples with species labels available for training, with most methods predicting common species at the training sites well (maximum F1 score of 0.86) relative to the uncommon species where none were predicted. Classification errors were most common between species in the same genus and different species that occur in the same habitat. Most methods performed better than the baseline in detecting if a species was not in the training data by predicting an untrained mixed-species class, especially in the untrained site. This work has highlighted that data science competitions can encourage advancement of methods, particularly by bringing in new people from outside the focal discipline, and by providing an open dataset and evaluation criteria from which participants can learn.


Assuntos
Ciência de Dados , Tecnologia de Sensoriamento Remoto , Humanos , Redes Neurais de Computação , Ecossistema
12.
Ecol Evol ; 12(9): e9277, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36110880

RESUMO

Resource selection in sexually dimorphic ungulates is at least partially explained by sex-specific resource requirements and risk aversion strategies. Females generally spend more time in areas with less risk and abundant, high-quality forage due to their smaller body size. However, demographically variable responses to risk are context dependent, and few have concurrently quantified male and female behavior within areas with the same resource base. We captured 111 (54 males, 57 females) adult white-tailed deer (Odocoileus virginianus) from 2009 to 2018 on a site in South Carolina, USA, where hunters were the primary source of adult mortality. We fit each deer with a GPS collar programmed to collect locations at 30-min intervals. Upon collar recovery, we analyzed the data to estimate sex- and time-specific selection for, and distance to, various cover types. While both sexes generally avoided risky areas (i.e., sites hunted more frequently) during the day, females (p = .41) were more likely than males (p = .16) to use risky areas containing abundant food resources during the day, where p = probability of selection. Our findings indicate that female white-tailed deer may be forced to utilize high risk areas during high risk periods due to their smaller body size and increased nutritional demands, whereas larger males are better able to forgo foraging opportunities during risky periods to mitigate risk; however, our study design left room for the possibility that our observations were driven by innate sex-specific patterns in white-tailed deer. Nonetheless, our study contributes information to the literature by describing sex-specific resource selection by diel period on a site where sexes shared the same resources and were presented with the same landscape of risk.

13.
Clin Neurol Neurosurg ; 221: 107404, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35987042

RESUMO

BACKGROUND: Traumatic brain injuries (TBIs) play a significant role in pediatric mortality and morbidity. Environment may play a role in the type, severity, and outcome of pediatric TBI (pTBI). Our objective was to characterize the impact of poor socioeconomic status (PSES) on the incidence, treatment, and outcomes of pTBI patients. METHODS: The Kids' Inpatient Database (KID) was queried from 2016 to 2019 for with TBI using International Classification of Disease, 10th revision (ICD 10) codes. Data defining demographics, complications, procedures, and outcomes was extracted. PSES was defined as Medicaid insurance and Q1 median income category. RESULTS: 26,417 patients had pTBI. 11,040 (41.8 %) of pTBI patients were on Medicaid insurance. 13,119 and 8165 (30.9 %) were in Q1 median income category. Land transport caused the majority of pTBI (41 %). Patients on Medicaid or Q1 median income were more likely to experience assault (OR 2.927, CI 95 % 2.455-3.491, p < 0.001 OR 2.033, CI 95 % 1.722-2.4000 p < 0.001 respectively). On propensity matched analysis, PSES was associated with increased mortality (OR 1.667, 95 % CI 1.322-2.100, p < 0.01), length of stay (LOS) (OR 1.369, 95 % CI 1.201-1.559, p < 0.01), and major complicated trauma (OR 1.354 95 % CI 1.090-1.682 p = 0.007). Total hospital charges were higher in pTBI patients on Medicaid ($112,101.52, +/- $203,716.35) versus non-Medicaid ($109,064.37 +/- $212,057.98) (p < 0.001). CONCLUSION: PSES is correlated with increased mortality, complications, and longer LOS. Healthcare coverage and clinical training should take these disparities into account to provide improved care and optimize healthcare resource utilization. LEVEL OF EVIDENCE: Level IV, Retrospective Database.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/terapia , Criança , Bases de Dados Factuais , Humanos , Tempo de Internação , Medicaid , Estudos Retrospectivos , Classe Social , Estados Unidos/epidemiologia
14.
Burns ; 47(3): 545-550, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33707085

RESUMO

BACKGROUND: Accurate resuscitation of pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among pediatric burn centers and the impact on fluid estimates. METHODS: Five pediatric burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received. RESULTS: Differences in the TBSA burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers' resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35ml/kg/% TBSA, p<0.001), (4.90 versus 6.35ml/kg/TBSA, p=0.002) and (3.38 versus 6.35ml/kg/TBSA, p<0.0001). CONCLUSIONS: This variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.


