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Concrete grinding residue (CGR) is a by-product created by concrete pavement maintenance operations. The application of CGR to roadside soils is not consistently regulated by state agencies across the USA, which is partially due to the lack of science-based information on its impacts to soils and plants. The objectives of this research were to determine the impact of CGR additions to soil on both smooth brome ( Bromus inermis L.) biomass and plant and soil chemical parameters. In a greenhouse study, two soils were treated with two CGR by-products at 8% and 25% by weight. Shoot biomass was significantly influenced by the main effects (Soil, CGR, and Rate) and by all two-way interactions, but not consistently positively or negatively correlated. Trace metal concentrations in the shoot biomass were variable, but 68% of these metals had the same concentration or lower in the 25% CGR treatments compared with the controls. Soil pH and electrical conductivity were significantly influenced by the main effects and two-way interactions of Soil × Rate and CGR × Rate, and soil pH was significantly greater in the CGR-treated soils. Calcium, Na, Mg, Al, and S concentrations in soils were all influenced by additions of CGR, but trace metal levels in the treatments were all within the range for uncontaminated soils. Ecosystem impact of applying CGR will be dependent upon the quality of CGR and soil characteristics. Controlling the liming potential of CGR should be considered a best management practice. [ABSTRACT FROM AUTHOR]

Objective: Important recent data on retrievable inferior vena cava filter (R-IVCF) used in civilian trauma centers suffer from poor follow-up in these transient patients. Because US military casualties can be more easily followed globally, our objective was to further characterize R-IVCF outcomes in a trauma population with improved follow-up. Methods: From July 2003 to June 2007, trauma registry records were retrospectively reviewed for US soldiers injured in Iraq and Afghanistan who had R-IVCF placement. Indications, type of filter, complications, outcomes, and retrieval data were analyzed. Results: Seventy-two R-IVCFs were placed during the study period. Mean follow-up was 28.0 ± 12.0 months, in 61 (85%) patients. Mean injury severity score (ISS) was 36.3 ± 10.4 and mean patient age was 27.4 ± 6.4 years. Fifty-nine R-IVCFs (82%) were not retrieved due to: death (1, 1.3%), technical failure (2, 2.8%), lost to follow-up (11, 15.2%), or contraindications to retrieval (45, 62.5%). Thirteen R-IVCFs were successfully removed, an overall retrieval rate of 18%. Median dwell time of those removed was 47 days (range, 10-94). IVCF indications were prophylactic in 23 (32%) and therapeutic in 49 (68%) cases. Both retrieval failures were due to incorporation into the caval wall, attempted at 90 and 156 days. Deep vein thromboses at the insertion site or pulmonary embolism following R-IVCF placement or removal were not observed. To date, there have been no reports of IVC stenosis or occlusion. Conclusion: R-IVCFs were safely and effectively used in severely injured military trauma patients with high ISS. Despite improved follow-up, overall retrieval remained low, reflecting the civilian experience. Indication, rather than follow-up losses, accounted for the low retrieval rate. Practice patterns for R-IVCF in trauma may need to be re-examined to optimize outcomes. [Copyright &y& Elsevier]

This paper presents methods to analyze convergence in cross-sectional data collected over time using distribution free statistics that are not sensitive to the magnitudes involved. Measures of concordance and discordance are employed in the empirical analysis of real personal income per capita for 48 U.S. States over the period 1929–2002. Although most States are converging with each other, some are converging faster than others. The methods used have the flexibility to focus on specific characteristics such as convergence in absolute differences or convergence in the ratio of rewards. The methods may also be used to consider convergence without switching and additionally be applied to other features such as the percentiles of the distributions. [ABSTRACT FROM AUTHOR]

