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Prognostic Factors to Reduce ICU Overtriage in Elderly Patients with Isolated Mild Traumatic Brain Injury

Surgical Science 2023年第7期14卷 517-532页

作者： Tomas Jacome Chris LaBorde Richard Lewis Danielle Tatum our lady of the lake regional medical center Baton Rouge LA USA LSU Health-Baton Rouge Baton Rouge LA USA

Introduction: Elderly patients with mild traumatic brain injury (mTBI) are frequently admitted to an intensive care unit (ICU), which is potentially both harmful and unnecessary. It is not known which patients may be safely observed in a non-ICU setting, potentially improving ICU utilization. The purpose of this study was to identify factors that predict which geriatric patients with traumatic brain injury may be admitted to a level of care other than the ICU. Methods: Adults ≥65+ years admitted with positive radiologic study demonstrating isolated mTBI (defined as Glasgow Coma Scale (GCS) 13 - 15) that was initially managed nonoperatively between January 2011-December 2016 were identified. Primary outcomes evaluated included over triage and Glasgow Outcome Scale (GOS). Results: 207 were identified. Most patients presented with GCS 15 (77.8%) and were admitted to ICU (85.5%). 27% (n = 55) met overtriage criteria. The most common TBI was subdural hemorrhage (SDH) (48.8%) followed by subarachnoid hemorrhage (SAH) (22.2%). Hemorrhage progression developed in 8.7% of subjects, but there was no difference across TBI type. 21.7% of patients developed a ≥2 point decrease in GCS during their hospital stay. Upon discharge, 89.9% had a GOS ≥ 4 - 5. Presence/type of a single intracranial hemorrhage (ICH) was not significantly associated with outcome, but presence of bilateral or multiple lesions was significantly associated with poor outcome (p = 0.04). Conclusions: Overtriage of patients to an ICU is costly, resource intensive, and avoidable. Here, we suggest a conservative framework to assist the determination of which patients can be safely observed in non-ICU setting. Future studies should determine if this framework is generalizable to the entire geriatric population who present with mTBI.

关键词： Traumatic Brain Injury Geriatric Trauma Overtriage Intensive Care Unit Outcomes

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Acute ethanol poisoning in a 6-year-old girl following ingestion of alcohol-based hand sanitizer at school

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World Journal of Emergency Medicine 2011年第3期2卷 232-233页

作者： Madeline Matar Joseph Cristina Zeretzke Sara Reader Dawn R. Sollee Division of Pediatric Emergency Medicine University of Florida Department of Emergency Medicine JacksonvilleFlorida USA our lady of the lake regional medical center Pediatric Residency Program Baton Rouge Louisiana USA University of Florida College of Pharmacy and College of Medicine Department of Emergency Medicine University of Florida Health Science Center-Jacksonville USA

BACKGROUND： Alcohol-based hand sanitizers （ABHSs） have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a school, resulting in intoxication. METHODS：The child was a 6-year-old girl who had been brought to the emergency department （ED） for hypothermia, altered mental status （AMS）, periods of hypoventilation, hypothermia and vomiting. Computed tomography of her head revealed nothing abnormal in intracranial pathology. Urine drug screening was negative. Alcohol level was 205 mg/dL on admission. Other abnormal values included potassium of 2.8 mEq/L, osmolality of 340 mOsm/kg and no hypoglycemia. Further investigation revealed that the patient had gone frequently to the class restroom for ingestion of unknown quantities of ABHSs during the day. The patient was admitted for one day for intravenous fluid hydration and close observation of her mental status. RESULTS：The patient was discharged from the hospital the next day without any complications. CONCLUSION： Despite the large safety margin of ABHSs, emergency physicians need to be aware of the potential risk of ingestion of a large amount of such products in children and consider it in the assessment and management of school-age children with acute AMS.

关键词： Pediatrics Toxicology Ethanol Hand-sanitizer Altered mental status

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Trends in the management of anorectal melanoma:A multiinstitutional retrospective study and review of the world literature

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World Journal of Gastroenterology 2021年第3期27卷 267-280页

作者： Josh Bleicher Jessica N Cohan Lyen C Huang William Peche T Bartley Pickron Courtney L Scaife Tawnya L Bowles John R Hyngstrom Elliot A Asare Department of Surgery Huntsman Cancer Institute at the University of UtahSalt Lake CityUT 84114United States Department of Surgery George E Wahlen Department of Veterans Affairs Medical CenterSalt Lake CityUT 84114United States Department of Surgery Intermountain Medical CenterMurrayUT 84107United States

