A survey of pain physicians: Needlesticks injuries.

OBJECTIVE: To investigate and characterize the incidence of needlestick injuries (NSI) in a sample of practicing pain medicine physicians, with the ultimate goal of aiding to prevent these injuries by raising awareness of their prevalence. DESIGN: A cross-sectional research survey. SETTING: A REDCap survey was emailed to physicians who had membership to the American Academy of Pain Medicine. SUBJECTS: Eligibility criteria included physicians who were actively practicing and identified as pain physicians who participated in procedures with needlesticks or sharps. METHODS: Basic demographics without identifiers were collected, including practice setting, years in practice, and training type. Respondents were asked to estimate the number of sharps-involved procedure days per week and per day. They were then asked to estimate the number of NSIs they sustained since completing training and in the past year. RESULTS: A total of 430 surveys were opened by email by potential participants, of which 124 responded (response rate 29%). Data from a total of 109 respondents that met inclusion criteria were included. Roughly 60% of respondents reported at least one NSI since completing training and approximately one-third had sustained more than three NSIs. In the last year, roughly 19% of providers reported at least one needlestick injury. The number of NSIs reported by providers since completing training was not significantly associated with practice setting, the number of procedure days per week, or the number of sharps-involved procedures per day. There was a significant relationship between years post-training and number of NSIs since completing training, with providers with more years post-training reporting higher incidences of NSIs (p < 0.0005). The number of NSIs since completing training and the number of NSIs were also associated, with providers that had sustained a greater number of total NSIs reporting a higher incidence of NSIs within the last year (p < 0.0005). CONCLUSIONS: This study characterizes NSIs in a population of pain medicine physicians. These data warrant caution and will hopefully raise awareness amongst providers.

Neural-hematopoietic-inflammatory axis in nonsmokers, electronic cigarette users, and tobacco smokers.

Amygdala activity in context of the splenocardiac model has not been investigated in healthy, young adults and has not been compared between nonsmokers, electronic cigarette users, and smokers. The purpose of the current study was to determine whether fluorodeoxyglucose positron emission tomography/computer tomography (FDG PET/CT) scans would demonstrate positively correlated metabolic activity in the amygdala, bone marrow, spleen, and aorta, elucidating activation of the splenocardiac axis in otherwise healthy young people who use tobacco products compared to nonusers. Moreover, the study was conducted to evaluate whether electronic cigarette users and tobacco smokers have similar levels of inflammation compared to nonusers. In 45 healthy adults (mean age = 25 years), including nonsmoker (n = 15), electronic cigarette user (n = 16), and smoker (n = 14) groups, metabolic activity in the amygdala, spleen, aorta, bone marrow of thoracic vertebrae, and adjacent erector spinae skeletal muscle was quantified through visualization of radioactive glucose (18 FDG) uptake by FDG-PET/CT. The maximum standardized uptake value for each region was calculated for correlation analyses and comparisons between groups. In correlation analyses, metabolic activity of the amygdala correlated with metabolic activity in the aorta (r = 0.757), bone marrow (r = 0.750), and spleen (r = 0.665), respectively. Metabolic activity in the aorta correlated with 18 FDG uptake in the thoracic vertebrae (r = 0.703) and spleen (r = 0.594), respectively. Metabolic activity in the spleen also correlated with 18 FDG uptake in the bone marrow (r = 0.620). Metabolic activity in the adjacent erector spinae skeletal muscle (our control tissue) was not positively correlated with any other region of interest. Finally, there were no statistically significant mean differences in metabolic activity between the three groups: nonsmokers, electronic cigarette users, and smokers in any target tissue. Amygdala metabolic activity, as measured by 18 FDG uptake in FDG-PET/CT scans, positively correlated with inflammation in the splenocardiac tissues, including: the aorta, bone marrow, and spleen, underscoring the existence of a neural-hematopoietic-inflammatory axis in healthy, young adults.

The Association of Medical Preoperative Evaluation Using Clinical Video Telehealth With Hospital Length of Stay: Descriptive Analysis.

BACKGROUND: Preoperative medical evaluation serves to identify risk factors and optimize patients before surgery. Providing a telehealth option in the perioperative setting has played a significant role in reducing barriers to quality perioperative health care. OBJECTIVE: We aimed to evaluate how telemedicine preoperative evaluations using Clinical Video Telehealth (CVT) impact hospital length of stay. METHODS: We performed a retrospective chart review between 2016 and 2017 of adult patients who underwent evaluations in our hospitalist-run preoperative medicine clinic. Patients seen in our preoperative CVT program were compared to patients seen in person to evaluate the association of visit type (preoperative CVT versus in-person evaluation) with hospital length of stay, defined as hospital stay from postoperative day 0 to discharge. There were 62 patients included in this retrospective study. RESULTS: The adjusted incidence rate ratio (IRR) for hospital length of stay was significantly shorter in patients who underwent preoperative CVT compared to an in-person visit (IRR 0.52, 95% CI 0.29-0.92, P=.02). CONCLUSIONS: After adjusting for age and comorbidities, we show that preoperative telemedicine in the perioperative setting is associated with a shorter hospital length of stay compared to in-person visits. This suggests that telemedicine can play a viable role in this clinical setting.

The Relative Utility of Concurrent Sources of Information for Diagnosis of Autism Spectrum Disorder in Early Childhood.

