160 results on '"Hall AB"'
Search Results
2. Bacteroidales species are a reservoir of phase-variable antibiotic resistance genes in the human gut microbiome
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Hall Ab, Xueying Jiang, and Wusheng Yan
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Genetics ,Phase variation ,Human gut ,Metagenomics ,Horizontal gene transfer ,Microbiome ,Biology ,biology.organism_classification ,Genome ,Bacteroidales ,Antibiotic resistance genes - Abstract
Phase-variable antibiotic resistance genes (ARGs) can mitigate the fitness cost of maintaining ARGs in the absence of antibiotics and could potentially prolong the persistence of ARGs in bacterial populations. However, the origin, prevalence, and distribution of phase-variable ARGs remains poorly understood. Here, we sought to assess the threat posed by phase-variable ARGs by systematically searching for phase-variable ARGs in the human gut microbiome and examining their origin, prevalence, and distribution. Through metagenomic assembly of 2227 human gut metagenomes and genomic analysis of the Unified Human Gastrointestinal Genome (UHGG) collection, we identified phase-variable ARGs and categorized them into three classes based on the invertase regulating phase variation. In the human gut microbiome, phase-variable ARGs are commonly and exclusively distributed in Bacteroidales species. Through genomic analysis, we observed that phase-variable ARGs have convergently originated from ARG insertions into phase-variable capsule polysaccharide biosynthesis (CPS) loci at least three times. Moreover, all identified phase-variable ARGs are located within integrative conjugative elements (ICEs). Therefore, horizontal transfer via ICEs could explain the wide taxonomic distribution of phase-variable ARGs. Overall, these findings reveal that phase-variable CPS loci in Bacteroidales species are an important hotspot for the emergence of clinically-relevant phase-variable ARGs.
- Published
- 2021
3. User-driven design of child restraint information to reduce errors in use: a pilot randomised controlled trial
- Author
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Hall, AB, Ho, C, Albanese, B, Keay, L, Hunter, K, Charlton, J, Hayen, A, Bilston, LE, and Brown, J
- Subjects
Public Health ,1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services, 1701 Psychology - Abstract
BACKGROUND:Incorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored. METHODS:We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial. RESULTS:There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p
- Published
- 2019
4. On the validity of the regression discontinuity design for estimating electoral effects: new evidence from over 40,000 close races
- Author
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Eggers, Andrew, Fowler, A, Hainmueller, J, Hall, AB, and Snyder, JM
- Abstract
The regression discontinuity (RD) design is a valuable tool for identifying electoral effects, but this design is only effective when relevant actors do not have precise control over election results. Several recent papers contend that such precise control is possible in large elections, pointing out that the incumbent party is more likely to win very close elections in the United States House of Representatives in recent periods. In this article, we examine whether similar patterns occur in other electoral settings, including the U.S. House in other time periods, statewide, state legislative, and mayoral races in the U.S. and national or local elections in nine other countries. No other case exhibits this pattern. We also cast doubt on suggested explanations for incumbent success in close House races. We conclude that the assumptions behind the RD design are likely to be met in a wide variety of electoral settings and offer a set of best practices for RD researchers going forward.
- Published
- 2017
5. Genome sequence of the Asian Tiger mosquito, Aedes albopictus, reveals insights into its biology, genetics, and evolution (vol 112, pg E5907, 2015)
- Author
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Chen, X-G, Jiang, X, Gu, J, Xu, M, Wu, Y, Deng, Y, Zhang, C, Bonizzoni, M, Dermauw, W, Vontas, J, Armbruster, P, Huang, X, Yang, Y, Zhang, H, He, W, Peng, H, Liu, Y, Wu, K, Chen, J, Lirakis, M, Topalis, P, Van Leeuwen, T, Hall, AB, Thorpe, C, Mueller, RL, Sun, C, Waterhouse, RM, Yan, G, Tu, ZJ, Fang, X, and James, AA
- Published
- 2016
6. Highly evolvable malaria vectors: The genomes of 16 Anopheles mosquitoes
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Neafsey, DE, Waterhouse, RM, Abai, MR, Aganezov, SS, Alekseyev, MA, Allen, JE, Amon, J, Arcà, B, Arensburger, P, Artemov, G, Assour, LA, Basseri, H, Berlin, A, Birren, BW, Blandin, SA, Brockman, AI, Burkot, TR, Burt, A, Chan, CS, Chauve, C, Chiu, JC, Christensen, M, Costantini, C, Davidson, VLM, Deligianni, E, Dottorini, T, Dritsou, V, Gabriel, SB, Guelbeogo, WM, Hall, AB, Han, MV, Hlaing, T, Hughes, DST, Jenkins, AM, Jiang, X, Jungreis, I, Kakani, EG, Kamali, M, Kemppainen, P, Kennedy, RC, Kirmitzoglou, IK, Koekemoer, LL, Laban, N, Langridge, N, Lawniczak, MKN, Lirakis, M, Lobo, NF, Lowy, E, MacCallum, RM, Mao, C, Maslen, G, Mbogo, C, McCarthy, J, Michel, K, Mitchell, SN, Moore, W, Murphy, KA, Naumenko, AN, Nolan, T, Novoa, EM, O'Loughlin, S, Oringanje, C, Oshaghi, MA, Pakpour, N, Papathanos, PA, Peery, AN, Povelones, M, Prakash, A, Price, DP, Rajaraman, A, Reimer, LJ, Rinker, DC, Rokas, A, Russell, TL, Sagnon, N, Sharakhova, MV, Shea, T, Simão, FA, Simard, F, Slotman, MA, Somboon, P, Stegniy, V, Struchiner, CJ, and Thomas, GWC
- Abstract
© 2015, american association for the advancement of science. All rigths reserved. Variation in vectorial capacity for human malaria among Anopheles mosquito species is determined by many factors, including behavior, immunity, and life history. To investigate the genomic basis of vectorial capacity and explore new avenues for vector control, we sequenced the genomes of 16 anopheline mosquito species from diverse locations spanning ∼100 million years of evolution. Comparative analyses show faster rates of gene gain and loss, elevated gene shuffling on the X chromosome, and more intron losses, relative to Drosophila. Some determinants of vectorial capacity, such as chemosensory genes, do not show elevated turnover but instead diversify through protein-sequence changes. This dynamism of anopheline genes and genomes may contribute to their flexible capacity to take advantage of new ecological niches, including adapting to humans as primary hosts.
- Published
- 2015
7. Extent and economic effect of heat loads on dairy cattle production in Australia
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MAYER, DG, primary, DAVISON, TM, additional, McGOWAN, MR, additional, YOUNG, BA, additional, MATSCHOSS, AL, additional, HALL, AB, additional, GOODWIN, PJ, additional, JONSSON, NN, additional, and GAUGHAN, JB, additional
- Published
- 1999
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8. The sequencing of medication administration in the management of hyperkalemia.
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Hall AB, Salazar M, and Larison DJ
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- 2009
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9. Possible vicarious contrast excretion causing symptomatic cholelithiasis.
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Hall AB, Blake A, Wheeler B, Cromer R, Hall, Andrew B, Blake, Andrea, Wheeler, Brad, and Cromer, Robert
- Abstract
A case report of a unique malleable, rubbery, white mass found at cholecystectomy after a diagnosis of symptomatic cholelithiasis. This likely represents either a unique form of a calcium-containing or contrast-containing stone. There are no reported incidents of vicarious contrast stones and calcium-containing stones are reported to be crystalline and hard. [ABSTRACT FROM AUTHOR]
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- 2011
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10. Hypercalcemia complicating Marjolin's ulcer.
- Author
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Hall AB, Buehler KE, Philipneri M, Hall, Andrew B, Buehler, Kelly E, and Philipneri, Marie
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A 54-year-old male with chronic osteomyelitis presented with new-onset hypercalcemia. Extensive initial evaluation did not reveal the underlying cause of his hypercalcemia. Subsequent biopsies revealed squamous cell carcinoma transformation consistent with Marjolin's ulcer. Timely surgery had been shown to be effective in achieving remission in patients with Marjolin's ulcers, even in the presence of hypercalcemia. Therefore, we recommend that patients with chronic wounds and new-onset or otherwise unexplained hypercalcemia should be evaluated for development of Marjolin's ulcers. [ABSTRACT FROM AUTHOR]
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- 2009
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11. Using parallelization to improve the efficiency of an automated taxi route generation algorithm
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Hall Abe, Gabilondo Michael, and Dechev Damian
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surface automation ,taxi routing ,multi-core processing ,lock-free ,Electronic computers. Computer science ,QA75.5-76.95 - Published
- 2012
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12. Treatment of ectopic intratracheal thyroid with a holmium laser.