BACKGROUND Anorectal melanoma(ARM)is a rare disease with a poor *** on optimal treatment is limited and surgical management varies *** hypothesized that the frequency of abdominoperineal resection used as primary treatment of ARM has decreased over the past several *** To update our understanding of outcomes for patients with ARM and analyze management trends around the *** This is a multi-institutional,retrospective study of patients treated for ARM at 7 *** included both large,academic,tertiary care centers and smaller,general community *** prospectively maintained institutional tumor registries,we identified 24 patients diagnosed with ARM between January 2000 and May *** analyzed factors prognostic for recurrence and *** then used Cox regression to measure overall survival(OS)and melanoma-specific *** also performed a literature review to assess trends in surgical management and *** Of the 24 patients diagnosed with ARM,12(50.0%)had local,8(33.3%)regional,and 4(16.7%)distant disease at *** time to recurrence was 10.4 mo[interquartile range(IQR)7.5-17.2]with only 2 patients(9.3%)not developing recurrence following surgical *** OS was 18.8 mo(IQR 13.5-33.9).One patient is still alive without recurrence at 21.4 mo from diagnosis;no other patient survived 5 *** surgical management with abdominoperineal resection(APR)vs wide excision(WE)did not lead to differences in OS[hazard ratio=1.4(95%CI:0.3-6.8)].Review of the literature revealed geographic differences in surgical management of ARM,with increased use of WE in the United States and Europe over time and more frequent use of APR in Asia and *** was no significant improvement in survival over *** There is wide variation in the management of ARM and survival outcomes remain poor regardless of *** management should aim to minimize morbidity.

关键词： Melanoma Anorectal melanoma Literature review Melanoma surgery Surgical oncology Colorectal surgery

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Potential of Arbidol for Post-exposure Prophylaxis of COVID-19 Transmission:A Preliminary Report of a Retrospective Cohort Study

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Current medical Science 2020年第3期40卷 480-485页

作者： Jin-nong ZHANG Wen-jing WANG Bo PENG Wei PENG Yi-sheng ZHANG Ya-ling WANG Yan WAN Jiang CHANG Ling MAO Xiao-ping MIAO Ya-nan LI Yi-fan ZHOU Bo HU Department of Emergency Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Peng Consulting Group Salt Lake City 84108UTUSA Salt lake regional medical center Heart and Lung Institute of UtahSalt Lake City 84108UTUSA School of Materials Science and Engineering Huazhong University of Science and TechnologyWuhan 430074China Department of Neurology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Department of Epidemiology and Biostatistics Key Laboratory for Environment and HealthSchool of Public HealthHuazhong University of Science and TechnologyWuhan 430030China

The efficient transmission of severe acute respiratory syndrome-2 coronavirus(SARS-CoV-2)from patients to health care workers or family members has been a worrisome and prominent feature of the ongoing *** the basis of clinical practice and in-vitro studies,we postulated that post-exposure prophylaxis(PEP)using Arbidol is associated with decreased infection among individuals exposed to confirmed cases of COVID-19 *** conducted a retrospective cohort study on family members and health care workers who were exposed to patients confirmed to have SARS-CoV-2 infection by real-time RT-PCR and chest computed tomography(CT)from January 1 to January 16,*** last follow-up date was Feb.26,*** emergence of fever and/or respiratory symptoms after exposure to the primary case was *** correlations between post-exposure prophylaxis and infection in household contacts and health care workers were respectively analyzed.A total of 66 members in 27 families and 124 health care workers had evidence of close exposure to patients with confirmed *** Cox regression based on the data of the family members and health care workers with Arbidol or not showed that Arbidol PEP was a protective factor against the development of COVID-19(HR 0.025,95%CI 0.003-0.209,P=0.0006 for family members and HR 0.056,95%CI 0.005-0.662,P=0.0221 for health care workers).our findings suggest Arbidol could reduce the infection risk of the novel coronavirus in hospital and family *** treatment should be promoted for PEP use and should be the subject of further investigation.

