MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers.

OBJECTIVE: To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system. METHODS: This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings. RESULTS: Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036). CONCLUSION: Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system. CLINICAL RELEVANCE STATEMENT: The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists. KEY POINTS: • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).

Contemporary Practices of Strength and Conditioning Coaches in High-Level Male Ice Hockey: A Survey-Based Investigation.

ABSTRACT: Galati, D, Turner, AN, Bishop, C, and Maloney, SJ. Contemporary practices of strength and conditioning coaches in high-level male ice hockey: a survey-based investigation. J Strength Cond Res 37(11): 2241-2250, 2023-The aim of this study was to provide an updated view of the common practices, ideologies, education level, and professional environment of strength and conditioning (S&C) coaches in elite male ice hockey. Nineteen S&C coaches from professional, semiprofessional, and top-tier collegiate hockey teams in North America completed an anonymous online survey. This was composed of 10 sections: (a) background information; (b) technology use, (c) testing and periodization, (d) strength and power, (e) flexibility/mobility, (f) speed, (g) plyometrics, (h) aerobic and anaerobic conditioning, (i) rehabilitation, and (j) challenges and areas of improvement. Fixed-response questions were analyzed through frequency analyses. Thematic analyses were used to identify common themes from open-response questions. Strength and conditioning coaches had an average of 8 (±6.5) years of experience when they accepted their current role. The majority held a master's degree and S&C certification. Muscular power, linear speed, and body composition were the most frequently tested qualities. Neuromuscular fatigue was the most important consideration during the season and least important consideration during the off-season. Training frequencies for all physical capacities were lower during the season compared with the off-season. All S&Cs had access to technology, with wearables, with force plates identified as the most used devices. This information may be used by S&C coaches to compare working practices with those used by their peers and inform them of the likely requirements and skill sets needed for job applications. Educational institutions may use this information to align teaching to current practice and to inform future research.

Effect of a dedicated PI-QUAL curriculum on the assessment of prostate MRI quality.

PURPOSE: The Prostate Imaging Quality (PI-QUAL) score is a metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study evaluated the impact of a prostate MRI quality training lecture on the participant's ability to assess prostate MRI image quality. METHODS: Eighteen in-training-radiologists of varying experience in reviewing diagnostic prostate MRI assessed the image quality of ten examinations. Then, they attended a dedicated lecture on MRI quality assessment using the PI-QUAL score. After the lecture, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic (ROC) analysis. The reference standard was the PI-QUAL score assessed by a fellowship trained abdominal radiologist with experience in reading prostate MRI. RESULTS: There was a significant improvement in the average area under the curve (AUC) for assessment of prostate MRI image quality from baseline (0.82; [0.576 - 0.888]) to post teaching (1.0; [0.954-1]), with an improvement of 0.18 (p < 0.03). When ROC curves were computed for different cohorts stratified based on year of training, difference ranged from 0.48 for second year residents to 0.32 for fourth year residents (p < 0.001-0.01). For abdominal imaging fellows, the pre-teaching AUC was 0.9 [0.557-1] and post teaching AUC was 1 [0.957-1], a difference of 0.1 (p = 0.20). CONCLUSIONS: A dedicated lecture on PI-QUAL improved the ability of radiologists-in-training to assess prostate MRI image quality, with variable impact depending on year of training.

A Mathematical Model for Determining the Body's Fluctuating Need for and Synthesis of Active Vitamin D.

The process by which 1,25(OH)2D3 is synthesized and degraded and how it is transported out of the cell and body is described. The changing demand for the synthesis of 1-25(OH)2D3 during different conditions experienced by the body is reviewed. A method of determining 1,25(OH)2D3 synthesis and demand, and the percent utilization of 25(OH)D3 to make 1,25(OH)2D3 is presented based on the measurement of the end metabolites of 1,25(OH)2D3 and of its immediate precursor, 25(OH)D3. A mathematical model has been developed to allow the calculation of 1,25(OH)2 D synthesis, and demand, and the percent utilization of 25(OH)D3. Simple algebraic equations have been derived which allow the calculation of these new parameters using the concentrations of the end metabolites of 1,25(OH)2D3 and its immediate precursor, 25(OH)D3 in the serum and urine. Vitamin D plays an important role in combating invading bacteria and viruses and in subduing the body's associated inflammatory response. This new approach to evaluating vitamin D status may help clinicians determine 25(OH)D3 and 1,25(OH)2D3 levels needed to suppress bacterial infections, viral replication during new viral infections and the reactivation of latent viruses, and to downregulate the inflammatory responses caused by bacteria and viruses.