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Hall AB, Gifford TO, Sabatini PR, Hall, Andrew B, Gifford, Thomas O, and Sabatini, Peter R
- Abstract
The report describes an 85-year-old woman who underwent ectopic intratracheal thyroid ablation with a holmium laser. This represents a novel use of a holmium laser and a potential alternative for commonly performed open intratracheal thyroid excisions. [ABSTRACT FROM AUTHOR]
- Published
- 2011
13. Non-cirrhotic hepatocellular carcinoma in a young active duty male.
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Thomas DB, Hall AB, Michel M, Thomas, David B, Hall, Andrew B, and Michel, Michael
- Abstract
A 22-year-old Airman was presented to the clinic with new onset abdominal pain, which revealed to be well-differentiated hepatocellular carcinoma. Hepatocellular carcinoma in a young patient with no cirrhosis or fibrosis is a relatively rare diagnosis with possible relationship to exercise supplement use. With the high incidence of supplement use in the military population, caution and further investigation into supplement use with correlation to the incidence of liver cancers may be warranted. [ABSTRACT FROM AUTHOR]
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- 2011
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14. Comparative safety and efficacy of a hybrid intravenous and oral diltiazem protocol for acute rate control in the emergency department.
- Author
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Hall AB, Wilson K, Guggino S, and Blind F
- Abstract
Study Objective: Intravenous diltiazem has experienced numerous supply shortages over the past few years. The purpose of this study was to compare the safety and efficacy of a traditional diltiazem intravenous bolus and continuous infusion protocol to a diltiazem intravenous bolus and oral maintenance protocol for acute rate control in the emergency department., Methods: Patients who received intravenous diltiazem in the emergency department between January 1, 2018 and May 31, 2019 were screened. Patients were included if they received the diltiazem intravenous bolus and continuous infusion protocol (IV + infusion group) or the hybrid diltiazem intravenous bolus and oral maintenance protocol (IV + PO group). The primary outcome was the proportion of patients with rate control, without need for additional rate control agents or additional boluses during the maintenance phase., Results: A total of 106 patients were matched with 53 patients in each group. For the primary outcome of rate control at four hours, 62.3% of patients in the intravenous bolus + infusion group versus 75.5% of patients in the IV bolus + PO group (p = 0.142) achieved rate control. There was no difference in rates of hypotension or bradycardia between groups., Conclusion: Results of this study demonstrated no difference in acute rate control when using a hybrid IV and oral diltiazem protocol, compared to a traditional IV bolus and infusion strategy. This information supports the further use of a hybrid diltiazem IV and oral protocol, which provides increased flexibility during shortages of either medication., Competing Interests: Declaration of competing Interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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15. Effectiveness of In-Theater Mental Health Assessments.
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Perez S, Dimayuga HU, Estrada KM, Flores A, and Hall AB
- Abstract
Introduction: The leading cause for medical evacuation from the U.S. Central Command area of responsibility is because of mental health conditions. The In-Theater Mental Health Assessment (ITMHA) is a DoD-required screening of deployed personnel. It is vital to examine the efficacy of ITMHA's potential to significantly impact the mental health outcomes of service members., Materials and Methods: All ITMHA results of individuals in 2 deployed Army battalions along with a brigade headquarters deployed to U.S. Central Command between October 2022 and October 2023 were collected and analyzed. Descriptive statistics were used to characterize the results of the ITMHA., Results: Of 670 deployed service members, 157 (23%) scored positive on ITMHA. Ten service members were referred for additional mental health evaluation. The remaining 147 (22%) service members who scored positive were not referred because of a lack of significant impairment or were already engaged in mental health services. One service member in the study was evacuated because of a mental health condition. The most common major life stressors identified were family/relationship issues, sleep problems, and mental health concerns., Conclusions: The number of deployed personnel identified through the ITMHA as requiring mental health care was modest. The ITMHA has multiple limitations that, if addressed, will improve its utility to mitigate mental health decline in the expeditionary environment., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
- Published
- 2024
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16. Basolateral amygdala corticotropin releasing factor receptor 2 interacts with nonmuscle myosin II to destabilize memory in males.
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Hafenbreidel M, Pandey S, Briggs SB, Arza M, Bonthu S, Fisher C, Tiller A, Hall AB, Reed S, Mayorga N, Lin L, Khan S, Cameron MD, Rumbaugh G, and Miller CA
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- Animals, Female, Male, Mice, Actins, Myosin Type II metabolism, Basolateral Nuclear Complex metabolism, Cocaine pharmacology, Methamphetamine pharmacology, Receptors, Corticotropin-Releasing Hormone metabolism
- Abstract
Preclinical studies show that inhibiting the actin motor ATPase nonmuscle myosin II (NMII) with blebbistatin (Blebb) in the basolateral amgydala (BLA) depolymerizes actin, resulting in an immediate, retrieval-independent disruption of methamphetamine (METH)-associated memory in male and female adult and adolescent rodents. The effect is highly selective, as NMII inhibition has no effect in other relevant brain regions (e.g., dorsal hippocampus [dPHC], nucleus accumbens [NAc]), nor does it interfere with associations for other aversive or appetitive stimuli, including cocaine (COC). To understand the mechanisms responsible for drug specific selectivity we began by investigating, in male mice, the pharmacokinetic differences in METH and COC brain exposure . Replicating METH's longer half-life with COC did not render the COC association susceptible to disruption by NMII inhibition. Therefore, we next assessed transcriptional differences. Comparative RNA-seq profiling in the BLA, dHPC and NAc following METH or COC conditioning identified crhr2, which encodes the corticotropin releasing factor receptor 2 (CRF2), as uniquely upregulated by METH in the BLA. CRF2 antagonism with Astressin-2B (AS2B) had no effect on METH-associated memory after consolidation, allowing for determination of CRF2 influences on NMII-based susceptibility. Pretreatment with AS2B prevented the ability of Blebb to disrupt an established METH-associated memory. Alternatively, combining CRF2 overexpression and agonist treatment, urocortin 3 (UCN3), in the BLA during conditioning rendered COC-associated memory susceptible to disruption by NMII inhibition, mimicking the Blebb-induced, retrieval-independent memory disruption seen with METH. These results suggest that BLA CRF2 receptor activation during memory formation in male mice can prevent stabilization of the actin-myosin cytoskeleton supporting the memory, rendering it vulnerable to disruption by NMII inhibition. CRF2 represents an interesting target for BLA-dependent memory destabilization via downstream effects on NMII., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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17. Esophageal Stent Migration Diagnosed With Point-of-Care Ultrasound.
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Harris S, Hall AB, and Derr C
- Abstract
This unique case depicts the first published report of a physician using point-of-care ultrasound to diagnose an esophageal stent migration. Discussed in this article are the sonographic findings that clinicians should be familiar with when evaluating patients with abdominal pain or chest pain who have a history of an esophageal stent. When coupled with a high index of suspicion, ultrasound can be one of the most portable, readily available, low-cost, and minimally invasive techniques for making a rapid diagnosis of esophageal stent migration., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Harris et al.)
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- 2023
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18. Declining Military Surgical Cases and the Impact on Military Surgical Graduate Medical Education.