关键词： Arbidol COVID-19 SARS-CoV-2 post-exposure prophylaxis

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The quality attribute of watershed ecosystem is more important than the landscape attribute in controlling erosion of red soil in southern China

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International Soil and Water Conservation Research 2022年第3期10卷 507-517页

作者： Qing Zhu Xi Guo Jiaxin Guo Jun Wu Yingcong Ye Wenbo Cai Shiyu Liu School of Design Shanghai Jiao Tong UniversityShanghai200240China Key Laboratory of Poyang lake Watershed Agricultural Resources and Ecology of Jiangxi Province Jiangxi Agricultural UniversityNanchangJiangxi330045China College of Land Resource and Environment Jiangxi Agricultural UniversityNanchangJiangxi330045China State Key Laboratory of Urban and regional Ecology Research Center for Eco-environment SciencesChinese Academy of SciencesBeijing100085China

Landscape and quality attributes are major ecosystem characteristics closely associated with soil conservation service(SCS).However,the intrinsic mechanisms by which these two attributes influence SCS are still ***,this study quantitatively analyzed the landscape pattern,ecological quality,and SCS in the Lianshui River watershed(a typical soil and water loss area of red soil in southern China)and its sub-watersheds in *** boosted regression tree model was used to explore the influence of 15 factors(i.e.,landscape and quality attributes)on SCS at the sub-watershed *** to the results,compared with the landscape attribute,the quality attribute of the watershed ecosystem could better explain the spatial heterogeneity of SCS across 66 *** overall degree of influence of five quality factors on SCS reached 57.81%,with the highest being the normalized differential build-up and bare soil index(NDBSI),at 25.11%.Among 10 landscape factors,aggregation had the greatest influence on SCS,at 28.64%.The relationships between key influencing factors and SCS were nonmonotonic and non-linear,with threshold *** example,NDBSI values of 0.18e0.41 had a positive influence on SCS,while NDBSI values of 0.41e0.65 had a negative influence on *** findings broaden our understanding of the response of SCS to changes in landscape and quality attributes at the sub-watershed scale,and could offer comprehensive support for soil erosion management in the watershed ecosystem.

关键词： Landscape pattern Ecological quality Soil conservation service Boosted regression tree Red soil region in southern China

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Organising a juvenile ratio monitoring programme for 10 key waterbird species in the Yangtze River floodplain:analysis and proposals

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Avian Research 2021年第4期12卷 645-657页

作者： Yuxi Wang Iderbat Damba Qingshan Zhao Yanbo Xie Xueqing Deng Rdi Ga Guanhua Liu Zhiwen Xu Yue Li Dali Gao Wenbin Xu Guoxun Chen Lei Cao School of Life Science University of Science and Technology of ChinaHefei 230026China State Key Laboratory of Urban and regional Ecology Research Center for Eco Environmental SciencesChinese Academy of SciencesBeijing 100085China University of Chinese Academy of Sciences Beijing 100049China Institute of Biology Mongolian Academy of SciencesUlaanbaatar 13330Mongolia Department of Modern Physics University of Science and Technology of ChinaHefei 230026China College of Life Sci-ence and Technology Inner Mongolia Normal UniversityHuhehaote 010000China Jiangxi Poyang lake National Reserve Authority Nan Chang 330038China Authority of Jiangxi Duchang Provincial Natural Reserve Duchang 332600China Authority of East Dongting lake National Nature Reserve Yueyang 414000China Anhui Shengjin lake National Reserve Author-ity Dongzhi 247000China Authority of Longgang lake National Nature Reserve Huanggang 435500China

Background:In the face of continued degradation and loss of wetlands in the Yangtze River floodplain(YRF),there is an urgent need to monitor the abundance and distribution of wintering *** understand fully observed annual changes,we need to monitor demographic rates to understand factors affecting global population *** reproduction success contributes to dynamic changes in population size and age structure,so an assessment of the juvenile ratio(*** winter birds as a proportion of total number aged)of overwintering waterbirds can be an important indicator of the reproductive success in the preceding breeding ***:During 2016-2019,we sampled juvenile ratios among 10 key waterbird species from the wetlands in the *** on these data,we here attempt to establish a simple,efficient,focused and reliable juvenile ratio monitoring scheme,to assess consistently and accurately relative annual breeding success and its contribution to the age structure among these waterbird ***:We compared juvenile ratio data collected throughout the winter and found that the optimal time for undertaking these samples was in the early stages of arrival for migratory waterbirds reaching their wintering area(early to mid-December).We recommend counting consistently at key points(*** where>1%biogeographical flyway population were counted)at sites of major flyway importance(Poyang lake,East Dongting lake,Shengjin lake,Caizi lake,Longgan lake and Chen lake).Based on this,the error rate of the programme(155 planned points,the count of 10 waterbird species is 826-8955)is less than 5%.Conclusions:We established a juvenile ratio monitoring programme for 10 key waterbird species in the wetlands of the YRF,and discuss the feasibility and necessity of implementing such a future programme,and how to use these data in our monitoring and understanding of the population dynamics of these waterbird populations.

