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Background: Chronic limb-threatening ischemia (CLTI) can be associated with dismal outcomes but there are limited real-world data to further define the impact of end-stage kidney disease (ESKD) on outcomes nationally in this subset of patients. We sought to characterize national patterns of inpatient treatment of CLTI and compare outcomes in patients without ESKD. Methods: The National Inpatient Sample was queried from 2015-2018 for all hospital admissions including treatment for CLTI. Mixed-effects linear and logistic regression models were used to estimate the effect of ESKD on outcomes and treatment choice. Results: We identified 11 652 hospital admissions with CLTI alone and 2705 with CLTI + ESKD. Hospital admissions with CLTI + ESKD patients included patients who were younger (66 vs 69 years, P <.0001), less likely to be white (39% vs 63%, P <.0001), and more likely to reside in lower income large metropolitan areas. Admissions for CLTI + ESKD patients had a lower likelihood of open arterial reconstruction (OR.40, P <.0001) and a higher likelihood of endovascular revascularization or major limb amputation (OR 1.70, P <.0001). Admissions for CLTI + ESKD also had a 4.5- and 1.5-fold higher odds of in-hospital death and complications. These findings were associated with a longer LOS (P <.0001), increased probability of discharge to rehabilitation facility (50% vs 41%, P <.0001), and greater hospital charges (median, $107 K vs $85 K, P <.0001). Conclusions: Compared to hospital admissions for patients without ESKD, admissions for patients with CLTI + ESKD demonstrated distinctive demographic characteristics, a lower likelihood of open revascularization and a higher likelihood of endovascular revascularization and major limb amputation. Chronic limb-threatening ischemia + ESKD hospital admissions showed worse overall outcomes and greater resource utilization compared to CLTI admissions without ESKD. [ABSTRACT FROM AUTHOR]

Among premature infants, the incidence of inguinal hernias is reported to be as high as 30%. Despite being one of the most commonly performed procedures, the optimal setting of inguinal hernia repair (IHR) that is inpatient versus outpatient remains debatable. We sought to compare the 30-day outcomes of each approach by querying the National Surgical Quality Improvement Program-Pediatric database. A retrospective cohort study comparing inpatient versus outpatient IHR using the National Surgical Quality Improvement Program-Pediatric database from 2013 to 2019 was performed. Demographic and clinical data were initially compared using univariate analysis. Continuous variables are presented as median and interquartile range and categorical variables are presented as n (%). Subsequently, cohorts were propensity matched using clinically and statistically significant patient characteristics. 928 patients underwent IHR, 634 (68.3%) while inpatient, 294 (31.7%) following hospital discharge. Inpatient IHR was associated with lower age at the time of surgery (120 versus 147 d; P < 0.0001), younger gestational age (27 versus 33 wk; P < 0.0001), decreased probability of repair in elective setting (87.2% versus 97.3%; P < 0.0001), and increased preoperative supplemental oxygen need (42% versus 4.4%; P < 0.0001). Comparison of propensity matched cohorts revealed that inpatient IHR was associated with increased procedure time (82 versus 51 min; P < 0.0001) and anesthetic duration (146 versus 102 min; P < 0.0001), wound infection rates (3.8% versus 0%; P = 0.007), blood transfusions (4.2% versus 0.5%; P = 0.036), unplanned intubations (2.8% versus 0%; P = 0.03), ventilator days (0 versus 0; range [0,30 versus 0,2]; P = 0.002), reoperation rate (5.6% versus 0%; P < 0.001), postoperative hospital length of stay (4 versus 1 d; P < 0.0001), and unplanned readmissions (8.9% versus 0.9%; P = 0.002). Inpatient IHR in premature neonates were associated with different postoperative outcomes than outpatient IHR. At least in the elective setting among premature infants, outpatient IHR can be considered safe in select patients while we await higher quality prospective data. • Inpatient inguinal hernia repairs (IHR) are associated with longer procedure times. • Inpatient IHR are associated with higher rate of adverse events: infections, re-intubations, reoperations. • Inpatient IHR are associated with longer postoperative ventilator days. [ABSTRACT FROM AUTHOR]

Introduction: There are a paucity of data regarding the safety of laparoscopic inguinal hernia repair in patients on antiplatelet and anticoagulant therapy (APT/ACT). We aim to compare the postoperative outcomes of laparoscopic (LIHR) vs. open repair of inguinal hernias (OIHR) in patients on APT/ACT. Method: We conducted a retrospective cohort study using the Vizient Clinical DataBase. We included adults receiving APT/ACT who underwent outpatient, elective, and primary inguinal hernia repair between 2017 and 2019. Subgroup analysis was performed on patients receiving aspirin, non-aspirin antiplatelet, and anticoagulant therapy. Mixed-effects logistic regression was used to assess both the effect of APT/ACT on the probability of receiving LIHR vs OIHR and their respective outcomes. Result: A total of 142,052 repairs were included, of which 21,441 (15%) were performed on patients receiving APT/ACT. Mean age was 69 years (± 10.5) and 93% were male. 19% of hernias were bilateral. 40% of operations were performed at teaching hospitals. On multivariable analysis, patients on non-aspirin antiplatelet or anticoagulant therapy were more likely to receive an open procedure (Odds Ratio (OR) = 1.2; 95% Confidence Intervals (CI) [1.1, 1.4] and OR = 1.4; CI [1.3, 1.5], respectively). LIHR was associated with a lower rate of length of stay > 1 day (OR = 0.65; CI [0.5, 0.9]). Rates of 30-day postoperative hematoma, transfusions, stroke, myocardial infarction, deep venous thrombosis, pulmonary embolism, readmission, and emergency department visits were similar between the two operative approaches. Conclusion: Patients on APT/ACT represent a substantial proportion of those undergoing inguinal hernia repair. Non-aspirin antiplatelet or anticoagulant therapy are independent predictors of choosing an open repair. Laparoscopic repair appears to be safe in patients receiving APT/ACT under current perioperative management patterns. [ABSTRACT FROM AUTHOR]

Background: Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals. Methods: We queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40 kg/m2, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index. Results: A total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61 years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40 kg/m2, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42–0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40 kg/m2 compared to males (11%) and other races (11–15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001). Conclusion: Nearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair. [ABSTRACT FROM AUTHOR]

