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Button battery ingestions (BBIs) are the second most frequently ingested foreign bodies, second to coins. Unfortunately, the incidence of BBI continues to rise, with the majority occurring in children younger than 6 years of age. In addition to the increase in incidence, the rate of significant complications and death resulting from BBI has increased nearly sevenfold with the majority of serious outcomes and fatalities occurring in children between 1 and 3 years of age. Button batteries have characteristic radiographic appearances that can facilitate an early diagnosis. Honey may be used as a temporary measure, if it is suspected that the ingestion was less than 12 hours prior (10 mL of oral honey, or 10 mL of oral sucralfate (if the patient is younger than 1 year)). Endoscopy, by a subspecialist, is indicated as soon as possible for removal of the battery.

Anatomic Severity Grading (ASG) score is utilized to assess preoperative abdominal aortic aneurysms (AAA) and provide a quantitative data on its anatomic complexity. The aim of this study is to determine the anatomical differences and long-term survival between male and female patients undergoing elective AAA repair.All patients undergoing intact AAA repair from 2007 to 2014 were included. ASG scores were calculated based on preoperative anatomical characteristics including aortic neck, aneurysm and iliac artery. Standard univariate analysis was used to evaluate patient and anatomical characteristics. Kaplan-Meier survival curves were used to evaluate long-term survival at 1 and 5-years.A total of 379 patients were identified, of which, majority of them were males (80%). Females were on average 3 years older (mean (S.D.): 74.32(8.63) vs 71.92(8.64) years) and were more likely to undergo open repair (29.7% vs. 17.5%) (Both P0.05). Both groups had similar comorbidities. The mean long-term follow-up (S.D.) was 6.21(3.81) years. No significant difference was seen between males versus females in long-term survival at both 1-year (86.3% vs. 92.8, P=0.06) and 5-year (68.5% vs 72.7%, P=0.38). In regard to the anatomical characteristics, females had shorter aortic neck length (mean in mm (S.D.): 17.67(1.41) vs. 27.20(15.76)), increased tortuosity index (mean (S.D.): 1.11(0.07) vs. 1.09(0.07)) and higher calcification (mean % (S.D.): 17.12(21.17) vs. 10.59(16.82)) (All P0.05). In contrast, males had larger aortic neck (mean in mm (S.D.): 23.81(4.17) vs. 22.41(4.16)) and iliac artery (mean in mm (S.D.): 7.70(1.91) vs. 6.28(1.67)) diameter (Both P0.05). The mean total ASG score was significantly higher among females versus males (Mean (S.D.): 17.23(4.01) vs. 15.67(3.96), P=0.003). After stratifying by ASG score15, females had significantly lower survival at 1-year compared to males (82.6% vs. 92.1%, P=0.04). However, this difference disappeared at 5-years.The data demonstrate that females present at an older age with more complex AAA anatomy than males. Based on anatomical complexities, females were more likely to undergo open repair, with a corresponding increase in 1-year mortality, but not at 5-year. The data suggest that care processes for optimization of aortic surgery in females are needed to improve 1-year survival.

We present the case of a tortuous intrathoracic common carotid artery (CCA) with a symptomatic right internal carotid artery lesion. This patient had a complex medical history, including a previous intraoperative cardiac arrest during attempted carotid endarterectomy (CEA) initially attributed to heparin anaphylaxis. She received maximum medical management but presented 6 months later to our institution with a secondary transient ischemic attack. Surgical options for the case were discussed amongst a multidisciplinary team. Transfemoral and transradial stenting were deemed non-viable due to the tortuous nature of the CCA. Repeat CEA under general anesthesia was deemed risk-prohibitive from a cardiac risk perspective. For these reasons, the patient was offered transcarotid artery revascularization (TCAR) under regional anesthesia. Intraoperatively, the “sheath stopper” was removed from the TCAR device, allowing the sheath to be advanced to 6 cm, effectively removing the tortuous component of the CCA. Flow reversal was established, and the operation proceeded in the standard fashion without neurologic change. The patient has remained on dual antiplatelet therapy and completed 2-year follow-up without evidence of restenosis, access site complication, or repeat neurologic event. This case demonstrates the potential applicability of TCAR to benefit a subset of patients who previously lacked a surgical option due to anatomical constraints.

