Racial and Ethnic Disparities in Operative Experience Among General Surgery Residents: A Multi-Institutional Study from the US ROPE Consortium.

OBJECTIVE: To determine the relationship between race/ethnicity and case volume among graduating surgical residents. BACKGROUND: Racial/ethnic minority individuals face barriers to entry and advancement in surgery; however, no large-scale investigations of the operative experience of racial/ethnic minority residents have been performed. METHODS: A multi-institutional retrospective analysis of the Accreditation Council for Graduate Medical Education case logs of categorical general surgery residents at 20 programs in the US Resident OPerative Experience Consortium database was performed. All residents graduating between 2010 and 2020 were included. The total, surgeon chief, surgeon junior, and teaching assistant case volumes were compared between racial/ethnic groups. RESULTS: The cohort included 1343 residents. There were 211 (15.7%) Asian, 65 (4.8%) Black, 73 (5.4%) Hispanic, 71 (5.3%) "Other" (Native American or Multiple Race), and 923 (68.7%) White residents. On adjusted analysis, Black residents performed 76 fewer total cases (95% CI, -109 to -43, P <0.001) and 69 fewer surgeon junior cases (-98 to -40, P <0.001) than White residents. Comparing adjusted total case volume by graduation year, both Black residents and White residents performed more cases over time; however, there was no difference in the rates of annual increase (10 versus 12 cases per year increase, respectively, P =0.769). Thus, differences in total case volume persisted over the study period. CONCLUSIONS: In this multi-institutional study, Black residents graduated with lower case volume than non-minority residents throughout the previous decade. Reduced operative learning opportunities may negatively impact professional advancement. Systemic interventions are needed to promote equitable operative experience and positive culture change.

Patient-Reported Outcomes Following Severe Abdominal Trauma: A Secondary Analysis of the Damage Control Laparotomy Trial.

INTRODUCTION: Little is known about patient-reported outcomes (PROs) following abdominal trauma. We hypothesized that patients undergoing definitive laparotomy (DEF) would have better PROs compared to those treated with damage control laparotomy (DCL). METHODS: The DCL Trial randomized DEF versus DCL in abdominal trauma. PROs were measured using the European Quality of Life-5 Dimensions-5 Levels (EQ-5D) questionnaire at discharge and six months postdischarge (1 = perfect health, 0 = death, and <0 = worse than death) and Posttraumatic Stress Disorder (PTSD) Checklist-Civilian. Unadjusted Bayesian analysis with a neutral prior was used to assess the posterior probability of achieving minimal clinically important difference. RESULTS: Of 39 randomized patients (21 DEF versus 18 DCL), 8 patients died (7 DEF versus 1 DCL). Of those who survived, 28 completed the EQ-5D at discharge (12 DEF versus 16 DCL) and 25 at 6 mo (12 DEF versus 13 DCL). Most patients were male (79%) with a median age of 30 (interquartile range (IQR) 21-42), suffered blunt injury (56%), and were severely injured (median injury severity score 33, IQR 21 - 42). Median EQ-5D value at discharge was 0.20 (IQR 0.06 - 0.52) DEF versus 0.31 (IQR -0.03 - 0.43) DCL, and at six months 0.51 (IQR 0.30 - 0.74) DEF versus 0.50 (IQR 0.28 - 0.84) DCL. The posterior probability of minimal clinically important difference DEF versus DCL at discharge and six months was 16% and 23%, respectively. CONCLUSIONS: Functional deficits for trauma patients persist beyond the acute setting regardless of laparotomy status. These deficits warrant longitudinal studies to better inform patients on recovery expectations.

Disparities in the Operative Experience Between Female and Male General Surgery Residents: A Multi-institutional Study From the US ROPE Consortium.

OBJECTIVE: To examine differences in resident operative experience between male and female general surgery residents. BACKGROUND: Despite increasing female representation in surgery, sex and gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level. METHODS: Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 and 2020 from the US Resident OPerative Experience Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents. RESULTS: There were 1343 graduates from 20 Accreditation Council for Graduate Medical Education-accredited programs, and 476 (35%) were females. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs 36%, P < 0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs 1177, P < 0.01), largely due to a diminished surgeon junior experience (829 vs 863, P < 0.01). On adjusted multivariable analysis, female sex was negatively associated with being a high-volume resident (OR = 0.74, 95% CI: 0.56 to 0.98, P = 0.03). Over the 11-year study period, the annual total number of cases increased significantly for both groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P = 0.02). CONCLUSIONS: Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents.

