8,718 research outputs found

    Geriatric Motorcycle-Related Outcomes: A Pennsylvania Multicenter Study

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    Introduction: Geriatric patients (GP) often experience increased morbidity and mortality following traumatic insult and as a result, require more specialized care due to lower physiologic reserve and underlying medical comorbidities. Motorcycle injuries (MCC) occur across all age groups, however, no large-scale studies evaluating outcomes of GP exist with data thus far limited to recreational based studies. We hypothesized that geriatric MCC will face worse outcomes and utilize more hospital resources despite greater helmet usage compared with their younger counterparts. Methods: We performed multicenter retrospective review of MCC patients at three Pennsylvania level I trauma centers from January 2016 to December 2020. Data was extracted from each institution’s electronic medical records and trauma registry. GP were defined as patients greater than or equal to 65 years of age. The primary outcome was mortality. Secondary outcomes included ventilator days (VD) and hospital (HLOS), intensive care unit (ICU LOS), and intermediate unit (IMU LOS) length of stays. 3:1 [(nongeriatric patients (NGP) to GP] propensity score matching (PSM) was based on sex, abbreviated injury scale (AIS) and injury severity score (ISS). p≤0.05 was considered significant. Results: 1538 (GP:7%[n=113]; NGP:93%[n=1425]) patients were included. Median ISS (GP:10 vs NG:6), median Charleston Comorbidity Index (GP:3 vs NGP:0), and helmet usage (GP:76.9% vs NGP:58.8%) were higher in GP (p≤0.05), however, mortality rates were similar (GP:1.7% vs NGP:2.6%; p=0.99). Following PSM (n=488), GP had significantly more comorbidities (p≤0.05). There was no difference in trauma bay interventions or complications between cohorts. Mortality remained similar between cohorts post-PSM (GP:1.8% vs NGP:3.2%; p=0.417). Differences in ventilator days as well as ICU LOS, IMU LOS and HLOS were negligible. Helmet usage (GP:64.5% vs NGP:66.8%; p=0.649) and insurance status (GP:87.4% vs NGP:91.5%; p=0.189) between groups were similar. Helmet use was more prevalent among insured NGP compared with those without insurance (69.1% vs 46.2%; p≤0.05). Conclusion: When matched for sex, ISS and AIS, age was not associated with interventions, complications, ventilator days, length of stay or mortality. There was no significant difference in helmet usage or insurance status between groups. Based on our study, there is no strong evidence for altering initial management of motorcycle-related trauma in geriatric patients

    Data_Sheet_1_“Personally, I feel sorry, but professionally, I don't have a choice.”1 Understanding the drivers of anti-Roma discrimination on the rental housing market.docx

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    The aim of our study is to assess the drivers of discriminatory behaviors of real-estate agents and private landlords toward prospective Roma tenants, relying on qualitative data from Hungary. Though there is a broad literature on the forms and frequency of discrimination, we know much less about the question of why people discriminate. Previous research suggests that discrimination on the basis of ethnicity is widespread in Hungary. To understand the drivers of discrimination, we analyzed: (a) the sources and justifications of discrimination of Roma people on the rental housing market among real-estate agents and private landlords, the actors making decisions about tenants (b) mapped the social embeddedness of discrimination, and (c) assessed the resilience of discriminatory intentions by analyzing the reactions to a 3-min advocacy video showing discrimination of Roma people on the rental housing market. We conducted and analyzed five online group discussions with 18 real estate agents and landlords advertising properties for rent in different regions of the country. Our qualitative study revealed that discrimination of Roma people is understood to be a widespread and socially acceptable practice driven by the need to avoid risks attributed to Roma tenants based on widely held stereotypes about them. We identified certain specificities in the justification and argumentation strategies of real-estate agents in comparison to private landlords. By providing counter-information presenting the perspective of Roma tenants, negative views could be challenged on the emotional level and also by shifting the group dynamics, strengthening the viewpoint of those without prejudice. We discuss our findings with regards to the possibilities of interventions against discrimination in societies in which neither social norms nor state institutions expect the equal treatment of the members of ethnic minority groups.</p