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Hall AB, Krzyzaniak M, Qureshi I, Cromer R, Tadlock MD, Patrick D, Hatch Q, Iverson MK, Walker A, and Glaser J
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- Humans, Retrospective Studies, Clinical Competence, Education, Medical, Graduate, Workload, Internship and Residency, General Surgery education
- Abstract
Background: Several studies have indicated a decline in the number, types, and complexity of surgical procedures within military treatment facilities (MTFs). This study aims to determine what effect, if any, these downward trends have had on the relationship between the military health system (MHS) and surgical graduate medical education., Methods: Graduating chief resident final ACGME case logs from 4 of thirteen military general surgery programs were evaluated from 2015 to 2020. The proportion of total cases performed by residents at military institutions were compared on a year over year basis., Results: The proportion of cases performed within the military hospitals declined 3.27% each year between 2015 and 2020 ( P < .0001) in 4 MTFs. All individual hospitals had significant declines in case volume except one (William Beaumont Army Medical Center) which increased 6.05% with each year, but also increased the number of MTF partnerships within its program ( P < .0001)., Conclusions: There has been a statistically significant decline over time in the proportion of cases logged by residents within the studied military treatment facilities. Investment into military hospitals to increase case numbers, case diversity, and complexity and/or acceptance of this gradual decline with greater shifting of educational workload onto civilian hospitals is required., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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19. Another Piece of the Complex Puzzle: Outcomes of Percutaneous Coronary Intervention in Older Adults.
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Davies RE, Hall AB, and Chen MA
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- Humans, Aged, Myocardial Ischemia, Coronary Artery Disease surgery, Percutaneous Coronary Intervention adverse effects
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- 2023
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20. The Impact of the Maritime Deployment Cycle on the Surgeon's Knowledge, Skills, and Abilities.
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Vasquez M, Edson TD, Lucas DJ, Hall AB, and Tadlock MD
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- Humans, United States, Military Personnel statistics & numerical data, Military Personnel psychology, Naval Medicine methods, Naval Medicine statistics & numerical data, Naval Medicine standards, Adult, Surgeons statistics & numerical data, Clinical Competence standards, Clinical Competence statistics & numerical data, Ships statistics & numerical data
- Abstract
Introduction: The U.S. Navy routinely deploys aircraft carriers and amphibious assault ships throughout the world in support of U.S. strategic interests, each with an embarked single surgeon team. Surgeons and their teams are required to participate in lengthy pre-deployment shipboard certifications before each deployment. Given the well-established relationship of surgeon volume to patient outcome, we aim to compare the impact of land vs. maritime deployments on Navy general surgeon practice patterns., Materials and Methods: Case logs and pre-deployment training initiation of land-based (n = 8) vs. maritime-based (n = 7) U.S. Navy general surgeons over a 3-year period (2017-2020) were compared. Average cases per week were plotted over 26 weeks before deployment. Student's t-test was utilized for all comparisons., Results: Cases declined for both groups in the weeks before deployment. At 6 months (26 weeks) before deployment, land-based surgeons performed significantly more cases than their maritime colleagues (50.3 vs. 14.0, P = .009). This difference persisted at 16 weeks (13.1 vs. 1.9, P = .011) and 12 weeks (13.1 vs. 1.9, P = .011). Overall, surgeon operative volume fell off earlier for maritime surgeons (16 weeks) than land-based surgeons (8 weeks). Within 8 weeks of deployment, both groups performed a similarly low number of cases as they completed final deployment preparations., Conclusions: Surgeons are a critical component of combat causality care teams. In this analysis, we have demonstrated that both land- and maritime-based U.S. Navy surgeons have prolonged periods away from clinical care before and during deployments; for shipboard surgeons, this deficit is large and may negatively impact patient outcomes in the deployed maritime environment. The authors describe this discrepancy and provide practical doctrinal solutions to close this readiness gap., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
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- 2023
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21. Basolateral Amygdala Corticotrophin Releasing Factor Receptor 2 Interacts with Nonmuscle Myosin II to Destabilize Memory.
- Author
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Hafenbreidel M, Briggs SB, Arza M, Bonthu S, Fisher C, Tiller A, Hall AB, Reed S, Mayorga N, Lin L, Khan S, Cameron MD, Rumbaugh G, and Miller CA
- Abstract
Inhibiting the actin motor ATPase nonmuscle myosin II (NMII) with blebbistatin (Blebb) in the basolateral amgydala (BLA) depolymerizes actin, resulting in an immediate, retrieval-independent disruption of methamphetamine (METH)-associated memory. The effect is highly selective, as NMII inhibition has no effect in other relevant brain regions (e.g. dorsal hippocampus [dPHC], nucleus accumbens [NAc]), nor does it interfere with associations for other aversive or appetitive stimuli, including cocaine (COC). To investigate a potential source of this specificity, pharmacokinetic differences in METH and COC brain exposure were examined. Replicating METH's longer half-life with COC did not render the COC association susceptible to disruption by NMII inhibition. Therefore, transcriptional differences were next assessed. Comparative RNA-seq profiling in the BLA, dHPC and NAc following METH or COC conditioning identified crhr2 , which encodes the corticotrophin releasing factor receptor 2 (CRF2), as uniquely upregulated by METH in the BLA. CRF2 antagonism with Astressin-2B (AS2B) had no effect on METH-associated memory after consolidation, allowing for determination of CRF2 influences on NMII-based susceptibility after METH conditioning. Pretreatment with AS2B occluded the ability of Blebb to disrupt an established METH-associated memory. Alternatively, the Blebb-induced, retrieval-independent memory disruption seen with METH was mimicked for COC when combined with CRF2 overexpression in the BLA and its ligand, UCN3 during conditioning. These results indicate that BLA CRF2 receptor activation during learning can prevent stabilization of the actin-myosin cytoskeleton supporting the memory, rendering it vulnerable to disruption via NMII inhibition. CRF2 represents an interesting target for BLA-dependent memory destabilization via downstream effects on NMII., Competing Interests: Competing Interests Authors have nothing to disclose.
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- 2023
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22. Explainability and causability for artificial intelligence-supported medical image analysis in the context of the European In Vitro Diagnostic Regulation.
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Müller H, Holzinger A, Plass M, Brcic L, Stumptner C, and Zatloukal K
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- Algorithms, Machine Learning, Software, Artificial Intelligence, Neural Networks, Computer
- Abstract
Artificial Intelligence (AI) for the biomedical domain is gaining significant interest and holds considerable potential for the future of healthcare, particularly also in the context of in vitro diagnostics. The European In Vitro Diagnostic Medical Device Regulation (IVDR) explicitly includes software in its requirements. This poses major challenges for In Vitro Diagnostic devices (IVDs) that involve Machine Learning (ML) algorithms for data analysis and decision support. This can increase the difficulty of applying some of the most successful ML and Deep Learning (DL) methods to the biomedical domain, just by missing the required explanatory components from the manufacturers. In this context, trustworthy AI has to empower biomedical professionals to take responsibility for their decision-making, which clearly raises the need for explainable AI methods. Explainable AI, such as layer-wise relevance propagation, can help in highlighting the relevant parts of inputs to, and representations in, a neural network that caused a result and visualize these relevant parts. In the same way that usability encompasses measurements for the quality of use, the concept of causability encompasses measurements for the quality of explanations produced by explainable AI methods. This paper describes both concepts and gives examples of how explainability and causability are essential in order to demonstrate scientific validity as well as analytical and clinical performance for future AI-based IVDs., (Copyright © 2022. Published by Elsevier B.V.)
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- 2022
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23. Committee on Surgical Combat Casualty Care position statement on the use of single surgeon teams and invited commentaries.