Relationship between pepper (Capsicum annuum L.) root morphology, inter-root soil bacterial community structure and diversity under water-air intercropping conditions.

MAIN CONCLUSION: The combination of water and gas at an aeration rate of 15 mg/L and irrigation amount of 0.8 Ep significantly promoted the root morphology, inter-root soil bacterial community structure and diversity of pepper, enhanced the structure of molecular symbiotic network, and stimulated the potential ecosystem function. Poor aeration adversely affects the root morphology of pepper (Capsicum annuum L.) and bacterial community. It is critical to understand the effects of water-air interactions on root morphology and bacterial community structure and diversity. A randomized block experiment was conducted under the two aeration rates of dissolved oxygen mass concentrations, including A: 15 mg/L, O: 40 mg/L, and C: non-aeration as control treatment, and two irrigation rates of W1 and W2 (0.8 Ep and 1.0 Ep). The results showed that aerated irrigation had a significant effect on the root morphology of pepper. Compared with treatment CW1, treatment AW1 increased root dry weight, root length, root volume, and root surface area by 13.63%, 11.09%, 59.47%, and 61.67%, respectively (P < 0.05). Aerated irrigation significantly increased the relative abundance of Actinobacteria, Gemmatimonadetes, Alphaproteobacteria, Gemmatimonas, Sphingomonas, and KD4-96 aerobic beneficial bacteria. It decreased the relative abundance of Proteobacteria, Monomycetes, Bacteroidetes, Corynebacterium, Gammaproteobacteria, Anaerolineae, Subgroup_6, MND1, Haliangium, and Thiobacillus. The Pielou_e, Shannon and Simpson indexes of treatment AW1 were significantly higher than treatments OW1 and CW1. The results of the ß-diversity of bacterial communities showed that the structure of soil bacterial communities differed significantly among treatments. Actinobacteria was a key phylum affecting root morphology, and AW1 treatment was highly correlated with Actinobacteria. Molecular ecological network analysis showed a relatively high number of bacterial network nodes and more complex relationships among species under the aeration of level 15 mg/L and 0.8 Ep, as well as the emergence of new phylum-level beneficial species: Dependentiae, BRC1, Cyanobacteria, Deinococcus-Thermus, Firmicutes, and Planctomycetes. Therefore, the aeration of 15 mg/L and 0.8 times crop-evaporation coefficient can increase root morphology, inter-root soil bacterial community diversity and bacterial network structure, and enhance potential ecosystem functions in the rhizosphere.

Prevalence of HIV and HCV among injecting drug users in three selected WHO-EMRO countries: a meta-analysis.

BACKGROUND: HIV and Hepatitis C Virus (HCV) infections are responsible for a significant burden of mortality and morbidity, particularly in developing countries. This study sought to determine the prevalence of HIV and Hepatitis C among injecting drug users in Afghanistan, Iran, and Pakistan. METHODS: This review conforms to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases including PubMed, Scopus, Web of Science/Knowledge, SID.ir, and MAGIRAN were searched. Studies that were published from 2003 up to 2018 were considered for analysis. Studies were screened for inclusion in duplicate, and also, that data were narratively synthesized. RESULTS: We report on data from 79 articles. The total number of participants in studies that assessed the prevalence of HIV among injecting drug users included 68,926 participants, while those from studies that assessed HCV prevalence were 23,016 participants. Overall HIV and HCV prevalence among injecting drug users in the three selected countries were 9.1% (95% CI 6.9-12.0%) and 48.3% (95% CI 43.9-52.7%), respectively. Iran had the highest HIV prevalence of 11.0% among injectable drug users (95% CI 8.4-14.2%), while Afghanistan had the lowest HIV prevalence of 3.1% (95% CI 1.5-6.3%) among three selected countries. In Pakistan, the prevalence of HIV was 8.6% (95% CI 4.8-15.0%). Regarding HCV prevalence, Pakistan had the highest while Afghanistan had the lowest, 54.4% (95% CI 33.5-73.9%) and 37.3% (95% CI 35.2-39.4%), respectively. HCV prevalence in Iran was 47.7% (95% CI 43.4-52.0%). CONCLUSION: Injecting drug users form a special cohort of persons at risk of HIV and Hepatitis C infections. The prevalence of HIV and Hepatitis noted from our findings is significantly high. Awareness of the grave risk of spreading HIV and Hepatitis C associated with sharing needles is recommended among this sub-group of drug users.

