The Case Files: A serious condition hiding behind nonspecific symptoms.
Diagnosis Differential; Female; Radiography Thoracic; Tomography X-Ray Computed; Middle Age; Ultrasonography; Electrocardiography; Physical Examination; Hematologic Tests; Heparin Low-Molecular-Weight; Platelet Aggregation Inhibitors -- Therapeutic Use; Takayasu Arteritis -- Diagnosis; Takayasu Arteritis -- Drug Therapy
Drogell K; Sitzlar B; Weber L; Campbell J; Simon EL
Emergency Medicine News
2020
2020-12-22
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Chapter 39 - Past, present, and future
history; life history; Bowhead whale; bowhead whale; Balaena mysticetus; conservation; whaling; International Whaling Commission; Inupiat; prehistoric
We discuss the evolution, phylogenetic relations to right whales, and geographical distribution of bowhead whales. We summarize its relations to humans, including whaling by indigenous and European whalers, conservation efforts, and modern challenges with increased shipping, fishing, and climate change. We also discuss their adaptations that have usually been explained as related to living in the Arctic but might be better explained as related to frugal use of limited resources.
Thewissen JGM; George JC
The Bowhead Whale
2021
2021-01-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00039-X" target="_blank" rel="noreferrer noopener"></a>
Chapter 34 - Indigenous knowledge in research and management
bowhead whale; Indigenous knowledge; scientific research; wildlife management
Indigenous whalers know a great deal about the habits and environment of bowhead whales. That knowledge is essential for safe and effective hunting and has also been invaluable to scientific research and management of bowheads. Studies in Chukotka, Nunavut, and Alaska have documented Indigenous knowledge about bowhead whales. From the methods used in counting whales to the confirmation of bowheads’ sense of smell to detailed accounts of how the animals avoid predators, collaborations between whalers and scientists are among the world’s best examples of using Indigenous and scientific knowledge together. Future progress includes a growing role for Indigenous scholarship and greater involvement of the holders of Indigenous knowledge in management and decision-making concerning whales and their habitat.
Huntington HP; Ferguson SH; George JC; Noongwook G; Quakenbush L; Thewissen JGM
The Bowhead Whale
2021
2021-01-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00034-0" target="_blank" rel="noreferrer noopener"></a>
Chapter 33 - Commercial whaling
United States; Bowhead whale; Balaena mysticetus; Germany; Basques; Britain; the Netherlands; whaling; Yankee
The commercial hunt of the four stocks of bowhead whales by the nations of Europe and North America commenced in 1540 and came to an effective end at the start of World War I. At that time, all four stocks had been driven to near extinction. Whalers from many nations were involved, but the most important ones were those from Basque Country, the Netherlands, Germany, Great Britain, and the United States. The Spitsbergen stock was the first to be depleted, followed by the West Greenland–East Canada stock (including whaling efforts in Hudson Bay and Strait of Belle Isle) and, finally, the Okhotsk and Bering–Chukchi–Beaufort stocks. Competition with other products (e.g., gaslight and petroleum), political factors (e.g., US Civil War), and changes in demands (e.g., women’s fashion) caused a waxing and waning of the whaling industry, but the decrease in yield eventually stopped the hunt. Native peoples across the circumpolar Arctic suffered greatly even though commercial whalers sometimes had good relations with native people they encountered. Despite any possible good intentions, the end result was, on balance, negative and led to major changes in the indigenous cultures it affected.
Thewissen JGM; George JC
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00033-9" target="_blank" rel="noreferrer noopener"></a>
Chapter 21 - Age estimation
bowhead; stable isotopes; tympanic bulla; Age estimation; aspartic acid racemization; ovarian corpora counts; whaling artifacts
In the late 1980s, annual carbon isotope cycles in the baleen plates of bowhead whales formed the basis of the first effective means of estimating bowhead age. However, the baleen aging method could only be used for aging subadult whales less than about 20 years old, due to wearing of the plates. Since then, seven additional methods of estimating the age of bowheads have been developed. Each age estimation method has strengths and weaknesses depending on the life stage of the whale. No single method is fully applicable through the entire 200-year lifespan of a bowhead, although a combination of techniques can be quite effective and precise.
George JC; Lubetkin SC; Zeh JE; Thewissen JGM; Wetzel D; Givens GH
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00021-2" target="_blank" rel="noreferrer noopener"></a>
Chapter 20 - Molecular insights into anatomy and physiology
DNA; lipid; blubber; Bowhead whale; Balaena mysticetus; molecular evolution; longevity
Bowhead whales are some of the largest animals that occupy the Arctic Circle. Despite the challenges of living and giving birth in icy waters, having huge blubber stores, eating a fat-rich diet, and undergoing arduous migrations, bowheads achieved the longest known life span of mammals of 268 years. Their longevity is extended by fixed mutations that prevent DNA damage and cancer and through evolutionary modifications to their metabolism that compensate for an oxygen-poor environment. Recently, the bowhead genome and transcriptome libraries were made publicly available for study. Analyses suggest that their life span has been extended by evolutionary changes that result in the upregulation of DNA repair pathways. Molecular biologists are now undertaking laboratory experiments with whale samples that are informed by the bowhead genome and transcriptome to tackle questions that were inaccessible using classical model organisms such as rodents or fish. Biomedical researchers are also applying insights gained from research on bowheads into investigations of potential therapies for aging, senescence, and cancer. Moreover, researchers are using these results to inform our understanding of the evolutionary history of these traits. This chapter reviews the molecular basis for bowhead whale longevity and survival in their unique habitat and offers insights for further exploration into the molecular mechanisms that shape the extraordinary lives of these animals.
