Intracavernosal abscess: An unusual finding during repair of neglected penile fracture.

Penile abscess with involvement of the corpus cavernosum is a relatively rare condition and is typically associated with cavernosography, intracavernosal injections, penile prosthesis, open trauma, priapism, and seeding from a distant infection. Less commonly, it can be seen following penile fracture, particularly in patients with identified risk factors of uncontrolled diabetes mellitus or other immunosuppression. We report a case of a healthy 24-year-old man with a penile abscess discovered during repair of a one-month-old, imaging confirmed, neglected penile fracture.

Motivations for Mobilization: Comparing Urban and Suburban Residents' Participation in the Politics of Planning and Development.

This paper compares and contrasts suburban and urban residents' attitudes and behavior toward development by comparing the frequency and motivation for mobilization of residents in the suburbs of Surrey, British Columbia, and Brampton, Ontario, with residents of their respective metropolitan urban cores. It finds that suburban residents engage less in planning politics than their urban counterparts and that they are more likely to oppose development than urban residents. However, while some variation exists in the concerns suburban and urban residents raise when they express their opposition to development, overall, the concerns of residents in suburbs and urban cores are largely the same. The data suggest that what differences exist between suburban and urban residents in the politics of urban development and planning likely arise due to the varying nature and prevalence of development encroaching on existing neighborhoods, rather than from underlying cultural differences.

The representativeness of neighbourhood associations in Toronto and Vancouver.

Neighbourhood associations are major players in urban politics throughout North American cities and increasingly are becoming a political force in other parts of the world. However, while there is a rich and well-developed literature on the role played by neighbourhood associations in urban politics, few studies examine whether their membership reflects the socio-demographic composition and interests of the broader public. This paper addresses this gap in the literature using survey data from voters conducted during the Vancouver and Toronto 2018 municipal elections. We compare the responses of participants who identify as members of neighbourhood associations (or their equivalents) with those of the broader voting public. We find that members of neighbourhood associations in both cities are not representative of the broader population. They are more likely to be white, older and have higher education than the average voter. In addition, while the ideology of neighbourhood association members differs little from that of the broader public, their policy priorities are different from those of the majority of voters in both cities. Our findings suggest that neighbourhood associations fail in providing descriptive representation and may not offer substantive representation. These findings raise important questions about the role of neighbourhood associations in local governance. Our study also demonstrates the merit of using individual-level surveys to learn more about the composition and policy preferences of neighbourhood associations.

Retrospective analysis of small intracranial hemorrhage in trauma: Is acute care surgery team management alone safe?

Background: The Brain Injury Guidelines (BIG) provide a validated framework for categorizing patients with small intracranial haemorrhages (ICH) who could be managed by acute care surgery without neurosurgical consultation or repeat head computed tomography in the absence of neurological deterioration. This replication study retrospectively applied BIG criteria to ICH subjects and only included BIG1 and BIG2 subjects.Methods: The trauma registry was queried from 2014 to 2019 for subjects with a traumatic ICH <1 cm, Glasgow Coma Scale score of 14/15 and not on anticoagulation therapy. Patients were then categorized under BIG 1 or BIG2 and outcomes were evaluated.Results: Two hundred fourteen subjects were reviewed (88 BIG1 and 126 BIG2). Twenty-three subjects had worse repeat imaging, but only one had worsening exam that resolved spontaneously. None required neurosurgical intervention. One died of non-neurological causes.Conclusions: Retrospective analysis supported our hypothesis that patients categorized as BIG1 or BIG2 could have been safely managed by acute care surgeons without neurosurgical consultation or repeat head imaging. A review of minor worsening on repeat imaging without changes in neurological exams and no need for neurosurgical interventions supports this evidence-based approach to the management of small intracranial haemorrhages.

Evaluating a symptom-triggered gastric residual volume policy in a surgical trauma intensive care unit: Simple and safe.