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Gurney JM, Jensen SD, Gavitt BJ, Edson TD, Brown SR, Cunningham CW, Drew BG, Eckert MJ, Hall AB, Holcomb JB, Knipp BS, Lesperance RN, Polk TM, Schreiber MA, Tadlock MD, and Shackelford SA
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- Humans, United States, Military Medicine, Military Personnel, Surgeons
- Abstract
Background: Over the last 20 years of war, there has been an operational need for far forward surgical teams near the point of injury. Over time, the medical footprint of these teams has decreased and the utilization of mobile single surgeon teams (SSTs) by the Services has increased. The increased use of SSTs is because of a tactical mobility requirement and not because of proven noninferiority of clinical outcomes. Through an iterative process, the Committee on Surgical Combat Casualty Care (CoSCCC) reviewed the utilization of SSTs and developed an expert-opinion consensus statement addressing the risks of SST utilization and proposed mitigation strategies., Methods: A small triservice working group of surgeons with deployment experience, to include SST deployments, developed a statement regarding the risks and benefits of SST utilization. The draft statement was reviewed by a working group at the CoSCCC meeting November 2021 and further refined. This was followed by an extensive iterative review process, which was conducted to ensure that the intended messaging was clear to senior medical leaders and operational commanders. The final draft was voted on by the entire CoSCCC membership. To inform the civilian trauma community, commentaries were solicited from civilian trauma leaders to help put this practice into context and to further the discussion in both military and civilian trauma communities., Results: After multiple revisions, the SST statement was finalized in January 2022 and distributed to the CoSCCC membership for a vote. Of 42 voting members, there were three nonconcur votes. The SST statement underwent further revisions to address CoSCCC voting membership comments. Statement commentaries from the President of the American Association for the Surgery for Trauma, the chair of the Committee on Trauma, the Medical Director of the Military Health System Strategic Partnership with the American College of Surgeons and a recently retired military surgeon we included to put this military relevant statement into a civilian context and further delineate the risks and benefits of including the trauma care paradigm in the Department of Defense (DoD) deployed trauma system., Conclusion: The use of SSTs has a role in the operational environment; however, operational commanders must understand the tradeoff between tactical mobility and clinical capabilities. As SST tactical mobility increases, the ability of teams to care for multiple casualty incidents or provide sustained clinical operations decreases. The SST position statement is a communication tool to inform operational commanders and military medical leaders on the use of these teams on current and future battlefields., (Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)
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- 2022
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24. US Central Command military blood utilization practices 2011 to 2020.
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Hall AB, Qureshi I, McMinn H, Kuper J, Gurney JM, Tadlock MD, and Cardin S
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- Blood Transfusion, Humans, Plasma, Resuscitation, United States, Military Medicine, Military Personnel
- Abstract
Background: Military involvement in Afghanistan ended in 2021, and while low-intensity troop engagements continue globally, casualty numbers are dwindling. To understand the clinical and operational connections between blood utilization and clinical paradigm shifts in resuscitation strategies, a review of blood product utilization and the changes in the last decade was conducted within the US Central Command area of responsibility. The intent of this review was to assess patterns of blood use during the last decade of the United States' involvement in the most recent major conflicts to potentially inform future blood requirements., Methods: Blood product and types transfused between January 1, 2011, and December 31, 2020, were acquired from the Medical Situational Awareness in Theater blood reports. All reported blood usage data in the US Central Command area of responsibility were queried., Results: Packed red blood cells and fresh frozen plasma (FFP) usage showed no statistically significant change over time ( τb = 0.24, p = 0.3252; τb = -0.47, p = 0.0603). Fresh and stored whole blood (SWB) use increased overtime ( τb = 0.69, p = 0.0056; τb = 0.83, p = 0.0015). A strong inverse relationship was found between SWB and FFP usage ( r = -0.68, p = 0.0309) and liquid plasma and FFP usage ( r = -0.65, p = 0.0407) over time., Conclusion: Whole blood usage increased significantly over time with a preference for SWB. Component therapy is anticipated to remain a critical element of resuscitation in the event of large-scale combat operations secondary to supply chain and longer storage times., Level of Evidence: Therapeutic/care management; Level III., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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25. Tactical Combat Casualty Care Maritime Scenario: Shipboard Missile Strike.
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Butler FK Jr, Burkholder T, Chernenko M, Chimiak J, Chung J, Cubano M, Gurney JM, Hall AB, Holcomb JB, Kotora J, Lenart M, Long A, Papalski W, Rich TA, Tripp M, Shackelford SA, Tadlock MD, Timby JW, and Drew B
- Subjects
- Blood Transfusion, Humans, Ships, Military Personnel
- Abstract
The types of injuries seen in combat action on a naval surface ship may be similar in many respects to the injuries seen in ground combat, and the principles of care for those injuries remain in large part the same. However, some contradistinctions in the care of combat casualties on a ship at sea must be highlighted, since this care may entail a number of unique challenges and different wounding patterns. This paper presents a scenario in which a guided missile destroyer is struck by a missile fired from an unmanned aerial vehicle operated by an undetermined hostile entity. Despite the presence of casualties who require care, the primary focus of a naval vessel that has just been damaged by hostile action is to prevent the ship from sinking and to conserve the fighting force on board the ship to the greatest extent possible. The casualties in this scenario include sailors injured by both blast and burns, as well as a casualty with a non-fatal drowning episode. Several of the casualties have also suffered the effects of a nearby underwater explosion while immersed. Challenges in the care of these casualties include delays in evacuation, the logistics of obtaining whole blood for transfusion while at sea, and transporting the casualties to the next higher level of care aboard a Casualty Receiving and Treatment Ship. As the National Defense Strategy pivots to a focus on the potential for maritime combat, the medical community must continue to maintain readiness by preparing fo., (2022.)
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- 2022
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26. Developing comic strips promoting diabetic retinopathy screening in Kilimanjaro, Tanzania, using Intervention Mapping.
- Author
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Hall CE, Hall AB, Mallya J, Courtright P, and Kok G
- Subjects
- Humans, Mass Screening, Tanzania, Diabetes Mellitus, Diabetic Retinopathy diagnosis, Diabetic Retinopathy prevention & control
- Abstract
Introduction: Intervention Mapping is the protocol used by the Kilimanjaro Diabetic Programme to plan, develop, implement, and evaluate an evidence-based screening programme for diabetic retinopathy. Two comic strips were developed to deliver the message on the need for diabetic retinopathy screening., Objectives: The first objective was to develop a culturally appropriate and accessible health message to promote diabetic retinopathy screening for the target audience. The second objective was to deliver a motivational message to promote acceptance of diabetic retinopathy screening irrespective of past eye health behaviour., Methods: A multi-method research design was used. Social cognitive theory provided the theoretical basis for the intervention, involving community participation to promote positive eye health behaviour., Results: For the Draughts Comic Strip, Flesch-Kincaid readability was 75.7% and comprehension was 87.04%, and for the Soap Opera Comic Strip Flesch-Kincaid readability was 75.6% and comprehension was 86.54%., Conclusion: The development of the diabetic retinopathy comic strips was a positive health education strategy implemented during a clinical trial comparing methods of screening for diabetic retinopathy at the Kilimanjaro Christian Medical Centre Hospital. The level of comprehension of the comic strips by stakeholders indicated their understanding of the message. Patients enroled in the clinical trial requested the comic strips. No discarded comic strips were found in the clinic during the clinical trial., Trial Registration: Trial registration number: ISRCTN31439939. Details available at https://www.isrctn.com/ ., (© 2022. The Author(s).)
- Published
- 2022
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27. Establishing a screening programme for diabetic retinopathy in Kilimanjaro Region, Tanzania using intervention mapping.
- Author
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Hall CE, Hall AB, Mallya J, Courtright P, and Kok G
- Subjects
- Blood Glucose, Humans, Mass Screening, Needs Assessment, Tanzania, Diabetes Mellitus, Diabetic Retinopathy diagnosis, Diabetic Retinopathy prevention & control
- Abstract
Background: The Kilimanjaro Diabetic Programme used the Intervention Mapping framework to develop a theory- and evidence-based diabetic retinopathy screening programme. A Working Committee of health care workers and stakeholders ensured community engagement and empowerment of the target audience., Objectives: To deliver a culturally appropriate, sustainable, community supported health intervention, promoting eye health behaviour change, to prevent avoidable blindness., Methods: The six steps of the Intervention Mapping protocol incorporated eight components: (1) a needs assessment of people with diabetes and health care workers (2) a clinical trial of diabetic retinopathy screening modes, (3) comic strips as a motivational strategy for diabetic retinopathy screening uptake, (4) health care worker education (5) an electronic database of people with diabetes (6) a self-carry diary (7) implementation of mobile diabetic retinopathy retinal screening (8) process and outcome programme evaluation., Results: The programme eliminated barriers to diabetic retinopathy screening in Kilimanjaro Christian Medical Centre eye and diabetic clinics, placing a digital retinal screening camera in the diabetic clinic and a fast-track screening system in the eye clinic. Two comic strips and a diary provided information about self-management and record of medications, treatment, blood sugar and blood pressure at clinic visits. An annual rural health care worker education programme met requests for knowledge on treatment and care of diabetes, targeting prevention of diabetic retinopathy. Rural digital retinal screening was implemented. Rural diabetes clinics were initiated., Conclusions: Intervention Mapping provided a systematic, iterative model to formulate and deliver an urban and rural diabetic retinopathy screening programme., Trial Registration Number: ISRCTN31439939. Details available at https://www.isrctn.com/., (© 2022. The Author(s).)
