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Participants whose intrinsic connectivity showed a better fit with Gradient 1 had faster identification of weak semantic associations. Furthermore, a better fit with Gradient 2 was linked to faster performance on picture semantic judgements. These findings show that individual differences in aspects of semantic cognition can be related to components of connectivity within the semantic network.
Delayed bowel function (DBF) and postoperative ileus (POI) are common gastrointestinal complications after surgery. There is no reliable imaging study to help diagnose these complications, forcing clinicians to rely solely on patient history and physical exam. Gastric point of care ultrasound (POCUS) is a simple bedside imaging technique to evaluate gastric contents but has not been evaluated in postoperative patients.

Twenty colorectal patients were enrolled in this pilot study. Patients were categorized as either full or empty stomach based upon their postoperative day one gastric POCUS exams and previously published definitions. The primary outcome was GI-3 recovery, a dual end point defined as tolerance of solid food and either flatus or bowel movement. Secondary outcomes were length of stay, emesis, time to first flatus, time to first bowel movement, nasogastric tube placement, aspiration events, and mortality.

Nine of 20 patients had a full stomach postoperatively. Patients with full stomachs were younger and received greater perioperative opioid doses (74.0±28.2 v 42.6±32.9 morphine equivalents, P=0.0363) compared to empty stomach patients. GI-3 recovery occurred significantly later for patients with postoperative day 1 full stomachs (2.1±0.4 versus 1±0days, P=0.00091).

Based upon this pilot study, gastric POCUS may hold promise as a noninvasive and simple bedside modality to potentially help identify colorectal patients at risk for postoperative DBF and POI and should be evaluated in a larger study.
Based upon this pilot study, gastric POCUS may hold promise as a noninvasive and simple bedside modality to potentially help identify colorectal patients at risk for postoperative DBF and POI and should be evaluated in a larger study.
Thyroidectomy and parathyroidectomy are relatively safe procedures, with overall morbidity rates of 2%-5%. The increasing age is associated with higher likelihood of poor outcomes. The modified five-point frailty index (mFI-5) is associated with complications, but many surgeons are unfamiliar with mFI-5. We assessed the accuracy of the mFI-5 versus the commonly-used American Society of Anesthesiologists (ASA) classification to predict complications following thyroidectomy and parathyroidectomy.

Patients undergoing thyroidectomy or parathyroidectomy in 2015-2018 NSQIP datasets were identified. The mFI-5 scores were calculated by adding the number of the following comorbidities congestive heart failure, hypertension requiring medication, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status. Receiver operating characteristics curves were plotted for 30-d mortality and serious morbidity (defined as deep surgical site infection, dehiscence, unplanned intubation, failure to weanation is a better predictor of mortality and serious morbidity than mFI-5 among patients undergoing thyroidectomy or parathyroidectomy and may be a better prognostic indicator to use when counseling patients before low-risk neck surgery.
Trauma centers have improved outcomes compared to nontrauma centers when caring for injured patients. A multicenter report found blunt trauma patients treated at American College of Surgeons' Level I trauma centers have improved survival compared to Level II centers. In a subsequent multicenter study, Level II centers had improved survival in all trauma patients. We sought to provide a more granular analysis by stratifying blunt mechanisms-to determine if there was a difference in mortality between Level I and Level II centers.

The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting to an American College of Surgeons' Level I or II trauma center after blunt trauma. A multivariable logistic regression analysis was performed controlling for comorbidities and Trauma and Injury Severity Score.

From 734,473 patients with blunt trauma, 507,715 (69.1%) were treated at a Level I center and 226,758 (30.9%) at a Level II center. The Level I cohort was younger (median age, 53 versus ing to a Level I center have no difference in mortality compared to a Level II center. However, when stratified by mechanism, those involved in MVA or bicycle accidents have a decreased associated risk of mortality. Future prospective studies examining variations in practice to account for these differences are warranted.
Complicated appendicitis is a common cause of morbidity in children. Studies have analyzed the risk factors in the surgical treatment of this pathology, including obesity and disease severity, but not operative time (OT). We hypothesize that OT is independently associated with increased morbidity for children with complicated appendicitis.

Data were extracted from the 2018 and 2019 National Surgical Quality Improvement Program-Pediatrics data sets. Patients aged 2-18y who underwent laparoscopic appendectomy for complicated appendicitis were identified. Patient demographics, disease severity, and operative details were evaluated. Surgical site infections (SSIs), hospital length of stay (LOS), ≤30-d readmissions and reoperations, interventional radiologic drain (IR-drain) placement, pneumonia, and death were analyzed. Logistic and linear regression analyses were performed.

