Outcomes After Rib Fracture in Elderly Patient Due To Blunt Trauma At Doctors Renaissance Hospital

Background: Blunt trauma remains the most common traumatic reason for presentation at a hospital. Despite their frequency, there remains high morbidity and mortality. This is particularly true amongst the elderly. About 16.5 percent of the American population was 65 years old or over in 2019. This number is projected to reach 22 percent in 2050. Some clinical guidelines requiring admission to an intensive care setting in trauma centers for elderly patients with two or more rib fractures have been adopted by some trauma centers. Usage of these guidelines may lead to significant decreases in hospital stats, ICU stats, and use of mechanical ventilation. However, the effectiveness of these guidelines has not been validated across different institutions. Hence, in our study we sought to determine the mortality rate of elderly patients with ribs fracture compared to patients \u3c 65 years of age at Doctor Renaissance Hospital (Level I trauma center). We also investigated the relationship between the side of injury, the need for mechanical ventilation, ICU length of stay, and overall length of hospital stay. Methods: We performed a retrospective cohort study involving all blunt trauma patients between 18 – 100 years with rib fractures, excluding those with major vascular injuries or those needing emergent surgery due to other injuries. Patients admitted to Doctor renaissance Hospital (Level I trauma) between 2017 – 2020 were divided into two groups. The experimental group consisted of 58 patients aged 65 years or older. The control group was made of 75 patients aged \u3c 65 years old admitted during the same time. (table 1) Outcomes parameters included pulmonary complications (such as pneumonia or respiratory failure), number of ventilator days, intensive care unit length and hospital stay, disposition, and mortality. Results: In the experimental group, 58 patients were identified. These patients were divided into four groups: those with right-sided rib fractures, left-sided rib fractures, and unspecified and bilateral rib fractures. The overall mortality was 1.72 % compared to 4 % in the control group (p \u3c 0.05). Patients with right-sided rib fractures had a median hospital length of stay of 4 days vs. 6 days in the control group (p \u3c 0.05) (figure 2). We found no difference in the number of days spent in ICU between the control and experimental group with right-sided rib fractures. Patients with left-sided rib fractures had a similar median hospital length of stay compared to the control group. We noted no difference between the number of days spent in the ICU or ventilator days between these patients (figure 2). Furthermore, patients with bilateral rib fractures had a median hospital stay of 8 days compared to 13 days in the control group (p \u3c 0.05) (figure 2). Also, patients in the control group with bilateral rib fractures had a median ICU stay of 3 days and median ventilator use of 2 days compared to 0 days (p \u3c 0.05) in the experimental group (table 2). Lastly, patients 65 and older with unspecified multiple rib fractures had a median length of stay of 3.5 days compared to 1.5 days in the control group (p \u3c 0.05). The median length of stay in ICU and ventilator use was 1 day longer in the control group than the experimental group. Conclusion: Elderly patients with more than 2 rib fractures admitted at Doctor hospital renaissance between 2017-2020 had better outcomes than patients younger than 65 admitted during the same period

Exploring Military Veteran Students’ Pathways in Engineering Education

Military Veteran Students’ Pathways in Engineering Education (Year 1: Award# 1428646)Military veterans hold tremendous promise for expanding and diversifying the engineeringworkforce. Given the diverse backgrounds of veterans, their increasing numbers, and thegrowing national demand for engineering professionals, the timing is ideal to study theconditions under which student veterans pursue engineering education and the factors that offerthem the greatest support for success. Increasing the participation of veterans in engineeringoffers the possibility of enhancing engineering’s diversity in many needed dimensions since,compared to civilian students, veterans are more likely to be older, first-generation collegestudents, disabled, African American, or Latino. Yet, little is known regarding the educationalpathways and experiences of student veterans into engineering. This project therefore aims toaddress gaps in the literature on student veterans in engineering through a comparative casestudy across four institutions: University of San Diego, North Carolina State University, PurdueUniversity, and Clemson University. The following research questions are addressed:1. Why do veterans pursue a Bachelor’s degree in engineering?2. How do military experiences shape student veterans’ educational experiences?3. What are the experiences of student veterans in engineering education?4. How do institutions support veterans in engineering education?The research plan incorporates content analysis of academic policies that student veteransencounter, interviews with key informants on each campus, focus group interviews with studentveterans, and in-depth student interviews to elicit rich narratives. The theoretical frameworkbuilds on Tinto’s student integration model and Schlossberg’s adult transition theory. Data willbe analyzed with the lens of intersectionality to elucidate differences stemming from theintersection of military status with race, gender, ability, sexual orientation, and socioeconomicstatus. Findings will provide context and information for various applications, such as:development of new strategies to support student veterans\u27 success, identification of overlookedareas to promote student veterans\u27 participation in engineering, and generation of criticalinformation for development of larger-scale studies for investigating student veterans inengineering. Thus, this study has potential for broad systemic impact by diversifying pathways toand through engineering programs, and in capitalizing on the informal and real-worldexperiences of engineering student veterans