- Published
- 2022
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28. Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period.
- Author
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Lee JJ, Hall AB, Carr MJ, MacDonald AG, Edson TD, and Tadlock MD
- Subjects
- Humans, Trauma Centers, Military Medicine education, Military Personnel education
- Published
- 2022
- Full Text
- View/download PDF
29. Bacteroidales species in the human gut are a reservoir of antibiotic resistance genes regulated by invertible promoters.
- Author
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Yan W, Hall AB, and Jiang X
- Subjects
- Drug Resistance, Microbial, Humans, Metagenomics, Phase Variation, Anti-Bacterial Agents pharmacology, Gastrointestinal Microbiome genetics
- Abstract
Antibiotic-resistance genes (ARGs) regulated by invertible promoters can mitigate the fitness cost of maintaining ARGs in the absence of antibiotics and could potentially prolong the persistence of ARGs in bacterial populations. However, the origin, prevalence, and distribution of these ARGs regulated by invertible promoters remains poorly understood. Here, we sought to assess the threat posed by ARGs regulated by invertible promoters by systematically searching for ARGs regulated by invertible promoters in the human gut microbiome and examining their origin, prevalence, and distribution. Through metagenomic assembly of 2227 human gut metagenomes and genomic analysis of the Unified Human Gastrointestinal Genome (UHGG) collection, we identified ARGs regulated by invertible promoters and categorized them into three classes based on the invertase-regulating phase variation. In the human gut microbiome, ARGs regulated by invertible promoters are exclusively found in Bacteroidales species. Through genomic analysis, we observed that ARGs regulated by invertible promoters have convergently originated from ARG insertions into glycan-synthesis loci that were regulated by invertible promoters at least three times. Moreover, all three classes of invertible promoters regulating ARGs are located within integrative conjugative elements (ICEs). Therefore, horizontal transfer via ICEs could explain the wide taxonomic distribution of ARGs regulated by invertible promoters. Overall, these findings reveal that glycan-synthesis loci regulated by invertible promoters in Bacteroidales species are an important hotspot for the emergence of clinically-relevant ARGs regulated by invertible promoters., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)
- Published
- 2022
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30. Impact of the utilization of 500 mL IV bags on crystalloid resuscitation volumes administered to trauma patients.
- Author
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Hall AB, Glas-Boben J, Santos JL, Wilson K, Morata L, and Wall W
- Subjects
- Administration, Intravenous, Adolescent, Adult, Aged, Aged, 80 and over, Crystalloid Solutions, Emergency Service, Hospital, Female, Florida, Humans, Injury Severity Score, Isotonic Solutions therapeutic use, Male, Middle Aged, Resuscitation, Retrospective Studies, Tertiary Care Centers, Treatment Outcome, Wounds and Injuries mortality, Young Adult, Isotonic Solutions administration & dosage, Wounds and Injuries therapy
- Abstract
Introduction: Administering large volumes of crystalloids to trauma patients has been shown to exacerbate metabolic complications of hemorrhage including dilutional coagulopathy and worsening acidosis The aim of this study was to evaluate crystalloid administration volumes in trauma patients after replacing 1 L IV containers with 500 mL IV containers in the emergency department trauma resuscitation bay., Materials and Methods: This was a single-center, IRB-approved, retrospective cohort evaluation of adult trauma patients conducted at an 864-bed community tertiary referral center located in the southeastern United States. Patterns of crystalloid administration were examined before and after the trauma resuscitation bay began to exclusively stock 500 mL IV containers. The primary outcome was mean total crystalloid volume infused from time of injury to hospital admission. Secondary outcomes included mean total crystalloid volume infused prior to administration of blood products, proportion of patients who received less than 2 L total of crystalloids, time to initiation of blood products, and mortality in both the emergency department and in-hospital., Results: Patient characteristics were largely similar between both groups including age, mechanism of injury, and Injury Severity Score. For the primary outcome, the mean total crystalloid volume infused from time of injury to hospital administration, patients in the 500 mL IV fluid container group were administered 555 mL less crystalloid when compared to the 1 L IV fluid container group, 1048 mL vs 1603 mL (p < 0.01; 95% CI 406 mL - 704 mL), respectively. After conversion to the 500 mL IV container bags, there was a 27.5% increase in the proportion of patients receiving less than 2 L of crystalloid, 90.5% vs 63.0% in the 500 mL IV fluid container and 1 L IV fluid container groups, respectively (p < 0.01)., Conclusions: Due to reduced mortality, expanding literature and guidelines clearly support minimizing IV crystalloid resuscitation. Institutions must now work to minimize use of IV crystalloids to hemorrhaging trauma patients and a simple solution of using smaller IV fluid bags was shown to improve adherence to this practice., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
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31. Practice Patterns in the Interventional Treatment of Coronary Bifurcation Lesions: A Global Survey.
- Author
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Nikolakopoulos I, Vemmou E, Karacsonyi J, Azzalini L, Bergmark BA, Chatzizisis YS, Hall AB, Wollmuth J, Croce K, Jneid H, Rangan BV, Burke MN, and Brilakis ES
- Subjects
- Coronary Angiography, Humans, Stents, Treatment Outcome, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Percutaneous Coronary Intervention
- Abstract
Objectives: The study aim was to assess current procedural strategies and perceptions for percutaneous coronary intervention (PCI) involving bifurcations., Methods: We distributed an online survey via email (8050 invitations) and social media., Results: Among 440 responders, median annual PCI volumes were 15 cases (interquartile range [IQR], 10-29 cases) for left main (LM) and 50 cases (IQR, 27-73 cases) for non-LM (nLM) bifurcation lesions. Radial access use was reported in 51% of LM and 82% of nLM cases. An upfront 2-stent strategy, most commonly double-kissing (DK) crush, was reported in 49% of LM and 29% of nLM lesions. Bailout stenting during provisional stenting was reported in 26% of LM-PCIs, usually using the T and protrusion technique. In provisional stenting cases, most operators (<35%) did not report predilating the side branch, but routinely postdilated after successful provisional stenting (>85%), most often using both kissing-balloon inflation and the proximal optimization technique. Intravascular imaging was used in 80% of LM and 46% of nLM cases., Conclusions: Among the survey responders, the DK crush technique was the most frequently used 2-stent strategy for bifurcation PCIs. For LM lesions, bailout stenting was performed after provisional strategy in approximately 25% of cases. For nLM lesions, use of intravascular imaging and coronary physiology was lower than for LM lesions.
- Published
- 2022
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- View/download PDF
32. How did absentee voting affect the 2020 U.S. election?
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Yoder J, Handan-Nader C, Myers A, Nowacki T, Thompson DM, Wu JA, Yorgason C, and Hall AB
- Abstract
The 2020 U.S. election saw a record turnout, saw a huge increase in absentee voting, and brought unified national Democratic control—yet these facts alone do not imply that vote-by-mail increased turnout or benefited Democrats. Using new microdata on millions of individual voters and aggregated turnout data across all 50 states, this paper offers a causal analysis of the impact of absentee vote-by-mail during the COVID-19 (coronavirus disease 2019) pandemic. Focusing on natural experiments in Texas and Indiana, we find that 65-year-olds voted at nearly the same rate as 64-year-olds, despite the fact that only 65-year-olds could vote absentee without an excuse. Being just old enough to vote no-excuse absentee did not substantially increase Democratic turnout relative to Republican turnout. Voter interest appeared to be more important in driving turnout across vote modes, neutralizing the electoral impact of Democrats voting by mail at higher rates during the historic pandemic.
- Published
- 2021
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33. Update on chronic total occlusion percutaneous coronary intervention.