Jump and Change of Direction Speed Asymmetry Using Smartphone Apps: Between-Session Consistency and Associations With Physical Performance.

ABSTRACT: Bishop, C, Perez-Higueras Rubio, M, Gullon, IL, Maloney, S, and Balsalobre-Fernandez, C. Jump and change of direction speed asymmetry using smartphone apps: between-session consistency and associations with physical performance. J Strength Cond Res 36(4): 927-934, 2022-The aims of this study were to (a) quantify the magnitude and direction of asymmetry from jump and change of direction speed (CODS) tests and (b) determine the relationship between these asymmetries and jump and CODS performance, in a test-retest design. Thirty Spanish national-level youth basketball athletes performed single leg countermovement jumps (SLCMJs), single leg drop jumps (SLDJs), and 505 CODS tests, all assessed using the My Jump 2 and CODTimer smartphone applications. All tests showed good to excellent reliability, with no significant differences identified between test sessions in jump, CODS, or asymmetry data. The direction of asymmetry showed substantial levels of agreement between test sessions for jump height during the SLDJ (Kappa = 0.72), but only fair levels of agreement for reactive strength during the SLDJ (Kappa = 0.25), fair levels of agreement for jump height during the SLCMJ (Kappa = 0.29), and slight levels of agreement for total time during the 505 test (Kappa = 0.18). Jump height asymmetry from the SLDJ was significantly associated with reduced jump height (ρ = -0.44), reactive strength (ρ = -0.46) and 505 times (ρ = 0.45-0.48) in test session 1, and reactive strength (ρ = -0.42) and 505 times (ρ = 0.40) in test session 2. These data show that jump height asymmetry from the SLDJ was associated with reduced jump and CODS performance in youth basketball athletes during repeated test sessions. In addition, the same asymmetry metric was the only one to show substantial levels of agreement between test sessions. Owing to the consistency of these data, SLDJ height asymmetry may be a useful metric to measure when monitoring interlimb asymmetries.

The relationship between vertical stiffness during bilateral and unilateral hopping tests performed with different strategies and vertical jump performances.

Vertical stiffness has been highlighted as a potential determinant of performance and may be estimated across a range of different performance tasks. The aim of the current study was to investigate the relationship between vertical stiffness determined during 9 different hopping tests and performance of vertical jumps. Twenty healthy, active males performed vertical hopping tests with three different strategies (self-selected, maximal, and controlled) and three different limb configurations (bilateral, unilateral preferred, and unilateral non-preferred), resulting in nine different variations, during which vertical stiffness was determined. In addition, participants performed squat jump (SQJ) and countermovement jump (CMJ) during which jump height, CMJ stiffness, and eccentric utilization ratio (EUR) were determined. Vertical stiffness in bilateral and unilateral preferred tasks performed with a self-selected and maximal, but not controlled, strategy was associated with stiffness in the CMJ (r = 0.61-0.64; p < 0.05). However, stiffness obtained during unilateral preferred and non-preferred hopping with self-selected strategy was negatively associated with performance in SQJ and CMJ tasks (r = -0.50 to -0.57; p < 0.05). These findings suggest that high levels of vertical stiffness may be disadvantageous to static vertical jumping performance. In addition, unilateral hopping with a self-selected strategy may be the most appropriate task variation if seeking to determine relationships with vertical jumping performance.Highlights Stiffness obtained during unilateral hopping with a preferred strategy was negatively associated with vertical jumping performancesStiffness obtained during hopping with preferred and maximal strategies was associated with stiffness obtained during a countermovement jumpIn this population, hopping stiffness may therefore be reflective of an individual's countermovement jump strategyHigh levels of stiffness may be disadvantageous to static-start vertical jumping.

The Obesity Paradox in Emergency General Surgery Patients.

BACKGROUND: Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m2 and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates. METHODS: A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed. RESULTS: A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m2, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9). CONCLUSIONS: When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings.

Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures.

PURPOSE: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. METHODS: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. RESULTS: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. CONCLUSION: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.

Effects of a Competitive Soccer Match on Jump Performance and Interlimb Asymmetries in Elite Academy Soccer Players.

ABSTRACT: Bromley, T, Turner, A, Read, P, Lake, J, Maloney, S, Chavda, S, and Bishop, C. Effects of a competitive soccer match on jump performance and interlimb asymmetries in elite academy soccer players. J Strength Cond Res 35(6): 1707-1714, 2021-The purpose of this study was to investigate the effects of a competitive soccer match on jump performance and interlimb asymmetries over incremental time points during a 72-hour period. Fourteen elite adolescent players from a professional English category 3 academy performed single-leg countermovement jumps pre, post, 24-, 48-, and 72-hour post-match on a single force platform. Eccentric impulse, concentric impulse, peak propulsive force, jump height, peak landing force, and landing impulse were monitored throughout. Interlimb asymmetries were also calculated for each metric as the percentage difference between limbs. Significant negative changes (p < 0.05) in jump performance were noted for all metrics at all time points, with the exception of jump height. Interlimb asymmetries were metric-dependent and showed very large increases, specifically post-match, with a trend to reduce back toward baseline values at the 48-hour time point for propulsive-based metrics. Asymmetries for landing metrics did not peak until the 24-hour time point and again reduced toward baseline at 48-hour time point. This study highlights the importance of monitoring distinct jump metrics, as jump height alone was not sensitive enough to show significant changes in jump performance. However, interlimb asymmetries were sensitive to fatigue with very large increases post-match. More frequent monitoring of asymmetries could enable practitioners to determine whether existing imbalances are also associated with reductions in physical performance or increased injury risk.

Perceived Health Risks Among Firefighters; The New Jersey Firefighter Health Survey.

OBJECTIVE: There is a growing literature on the risk of chronic disease among firefighters, including cardiovascular disease (CVD) and cancer. However there is little information on firefighter's perception thereof. METHODS: Firefighters attending a union convention in New Jersey completed a survey with four domains: firefighting experience; perceived additional risk for chronic diseases (six-point Likert scale); cancer screening history; demographics, and risk behaviors. RESULTS: Among 167 enrolled firefighters, all were men and 86.6% active career. Median perceived risk ranged from high risk (colon, hematologic, breast, prostate, and testicular cancers) to very high risk (CVD, pulmonary diseases, all cancers, lung and oral cancer). CONCLUSIONS: NJ Firefighters attributed considerable additional risk to acquiring chronic disease as a result of their firefighting activities. Understanding firefighter perceptions of their own morbidity and mortality will help develop future firefighter preparatory programs.

Does a Loaded Warm-Up Influence Jump Asymmetry and Badminton-Specific Change of Direction Performance?

PURPOSE: Previously, it has been shown that loaded warm-up (LWU) can improve change-of-direction speed (CODS) in professional badminton players. However, the effect of asymmetry on CODS in badminton players and the influence of LWU on asymmetry has not been examined. METHODS: A total of 21 amateur badminton players (age 29.5 [8.4] y, playing experience 8.4 [4.2] y) completed 2 trials. In the first, they performed a control warm-up. In the second, they performed the same warm-up but with 3 exercises loaded with a weight vest (LWU). Following both warm-ups, players completed single-leg countermovement jump and badminton-specific CODS tests. RESULTS: No significant differences between control warm-up and LWU were observed for CODS, single-leg countermovement jump, or single-leg countermovement jump asymmetry. However, small effect sizes suggested faster CODS (mean difference: -5%; d = -0.32) and lower asymmetries (mean difference: -3%; d = -0.39) following LWU. Five players (24%) experienced CODS improvements greater than the minimum detectable change while 2 (10%) responded negatively. Asymmetry was not correlated with CODS following control warm-up (ρ = .079; P = .733) but was negatively associated with CODS after LWU (ρ = -.491; P = .035). CONCLUSION: LWU may prove a strategy to trial on an individual basis, but generic recommendations should not be applied.

Impact of contact versus non-contact wide-angle viewing systems on outcomes of primary retinal detachment repair (PRO study report number 5).

