ABSTRACT
BACKGROUND: The PediBIRN-7 clinical prediction rule incorporates the (positive or negative) predictive contributions of completed abuse evaluations to estimate abusive head trauma (AHT) probability after abuse evaluation. Applying definitional criteria as proxies for AHT and non-AHT ground truth, it performed with sensitivity 0.73 (95 % CI: 0.66-0.79), specificity 0.87 (95 % CI: 0.82-0.90), and ROC-AUC 0.88 (95 % CI: 0.85-0.92) in its derivation study. OBJECTIVE: To validate the PediBIRN-7's AHT prediction performance in a novel, equivalent, patient population. PARTICIPANTS AND SETTINGS: Consecutive, acutely head-injured children <3 years hospitalized for intensive care across eight sites between 2017 and 2020 with completed skeletal surveys and retinal exams (N = 342). METHODS: Secondary analysis of an existing, cross-sectional, prospective dataset, including assignment of patient-specific estimates of AHT probability, calculation of AHT prediction performance measures (ROC-AUC, sensitivity, specificity, predictive values), and completion of sensitivity analyses to estimate best- and worst-case prediction performances. RESULTS: Applying the same definitional criteria, the PediBIRN-7 performed with sensitivity 0.74 (95 % CI: 0.66-0.81), specificity 0.77 (95 % CI: 0.70-0.83), and ROC-AUC 0.83 (95 % CI: 0.78-0.88). The reduction in ROC-AUC was statistically insignificant (p = .07). Applying physicians' final consensus diagnoses as proxies for AHT and non-AHT ground truth, the PediBIRN-7 performed with sensitivity 0.73 (95 % CI: 0.66-0.79), specificity 0.87 (95 % CI: 0.82-0.90), and ROC-AUC 0.90 (95 % CI: 0.87-0.94). Sensitivity analyses demonstrated minimal changes in rule performance. CONCLUSION: The PediBIRN-7's overall AHT prediction performance has been validated in a novel, equivalent, patient population. Its patient-specific estimates of AHT probability can inform physicians' AHT-related diagnostic reasoning after abuse evaluation.
Subject(s)
Child Abuse , Craniocerebral Trauma , Humans , Child Abuse/diagnosis , Child Abuse/statistics & numerical data , Craniocerebral Trauma/diagnosis , Infant , Female , Male , Child, Preschool , Clinical Decision Rules , Cross-Sectional Studies , Sensitivity and Specificity , Prospective StudiesABSTRACT
BACKGROUND: Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma. OBJECTIVE: The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries. PARTICIPANTS AND SETTING: This retrospective study utilized a de-identified PediBIRN database of 701 children <3-years-old presenting to intensive care for head trauma. Children with motor vehicle related trauma and preexisting brain abnormalities were excluded. All had imaging showing head injury and a dedicated ophthalmology examination. METHODS: Contact injuries included craniofacial soft tissue injuries, skull fractures and epidural hematoma. Inertial injuries included acute impairment or loss of consciousness and/or bilateral and/or interhemispheric subdural hemorrhage. Abuse was defined in two ways, by 1) predetermined criteria and 2) caretaking physicians/multidisciplinary team's diagnostic consensus. RESULTS: PediBIRN subjects with cRH frequently experienced inertial injury (99.4 % (308/310, OR = 53.74 (16.91-170.77)) but infrequently isolated contact trauma (0.6 % (2/310), OR = 0.02 (0.0004-0.06)). Inertial injuries predominated over contact trauma among children with cRH sorted AHT by predetermined criteria (99.1 % (237/239), OR = 20.20 (6.09-67.01) vs 0.5 % (2/339), OR = 0.04 (0.01-0.17)). Fifty-nine percent of patients with cRH, <24 h altered consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling. CONCLUSIONS: cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.