Cooper LN; Gorbunova V
The Bowhead Whale
2021
2021-01-01
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<a href="http://doi.org/10.1016/B978-0-12-818969-6.00020-0" target="_blank" rel="noreferrer noopener"></a>
Chapter 18 - Sensory systems
Bowhead whale; balance; olfaction; Balaena mysticetus; vision; audition; gustation; magnetosense; mechanosense
The sensory biology of bowhead whales reflects features both related to their origin from land mammals and adaptations to their current environment, polar seas. There is anatomical and genomic evidence that bowheads have a sense of smell. Their sense of taste may be limited to detecting salty flavorants and there is no vomeronasal organ. They lack binocular vision and color vision, and it is likely that they can perceive the magnetic field. Similar to other mysticetes, their organ of hearing is adjusted to low frequencies. Their organ of balance is much smaller than could be expected when compared to land mammals, and the functional reason for this is unclear. Sensory hairs on the face may detect water current, and, when exposed to air, wind direction.
Thewissen JGM; George JC; Suydam RS; Sformo TL
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00018-2" target="_blank" rel="noreferrer noopener"></a>
Chapter 13 - Female and male reproduction
cetacean; pregnancy; Bowhead whale; testis; reproduction; Balaena mysticetus; uterus; vagina; ovary; penis; gestation; calving interval; conception; epididymis; mysticete; ovulation; sexual maturity; spermatozoa; uterine tube
An understanding of the functional morphology of the bowhead whale continues to have significance for population management. This chapter first examines the anatomical features of the bowhead whale reproductive system, with an emphasis on the female. This is followed by a consideration of the functional parameters of the female reproductive cycle, testicular function in the male, and the age at sexual maturity in both sexes.
Tarpley RJ; Hillmann DJ; George JC; Thewissen JGM
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00013-3" target="_blank" rel="noreferrer noopener"></a>
Chapter 10 - Postcranial skeleton and musculature
forelimb; myology; Bowhead whale; muscles; skeleton; Balaena mysticetus; hindlimb;
The postcranial skeleton of bowhead whales was described in detail more than 100 years ago. The musculature of bowheads has not been studied in detail but matches that of other mysticetes in general features. In this chapter, we focus on some aspects of the skeleton that differs from that of other cetaceans. First, the skeleton of bowheads changes with ontogenetic age. Some of these changes are gross-morphologically, while others are biochemical and histological. Several are related to the life history of the species. Our discussion focuses on the changes in the morphology of the cervical vertebral column, the ontogenetic variation in carpals, and the variation in the hind limb. Individuals with external hind limbs occur infrequently, but there is a great variation in the size of ox coxae, femur, and tibia.
Thewissen JGM; Hillmann DJ; George JC; Tarpley RJ; Sheffield Gay; Stimmelmayr R; Suydam RS
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00010-8" target="_blank" rel="noreferrer noopener"></a>
Chapter 9 - Anatomy of skull and mandible
bones; whale; Bowhead whale; skull; mandible; osteology; Balaena mysticetus;
The skull of the bowhead whale is composed of all the bones commonly found in mammals, although the shape of these bones is far from ordinary. Features related to feeding dominate the skull: there are no teeth, and the rostrum is long and curved, resembling a bow. The incisive and maxilla form a high arch that forms the origin of the baleen rack, and the mandibles are straight in lateral view, but deeply curved in the horizontal plane to make room for the tongue and baleen. The blowhole is located near the apex of the skull, and the boney portion of the nasal passage opens caudally into the nasopharynx ventral to the braincase. As in other baleen whales, the occipital projects rostrally, covering a portion of the parietals and frontals.
Hillmann DJ; Tarpley RJ; George JC; Nader PB; Thewissen JGM
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00009-1" target="_blank" rel="noreferrer noopener"></a>
Chapter 8 - Prenatal development
Bowhead whale; fetus; Balaena mysticetus; embryo; gestation; heterochrony
The prenatal development of bowhead whales is poorly known, and no complete ontogenetic series exist. However, the available embryos and fetuses elucidate aspects of the development of the species, as well as that of all of mysticetes in general, and demonstrate the role of heterochrony in development. For instance, hair on the face of bowhead whale embryos develops at the same ontogenetic stage as it does in terrestrial mammals, even though body hair never develops. The absence of teeth characterizes all modern baleen whales, but bowhead whale fetuses initiate teeth around the same time as land mammals, to then resorb them in the fetal period. Baleen forms after that, late in the fetal period.
Thewissen JGM; Hillmann DJ; George JC; Stimmelmayr R; Tarpley RJ; Sheffield Gay; Suydam RS
The Bowhead Whale
2021
2021-01-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00008-X" target="_blank" rel="noreferrer noopener"></a>
Chapter 7 - Life history, growth, and form
life history; Bowhead whale; Balaena mysticetus; growth and form; longevity
Bering–Chukchi–Beaufort Sea bowhead whales are born at about 4.2m in length and 1000kg, in lead systems along the NW Alaskan coast. Bowheads in the other northern stocks are also born in ice-covered seas. Maximum body lengths (standard measure) can reach 19m. Regarding coloration: the skin is gray on neonates and young calves, and black on yearlings and adults. The size and shape of the chin patch is variable and does not change through life. After adulthood age, the specific areas of the skin lose pigment and turn white around the eye, the peduncle, genital groove, and base of the pectoral limb. Growth is rapid from birth to age 1, followed by a 3- to 4-year growth hiatus. Following the hiatus, the increase in body length is slow to sexual maturity at ~25years and ~13.5m in length. The Iñupiat recognize several growth forms associated with age; these include aġvaaq (neonate), ingutuq (yearling), qairaliq (postyearling), along with several names for large adults. Allometry of the head is marked and likely associated with extreme development of the baleen rack. The head is very large in relation to body—perhaps the largest in Mammalia. The blubber is among the thickest of any cetacean (to ~38cm). Body mass is similar to right whales of similar length; large bowheads can reach 100 metric tons or larger. Longevity can reach 200 or more years. The age of physical maturity is unclear, and adults may increase in length through life. Their ability to navigate ice-covered seas and break through ice to breathe is singular among baleen whales.