- Author
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Assali M, Buda KG, Megaly M, Hall AB, Burke MN, and Brilakis ES
- Subjects
- Chronic Disease, Coronary Angiography methods, Humans, Registries, Risk Factors, Treatment Outcome, Coronary Occlusion diagnostic imaging, Coronary Occlusion surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods
- Abstract
Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be challenging to perform. The main indication for CTO PCI is to improve symptoms. Several contemporary studies have reported high CTO PCI success rates at experienced centers but success rates in all-comer registries remain low. Several scores can estimate the difficulty and the likelihood of success of CTO PCI. Dual arterial access and use of CTO crossing algorithms can improve the success and safety of CTO PCI. Intracoronary imaging can optimize stent expansion and minimize adverse cardiovascular events. While complications are more common in CTO PCI, careful planning and prompt diagnosis and treatment can prevent them or minimize their adverse consequences. In this article, we review contemporary data on the indications, safety and efficacy of CTO PCI., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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34. The Capacity to Produce Hydrogen Sulfide (H 2 S) via Cysteine Degradation Is Ubiquitous in the Human Gut Microbiome.
- Author
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Braccia DJ, Jiang X, Pop M, and Hall AB
- Abstract
As one of the three mammalian gasotransmitters, hydrogen sulfide (H
2 S) plays a major role in maintaining physiological homeostasis. Endogenously produced H2 S plays numerous beneficial roles including mediating vasodilation and conferring neuroprotection. Due to its high membrane permeability, exogenously produced H2 S originating from the gut microbiota can also influence human physiology and is implicated in reducing intestinal mucosal integrity and potentiating genotoxicity and is therefore a potential target for therapeutic interventions. Gut microbial H2 S production is often attributed to dissimilatory sulfate reducers such as Desulfovibrio and Bilophila species. However, an alternative source for H2 S production, cysteine degradation, is present in some gut microbes, but the genes responsible for cysteine degradation have not been systematically annotated in all known gut microbes. We classify mechanisms of cysteine degradation into primary, secondary, and erroneous levels of H2 S production and perform a comprehensive search for primary, secondary, and erroneous cysteine-degrading enzymes in 4,644 non-redundant bacterial genomes from the Unified Human Gastrointestinal Genome (UHGG) catalog. Of the 4,644 genomes we have putatively identified 2,046 primary, 1,951 secondary, and 5 erroneous cysteine-degrading species. We identified the presence of at least one putative cysteine-degrading bacteria in metagenomic data of 100% of 6,623 healthy subjects and the expression of cysteine-degrading genes in metatranscriptomic data of 100% of 736 samples taken from 318 individuals. Additionally, putative cysteine-degrading bacteria are more abundant than sulfate-reducing bacteria across healthy controls, IBD patients and CRC patients ( p < 2.2e-16, Wilcoxon rank sum test). Although we have linked many taxa with the potential for cysteine degradation, experimental validation is required to establish the H2 S production potential of the gut microbiome. Overall, this study improves our understanding of the capacity for H2 S production by the human gut microbiome and may help to inform interventions to therapeutically modulate gut microbial H2 S production., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Braccia, Jiang, Pop and Hall.)- Published
- 2021
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35. The taxonomic distribution of histamine-secreting bacteria in the human gut microbiome.
- Author
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Mou Z, Yang Y, Hall AB, and Jiang X
- Subjects
- Bacteria genetics, Bacteria metabolism, Biological Transport, Histamine, Humans, Gastrointestinal Microbiome, Microbiota
- Abstract
Background: Biogenic histamine plays an important role in immune response, neurotransmission, and allergic response. Although endogenous histamine production has been extensively studied, the contributions of histamine produced by the human gut microbiota have not been explored due to the absence of a systematic annotation of histamine-secreting bacteria., Results: To identify the histamine-secreting bacteria from in the human gut microbiome, we conducted a systematic search for putative histamine-secreting bacteria in 36,554 genomes from the Genome Taxonomy Database and Unified Human Gastrointestinal Genome catalog. Using bioinformatic approaches, we identified 117 putative histamine-secreting bacteria species. A new three-component decarboxylation system including two colocalized decarboxylases and one transporter was observed in histamine-secreting bacteria among three different phyla. We found significant enrichment of histamine-secreting bacteria in patients with inflammatory bowel disease but not in patients with colorectal cancer suggesting a possible association between histamine-secreting bacteria and inflammatory bowel disease., Conclusions: The findings of this study expand our knowledge of the taxonomic distribution of putative histamine-secreting bacteria in the human gut., (© 2021. The Author(s).)
- Published
- 2021
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36. Gut microbiome ADP-ribosyltransferases are widespread phage-encoded fitness factors.
- Author
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Brown EM, Arellano-Santoyo H, Temple ER, Costliow ZA, Pichaud M, Hall AB, Liu K, Durney MA, Gu X, Plichta DR, Clish CA, Porter JA, Vlamakis H, and Xavier RJ
- Subjects
- ADP Ribose Transferases genetics, Animals, Bacteriophages genetics, Caco-2 Cells, Cell Line, Tumor, Feces chemistry, Feces microbiology, Female, Gastrointestinal Microbiome genetics, Germ-Free Life, HT29 Cells, Humans, Intestinal Mucosa metabolism, Intestinal Mucosa microbiology, Male, Mice, Mice, Inbred C57BL, Myosin Heavy Chains metabolism, ADP Ribose Transferases metabolism, Actin Cytoskeleton metabolism, Bacteroides metabolism, Bacteroides thetaiotaomicron metabolism, Epithelial Cells metabolism, Inosine metabolism
- Abstract
Bacterial ADP-ribosyltransferases (ADPRTs) have been described as toxins involved in pathogenesis through the modification of host proteins. Here, we report that ADPRTs are not pathogen restricted but widely prevalent in the human gut microbiome and often associated with phage elements. We validated their biochemical activity in a large clinical isolate collection and further examined Bxa, a highly abundant ADPRT in Bacteroides. Bxa is expressed, secreted, and enzymatically active in Bacteroides and can ADP-ribosylate non-muscle myosin II proteins. Addition of Bxa to epithelial cells remodeled the actin cytoskeleton and induced secretion of inosine. Bxa-encoding B. stercoris can use inosine as a carbon source and colonizes the gut to significantly greater numbers than a bxa-deleted strain in germ-free and altered Schaedler flora (ASF) mice. Colonization correlated with increased inosine concentrations in the feces and tissues. Altogether, our results show that ADPRTs are abundant in the microbiome and act as bacterial fitness factors., Competing Interests: Declaration of interests R.J.X. is a consultant to Novartis., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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37. Timeline of Psychological and Physiological Effects Occurring During Military Deployment on a Medical Team.
- Author
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Hall AB, Qureshi I, Wilson RL, and Glasser JJ
- Subjects
- Humans, Military Deployment, Retrospective Studies, Time Factors, Military Personnel, Stress Disorders, Post-Traumatic
- Abstract
Background: The negative effects of deployment on military mental health is a topic of major interest. Predeployment and postdeployment assessments are common, but to date there has been little to no intradeployment assessment of military members. This study attempts to determine the physiological and psychiatric effects on Servicemembers over the course of deployment, to provide a baseline data set and to allow for better prediction, prevention, and intervention on these negative effects., Methods: A retrospective analysis was performed on physiological and psychiatric data collected on a single deployed medical team between 16 January 2020 and 12 July 2020. Patient health screening questionnaires (PHQ-9) and physiological measurements were completed serially twice weekly on five active-duty military volunteers for the entirety of a scheduled 6-month deployment., Results: Depression symptom development followed a linear trend (p = .0149) and severity followed a quadratic trend (p < .001) over a length of a deployment. Weight (p = .435) and pulse (p = .416) were not statistically altered. Mean arterial pressure (MAP) had a statistically significant reduction (p < .001)., Conclusion: In this specific population, there was a linear relationship between time deployed and depression symptoms and severity. Depression symptom severity decreases toward the end of deployment but does not return to baseline before deployment's end., (2021.)
- Published
- 2021
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38. Clinical utilization of deployed military surgeons.