In the new security environment with a new U.S. defense strategy, nuclear weapons remain critical to U.S. national security as well as to international security. However, legacy nuclear systems are not optimally configured for the new and emerging contingencies of this environment. A common thread likely to run through the desirable characteristics of most future systems is reduced collateral damage (RCD). Improved accuracy enables lower yield weapons to accomplish the missions once allocated to higher yield legacy warheads, with correspondingly reduced collateral effects. Lower yield, earth-penetrating weapons and other new or modified RCD weapons can play a critical role, in conjunction with the other capabilities of the New Triad, in achieving U.S. defense objectives of deterrence, dissuasion and assurance. As the United States implements the Nuclear Posture Review, it is important to assess such capabilities in the context of U.S. defense strategy and to be in a position to develop and deploy them--if required--within the much smaller nuclear force towards which the United States is moving. [ABSTRACT FROM AUTHOR]

Details the self-directed program designed to improve career planning services for the blind developed by the Florida State University in Tallahassee. Strategies for making career information materials and resources more accessible to the blind; Development and implementation considerations for the self-directed career planning program.

The aim of this study was to determine the extent to which Sentinel-2 Normalised Difference Vegetation Index (NDVI) reflects soil moisture conditions, and whether this product offers an improvement over Landsat-8. Based on drought exposure, cloud-free imagery availability, and measured soil moisture, five sites in the Southwestern United States were selected. These sites, normally dry to arid, were in various states of drought. A secondary focus was therefore the performance of the NDVI under extreme conditions. Following supervised classification, the NDVI values for one-kilometre radius areas were calculated. Sentinel-2 NDVI variants using Spectral Bands 8 (10 m spatial resolution), 5, 6, 7, and 8A (20 m spatial resolution) were calculated. Landsat-8 NDVI was calculated at 30 m spatial resolution. Pearson correlation analysis was undertaken for NDVI against moisture at various depths. To assess the difference in correlation strength, a principal component analysis was performed on the combination of all bands and the combination of the new red-edge bands. Performance of the red-edge NDVI against the standard near infrared (NIR) was then evaluated using a Steiger comparison. No significant correlations between Landsat-8 NDVI and soil moisture were found. Significant correlations at depths of less than 30 cm were present between Sentinel-2 NDVI and soil moisture at three sites. The remaining two sites were characterised by low vegetation cover, suggesting a cover threshold of approximately 30–40% is required for a correlation to be present. At all sites of significant positive moisture to NDVI correlation, the linear combination of the red-edge bands produced stronger correlations than the poorer spectral but higher spatial resolution band. NDVI calculated using the higher spectral resolution bands may therefore be of greater use in this context than the higher spatial resolution option. Results suggest potential for the application of Sentinel-2 NDVI in soil moisture monitoring, even in extreme environments. To the best of our knowledge, this paper represents the first study of this kind using Sentinel-2. [ABSTRACT FROM AUTHOR]

Estimates soil ingestion in normal children in Washington. Use of aluminum, silicon and titanium as soil tracer elements in assessing daily soil ingestion; Analysis on the collected samples using x-ray fluorescence spectrometry; Absence of a consistent pattern emerged on a demographic profile predictive of soil ingestion.

Abstract: Speech disorder that continues into middle childhood is rarely studied compared with speech disorder in the early years. Speech production in single words, connected speech and nonword repetition was assessed for 7390 eight-year-old children within the Avon Longitudinal Study of Parents and Children (ALSPAC). The majority (n =6399) had typical speech and 50 of these children served as controls. The remainder were categorised as using common clinical distortions only (CCD, n =582) or speech difficulties (SDiff, n =409). The samples from the CCD children were not analysed further. Speech samples from the SDiff and the control children were transcribed and analysed in terms of percentage consonants correct, error type and syllable structure. Findings were compared with those from children in the Shriberg et al. (1997) lifespan database (n =25). The 8-year-old children from ALSPAC in the SDiff and control groups achieved similar speech accuracy scores to the 8-year-old children in the lifespan database. The SDiff group had consistently lower scores than the ALSPAC control group, with the following measures most clearly differentiating the groups: single word task (percentage of substitutions and distortions), connected speech task (percentage of vowels correct (PVC), percentage of omission of singletons and entire clusters, and stress pattern matches), nonword repetition task (PVC, percentage of entire clusters omitted, percentage of distortions, and percentage of stress pattern matches). Connected speech and nonword samples provide useful supplementary data for identifying older children with atypical speech. Learning outcomes: The reader will recognize the methods used to identify speech characteristics in a large scale population study. They will describe how measures of speech accuracy in connected speech compare with the Shriberg et al. (1997) lifespan database. The reader will also recall information on how typically and atypically developing children differ on a range of measures across different types of speech sample. [Copyright &y& Elsevier]