George JC; Thewissen JGM; Von Duyke A; Breed GA; Suydam RS; Sformo TL; Person BT; Brower Jr HK
The Bowhead Whale
2021
2021-01-01
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journalArticle
<a href="http://doi.org/10.1016/B978-0-12-818969-6.00007-8" target="_blank" rel="noreferrer noopener"></a>
Carpal morphology and function in the earliest cetaceans
ARTICLES
During the land-to-water transition in the Eocene epoch, the cetacean skeleton underwent modifications to accommodate life in the seas. These changes are well-documented in the fossil record. The forelimb transformed from a weight-bearing limb with mobile joints to a flipper with an immobile carpus. We used micro-CT imaging to assess evolutionary changes in carpal size, orientation, and articulation within Eocene cetacean taxa associated with the transition from a terrestrial to amphibious niche. We compared Ambulocetus natans, a well-preserved amphibious archaeocete, with other archaeocetes, and with Eocene terrestrial artiodactyls, the sister group to Cetacea. A cylindrical carpus in terrestrial taxa evolved into a mediolaterally flattened, cambered carpus in the semi-aquatic and fully aquatic cetaceans. Specifically, the pisiform bone shifted from a ventral orientation in terrestrial taxa to a lateral orientation, in plane with the carpus, within semi-aquatic and fully aquatic taxa. Flattening of the carpus, including lateral rotation of the pisiform, likely relates to functional shifts from weight-bearing terrestrial locomotion to aquatic locomotion. This laterally projecting pisiform morphology is retained in all extant cetaceans. Our results suggest this shift, along with other modifications to the carpus, predominantly occurred during the middle Eocene and facilitated an obligatorily aquatic lifestyle in late Eocene cetaceans.
Gavazzi LM; Cooper LN; Fish FE; Hussain ST; Thewissen JGM
Journal of Vertebrate Paleontology
2021
1905-07
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journalArticle
<a href="http://doi.org/10.1080/02724634.2020.1833019" target="_blank" rel="noreferrer noopener">10.1080/02724634.2020.1833019</a>
Modern thermoplastic (hot glue) versus organic-based adhesives and haft bond failure rate in experimental prehistoric ballistics.
ADHESIVES; Ballistics; BALLISTICS; BOND ratings; DENTAL adhesives; Experimental archaeology; EXPERIMENTAL archaeology; GLUE; Hafting; Hide glue; Modern thermoplastic; Pine rosin; Prehistoric weaponry
The prehistoric production of composite technologies throughout human evolution was facilitated greatly by the use of adhesives. One such technology was projectile weaponry, which used adhesive to attach a stone point to a wooden shaft. Prehistoric projectile weaponry is often studied via experimental archaeology, which recreates ancient technologies to understand their manufacture and function. Here, we explore whether a modern thermoplastic adhesive can serve as a suitable replacement for two organic adhesives that would have been used by past peoples – pine rosin and hide glue – in modern experimental tests of prehistoric weaponry. We conducted a ballistics experiment and shot groups of stone-tipped arrows, each group hafted with one of the three adhesives, and assessed the haft bond failure rate. The modern thermoplastic adhesive was similar to that of the pine rosin and significantly failed less often than the hide glue. We conclude that in some cases modern thermoplastic adhesive can be substituted for organic-based adhesives in experimental archaeology. Our results also show that hafting bond failure rate was significantly different between the pine rosin and the hide glue, suggesting that prehistoric hunter-gatherers faced costs or benefits in selecting adhesives for hafting. [ABSTRACT FROM AUTHOR]
Wilson M; Perrone A; Smith H; Norris D; Pargeter J; Eren MI
International Journal of Adhesion & Adhesives
2021
2021-01
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journalArticle
<a href="http://doi.org/10.1016/j.ijadhadh.2020.102717" target="_blank" rel="noreferrer noopener"></a>
Full acceptance of bariatric surgery? ... Let's face reality and demand better evidence!
BARIATRIC surgery; MEDICAL personnel; GASTRIC bypass; CAROTID endarterectomy; EVIDENCE
Dan A
Bariatric Times
2021
2021-01
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Metastatic adenocarcinoma of the lung presenting as a soft tissue mass.