- Author
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Hall AB, Qureshi I, Gurney JM, Shackelford S, Taylor J, Mahoney C, Trask S, Walker A, and Wilson RL
- Subjects
- Afghan Campaign 2001-, Africa, Clinical Competence statistics & numerical data, Humans, Iraq War, 2003-2011, Military Medicine organization & administration, Surgeons organization & administration, Surgical Procedures, Operative statistics & numerical data, War-Related Injuries surgery, Military Medicine statistics & numerical data, Military Personnel statistics & numerical data, Surgeons statistics & numerical data
- Abstract
Background: Combat casualty care has been shaped by the prolonged conflicts in Southwest Asia, namely Afghanistan, Iraq, and Syria. The utilization of surgeons in austere locations outside of Southwest Asia and its implication on skill retention and value have not been examined. This study hypothesizes that surgeon utilization is low in the African theater. This lack of activity is potentially damaging to surgical skill retention and patient care., Methods: Military case logs of surgeons deployed to Africa under command of Special Operations Command Africa between January 1, 2016, and January 1, 2020, were examined. Cases were organized based on population served, general type of procedure, current procedural terminology codes, and location., Results: Twenty deployment caseloads representing 74% of the deployments during the period were analyzed. In 3,294 days, 101 operations were performed, which included 45 on combat/terrorism related injuries and 19 on US personnel. East and West African deployments, combat, and noncombat zones, respectively, were compared. East Africa averaged 4.1 ± 3.8 operations per deployment, and West Africa, 7.3 ± 8.0 (p = 0.2434). In East Africa, 56.1% of total operations were related to combat/terrorism, compared with 29.6% of total operations in West Africa (p = 0.0077). West Africa had a significantly higher proportion of elective (p = 0.0002) and humanitarian cases (p = <0.0001)., Conclusion: Surgical cases for military surgeons were uncommon in Africa. The low volumes have implications for skill retention, morale, and sustainability of military surgical end strength. Reduction in deployment lengths, deployment location adjustments, and/or skill retention strategies are required to ensure clinical peak performance and operational readiness. Failure to implement changes to current practices to optimize surgeon experience will likely decrease surgical readiness and could contribute to decreased retention of deployable military surgeons to support global operations., Level of Evidence: Economic/decision, level III., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
39. Double kissing crush bifurcation stenting: step-by-step troubleshooting.
- Author
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Hall AB, Chavez I, Garcia S, Gössl M, Poulose A, Sorajja P, Wang Y, Louvard Y, Chatzizisis YS, Banerjee S, Xenogiannis I, Burke MN, and Brilakis ES
- Subjects
- Coronary Angiography, Humans, Stents, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Drug-Eluting Stents
- Abstract
The double kissing crush (DK crush) is the most studied two-stent coronary bifurcation stenting strategy. While published data support its use, DK crush can be challenging to perform. In this review we provide a detailed step-by-step description and troubleshooting for each stage of the DK crush technique.
- Published
- 2021
- Full Text
- View/download PDF
40. Inadvertent Methylergonovine administration to a newborn.
- Author
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Wilson K, Santiago R, Preziosi M, Fisher R, and Hall AB
- Subjects
- Female, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Emergency Service, Hospital, Medication Errors, Methylergonovine poisoning, Poisoning diagnosis, Poisoning therapy
- Abstract
Previous case reports describe the inadvertent administration of methylergonovine to newborns resulting in rare, life-threatening events including neonatal death. To our knowledge, no case reports exist detailing inadvertent methylergonovine administration in the emergency medicine literature. A newborn infant presented to the emergency department (ED) at hour five of life following methylergonovine administration with periods of apnea and cyanosis. The infant required intubation, mechanical ventilation, and a seven day neonatal intensive care stay. This rare case describes the potential for this error to occur in the community and heightens the vigilance of emergency medicine providers when caring for newborns in their first hours of life., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
41. Characterizing Transcriptional Regulatory Sequences in Coronaviruses and Their Role in Recombination.
- Author
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Yang Y, Yan W, Hall AB, and Jiang X
- Subjects
- Models, Genetic, Nucleic Acid Conformation, Phylogeny, RNA, Messenger genetics, RNA-Seq, Transcription, Genetic, Coronavirus genetics, Genome, Viral, RNA, Viral genetics, Recombination, Genetic, Regulatory Sequences, Nucleic Acid, SARS-CoV-2 genetics
- Abstract
Novel coronaviruses, including SARS-CoV-2, SARS, and MERS, often originate from recombination events. The mechanism of recombination in RNA viruses is template switching. Coronavirus transcription also involves template switching at specific regions, called transcriptional regulatory sequences (TRS). It is hypothesized but not yet verified that TRS sites are prone to recombination events. Here, we developed a tool called SuPER to systematically identify TRS in coronavirus genomes and then investigated whether recombination is more common at TRS. We ran SuPER on 506 coronavirus genomes and identified 465 TRS-L and 3,509 TRS-B. We found that the TRS-L core sequence (CS) and the secondary structure of the leader sequence are generally conserved within coronavirus genera but different between genera. By examining the location of recombination breakpoints with respect to TRS-B CS, we observed that recombination hotspots are more frequently colocated with TRS-B sites than expected., (Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution 2020.)
- Published
- 2021
- Full Text
- View/download PDF
42. An Unusual Treatment for Ventricular Tachycardia.
- Author
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Hall AB, Nikolakopoulos I, Vemmou E, Karacsonyi J, and Brilakis ES
- Subjects
- Arrhythmias, Cardiac, Electrocardiography, Humans, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular therapy
- Published
- 2021
- Full Text
- View/download PDF
43. Preprocedure Planning for Chronic Total Occlusion Percutaneous Coronary Intervention: The Separation Is in the Preparation.
- Author
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Hall AB
- Subjects
- Coronary Angiography, Humans, Treatment Outcome, Coronary Occlusion surgery, Percutaneous Coronary Intervention
- Abstract
To perform chronic total occlusion percutaneous coronary intervention safely, efficiently, and successfully, adequate time must be dedicated to thorough preprocedural planning. This process should encompass a patient encounter, becoming fully familiarized with the patient's clinical traits, a detailed review of coronary anatomy, laying out an algorithmic procedural approach and making any relevant plans for actions that will enhance intraprocedural safety., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
44. Isolating Populations to Control Pandemic Spread in an Austere Military Environment.
- Author
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Hall AB, Dixon M, Dennis AJ, and Wilson RL
- Subjects
- Africa, Humans, Pandemics prevention & control, SARS-CoV-2, COVID-19, Military Personnel
- Abstract
Background: The COVID-19 pandemic has been a struggle for medical systems throughout the world. In austere locations in which testing, resupply, and evacuation have been limited or impossible, unique challenges exist. This case series demonstrates the importance of population isolation in preventing disease from overwhelming medical assets., Methods: This is a case series describing the outbreak of COVID-19 in an isolated population in Africa. The population consists of a main population with a Role 2 capability, with several supported satellite populations with a Role 1 capability. Outbreaks in five satellite population centers occurred over the course of the COVID-19 pandemic from its start on approximately 1 March 2020 until 28 April 2020, when a more robust medical asset became available at the central evacuation hub within the main population., Results: Population movement controls and the use of telehealth prevented the spread within the main population at risk and enabled the setup of medical assets to prepare for anticipated widespread disease., Conclusion: Isolation of disease in the satellite populations and treating in place, rather than immediately moving to the larger population center's medical facilities, prevented widespread exposure. Isolation also protected critical patient transport capabilities for use for high-risk patients. In addition, this strategy provided time and resources to develop infrastructure to handle anticipated larger outbreaks., (2020.)
- Published
- 2020
- Full Text
- View/download PDF
45. Current challenges in military trauma readiness: Insufficient relevant surgical case volumes in military treatment facilities.