Does continuous straw returning keep China farmland soil organic carbon continued increase? A meta-analysis.

The straw returning technique is one of the important measures for soil carbon sequestration and soil organic carbon (SOC) promotion in the world. However, the patterns of straw utilization in China with various methods among regions, the effect and variability of straw returning on SOC in different areas of China remain uncertain. We conducted a meta-analysis of 446 sets of data from 95 studies in China field to explore how the environmental factors and field management affect SOC after straw returning. The results showed that straw returning to the field significantly increase SOC content by an average of 13.97% (n = 446). The SOC increased effects are more obvious under areas with mean annual precipitation (MAP) > 500 mm, temperature (MAT) > 10 °C, loam or sandy soil, or the initial SOC content <10 g kg-1. The effect of straw returning on SOC also depends on planting systems, ranging from 5.43% of rice continuous cropping to 17.05% of the maize-wheat ration. In the rotation system, the SOC increasing effect under paddy-wheat rotation (15.79% in rice and 14.87% in wheat season) was more significant than under wheat-maize rotation (17.05% in wheat and 11.81% in maize season). The proper duration of straw returning is 6-9 years, while it will decrease SOC by 17.06%-20.05% more than 10 years. Moreover, the effects of straw returning under the conditions with deep tillage, the amount of straw more than 9000 kg ha-1, or combined pure N with 180-240 kg N ha-1 were better than other methods.

Improving the Theoretical Understanding Toward Patient-Driven Health Care Innovation Through Online Value Cocreation: Systematic Review.

BACKGROUND: Patient participation in the health care domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven service innovation has both potential and challenges for health care organizations. Over the last 5 years, articles have surfaced that focus on value cocreation in health care services and the importance of engaging patients and other actors in service delivery. However, a theoretical understanding of how to use OHCs for this purpose is still underdeveloped within the health care service ecosystem. OBJECTIVE: This paper aimed to introduce a theoretical discussion for better understanding of the potential of OHCs for health care organizations, in particular, for patient empowerment. METHODS: This literature review study involved a comprehensive search using 12 electronic databases (EMBASE, PsycINFO, Web of Science, Scopus, ScienceDirect, Medical Literature Analysis and Retrieval System Online, PubMed, Elton B Stephens Co [academic], Cumulative Index of Nursing and Allied Health Literature, Accelerated Information Sharing for Law Enforcement, Association for Computing Machinery, and Google Scholar) from 2013 to 2019. A total of 1388 studies were identified from the database search. After removing duplicates and applying inclusion criteria, we thematically analyzed 56 articles using the Braun and Clarke thematic analysis approach. RESULTS: We identified a list of 5 salient themes: communication extension, improved health literacy for patients and health care organizations, communication transparency with patients, informational and social support for patients, and patient empowerment in self-management. The most frequent theme was communication extension, which covers 39% (22/56) of the literature. This theme reported that an extension of communication between patients, caregivers, and physicians and organizations led to new opportunities to create value with minimal time and cost restrictions. Improved health literacy and communication transparency with patients were the second and third most frequent themes, respectively, covering 26% (15/56) and 25% (14/56) of the literature, respectively. The frequency of these themes indicated that the use of OHCs to generate new knowledge from patients' interactions helped health care organizations to customize treatment plans and establish transparent and effective communication between health care organizations and patients. Furthermore, of the 56 studies, 13 (23%) and 10 (17%) studies contended the opportunity of using OHCs in terms of informational and emotional support and empowering patients in their self-management of diseases. CONCLUSIONS: This review enables better understanding of the current state of the art of the online value cocreation and its potential for health care organizations. This study found that the opportunities for health care organizations through enhancement of patient participation and their cocreation of value in digital health platforms have been rapidly increasing. The identified gaps and opportunities in this study would identify avenues for future directions in modernized and more effective value-oriented health care informatics research.