Simple Summary: There have been a number of advances in the treatment paradigm of pancreatic ductal adenocarcinoma (PDAC) over the past two decades. Medical and surgical approaches to PDAC have continued to evolve. The individual effects of these changes have been investigated. Understanding the implementation of these changes over time and its effect on patient survival is important. While patient survival from PDAC has been reported to have modest improvements over the decades, the National Cancer Database offers the ability to study survival trends. We aim to evaluate survival trends in patients diagnosed with PDAC in the United States. Over the last two decades, there have been many reported advances in the clinical management of pancreatic ductal adenocarcinoma (PDAC). We sought to evaluate changes in survival for patients diagnosed with PDAC between 2004 and 2017. The National Cancer Database was queried for patients diagnosed with PDAC between 2004 and 2017. There were 55,401 patients who underwent surgery and 109,477 patients who underwent non-surgical treatment for PDAC between 2004 and 2017. Patients were categorized into four groups by year of diagnosis. Median survival improved from 15.5 months to 25.3 months for patients treated with surgery between the years 2016 and 2017 compared with between 2004 and 2007 (p < 0.001). Median survival improved from 7.2 months to 10.1 months for patients treated without surgery during the same years (p < 0.001). On multivariable analysis, the hazard ratio for death was estimated to multiply by 0.975 per year for patients treated with surgery and 0.959 per year for patients treated without surgery (p < 0.001). This increase in survival in the setting of evolving care validates continued efforts aimed at improving survival for patients with this devastating disease. [ABSTRACT FROM AUTHOR]

Introduction A recent randomized controlled trial (RCT), the Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN), demonstrated better outcomes with endovascular treatment compared with medical therapy for acute ischemic stroke (AIS). However, previous trials have provided mixed results regarding the efficacy of endovascular treatment for AIS. A meta-analysis of all available trial data was performed to summarize the available evidence. Methods A literature search was performed to identify all prospective RCTs comparing endovascular therapies with medical management for AIS. Two datasets were created: (1) all patients randomized after confirmation of large vessel occlusion (LVO) (consistent with the contemporary standard of practice at the majority of centers); and (2) all patients with outcome data who underwent randomization regardless of qualifying vascular imaging. The pre-specified primary outcome measure was modified Rankin Scale score of 0-2 at 90 days. A fixed-effect model was used to determine significance. Results Five prospective RCTs comparing endovascular therapies with medical management were included in dataset 1 (1183 patients) and six were included in dataset 2 (1903 total patients). Endovascular therapies were associated with significantly improved outcomes compared with medical management (OR 1.67, 95% CI 1.29 to 1.16, p=0.0001) for patients with LVO (dataset 1). This benefit persisted when patients from all six RCTs were included, even in the absence of confirmation of LVO (OR 1.27, 95% CI 1.05 to 1.54, p=0.019; dataset 2). Conclusions A meta-analysis of prospective RCTs comparing endovascular therapies with medical management demonstrates superior outcomes in patients randomized to endovascular therapy. [ABSTRACT FROM AUTHOR]

In a two-stage, drop-the-losers clinical trial, researchers choose the 'best' among a number of treatments at an interim analysis after the first stage. The selected treatment continues to the second stage for confirmation of efficacy, and the remaining treatments (the 'losers') are dropped from the study. Wu et al. ( Biometrika 2010; 97:405-418) showed how to construct confidence limits for the mean difference between the selected treatment and the control when the treatment is chosen after the first stage based on the highest efficacy in the primary clinical endpoint. In this article, we show how to construct a lower confidence limit for the mean difference when the treatment is chosen based on first-stage safety data, early endpoint efficacy data, a combination of safety and efficacy data or any other prespecified selection rule. The result extends the applicability of drop-the-losers designs, for in practice, the 'best' treatment often is not chosen for efficacy alone. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Several decades of research have identified the contributions of psychosocial influences on adolescent and young adult sexual behavior; however, few studies have examined parental and peer influence and sexual values during the transition from high school to college. The current study tested the influence of sexual values and perceived awareness and caring (PAC), or beliefs about how much parents and peers know and care about students' behavior, on sexual behavior during this transitional period. Using data from a longitudinal study, generalized estimating equations and the generalized linear model were used to examine the associations among sexual values, parental and peer PAC, and sexual behavior, both cross-sectionally and longitudinally. Participants ( N = 1,847; 61% female) completed web-based surveys the summer before college matriculation and at the end of the first semester in college. Results indicated that individuals with high levels of both parental and peer PAC engaged in less frequent sexual behaviors and that PAC moderated the effect of sexual values on sexual behaviors. Furthermore, both PAC variables decreased during the transition from high school to college, and high school sexual values, parental PAC, and their interaction predicted the number of sexual partners during the first semester of college. Only sexual values and high school unsafe sexual behaviors predicted unsafe sexual behavior in college. Findings suggest that complex associations exist among perceived awareness and caring, sexual values, and sexual behaviors, and that the transition from high school to college may be an ideal time for safer-sex interventions. [ABSTRACT FROM AUTHOR]

Abstract: Heavy alcohol consumption has been associated with collegiate sporting events, but little is known about specific levels of consumption over the course of an entire sports season. Ongoing web-based daily monitoring at the University of Texas at Austin allowed assessment of drinking levels of students (n =541) over two full football seasons. High-profile football game days were among the heaviest days for alcohol consumption, comparable to consumption on other well-known drinking days such as New Years Eve and Halloween weekend. Men increased their drinking for all games, and women with greater social involvement were more likely to drink heavily during away games. Among lighter drinkers, away games were associated with a greater likelihood of behavioral risks as intoxication increased. [Copyright &y& Elsevier]

The authors examined the global- and event-level associations between alcohol intoxication and 10 behavioral risks during the 1st year of college. Participants (n = 1113; 62% female; 54% Caucasian) completed 30 days of Web-based self-monitoring that assessed alcohol consumption and involvement in 10 behavioral risks. Generalized estimating equations analyses were used to determine which behaviors covaried with event-level versus global indices of intoxication as well as the moderating effects of gender on the intoxication-behavior associations. Alcohol use was globally related to 8 of the 10 behavioral risks; more important, 5 of the 10 behaviors specifically covaried with daily alcohol intoxication. The differential pattern of associations observed can inform clinical work by identifying groups of students who may most benefit from various intervention approaches and content. [ABSTRACT FROM AUTHOR]

The Rutgers Alcohol Problem Index (RAPI; H. R. White & E. W. Labouvie, 1989) is a frequently used measure of alcohol-related consequences in adolescents and college students, but psychometric evaluations of the RAPI are limited and it has not been validated with college students. This study used item response theory (IRT) to examine the RAPI on students (N = 895; 65% female, 35% male) assessed in both high school and college. A series of 2-parameter IRT models were computed, examining differential item functioning across gender and time points. A reduced 18-item measure demonstrating strong clinical utility is proposed, with scores of 8 or greater implying greater need for treatment. [ABSTRACT FROM AUTHOR]