BACKGROUND/AIMS: Vitrectomy to repair retinal detachment is often performed with either non-contact wide-angle viewing systems or wide-angle contact viewing systems. The purpose of this study is to assess whether the viewing system used is associated with any differences in surgical outcomes of vitrectomy for primary non-complex retinal detachment repair. METHODS: This is a multicenter, interventional, retrospective, comparative study. Eyes that underwent non-complex primary retinal detachment repair by either pars plana vitrectomy (PPV) alone or in combination with scleral buckle/PPV in 2015 were evaluated. The viewing system at the time of the retinal detachment repair was identified and preoperative patient characteristics, intraoperative findings and postoperative outcomes were recorded. RESULTS: A total of 2256 eyes were included in our analysis. Of those, 1893 surgeries used a non-contact viewing system, while 363 used a contact lens system. There was no statistically significant difference in single surgery anatomic success at 3 months (p=0.72), or final anatomic success (p=0.40). Average postoperative visual acuity for the contact-based cases was logMAR 0.345 (20/44 Snellen equivalent) compared with 0.475 (20/60 Snellen equivalent) for non-contact (p=0.001). After controlling for numerous confounding variables in multivariable analysis, viewing system choice was no longer statistically significant (p=0.097). CONCLUSION: There was no statistically significant difference in anatomic success achieved for primary retinal detachment repair when comparing non-contact viewing systems to contact lens systems. Postoperative visual acuity was better in the contact-based group but this was not statistically significant when confounding factors were controlled for.

Lower limb stiffness testing in athletic performance: a critical review.

Stiffness describes the resistance of a body to deformation. In regard to athletic performance, a stiffer leg-spring would be expected to augment performance by increasing utilisation of elastic energy. Two-dimensional spring-mass and torsional spring models can be applied to model whole-body (vertical and/or leg stiffness) and joint stiffness. Various tasks have been used to characterise stiffness, including hopping, gait, jumping, sledge ergometry and change of direction tasks. Appropriate levels of reliability have been reported in most tasks, although they vary between investigations. Vertical stiffness has demonstrated the strongest reliability across tasks and may be more sensitive to changes in high-velocity running performance than leg stiffness. Joint stiffness demonstrates the weakest reliability, with ankle stiffness more reliable than knee stiffness. Determination of stiffness has typically necessitated force plate analyses; however, validated field-based equations permit determination of whole-body stiffness without force plates. Vertical, leg and joint stiffness measures have all demonstrated relationships with performance measures. Greater stiffness is typically demonstrated with increasing intensity (i.e., running velocity or hopping frequency). Greater stiffness is observed in athletes regularly subjecting the limb to high ground reaction forces (i.e., sprinters). Careful consideration should be given to the most appropriate assessment of stiffness on a team/individual basis.

Train the Engine or the Brakes? Influence of Momentum on the Change of Direction Deficit.

PURPOSE: Currently, it is unclear which physical characteristics may underpin the change of direction deficit (COD-D). This investigation sought to determine if momentum, speed-, and jump-based measures may explain variance in COD-D. METHODS: Seventeen males from a professional soccer academy (age, 16.76 [0.75] y; height, 1.80 [0.06] m; body mass, 72.38 [9.57] kg) performed 505 tests on both legs, a 40-m sprint, and single-leg countermovement and drop jumps. RESULTS: The regression analyses did not reveal any significant predictors for COD-D on either leg. "Large" relationships were reported between the COD-D and 505 time on both limbs (r = .65 to .69; P < .01), but COD-D was not associated with linear momentum, speed-, or jump-based performances. When the cohort was median split by COD-D, the effect sizes suggested that the subgroup with the smaller COD-D was 5% faster in the 505 test (d = -1.24; P < .001) but 4% slower over 0-10 m (d = 0.79; P = .33) and carried 11% less momentum (d = -0.81; P = .17). CONCLUSION: Individual variance in COD-D may not be explained by speed- and jump-based performance measures within academy soccer players. However, when grouping athletes by COD-D, faster athletes with greater momentum are likely to display a larger COD-D. It may, therefore, be prudent to recommend more eccentric-biased or technically focused COD training in such athletes and for coaches to view the COD action as a specific skill that may not be represented by performance time in a COD test.

A qualitative study of community perspectives surrounding cleaning practices in the context of Zika prevention in El Salvador: implications for community-based Aedes aegypti control.