Identification of Body Composition, Dietary Patterns and Its Associated Factors in Medical University Students in China.

This study aimed to measure the body composition, dietary patterns and its associated factors in medical students. A cross-sectional study was conducted among 695 students studying at Nanjing medical university, China. Data regarding dietary intake factors was collected by a validated food frequency questionnaire. Principle component analysis and multivariate linear regressions were used. Body composition including BMI and visceral fats index of the males were significantly higher (P < .05) than females. While body fats percentage and fats mass index/free fat mass index (FMI/FFMI) ratio of females was significantly higher (P < .05) than males. Three dietary patterns were identified: western dietary pattern, meat pattern, and vegetables and fruits pattern. The western pattern was having an independent negative association (P < .05) with age and financial status, while positive association (P < .05) with sleeping duration and FMI/FFMI ratio. Vegetables and fruits patterns was having positive association with physical exercise and while negative association with FMI/FFMI ratio. Meat pattern was having positive association with educational levels and sleeping duration, while negative association with physical exercise and FMI/FFMI ratio. In conclusion, medical students adopted less healthy dietary patterns as compared to healthy dietary patterns, which were found to be more associated with some adverse dietary and lifestyle behavior outcomes.

Expression of Gstt1 in Type 2 Diabetic Retinopathy Patients.

Type 2 diabetes mellitus (T2DM) is the most common metabolic and multifactorial disease in which both genetic and environmental factors are involved. In diabetes, the defects in the cellular metabolism result in higher levels of free radicals. These radicals react with other vital cellular molecules, which are responsible in diabetes side effects and known as diabetic retinopathy (DR), a disease of the retina that results in impairment or loss of vision. In the present study, we investigated the expression of glutathione S-transferases class theta 1 (GSTT1) in type 2 DR subjects. Highly significant differences (P ≤ 0.05) were observed in GSST1 expression in DR patients compared with diabetic and control groups.

Design and Evaluation of a Contextual Model for Information Retrieval From Web-Scale Discovery Services to Improve Evidence-Based Practice by Health Care Practitioners: Mixed Methods Study.

BACKGROUND: Practicing evidence-based health care is challenging because of overwhelming results presented to practitioners by Google-like Web-scale discovery (WSD) services that index millions of resources while retrieving information based on relevancy algorithms with limited consideration for user information need. OBJECTIVE: On the basis of the user-oriented theory of information need and following design science principles, this study aimed to develop and evaluate an innovative contextual model for information retrieval from WSD services to improve evidence-based practice (EBP) by health care practitioners. METHODS: We identified problems from literature to support real-world requirements for this study. We used design science research methodology to guide artefact design. We iteratively improved prototype of the context model using artificial formative evaluation. We performed naturalistic summative evaluation using convergent interviewing of health care practitioners and content analysis from a confirmatory focus group consisting of health researchers to evaluate the model's validity and utility. RESULTS: The study iteratively designed and applied the context model to a WSD service to meet 5 identified requirements. All 5 health care practitioners interviewed found the artefact satisfied the 5 requirements to successfully evaluate the model as having validity and utility. Content analysis results from the confirmatory focus group mapped top 5 descriptors per requirement to support a true hypothesis that there is significant discussion among participants to justify concluding that the artefact had validity and utility. CONCLUSIONS: The context model for WSD satisfied all requirements and was evaluated successfully for information retrieval to improve EBP. Outcomes from this study justify further research into the model.

Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia.

INTRODUCTION: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. CONCLUSION: The guideline highlights select pre-hospital criteria's and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

Barriers Associated With Evidence-Based Practice Among Nurses in Low- and Middle-Income Countries: A Systematic Review.