Method: This study examined the association between marijuana-related problems and social norms, impulsivity, and perceived use utility among 292 college students. Zero-inflated negative binomial regression was used to simultaneously predict expected nonusers as well as predict counts of reported marijuana-related problems among expected users. Gender, social norms, impulsivity, and perceived use utility were used to predict expected nonusers as well as number of marijuana-related problems among expected users.Results: Only social norms were associated with the prediction of zero-values. In contrast, only perceived use utility was associated with the prediction of number of marijuana-related problems.Conclusions: Results generally are consistent with theories of the differential association of social-environmental and biopsychological variables with use and problems, respectively. Zero-inflated regression models are a useful strategy to examine risk behaviors with low base rates. [ABSTRACT FROM AUTHOR]

This article is a summary of a symposium presented at the 2005 Research Society on Alcoholism annual conference organized by Dan J. Neal and chaired by William R. Corbin. Event-level data, wherein each “event” (e.g., day) is captured as its own data point, capture the complex patterns of drinking and other high-risk behaviors in ways that the typical aggregate approach cannot. Because of their richness, methodologies that incorporate event-level data are becoming more common in alcohol research. At least 3 distinct forms of event-level data can be gathered: retrospective data (those collected on a single occasion, using memory aids to help each participant reconstruct all drinking events over a specific period of time), daily monitoring data (reporting on all events for that day), and momentary assessment (those recorded immediately following a drinking event or in response to a prompt from researchers). The goal of this symposium was to address many issues associated with event-level methodology, as well as demonstrate projects that are currently implementing such innovative data collection. The 4 presentations included in this symposium were “Realizing the Promise and Avoiding the Pitfalls of Retrospective Daily Estimation Assessments of Alcohol Use” by Frances K. Del Boca; “Using Interactive Voice Response Technology to Assess the Alcohol-Victimization Link” by Kathleen Parks, Linda King, and Ann Pardi; “Methodological Issues in Using Personal Data Assistants to Self-monitor Alcohol Consumption” by R. Lorraine Collins, Mark Muraven, and Charlene Vetter; and “Collecting Event-level Data Using the World Wide Web” by Dan J. Neal and Kim Fromme. [ABSTRACT FROM AUTHOR]

Objective: Heavy drinking is prevalent on college campuses, and collegiate sporting events may precipitate heavy drinking. Despite this, relatively few studies have examined student drinking on the days of sporting events. In 2003, Syracuse University won the men's National College Athletic Association basketball championship; ongoing data collection allowed an investigation of alcohol consumption at Syracuse University during the two Final Four game days, when the semifinals and championship games are played. The goals of the study were to examine the level of alcohol use on these days and to examine factors related to game-day consumption. Method: As a part of an on- going study, 206 undergraduate students completed several questionnaires, then returned daily drinking diaries at 1-week intervals for 4 consecutive weeks. Results: Alcohol consumption levels on the two game days exceeded what is typical on campus. Further analyses conducted using zero-inflated negative binomial regression modeling demonstrated that heavier drinkers were more likely to drink alcohol, and drink alcohol heavily, on both game days. Furthermore, lack of impulse control was independently associated with an increased likelihood of drinking on both days. Conclusions: Although results from this study should be considered preliminary, these data document heavier drinking associated with high-profile athletic events. Sporting events may be a particularly opportune time and venue for collegiate risk-reduction programs. [ABSTRACT FROM AUTHOR]

Efforts to reduce the frequency of high-risk drinking have included the use of motivational interventions. Both the technique used in motivational interventions and an underlying theory of behavior change (i.e., self-regulation theory) invoke the construct of discrepancy development. This study was designed to determine whether techniques purported to develop discrepancy actually do so and to compare methods of developing discrepancy on indices of intention to reduce alcohol use. Male and female college drinkers (N=92) were selected if they reported two or more binge episodes in the last month, or scored 4 or higher on the Rutgers Alcohol Problem Index (RAPI). Participants were randomly assigned by gender to three conditions all conducted in a small group format: attention-control, personalized normative feedback (PNF), and personal strivings assessment (PSA). Personalized normative feedback was designed to develop discrepancy based on behavioral comparisons of self and others. Personal strivings assessment was designed to develop discrepancy between current and ideal self. It was hypothesized that participants who engage in discrepancy building activities would experience discrepancy specific to the activity in which they engaged, and that all participants who developed discrepancy would show higher levels of intention to reduce alcohol use. Results indicated that only the personalized normative feedback increased discrepancy and intention to reduce alcohol use. [Copyright &y& Elsevier]

The self-regulation questionnaire (SRQ) is a 63-item instrument designed to measure the generalized ability to regulate behavior so as to achieve desired future outcomes. This study extended previous psychometric evaluations of the SRQ by determining the factor structure and internal consistency of the SRQ and providing convergent and discriminant evidence for its validity. Participants were undergraduates (N=391; 55% women) from two consecutive semesters (n1=208; n2=183). A single-factor solution emerged (31 items), invariant across gender and semester. These items were combined to create a short version of the SRQ (SSRQ; α=.92), which was highly correlated with the original SRQ (r=.96). Unrelated to demographic variables and alcohol use, the SSRQ correlated significantly with alcohol-related problems. The association between the SSRQ and problems remained even after controlling for social desirability and alcohol consumption. These results support the use of the SSRQ in young adult samples. Further psychometric evaluation of the SSRQ is necessary, however, to further establish its validity and utility as a measure of generalized self-regulation capacity. [Copyright &y& Elsevier]

Investigates the clinical significance of previously reported statistically significant mean reductions in drinking and related problems among college students in a randomized trial of a brief indicated preventive intervention. Alcohol-related problems and dependence; Baseline differences between high-risk and functional comparison groups.

Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016–June 2019. Demographics, antimicrobial use, microbiology, and outcomes were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival. Among 92 gastroschisis patients, mortality was 77%(n = 71); 23%(n = 21) died within 48 h. 98%(n = 90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n = 38). Patients spent 86%(SD = 20%) of their hospital stay on antibiotics and 38%(n = 35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p < 0.001) compared to survivors. There was no difference in the proportion of hospital stay on second-line antibiotics (p = 0.1). Conclusion: We identified frequent late deaths, prolonged antibiotic courses, and regular use of second-line antibiotic agents in this retrospective cohort of Rwandan gastroschisis patients. Future studies are needed to evaluate antimicrobial resistance in pediatric surgical patients in Rwanda. What is Known: • Global disparities in gastroschisis outcomes are extreme, with <4% mortality in high-income settings and 75-100% mortality in low-income settings. • Antimicrobial surveillance data is sparse across Africa, but existing evidence suggests high levels of resistance to first-line antibiotics in Rwanda. What is New: • In-hospital survival for gastroschisis was 23% from 2016-2019 and most deaths occurred late (>48hrs after admission) due to sepsis. • Rwandan gastroschisis patients received prolonged courses of antibiotics and second-line antibiotics were frequently used without culture data, raising concern for antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background: The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are used to evaluate the safety and quality of health care provided by health care systems and individual facilities. To understand better the incidence of PSIs and HACs in hospitalized patients with stroke, we determined the rates of these events among patients with a diagnosis of stroke in the Nationwide Inpatient Sample (NIS) database. Methods: We queried the NIS for all hospitalizations involving ischemic stroke. We determined the incidence of various PSIs and HACs by searching the hospital records for International Classification of Diseases, 9th edition, codes indicating each PSI or HAC. Statistical analysis was performed with SAS statistical software package. Results: There were 903,647 hospitalizations involving stroke in the NIS database for years 2002–2010. Among these hospitalizations, 137,161 (15.2%) patients experienced ≥1 Agency for Healthcare Research and Quality PSIs. The most common PSIs included postoperative respiratory failure (9.44%), sepsis (4.43%), and pressure ulcer (2.19%). Of stroke patients, 28,323 (3.13%) experienced ≥1 HACs. The most common HACs included falls and trauma (2.51%) and stage III and IV pressure ulcers (0.43%). Increasing comorbidity score (P ≤ 0.001) was associated with increased likelihood of all PSIs and HACs. The presence of PSIs or HACs resulted in increased length of stay, increased hospital charges, and an increase in mortality rates (P < 0.0001). Conclusions: Our results estimate baseline national incidence rates of PSIs and HACs in patients with stroke. These data may be used to determine individual institutional improvements or success by comparison. [Copyright &y& Elsevier]

Limited English proficiency (LEP) is linked to lower health care access and worse clinical outcomes. This study aims to explore the potential role of LEP on clinical outcomes of pediatric burn patients. We conducted a single-institution retrospective study of burn patients presenting at a tertiary pediatric burn referral program between January 2016 and December 2020. Patient demographics, burn mechanism, severity, interventions, and primary patient language were abstracted from the electronic health record. Clinical outcomes (length of stay [LOS], clinic follow-up, and 30-day readmission) of patients with LEP were compared to patients with English as primary language (EPL). Thirty-five (4.2%) patients with LEP were identified of 840 total patients. On univariate analysis, there was no difference in mean total body surface area (6.5% versus 6.1%), report of physical abuse (2.9% versus 8.9%), or need for grafting (14.3% versus 15.0%) comparing patients with LEP to those with EPL. Patients with LEP were more likely to have a scald burn (68.6% versus 48.9%, P = 0.025) and less likely to have a flame/fire burn (20.0% versus 37.6%, P = 0.047). On multivariate analysis, there was no difference between patients with LEP compared to patients with EPL for LOS (2.9 versus 3.5 d), 30-day readmissions (5.6% versus 5.7%), or clinic follow-up (80.6% versus 75.0%). In patients with >10% total body surface area, patients with LEP had a longer emergency department LOS (277 min versus 145 min, P = 0.06) but no difference in outcome measures. Pediatric patients with LEP were not found to have worse burn outcomes compared to EPL patients in our patient sample. However, a true association is difficult to determine given the small sample size of LEP patients and the potential underestimation of language discordancy as recorded in the electronic medical record. Further research is needed to better explore the role of primary language and health communication as a social determinant of health in pediatric burn patients. [ABSTRACT FROM AUTHOR]

Introduction: Optimal material and timing of cranioplasty in the pediatric population continue to be debated. Autologous and alloplastic materials have various indications for use and risk factors for complications. Methods: A single-center retrospective cohort study was undertaken of all pediatric patients who underwent cranioplasty with any material from 1991–2021. Results: 149 cranioplasty implants were included. Younger age (6 years old or under), a diagnosis of craniosynostosis as reason for implant, use of autologous bone, and shorter times to cranioplasty were predictive of need for revision surgery. No factors studied had a statistically significant impact on rate of removal of implant at time of revision surgery. Conclusion: Autologous and alloplastic cranioplasty materials both have good outcomes with low rates of revision surgery in the pediatric population. Alloplastic implants may be considered in the setting of infection as reason for craniectomy given the lower rate of revision surgery and need for removal. Patients with craniosynostosis as reason for cranioplasty have a higher risk of requiring revision or additional surgeries, regardless of implant used. [ABSTRACT FROM AUTHOR]

The objective of this research was to quantify the effect of surface degradation and abrasion separately and in combination on the flexural strength of lithia disilicate ceramics. Lithia disilicate disks were fabricated using the lost wax technique and pressing in vacuum. The eight groups in this pilot experiment were (i) reference, hydrated in distilled water for 24 h prior to fracture; (ii) reference, non-hydrated group; (iii) 28-day pH cycling group; (iv) 125K chewing cycle group; (v) combined pH cycling + 125K chewing cycle; (vi) constant pH 2 solution for 28 days; (vii) constant pH 7 solution for 28 days; and (viii) constant pH 10 solution for 28 days. pH cycling is a method that alternates between pH 2, 7 and 10 over 28 days. A total of 15 disks were used for each group. All the groups were tested using the biaxial piston and a three-ball flexural strength test to obtain their biaxial flexural strength. pH 2 constant immersion demonstrated the highest fracture strength and was significantly greater than all other groups (p < 0.0001). Chewing and pH cycling + chewing groups exhibited the lowest fracture strengths and were significantly lower than all other groups (p < 0.0001). The damage observed from the chewing simulator does not represent apparent clinical fractures. [ABSTRACT FROM AUTHOR]

Global attention requires disengagement from focal elements of stimuli. Since people with Parkinson's disease (PD) may reveal impaired disengagement, this study attempted to learn if people with PD may be impaired at allocating global attention. Healthy adults and people with PD attempted to bisect lines of uniform thickness and lines composed of two segments of unequal thickness and length. When the longer line segment was to the right of the shorter segment, the group with PD demonstrated an increased deviation toward the longer segment, supporting the postulate that people with PD have an impaired ability to disengage focal attention and engage global spatial attention. [ABSTRACT FROM AUTHOR]

Global attention requires disengagement from focal elements of stimuli. Since people with Parkinson’s disease (PD) may reveal impaired disengagement, this study attempted to learn if people with PD may be impaired at allocating global attention. Healthy adults and people with PD attempted to bisect lines of uniform thickness and lines composed of two segments of unequal thickness and length. When the longer line segment was to the right of the shorter segment, the group with PD demonstrated an increased deviation toward the longer segment, supporting the postulate that people with PD have an impaired ability to disengage focal attention and engage global spatial attention. [ABSTRACT FROM AUTHOR]