关键词： Juvenile ratio Monitoring scheme The Yangtze River floodplain Statistical independence

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Climate change induced eutrophication of cold-water lake in an ecologically fragile nature reserve

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Journal of Environmental Sciences 2019年第1期31卷 359-369页

作者： Xiaotian Lu Yonglong Lu Deliang Chen Chao Su Shuai Song Tieyu Wang Hanqin Tian Ruoyu Liang Meng Zhang Kifayatullah Khan State Key Laboratory of Urban and regional Ecology Research Center for Eco-Environmental Sciences Chinese Academy of Sciences University of Chinese Academy of Sciences Department of Earth Sciences Goteborg University International center for Climate and Global Change Research School of Forestry and Wildlife Sciences Auburn University Department of Environmental and Conservation Sciences University of Swat

Aquatic ecosystem sustainability around the globe is facing crucial challenges because of increasing anthropogenic and natural disturbances. In this study, the Tianchi lake, a typical cold-water lake and a UNESCO/MAB(Man and Biosphere) nature reserve located in high latitude and elevation with the relatively low intensity of human activity was chosen as a system to examine the linkages between climate change and eutrophication. As a part of the UNESCO Bogda Man and Biosphere Reserve, Tianchi lake has been well preserved for prevention from human intervention, but why has it been infected with eutrophication recent years? our results show that climate change played a significant role in the eutrophication in the Tianchi lake. Increased temperature, changed precipitation pattern and wind-induced hydrodynamic fluctuations in the summer season were suggested to make a major contribution to the accelerated eutrophication. The results also showed that the local temperature and precipitation changes were closely linked to the large-scale atmospheric circulation, which opens the door for the method to be applied in other regions without local climatic information. This study suggests that there is an urgent need to take into consideration of climate change adaptation into the conservation and management of cold-water lakes globally.

关键词： Eutrophication Climate change Atmospheric circulation Alpine lakes

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Alignment of social and ecological structures increased the ability of river management

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Science Bulletin 2019年第18期64卷 1318-1324页

作者： Shuai Wang Bojie Fu Orjan Bodin Jianguo Liu Mengmeng Zhang Xiaoyan Li State Key Laboratory of Earth Surface Processes and Resource Ecology Faculty of Geographical ScienceBeijing Normal UniversityBeijing 100875China State Key Laboratory of Urban and regional Ecology Research Center for Eco-Environmental SciencesChinese Academy of SciencesBeijing 100085China Stockholm Resilience Centre Stockholm UniversityStockholm 10691Sweden center for Systems Integration and Sustainability Department of Fisheries and WildlifeMichigan State UniversityEast LansingMl 48823USA

Large hydrologic basins involve multiple stakeholders, and coupled dynamic social and ecological processes. Managing such basins has long been a challenge. Balancing the demand for water from nature against that from humans is always difficult, particularly in arid watersheds. Here, we analyze potential institutional causes of ecological degradation and how it can be reversed by introducing new forms of governance. The framework and assumptions are illustrated using China’s second-largest endorheic basin, where empirical evidence shows that the introduction of a new governing authority connecting midstream and downstream actors facilitated the establishment of a new governance regime that is better aligned with the biophysical scales of the watershed. A trans-regional water allocation project initiated by the new higher-level authority successfully rescued downstream oases and restored a dried terminal lake. These outcomes suggest that when social and ecological structures are better aligned our ability to manage the interplay between social and ecological processes increases. However, the lack of direct connection between the actors of the middle and lower reaches resulted in the paradox of an increase in water demand. We therefore suggest that measures to stimulate the emergence of horizontal social ties linking different critical groups of actors across the watershed could further the alignment of the institutional and biophysical structures-without these changes sustainable management of river basins and other common pool resources will remain problematic.