Subject(s)
Child Abuse , Craniocerebral Trauma , Hypoxia, Brain , Child , Humans , Infant , Child, Preschool , Retinal Hemorrhage/epidemiology , Retinal Hemorrhage/etiology , Retrospective Studies , Craniocerebral Trauma/etiology , Craniocerebral Trauma/complications , Child Abuse/diagnosis , Ischemia/complications , Hypoxia, Brain/complicationsABSTRACT
BACKGROUND: To assess for occult fractures, physicians often opt to obtain skeletal surveys (SS) in young, acutely head-injured patients who present with skull fractures. Data informing optimal decision management are lacking. OBJECTIVE: To determine the positive yields of radiologic SS in young patients with skull fractures presumed to be at low vs. high risk for abuse. PARTICIPANTS AND SETTING: 476 acutely head injured, skull-fractured patients <3 years hospitalized for intensive care across 18 sites between February 2011 and March 2021. METHODS: We conducted a retrospective, secondary analysis of the combined, prospective Pediatric Brain Injury Research Network (PediBIRN) data set. RESULTS: 204 (43 %) of 476 patients had simple, linear, parietal skull fractures. 272 (57 %) had more complex skull fracture(s). Only 315 (66 %) of 476 patients underwent SS, including 102 (32 %) patients presumed to be at low risk for abuse (patients who presented with a consistent history of accidental trauma; intracranial injuries no deeper than the cortical brain; and no respiratory compromise, alteration or loss of consciousness, seizures, or skin injuries suspicious for abuse). Only one of 102 low risk patients revealed findings indicative of abuse. In two other low risk patients, SS helped to confirm metabolic bone disease. CONCLUSIONS: Less than 1 % of low risk patients under three years of age who presented with simple or complex skull fracture(s) revealed other abusive fractures. Our results could inform efforts to reduce unnecessary skeletal surveys.
Subject(s)
Child Abuse , Craniocerebral Trauma , Skull Fractures , Humans , Child , Infant , Retrospective Studies , Prospective Studies , Skull Fractures/diagnostic imaging , Skull Fractures/epidemiology , RadiographyABSTRACT
Numerous studies have investigated effects of long-term manure application on total phosphorus (P) and inorganic P (Pi ), but few have evaluated soil organic P (Po ). Little is known about crop management effects on Po in soils with varying minerology. In this study, sequential fractionation was used to characterize specific P forms after 25 years of broiler litter (BL) or ammonium nitrate (Con) applications to an Alabama Hartsells soil. Crops (corn [Zea mays L.], soybean [Glycine Willd.], and corn or soybean with a wheat [Triticum aestivum L.] cover crop) were under conventional tillage (CT) or no-tillage (NT). Regardless of crop, tillage, or fertilizer type, the proportion of extractable Pi was relatively stable at 21%-49% at 0-5 cm and 25%-45% at 5-10 cm. Extractable Pi ranged from 0.69 to 2.4 mg g-1 . BL increased total extractable Pi (p ≤ 0.001) at 0-5 cm and 5-10 cm. Total extractable P was influenced at 0-5 cm (p ≤ 0.006) by both tillage and fertilization type, but not at 5-10 cm or at either depth in soybean plots. Long-term BL application increased total extractable soil P at 0-5 cm. In corn systems, CT did not reduce P loading to topsoil or result in P leaching to lower soil depths, compared to NT. Soybean and soybean-wheat reduced P loading in BL plots, compared to corn and corn-wheat. Soil Po was classed in the order of monoesters > phytate and polyphosphates, where most was extractable with NaOH. BL increased extractable Po in all fractions. Care should be taken when applying BL to highly weathered soils to avoid legacy Po accumulation. Soybean rotations and cover crops could help remediate P-laden soils after repeated BL application.