Neonatal surgical diseases are prime examples of the global disparity in surgical access and outcomes, with survival for conditions like gastroschisis reaching above 95% in high-income settings but usually fatal in low-income settings. This study aims to examine outcomes and predictors of mortality in patients with two specific neonatal surgical conditions that often require early transfer and prolonged inpatient care (gastroschisis and intestinal atresia) at Rwanda's main pediatric referral hospital. A single-institution retrospective chart review of neonates with gastroschisis and intestinal atresia was conducted between January 2016 and June 2019. Abstracted data included demographics, referral history, admission interventions, operative details, in-hospital complications, nutrition patterns, length of stay, and mortality. Daily logs were created to evaluate feeding status, infection status, and antibiotic usage. Descriptive and univariate analysis was conducted, with the primary outcome being survival to hospital discharge. A total of 112 patients met inclusion criteria (82% gastroschisis [ n = 92] and 18% intestinal atresia [ n = 20]). Median age at arrival was 0 d (GS) [IQR 0-1 d] and 8.5 d (IA) [IQR 4-10 d] (P < 0.0001). Survival to discharge was 22.8% (GS) (n = 21) and 60% (IA) (n = 12) with a mean length of stay of 28.3 d (GS) and 18.4 d (IA). The median number of days to initiation of oral feeds was 8.5 d [IQR 7-11] for gastroschisis survivors. Neonatal surgical conditions that require early transfer and prolonged nutritional intervention are challenging in low-resource settings, but through treatment by a comprehensive pediatric surgical service, improving survival is possible. [ABSTRACT FROM AUTHOR]

Objective To evaluate the safety of continuing acetyl salicylic acid (ASA) in patients undergoing brain tumor resection. Many patients are on antiplatelet agents that are withheld before elective neurosurgical procedures to reduce bleeding risk. Cessation of ASA in patients with cardiovascular disease is associated with a known increased risk of thrombotic events, especially in patients with coronary stents. Methods The medical records of patients who underwent surgical resection of a brain tumor at the University of Florida from 2010 to 2014 were evaluated. The patients were separated into groups based on preoperative ASA use and whether or not it was stopped before surgery. Patients were evaluated for thrombotic complications, postoperative hemorrhage, estimated blood loss, length of hospital stay, and discharge disposition. Results Of the 452 patients analyzed, 368 patients were not on chronic ASA therapy, 55 patients had their ASA discontinued before surgery, and 28 patients were continued on ASA perioperatively. The patients on preoperative ASA were comparable on all collected demographic variables. There were no statistical differences detected between the groups for outcomes including bleeding complications, need for reoperation, or thrombotic complications. Conclusions In this analysis, perioperative low dose ASA use was not associated with increased risk of perioperative complications. [ABSTRACT FROM AUTHOR]

Cerebral vasospasm (CV) and the resulting delayed cerebral ischemia (DCI) significantly contribute to poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Free hemoglobin (Hb) within the subarachnoid space has been implicated in the pathogenesis of CV. Haptoglobin (Hp) binds free pro-oxidant Hb, thereby modulating its harmful effects. Humans can be of three Hp phenotypes: Hp1-1, Hp2-1, or Hp2-2. In several disease states, the Hp2-2 protein has been associated with reduced ability to protect against toxic free Hb. We hypothesized that individuals with the Hp2-2 phenotype would have more CV, DCI, mortality, and worse functional outcomes after aSAH. In a sample of 74 aSAH patients, Hp2-2 phenotype was significantly associated with increased focal moderate (P = 0.014) and severe (P = 0.008) CV and more global CV (P = 0.014) after controlling for covariates. Strong trends toward increased mortality (P = 0.079) and worse functional outcomes were seen for the Hp2-2 patients with modified Rankin scale at 6 wk (P = 0.076) and at 1 y (P = 0.051) and with Glasgow Outcome Scale Extended at discharge (P = 0.091) and at 1 y (P = 0.055). In conclusion, Hp2-2 phenotype is an independent risk factor for the development of both focal and global CV and also predicts poor functional outcomes and mortality after aSAH. Hp phenotyping may serve as a clinically useful tool in the critical care management of aSAH patients by allowing for early prediction of those patients who require increased vigilance due to their inherent genetic risk for the development of CV and resulting DCI and poor outcomes. [ABSTRACT FROM AUTHOR]

This research tested a multilevel structural equation model of associations between 3 aspects of affective functioning (state affect, trait affect, and affective lability) and 3 alcohol outcomes (likelihood of drinking, quantity on drinking days, and dependence symptoms) in a sample of 263 college students. Participants provided 49 days of experience sampling data over 1.3 years in a longitudinal burst design. Within-person results: At the daily level, positive affect was directly associated with greater likelihood and quantity of alcohol consumption. Daily negative affect was directly associated with higher consumption on drinking days and with higher dependence symptoms. Between-person direct effects: Affect lability was associated with higher trait negative, but not positive, affect. Trait positive affect was inversely associated with the proportion of drinking days, whereas negative affectivity predicted a greater proportion of drinking days. Affect lability exhibited a direct association with dependence symptoms. Between-person indirect effects: Trait positive affect was associated with fewer dependence symptoms via proportion of drinking days. Trait negative affect was associated with greater dependence symptoms via proportion of drinking days. The results distinguish relations of positive and negative affect to likelihood versus amount of drinking and state versus trait drinking outcomes, and highlight the importance of affect variability for predicting alcohol dependence symptoms. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The aims of this study were to test the hypotheses that (a) a laserscanner used for measuring maximum depth and volume loss will yield the same results as a surface profilometer; (b) the surface roughness will affect the maximum depth and volume loss measured with the laserscanner; (c) analytical results using the laserscanner from multiple operators have no more than 10% inter‐rater difference and; (d) replicating samples using either stone or impression material is an accurate method for measuring wear using the laserscanner. Materials and Methods: The volume and maximum depth of indentations from fine, medium and rough burs on glass‐ceramic disks were measured using two devices, a surface profilometer (Dektak II, Veeco) and a 3D Laserscanner (LAS‐20, SD Mechatronik). Replicates of the indentations made from polyvinysiloxane impression material and gypsum were also measured. Results: Comparison of profilometer and laserscanner readings using ceramic disks demonstrated a mean error of 13.61% for depth and 25.32% for volume. Replication errors were minimal (2.6% for impression, 2.5% for stone). Surface profilometer data for volume measurements revealed a difference of 6.1% for impression and 6.5% for stone compared with ceramics. However, when measurements for replicates were compared between laserscanner and surface profilometer, depth had a mean error of 74% for impression and 51% for stone. Volume differences of 78% for impression and 44% for stone were recorded. Conclusion: This work demonstrated that the laserscanner was a convenient device for measuring wear but there is a need to validate the accuracy of the measurements. [ABSTRACT FROM AUTHOR]