BACKGROUND: Routine checking of gastric residual volumes (GRVs) during enteral feeding within surgical trauma intensive care units (STICUs) is a common practice. However, data on the necessity of this practice and its impact on nutrient delivery are limited. We aim to study the association between the replacement of a routine GRV (rGRV) policy with a triggered GRV (tGRV) policy and the safe achievement of daily nutrition goals. METHODS: We prospectively collected data on patients after we instituted a tGRV policy and compared them with a historical cohort of patients who had rGRV assessments in our STICU at a level 1 trauma center. The primary end point was achieving 80% of prescribed nutrient goals. Secondary end points included aspiration pneumonia, witnessed emesis, and glycemic control. RESULTS: A total of 145 patients accounting for 1405 STICU days were treated under the tGRV policy, and 156 patients accounting for 1694 STICU days were treated under the rGRV policy. There were no statistically significant differences between the tGRV and rGRV groups with regard to the proportion of days meeting or exceeding protein (56.7% vs 56.2%) or calorie (56.4% vs 56.0%) goals. After adjusting for in-hospital deaths, injury severity score, complications, and STICU time, the predictive margins for meeting caloric and protein goals were higher among the tGRV patients (57% vs 56%), but these differences were not statistically significant. CONCLUSION: A tGRV policy did not change protein or calorie delivery among patients or increase the risk of emesis compared with traditional monitoring methods.

The impact of clinical crisis management on trauma team outcomes following a prolonged strike by nursing, technical, and support staff.

There is a paucity of literature describing the preparation of hospital institutions prior to a nursing strike and the quality outcomes during and after a prolonged nursing strike. No published study was found describing the effects of a prolonged strike on quality outcomes specific to trauma patients. The American College of Surgeons (ACS) suggests specific critiques and complications data that each trauma program may choose to track as quality indicators, and those metrics are submitted to regional, state and national databanks and closely examined during site accreditations. This research study analyzed data from three equal time periods following a multiservices strike involving both nurses and service/technical staff lasting 63 days. The purposes of this study were to (1) evaluate the effects of prestrike organizational leadership and crisis management planning on organizational staffing and emergency management to reduce health care risk during the strike, (2) describe outcomes data from three equal time periods: prestrike, strike, and poststrike, and (3) specifically compare the trauma program's selected ACS trauma metrics for critiques and complication rates for our high-risk/high-volume population as a level 1 trauma center.

The combined effects of alcohol and marijuana use prior to traumatic brain injury on mortality.

BACKGROUND: Alcohol (ETOH) intoxication is a common comorbidity in traumatic brain injury (TBI), and marijuana (THC) has been implicated as a major risk factor for trauma. The objective this study was to investigate the combined effects of ETOH and THC on mortality after TBI. MATERIALS AND METHODS: A retrospective review of patient data was performed to assess adult (>18 years) patients with brain injuries between January 2012 and December 2018. Included patients sustained TBI (Abbreviated Injury Scale (AIS 1-6)) and were divided into two groups: No Substances and THC + ETOH. RESULTS: 1085 (median age 52 years [range: 18-97 years]; 33.5% female (364/1085)) patients met the inclusion criteria. Significant differences for mortality at discharge were found between groups (p = 0.0025) with higher mortality in the No Substances group. On multiple logistic regression, a positive test for both ETOH + THC was found not to independently predict mortality at discharge, while age, Glasgow Coma Scale, intensive care unit stay, Injury Severity Score, length of hospital stay, and days on ventilator were independent predictors. CONCLUSIONS: After controlling for confounding variables, positive ETOH + THC screens were not found to be independent predictors of mortality at discharge. Therefore, our results indicated no survival benefit for TBI patients with concomitant ETOH and THC use prior to injury.

The effects of alcohol and marijuana on survival after severe traumatic brain injury: A retrospective cohort study.