UNITED States; METASTASIS; ADENOCARCINOMA; EPIDERMAL cyst; LUNGS; TISSUES
Lung cancer is the leading cause of cancer death in the United States, with more than 230,000 new cases, and approximately 150,000 deaths estimated for 2018. Lung cancer most commonly metastasizes to the brain, liver, lungs, bone, and adrenal system; however, there have been several cases of spread to soft tissues, with an incidence rate of approximately 0.75-9%. The objective of this case report is to highlight an unusual presentation of metastatic adenocarcinoma of the lung. In this case report, patient presented with a 3 × 3 cm soft tissue mass on the back. The mass was slowly growing but had become more painful and wished to have it excised. Preoperatively, the mass was suspected to be a sebaceous cyst but intraoperatively had deep attachments and other suspicious findings. Pathology had a positive immunoprofile for metastatic adenocarcinoma favoring a lung primary. Given this presentation of metastases, the prognosis is poor with a survival time decreasing to around 5 months. Overall, this case reinforces the importance of sending all soft tissue masses for final pathology with accurate labeling and the importance of immunohistochemical testing in aiding the identification of the primary. [ABSTRACT FROM AUTHOR]
Yglesias B; Brooker M; DeVito R; Swiger A
Case Reports in Surgery
2021
2021-01-06
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journalArticle
<a href="http://doi.org/10.1155/2021/8856503" target="_blank" rel="noreferrer noopener"></a>
Bivariate markov model based analysis of ecg for accurate identification and classification of premature heartbeats and irregular beat-patterns
Machine learning; ECG analysis; Intelligent system; Irregular beat pattern; Markov model; Medical diagnosis; Premature beat classification; Real-time system; Signal analysis
This paper describes a novel intelligent analysis technique based upon bivariate Markov model that integrates morphological and temporal features with a rule-based interval analysis of ECG signals to localize and accurately classify the premature beats to four major classes: (1) Premature Atrial Complex (PAC), (2) Blocked PAC (B-PAC), (3) Premature Ventricular Complex (PVC), and (4) Premature Junctional Complex (PJC). The paper also describes a beat-pattern classification algorithm to sub classify premature beat-patterns into bigeminy, trigeminy and quadrigeminy. The approach utilizes two phases: (1) a training phase that builds bivariate Markov model from standardized databases of ECG signals, and (2) a dynamic phase that detects embedded P and R waves in T-waves of premature beats using a combination of area subtraction and clinically significant rule-based analysis of R-R intervals. It detects and classifies premature beats using graph matching based upon the forward-backward algorithm and performs a look ahead pattern analysis for the sub-classification of beat-patterns. The algorithms have been presented. The software has been implemented that uses a combination of MATLAB and C++ libraries. Performance results show that processing time is realistic for real-time detection with 98%-99% sensitivity for the premature beat classification and 95%-98% sensitivity for the beat pattern identification.
Gawde PR; Bansal AK; Nielson JA; Khan JI
Intelligent Systems And Applications, INTELLISYS, Vol 2
2019
1905-07
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journalArticle
<a href="http://doi.org/10.1007/978-3-030-01057-7_22" target="_blank" rel="noreferrer noopener">10.1007/978-3-030-01057-7_22</a>
What every emergency physician should know about research: Introduction to a research primer for low- and middle-income countries
Emergency medicine research; Introduction; Low budget; Overview
Research is the search for new, generalisable knowledge (Truth in the Universe) to improve our collective ability to correctly diagnose and treat human suffering. In the formal sense, medical research implies both creating new knowledge, and also disseminating that new knowledge as well as putting it into practice. This is the first paper in this Research Primer. It briefly covers why each emergency physician should know and care about research. The paper reminds us that it does not take a physician to do research, but that it is the practicing physician who best knows what new knowledge is needed at the bedside. It introduces the scope of the other papers included in this special issue. The paper reviews the definitions of research and the scope of research practice in emergency medicine; overviews the hows and whys of research, as well as discusses the research question, study justification, literature search and touching on research design.
Totten V; Simon EL; Stassen W
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.10.009" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.10.009</a>
Research skills and the data spreadsheet: a research primer for low- and middle-income countries
Research; Data; Spreadsheet
The specialty of Emergency Medicine continues to expand and mature worldwide. As a relatively new specialty, the body of research that underpins patient management in the emergency department (ED) setting needs to be expanded for optimum patient care. Research in the ED, however, is complicated by a number of issues including limited time and resources, urgency for some therapeutic investigations and interventions, and difficulties in obtaining truly informed patient consent. Notwithstanding these issues, many of the fundamental principles of medical research apply equally to ED research. In all medical disciplines, data needs to be collected, collated and stored for analysis and a data spreadsheet is employed for this purpose. Like other aspects of clinical research, the use of the data spreadsheet needs to be exacting and appropriate. This research primer explores the choice of available spreadsheets and a range of principles for their best-practice use. It is deliberately, not an exhaustive review of the subject. However, we aim to explore basic principles and some of the most accessible and widely used data spreadsheets.
Taylor DM; Hodkinson PW; Khan AS; Simon EL
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.05.003" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.05.003</a>
Getting accepted - successful writing for scientific publication: A research primer for low- and middle-income countries
Publishing; Evidence-based medicine; Scientific writing
Clear and precise writing is a vital skill for healthcare providers and those involved in global emergency care research. It allows one to publish in scientific literature and present oral and written summaries of their work. However, writing skills for publishing are rarely part of the curriculum in the healthcare education system. This review gives you a step-by-step guide on how to successfully write for scientific publication following the IMRaD principle (Introduction, Methods, Results, and Discussion) with every part supporting the key message. There are specific benefits of writing for publication that justify the extra work involved. Any lessons learned about improving global emergency care delivery can be useful to emergency clinicians. The end result can lead to changing others' practice and pave the way for further research.
Simon EL; Osei-Ampofo M; Wachira BW; Kwan J
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.06.006" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.06.006</a>
Conference presentations: A research primer for low- and middle-income countries
Research methods; Conference presentation; Conference proceedings
Presenting research at a conference is an opportunity to disseminate the findings, network with other researchers, and to develop your academic track record. Although every conference will have some local differences, there are common approaches to presenting your research in the best manner. This will differ depending on whether it is an oral or a poster presentation. This research primer aims to support researchers in the early stages of their careers to undertake the best possible presentation.