Introduction: Deep brain stimulation (DBS) is an effective treatment for multiple movement disorders and shows substantial promise for the treatment of some neuropsychiatric and other disorders of brain neurocircuitry. Optimal neuroanatomical lead position is a critical determinant of clinical outcomes in DBS surgery. Lead migration, defined as an unintended post-operative displacement of the DBS lead, has been previously reported. Despite several reports, however, there have been no systematic investigations of this issue. This study aimed to: 1) quantify the incidence of lead migration in a large series of DBS patients, 2) identify potential risk factors contributing to DBS lead migration, and 3) investigate the practical importance of this complication by correlating its occurrence with clinical outcomes. Methods: A database of all DBS procedures performed at UF was queried for patients who had undergone multiple post-operative DBS lead localization imaging studies separated by at least two months. Bilateral DBS implantation has commonly been performed as a staged procedure at UF, with an interval of six or more months between sides. To localize the position of each DBS lead, a head CT is acquired ~4 weeks after lead implantation and fused to the pre-operative targeting MRI. The fused targeting images (MR + stereotactic CT) acquired in preparation for the delayed second side lead implantation provide an opportunity to repeat the localization of the first implanted lead. This paradigm offers an ideal patient population for the study of delayed DBS lead migration because it provides a large cohort of patients with localization of the same implanted DBS lead at two time points. The position of the tip of each implanted DBS lead was measured on both the initial post-operative lead localization CT and the delayed CT. Lead tip displacement, intracranial lead length, and ventricular indices were collected and analyzed. Clinical outcomes were characterized with validated rating scales for all cases, and a comparison was made between outcomes of cases with lead migration versus those where migration of the lead did not occur. Results: Data from 138 leads in 132 patients with initial and delayed lead localization CT scans were analyzed. The mean distance between initial and delayed DBS lead tip position was 2.2 mm and the mean change in intracranial lead length was 0.45 mm. Significant delayed migration (>3 mm) was observed in 17 leads in 16 patients (12.3% of leads, 12.1% of patients). Factors associated with lead migration were: technical error, repetitive dystonic head movement, and twiddler’s syndrome. Outcomes were worse in dystonia patients with lead migration (p = 0.035). In the PD group, worse clinical outcomes trended in cases with lead migration. Conclusions: Over 10% of DBS leads in this large single center cohort were displaced by greater than 3 mm on delayed measurement, adversely affecting outcomes. Multiple risk factors emerged, including technical error during implantation of the DBS pulse generator and failure of lead fixation at the burr hole site. We hypothesize that a change in surgical technique and a more effective lead fixation device might mitigate this problem. [ABSTRACT FROM AUTHOR]

Background Prophylactic use of antiepileptic drugs (AEDs) for patients undergoing brain tumor surgery is common practice despite lack of clear evidence. We hypothesized that prophylactic AED (pAED) use did not affect seizure rates in patients with brain tumor who underwent craniotomy for tumor resection. Methods A retrospective review was performed of 606 patients who underwent surgery for brain tumors from 2006 to 2013 at the University of Florida, excluding patients with preexisting seizure condition before tumor diagnosis. Data were analyzed to determine seizure incidence, AED use, and AED toxicities. Results Most patients (81%) had no seizure on presentation. Eight patients did not present with seizure but had seizure postoperatively, and 9 patients did not present with seizure or have seizure postoperatively but did have seizure on follow-up. Despite not presenting with a seizure preoperatively, 208 patients (43%) were placed on pAED preoperatively, 313 patients (64%) were on AED in the postoperative period, and 274 patients (56%) remained on AED at discharge. The pAED use odds ratio for seizures was 1.3 (95% confidence interval, 0.5–3.4; P = 0.599). At last follow-up, 34% of patients with no seizure on presentation remained on pAEDs. Conclusions pAEDs did not significantly reduce postoperative seizures in patients with brain tumor in this analysis. In addition, pAED was often continued once prescribed even if the patient remained seizure free. [ABSTRACT FROM AUTHOR]

Objectives (1) To assess whether there is evidence of an association between the number of peri-implant tissue complications and patient characteristics such as gender, diabetes status, smoking status, and bite force; (2) To assess whether there is evidence of an association between the number of peri-implant tissue complications and location of the implant, surgical technique used, bone graft status and sinus lift status. Materials and methods This randomized, controlled clinical trial included a total of 176 implants (OsseoSpeed, DENTSPLY) in 67 participants with 88 fixed dental prostheses. Information was obtained from health histories, a baseline exam, surgical notes, and post-operative exams. The data were analyzed using Fisher's exact and Mann-Whitney tests and generalized estimating equations using logistic regression with a significance level set at 0.05. Results All 176 implants survived within a recall period of 3 years, but 11 implants demonstrated peri-implant tissue complications. Ten sites showed dehiscence and one case exhibited vertical bone loss. There was a statistically significant association between surgical technique used (1-stage or 2-stage) and the presence of soft tissue complications ( P = 0.005), where 2-stage surgery was associated with a higher frequency of peri-implant soft tissue complications. A correlation, although not statistically significant ( P = 0.077), was noted, between peri-implant tissue complications and bone grafting, suggesting a possible role for this factor as well. Conclusions Participants who did not require any second-stage surgery at the implant sites experienced fewer complications. Therefore, additional surgical procedures should be performed judiciously considering their possible effects on peri-implant tissue health. Clinical significance The clinical implication of this research study is that secondary surgery should be considered with caution during implant placement and it should be performed only when other options have been exhausted, as it has been shown to have a direct adverse effect on the long-term peri-implant tissue health. [ABSTRACT FROM AUTHOR]

Objective: Fractures of posterior fixed dental all-ceramic prostheses can be caused by one or more factors including prosthesis design, flaw distribution, direction and magnitude of occlusal loading, nature of supporting infrastructure (tooth root/implant), and presence of adjacent teeth. This clinical study of implant-supported, all-ceramic fixed dental prostheses, determined the effects of (1) presence of a tooth distal to the most distal retainer; (2) prosthesis loading either along the non-load bearing or load bearing areas; (3) presence of excursive contacts or maximum intercuspation contacts in the prosthesis; and (4) magnitude of bite force on the occurrence of veneer ceramic fracture. Methods: 89 implant-supported FDPs were randomized as either a three-unit posterior metal-ceramic (Au-Pd-Ag alloy and InLine POM, Ivoclar, Vivadent) FDP or a ceramicceramic (ZirCAD and ZirPress, Ivoclar, Vivadent) FDP. Two implants (Osseospeed, Dentsply) and custom abutments (Atlantis, Dentsply) supported these FDPs, which were cemented with resin cement (RelyX Universal Cement). Baseline photographs were made with markings of teeth from maximum intercuspation (MI) and excursive function. Patients were recalled at 6 months and 1-3 years. Fractures were observed, their locations recorded, and images compared with baseline photographs of occlusal contacts. Conclusion: No significant relationship existed between the occurrence of fracture and: (1) the magnitude of bite force; (2) a tooth distal to the most distal retainer; and (3) contacts in load-bearing or non-load-bearing areas. However, there was a significantly higher likelihood of fracture in areas with MI contacts only. Clinical significance: Because of the absence of a periodontal ligament, this clinical study demonstrates that there is a need to evaluate occlusion differently with implant-supported prostheses than with natural tooth supported prostheses. Implant supported prostheses should have minimal occlusion and lighter contacts than those supported by natural dentition. [ABSTRACT FROM AUTHOR]