BACKGROUND: In El Salvador, Aedes aegypti mosquitoes transmitting Zika and other arboviruses use water storage containers as important oviposition sites. Promotion of water storage container cleaning is a key element of prevention programs. We explored community perceptions surrounding cleaning practices among pregnant women, male partners of pregnant women, and women likely to become pregnant. METHODS: Researchers conducted 11 focus groups and 12 in-depth interviews which included individual elicitations of Zika prevention measures practiced in the community. Focus group participants rated 18 images depicting Zika-related behaviors according to effectiveness and feasibility in the community context, discussed influencing determinants, voted on community intentions to perform prevention behaviors, and performed washbasin cleaning simulations. In-depth interviews with male partners of pregnant women used projective techniques with images to explore their perceptions on a subset of Zika prevention behaviors. RESULTS: General cleaning of the home, to ensure a healthy environment, was a strong community norm. In this context, participants gave water storage container cleaning a high rating, for both its effectiveness and feasibility. Participants were convinced that they cleaned their water storage containers effectively against Zika, but their actual skills were inadequate to destroy Aedes aegypti eggs. A further constraint was the schedule of water availability. Even during pregnancy, male partners rarely cleaned water storage containers because water became available in homes when they were at work. Furthermore, prevailing gender norms did not foster male participation in domestic cleaning activities. Despite these factors, many men were willing to provide substantial support with cleaning when their partners were pregnant, in order to protect their family. CONCLUSIONS: Behavior change programs for the prevention of Zika and other arboviruses need to improve community members' mosquito egg destruction skills rather than perpetuate the promotion of non-specific cleaning in and around the home as effective. Egg elimination must be clearly identified as the objective of water storage container maintenance and programs should highlight the effective techniques to achieve this goal. In addition, programs must build the skills of family members who support pregnant women to maintain the frequency of effective egg destruction in all water storage containers of the home.

Surgical Outcomes of Primary RRD With and Without Concurrent Full-Thickness Macular Hole (PRO Study Report No. 7).

BACKGROUND AND OBJECTIVE: Non-causal macular holes (MHs) can occur concurrently with rhegmatogenous retinal detachments (RRDs). The visual outcomes and surgical approach for these eyes are variable. PATIENTS AND METHODS: This was a multi-institutional, retrospective review of all primary retinal detachment surgeries from January 1, 2015, through December 31, 2015. Pre-, intra-, and postoperative metrics were recorded. RESULTS: There were 2,242 eyes that had pars plana vitrectomy for primary RRD, 43 (1.9%) of which had a MH at the time of surgery. The mean postoperative logMAR visual acuity (VA) for the MH cohort was 0.87 ± 0.64 (20/148) and for eyes without a MH was 0.47 ± 0.63 (20/59; P < .0001). The single-surgery re-attachment rate for the MH cohort and no MH cohort was 86.1% and 84.9%, respectively (P = 1.0000). CONCLUSIONS: Patients with noncausal MHs and RRD had significantly worse VA than patients without a MH. Preoperative counseling is imperative in patients with both RRD and MH. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:500-505.].

Low Vitamin D States Observed in U.S. Marines and Navy Sailors with Early Multi-Symptom Illness.

Research has implicated immune system inflammation as an underlying etiology of multi-symptom illnesses, and vitamin D has been shown to have a significant role in immune system function. In this retrospective review performed on the medical charts of service members who presented with signs and symptoms of multi-symptom illnesses, we focused on serum 25(OH)D3 levels and looked for associations of vitamin D status (deficient, insufficient, and normal) with age (20-31 years versus 31-56 years) and deployment status (war zones versus other). Two groups (U.S. Marines and Navy Sailors) were sampled and both showed high incidences of below normal vitamin D levels. However, with the Marines, age-related differences in serum levels (p = 0.009) were found only among those who deployed to Iraq/Afghanistan in comparison to those in non-combat locations. The comparison within the Navy sample showed that mobilized sailors had lower 25(OH)D3 levels than the group that did not deploy (p = 0.04). In addition, 100% of the sailors who deployed had below normal levels versus only 33% in the cadre group. The data suggest that personnel returning from a war zone with signs of early multi-symptom illness should be checked for low vitamin D status.