A total of 8168 patients were analyzed, with a mean age of 9.96±3.9y and a mean weight of 41.2±21.2kg. The mean OT was 55.8±24.9min, wof routine operations to reduce patient morbidity.
Pediatric trauma patients who lack insurance coverage may have less access to transport other than emergency medical services (EMS) or face financial barriers that prevent utilization of these services. We analyzed the association between health insurance coverage and EMS transport while controlling for injury and patient characteristics.

De-identified Trauma Quality Programs registry data were queried for pediatric trauma patients age <18y. The primary outcome was arrival by EMS (excluding interfacility transfer) versus private transport or walk-in, and the primary exposure was insurance coverage (any versus none). After exact matching on injury and facility characteristics, propensity matching was used to balance demographic covariates and comorbidities between insured and uninsured patients.

Of the 130,246 patients analyzed, 9501 (7%) did not have insurance coverage. After matching 9494 uninsured cases to 9494 insured controls, fixed-effects logistic regression found that uninsured patients had 18 costs of pediatric trauma care borne by institutions and families.
Penetrating cardiac injuries (PCIs) have high in-hospital mortality rates. Guidelines regarding the use of pericardial window (PW) for diagnosis and treatment of suspected PCIs are not universally established. The objective of this review was to provide a critical appraisal of the current literature to determine the effectiveness and safety of PW as both a diagnostic and therapeutic technique for suspected PCIs in patients with hemodynamic stability.

A review was conducted using PubMed/MEDLINE, Google Scholar, and Embase to identify literature evaluating the accuracy and therapeutic efficacy of PW and its role in a hemodynamically stable patient with penetrating thoracic or thoracoabdominal trauma.

Eleven studies evaluating diagnostic PW and two studies evaluating therapeutic PW were included. These studies ranged from (y) 1977 to 2018. Existing literature indicates that PW is highly sensitive (92%-100%) and specific (96%-100%) for the diagnosis of suspected PCIs. PW and drainage, when compared with steiaphragmatic, and laparoscopic approaches for PW have been shown to have similar efficacy and safety.
There has been concern that the incidence of non-accidental trauma (NAT) cases in children would rise during the COVID-19 pandemic due to the combination of social isolation and economic depression. Our goal was to evaluate NAT incidence and severity during the pandemic across multiple US cities.

Multi-institutional, retrospective cohort study comparing NAT rates in children <18y old during the COVID-19 pandemic (March-August 2020) with a recent historical data (January 2015-February 2020) and during a previous economic recession (January 2007-December 2011) at level 1 Pediatric Trauma Centers. Selleckchem Roxadustat Comparisons were made in local and national macroeconomic indicators.

Overall rates of NAT during March-August 2020 did not increase compared to historical data (P=0.8). Severity of injuries did not increase during the pandemic as measured by Glasgow Coma Scale (GCS) (P=0.97) or mortality (P=0.7), but Injury Severity Score (ISS) slightly decreased (P=0.018). Racial differences between time periods were seen, with increased proportions of NAT occurring in African-Americans during the pandemic (P<0.001). NAT rates over time had low correlation (r=0.32) with historical averages, suggesting a difference from previous years. Older children (≥3 y) had increased NAT rates during the pandemic. Overall NAT rates had low inverse correlation with unemployment (r=-0.37) and moderate inverse correlation with the stock market (r=-0.6). Significant variation between sites was observed.

Overall NAT rates in children did not increase during the COVID-19 pandemic, but rates were highly variable by site and increases were seen in African-Americans and older children. Further studies are warranted to explore local influences on NAT rates.
Overall NAT rates in children did not increase during the COVID-19 pandemic, but rates were highly variable by site and increases were seen in African-Americans and older children. Further studies are warranted to explore local influences on NAT rates.
Following the declaration of the COVID-19 pandemic, there were reports of decreased trauma hospitalizations, although violent crime persisted. COVID-19 has had the greatest impact on minoritized and vulnerable communities. Decreases in traumatic events may not extend to these communities, given pandemic-related socioeconomic and psychological burdens that increase the risk of exposure to trauma and violence.

This was a retrospective cohort study (n=1634) of all trauma activations presenting to our institution January 1, 2020 to May 31, 2020, and same time periods in 2018 and 2019. Census tracts and associated Social Vulnerability Index quartiles were determined from patient addresses. Changes in trauma activations pre and post Massachusetts' state-of-emergency declaration compared to a historical control were analyzed using a difference-in-differences methodology.

Weekly all-cause trauma activations fell from 26.44 to 8.25 (rate ratio=0.36 [0.26, 0.50]) postdeclaration, with significant difference-in-diignificant decreases in overall trauma, to a greater extent in nonviolent injuries. Among those living in the most socially vulnerable communities, there was no decrease in violent trauma. These findings highlight the need for violence and injury prevention programs in vulnerable communities, particularly in times of crisis.
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