Objective: Deep brain stimulation (DBS) has been used for more than a decade to treat Parkinson's disease (PD); however, its mechanism of action remains unknown. Given the close proximity of the electrode trajectory to areas of the brain known as the “germinal niches,” we sought to explore the possibility that DBS influences neural stem cell proliferation locally, as well as more distantly. Methods: We studied the brains of a total of 12 idiopathic Parkinson's disease patients that were treated with DBS (the electrode placement occurred 0.5–6 years before death), and who subsequently died of unrelated illnesses. These were compared to the brains of 10 control individuals without CNS disease, and those of 5 PD patients with no DBS. Results: Immunohistochemical analyses of the subventricular zone (SVZ) of the lateral ventricles, the third ventricle lining, and the tissue surrounding the DBS lead revealed significantly greater numbers of proliferating cells expressing markers of the cell cycle, plasticity, and neural precursor cells in PD-DBS tissue compared with both normal brain tissue and tissue from PD patients not treated with DBS. The level of cell proliferation in the SVZ in PD-DBS brains was 2–6 fold greater than that in normal and untreated PD brains. Conclusions: Our data suggest that DBS is capable of increasing cellular plasticity in the brain, and we hypothesize that it may have more widespread effects beyond the electrode location. It is unclear whether these effects of DBS have any symptomatic or other beneficial influences on PD. [ABSTRACT FROM AUTHOR]

Objective--To investigate the effects of bevacizumab, a human monoclonal antibody against vascular endothelial growth factor, on the angiogenesis and growth of canine osteosarcoma cells xenografted in mice. Animals--27 athymic nude mice. Procedures--To each mouse, highly metastasizing parent osteosarcoma cells of canine origin were injected into the left gastrocnemius muscle. Each mouse was then randomly allocated to 1 of 3 treatment groups: high-dose bevacizumab (4 mg/kg, IP), low-dose bevacizumab (2 mg/kg, IP), or control (no treatment). Tumor growth (the number of days required for the tumor to grow from 8 to 13 mm), vasculature, histomorphology, necrosis, and pulmonary metastasis were evaluated. Results--Mice in the high-dose bevacizumab group had significantly delayed tumor growth (mean ± SD, 13.4 ± 3.8 days; range, 9 to 21 days), compared with that for mice in the low-dose bevacizumab group (mean ± SD, 9.4 ± 1.5 days; range, 7 to 11 days) or control group (mean ± SD, 7. 2 ± 1.5 days; range, 4 to 9 days). Mice in the low-dose bevacizumab group also had significantly delayed tumor growth, compared with that for mice in the control group. Conclusions and Clinical Relevance--Results indicated that bevacizumab inhibited growth of canine osteosarcoma cells xenografted in mice, which suggested that vascular endothelial growth factor inhibitors may be clinically useful for the treatment of osteosarcoma in dogs. Impact for Human Medicine--Canine osteosarcoma is used as a research model for human osteosarcoma; therefore, bevacizumab may be clinically beneficial for the treatment of osteosarcoma in humans. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare subthalamic nucleus (STN) to globus pallidus internus (GPi) deep brain stimulation (DBS) for control of motor fluctuations and for potential dyskinesia-suppressing qualities. Methods: We conducted a retrospective database review of all patients who underwent GPi or STN DBS for idiopathic Parkinson''s disease. Direct dyskinesia suppression (dDS) was defined as improvement in dyskinesia subscore of the Unified Parkinson''s Disease Rating Scale (UPDRS) part IV (items 32–34), despite lack of reduction in dopaminergic medication dosage. We analyzed the data using methods appropriate for a case–control study. Results: A total of 133 patients were evaluated. At the last evaluation Dyskinesia scores and motor fluctuations significantly improved in both the GPi (p < 0.0001) and STN groups (p < 0.0001). The GPi group was more likely than the STN group to experience dDS (odds ratio = 1.95, 95% CI = 0.556, 3.21). However, the association between DBS target and dDS was not statistically significant (Pearson chi-square = 2.286, p = 0.131). Conclusions: The overall clinical outcome of STN and GPi DBS for control of dyskinesia and motor fluctuations was similar. STN and GPi DBS both had some direct dyskinesia suppression effects. [Copyright &y& Elsevier]

lcohol abuse among college students continues to be a large societal problem in need of further study. This project investigated the influence of different types of negative repetitive thought (NRT) on alcohol use and binging behavior among undergraduates. Specifically, angry rumination, depressive rumination, co-rumination, and worry were examined. An initial exploratory factor analysis supported the distinctiveness of these four forms of NRT. With respect to quantity of weekly drinking, worry was significantly associated with less alcohol use among drinkers whereas angry rumination was associated with greater weekly usage. The effect of co-rumination was moderated by sex such that higher levels of co-rumination was associated with less weekly drinking in men but more weekly drinking in women. The tendency to co-ruminate was also significantly associated with of being a binge drinker, and demonstrated similar gender moderation. Higher levels of worry were associated with less binge drinking among women, but no association between worry and binging was present among men. The implications for these findings in the study of NRT and alcohol use are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To estimate the lifetime prevalence of four sexually transmitted infections (STIs) and to identify correlates of these infections among patients seeking care for a substance use disorder at a specialized DeAddictions Unit in southern India. Methods: Consecutive inpatients (n =361; 98% male; M age=36.7 years) admitted to DeAddictions Unit of the National Institute of Mental Health and Neuro Sciences in Bangalore, India, participated in a structured interview to obtain demographic, psychiatric, sexual behavior, and substance use data; each patient also provided a blood sample for serologic testing for HIV, chlamydia, syphilis, and hepatitis B. Results: One-quarter of all patients tested positive for at least one STI. Lifetime seroprevalence rates were 12.9% for syphilis, 10.3% for chlamydia, 3.1% for hepatitis B, and 1.1% for HIV. Analyses did not reveal any consistent pattern of associations between STI status and sociodemographic, psychiatric, and sexual behavioral characteristics. Conclusions: All patients should receive a comprehensive sexual assessment during standard care; for those patients who report risky sexual practices, we recommend voluntary counseling and testing for STIs. Although we do not recommend universal testing for STIs at this time, this should be revisited based upon national surveillance data. [Copyright &y& Elsevier]