Assuntos
Hidratação/métodos , Ressuscitação/tendências , Superfície Corporal , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Hidratação/normas , Hidratação/tendências , Humanos , Lactente , Masculino , Pediatria/métodos , Pediatria/tendências , Ressuscitação/métodos , Ressuscitação/normas , Estudos Retrospectivos
15.
J Pediatr Surg ; 55(7): 1409-1413, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32178798

RESUMO

Decannulation from pediatric veno-arterial extracorporeal membrane oxygenation (VA-ECMO) involves the removal of large arterial perfusion cannulas from relatively small lower extremity arteries. While these challenging repairs are frequently performed by general pediatric surgeons, there is little standardization with regard to vascular techniques within the pediatric surgery training paradigm, resulting in variability in the repair of these arteriotomies and potential future consequences for lower extremity perfusion and growth. Herein we present a technique for repair of large common femoral arteriotomies following removal of ECMO perfusion cannulas utilizing a dual-layer patch of ipsilateral saphenous vein harvested via the arterial cutdown incision. This vein segment is everted to maximize endothelial surface area of the patch and dual layered to provide additional support against aneurysmal degeneration. The described technique is an effective repair of arteriotomy following VA-ECMO decannulation, which minimizes vascular complications and is an accessible technique to those without advanced vascular surgical training. LEVEL OF EVIDENCE: Level IV; operative technique description with small case series.


Assuntos
Cateterismo Periférico/métodos , Oxigenação por Membrana Extracorpórea/métodos , Artéria Femoral/cirurgia , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Criança , Humanos
16.
J Pediatr Surg ; 55(6): 1065-1071, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32197827

RESUMO

PURPOSE: Pectus excavatum is a common chest wall deformity amenable to surgical correction, most commonly by a technique known as the Nuss Procedure. The surgery is associated with significant postoperative pain and lengthy hospital stays. We hypothesized that a standardized enhanced recovery after surgery (ERAS) pathway would result in significantly reduced length of stay (LOS) and reduced levels of postoperative pain without an increase in readmissions or emergency department (ED) visits. METHODS: We instituted a pectus excavatum ERAS program at a high-volume academic center. Our ERAS protocol standardized perioperative exercise and pharmacologic regimens, pre- and post-operative education, and early return to activity. We conducted a retrospective review of all patients undergoing the Nuss procedure from 2015 to 2018. ERAS was implemented at the mid-point of the study period, and pre- and post-protocol patients were compared in our analysis. The primary outcome measure was LOS. The secondary outcomes included pain scores, incidence of urinary retention, and readmissions or ED visits. RESULTS: One hundred nine patients were included in this study (51 patients pre-ERAS and 58 post-ERAS). The average length of hospitalization prior to implementation of ERAS was 3.49 and after the implementation 2.90 (p = 0.0007). The implementation of ERAS showed a trend of decreasing readmissions and emergency department visits, but this did not reach statistical significance. There was a statistically significant decrease in both requirement for urinary catheter placement and pain scores on postoperative day 0. CONCLUSIONS: Implementation of ERAS for the Nuss procedure leads to a significant reduction in LOS, early pain scores, and urinary catheter usage, without an increase in post-operative ED visits and hospital readmissions. An ERAS protocol should be utilized in this patient population. TYPE OF STUDY: Retrospective comparative study. TYPE OF EVIDENCE: Level III.


Assuntos
Tórax em Funil/cirurgia , Dor Pós-Operatória/terapia , Adolescente , Analgésicos/uso terapêutico , Criança , Pré-Escolar , Recuperação Pós-Cirúrgica Melhorada , Feminino , Gabapentina/uso terapêutico , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Readmissão do Paciente , Período Pós-Operatório , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Adulto Jovem
17.
J Investig Med ; 67(1): 59-62, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30367008

RESUMO

This study sought to determine the proportion of children with long bone fractures who undergo duplicate radiographic imaging after transfer to a pediatric trauma center (PTC) for further management. The secondary objective was to explore provider rationale and diagnostic yield of repeat X-rays. This was a single-site, retrospective cohort study conducted at a PTC. All patients, aged 0-21 years, who were transferred to the PTC for management of a long bone fracture were included. Electronic medical records were reviewed to determine the proportion of children who had repeat radiographic imaging and the provider rationale for obtaining this. T-test and Χ2 analyses were used to compare patients who had repeat X-rays with those who did not. During the study period, 309 patients (63% male, mean age 7.2±4.3 years) were transferred from 30 referring hospitals. Of these, 43% (n=133) underwent repeat radiographs. Patient age (p=0.9), gender (p=0.7), fracture location (p=0.19), and type of referring emergency department (pediatric vs general, p=0.3) were not significantly associated with repeat imaging. Rationale for repeat imaging could be ascertained in 31% of cases (n=41); the most common reasons were request by orthopedist (17%, n=23) and suboptimal original imaging (10%, n=13). Repeat imaging at the PTC did not reveal new or additional diagnoses in any case. Nearly half of the children in our study population undergo repeat and likely unnecessary imaging. Strategies to reduce repeat radiographs should be developed, as redundant imaging exposes patients to additional radiation and increases medical expense.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Transferência de Pacientes , Centros de Traumatologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem
18.
J Burn Care Res ; 40(6): 930-935, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31304968

