Development and Validation of A Predictive Model For Childhood Mortality After A Traumatic Brain Injury: Analysis of the National Trauma Data Bank

Introduction: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children. While most TBI-related admissions are mild, identifying early predictors of poor outcome may assist clinicians with timely medical decisions and effective triage utilization. Objective: We sought to develop and validate a clinical tool for predicting in-hospital death in children after a traumatic brain injury. Methods: Data was collected for children (≤18 years) from the National Trauma Data Bank between the years of 2007 to 2015. We included children who sustained any TBI, defined as: (i) open and closed skull fractures, (ii) cerebellar, cortical, or brain stem contusions, and (iii) subarachnoid, subdural, or epidural hemorrhages. We excluded studies that did not report patient age or individuals who were dead on arrival or died in the emergency room (ER). Our interest was in clinical variables that can be readily measured upon admission to the ER. As such, the predictors included patient demographics, mechanism and intent of injury, vital signs in the ER, mode of transportation, respiratory status, time from injury to ER arrival, Glasgow Coma Score (GCS), and Injury Severity Score (ISS). Multivariable logistic regression, with forward selection, was used to investigate associations between predictive variable and mortality. We randomly split the samples into a training set (70%) and a test set (30%). Model performance was measured via the C-statistic and accuracy [(true positive + true negative) / patient population]. Results: A total of 124,078 children were included in the study (69% male; median [IQR] age, 13.0 [6.0, 16.0.] years; 69% White). The rate of death was 5.5% (n=6,862). Children more likely to die were older (16 vs. 12 years, p Conclusion: Herein, we provide an accurate early prediction model for mortality in children after a TBI. Translation of our findings has led to the development of a web application that can be used by emergency healthcare providers in trauma centers

DEVELOPMENT AND VALIDATION OF A PREDICTIVE MODEL FOR CHILDHOOD MORTALITY AFTER A TRAUMATIC BRAIN INJURY: ANALYSIS OF THE NATIONAL TRAUMA DATA BANK

Introduction: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children. While most TBI-related admissions are mild, identifying early predictors of poor outcome may assist clinicians with timely medical decisions and effective triage utilization. Objective: We sought to develop and validate a clinical tool for predicting in-hospital death in children after a traumatic brain injury. Methods: Data was collected for children (≤18 years) from the National Trauma Data Bank between the years of 2007 to 2015. We included children who sustained any TBI, defined as: (i) open and closed skull fractures, (ii) cerebellar, cortical, or brain stem contusions, and (iii) subarachnoid, subdural, or epidural hemorrhages. We excluded studies that did not report patient age or individuals who were dead on arrival or died in the emergency room (ER). Our interest was in clinical variables that can be readily measured upon admission to the ER. As such, the predictors included patient demographics, mechanism and intent of injury, vital signs in the ER, mode of transportation, respiratory status, time from injury to ER arrival, Glasgow Coma Score (GCS), and Injury Severity Score (ISS). Multivariable logistic regression, with forward selection, was used to investigate associations between predictive variable and mortality. We randomly split the samples into a training set (70%) and a test set (30%). Model performance was measured via the C-statistic and accuracy [(true positive + true negative) / patient population]. Results: A total of 124,078 children were included in the study (69% male; median [IQR] age, 13.0 [6.0, 16.0.] years; 69% White). The rate of death was 5.5% (n=6,862). Children more likely to die were older (16 vs. 12 years, p Conclusion: Herein, we provide an accurate early prediction model for mortality in children after a TBI. Translation of our findings has led to the development of a web application that can be used by emergency healthcare providers in trauma centers

Association of Micronutrients and Prevalence of Antibodies in Hyperthyroidism

Thyroid hormones play a pivotal role in the overall physiological and developmental function of the human body. Alterations in thyroid hormones drastically affect regular metabolic processes as well as physical well-being. Thyroid alterations directly influence the functioning of all major body systems including cardiovascular, neurological, gastrointestinal, etc. The thyroid hormonal imbalance is primarily classified into two major conditions: hyperthyroidism and hypothyroidism. The present chapter details the pathology of thyroid imbalance in the context of human reproductive health, autoimmunity, and micronutrient imbalance. Some novel micronutrient associations independent of iodine deficiencies are discussed. Additionally, the early predictive capability of the anti-TPO antibody as well as other autoimmune correlations are discussed. Given its role in reproductive health, the associations of various sex hormones with thyroid function were also explored

Considerations in the evaluation and management of oral potentially malignant disorders during the COVID-19 pandemic

Aim: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. Methods: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. Results: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. Conclusions: The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID-19 illness are also higher risk for the development of OPMDs. © 2020 Wiley Periodicals, Inc

TIPRA – Three-Dimensional Integrated Progression Analyser: A New World Programme Exploring the Structure-Function Correlation in Glaucoma Using a Holistic 3-Dimensional Approach

Glaucoma is a chronic, progressive eye disease that causes irreversible damage to the optic nerve head. Visual field loss, the functional change seen in glaucoma correlates well with structural loss in the neurosensory part of the eye involving the retinal ganglion cell layer (GCL) and retinal nerve fibre layer (RNFL). Early assessment and prevention of disease progression safeguard against visual field loss. Structural loss is evaluated via progressive stereoscopic optic disc photography and optical coherence tomography (OCT), which measures the GCL and RNFL thickness. Meanwhile, defects in visual fields indicate a functional loss. Ophthalmologists most correlate both the structural and functional data to interpret a patient’s likelihood of glaucomatous damage and progression. In this chapter, we have elucidated means to correlate structural loss with functional loss in glaucoma patients from a neophyte’s perspective and highlighted the finer nuances of these parameters in detail. This understanding of various terminologies related to structural and functional vision loss, along with the correlative interpretation of the structural and functional tests in a glaucoma patient, form the fulcrum of this chapter