BACKGROUND: Evidence-based practice (EBP) is both a goal and an approach that requires a combination of clinical experience with the most credible recent research evidence when making decisions in healthcare practice. The approach has been widely embraced; however, an evidence-to-practice gap still exists. AIM: To assess barriers to EBP among nurses in low- and middle-income countries. METHODS: This review conforms to the PRISMA statement. Databases PubMed, Scopus, EMBASE, and Web of Science/Knowledge were searched using a combination of keywords that included "barriers," "evidence-based practice," and "nurses." The references of the selected articles were also hand-searched to obtain additional relevant articles. Studies published in peer-reviewed journals in English between 2000 and 2018 were included in the review. RESULTS: Sixteen articles were included in the analysis, with a total number of 8,409 participants. Both qualitative and quantitative studies were included in the review. Three main themes emerged from eight categories found. The three main themes were institutional-related barriers, interdisciplinary barriers, and nurse-related barriers. The theme of institutional-related barriers emerged from four categories, which included scant resources, limited access to information, inadequate staffing, and lack of institutional support. The theme of interdisciplinary barriers emerged from subcategories that included lack of communication between academic and clinical practice environments, inconsistency between education and practice in the nursing discipline, lack of teamwork, and the public's negative image about the nursing profession. Finally, the theme of nurse-related barriers emerged from categories including perceived limitations in the scope of nurses' practice, time, knowledge of EBP, and individual-related barriers. LINKING EVIDENCE TO ACTION: These findings may guide the design of future interventions aimed at fostering EBP. Implementing EBP in practice should be systematic and requires institutional will and interdisciplinary and individual commitment. It should be a collective goal and a win-win situation for nurses, clinicians, and healthcare organizations.

Retrospective Analysis of Thoracolumbar Junction Injuries Using the Thoracolumbar Injury Severity and Classification Score, American Spinal Injury Association Class, Injury Severity Score, Age, Sex, and Length of Hospitalization.

STUDY DESIGN: Retrospective review of patient cohort. OBJECTIVE: Our goal was to assess the validity of the Thoracolumbar Injury Classification and Severity (TLICS) score system by comparing the TLICS system to prior management of thoracolumbar injuries at our institution between January 1, 2006 to March 31, 2011. SUMMARY OF BACKGROUND DATA: TLICS was introduced in 2005 to classify and assign treatment recommendations for injuries based on 3 axes: mechanism of injury, integrity of the posterior ligamentous complex, and neurological status. METHODS: We retrospectively obtained and analyzed patient data regarding thoracolumbar junction injuries at a major academic medical center servicing level I trauma. In addition, we compared the American Spinal Injury Association (ASIA) class at time of injury to last follow-up to determine if there was any change in neurological status after intervention. We also compared sex, injury severity score (ISS), length of hospitalization, and age between nonoperatively and operatively treated patients. RESULTS: Included in our study were 201 patients (70% male and 30% female). We found the TLICS system agreed with prior thoracolumbar junction injury management at our institution 98% of the time in nonoperatively treated patients and 78% of the time in operatively treated patients. Age, sex, and ISS were not statistically significant factors in patients who were treated operatively versus nonoperatively, however, there was a trend towards higher ISS in operatively treated patients. Average TLICS score between nonoperative and operative groups was 1.56 and 4.8, respectively, and was a statistically significant difference. There was no statistically significant difference in ASIA class improvement between operative and nonoperative treatment, however, this is likely because of having only 20 patients in this subcohort. Of note, about 50% of the 17 operatively treated patients had improvement in ASIA class. CONCLUSIONS: Our data suggest that TLICS is a valuable tool in a spine surgeon's armamentarium in treating thoracolumbar junction injuries. Some surgeons might be more likely to operate on thoracolumbar junction injuries that should be treated nonoperatively according to the TLICS score. As with all classification schemes, the TLICS system should be used in conjunction with sound clinical judgment.

Producing financially literate medical graduates -- a national need for a brighter Pakistan.

OBJECTIVE: To compare the awareness of financial wellness between male and female medical students. METHODS: The cross-sectional questionnaire-based survey was conducted from February to December 2011 and comprised first year medical students belonging to different medical colleges of Karachi. Students from both genders, aged 19-24 years, belonging to all ethnic groups willing to participate were included. A close-ended questionnaire evaluated aspects of financial wellness, using four-point Likert's scale: never, sometimes, mostly, and always from 0 to 4. Besides, factor analysis was performed to investigate common financial wellness among the participants. RESULTS: Of the total 800 students approached, complete responses were received from 736(92%); 210(28.5%) boys and 526(71.5%) girls. The mean financial wellness score of boys was 8.60±3.04 and that of the girls was 7.61±3.12 (p<0.0005). Greater number of boys 93(44%) set both short- and long-term financial goals compared to 180(36%) girls (p=0.03). Besides, 218(42%) girls confined themselves to the budget compared to 81(39%) boys (p>0.05). More boys 71(34%) were spendthrift (p<0.0001) and 57(27%) preferred to keep their savings in bank accounts compared to the girls (p<0.0001). Overall, boys were better in financial security wellness compared to the girls (p=0.001). CONCLUSIONS: Male medical students exhibited awareness of financial wellness better than girls.