关键词： River management Heihe River Social ecological system Institutional fit

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Size matters: wintering ducks stay longer and use fewer habitats on largest Chinese lakes

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Avian Research 2019年第4期10卷 415-422页

作者： Fanjuan Meng Hongbin Li Xin Wang Lei Fang Xianghuang Li Lei Cao Anthony David Fox State Key Laboratory of Urban and regional Ecology Research Center for Eco‑Environmental SciencesChinese Academy of SciencesBeijing 100085China University of Chinese Academy of Sciences Beijing 100049China School of Life Sciences University of Science and Technology of ChinaHefei 230026China Department of Bioscience Aarhus UniversityAarhusDenmark

Background:Evidence suggests that wintering waterbirds have become conspicuously more concentrated at two largest lakes of the Yangtze River Floodplain,East Dong Ting lake(Hunan Province,29°20′N,113°E)and Poyang lake(Jiangxi Province,29°N,116°20′E),relative to other lakes,despite the establishment of reserves *** this relationship is likely due to greater extent of undisturbed habitats in larger lakes,we understand little of the drivers affecting individual behaviours behind this ***:We tracked wintering movements of three duck species(Eurasian Wigeon Mareca penelope,Falcated Duck *** and Northern Pintail Anas acuta)using GPS transmitters,examining differences between the two largest lakes and other smaller lakes in ducks’habitat use,duration of stay at each lake and the daily distances moved by the tagged birds while at these ***:The Eurasian Wigeon and Falcated Duck stayed five times longer and almost exclusively used natural habitat types at the two large lakes(91‒95%of positions)compared to length of stay time at smaller lakes,where they spent 28‒33 days on average(excluding the capture site)and exploited many more different habitats(including c.50%outside lakes).Conclusions:our study is the first to show that shorter length of stay and more varied habitat use by ducks at small lakes may contribute to explaining the apparent regional concentration of numbers present of these and other species at the largest lakes in recent *** compares with their declining abundance at smaller lakes,where habitat loss and degradation has been more manifest than on the larger lakes.

关键词： Anas acuta GPS/GSM telemetry Mareca falcata Mareca penelope Winter residency time Yangtze River Floodplain

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Redesigning crop varieties to win the race between climate change and food security

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Molecular Plant 2023年第10期16卷 1590-1611页

作者： Kevin V.Pixley Jill E.Cairns Santiago Lopez-Ridaura Chris O.Ojiewo Maryam Abba Dawud Inoussa Drabo Taye Mindaye Baloua Nebie Godfrey Asea Biswanath Das Happy Daudi Haile Desmae Benoit Joseph Batieno Ousmane Boukar Clare T.M.Mukankusi Stanley T.Nkalubo Sarah J.Hearne Kanwarpal S.Dhugga Harish Gandhi Sieglinde Snapp Ernesto Adair Zepeda-Villarreal International Maize and Wheat Improvement center(CIMMYT) TexcocoMexico International Maize and Wheat Improvement center(CIMMYT) HarareZimbabwe International Maize and Wheat Improvement center(CIMMYT) NairobiKenya lake Chad Research Institute(LCRI) MaidiguriNigeria International Maize and Wheat Improvement center(CIMMYT) DakarSenegal Ethiopian Institute of Agricultural Research(EIAR) Addis AbabaEthiopia National Agricultural Research Organization(NARO) KampalaUganda Tanzania Agricultural Research Institute(TARI) NaliendeleTanzania Institut de l'Environnement et de Recherches Agricoles(INERA) OuagadougouBurkina Faso International Institute of Tropicl Agriculture(IITA) KanoNigeria Alliance of Bioversity International and CIAT KampalaUganda

Climate change poses daunting challenges to agricultural production and food *** temperatures,shifting weather patterns,and more frequent extreme events have already demonstrated their effects on local,regional,and global agricultural *** varieties that withstand climate-related stresses and are suitable for cultivation in innovative cropping systems will be crucial to maximize risk avoidance,productivity,and profitability under climate-changed *** surveyed 588 expert stakeholders to predict current and novel traits that may be essential for future pearl millet,sorghum,maize,groundnut,cowpea,and common bean varieties,particularly in sub-Saharan *** then review the current progress and prospects for breeding three prioritized future-essential traits for each of these *** predict that most current breeding priorities will remain important,but that rates of genetic gain must increase to keep pace with climate challenges and consumer ***,the predicted future-essential traits include innovative breeding targets that must also be prioritized;for example,(1)optimized rhizosphere microbiome,with benefits for P,N,and water use efficiency,(2)optimized performance across or in specific cropping systems,(3)lower nighttime respiration,(4)improved stover quality,and(5)increased early *** further discuss cutting-edge tools and approaches to discover,validate,and incorporate novel genetic diversity from exotic germplasm into breeding populations with unprecedented precision,accuracy,and *** conclude that the greatest challenge to developing crop varieties to win the race between climate change and food security might be our innovativeness in defining and boldness to breed for the traits of tomorrow.

关键词： climate change food security crop breeding cropping systems expert survey sub-Saharan Africa

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