Critical success factor bagi program keusahawanan di jabatan perdagangan politeknik

Konsep Critical Success Factor berkait rapat mengenai pengurusan dalam mencapai misi dan matlamat perniagaan dalam sesebuah organisasi. Oleh itu, kajian ini adalah bertujuan untuk mengkaji empat elemen Critical Success Factor di Jabatan Perdagangan Politeknik seterusnya melihat kecenderungan pelajar untuk melibatkan diri dalam bidang keusahawanan. Kajian jenis kuantitatif ini telah dibuat ke atas pensyarah di Jabatan Perdagangan Politeknik bagi zon Utara. Seramai 190 sampel kajian yang terlibat dalam penyelidikan ini melalui pengedaran borang kaji selidik. Antara enam buah politeknik di zon Utara yang terlibat dalam penyelidikkan ini adalah Politeknik Politeknik Tunku Syed Sirajuddin, Perlis, Politeknik Sultan Abdul Halim Muazzam Shah, Kedah, Politeknik Tunku Sultanah Bahiyah, Kedah, Politeknik Seberang Perai, Pulau Pinang, Politeknik Ungku Omar, Perak dan Politeknik Sultan Azlan Shah, Perak. Data yang diperolehi dianalisis mendapati nilai skor min bagi ketiga-tiga persoalan kajian iaitu, mengenalpasti elemen Critical Success Factor yang digunakan, cabaran dalam usaha melaksanakan elemen Critical Success Factor dan mengenalpasti tahap kecenderungan pelajar untuk melibatkan diri dalam bidang keusahawanan adalah tinggi. Manakala bagi persoalan kajian keempat iaitu mencari hubungan korelasi Pearson antara elemen Critical Suceess Factor dengan kecenderungan pelajar untuk melibatkan diri dalam bidang keusahawanan adalah berada pada tahap lemah, sekaligus menunjukkan Ho tidak diterima. Kesimpulannya, elemen Critical Success Factor ini memainkan peranan dalam pembentukkan organisasi yang berkesan supaya pembentukan matlamat dan objektif tercapa

Integrated design of third generation concentrated solar power plants under uncertainty

This research focuses on the Gen3 (3rd generation) solar tower CSP (concentrated solar power) variant. A methodology is introduced to evaluate two different approaches to deploying this technology - one is the conventional "build large" approach and the other is a "build modular" approach. Performance and cost models of the two different approaches are built and validated against industry data and then the two different approaches compete across three locations (Daggett CA, New Orleans LA, and Boston MA) and three different capacity factors (20%, 30%, and 40%). For these nine cases, the comparison between the two different approaches is first done with deterministic inputs and then with stochastic inputs for selected variables. The results show that when the "build large" approach is compared against the "build modular" approach using deterministic inputs, the "build large" approach" is favored and has a NPV that is 5%-15% higher than that of the "build modular" approach for most of the nine cases, which aligns with the current industry belief that the "build large" approach is better due to economies of scale. However, when the same approaches are compared using stochastic inputs, the "build modular" approach is preferred over the "build large" approach. The ENPVs for the "build modular" approach are 20% higher than that of the "build large" approach while requiring 50% less initial capital than the "build large" approach. This reversal is driven primarily by the flexibility and the learning rate inherent to the "build modular" approach. By employing a "build modular" approach for this technology, a firm that is entering the CSP market could gain a competitive advantage over other firms in the CSP and renewable energy markets.S.M

GABAergic transmission in temporal lobe epilepsy: The role of neurosteroids

Modification of GABAergic inhibition is an intensely investigated hypothesis guiding research into mechanisms underlying temporal lobe epilepsy (TLE). Seizures can be initiated by blocking gamma amino butyric acid type A (GABAA receptors, GABARs), which mediate fast synaptic inhibition in the brain, and controlled by drugs that enhance their function. Derivatives of steroid hormones called neurosteroids are natural substances that physiologically enhance GABAR function and suppress seizures. GABAR structure, function, expression, assembly, and pharmacological properties are changed in the hippocampus of epileptic animals. These alterations render GABARs less sensitive to neurosteroid modulation, which may contribute to seizure susceptibility. Plasticity of GABARs could play a role in periodic exacerbation of seizures experienced by women with epilepsy, commonly referred to as catamenial epilepsy. (C) 2011 Elsevier Inc. All rights reserved

Intraoperative Life Threatening Acute Lung Injury Due to Multiple Septic Pulmonary Emboli during Transpedicular Biopsy and Kyphoplasty

A 55-year-old gentleman was presented to our clinic two months after a trivial fall with persistent pain, gibbus at the thoraco-lumbar junction and intact neurology. Radiological and laboratory investigations suggested osteoporotic fracture or metastasis. Due to unremitting pain, a plan was made to do transpedicular biopsy and kyphoplasty. Biopsy needles were inserted into both pedicles and an attempt at aspiration was made. Since the aspirate was dry, 5 to 6 mL of saline was injected through one needle and an attempt at aspiration was made through the other. Three-millilitres of sero-sanguineous material mixed with pus came out and kyphoplasty was deferred. After extubation, the patient developed severe bronchospasm and was transferred to the intensive care unit. Investigations confirmed multiple septic pulmonary emboli and the patient recovered completely after treatment. This report highlights that confirmation of the diagnosis is essential before performing any procedure that increases the intravertebral pressure and the place should have appropriate facilities to manage complications