Objective: This study aims to evaluate the use of prophylactic intravenous hydration (IV prophylaxis) and carbon dioxide (CO2) angiography in reducing contrast associated-acute kidney injury (CA-AKI) and determine the overall incidence and risk factors of CA-AKI in high-risk patients undergoing peripheral vascular interventions (PVI). Method: Only patients undergoing elective PVI from 2017 to 2021 with chronic kidney disease (CKD) stage 3-5 in the Vascular Quality Initiative (VQI) database were included. Patients were grouped into IV prophylaxis vs no prophylaxis. The study’s primary outcome was CA-AKI, defined as a rise in creatinine (>.5 mg/dL) or new dialysis within 48 hours following contrast administration. Standard univariate and multivariable (logistic regression) analyses were conducted. Results: A total of 4497 patients were identified. Of these, 65% received IV prophylaxis. The overall incidence of CA-AKI was .93%. No significant difference was seen in overall contrast volume (mean (SD): 66.89(49.54) vs 65.94(51.97) milliliters, P > .05) between the 2 groups. After adjusting for significant covariates, the use of IV prophylaxis (OR (95% CI): 1.54(.77-3.18), P = .25) and CO2 angiography (OR (95%CI): .95(.44-2.08), P = .90) was not associated with a significant reduction in CA-AKI compared to the patients with no prophylaxis. The severity of CKD and diabetes were the only predictor of CA-AKI. Compared to patients with no CA-AKI, patients with CA-AKI were at risk of higher 30-day mortality (OR (95% CI): 11.09 (4.25-28.93)) and cardiopulmonary complications (OR (95% CI): 19.03 (8.74-41.39) following PVI (Both P < .001). Conclusion: Using a large national vascular database, our study demonstrates that prophylactic use of IV hydration and CO2 angiography in high-risk CKD patients is not associated with a reduction in renal injury following PVI. Reduced kidney function and history of diabetes is an independent predictor of CA-AKI and patients that develop post-procedural AKI are at an increased risk of morbidity and mortality.

Research has continued to broaden understanding of tornadoes and their effect on civil infrastructure. Because a significant portion of the losses associated with tornado events impact resi...

Completion cerebral angiography (CCA) after transcarotid artery revascularization (TCAR) has been used to identify distal embolization after stenting and serve as a measure of intraoperative quality control. Nevertheless, no general evidence has been reported regarding the benefit of performing routine CCA. The aim of the present study was to evaluate the potential risks and benefits of routine CCA.We retrospectively reviewed the Vascular Quality Initiative database for TCAR from 2016 to 2021. The patients were divided into two groups: those with no CCA performed and those with CCA performed. The primary outcome was in-hospital stroke or death. The secondary outcomes included stroke, death, myocardial infarction, and a return to the operating room (RTOR). Clinically relevant and statistically significantly variables on univariable analysis were added to a logistic regression model clustered by center identifier.A total of 18,155 patients who had undergone TCAR were identified, of whom 11,607 (63.7%) had undergone routine CCA. The patients with routine CCA were more likely to have contralateral carotid occlusion and to have received general anesthesia. After adjusting for potential confounders, we found no differences in the risk of stroke/death (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.8-1.3; P = .820), stroke/transient ischemic attack (TIA; aOR, 1.00; 95% CI, 0.8-1.3; P = .998), stroke (aOR, 1.1; 95% CI, 0.8-1.4; P = .452), death (aOR, 0.98; 95% CI, 0.6-1.6; P = .953), myocardial infarction (aOR, 0.78; 95% CI, 0.5-1.2; P = .240), or RTOR (aOR, 1.5; 95% CI, 0.6-3.8; P = .412) between patients who had undergone CCA and those who had not. A subanalysis of the patients with new occlusions detected by CCA (69 patients [0.6%]; 19 not treated and 50 treated) indicated a higher risk of stroke/death for the patients with treated new occlusions (aOR, 7.1; 95% CI, 2.9-17.3; P .001) and stroke/TIA (aOR, 5.8; 95% CI, 2.3-14.7; P .001) than for the patients who had not undergone CCA. However, no differences were found in stroke/death (aOR, 3.3; 95% CI, 0.37-29.5; P = .283) or stroke/TIA (aOR, 3.1; 95% CI, 0.3-29.4; P = .327) for patients with nontreated new occlusions compared with patients who had not undergone CCA.In the present retrospective study, routine performance of CCA was not beneficial, with no significant differences in in-hospital stroke or death detected. The detection of new lesions on CCA was rare. Moreover, identifying new occlusions using CCA was associated with higher odds of stroke or death when these new lesions were treated. Further studies are needed to define the etiology of the worse outcomes for patients undergoing intervention for lesions discovered using CCA and delineate the optimal timing for further imaging and intervention.

Cross-Laminated Timber (CLT) is an engineered wood product with high rigidity, dimensional stability, and desirable environmental properties. Because of these characteristics, it presents the potential to resist the impact loads associated with windborne debris in both tornadoes and hurricanes. Full-scale experimental debris impact testing was performed on 3-layer CLT in order to determine its response to debris impact loading scenarios. A variety of missile masses, speeds, and impact locations were tested to determine this response. Various forms of failure were observed including missile perforation, excessive backside deflection, and dislodgement of debris on the backside of tested panels. Analysis of the experimental data was then performed with the goal producing a debris impact fragility curve for CLT. The resulting curves were based on relating a missile's kinetic energy with the probability of failure as defined by relevant testing standards. The results of this study point towards 3-ply CLT having a high likelihood of surviving impacts from EF-2 and EF-3 level missiles with a decreased likelihood of surviving debris from EF-4 and EF-5 level events. For qualification as a material for safe rooms, thicker panels and additional connection design would be required.