BACKGROUND: Alcohol (ETOH) and marijuana (THC) use have previously shown to improve outcomes after Traumatic Brain Injury (TBI). However, whether TBI severity impacts outcomes among patients tested positive for both ETOH and THC remains unclear. MATERIALS AND METHODS: A retrospective review from the Northern Ohio Regional Trauma Registry, which includes deidentified data from six regional hospitals, including three Level 1 and three Level 3 trauma centers, was performed to assess adult (>18 years) patients with severe TBI (head Abbreviated Injury Score ≥ 3) between January 2012 and December 2018 having an alcohol and drug toxicology screen and data regarding outcome at discharge. Patients were divided into two groups: 1) patients with a negative ETOH and drug test, and 2) patients positive for ETOH + THC. Mortality at discharge was the primary outcome measure and multiple logistic regression was used to assess predictors of mortality at discharge. RESULTS: A total of 854 (median age: 51 years [range: 18-72]; 34.4% female [294/854]) patients were included. On multiple logistic regression, age (p = 0.003), days in intensive care unit (ICU) (p < 0.001), Glasgow Coma Scale (GCS) (p < 0.001), Injury Severity Score (ISS) (p < 0.001), length of stay (LOS) (p < 0.001), and days on ventilator support (p = 0.032) were significant predictors of mortality at discharge. Blood alcohol content (BAC), cause of TBI, drug class, and sex were not significant predictors of mortality at discharge. CONCLUSIONS: After severe TBI, positive THC and BAC screening did not predict mortality at discharge after controlling for confounding variables, indicating no survival benefit for patients with severe TBI.

Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review.

BACKGROUND: Kiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken. METHODS: Inpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010-December 2013 (pre-rotavirus vaccine) and January 2016-September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre- and post-rotavirus vaccine introduction. RESULTS: The incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12·8% vs. 7·2%, p < 0·001) and all-cause under-five mortality (15·9% vs. 5·7%, p = 0·006) pre- and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction. CONCLUSIONS: AGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.

Effects of extreme high flow events on macroinvertebrate communities in Vermont streams.

Heavy precipitation events and subsequent high flows are occurring with greater frequency and intensity, which could have substantial implications for biomonitoring programs that typically evaluate changes in biological condition due to stressors at local and watershed scales. In this study we evaluated response and recovery of macroinvertebrate communities at nine reference quality streams located in multiple watersheds throughout Vermont to flooding from Tropical Storm (TS) Irene in 2011. At each site, the Vermont Department of Environmental Conservation (VT DEC) had collected macroinvertebrate data on an annual basis from 2009-2013. We compared the data collected in the days and weeks following TS Irene (2011) to samples collected for 2 years prior to the event (2009-2010) and 2 years after (2012-2013). While most metrics used in Vermont's biocriteria did not demonstrate a response to TS Irene, density showed a significant reduction in 2011 (across sites, percent change ranged from -24 to -91%; mean -66%). The percent change in density at each site was significantly correlated with the amount of localized rainfall during the storm (r s = -0.79, p = .02) and was most evident at small to medium-sized, high gradient streams. Reduced density caused several of these sites to fail to meet minimum criteria for biological integrity, though densities rebounded the following year. While the quick recovery indicated resiliency at these reference streams, the timing and magnitude of flood events may decrease the ability of biomonitoring programs to accurately evaluate the effect of watershed stressors.

Persistent epigenetic changes in adult daughters of older mothers.

Women of advanced maternal age account for an increasing proportion of live births in many developed countries across the globe. Offspring of older mothers are at an increased risk for a variety of subsequent health outcomes, including outcomes that do not manifest until childhood or adulthood. The molecular underpinnings of the association between maternal aging and offspring morbidity remain elusive. However, one possible mechanism is that maternal aging produces specific alterations in the offspring's epigenome in utero, and these epigenetic alterations persist into adulthood. We conducted an epigenome-wide association study (EWAS) of the effect of a mother's age on blood DNA methylation in 2,740 adult daughters using the Illumina Infinium HumanMethylation450 array. A false discovery rate (FDR) q-value threshold of 0.05 was used to identify differentially methylated CpG sites (dmCpGs). We identified 87 dmCpGs associated with increased maternal age. The majority (84%) of the dmCpGs had lower methylation in daughters of older mothers, with an average methylation difference of 0.6% per 5-year increase in mother's age. Thirteen genomic regions contained multiple dmCpGs. Most notably, nine dmCpGs were found in the promoter region of the gene LIM homeobox 8 (LHX8), which plays a pivotal role in female fertility. Other dmCpGs were found in genes associated with metabolically active brown fat, carcinogenesis, and neurodevelopmental disorders. We conclude that maternal age is associated with persistent epigenetic changes in daughters at genes that have intriguing links to health.