Background: Persons with co-occurring Axis I mental disorders and substance use disorders often experience multiple negative consequences as a result of their substance use. Because no existing measure adequately assesses these population-specific problems, we developed the Problems Assessment for Substance Using Psychiatric Patients (PASUPP). This paper describes the scale development and factor structure, and provides initial reliability and validity evidence for the PASUPP. Methods: An initial pool of 54 items was assembled by reviewing existing measures for relevant items and generating new items. Then, 239 patients (90% male, 61% White) with documented Axis I psychiatric and current substance use disorders rated the lifetime and last 3-month occurrence of each problem, and completed additional measures of substance use and related functioning. Results: Lifetime endorsements ranged from 31 to 95%, whereas 3-month endorsements ranged from 24 to 78%. Item analyses reduced the set to 50 items. The PASUPP is internally consistent (alpha = 0.97) and unidimensional. Scale validity was suggested by moderate correlation with other measures of substance problem severity. Conclusions: Promising psychometric properties are reported for a population-specific measure of substance use problems. Such a measure could be useful for initial assessments and outcome evaluations with substance using psychiatric patients. [Copyright &y& Elsevier]

The purpose of this study was to investigate the prevalence and correlates of HIV risk among men receiving treatment for substance abuse in India. Consecutive inpatients from the major substance abuse hospital in southern India were screened using a structured interview and standardized measures to obtain demographic, psychiatric, sexual behavior, and substance use data at the time of admission. Seventy-seven percent of the 352 men who were screened reported that they were sexually active during the past year, and 13% reported that they had engaged in sexual practices associated with greater risk. The most common risk practices in the past year included having multiple sexual partners (7%), paying for sex (5%), and having unprotected anal sex (4%). Engaging in risky sexual practices was associated with the presence of a co-occurring psychiatric disorder and higher scores on a drug abuse screening measure. Assessing HIV risk in substance abuse settings can help to identify patients who may benefit from HIV-risk reduction programs. [ABSTRACT FROM AUTHOR]

The aim of this work is to investigate the effects produced by polymicrobial biofilm (Porphyromonas gingivalis, Streptococcus mutans, Streptococcus sanguinis, and Streptococcus salivarius) on the corrosion behavior of titanium dental implants. Pure titanium disks were polished and coated with titanium nitride (TiN) and silicon carbide (SiC) along with their quarternized versions. Next, the disks were cultivated in culture medium (BHI) with P. gingivalis, S. mutans, S. sanguinis, and S. salivarius and incubated anaerobically at 37 °C for 30 days. Titanium corrosion was evaluated through surface observation using Scanning Electron Microscope (SEM) and Atomic Force Microscopy (AFM). Furthermore, the Ti release in the medium was evaluated by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). SEM images showed that coated Ti disks exhibited lower corrosion compared to non-coated disks, except for the quartenized TiN. This was confirmed by AFM, where the roughness was higher in non-coated Ti disks. ICP showed that Ti levels were low in all coating disks. These results indicate that these SiC and TiN-based coatings could be a useful tool to reduce surface corrosion on titanium implant surfaces. [ABSTRACT FROM AUTHOR]

Titanium (Ti) corrodes clinically in the presence of bacteria. We investigated this phenomenon as a function of Ti particles found in biopsied tissues around peri-implantitis sites and surface roughness of failed Ti implants. Tissue biopsies were surgically collected from peri-implantitis sites, processed, and embedded in resin. The resin-embedded samples were hand trimmed to the region of interest and semi-thick (500 nm) sections were collected onto coverslips. One section was toluidine blue post-stained as a reference. The remainder sections were left unstained for energy-dispersive X-ray spectroscopy (EDX) analysis. Processed samples were examined under scanning electron microscopy (SEM) and EDX. Corresponding failed implants were also removed and examined under SEM and EDX. Five out of eight biopsied samples demonstrated the presence of Ti particles in the soft tissue, suggesting the true rate among all failures was between 24.5% and 91.5% (the lower bound of a 95% confidence interval for the true rate of Ti presence). SEM analysis of failed implant bodies also indicated changes in surface morphology and appeared less detailed with decreased weight percent of Ti on the surface of the failed implants. In conclusion, Ti particles were noted in 5/8 biopsied samples. Surface morphologies were smoother in failed implants compared with the reference implant. [ABSTRACT FROM AUTHOR]

The effect of pH changes on the chemical durability of dental glass–ceramic materials was evaluated using weight loss and ion release levels. The hypothesis that increased pH changes will exhibit greater corrosion was investigated. The ion concentration was analyzed using inductively coupled plasma atomic emission spectrometer (ICP). The surface compositions were investigated using X-ray photoelectron spectroscopy (XPS). The surface morphologies were examined using scanning electron microscopy (SEM). Dental glass–ceramics were tested in constant immersion, 3-day cycling, and 1-day cycling with pH 10, pH 2, and pH 7 for 3, 15, and 30 days. The 1-d cycling group demonstrated the highest levels of weight loss compared with 3-d cycling and constant immersion. For the ion release, Si4+ and Ca2+ had the highest rates of release in 1-d cycling, whereas the Al3+ release rate with constant pH 2 was highest. The alteration/passivation layer that was formed on the surface of disks possibly prevented further dissolution of pH 10 corroded disks. XPS analysis demonstrated different surface compositions of corroded disks in pH 10 and pH 2. Si4+, K+, Na+, Al3+, and Ca2+ were detected on the surface of corroded pH 10 disks, whereas a Si4+ and P5+-rich surface formed on corroded pH 2 disks. SEM results demonstrated rougher surfaces for corroded disks in cycling conditions and pH 2 constant immersion. In conclusion, increased pH changes significantly promote the corrosion of dental glass–ceramic materials. [ABSTRACT FROM AUTHOR]

The effect of a novel silicon carbide (SiC) coating on the chemical durability of a fluorapatite glass-ceramic veneer was investigated by examining weight loss and ion release levels. The hypothesis that this novel coating will exhibit significant corrosion resistance was tested. Inductively coupled plasma atomic emission spectrometer (ICP) was used for ion concentration determination and scanning electron microscopy (SEM) for surface morphology analyses. Samples were immersed in pH 10 and pH 2 buffer solutions to represent extreme conditions in the oral cavity. Analyses were done at 15 and 30 days. The SiC coated group demonstrated significant reduction in weight loss across all solutions and time points (p < 0.0001). Ion release analyses demonstrated either a marginally lower or a significantly lower release of ions for the SiC-coated disks. SEM analysis reveals planarization of surfaces by the SiC-coated group. The surfaces of coated samples were not as corroded as the non-coated samples, which is indicative of the protective nature of these coatings. In conclusion, SiC is a novel coating that holds promise for improving the performance of ceramic materials used for dental applications. [ABSTRACT FROM AUTHOR]