Intellectual wellness awareness: a neglected area in medical universities of Pakistan.

OBJECTIVE: To compare the presence of intellectual wellness awareness in students of public and private sector medical colleges in a metropolitan city. METHODS: The cross-sectional questionnaire-based survey was conducted from March to November 2011 at Bahria University Medical and Dental College, Karachi, and overall covered five private and 3 public sector medical colleges of the city.The study randomly selected 800 medical students.The responses - never, sometimes, mostly and always (numbered 0-4)--were analysed in terms of frequency, proportion and percentages using Predictive Analysis Software version 18. RESULTS: Of the 800 forms distributed, 736 (92%) completed forms were analysed. Among the respondents, 526 (71.5%) were females. Besides, 450 (61%) belonged to private medical colleges and 236 (39) were from public medical colleges. The participants of private medical colleges had taken part in intellectual discussions actively compared to those from public colleges (p < 0.001). Habit of reading books to acquire knowledge was found in 126 (44%) private college students compared to 149 (33%) in public colleges (p < 0.004). The importance of creative mental activities (p = 0.954) and current information about local and international affairs (p < 0.564) was deficient in both sets of students. CONCLUSION: Students of private medical colleges were better in terms of presence of intellectual wellness awareness, took active participation in class discussions, had good reading habits and carefully selected television programmes and movies.

Determinants of Diarrhea Among Children Aged 1 to 6 Years in Flood-Affected Areas of Pakistan: A Cross-Sectional Study.

Frequent floods can contribute to the spread of various diseases and complications, some of which may result in diarrhea, especially among children. The current study aimed to find the determinants of diarrhea among children aged 1-6 years in flood-affected areas in Khyber Pakhtunkhwa, Pakistan. A cross-sectional study was conducted in flood-affected districts. Data regarding sociodemographic information related to diarrhea and anthropometric data were collected through a validated questionnaire. Logistic regression was used to find the determinants of diarrhea. In the presence of diarrhea, the prevalences found of stunting, wasting, and being underweight were 75.2%, 76.5%, and 74.1%, respectively, which is higher than those in children without diarrhea (stunting, 24.8%; wasting, 23.5%; and being underweight, 25.9%). In bivariate regression, children aged 2-4 years (odds ratio [OR] = 1.65, P < 0.05), large family size (OR = 7.46, P < 0.01), low income (OR = 2.55, < 0.001), bathing in ponds (OR = 3.05, P < 0.05), drinking of untreated water (OR = 3, P < 0.05), flooding (OR = 1.8, P < 0.05), children living in mud houses (OR = 1.5, P < 0.05), and usage of utensils without lids (OR = 1.96, P < 0.001) were significantly associated with occurrence of diarrhea. In multivariate regression, the identified risk factors (P < 0.05) for diarrhea in flood-affected areas included illiterate mothers, flooding, large family size, households without livestock, poor water quality, untreated water, and lack of toilet facilities. In conclusion, addressing the determinants of diarrhea identified in this study is crucial for mitigating the impact of frequent floods on children in flood-affected areas. Moreover, the higher prevalence of malnutrition underscores the urgent need for comprehensive strategies and proper water, sanitation, and hygiene programs to reduce the occurrence and determinants of diarrhea.

Impact of Intra-Operative Shock and Resuscitation on Surgical Site Infections After Trauma Laparotomy.