Knott JC; Taylor DM; Simon EL
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.05.002" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.05.002</a>
Collaboration with non-emergency care specialists and other emergency care providers: A research primer for low- and middle-income countries
Collaboration; Best practice consensus; Emergency medicine research; Research networks; Systems development
As emergency and acute care systems develop, the ability to broadly engage key stakeholders becomes paramount for success. Collaborating with emergency medicine clinicians as well as other providers who have already developed their specialties, administrative leadership, as well as networking locally and regionally would maximise the success of developing a sustainable emergency care system.
Gutierrez CE; Simon EL
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.10.006" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.10.006</a>
Study design: A research primer for low- and middle-income countries
Emergency medicine; Research methods; Study design
Study design is critical to ensure that research questions are answered in an appropriate and rational manner for all aspects of health, but particularly in emergency care. Appropriate study design selection is one of the most critical decisions to make at the earliest stage of a research project; once this is clear, much of the methodology and sample size estimations should be straightforward. Selection of an appropriate study design is fundamental to good research and deserves careful consideration at the outset of any research project. The classic gold standard for study design is the double-blind randomised clinical trial, but it is often not possible to achieve this ideal in the busy clinical emergency environment or with the resources available. Descriptive studies are common in emergency care; they include retrospective clinical records reviews, prospective cohort studies and case-control studies. Case reports and surveys can be a useful introduction to research for novice researchers. When sufficient empirical evidence on a topic exists, results of similar studies can be combined in systematic reviews and/or meta-analyses to pool the results from multiple studies to determine stronger evidence for or against an intervention or treatment, but these techniques require specialist expertise and statistical skills.
Graham CA; Simon EL; Knott J
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.10.007" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.10.007</a>
Mentorship and how to conduct research: A research primer for low- and middle-income countries
Emergency medicine; Research; Mentorship; Low income countries
Development of a successful research program can seem daunting when looked at from the starting line. It will take years if not decades to succeed and become sustainable. It requires local partnerships and mentoring; it mandates the establishment of review boards; it requires national health policies to allow for protected time for research in salaries and for fund granting agencies to be set up; it requires training of researchers and support staff as well as a change in the mindset of clinical staff on the floor. It will almost inevitably require international support of some kind for low- and middle-income country researchers, be it university programs or other academic or private institutions. Success can occur; most likely it will occur by partnering with local research experts outside of emergency medicine in some combination with international networks and mentoring. Perhaps the most critical elements to success are intellectual curiosity and a burning flame of passion - and neither of those carry a financial cost.
Ducharme J; Simon EL; Jouriles N; Kole T; Maharjan RK
African Journal Of Emergency Medicine
2020
1905-7
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.09.005" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.09.005</a>
Funding sources for research: A research primer for low- and middle-income countries
Emergency medicine; Research; Mentorship; Low income countries
Research is a fundamental component of the development of quality emergency care systems. Developing qualified professionals and programs to conduct emergency care research is essential to understanding epidemiology in low resource settings. This leads to evaluating research outcomes, developing clinical practice guidelines and program implementation. This paper aims to introduce the reader to opportunities for research funding at various stages of one's career. We will discuss concepts necessary to obtain funding for research, a crucial step towards initiating a research program. The chapter further describes competitive funding mechanisms including governmental agencies, foundations and private industry along with organisations that offer funding for global health and emergency care research. We describe categories of grants specific to a stage of an investigator's career, developing a team for a proposal and the grant application process.
DeVos E; Simon EL; Aluisio A
African Journal Of Emergency Medicine
2020
1905-07
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<a href="http://doi.org/10.1016/j.afjem.2020.09.012" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.09.012</a>
Analysing the literature: A research primer for low- and middle-income countries
Social media; Evidence-based medicine; Librarian search strategies; Patient safety/QI
Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency medicine research. An emerging array of Free Online Open Access medical education (FOAMed) resources also provide opportunities to observe Evidence-based medicine critical appraisal in written or audio format and to actively participate as a learner. This chapter will highlight accessible resources that provide both methodological background and virtual mentoring for readers to develop EBM skills.