Subject(s)
Agriculture , Soil , Animals , Alabama , Phosphorus , Manure , Chickens , Crops, Agricultural , Glycine max , Zea mays , Fertilizers , TriticumABSTRACT
BACKGROUND: Abusive head trauma (AHT) remains a major pediatric problem with diagnostic challenges. A small pilot study previously associated subcortical brain injury with AHT. OBJECTIVES: To investigate the association of subcortical injury on neuroimaging with the diagnosis of AHT. PARTICIPANTS AND SETTING: Children <3 years with acute TBI admitted to 18 PICUs between 2011 and 2021. METHODS: Secondary analysis of existing, combined, de-identified, cross-sectional dataset. RESULTS: Deepest location of visible injury was characterized as scalp/skull/epidural (n = 170), subarachnoid/subdural (n = 386), cortical brain (n = 170), or subcortical brain (n = 247) (total n = 973). Subcortical injury was significantly associated with AHT using both physicians' diagnostic impression (OR: 8.41 [95 % CI: 5.82-12.44]) and a priori definitional criteria (OR: 5.99 [95 % CI: 4.31-8.43]). Caregiver reports consistent with the child's gross motor skills and historically consistent with repetition decreased as deepest location of injury increased, p < 0.001. Patients with subcortical injuries were significantly more likely to have traumatic extracranial injuries such as rib fractures (OR 3.36, 95 % CI 2.30-4.92) or retinal hemorrhages (OR 5.97, 95 % CI 4.35-8.24), respiratory compromise (OR 12.12, 95 % CI 8.49-17.62), circulatory compromise (OR 6.71, 95 % CI 4.87-9.29), seizures (OR 3.18, 95 % CI 2.35-4.29), and acute encephalopathy (OR 12.44, 95 % CI 8.16-19.68). CONCLUSIONS: Subcortical injury is associated with a diagnosis of AHT, historical inaccuracies concerning for abuse, traumatic extracranial injuries, and increased severity of illness including respiratory and circulatory compromise, seizures, and prolonged loss of consciousness. Presence of subcortical injury should be considered as one component of the complex AHT diagnostic process.
Subject(s)
Brain Injuries , Child Abuse , Craniocerebral Trauma , Humans , Child , Infant , Cross-Sectional Studies , Pilot Projects , Retrospective Studies , Craniocerebral Trauma/diagnosis , Brain Injuries/complications , Child Abuse/diagnosis , Seizures/complicationsABSTRACT
BACKGROUND: Physician diagnoses of abusive head trauma (AHT) have been criticized for circular reasoning and over-reliance on a "triad" of findings. Absent a gold standard, analyses that apply restrictive reference standards for AHT and non-AHT could serve to confirm or refute these criticisms. OBJECTIVES: To compare clinical presentations and injuries in patients with witnessed/admitted AHT vs. witnessed non-AHT, and with witnessed/admitted AHT vs. physician diagnosed AHT not witnessed/admitted. To measure the triad's AHT test performance in patients with witnessed/admitted AHT vs. witnessed non-AHT. PARTICIPANTS AND SETTING: Acutely head injured patients <3 years hospitalized for intensive care across 18 sites between 2010 and 2021. METHODS: Secondary analyses of existing, combined, cross-sectional datasets. Probability values and odds ratios were used to identify and characterize differences. Test performance measures included sensitivity, specificity, and predictive values. RESULTS: Compared to patients with witnessed non-AHT (n = 100), patients with witnessed/admitted AHT (n = 58) presented more frequently with respiratory compromise (OR 2.94, 95% CI: 1.50-5.75); prolonged encephalopathy (OR 5.23, 95% CI: 2.51-10.89); torso, ear, or neck bruising (OR 11.87, 95% CI: 4.48-31.48); bilateral subdural hemorrhages (OR 8.21, 95% CI: 3.94-17.13); diffuse brain hypoxia, ischemia, or swelling (OR 6.51, 95% CI: 3.06-13.02); and dense, extensive retinal hemorrhages (OR 7.59, 95% CI: 2.85-20.25). All differences were statistically significant (p ≤ .001). No significant differences were observed in patients with witnessed/admitted AHT (n = 58) vs. patients diagnosed with AHT not witnessed/admitted (n = 438). The triad demonstrated AHT specificity and positive predictive value ≥0.96. CONCLUSIONS: The observed differences in patients with witnessed/admitted AHT vs. witnessed non-AHT substantiate prior reports. The complete absence of differences in patients with witnessed/admitted AHT vs. physician diagnosed AHT not witnessed/admitted supports an impression that physicians apply diagnostic reasoning informed by knowledge of previously reported injury patterns. Concern for abuse is justified in patients who present with "the triad."