The article presents a study which compares the predictors of sexual harassment proclivity between Japanese and Americans. It assesses the relationship between the culture and sexual harassment with the expectation that a culture of high male dominance in Japan would result in a greater sexual harassment than a culture of moderately high male dominance in the U.S. It notes that sexual harassment does not exist in a vacuum but is joined by maladaptive traits and beliefs. It concludes that Japanese men were higher in harassment proclivity. Thus, it suggests that understanding the cultural and individual difference variables attributed to sexual harassment are considered vital elements in making a reduction of the sexual harassment of women.

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ofelia Loani Elvir Lazo reports financial support, administrative support, statistical analysis, and writing assistance were provided by Cedars-Sinai Medical Center., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: This review article discusses the pharmacology of the most commonly used chronic medications in patients undergoing elective surgical procedures. The mechanism of action and adverse side effects of cardiovascular medications (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, and psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs) will be reviewed. Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups. Results and Conclusions: An understanding of the pharmacology and pharmacokinetics of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also effect the morbidity, mortality, and recovery time of surgical patients. Part I of this two-part review article focuses on the mechanisms of action and adverse side effects of the chronic medications most commonly taken by surgical patients in the preoperative period.

Background: This review article discusses the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs).  In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided. Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups. Results and Conclusions: An understanding of the pharmacodynamic effects of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period.

Data collected through routine syndromic surveillance for influenza-like illness in the Micronesian United States-affiliated Pacific Islands highlighted out-of-season influenza outbreaks in the spring of 2019. This report describes the data collected through the World Health Organization's Pacific Syndromic Surveillance System for the Commonwealth of the Northern Mariana Islands (CNMI), Guam, the Federated States of Micronesia (FSM) and the Republic of the Marshall Islands (RMI). Compared with historical data, more cases of influenza-like illness were observed in all four islands described here, with the highest number reported in Guam in week 9, CNMI and FSM in week 15, and RMI in week 19. The outbreaks predominantly affected those aged < 20 years, with evidence from CNMI and RMI suggesting higher attack rates among those who were unvaccinated. Cases confirmed by laboratory testing suggested that influenza B was predominant, with 83% (99/120) of subtyped specimens classified as influenza B/Victoria during January-May 2019. These outbreaks occurred after the usual influenza season and were consistent with transmission patterns in Eastern Asia rather than those in Oceania or the United States of America, the areas typically associated with the United States-affiliated Pacific Islands due to their geographical proximity to Oceania and political affiliation with the United States of America. A plausible epidemiological route of introduction may be the high levels of international tourism from Eastern Asian countries recorded during these periods of increased influenza B/Victoria circulation. This report demonstrates the value of year-round surveillance for communicable diseases and underscores the importance of seasonal influenza vaccination, particularly among younger age groups., ((c) 2021 The authors; licensee World Health Organization.)