The CELIOtomy Risk Score: An effort to minimize futile surgery with analysis of early postoperative mortality after emergency laparotomy.

BACKGROUND: Emergency surgical services often encounter patients with generalized peritonitis. Difficult perioperative decisions impact morbidity, mortality, cost, and utilization of hospital resources. The ability to preoperatively predict patient nonsurvival despite surgical intervention using clinical physiologic indicators was the aim of this study and would be helpful in counseling patients/families. METHODS: A retrospective cohort from an institutional database was queried for nontrauma patients with peritonitis undergoing emergency laparotomy from 2012 to 2016. Time to mortality after surgery was compared: early (≤72 hours) versus late (>72 hours) and no death. RESULTS: After 534 emergency laparotomies, there were 74 (13.9%) mortalities. Of these, death occurred early (≤72 hours) after surgery in 28 (37.8%) patients and late (>72 hours) in 46 (62.2%). Early death patients had a significantly more deranged physiology, as evidenced by higher Acute Physiology and Chronic Health Evaluation II scores (mean 28.1 ± 8.4 vs 22.9 ± 8.7, P = .01), worse acute kidney injury (preoperative creatinine 3.7 ± 3.2 vs 1.9 ± 1.4, P = .001), and greater level of acidosis (pH 7.19 ± 0.12 vs 7.27 ± 0.13, P = .017). Additionally, preoperative lactate was significantly increased in patients with early mortality (6.8 ± 4.1 vs 5.1 ± 4.0, P = .045). Using logarithmic regression, a nomogram was constructed using age, Glasgow Coma Scale, lactate, creatinine, and pH. This nomogram had an area under the curve of 0.908 on receiver operator curve analysis. A score of 13 equates to greater than 50% risk of early mortality after surgery. CONCLUSION: Early mortality (≤72 hours after emergency laparotomy) is associated with decreased pH, elevated creatinine, and elevated lactate. These factors combined into the nomogram constructed may assist surgical teams with patient and family discussions to prevent futile surgical interventions.

Surgery Resident Time Consumed by the Electronic Health Record.

OBJECTIVE: Time spent on the Electronic Health Record (EHR) influences surgical residents' clinical availability. Objective data assessing EHR usage among surgical residents are lacking and necessary. DESIGN/PARTICIPANTS: Active EHR usage data for 70 surgical residents were collected from April 2015 through April 2016. Active EHR usage was defined as more than 15 keystrokes, or 3 mouse clicks, or 1700 "mouse miles" per minute. Usage data of different specialties, interns (PGY 1), juniors (PGY 2, 3), and seniors (PGY 4, 5) were compared. SETTING: Carolinas Medical Center, Charlotte, NC. RESULTS: Interns spent more time than juniors on total EHR activities per day (134.5 vs 105.5 minutes, p < 0.001) and juniors spent more time per day than seniors (105.5 vs 78.7 minutes, p < 0.001). Among different EHR activities per patient, interns spent greater time than juniors on chart review (8.1 vs 6.2 minutes, p < 0.001), documentation (9.0 vs 6.5 minutes, p < 0.001), and orders (3.6 vs 3.0 minutes, p < 0.001). Juniors spent the same time as seniors on chart review (6.2 vs 6.5 minutes, p = 0.2). Juniors spent more time than seniors on documentation (6.5 vs 5.2 minutes, p < 0.001) and orders (3.0 vs 2.7 minutes, p < 0.05). Comparing EHR activities per patient among different specialties, General Surgery residents spent more time than Orthopedic residents on total EHR time (19.9 vs 15.9 minutes, p < 0.001), chart review (6.8 vs 5.7 minutes, p < 0.001), documentation (6.3 vs 5.6 minutes, p < 0.001), and orders (3.6 vs 2.6 minutes, p < 0.001). General Surgery residents spent less time than OB/GYN residents on total EHR time (19.9 vs 22 minutes, p < 0.01), chart review (6.8 vs. 7.5 minutes, p < 0.05), and documentation (6.3 vs 7.6 minutes, p < 0.001), but more time on orders (3.6 vs 2.9 minutes, p < 0.001). CONCLUSIONS: These are the first reported objective findings on surgical resident use of the EHR and may provide an opportunity for improvement in EHR training and usage.