    Experimental generation of polarization entanglement from spontaneous parametric down-conversion pumped by spatiotemporally highly incoherent light

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    The influence of pump coherence on the entanglement produced in spontaneous parametric down-conversion (SPDC) is important to understand, both from a fundamental perspective, and from a practical standpoint for controlled generation of entangled states. In this context, it is known that in the absence of postselection, the pump coherence in a given degree of freedom (DOF) imposes an upper limit on the generated entanglement in the same DOF. However, the cross-influence of the pump coherence on the generated entanglement in a different DOF is not well-understood. Here, we experimentally investigate the effect of a spatiotemporally highly-incoherent (STHI) light-emitting diode (LED) pump on the polarization entanglement generated in SPDC. Our quantum state tomography measurements using multimode collection fibers to reduce the influence of postselection yield a two-qubit state with a concurrence of 0.531+/-0.006 and a purity of 0.647+/-0.005, in excellent agreement with our theoretically predicted concurrence of 0.552 and purity of 0.652. Therefore, while the use of an STHI pump causes reduction in the entanglement and purity of the output polarization two-qubit state, the viability of SPDC with STHI pumps is nevertheless important for two reasons: (i) STHI sources are ubiquitous and available at a wider range of wavelengths than lasers, and (ii) the generated STHI polarization-entangled two-photon states could potentially be useful in long-distance quantum communication schemes due to their robustness to scattering

    The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study.

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    Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions

    Hemotympanum as a Complication of a Valsalva Maneuver during Childbirth

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    Background. Hemotympanum may occur due to otic barotrauma secondary to Valsalva maneuver during the second phase of labor. A pressure differential across the tympanic membrane (TM) of about five psi can cause rupture. The increased intrathoracic and intraabdominal pressure spikes repeatedly manifested by “pushing” during second-stage labor easily approach (and may exceed) this level. Clinical Presentation. This case report describes a healthy thirty-seven-year-old multipara patient admitted for the 40-weeks’ gestational age routine follow-up that proceeded to active labor followed by an aural fullness and bloody otorrhea. Otoscopic examination with a light microscope confirmed the hemotympanum of the right tympanic membrane. Conclusion. Forceful Valsalva can cause hemotympanum. Investigating the benefits and disadvantages of the pushing methods could help reduce such complications in the future. A prompt evaluation of an otolaryngologist should be requested in the event of a new postpartum hearing disturbance or bloody otorrhea

    International consensus statement on obstructive sleep apnea

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    Background: Evaluation and interpretation of the literature on obstructive sleep apnea is needed to consolidate and summarize key factors important for clinical management of the OSA adult patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA and treatment on the multiple comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion: This review of the literature in OSA consolidates the available knowledge and identifies the limitations of the current evidence. This effort aims to highlight the basis of OSA evidence-based practice and identify future research needs. Knowledge gaps and opportunities for improvement include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy. This article is protected by copyright. All rights reserved

    Multi-environment lifelong deep reinforcement learning for medical imaging

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    Deep reinforcement learning(DRL) is increasingly being explored in medical imaging. However, the environments for medical imaging tasks are constantly evolving in terms of imaging orientations, imaging sequences, and pathologies. To that end, we developed a Lifelong DRL framework, SERIL to continually learn new tasks in changing imaging environments without catastrophic forgetting. SERIL was developed using selective experience replay based lifelong learning technique for the localization of five anatomical landmarks in brain MRI on a sequence of twenty-four different imaging environments. The performance of SERIL, when compared to two baseline setups: MERT(multi-environment-best-case) and SERT(single-environment-worst-case) demonstrated excellent performance with an average distance of 9.90±7.359.90\pm7.35 pixels from the desired landmark across all 120 tasks, compared to 10.29±9.0710.29\pm9.07 for MERT and 36.37±22.4136.37\pm22.41 for SERT(p<0.05p<0.05), demonstrating the excellent potential for continuously learning multiple tasks across dynamically changing imaging environments
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