Background: Cervical carotid artery injuries entail high morbidity and mortality and are technically challenging to repair. This retrospective study describes the management and outcomes of cervical carotid injuries sustained during the recent wars in Iraq and Afghanistan., Methods: The Department of Defense Trauma Registry was queried to identify US military personnel who sustained battle-related cervical carotid injury between January 2002 and December 2015. Retrospective chart reviews of the military Electronic Health Record were performed on patients identified. Demographics, injury characteristics, surgical management, and outcomes were reviewed. Statistical analysis was performed to identify associations between injury and management factors, as well as stroke and mortality., Results: In total, 67 patients (100% male; age, 25 ± 7 years) were identified with cervical carotid artery injuries. Fifty-six patients (84%) sustained a common carotid artery (CCA) or internal carotid artery (ICA) injury, and 11 patients (16%) had an isolated external carotid artery (ECA) injury. The anatomic distribution of injury was as follows: CCA, 26 (38.8%); ICA, 24 (35.8%); CCA and ICA 2 (3%); ICA and ECA 3 (4.5%); and CCA, ICA, and ECA 1 (1.5%). Of the 56 CCA or ICA injuries, 39 underwent vascular repair, 9 (16%) were managed with ligation, 1 was treated with a temporary vascular shunt but succumbed to injuries before vascular repair, and 7 (13%) were treated nonoperatively. Seven (23%) of 30 ICA injuries were ligated compared with 2 (7.7%) of 26 injuries isolated to the CCA (p = 0.02). Compared with repair, ligation of the CCA/ICA was associated with a higher rate of stroke (89% vs. 33%, p = 0.003) and increased mortality without statistical significance (22% vs. 10%, p = 0.3). Every patient who underwent ICA ligation had a stroke (7/7). There was no difference in Injury Severity Score between the ligation and repair groups (23.8 ± 10.6 vs. 24.7 ± 13.4, p = 0.9). At a mean follow-up of 34.5 months, 10 of 17 stroke survivors had permanent neurologic deficits., Conclusion: In modern combat, penetrating injuries involving the cervical carotid arteries are relatively infrequent. In this experience, isolated ICA injuries were three times more likely to be ligated than those involving the CCA. As a surgical maneuver, ICA ligation resulted in stroke in all cases., Level of Evidence: Retrospective cohort analysis, level III.

Background: The incidence of wartime upper-extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss., Methods: The Department of Defense Trauma Registry (DoDTR) was queried to identify US service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed., Results: Analysis identified 247 casualties who sustained 308 UEVIs. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n = 195), followed by the brachial vessels (27.3%, n = 84) and the axillary vessels (9.4%, n = 29). The predominant MOIs were penetrating explosive fragments (74.1%, n = 183) and gunshot wounds (25.9%, n = 64). Associated fractures were identified in 151 (61.1%) casualties and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management were available for 171 injuries and included repair (48%, n = 82) and ligation (52%, n = 89). The early limb loss rate was 12.1% (n = 30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion; the average injury severity score (ISS) was 32.3, and the mortality was 6.7% (n = 2). In those without amputation, the ISS and mortality were low at 20 and 4.6% (n = 10), respectively. Overall mortality was 4.9% (n = 12)., Conclusions: The early limb loss rate was increased compared with initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care., (Published by Elsevier Inc.)

Objective: Vascular injury is a leading cause of death and disability in military and civilian trauma. Although a previous interim study defined the distribution of vascular injury during the wars in Iraq and Afghanistan, a contemporary epidemiologic assessment has not been performed. The objective of this study was to provide a current analysis of vascular injury during the final 7 years of the war in Afghanistan, including characterization of anatomic injury patterns, mechanisms of injury, and methods of acute management., Methods: The Department of Defense Trauma Registry was analyzed to identify U.S. military service members who sustained a battle-related vascular injury and survived to be treated at a surgical facility in Afghanistan between January 1, 2009, and December 31, 2015. All battle-related injuries (nonreturn to duty) were used as a denominator to establish the injury rate. Mechanism and anatomic distribution of injury as well as the acute management strategies of revascularization, ligation, and use of endovascular techniques were defined., Results: Of 3900 service members who sustained a battle-related injury, 685 patients (17.6%) had 1105 vascular injuries (1.6 vascular injuries per patient). Extremity trauma accounted for 72% (n = 796) of vascular injuries, followed by the torso (17%; n = 188) and cervical (11%; n = 118) regions. Lower extremity vascular injury was the most prevalent anatomic location (45%; 501/1105). Explosion with fragment penetration accounted for 70% (477/685) of injuries, whereas gunshot wounds accounted for 30% (205/685). Open repair was performed in 559 cases (57%; 554/981), whereas ligation was the initial management strategy in 40% (395/981) of cases. In addition, 374 diagnostic endovascular procedures were completed, 27 therapeutic endovascular interventions to include stent placement and angioplasty were performed and 55 inferior vena cava filters were placed. Mortality of the vascular injury cohort was 5%., Conclusions: The rate of vascular injury in modern combat is higher than that reported in previous wars. Open reconstruction is performed in half of cases, although ligation is an important damage control option, especially for minor or distal vessel injuries. Angiographic techniques are increasingly being used and documented within wartime registries more than ever. Proficiency with open and endovascular methods of vascular injury management remains a critical need for the U.S. military and will require partnership with civilian institutions to attain and maintain., (Published by Elsevier Inc.)