Introduction: Searching for the Historical Roots of 11 March 2011.

Debates about preserving traces of disaster for historical commemoration have emerged amid the processes of recovery and healing from the 2011 Great Tohoku Earthquake, tsunami, and nuclear power plant disasters. Prompted by the tensions that underlie decisions about the value of maintaining damaged artifacts and structures for public memorialization, this essay introduces the forum "Japan Before Disaster Studies," which encourages a reconsideration of "disaster heritage" as something that also maintains an active awareness of the roles of technology and science in the depths of Japan's disaster histories. Reconstructing these roots of disaster histories should enrich a more accessible understanding of the actors, institutions, policies, and discourses connected to various disaster contexts.

Contemporary Incidence and Mortality Rates of Neuroendocrine Prostate Cancer.

AIM: The purpose of the study was to provide an update ever the incidence and mortality for neuroendocrine prostate cancer (NEPC) in the United States. PATIENTS AND METHODS: Using a large national database, we examined changes in age-adjusted incidence (AAIR), mortality rates (MR) and 5-year cancer-specific survival (CSS) for 378 patients diagnosed with NEPC between 1992 and 2011. Analysis was performed for all NEPC and for its two major sub-groups [small cell carcinoma (SCC) and neuroendocrine carcinoma (NEC)]. RESULTS: AAIR of NEPC continues to rise in recent years (2004-2011:+6.8%/year, p>0.05). AAIR of SCC has been increasing significantly by 6.94%/year since 2001 (from 0.470 to 0.582/1,000,000 person years, p<0.05). Overall incidence-based mortality rates for NEPC did not change significantly since 1992 and similar trends were observed for SCC and NEC. CONCLUSION: The AAIR of SCC is increasing with no change in the MR of NEPC over the past 20 years.

Testosterone Replacement Therapy on the Natural History of Prostate Disease.

The physiology of testosterone production and action are closely related to prostatic disease. An understanding of the natural history of testosterone and prostate growth and development is needed in order to understand this complex relationship. Lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH), prostate cancer, and sexual function are common disorders for which testosterone is thought to play a role. Proposed in this review are some theories as to how testosterone interacts to potentially ameliorate these conditions. Further research is needed, but we feel our proposed points are valid given the review of the literature.

Partial nephrectomy for T2 renal masses: contemporary trends and oncologic efficacy.

PURPOSE: Increasing popularity and improved technical feasibility of partial nephrectomy (PN) has encouraged urologists to treat larger renal masses with nephron-sparing surgery. We used a national database to characterize practice patterns for the surgical management of patients with T2 renal tumors and examined the effect of PN on cancer-specific survival in such patients. METHODS: Between 2001 and 2011, 10,259 patients with primary tumor size >7 cm confined to the kidney (T2) were treated surgically for kidney cancer. PN trends were examined using annual percentage change (APC). Multivariate survival models were developed to identify independent determinants of PN use and cancer-specific survival (CSS) following surgical treatment of kidney cancer. RESULTS: Overall, 543 patients (5.29 %) were treated with PN versus 9716 (94.71 %) who underwent radical nephrectomy (RN). The use of PN increased progressively between 2001 and 2011 (APC +11.1 %, p < 0.05). Male gender, geographic location, year of diagnosis, and disease stage were independent determinants of increased PN use (all p values <0.05). Cancer-specific mortality was not inferior for patients treated with PN versus RN (HR 0.68, 95 % CI 0.50-0.94). Male gender, younger age, white race, tumor size >10 cm, localized disease, and papillary histology were all associated with improved CSS with PN (all p values <0.05). CONCLUSIONS: PN is increasingly utilized to treat T2 renal masses. Our analysis demonstrates that PN for T2 renal masses has no contraindicated effect on CSS.