Carpenter CR; Hollong B; Simon EL; Graham CA
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
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<a href="http://doi.org/10.1016/j.afjem.2020.04.003" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.04.003</a>
Alcohol intoxication disrupts SHH-GLI1 signaling in mediating activation of primitive hematopoietic precursor cells during the granulopoietic response to bacteremia
Shi X; Simms KJ; Zhang P
Shock
2020
2020-06
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Lipoxin A4 induces lipid class switching and inflammation resolution at the genomic level in human osteoarthritis
Dave M; Islam A; Parekh Akshat; Patel J; Chawla A; Amin A
Arthritis & Rheumatology
2020
2020-10
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
First person - Mohammad Yunus Ansari
Ansari MY
Journal of Cell Science
2020
2020-11
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<a href="http://doi.org/10.1242/jcs.256644" target="_blank" rel="noreferrer noopener">10.1242/jcs.256644</a>
Altered endochondral ossification and primary cilia in a hypothyroid swine model
Mohrman A; Reber E; Safadi F; Adamczyk M
Journal Of Bone and Mineral Research
2020
2020-11
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
A novel regulatory role of TRAPPC9 in osteoarthritis
Hussein N; Safadi F
Journal Of Bone and Mineral Research
2020
2020-11
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Resistance to BRAF and MEK inhibitors in BRAF-mutant melanoma
Patel Hima; Yacoub N; Garrett JT
Journal of the American Academy of Dermatology
2020
2020-12
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Endothelial Trpv4 contributes to pressure overload-induced pathological hypertrophy via modulation of coronary angiogenesis
Angiogenesis; Fibrosis; Ion channels; Cardiac hypertrophy;
Adapala RK; Kanugula AK; Ohanyan VA; Paruchuri SM; Chilian WM; Thodeti CK
Circulation Research
2020
2020-12-04
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Evaluation of the FUSION-X-US-II prototype to combine automated breast ultrasound and tomosynthesis
Imaging; Ultrasonography; Mammography; mammary; Early detection of cancer; Multimodal imaging; three-dimensional
Objective The FUSION-X-US-II prototype was developed to combine 3D automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device. We evaluated the performance of ABUS and tomosynthesis in a single examination in a clinical setting. Methods In this prospective feasibility study, digital breast tomosynthesis and ABUS were performed using the FUSION-X-US-II prototype without any change of the breast position in patients referred for clarification of breast lesions with an indication for tomosynthesis. The tomosynthesis and ABUS images of the prototype were interpreted independently from the clinical standard by a breast diagnostics specialist. Any detected lesion was classified using BI-RADS (R) scores, and results of the standard clinical routine workup (gold standard) were compared to the result of the separate evaluation of the prototype images. Image quality was rated subjectively and coverage of the breast was measured. Results One hundred one patients received both ABUS and tomosynthesis using the prototype. The duration of the additional ABUS acquisition was 40 to 60 s. Breast coverage by ABUS was approximately 80.0%. ABUS image quality was rated as diagnostically useful in 86 of 101 cases (85.1%). Thirty-three of 34 malignant breast lesions (97.1%) were identified using the prototype. Conclusion The FUSION-X-US-II prototype allows a fast ABUS scan in combination with digital breast tomosynthesis in a single device integrated in the clinical workflow. Malignant breast lesions can be localized accurately with direct correlation of ABUS and tomosynthesis images. The FUSION system shows the potential to improve breast cancer screening in the future after further technical improvements.
Schaefgen B; Juskic M; Radicke M; Hertel M; Barr R; Pfob A; Togawa R; Nees J; von Au A; Fastner S; Harcos A; Gomez C; Stieber A; Riedel F; Hennigs A; Sohn C; Heil J; Golatta M
European Radiology
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<a href="http://doi.org/10.1007/s00330-020-07573-3" target="_blank" rel="noreferrer noopener">10.1007/s00330-020-07573-3</a>
Post-traumatic stress and stress disorders during the COVID-19 pandemic: Survey of emergency physicians.
OBJECTIVE: Emergency physicians routinely encounter stressful clinical situations, including treating victims of crime, violence, and trauma; facing the deaths of patients; and delivering bad news. During a pandemic, stress may be increased for healthcare workers. This study was undertaken to identify symptoms of post-traumatic stress disorder (PTSD) among emergency physicians during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional survey was developed using the Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (DSM-5) and the PTSD Checklist for DSM-5 (PCL-5). The survey was distributed to members of the American College of Emergency Physicians from May 21, 2020, through June 22, 2020. RESULTS: Among 1300 emergency physicians, a significant number of participants (22.3%; 95% confidence interval, 20.3-24.3%) reported symptoms of stress consistent with PTSD (PCL score ≥ 33). Higher PCL-5 scores were associated with age younger than 50 years (P < 0.05) and <10 years in practice (P < 0.05). The major sources of stress identified by participants included disinformation about COVID-19, computer work/electronic medical record, personal protective equipment concerns, and workload. The most common consequences of workplace stress were feeling distant or cut off from other people and sleep disturbance, such as trouble falling or staying asleep. CONCLUSIONS: A significant number of emergency physicians reported symptoms of stress consistent with PTSD. Higher PCL-5 scores were associated with age younger than 50 years and <10 years in practice.
Marco CA; Larkin GL; Feeser VR; Monti JE; Vearrier L
Journal of the American College of Emergency Physicians Open
2020
2020-12
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journalArticle
<a href="http://doi.org/10.1002/emp2.12305" target="_blank" rel="noreferrer noopener">10.1002/emp2.12305</a>
Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments.
OBJECTIVE: Our investigation compared throughput metrics and utilization measures for freestanding emergency departments (FSEDs) versus hospital-based emergency departments (HBEDs) of similar volumes in the United States. METHODS: This study is a cross sectional survey of 183 FSEDs and 317 HBEDs located across the United States using the Emergency Department Benchmarking Alliance (EDBA) Database. We measured common emergency department (ED) throughput metrics. Primary outcomes included overall length of stay, length of stay for admitted, and length of stay for treated and released patients. Outcomes were weighted based on the proportion of ED volume per facility as per a prior pilot study. Multiple linear regression analysis was used to adjust for measured differences between FSEDs and HBEDs. The variables that were controlled for in regression analysis included geographic location of the ED (urban, suburban, and rural), percent of high acuity capacity, ED volume, percentage of patients arriving via emergency medical services (EMS), and percentage of pediatric patients. RESULTS: Nationally, the median length of stay in minutes (104.2 vs 140.0), length of stay for treated and released patients (98.6 vs 122.9), door-to-bed (4.0 vs 8.0), door-to-doctor (11.0 vs 16.0), percentage of patients admitted through the ED (4.0 vs 11.0), and percentage of patients leaving the ED without being seen (LWBS) (0.9 vs 1.5), were significantly lower at FSEDs compared to HBEDs (P < 0.0001 for all comparisons). Length of stay for admitted patients (265.9 vs 241.8) and median boarding time (96.8 vs. 71.3) were significantly lower in HBEDs compared to FSEDs. X-ray, computed tomography, and ECG utilization per 100 patients was significantly lower at the FSEDs compared to HBEDs. Multiple linear regression analysis demonstrated that the length of stay for treated and released patients was 8.67 minutes shorter for FSEDs as compared to HBEDs (95% confidence interval [CI] = -1.4 to -16.0). The length of stay for admitted patients was 44 minutes longer for FSEDs as compared to HBEDs (95% CI = 25.5 to 63.0). CONCLUSIONS: In this study of similarly sized EDs in the United States, throughput metrics for FSEDs tended to be significantly shorter from the arrival of the patient until their departure, except for patients requiring hospital admission. For measures favoring FSEDs, throughput times range from 20%-50% shorter than HBEDs.
