The coronavirus disease clavicle study: a predictor of future trauma trends.

Background: Clavicle fractures are a common presentation to the emergency department after falls and sporting injuries. During 2020, the coronavirus disease 2019 (COVID-19) pandemic brought with it a long period of social isolation, resulting in a change of behavior patterns and, in return, the presentation of fractures to our local hospitals. The effects of this global pandemic on the presentation and management of clavicles were noted with particular interest to the change in mechanism and its future implications. Methods: We performed a longitudinal observational study in 10 hospitals in the North West of England, reviewing all patients presenting with a clavicle fracture during 6 weeks in the first peak of COVID-19 pandemic and compared these with the same period in 2019. Collection points included the patient demographics, fracture characteristics, mechanism of injury, and management. Results: A total of 427 clavicle fractures were assessed with lower numbers of patients presenting with a clavicle fracture during the COVID-2020 period (n = 177) compared with 2019 (n = 250). Cycling-related clavicle fractures increased 3-fold during the pandemic compared with the 2019 control group. We also noted an overall increase in clavicle fractures resulting from higher energy trauma as opposed to low energy or fragility fracture. We also found a faster time to surgery in the COVID cohort by 2.7 days on average when compared with 2019. Conclusions: Government restrictions and the encouragement of social distancing led to behavioral changes with a vast increase in cyclists on the road. This created a significant rise in clavicle fractures related to this activity. This is likely to be further driven by the government pledge to double cyclists on the road by 2025 in the United Kingdom. We forecast that this increase in cyclists, a behavior change accelerated by the pandemic, is a reliable predictor for future trauma trends.

Early Graft, Limb and Mortality Outcomes from the Omniflow II Bio-Synthetic Graft.

BACKGROUND: Omniflow II biosynthetic grafts are a commonly used alternative to autologous grafts in vascular bypass procedures. They are chosen for their purported resilience to infection, often in instances of existing graft failure or infection. We examined the short term, 1-3 year outcomes of Omniflow grafts in terms of patency, limb survival and mortality in a sample of 24 individuals. METHODS: This is a single centred retrospective study of Omniflow II grafts implanted between September 23, 2015 and April 05, 2018 in our department. It includes grafts in all anatomical locations. Primary outcome measures were overall patient survival and time to this, primary graft patency (patency with no intervention) and then limb survival at 1 and 3 years. Kaplan-Meier survival analysis was plotted for the 3 primary outcome measures. RESULTS: A total of 24 grafts from 24 individuals were included with mean age 71.4 ± 11.7. We included 5 female and 19 male patients. The commonest indication was rest pain/claudication (N = 8) followed by graft occlusion (N = 6). Femoro-popliteal bypass (N = 13) and Femoro-distal bypass (N = 5) were the commonest procedures. Kaplan-Meier survival analysis demonstrated that 1 and 3-year primary patency rates were 54.2% and 37.5% respectively with Limb survival probability of 75% at 1 year and 70.8% at 3 years. These rates were all considerably lower than those found in previous comparative studies. Mortality however, compared favourably with 1 and 3-year survival probability 91.7% and 87.5% on average 296 days (range 95-451 days) after graft implantation. CONCLUSIONS: We found that rates of primary patency and limb salvage for this graft type were markedly lower than in comparable studies. Further work in the form of a RCT is indicated.

Feasibility and early experience of a novel multidisciplinary alcohol-associated liver disease clinic.

BACKGROUND: Alcohol cessation improves mortality in alcohol-associated liver disease (ALD), but access to treatment is limited. To address this gap, implementation and early feasibility and outcomes of a multidisciplinary ALD clinic are described. METHODS: The clinic comprised a hepatologist, psychiatrist, psychologist, nurse, and social worker. Patients included those with alcohol-associated cirrhosis or acute alcoholic hepatitis who were not in the transplant evaluation process, who had less than 6 months' sobriety and willingness to engage in alcohol use treatment. Psychosocial metrics in addition to routine hepatic function labs were collected. Treatment plans were tailored based on patient preferences and needs after multidisciplinary discussion. RESULTS: 89 patients were referred from both inpatient and outpatient settings, with 51 seen during the initial year. 38 remained active in clinic (4 died, 6 discharged, 3 moved to transplant clinic). 55% were women, 88% were white, 61% had private insurance. 49% had alcoholic hepatitis. 71% were decompensated. 80% had severe alcohol use disorder (AUD) and 84% had at least 1 comorbid psychiatric or substance use disorder. 63% chose one-on-one AUD treatment, 57% were prescribed relapse prevention medications. Mean MELD-Na score improved from baseline of 14 (SD 6.6) to 11.3 at 6 months (p=0.01). Hospital utilization significantly declined when comparing 6 months before to 6 months after initial visit (emergency department visits: 0.51 to 0.20 per person-month; inpatient admission: 0.34 to 0.14 per person-month; (ß= -0.89, 95% CI -1.18 to -0.60). CONCLUSIONS: A multidisciplinary ALD clinic was feasible with encouraging early outcomes. Further research should explore ways to expand this model and increase clinic capacity.

Living on the edge: Vulnerability of coral-dependent fishes in the Gulf.

In the Gulf, multiple human impacts and recurrent bleaching events have resulted in serious declines of coral assemblages, particularly in near-shore areas. However, the degree to which the extinction risk of coral-dependent fishes is impacted by these coral declines has been uncertain. Using primary literature and expert knowledge, coral-dependent fishes of the Gulf were identified and species-specific data on the regional distribution, population status, life history characteristics, and major threats were compiled to determine their likelihood of extinction under the IUCN Red List of Threatened Species' Categories and Criteria. Due to the limited area and degraded and fragmented nature of coral assemblages in the Gulf, all coral-dependent fishes (where data was sufficient to assess) were listed at elevated risk of extinction. Cross-boundary collaboration among Gulf States is necessary for effective management and protection of coral assemblages and their associated communities within this globally important region.

Characterization of T wave alternans with ambulatory electrocardiography.

T wave alternans (TWA) is a marker of ventricular electrical instability considered to be predictive for ventricular tachyarrhythmias. Techniques have been developed to detect TWA at the microv level as a method for arrhythmia risk stratification of persons at high risk for sudden cardiac death. Currently, TWA is typically calculated using spectral analysis, whereby TWA is presumed to assume characteristics of stationarity. In contrast, a nonspectral method known as modified moving average analysis is purported to detect transient TWA that would not be observed using a spectral approach. The purpose of this pilot study work was to establish the basic TWA signal properties obtained with a device developed by GE Medical Systems using a descriptive, correlational study design. Ambulatory electrocardiography (AECG) recordings (N = 24) were digitized and processed, and TWA was calculated via the modified moving average technique. Findings showed that noise was positively correlated with TWA in AECG channel 1 (r = .899, p < .01) and AECG channel 2 (r = .758, p < .01). However, no significant difference (p = .237) was observed in TWA values between the AECG channels. A weak positive correlation was found between TWA and heart rate, expressed as beats per min (r = .262). Heart rate mildly predicted TWA (R = 0.34). Nonstationarity was evaluated by testing for trend and randomness. TWA values measured from AECG recordings were found to be influenced moderately by noise and minimally by heart rate and lead placement.