Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.

Spatiotemporal variation in global floods with different affected areas and the contribution of influencing factors to flood-induced mortality (1985–2019)

Floods are great threats to human life and property. Extensive research has investigated the spatiotemporal variation in flood occurrence, while few have studied the heterogeneity in global flood events of different sizes, which may require different coping strategies and risk reduction policies. In this study, we analysed the spatiotemporal patterns of global flood events with different affected areas (classified in three levels) during 1985–2019 and examined the contribution of different influencing factors to flood-induced mortality using Geodetector. The results show that (1) the increase in global flood frequency was mainly caused by Level II and Level III floods, and the average area affected by flood events has been increasing yearly since 1985. (2) In America and Africa, the frequency of Level III floods has increased monotonically. At the same time, the frequency of Level I floods in Europe and Level II floods in Asia has increased significantly. (3) For Europe and Asia, most of the deaths occurred with Level II floods; while for America and Africa, Level III floods caused the most mortality. (4) The top three factors contributing to the spatial heterogeneity in flood-induced mortality were the affected population, GDP per capita and flood duration. The contribution of each factor varied among the different types of floods. Topographic factors (percentage of mountainous area) magnified flood-induced mortality during extreme events with heavy rainfall, especially for Level III floods. The heterogeneity in flood frequency and flood-induced mortality indicates that flood protection measures should be more targeted. In addition, the increase in large-scale floods (Level III) highlights the need for transregional cooperation in flood risk management.

Analysis of professional competencies and basic skills in distance education tutor tutorials

This study aims to examine how the ability to apply professional competency tutors and how the ability to apply basic skills tutorial tutors Early Childhood Education Program in the Makassar Open University Distance Learning Program Unit. This research is type of qualitative research. Research sample consisted of six tutors as key informants. Purposive sampling technique is used with the consideration of key informants in the level II regional pokjar. Data analysis used four stages, namely identification, data reduction, interpretation, explanation, and conclusion. The results of this study indicate that tutors have tutorial readiness, tutors do not check module readiness and do not convey special competencies (KK), the presentation of material is still not optimal. The tutor does not provide apperception, the tutor is flexible and positive in the tutorial, presents the material using power points, the tutor has not maximized the assessment process or learning outcomes. Keywords: Basic, competence, application, professional, skills, tutorial;

The Radial Synergy Test: An Aid to Diagnose de Quervain’s Tenosynovitis

Background: Diagnosis of de Quervain’s tenosynovitis is made clinically. Finkelstein’s and Eichoff’s tests are commonly utilized examination maneuvers. Their specificity has been questioned due to a propensity to provoke pain in asymptomatic patients. Using the principle of synergism, the novel radial synergy test takes advantage of isometric contraction of the first dorsal compartment with resisted abduction of the small finger. Methods: Electromyography was performed on 3 authors and the first dorsal compartment sampled during the maneuver. Sensitivity evaluation was performed via retrospective chart review for patients diagnosed with de Quervain’s from 2013 to 2018. Inclusion criteria were documented radial synergy test, Eichoff’s test, and ≥90% pain relief after lidocaine/corticosteroid injection. We enrolled 222 patients with 254 affected extremities. Specificity evaluation was performed via a prospective cohort of volunteers undergoing radial synergy and Eichoff’s tests. Inclusion criterion was lack of preexisting wrist pain. Score > 0 on Visual Analog Scale was considered positive. We enrolled 48 volunteers with 93 tested extremities. Results: Electromyography revealed positive recruitment of the first dorsal compartment. Sensitivity of the radial synergy test was inferior to Eichoff’s test (97% vs 91%, relative risk [RR] = 0.93 [95% confidence interval [CI] = 0.89-0.97], P < .01). Specificity of the radial synergy test was superior to Eichoff’s test (99% vs 74%, RR = 1.33 [95% CI = 1.18-1.51], P < .001). Conclusions: We describe and evaluate the radial synergy test, a novel examination maneuver to aid the diagnosis of de Quervain’s. This serves as an adjunct for future diagnostic evaluations with its high specificity. Level of Evidence: Level II, diagnostic study.

Safety assessment method of steel protective structure against large-scale debris flow

Recently, steel pipe open type protective structures (steel open dams) have been damaged because of large-scale debris flow resulting from torrential rainfall based on abnormal climate. This article proposes a safety assessment method for the load-carrying capacity of a steel open dam against large-scale debris flow load (level II load) using the energy constant law. First, the safety assessment method of steel open dams is proposed that the ultimate strength must be larger than the required strength against the level II load, which is determined by using the energy constant law. Second, the load-carrying capacities of three types of steel open dams with different structural shapes against the front and eccentric debris flow loadings are investigated by a push-over analysis. Finally, the safety assessments on load-carrying capacities against the front and eccentric debris flow loading are confirmed and the strength reduction by the eccentric loading is examined for three steel open dams.