Dark C;Canellas M; Mangira C; Jouriles N; Simon EL
Journal of the American College of Emergency Physicians Open
2020
2020-12
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journalArticle
<a href="http://doi.org/10.1002/emp2.12318" target="_blank" rel="noreferrer noopener">10.1002/emp2.12318</a>
Pathophysiology of aspiration in a unilateral SLN lesion model using quantitative analysis of VFSS.
Pathophysiology; Dysphagia; Superior laryngeal nerve; Videofluoroscopy; Swallow
OBJECTIVE: The purpose of this study was to elucidate the pathophysiology of aspiration in previously studied female infant piglets after a unilateral superior laryngeal nerve (uSLN) lesion. METHODS: Videofluoroscopic swallow studies (VFSS) were acquired from 15 female piglets ages 2-3 weeks (9 with uSLN lesion and 6 controls). VFSS were analyzed at 30 frames/second sampling rate. Quantitative measures were conducted and compared between groups using published methodologies for VFSS assessment in adult and infant humans. Measures included the: 1) number of lingual-palatal contacts (LPC) (i.e. pre-swallow), 2) total pharyngeal transit time (TPT), 3) offset of swallow (offP), as well as onset of: 4) pharyngeal stage (onP), 5) pharyngoesophageal segment opening (oPES), 6) maximum PES opening (maxPES), 7) airway closure onset (oAC), and 8) maximum airway closure (maxAC). Measures 5-7 were determined relative to onP. Bolus residue was rated by severity (0 (none) to 3 (severe)). A gamma regression was used to compare continuous measures between lesioned and control groups. RESULTS: The number of LPC (p = .006), TPT (p = .023) and timing of maxAC (p = .041) were significantly greater in the uSLN lesion than the control group. CONCLUSIONS: Outcomes of this study replicated prior published findings and elucidated that piglets with right uSLN lesions exhibited delayed maxAC. Noteworthy was the use of clinically relevant quantitative videofluoroscopic measures in piglets for comparison to future studies in human pediatric populations.
Stevens M; Mayerl CJ; Bond L; German RZ; Barkmeier-Kraemer JM
International Journal of Pediatric Otorhinolaryngology
2021
2021-01
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journalArticle
<a href="http://doi.org/10.1016/j.ijporl.2020.110518" target="_blank" rel="noreferrer noopener">10.1016/j.ijporl.2020.110518</a>
Acute kidney injury associated with urinary stone disease in children and young adults presenting to a pediatric emergency department.
AKI; kidney stones; pediatric; urinary stone disease (USD); urolithiasis
Background: Acute kidney injury (AKI) due to urinary stone disease (USD) is rare in adults; AKI rates in children with USD may be higher, and emerging data links stones to chronic kidney disease (CKD) development in adults. Methods: This study is a retrospective analysis of USD patients at a single pediatric hospital system's emergency department (ED). Patients were initially identified by USD ICD codes; USD was then confirmed by imaging or physician documentation; patients had to have baseline creatinine (Cr) and Cr in the ED for comparison to be included. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Network (AKIN), and Pediatric Risk, Injury, Failure, Loss, End Stage (pRIFLE). Results: Of the 589 total visits, 264/589 (45%) had data to evaluate for AKI, 23% were AKI(+) and 77% were AKI(-). pRIFLE was most common (82%) and 18% were only positive by AKIN/KDIGO. AKI(+) were more likely to be younger (16.7 vs. 17.4 years, p = 0.046) and more likely to present with vomiting {odds ratio [OR] [95% confidence interval (CI)]: 2.4 [1.4-4.3], p = 0.002}; also, the proportion of AKI(+) was significantly higher in <18 vs. ≥18 years [26.9 vs. 15.5%, p = 0.032, OR (95% CI): 2.0 (1.1-3.9)]. Urinary tract infection (UTI) and obstruction rates were similar between groups. AKI(+) patients had a significant OR <1 suggesting less risk of receiving non-steroidal anti-inflammatory drugs (NSAIDs); however, 51% of them did receive NSAIDs during their ED encounter. AKI(+) patients were more likely to require admission to the hospital (53 vs. 32%, p = 0.001). Conclusion: We have demonstrated a novel association between USD-induced renal colic and AKI in a group of young adults and children. AKI(+) patients were younger and were more likely to present with vomiting. AKI(+) patients did not have higher rates of obstruction or UTI, and 51% of AKI(+) received NSAIDs.