This is a revision of the previous joint Policy Statement titled “Guidelines for Care of Children in the Emergency Department.” Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report “The Future of Emergency Care in the US Health System.” Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.

Given a vast inventory of culverts with different physical and environmental characteristics, the task of condition assessment can become difficult or impossible. Using a database of approx...

The PastPlace gazetteer is a subset of Wikidata, itself a systematization of Wikipedia, and so contains all the world’s “notable” places. To this have been linked historical place name “attestations”, meaning instances of a particular character string being used to refer to the place in a specified and usually dated historical map or other document. The system inherits much historical content from the Great Britain Historical GIS , and the main sources are described, but place name content can be extended globally through crowd-sourcing name attestations from historical maps: the related Old Maps Online project and GB1900 crowd-sourcing system are introduced. The article describes the Linked Data Applications Programming Interface by which this information is made accessible to computers, and more briefly the PastPlace web app for humans.

Publishing peer review materials alongside research articles promises to make the peer review process more transparent as well as making it easier to recognise these contributions and give credit to peer reviewers. Traditionally, the peer review reports, editors letters and author responses are only shared between the small number of people in those roles prior to publication, but there is a growing interest in making some or all of these materials available. A small number of journals have been publishing peer review materials for some time, others have begun this practice more recently, and significantly more are now considering how they might begin. This article outlines the outcomes from a recent workshop among journals with experience in publishing peer review materials, in which the specific operation of these workflows, and the challenges, were discussed. Here, we provide a draft as to how to represent these materials in the JATS and Crossref data models to facilitate the coordination and discoverability of peer review materials, and seek feedback on these initial recommendations.

“Semantic” gazetteers should form a geographical “backbone” to our knowledge of the past, but they need to contain toponyms appearing in specific sources, to be under open copyrights and to be large, representing all the features of interest. Academic gazetteer projects are achieving the first two goals but are generally either limited to main settlements or cover small areas. The GB1900 project is creating a new spinal gazetteer of Britain from the Ordnance Survey’s County Series 1:10,560 second edition mapping from circa 1900. It will be under Creative Commons licensing. To date, c. 1.7 million features have been identified, and the final result is likely to comprise 3-4 million text strings plus coordinates: possibly the largest specifically historical gazetteer ever built.This has been achieved through large-scale crowd-sourcing, using Zooniverse-based software. The article describes the project’s history, the software system and the transcription process. Over 1,000 volunteer transcribers have been recruited, and the article describes publicity methods, volunteer characteristics and motivation: it is argued that while “citizen science” projects appeal to a general desire to advance knowledge, map-based projects can appeal to more locally-focused individual interests: finding meaning in maps and places. We conclude with recommendations for other similar projects.

Introduction: Surgical education relies heavily on operative exposure with live patients. However, the carotid endarterectomy (CEA) demands an experienced surgeon with a very low complication rate. The high-risk nature of this procedure and the decline in number of CEAs performed annually has created a training gap. Current surgical skill simulators do not provide a comparable surgical experience. Hypothesis: The SIMPLE-CEA is a comprehensive and realistic operative exercise that replicates all vital steps in a CEA and permits measurement of clinically significant metrics. Methods: Using a novel method, anatomically accurate models of the human neck and carotid artery were created using poly-vinyl alcohol hydrogels. Relevant structures were also fabricated including the vagus and hypoglossal nerves, internal jugular and facial veins, sternocleidomastoid and sternohyoid muscles, and carotid sheath. 3D models were created based on an amalgamation of patient data using CAD software. Injection molds of the modeled tissues were 3D printed. Graded polymerization of the hydrogel was achieved by inducing crosslinks during freeze/thaw cycles, which stiffened the simulated tissues to realistic tactile properties. Bleeding was simulated using pressure bags and a ventricular assistive device was used to create pulsatile flow in the carotid. Results: Realistic models were produced using 3D printed injection models and polymer hydrogels. Preliminary findings show an average of 4/5 for face validity surveys according to experts who performed preliminary testing. Comparison of surgeon performance was feasible using construct metrics such as carotid clamp time, estimated blood loss, and nerve injury. Conclusion: SIMPLE-CEA is a realistic, inexpensive model of high fidelity, offering comprehensive training for CEA and allows residents to master required skills prior to operating on a live patient. Next steps include testing content and construct validity of the model.