Subject(s)
Child Abuse , Craniocerebral Trauma , Physicians , Child , Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Cross-Sectional Studies , Hematoma, Subdural , HumansABSTRACT
BACKGROUND: The PediBIRN 4-variable clinical decision rule (CDR) detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care (PICU) settings. Preliminary analysis of its performance in Pediatric Emergency Department settings found that elimination of its fourth predictor variable enhanced screening accuracy. OBJECTIVE: To compare the AHT screening performances of the "PediBIRN-4" CDR vs. the simplified 3-variable CDR in PICU settings. PARTICIPANTS AND SETTINGS: 973 acutely head-injured children <3 years hospitalized for intensive care across 18 sites between February 2011 and March 2021. METHODS: Retrospective, secondary analysis of the combined, prospective PediBIRN data sets. AHT definitional criteria and physicians' diagnoses were applied iteratively to sort patients into abusive vs. other head trauma cohorts. Outcome measures of CDR performance included sensitivity, specificity, predictive values, likelihood ratios, ROC AUC, and the correlation between each CDR's patient-specific estimates of AHT probability and the overall positive yield of patients' completed abuse evaluations. RESULTS: Applied accurately and consistently, both CDR's would have performed with sensitivity ≥93% and negative predictive value ≥91%. Eliminating the PediBIRN-4's fourth predictor variable resulted in significantly higher specificity (↑'d ≥19%), positive predictive value (↑'d ≥8%), and ROC AUC (↑'d ≥5%), but a 3% reduction in sensitivity. Both CDRs provided patient-specific estimates of abuse probability very strongly correlated with the positive yield of patients' completed abuse evaluations (Pearson's r = 0.95 and 0.91, p = .13). CONCLUSION: The PediBIRN 3-variable CDR performed with greater AHT screening accuracy than the 4-variable CDR. Both are good predictors of the results of patients' subsequent completed abuse evaluations.
Subject(s)
Child Abuse , Craniocerebral Trauma , Child , Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/epidemiology , Humans , Infant , Mass Screening , Prospective Studies , Retrospective StudiesABSTRACT
INTRODUCTION: Although emergency medicine (EM) residency program directors (PD) have multiple sources to evaluate each applicant, some programs await the release of the medical student performance evaluation (MSPE) to extend interview offers. While prior studies have demonstrated that MSPE content is variable and selectively positive, no prior work has evaluated the impact of the MSPE on the likelihood to invite (LTI) applicants for a residency interview. This study aimed to evaluate how information in the MSPE impacted LTI, with the hypothesis that changes in LTI would be relatively rare based on MSPE review alone. METHODS: We conducted a prospective, observational study analyzing applications to three EM residency programs during the 2019-2020 match cycle. Reviewers assessed applications and rated the LTI on a five-point Likert scale where LTI was defined as follows: 1 = definitely no; 2 = probably no; 3 = unsure; 4 = probably yes; and 5 = definitely yes. The LTI was recorded before and after MSPE review. A change in LTI was considered meaningful when it changed the overall trajectory of the applicant's likelihood to receive an invitation to interview. RESULTS: We reviewed a total of 877 applications with the LTI changing ≥1 point on the Likert scale 160 (18.2%) times. The LTI was meaningfully impacted in a minority of applications - 48 total (5.5 %, p< 0.01) - with only 1 (0.11%) application changing from 1 or 2 (definitely/probably no) to 4 or 5 (probably/definitely yes) and 34 (3.8%) changing from 3 (unsure) to 4 or 5 (probably/definitely yes). Thirteen (1.5%) applications changed from 4 or 5 (probably/definitely yes) to 3 (unsure or probably/definitely no). CONCLUSION: Review of the MSPE resulted in a meaningful change in LTI in only 5.5% of applications. Given the time required for program leadership to review all parts of the variably formatted MSPEs, this finding supports a more efficient application review, where the PD's focus is on succinct and objective aspects of the application, such as the Standardized Letter of Evaluation.
Subject(s)
Education, Medical, Undergraduate , Emergency Medicine/education , Internship and Residency , Students, Medical/psychology , Adult , Educational Measurement , Female , Humans , Male , Prospective StudiesABSTRACT
OBJECTIVE: To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings. STUDY DESIGN: This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3 years (n = 183 and n = 237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included "higher risk" patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models. RESULTS: Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P = .11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P = .05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P = .22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%â81% vs 78%â73%, P = .01), and potential cases of missed abusive head trauma (40%â21% vs 29%â32%, P = .003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%â7% vs 11%â13%, P = .22). CONCLUSIONS: PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03162354.