Pembrolizumab monotherapy for non-small cell lung cancer (NSCLC):can patient stratification be improved in the UK Tayside population? A retrospective cohort study

OBJECTIVE: Pembrolizumab is a programmed cell death protein-1 (PD-1) inhibitor used to treat advanced patients with non-small cell lung cancer (NSCLC) with a programmed cell death ligand-1 (PD-L1) tumour proportion score (TPS) ≥50. Further sub-division of TPS-based stratification has not been evaluated in the UK, although smoking-induced tumour mutational burden and the immunogenic effects of prior radiotherapy are suggested to improve response.AIMS: To investigate if PD-L1 TPS ≥80%, smoking status or radiotherapy before or within 2 months of treatment influenced progression-free survival (PFS) in patients with NSCLC treated with pembrolizumab monotherapy.METHODS: PD-L1 TPS, smoking status and radiotherapy exposure were compared in patients with NSCLC in National Health Service (NHS) Tayside (n=100) treated with pembrolizumab monotherapy between 1 November 2017 and 18 February 2022. Survival estimates were compared using log-rank analysis, and Cox proportional hazards analysis was used to investigate the influence of potential confounding factors, including tumour stage and performance status.RESULTS: PFS was not significantly different (log-rank HR=0.330, p=0.566) comparing patients with PD-L1 TPS 50-79% and PD-L1 TPS ≥80%. Smokers had significantly improved PFS (log-rank HR=4.867, p=0.027), while patients receiving radiotherapy had significantly decreased PFS (log-rank HR=6.649, p=0.012). A Cox regression model confirmed that both radiotherapy (p=0.022) and performance status (p=0.009) were independent negative predictors of PFS.CONCLUSIONS: More rigorous PD-L1 TPS stratification did not influence survival outcomes. Smoking history improved PFS, although it was not an independent response predictor, while radiotherapy and performance status independently influenced clinical response. We suggest that further stratification of PD-L1 TPS is not warranted, while performance status and radiotherapy treatment may be additional clinically useful biomarkers of response to pembrolizumab in patients with NSCLC.</p

Cobalt complexes modulate plasmid conjugation in <i>Escherichia coli</i> and <i style="">Klebsiella pneumoniae</i>

Antimicrobial resistance genes (ARG), such as extended-spectrum β-lactamase (ESBL) and carbapenemase genes, are commonly carried on plasmids. Plasmids can transmit between bacteria, disseminate globally, and cause clinically important resistance. Therefore, targeting plasmids could reduce ARG prevalence, and restore the efficacy of existing antibiotics. Cobalt complexes possess diverse biological activities, including antimicrobial and anticancer properties. However, their effect on plasmid conjugation has not been explored yet. Here, we assessed the effect of four previously characterised bis(N-picolinamido)cobalt(II) complexes lacking antibacterial activity on plasmid conjugation in Escherichia coli and Klebsiella pneumoniae. Antimicrobial susceptibility testing of these cobalt complexes confirmed the lack of antibacterial activity in E. coli and K. pneumoniae. Liquid broth and solid agar conjugation assays were used to screen the activity of the complexes on four archetypical plasmids in E. coli J53. The cobalt complexes significantly reduced the conjugation of RP4, R6K, and R388 plasmids, but not pKM101, on solid agar in E. coli J53. Owing to their promising activity, the impact of cobalt complexes was tested on the conjugation of fluorescently tagged extended-spectrum β-lactamase encoding pCTgfp plasmid in E. coli and carbapenemase encoding pKpQILgfp plasmid in K. pneumoniae, using flow cytometry. The complexes significantly reduced the conjugation of pKpQILgfp in K. pneumoniae but had no impact on pCTgfp conjugation in E. coli. The cobalt complexes did not have plasmid-curing activity, suggesting that they target conjugation rather than plasmid stability. To our knowledge, this is the first study to report reduced conjugation of clinically relevant plasmids with cobalt complexes. These cobalt complexes are not cytotoxic towards mammalian cells and are not antibacterial, therefore they could be optimised and employed as inhibitors of plasmid conjugation.</p

Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial

Background: Stroke is the most common disabling neurological condition in adults. Falls and poor mobility are major contributors to stroke-related disability. Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population. Currently there is good evidence that exercise can enhance mobility after stroke, yet ongoing exercise programs for general community-based stroke survivors are not routinely available. This randomised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors. Methods and design: Three hundred and fifty community dwelling stroke survivors will be recruited. Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessments and exercise program. After the completion of the pre-test assessment, participants will be randomly allocated to one of two intervention groups. Both intervention groups will participate in weekly group-based exercises and a home program for twelve months. In the lower limb intervention group, individualised programs of weight-bearing balance and strengthening exercises will be prescribed. The upper limb/cognition group will receive exercises aimed at management and improvement of function of the affected upper limb and cognition carried out in the seated position. The primary outcome measures will be falls (measured with 12 month calendars) and mobility. Secondary outcome measures will be risk of falling, physical activity levels, community participation, quality of life, health service utilisation, upper limb function and cognition. Discussion: This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors. We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke. This program, if found to be effective, has the potential to be implemented within existing community services. Trial registration: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000479505)

Evaluation of serum glycoprotein biomarker candidates for detection of esophageal adenocarcinoma and surveillance of Barrett’s esophagus

Esophageal adenocarcinoma (EAC) is thought to develop from asymptomatic Barrett’s esophagus (BE) with a low annual rate of conversion. Current endoscopy surveillance for BE patients is probably not cost-effective. Previously, we discovered serum glycoprotein biomarker candidates which could discriminate BE patients from EAC. Here, we aimed to validate candidate serum glycoprotein biomarkers in independent cohorts, and to develop a biomarker candidate panel for BE surveillance. Serum glycoprotein biomarker candidates were measured in 301 serum samples collected from Australia (4 states) and USA (1 clinic) using previously established lectin magnetic bead array (LeMBA) coupled multiple reaction monitoring mass spectrometry (MRM-MS) tier 3 assay. The area under receiver operating characteristic curve (AUROC) was calculated as a measure of discrimination, and multivariate recursive partitioning was used to formulate a multimarker panel for BE surveillance. Complement C9 (C9), gelsolin (GSN), serum paraoxonase/arylesterase 1 (PON1) and serum paraoxonase/lactonase 3 (PON3) were validated as diagnostic glycoprotein biomarkers in lectin pull-down samples for EAC across both cohorts. A panel of 10 serum glycoprotein biomarker candidates discriminated BE patients not requiring intervention [BE+/- low grade dysplasia] from those requiring intervention [BE with high grade dysplasia (BE-HGD) or EAC] with an AUROC value of 0.93. Tissue expression of C9 was found to be induced in BE, dysplastic BE and EAC. In longitudinal samples from subjects that have progressed towards EAC, levels of serum C9 were significantly (P\u3c0.05) increased with disease progression in EPHA (erythroagglutinin from Phaseolus vulgaris) and NPL (Narcissus pseudonarcissus lectin) pull-down samples. The results confirm alteration of complement pathway glycoproteins during BE-EAC pathogenesis. Further prospective clinical validation of the confirmed biomarker candidates in a large cohort is warranted, prior to development of a first-line BE surveillance blood test