RESUMO

Pruritus is a common problem following burn injuries; however, the literature to date has focused on adult survivors and/or pediatric survivors of large burns. The current study examines acute postburn pruritus in children under the age of 4 years (N = 256) with smaller burns (mean TBSA = 3.99%), which represents the most common type of patient typically treated in pediatric burn centers. Parents rated their child for pruritus, irritability, and sleep disturbances; additionally, parents completed a self-report of distress. Nearly half (47.3%) were rated by parents as displayed some level of pruritus, with the greatest proportion rated as mild. Regression analysis indicated that child minority status, greater burn TBSA, and more days elapsed since burn predicted higher levels of pruritus. In turn, pruritus was positively correlated with child irritability, delayed sleep onset, sleep disturbance, and parent distress. Thus, our results indicate that parent-rated pruritus in young pediatric burn patients is important to evaluate, as itch is significantly associated with other important clinical outcomes as early as the first month of the burn for pediatric patients and their parents.


Assuntos
Queimaduras/complicações , Prurido/etiologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Humor Irritável , Masculino , Grupos Minoritários , Pais/psicologia , Angústia Psicológica , Análise de Regressão , Estudos Retrospectivos , Transtornos do Sono-Vigília/etiologia , Fatores de Tempo , Índices de Gravidade do Trauma
19.
J Laparoendosc Adv Surg Tech A ; 29(10): 1372-1377, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295045

RESUMO

Introduction: Solid pseudopapillary neoplasm (SPN) is the most commonly encountered pancreatic tumor in adolescents. Owing to its malignant potential, the current recommendation for management is complete surgical resection; however, there is no broad consensus on the operation of choice to accomplish this. Herein, we describe three consecutive laparoscopic spleen-preserving distal pancreatectomies for SPN in adolescents. Materials and Methods: Our cohort included all patients <18 years of age treated at our institution from 2015 to 2018 who underwent surgical resection of an SPN. Results: Three patients (age 13-16) were identified. Two of the patients were male. All patients underwent laparoscopic distal pancreatectomy with preservation of the main splenic artery and vein. No patients suffered from postoperative pancreatic fistula. Median length of stay was 5 days. Final histology revealed SPN in all 3 cases, with tumor size ranging from 2 to 10 cm in greatest dimension. All margins were negative for tumor. All 3 patients have been followed (mean: 6 months) with surveillance ultrasound demonstrating a normal remnant pancreas and normal splenic perfusion. Conclusions: Laparoscopic spleen-preserving distal pancreatectomy is a safe and effective treatment for SPNs of the body and tail of the pancreas in adolescents. This approach achieves the margin negative resection that is appropriate for the disease without subjecting children to the risk of postsplenectomy sepsis or the need for antibiotic prophylaxis, and may be associated with a reduction in perioperative morbidity. Therefore, laparoscopic distal pancreatectomy with splenic preservation is our preferred operation in adolescents presenting with SPN.


Assuntos
Carcinoma Papilar/cirurgia , Laparoscopia/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Baço/cirurgia , Adolescente , Feminino , Humanos , Masculino , Artéria Esplênica/cirurgia , Resultado do Tratamento
20.
J Pediatr Surg ; 54(11): 2408-2412, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31079865

RESUMO

PURPOSE: Due to the large abdominal defect from the omphalocele and extreme pubic diastasis in cloacal exstrophy (CE), bioprosthetic material may be used to bridge this gap during abdominal closure in CE. This study examined presurgical factors associated with the use of bioprosthetic materials in CE closure and complications in these patients. METHODS: An institutional database of exstrophy-epispadias complex patients was reviewed for CE. Inclusion criteria included CE and primary closure performed at the host institution from 1998 to 2018. Data collection included demographics, presurgical factors, use of bioprosthetic material, complications, and outcomes. RESULTS: All 32 patients had a staged closure and pelvic osteotomy prior to bladder closure. Ten of the 32 patients incorporated a bioprosthetic material during abdominal wall closure. There is at least 3 months follow up for all patients, all had successful bladder closure without any postoperative hernias. Those who underwent closure without bioprosthetic material were younger at the time of closure (565 vs 693 days, p = 0.043). The differences in complication rates and mean pubic diastasis was not statistically significant, p = 0.079 and p = 0.457 respectively. CONCLUSIONS: The use of bioprosthetic material is associated with older age at abdominal wall and bladder closure. The use of bioprosthetic material is a useful adjunct for secure abdominal wall closure in the reconstruction of CE. TYPE OF STUDY: Prognostic. LEVEL OF EVIDENCE: III.


Assuntos
Abdominoplastia/métodos , Anus Imperfurado/cirurgia , Bioprótese , Extrofia Vesical/cirurgia , Hérnia Umbilical/cirurgia , Escoliose/cirurgia , Anormalidades Urogenitais/cirurgia , Parede Abdominal/cirurgia , Pré-Escolar , Epispadia/cirurgia , Feminino , Humanos , Lactente , Masculino , Osteotomia , Estudos Retrospectivos
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