Subject(s)
Child Abuse , Craniocerebral Trauma , Child , Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Critical Care , Humans , Intensive Care Units, Pediatric , Mass ScreeningABSTRACT
BACKGROUND: The traditional pathologic grading for human renal cell carcinoma (RCC) has low concordance between biopsy and surgical specimen. There is a need to investigate adjunctive pathology technique that does not rely on the nuclear morphology that defines the traditional grading. Changes in collagen organization in the extracellular matrix have been linked to prognosis or grade in breast, ovarian, and pancreatic cancers, but collagen organization has never been correlated with RCC grade. In this study, we used Second Harmonic Generation (SHG) based imaging to quantify possible differences in collagen organization between high and low grades of human RCC. METHODS: A tissue microarray (TMA) was constructed from RCC tumor specimens. Each TMA core represents an individual patient. A 5 µm section from the TMA tissue was stained with standard hematoxylin and eosin (H&E). Bright field images of the H&E stained TMA were used to annotate representative RCC regions. In this study, 70 grade 1 cores and 51 grade 4 cores were imaged on a custom-built forward SHG microscope, and images were analyzed using established software tools to automatically extract and quantify collagen fibers for alignment and density assessment. A linear mixed-effects model with random intercepts to account for the within-patient correlation was created to compare grade 1 vs. grade 4 measurements and the statistical tests were two-sided. RESULTS: Both collagen density and alignment differed significantly between RCC grade 1 and RCC grade 4. Specifically, collagen fiber density was greater in grade 4 than in grade 1 RCC (p < 0.001). Collagen fibers were also more aligned in grade 4 compared to grade 1 (p < 0.001). CONCLUSIONS: Collagen density and alignment were shown to be significantly higher in RCC grade 4 vs. grade 1. This technique of biopsy sampling by SHG could complement classical tumor grading approaches. Furthermore it might allow biopsies to be more clinically relevant by informing diagnostics. Future studies are required to investigate the functional role of collagen organization in RCC.
Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Collagen/metabolism , Kidney Neoplasms/diagnostic imaging , Neoplasm Grading , Biomarkers, Tumor/metabolism , Biopsy , Extracellular Matrix/pathology , Humans , Kidney/pathology , Linear Models , Prognosis , Second Harmonic Generation Microscopy , Tissue Array AnalysisABSTRACT
OBJECTIVES: To investigate the association of in-hospital weight gain with failure to thrive (FTT) etiologies. METHODS: With this retrospective cross-sectional study, we included children <2 years of age hospitalized for FTT between 2009 and 2012 at a tertiary care children's hospital. We excluded children with a gestational age <37 weeks, intrauterine growth restriction, acute illness, or preexisting complex chronic conditions. Average daily in-hospital weight gain was categorized as (1) below average or (2) average or greater for age. χ2, Fisher's exact test, and 1-way analysis of variance tests were used to compare patient demographics, therapies, and FTT etiologies with categorical weight gain; multivariable logistic regression models tested for associations. RESULTS: There were 331 children included. The primary etiologies of FTT were neglect (30.5%), gastroesophageal reflux disease (GERD) (28.1%), child-centered feeding difficulties (22.4%), and organic pathology (19.0%). Average or greater weight gain for age had a specificity of 22.2% and positive predictive value of 33.9% for differentiating neglect from other FTT etiologies. However, sensitivity and negative predictive value were 91.1% and 85.0%, respectively. After adjusting for demographics and therapies received, neglect (P = .02) and child-centered feeding difficulties (P = .01) were more likely to have average or greater weight gain for age compared with organic pathology. Children with GERD gained similarly (P = .11) to children with organic pathology. CONCLUSIONS: In-hospital weight gain was nonspecific for differentiating neglect from other FTT etiologies. Clinicians should exercise caution when using weight gain alone to confirm neglect. Conversely, below average weight gain may be more useful in supporting GERD or organic pathologies but cannot fully rule out neglect.