Background: Patients undergoing trauma laparotomy experience high rates of surgical site infection (SSI). Although intra-operative shock is a likely contributor to SSI risk, little is known about the relation between shock, intra-operative restoration of physiologic normalcy, and SSI development. Patients and Methods: A retrospective review of trauma patients who underwent emergent definitive laparotomy was performed. Using shock index and base excess at the beginning and end of laparotomy, patients were classified as normal, persistent shock, resuscitated, or new shock. Univariable and multivariable analyses were performed to identify predictors of organ/space SSI, superficial/deep SSI, and any SSI. Results: Of 1,191 included patients, 600 (50%) were categorized as no shock, 248 (21%) as resuscitated, 109 (9%) as new shock, and 236 (20%) as persistent shock, with incidence of any SSI as 51 (9%), 28 (11%), 26 (24%), and 32 (14%), respectively. These rates were similar in organ/space and superficial/deep SSIs. On multivariable analysis, resuscitated, new shock, and persistent shock were associated with increased odds of organ/space SSI (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.5; p < 0.001) and any SSI (OR, 2.0; 95% CI, 1.4-3.2; p < 0.001), but no increased risk of superficial/deep SSI (OR, 1.4; 95% CI, 0.8-2.6; p = 0.331). Conclusions: Although the trajectory of physiologic status influenced SSI, the presence of shock at any time during trauma laparotomy, regardless of restoration of physiologic normalcy, was associated with increased odds of SSI. Further investigation is warranted to determine the relation between peri-operative shock and SSI in trauma patients.

Expanding deep phenotypic spectrum associated with atypical pathogenic structural variations overlapping 15q11-q13 imprinting region.

BACKGROUND: The 15q11-q13 region is a genetic locus with genes subject to genomic imprinting, significantly influencing neurodevelopment. Genomic imprinting is an epigenetic phenomenon that causes differential gene expression based on the parent of origin. In most diploid organisms, gene expression typically involves an equal contribution from both maternal and paternal alleles, shaping the phenotype. Nevertheless, in mammals, including humans, mice, and marsupials, the functional equivalence of parental alleles is not universally maintained. Notably, during male and female gametogenesis, parental alleles may undergo differential marking or imprinting, thereby modifying gene expression without altering the underlying DNA sequence. Neurodevelopmental disorders, such as Prader-Willi syndrome (PWS) (resulting from the absence of paternally expressed genes in this region), Angelman syndrome (AS) (associated with the absence of the maternally expressed UBE3A gene), and 15q11-q13 duplication syndrome (resulting from the two common forms of duplications-either an extra isodicentric 15 chromosome or an interstitial 15 duplication), are the outcomes of genetic variations in this imprinting region. METHODS: Conducted a genomic study to identify the frequency of pathogenic variants impacting the 15q11-q13 region in an ethnically homogenous population from Bangladesh. Screened all known disorders from the DECIPHER database and identified variant enrichment within this cohort. Using the Horizon analysis platform, performed enrichment analysis, requiring at least >60% overlap between a copy number variation and a disorder breakpoint. Deep clinical phenotyping was carried out through multiple examination sessions to evaluate a range of clinical symptoms. RESULTS: This study included eight individuals with clinically suspected PWS/AS, all previously confirmed through chromosomal microarray analysis, which revealed chromosomal breakpoints within the 15q11-q13 region. Among this cohort, six cases (75%) exhibited variable lengths of deletions, whereas two cases (25%) showed duplications. These included one type 2 duplication, one larger atypical duplication, one shorter type 2 deletion, one larger type 1 deletion, and four cases with atypical deletions. Furthermore, thorough clinical assessments led to the diagnosis of four PWS patients, two AS patients, and two individuals with 15q11-q13 duplication syndrome. CONCLUSION: Our deep phenotypic observations identified a spectrum of clinical features that overlap and are unique to PWS, AS, and Dup15q syndromes. Our findings establish genotype-phenotype correlation for patients impacted by variable structural variations within the 15q11-q13 region.

A multi-institutional study from the US ROPE consortium examining factors associated with endocrine surgery exposure for general surgery residents.