Farris N; Raina R; Tibrewal A; Brown M; Colvis M; Schwaderer A; Kusumi K
Frontiers in Pediatrics
2020
1905-07
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journalArticle
<a href="http://doi.org/10.3389/fped.2020.591520" target="_blank" rel="noreferrer noopener">10.3389/fped.2020.591520</a>
Long bone histomorphogenesis of the naked mole-rat: Histodiversity and intraspecific variation.
bone microstructure; bone modeling; endosteal bone; Heterocephalus glaber; lamellar bone; lamellar-zonal bone; long bone growth; lamellar‐ zonal bone
Lacking fur, living in eusocial colonies and having the longest lifespan of any rodent, makes naked mole-rats (NMRs) rather peculiar mammals. Although they exhibit a high degree of polymorphism, skeletal plasticity are considered a novel model to assess the effects of delayed puberty on the skeletal system, scarce information on their morphogenesis exists. Here, we examined a large ontogenetic sample (n = 76) of subordinate individuals to assess the pattern of bone growth and bone microstructure of fore- and hindlimb bones by using histomorphological techniques. Over 290 undecalcified thin cross-sections from the midshaft of the humerus, ulna, femur, and tibia from pups, juveniles and adults were analyzed with polarized light microscopy. Similar to other fossorial mammals, NMRs exhibited a systematic cortical thickening of their long bones, which clearly indicates a conserved functional adaptation to withstand the mechanical strains imposed during digging, regardless of their chisel-tooth predominance. We describe a high histodiversity of bone matrices and the formation of secondary osteons in NMRs. The bones of pups are extremely thin-walled and grow by periosteal bone formation coupled with considerable expansion of the medullary cavity, a process probably tightly regulated and adapted to optimize the amount of minerals destined for skeletal development, to thus allow the female breeder to produce a higher number of pups, as well as several litters. Subsequent cortical thickening in juveniles involves high amounts of endosteal bone apposition, which contrasts with the bone modeling of other mammals where a periosteal predominance exists. Adults have bone matrices predominantly consisting of parallel-fibered bone and lamellar bone, which indicate intermediate to slow rates of osteogenesis, as well as the development of poorly vascularized lamellar-zonal tissues separated by lines of arrested growth (LAGs) and annuli. These features reflect the low metabolism, low body temperature and slow growth rates reported for this species, as well as indicate a cyclical pattern of osteogenesis. The presence of LAGs in captive individuals was striking and indicates that postnatal osteogenesis and its consequent cortical stratification most likely represents a plesiomorphic thermometabolic strategy among endotherms which has been suggested to be regulated by endogenous rhythms. However, the generalized presence of LAGs in this and other subterranean taxa in the wild, as well as recent investigations on variability of environmental conditions in burrow systems, supports the hypothesis that underground environments experience seasonal fluctuations that may influence the postnatal osteogenesis of animals by limiting the extension of burrow systems during the unfavorable dry seasons and therefore the finding of food resources. Additionally, the intraspecific variation found in the formation of bone tissue matrices and vascularization suggested a high degree of developmental plasticity in NMRs, which may help explaining the polymorphism reported for this species. The results obtained here represent a valuable contribution to understanding the relationship of several aspects involved in the morphogenesis of the skeletal system of a mammal with extraordinary adaptations.
Montoya-Sanhueza G; Bennett NC; Oosthuizen MK; Dengler-Crish CM; Chinsamy A
Journal of Anatomy
2020
2020-12-11
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journalArticle
<a href="http://doi.org/10.1111/joa.13381" target="_blank" rel="noreferrer noopener">10.1111/joa.13381</a>
Prevalence, predictors and trends of opioid prescribing for lower back pain in united states emergency departments.
low back pain; opioid; opioid prescribing; pain
WHAT IS KNOWN AND OBJECTIVE: Current evidence-based guidelines for the treatment of acute low back pain (ALBP) recommend the use of opioid medications only after failure of nonpharmacological therapy, non-steroidal anti-inflammatory drugs and skeletal muscle relaxants and after thorough evaluation of risks and benefits. Despite this recommendation and the state of the opioid epidemic in the United States (US), opioids remain a common drug of choice for ALBP in the emergency department (ED). The purpose of this study was to quantify the prevalence and identify predictors of opioid prescribing for acute lower back pain (ALBP) in emergency departments (EDs) in the United States. METHODS: This was a national, cross-sectional study of the National Hospital Ambulatory Care Survey from 2013-2016. ED visits for patients aged ≥18 years treated for ALBP were included. Patients presenting with specified reasons that an opioid may be indicated were excluded. The primary endpoint was frequency of opioids prescribed. A multivariate logistic regression model identified patient- and provider-level predictors of opioid use. RESULTS AND DISCUSSION: This analysis included 2260 visits for ALBP. Opioids were prescribed in 32.3% of visits. Positive predictors of opioid prescribing were pain score of 7-10 (OR 1.85; 95% CI 1.26-2.70), and patients seen in the Southern (OR 2.53; 95% CI 1.47-4.36) or Western US (OR 2.10; 95% CI 1.19-3.70). Opioids were prescribed less often to patients who received a NSAID or acetaminophen (OR 0.38; 95% CI 0.28-0.52 and OR 0.03; 95% CI 0.01-0.10, respectively). WHAT IS NEW AND CONCLUSION: Opioid prescribing rates for ALBP remain high and the predictors identified demonstrate that this prescribing pattern is not uniformly distributed across the patient and provider characteristics studied.
Walkerly A; Neugebauer RE; Misko B; Shively Danielle; Singh S; Chahda B; Dhanireddy S; King K; Lloyd M; Fosnight S; Costello M; Palladino C; Soric M
Journal of Clinical Pharmacy and Therapeutics
2020
2020-12-11
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journalArticle
<a href="http://doi.org/10.1111/jcpt.13324" target="_blank" rel="noreferrer noopener">10.1111/jcpt.13324</a>