Subject(s)
Child Abuse/diagnosis , Failure to Thrive/etiology , Gastroesophageal Reflux/complications , Weight Gain/physiology , Weight Loss/physiology , Cross-Sectional Studies , Failure to Thrive/diagnosis , Failure to Thrive/rehabilitation , Female , Gastroesophageal Reflux/diagnosis , Humans , Infant , Infant, Newborn , Male , Patient Readmission/statistics & numerical data , Reproducibility of Results , Retrospective Studies , Risk AssessmentABSTRACT
OBJECTIVE: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. STUDY DESIGN: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT. RESULTS: In the PediBIRN study sample of 500 young, acutely head-injured patients hospitalized for intensive care, minority race/ethnicity patients (n = 229) were more frequently evaluated (P < .001; aOR, 2.2) and reported (P = .001; aOR, 1.9) for suspected AHT than white/non-Hispanic patients (n = 271). These disparities occurred almost exclusively in lower risk patients, including those ultimately categorized as non-AHT (P = .001 [aOR, 2.4] and P = .003 [aOR, 2.1]) or with an estimated AHT probability of ≤25% (P <.001 [aOR, 4.1] and P <.001 [aOR, 2.8]). Similar site-specific analyses revealed that these results reflected more extreme disparities at only 2 of 18 sites, and were not explained by local confounders. CONCLUSION: Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians' implicit bias.
Subject(s)
Child Abuse/ethnology , Craniocerebral Trauma/ethnology , Ethnicity/statistics & numerical data , Healthcare Disparities/ethnology , Mandatory Reporting , White People/statistics & numerical data , Bias , Child , Child Abuse/diagnosis , Child Abuse/therapy , Child, Preschool , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/therapy , Critical Care , Hospitalization , Humans , Infant , Infant, Newborn , Minority Groups/statistics & numerical data , United StatesSubject(s)
Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Decision Support Techniques , Female , Humans , MaleABSTRACT
OBJECTIVE: To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. STUDY DESIGN: We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients' completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. RESULTS: Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% (P < .001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% (P = .058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. CONCLUSIONS: Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.
Subject(s)
Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Decision Support Techniques , Child , Craniocerebral Trauma/etiology , Female , Humans , Infant , Intensive Care Units, Pediatric , Male , Reproducibility of Results , Retrospective Studies , Trauma Severity IndicesABSTRACT
Components of the extracellular matrix (ECM) have recently been shown to influence stem cell specification. However, it has been challenging to assess the spatial and temporal dynamics of stem cell-ECM interactions because most methodologies utilized to date require sample destruction or fixation. We examined the efficacy of utilizing the endogenous optical signals of two important ECM proteins, elastin (Eln), through autofluorescence, and type I collagen (ColI), through second harmonic generation (SHG), during mouse embryonic stem cell differentiation. After finding favorable overlap between antibody labeling and the endogenous fluorescent signal of Eln, we used this endogenous signal to map temporal changes in Eln and ColI during murine embryoid body differentiation and found that Eln increases until day 9 and then decreases slightly by day 12, while Col1 steadily increases over the 12-day period. Furthermore, we combined endogenous fluorescence imaging and SHG with antibody labeling of cardiomyocytes to examine the spatial relationship between Eln and ColI accumulation and cardiomyocyte differentiation. Eln was ubiquitously present, with enrichment in regions with cardiomyocyte differentiation, while there was an inverse correlation between ColI and cardiomyocyte differentiation. This work provides an important first step for utilizing endogenous optical signals, which can be visualized in living cells, to understand the relationship between the ECM and cardiomyocyte development and sets the stage for future studies of stem cell-ECM interactions and dynamics relevant to stem cells as well as other cell and tissue types.
Subject(s)
Cell Differentiation , Collagen Type I/metabolism , Elastin/metabolism , Extracellular Matrix/metabolism , Mouse Embryonic Stem Cells/metabolism , Myocytes, Cardiac/metabolism , Animals , Cell Line , Mice , Microscopy, Fluorescence, Multiphoton , Mouse Embryonic Stem Cells/cytology , Myocytes, Cardiac/cytologyABSTRACT
BACKGROUND AND OBJECTIVE: To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. METHODS: We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. RESULTS: In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT. CONCLUSIONS: Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.