Automated zebrafish chorion removal and single embryo placement: optimizing throughput of zebrafish developmental toxicity screens.

The potential of the developing zebrafish model for toxicology and drug discovery is limited by inefficient approaches to manipulating and chemically exposing zebrafish embryos-namely, manual placement of embryos into 96- or 384-well plates and exposure of embryos while still in the chorion, a barrier of poorly characterized permeability enclosing the developing embryo. We report the automated dechorionation of 1600 embryos at once at 4 h postfertilization (hpf) and placement of the dechorionated embryos into 96-well plates for exposure by 6 hpf. The process removed ≥95% of the embryos from their chorions with 2% embryo mortality by 24 hpf, and 2% of the embryos malformed at 120 hpf. The robotic embryo placement allocated 6-hpf embryos to 94.7% ± 4.2% of the wells in multiple 96-well trials. The rate of embryo mortality was 2.8% (43 of 1536) from robotic handling, the rate of missed wells was 1.2% (18 of 1536), and the frequency of multipicks was <0.1%. Embryo malformations observed at 24 hpf occurred nearly twice as frequently from robotic handling (16 of 864; 1.9%) as from manual pipetting (9 of 864; 1%). There was no statistical difference between the success of performing the embryo placement robotically or manually.

Measurement of response regulator autodephosphorylation rates spanning six orders of magnitude.

Two-component regulatory systems, comprising sensor kinase and response regulator proteins, carry out signal transduction in prokaryotic and eukaryotic microorganisms, as well as plants. Response regulators act as phosphorylation-mediated switches, turning on and off cellular responses to environmental stimuli. Self-catalyzed dephosphorylation is an important determinant of the duration of the response regulator activated state. Reported response regulator autodephosphorylation rates vary over almost a million-fold range, consistent with control of biological processes that occur on widely different timescales. We describe general considerations for the design and execution of in vitro assays to measure the autodephosphorylation rates of purified response regulator proteins, as well as specific methods that utilize loss of 32P, changes in fluorescence, or release of inorganic phosphate. The advantages and disadvantages of different methods are discussed, including suitability for different timescales. In addition to outlining established methods, an assay modification is proposed to measure fast autodephosphorylation rates with radioactivity, and optimization of the fluorescence/pH jump method is described.

Pregnancy is not a sufficient indicator for trauma team activation.

BACKGROUND: Trauma complicates 6% to 7% of all pregnancies. Adverse outcomes are rare when monitoring is normal and early warning signs absent. Trauma systems often use pregnancy as the sole criterion (PSC) for partial trauma team activation. This study compares outcomes of pregnant patients presenting with PSC versus other physiologic, mechanistic, or anatomic (OPMA) activation criteria. METHODS: Three hundred fifty-two consecutive obstetric partial trauma team activation patients (2000-2005) were grouped by length of gestation and evaluated for activation criteria and early maternal and fetal outcomes. Data were analyzed using descriptive statistics and analysis of variance. RESULTS: Patients ranged in age from 16 to 44 (mean age, 28 +/- 6.4) and in weeks gestation between 1 and 40 weeks (mean, 25 +/- 8 weeks). Eighty-two percent had been in vehicle crashes. One hundred eighty-eight (58%) were activated based on PSC and 137 on OPMA. No PSC patient had injuries sufficient to warrant trauma service admission. Ninety-four percent of all PSCs of <20 weeks were discharged home from the emergency department. There were no maternal mortalities. There were four fetal mortalities; two pregnancies were terminally compromised before the trauma event. No patient in the PSC group required admission to the trauma service. There were seven cases of abruption (2%) and 18 cases of vaginal bleeding or discharge (6%). No case of vaginal bleeding or abruption in the first 20 weeks was hypotensive at the scene or on arrival. CONCLUSION: In this study, pregnancy was not an independent predictor of the need for trauma team activation. Standard OPMA trauma activation criteria apply equally to pregnant and nonpregnant patients. These data provide support for more judicious allocation of scarce trauma systems resources.