BACKGROUND: Prior analyses of general surgery resident case logs have indicated a decline in the number of endocrine procedures performed during residency. This study aimed to identify factors contributing to the endocrine operative experience of general surgery residents and compare those who matched in endocrine surgery fellowship with those who did not. METHODS: We analyzed the case log data of graduates from 18 general surgery residency programs in the US Resident Operative Experience Consortium over an 11-year period. RESULTS: Of the 1,240 residents we included, 17 (1%) matched into endocrine surgery fellowships. Those who matched treated more total endocrine cases, including more thyroid, parathyroid, and adrenal cases, than those who did not (81 vs 37, respectively, P < .01). Program-level factors associated with increased endocrine volume included endocrine-specific rotations (+10, confidence interval 8-12, P < .01), endocrine-trained faculty (+8, confidence interval 7-10, P < .01), and program co-location with otolaryngology residency (+5, confidence interval 2 -8, P < .01) or endocrine surgery fellowship (+4, confidence interval 2-6, P < .01). Factors associated with decreased endocrine volume included bottom 50th percentile in National Institute of Health funding (-10, confidence interval -12 to -8, P < .01) and endocrine-focused otolaryngologists (-3, confidence interval -4 to -1, P < .01). CONCLUSION: Several characteristics are associated with a robust endocrine experience and pursuit of an endocrine surgery fellowship. Modifiable factors include optimizing the recruitment of dedicated endocrine surgeons and the inclusion of endocrine surgery rotations in general surgery residency.

Interactive effects of biochar and chemical fertilizer on water and nitrogen dynamics, soil properties and maize yield under different irrigation methods.

Long-term application of nitrogen (N) fertilizer adversely degrades soil and decreases crop yield. Biochar amendment with N fertilizer not only can increase yield but also can improve the soil. A 3-year field experiment was conducted to determine the effect of biochar doses with N fertilizer on maize yield and soil N and water dynamics under border irrigation (BI) and drip irrigation (DI) methods. Treatments were 260 kg N ha-1 without biochar addition and combined with low, medium, and high doses of biochar, namely, 15.5 t ha-1, 30.7 t ha-1, and 45.3 t ha-1 (NB0, NB1, NB2, and NB3), respectively. The biochar doses and irrigation methods significantly (p < 0.05) increased maize growth and yield characteristics, irrigation water use efficiency (IWUE), and fertilizer N use efficiency (FNUE) and enhanced the soil properties. In the BI and DI method, the NB1, NB2, and NB3 treatments increased yield by 4.96%-6.10%, 8.36%-9.85%, and 9.65%-11.41%, respectively, compared to NB0. In terms of IWUE and FNUE, the non-biochar treatment had lower IWUE and FNUE compared to biochar combined with N fertilizer treatments under both BI and DI methods. In the BI method, the IWUE in NB2 and NB3 ranged from 3.36 to 3.43 kg kg-1, and in DI, it was maximum, ranging from 5.70 to 5.94 kg kg-1. Similarly, these medium and high doses of biochar increased the FNUE of maize. The FNUEs in NB2 and NB3 under BI ranged from 38.72 to 38.95 kg kg-1 and from 38.89 to 39.58 kg kg-1, while FNUEs of these same treatments under DI ranged from 48.26 to 49.58 kg kg-1 and from 48.92 to 50.28 kg kg-1. The effect of biochar was more obvious in DI as compared to the BI method because soil water content (SWC) and soil N concentrations (SNCs) were higher at rhizosphere soil layers under DI. Biochar improved SWC and SNC at 0-20 cm and 20-40 cm soil layers and decreased below 60-cm soil layers. In contrast, despite biochar-controlled SWC and SNCs, still, values of these parameters were higher in deeper soil layers. In the BI method, the SNCs were higher at 60-80 cm and 80-100 cm compared to the top and middle soil layers. Depth-wise results of SNC demonstrated that the biochar's ability to store SNC was further enhanced in the DI method. Moreover, biochar increased soil organic matter (OM) and soil aggregate stability and maintained pH. The NB0 treatment increased soil OM by 11.11%-14.60%, NB2 by 14.29%-19.42%, and NB3 by 21.98%-23.78% in both irrigation methods. This increased OM resulted in improved average soil aggregates stability by 2.45%-11.71% and 4.52%-14.66% in the BI and DI method, respectively. The results of our study revealed that combined application of N fertilizer with a medium dose of biochar under the DI method would be the best management practice, which will significantly increase crop yield, improve SWC, enrich SNC and OM, improve soil structure, and maintain pH.