Subject(s)
Child Abuse/diagnosis , Child Abuse/statistics & numerical data , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/epidemiology , Decision Support Techniques , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/statistics & numerical data , Male , Mass Screening/statistics & numerical data , Patient Admission/statistics & numerical data , Prospective Studies , Sensitivity and Specificity , United StatesABSTRACT
A 42-day study was conducted to evaluate the effect of genotype: terminal sire line Duroc×F1 (DC×F1); terminal sire line Embrapa MS-115×F1 (MS-115×F1); and MS-115×Moura (MS-115×MO) and three dietary oil sources: soybean; canola; and canola+flax, on performance, carcass traits, pork quality, and fatty acid composition. Genotype affected the technological quality of pork and fatty acid profile. MS-115-sired pigs had better meat color and Duroc-sired pigs had higher intramuscular fat content, more saturated fat and better omega-6/omega-3 ratio. Moura breed influenced positively meat tenderness and intramuscular fat. Diet did not affect the technological quality of the meat. Canola or canola+flax oil diet supplementations increased monounsaturated and C18:3 and decreased C18:2 fatty acids, reducing the omega-6/omega-3 ratio. The best omega-6/omega-3 ratio was obtained through supplementation with canola+flax.
Subject(s)
Adipose Tissue/metabolism , Dietary Fats/metabolism , Dietary Supplements , Fatty Acids , Genotype , Meat/analysis , Plant Oils/metabolism , Animals , Brassica rapa , Breeding , Color , Fatty Acids/genetics , Fatty Acids/metabolism , Fatty Acids, Monounsaturated/metabolism , Flax , Linseed Oil/metabolism , Muscle, Skeletal/metabolism , Rapeseed Oil , Stress, Mechanical , SwineABSTRACT
Study of immigrant populations may contribute to a better understanding of the epidemiology of diseases associated with the aging process. We examined the prevalence of cardiovascular risk factors, including apolipoprotein E (ApoE) polymorphism, in elderly subjects who were born in Japan, migrated to South Brazil and have lived in that region for over 40 years, versus a group of elderly, locally born Brazilians living in the same region. These Japanese subjects came to Brazil after World War II (1950-1960) from several Japanese cities, mainly Nagasaki, Kumamoto and Hokkaido. Among 1007 subjects genotyped for ApoE polymorphism, we selected 540 elderly subjects (>60 years old), consisting of 270 Japanese-Brazilians and 270 Brazilians of European ancestry from Rio Grande do Sul State (Gaucha population). The Japanese-Brazilian group had significantly lower prevalences of obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome than did the Gaucho population group. ApoE polymorphism frequencies were similar in the two groups. The differences in cardiovascular risk factors observed in the two populations cannot be explained by ApoE polymorphism; they could be related to conservation of Japanese lifestyle habits, such as diet.
Subject(s)
Apolipoproteins E/genetics , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/genetics , Emigrants and Immigrants , Aged , Aged, 80 and over , Aging , Brazil/epidemiology , Cardiovascular System/pathology , Diet/ethnology , Female , Genotype , Humans , Hypertension/epidemiology , Japan/ethnology , Life Style , Male , Middle Aged , Polymorphism, Single Nucleotide , Risk FactorsABSTRACT
O objetivo foi avaliar a presença de Staphylococcus coagulase positiva em paleta suína fermentada, correlacionando o seu desenvolvimento com os parâmetros físico-químicos de cloretos e atividade de água. Ocorreu presença de Staphylococcus coagulase positiva na etapa de embalagem onde existe manipulação do produto e durante o armazenamento. Apesar dos valores encontrados estarem acima do padrão descrito pela legislação, seria pouco provável a produção de enterotoxinas. Em relação aos valores de cloretos e atividade de água encontrados em todos os pontos analisados, os mesmos caracterizam-se por estarem dentro da faixa de crescimento do Staphylococcus coagulase positiva.
Subject(s)
Meat Products , Staphylococcus aureus , SwineABSTRACT
Hexavalent chromium (Cr [VI]) genotoxicity was studied using fish micronucleus analysis in peripheral blood erythrocytes from Pimephales promelas, the fathead minnow. Forty-five- to 60-d-old fish were used to assess the spontaneous level of genotoxic damage. The genotoxic effect of Cr (VI) obtained from potassium dichromate (K2Cr2O7) in tests performed for 7-, 14-, and 21-d exposure periods was estimated. Significant micronucleated erythrocyte (MNE) induction was detected in fish exposed for 7 d to 2.5 mg/L of Cr (VI), and induction decreased after 21 d of exposure. The results suggest a handling effect in fish manipulated compared to those not manipulated, thus demonstrating the importance of including parallel negative controls in experimental design. Basal levels of MNE are reported, providing laboratory values for future assay quality control. The importance of determining the period with the highest expression of the genotoxic effects in this assay system was also confirmed.