Communicating appreciation to staff is critical in healthcare settings today. Five specific Languages of Appreciation have been identified that can be communicated in individualized ways in the workplace to affirm, encourage, mediate stress, and improve employee morale. In tight budget environments, such an employee recognition program doesn't require financial resources or a line item in the budget.

The main objectives of this study were to assess the ease of the use of the TrachView videoscope and to compare it with direct laryngoscopy (DL) for teaching orotracheal intubation to emergency medicine (EM) medical students. Thirty-seven EM students with no earlier intubation experience were asked to intubate a manikin's trachea using DL alone and DL in combination with the TrachView. This investigation involved a randomized, cross-over study design and each trainee received a 10-min demonstration with each technique before the beginning of the study. The Percentage Of Glottic Opening (POGO) scores (%) were recorded and the ease of use of the device for intubation was evaluated by each student using a three-point rating scale. The median POGO score for the DL alone was 25% (range, 0-100%). However, the POGO score improved to 90% (range, 15-100%) with the addition of the TrachView device (P<0.001). The TrachView was considered easy to use by a majority of the EM students and improved visualization of the vocal cords compared with DL alone. The time to achieve successful intubation of the manikin's trachea was shorter when the TrachView was used as an adjunct to DL.

Objective: The purpose of this review is to evaluate the impact of recent epidemiologic literature on the National Research Council (NRC) assessment of the lung and bladder cancer risks from ingesting low concentrations (< 100 µg/L) of arsenic-contaminated water., Data Sources, Extraction, and Synthesis: PubMed was searched for epidemiologic studies pertinent to the lung and bladder cancer risk estimates from low-dose arsenic exposure. Articles published from 2001, the date of the NRC assessment, through September 2010 were included. Fourteen epidemiologic studies on lung and bladder cancer risk were identified as potentially useful for the analysis., Conclusions: Recent epidemiologic studies that have investigated the risk of lung and bladder cancer from low arsenic exposure are limited in their ability to detect the NRC estimates of excess risk because of sample size and less than lifetime exposure. Although the ecologic nature of the Taiwanese studies on which the NRC estimates are based present certain limitations, the data from these studies have particular strengths in that they describe lung and bladder cancer risks resulting from lifetime exposure in a large population and remain the best data on which to conduct quantitative risk assessment. Continued follow-up of a population in northeastern Taiwan, however, offers the best opportunity to improve the cancer risk assessment for arsenic in drinking water. Future studies of arsenic < 100 µg/L in drinking water and lung and bladder cancer should consider adequacy of the sample size, the synergistic relationship of arsenic and smoking, duration of arsenic exposure, age when exposure began and ended, and histologic subtype.