Test–Retest Reliability and Construct Validity of the German Translation of the Gait Outcome Assessment List (GOAL) Questionnaire for Children with Ambulatory Cerebral Palsy

The Gait Outcome Assessment List (GOAL) is a patient or caregiver-reported assessment of gait-related function across different domains of the International Classification of Functioning, Disability, and Health (ICF) developed for ambulant children with cerebral palsy (CP). So far, the questionnaire is only available in English. The aim of this study was to translate the GOAL into German and to evaluate its reliability and validity by studying the association between GOAL scores and gross motor function as categorized by the gross motor function classification system (GMFCS) in children with cerebral palsy (CP). The GOAL was administered to primary caregivers of n = 91 children and adolescents with CP (n = 32, GMFCS levels I; n = 27, GMFCS level II; and n = 32, GMFCS level III) and n = 15 patients were capable of independently completing the whole questionnaire (GMFCS level I). For assessing test–retest reliability, the questionnaire was completed for a second time 2 weeks after the first by the caregivers of n = 36 patients. Mean total GOAL scores decreased significantly with increasing GMFCS levels with scores of 71 (95% confidence interval [CI]: 66.90–74.77) for GMFCS level I, 56 (95% CI: 50.98–61.86) for GMFCS level II, and 45 (95% CI: 40.58–48.48) for GMFCS level III, respectively. In three out of seven domains, caregivers rated their children significantly lower than children rated themselves. The test–retest reliability was excellent as was internal consistency given the GOAL total score. The German GOAL may serve as a much needed patient-reported outcome measure of gait-related function in ambulant children and adolescents with CP.

Prolactin Level and Breastmilk Production among Mothers of Low-Birth-Weight Infants Admitted to Level II Neonatal Intensive Care Unit

Background. Kangaroo mother care (KMC) has been proven by several studies to promote breastfeeding, but many of the studies focus on the success of exclusive breastfeeding, and less on its galactogenic effects. Objective. We aim to determine the maternal serum prolactin levels and breastmilk volume of mothers who rendered KMC to their infants. Materials and Methods. This is a randomized controlled, open-labeled, interventional study in the Neonatal Intensive Care Unit of a tertiary government hospital. Infants weighing < 2000 grams admitted in NICU Level II, together with medically stable mothers and no contraindication for breastfeeding were simultaneously enrolled. Primary outcome measures were maternal serum prolactin levels and expressed milk volume on day 3 and day 7 postpartum. Two-sample t-test was used to compare groups, and paired t-test to compare within groups. Tests were two-tailed, with a p-value of < 0.05 considered statistically significant. Trial Registration. Australia-New Zealand Clinical Trial Registry ID ACTRN12614000218695 Results. Fifty mother-infant dyads were equally allocated into KMC and control groups (p < 0.001). There was significantly larger milk volume on the third day (29.6 ± 27.8 mL vs 16.3 ± 26.1 mL; p < 0.001) and seventh post-partum day (72.4 ± 62.3 mL vs 47.3 ± 43.8 mL; p < 0.000). There were increased serum prolactin levels compatible with post-partum state. The increase was more evident in the KMC (5244 ± 2702 mIU/L, on the 3rd postpartum day versus 4969 ± 2426 mIU/L, on the 7th postpartum day, p = 0.996) compared to control group (4129 ± 2485 mIU/L on the 3rd postpartum day versus 3705 ± 2731 mIU/L on the 7th postpartum day, p = 0.301). Conclusion. We noted a significantly larger milk volume in the KMC group. There was also a greater increase in the prolactin levels in the KMC group, but this did not reach statistical significance. Further studies should be done to determine mechanism of galactogenesis through KMC.

Analisis Uji Balistik Komposit Serat Pelepah Salak Dengan Resin Epoksi dan Silicon Carbida (SiC) Menggunakan Metode Vacuum Bag

Komposit adalah dua macam atau lebih material yang digabungkan atau dikombinasikan dalam sekala makroskopis (dapat terlihat langsung oleh mata) sehingga menjadi material baru yang lebih berguna. Selama ini penggunaan komposit menggunakan bahan yang terbuat dari logam ataupun baja. Penelitian ini dilaksanakan untuk membuat material komposit berpenguat serat alam yaitu serat pelepah salak yang mampu dimanfaatkan sebagai pengganti material logam yang digunakan pada alutsista TNI AU seperti rompi anti peluru. Penelitian ini bertujuan untuk mengetahui sifat mekanis berupa kekuatan tarik dan nilai kekerasan dari komposit serat salak serta mengetahui kekuatan balistik dari sebuah komposit yang ditembakkan dengan peluru kaliber 9 mm (MU-1TJ) dengan beberapa variasi jarak penembakan sesuai standar NIJ menggunakan Alat Uji Tembak Presisi. Pembuatan komposit ini menggunakan metode komposit Vacuum Bag. Dari hasil pengujian diperoleh sifat mekanis komposit serat pelepah salak berupa kekuatan tarik sebesar 21,46 N/mm2 dan nilai kekerasan salak sebesar 23,64 HV. Hasil dari pengujian balistik terdapat 2 spesimen yang memenuhi standar NIJ dan 2 spesimen yang tidak memenuhi standar NIJ. Spesimen pertama yang memenuhi standar NIJ level IIA adalah spesimen komposit dengan komposisi kevlar dan Filler SiC, dimana hasil penembakan jarak 30 mm memiliki BFS 6,26 mm, jarak 25 m memiliki BFS 11,86 mm, jarak 10 m dan 5 m peluru menembus spesimen. Spesimen kedua yang memenuhi standar NIJ level II dan IIA adalah spesimen komposit hybrid dengan komposisi perbaduan serat pelepah salak, serat kevlar, filler SiC dan Al7075-T6, dimana hasil penembakan jarak 30 mm memiliki BFS 0 mm, jarak 25 m memiliki BFS 0 mm, jarak 10 m memiliki BFS 0 mm dan jarak 5 m memiliki BFS 0 mm (semua peluru tidak menembus spesimen).