- Author
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Hall AB, Davis E, Vasquez M, Umberger J, Tadlock MD, Qureshi I, Walker A, Glaser J, McClendon H, and Gurney JM
- Subjects
- Humans, Military Medicine education, Retrospective Studies, Specialties, Surgical education, United States epidemiology, Wounds and Injuries epidemiology, Military Medicine organization & administration, Specialties, Surgical organization & administration, Wounds and Injuries surgery
- Abstract
Background: The management of battlefield trauma requires a specific skill set, which is optimized by regular trauma experience. As military casualties from the prolonged conflicts in the Middle East decrease, challenges exist to maintain battlefield trauma readiness. Military surgeons must therefore depend on the Military Health System. The purpose of the study was to evaluate the frequency of surgical cases relevant to deployed combat casualty care performed at military treatment facilities (MTFs)., Methods: Combat casualty care relevant cases (CCC-RCs) were defined as emergent, open surgical cases in which the patient required a blood transfusion. Case logs from four military treatment centers with surgical residency training programs were used. Twenty-four months of case records between January 1, 2017, and January 1, 2019, were included to determine total numbers of CCC-RCs at each institution. The results were compared with San Antonio Military Medical Center's, the Department of Defense's only American College of Surgeons-verified level 1 trauma center., Results: Fifty-one trauma/general surgeons and six vascular surgeons case logs were examined. Thirty (0.3%) of 10,529 cases performed by trauma/general and vascular surgeons over the 2-year study period were considered CCC-RCs. These results were in contrast to San Antonio Military Medical Center, which had a significantly higher proportion of CCC-RCs (113 of 320 cases, 35.3%, p < 0.0001)., Conclusion: A cross-section of MTF surgical case complexity demonstrates a lack of cases considered to be CCC-RCs. At the MTFs evaluated, surgical case surrogates for combat trauma and combat casualty care is close to zero. These data are potentially representative of other military treatment centers, which focus on beneficiary care. For readiness purposes, MTFs that care primarily for Tricare beneficiaries without a significant trauma population should not be considered meaningful sources of CCC-RCs for trauma/general and vascular surgeons., Level of Evidence: Therapeutic/care management study, level V.
- Published
- 2020
- Full Text
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46. Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention.
- Author
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Xenogiannis I, Choi JW, Alaswad K, Khatri JJ, Doing AH, Dattilo P, Jaffer FA, Uretsky B, Krestyaninov O, Khelimskii D, Patel M, Mahmud E, Potluri S, Koutouzis M, Tsiafoutis I, Jaber W, Samady H, Jefferson BK, Patel T, Megaly MS, Hall AB, Vemmou E, Nikolakopoulos I, Rangan BV, Abdullah S, Garcia S, Banerjee S, Burke MN, and Brilakis ES
- Subjects
- Aged, Chronic Disease, Coronary Artery Disease diagnostic imaging, Coronary Occlusion diagnostic imaging, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Coronary Artery Disease therapy, Coronary Occlusion therapy, Percutaneous Coronary Intervention adverse effects, Plaque, Atherosclerotic
- Abstract
Background: When crossing into the distal true lumen fails during chronic total occlusion (CTO) percutaneous coronary intervention (PCI), subintimal plaque modification (SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization., Methods: Between January 2012 and May 4, 2019, 4,659 CTO PCIs were included in the PROGRESS-CTO registry, of which 935 (20%) had a prior unsuccessful attempt. Of those 935 patients, 119 (13%) had prior SPM. We analyzed the outcomes of the 58 SPM procedures for which data were available, as well as the outcomes of the 60 subsequent CTO PCI attempts., Results: Mean patient age was 67 ± 9 years and 86% were men. Patients had high prevalence of cardiovascular risk factors such as dyslipidemia (91%), hypertension (93%) diabetes (48%), prior PCI (61%), and prior coronary artery bypass graft surgery (47%). The target CTO lesions often had proximal cap ambiguity (54%), moderate/severe calcification (73%), moderate/severe tortuosity (63%), and high J-CTO score (mean 3.2 ± 1.1). The technical and procedural success of subsequent CTO PCI were high (83% for both) with an acceptable rate of in-hospital major adverse cardiovascular events (3.3%). Technical and procedural success were higher for repeat attempts that were performed ≥60 days after the index CTO PCI (94% vs. 69%, p = .015). Median (interquartile range) subsequent procedure time was 147 (100, 215) min, contrast volume was 185 (150, 260) ml, and air kerma radiation dose was 2.5 (1.4, 4.2) Gray., Conclusion: Repeat CTO PCI attempts after SPM are associated with high likelihood for successful revascularization with acceptable risks., (© 2019 Wiley Periodicals, Inc.)
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- 2020
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47. User-driven design of child restraint information to reduce errors in use: a pilot randomised controlled trial.
- Author
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Hall AB, Ho C, Albanese B, Keay L, Hunter K, Charlton J, Hayen A, Bilston LE, and Brown J
- Subjects
- Child, Humans, Pilot Projects, Child Restraint Systems
- Abstract
Background: Incorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored., Methods: We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial., Results: There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p<0.001). The mean error percentage in the control group was 23% (95% CI 16% to 31%) compared with 14% in the intervention group (95% CI 8% to 20%, p=0.056). For every one point increase in comprehension, there was an almost 2% (95% CI -2.7% to -1.0%) reduction in errors (y=45.5-1.87x, p value for slope <0.001)., Conclusions: Consumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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48. Ketamine Use for Prolonged Field Care Reduces Supply Use.
- Author
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Hall AB, Morrow L, and Dixon M
- Subjects
- Adult, Analgesics therapeutic use, Humans, Male, Pain drug therapy, Pain Management, Analgesia, Ketamine therapeutic use, Wounds, Gunshot therapy
- Abstract
This case describes the prolonged treatment of a 38-year-old man with a transpelvic gunshot wound requiring a diverting ostomy and cystostomy for damage control procedures with a comminuted acetabular and femoral head fracture. The team used a ketamine drip for prolonged field care over 48 hours. The benefit of using a ketamine drip included low supply requirement, excellent analgesia, and ease of administration, but side-effects included somnolence and atelectasis necessitating oxygen supplementation before evacuation., (2020.)
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- 2020
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49. Cholesterol Metabolism by Uncultured Human Gut Bacteria Influences Host Cholesterol Level.
- Author
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Kenny DJ, Plichta DR, Shungin D, Koppel N, Hall AB, Fu B, Vasan RS, Shaw SY, Vlamakis H, Balskus EP, and Xavier RJ
- Subjects
- Bacteria enzymology, Bacteria genetics, Feces chemistry, Feces microbiology, Gastrointestinal Microbiome genetics, Humans, Lipid Metabolism physiology, Metabolomics, Metagenomics, Oxidoreductases genetics, Bacteria metabolism, Cholestanol biosynthesis, Cholesterol blood, Cholesterol metabolism, Gastrointestinal Microbiome physiology, Oxidoreductases metabolism
- Abstract
The human microbiome encodes extensive metabolic capabilities, but our understanding of the mechanisms linking gut microbes to human metabolism remains limited. Here, we focus on the conversion of cholesterol to the poorly absorbed sterol coprostanol by the gut microbiota to develop a framework for the identification of functional enzymes and microbes. By integrating paired metagenomics and metabolomics data from existing cohorts with biochemical knowledge and experimentation, we predict and validate a group of microbial cholesterol dehydrogenases that contribute to coprostanol formation. These enzymes are encoded by ismA genes in a clade of uncultured microorganisms, which are prevalent in geographically diverse human cohorts. Individuals harboring coprostanol-forming microbes have significantly lower fecal cholesterol levels and lower serum total cholesterol with effects comparable to those attributed to variations in lipid homeostasis genes. Thus, cholesterol metabolism by these microbes may play important roles in reducing intestinal and serum cholesterol concentrations, directly impacting human health., Competing Interests: Declaration of Interests E.P.B. has consulted for Merck, Novartis, and Kintai Therapeutics. She is on the Scientific Advisory Boards of Kintai Therapeutics and Caribou Biosciences and is an Institute Member of the Broad Institute of MIT and Harvard. R.J.X. is a consultant to Novartis and Nestle., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2020
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50. Universal vote-by-mail has no impact on partisan turnout or vote share.
- Author
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Thompson DM, Wu JA, Yoder J, and Hall AB
- Abstract
In response to coronavirus disease 2019 (COVID-19), many scholars and policy makers are urging the United States to expand voting-by-mail programs to safeguard the electoral process. What are the effects of vote-by-mail? In this paper, we provide a comprehensive design-based analysis of the effect of universal vote-by-mail-a policy under which every voter is mailed a ballot in advance of the election-on electoral outcomes. We collect data from 1996 to 2018 on all three US states that implemented universal vote-by-mail in a staggered fashion across counties, allowing us to use a difference-in-differences design at the county level to estimate causal effects. We find that 1) universal vote-by-mail does not appear to affect either party's share of turnout, 2) universal vote-by-mail does not appear to increase either party's vote share, and 3) universal vote-by-mail modestly increases overall average turnout rates, in line with previous estimates. All three conclusions support the conventional wisdom of election administration experts and contradict many popular claims in the media., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)
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- 2020
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