Background: High velocity fragments have resulted in a multitude of complex injuries in the military patients, placing them at increased risk of venous thromboembolism., Methods: A retrospective analysis was performed of all the intravascular ultrasound (IVUS)-guided bedside inferior vena cava (IVC) filters placed between August 2003 and October 2007., Results: Fourteen patients had bedside IVUS-guided retrievable filter placement. Thirteen males and one female and the mean (+SD) injury severity scores (ISS) was 37.2 (+9.9). The most common causes of injury were explosive devices (57%), gunshot wounds (28%), rocket-propelled grenades (7%), and motor vehicle crashes (7%). Indications for filter insertion were deep venous thrombosis in 36% of patients and pulmonary embolus in 28%. Thirty five percent had filters inserted prophylactically., Conclusions: Military trauma population ISS is considerably higher than what is reported in the civilian population. The bedside IVUS-guided IVC filter insertion is particularly useful in this population.

Low-dose extrapolation model selection for evaluating the health effects of environmental pollutants is a key component of the risk assessment process. At a workshop held in Baltimore, Maryland, on 23-24 April 2007, sponsored by U.S. Environmental Protection Agency and Johns Hopkins Risk Sciences and Public Policy Institute, a multidisciplinary group of experts reviewed the state of the science regarding low-dose extrapolation modeling and its application in environmental health risk assessments. Participants identified discussion topics based on a literature review, which included examples for which human responses to ambient exposures have been extensively characterized for cancer and/or noncancer outcomes. Topics included the need for formalized approaches and criteria to assess the evidence for mode of action (MOA), the use of human versus animal data, the use of MOA information in biologically based models, and the implications of interindividual variability, background disease processes, and background exposures in threshold versus nonthreshold model choice. Participants recommended approaches that differ from current practice for extrapolating high-dose animal data to low-dose human exposures, including categorical approaches for integrating information on MOA, statistical approaches such as model averaging, and inference-based models that explicitly consider uncertainty and interindividual variability.

Objective: Conflicting data exist regarding the effect of chronic renal insufficiency (CRI) on carotid endarterectomy (CEA) outcomes. A large database was used to analyze the effect of CRI, defined by glomerular filtration rate (GFR), as an independent risk factor of CEA., Methods: Prospectively collected data regarding CEAs performed at 123 Veterans Affairs Medical Centers as part of the National Surgical Quality Improvement Program were retrospectively analyzed. Renal function was used to divide patients into three CRI groups: normal or mild (control; GFR >/=60 mL/min/1.73 m(2)), moderate (GFR 30 to 59), and severe (GFR <30). Bivariate analysis and multivariate logistic regression were used to characterize risk factors and their associations with 30-day morbidity and mortality., Results: Between Jan 1, 1996, and Dec 31, 2003, 22,080 patients underwent CEA. Patients missing creatinine levels, already dialysis-dependent, or in acute renal failure just before surgery were excluded. This left 20,899 available for analysis, of which 13,965 had a GFR of >/=60, 6,423 had a GFR of 30 to 59, and 511 had a GFR of <30. The incidence of neurologic complications did not differ significantly (control, 1.7%; moderate CRI, 1.9%; severe CRI, 2.7%). The moderate CRI group experienced significantly more cardiac events (1.7% vs 0.9% for controls, P < .001). This remained predictive in the multivariate model even adjusting for all other risk factors (adjusted odds ratio [AOR], 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009). The moderate CRI group also had higher rates of pulmonary complications (2.1% vs 1.3% control; P < .001; AOR, 1.3; 95% CI, 1.0-1.7; P = .031) but not 30-day mortality (P = .269). Those with severe CRI had a much higher mortality (3.1% vs 1.0% control, P < .001), which remained significant in the multivariate model (AOR, 2.7; 95% CI, 1.6-4.8; P < .001)., Conclusion: Although impaired renal function does not independently increase the risk of neurologic or infectious complications, CRI is a significant negative independent risk factor in predicting other outcomes after CEA. Patients with moderate CRI (GFR, 30-59 mL/min/1.73 m(2)) are at increased risk for cardiac and pulmonary morbidity, but not death, and those with severe CRI (GFR <30 mL/min/1.73 m(2)) have a much higher operative mortality. Patients with CRI should be carefully evaluated before CEA to optimize existing cardiac and pulmonary disease. Understanding this increased risk may assist the surgeon in preoperative counseling and perioperative management.