The development of effective screening methods for Autism Spectrum Disorder (ASD) in early childhood remains a public health priority for communities around the world. Little is known regarding the concurrence between parent concerns about ASD and formal ASD diagnostic methods. This study aimed to examine the relationships among a priori parental ASD concern, ADOS classification, and a physician specialist's diagnosis. One hundred and thirty-four toddlers (74% male; mean age = 31.8 months, SD 4.4) received an evaluation at a university center specializing in ASD and neurodevelopmental disorders. Correspondence between a priori parental ASD suspicion and physician diagnosis of ASD was 61% (p = 0.028). Correspondence between a priori parental suspicion of ASD and ADOS ASD classification was 57% (p = 0.483). Correspondence between ADOS classification and physician diagnosis of ASD was 88% (p = 0.001). Our results have implications for evaluations in low resource regions of the world where access to physician specialists may be limited; the high correspondence between ADOS classification and a physician specialist's diagnosis supports the use of trained ADOS evaluators, such as field health workers or early childhood educators, in a tiered screening process designed to identify those most in need of a specialist's evaluation. Our results also have implications for public health efforts to provide parent education to enable parents to monitor their child's development and share concerns with their providers. Parent awareness and expression of concern coupled with timely responses from providers may lead toward earlier identification of ASD, and other neurodevelopmental disorders, and hence, generate opportunities for earlier and more personalized intervention approaches, which in turn may help improve long-term outcomes. Empowering parents and community members to screen for ASD may be especially important in regions of the world where access to formal diagnosis is limited.

Elevated Cellular Oxidative Stress in Circulating Immune Cells in Otherwise Healthy Young People Who Use Electronic Cigarettes in a Cross-Sectional Single-Center Study: Implications for Future Cardiovascular Risk.

Background Tobacco cigarettes (TCs) increase oxidative stress and inflammation, both instigators of atherosclerotic cardiac disease. It is unknown if electronic cigarettes (ECs) also increase immune cell oxidative stress. We hypothesized an ordered, "dose-response" relationship, with tobacco-product type as "dose" (lowest in nonsmokers, intermediate in EC vapers, and highest in TC smokers), and the "response" being cellular oxidative stress (COS) in immune cell subtypes, in otherwise, healthy young people. Methods and Results Using flow cytometry and fluorescent probes, COS was determined in immune cell subtypes in 33 otherwise healthy young people: nonsmokers (n=12), EC vapers (n=12), and TC smokers (n=9). Study groups had similar baseline characteristics, including age, sex, race, and education level. A dose-response increase in proinflammatory monocytes and lymphocytes, and their COS content among the 3 study groups was found: lowest in nonsmokers, intermediate in EC vapers, and highest in TC smokers. These findings were most striking in CD14dimCD16+ and CD14++CD16+ proinflammatory monocytes and were reproduced with 2 independent fluorescent probes of COS. Conclusions These findings portend the development of premature cardiovascular disease in otherwise healthy young people who chronically vape ECs. On the other hand, that the COS is lower in EC vapers compared with TC smokers warrants additional investigation to determine if switching to ECs may form part of a harm-reduction strategy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03823885.

Acute and chronic sympathomimetic effects of e-cigarette and tobacco cigarette smoking: role of nicotine and non-nicotine constituents.

Electronic cigarettes (ECs) and tobacco cigarettes (TCs) both release nicotine, a sympathomimetic drug. We hypothesized that baseline heart rate variability (HRV) and hemodynamics would be similar in chronic EC and TC smokers and that after acute EC use, changes in HRV and hemodynamics would be attributable to nicotine, not non-nicotine, constituents in EC aerosol. In 100 smokers, including 58 chronic EC users and 42 TC smokers, baseline HRV and hemodynamics [blood pressure (BP) and heart rate (HR)] were compared. To isolate the acute effects of nicotine vs. non-nicotine constituents in EC aerosol, we compared changes in HRV, BP, and HR in EC users after using an EC with nicotine (ECN), EC without nicotine (EC0), nicotine inhaler (NI), or sham vaping (control). Outcomes were also compared with TC smokers after smoking one TC. Baseline HRV and hemodynamics were not different in chronic EC users and TC smokers. In EC users, BP and HR, but not HRV outcomes, increased only after using the ECN, consistent with a nicotine effect on BP and HR. Similarly, in TC smokers, BP and HR but not HRV outcomes increased after smoking one TC. Despite a similar increase in nicotine, the hemodynamic increases were significantly greater after TC smokers smoked one TC compared with the increases after EC users used the ECN. In conclusion, chronic EC and TC smokers exhibit a similar pattern of baseline HRV. Acute increases in BP and HR in EC users are attributable to nicotine, not non-nicotine, constituents in EC aerosol. The greater acute pressor effects after TC compared with ECN may be attributable to non-nicotine, combusted constituents in TC smoke.NEW & NOTEWORTHY Chronic electronic cigarette (EC) users and tobacco cigarette (TC) smokers exhibit a similar level of sympathetic nerve activity as estimated by heart rate variability. Acute increases in blood pressure (BP) and heart rate in EC users are attribute to nicotine, not non-nicotine, constituents in EC aerosol. Acute TC smoking increased BP significantly more than acute EC use, despite similar increases in plasma nicotine, suggestive of additional adverse vascular effects attributable to combusted, non-nicotine constituents in TC smoke.

In Vitro Microleakage Comparison of Flowable Nanocomposites and Conventional Materials Used in Pit and Fissure Sealant Therapy.

OBJECTIVES: Pit and fissure sealants are recognized as an effective preventive approach in pediatric dentistry. Composite resin is the most commonly used sealant material. Adding nanoparticles to composite resin could result in production of flowable composite with higher mechanical properties and better flowability than previous sealants. This study aimed to compare the microleakage of a flowable nanocomposite and materials conventionally used as pit and fissure sealants. MATERIALS AND METHODS: A total of 185 extracted mandibular third molar teeth were selected and randomly divided into 5 groups (n=36): flowable nanocomposite, flowable composite, filled sealants, nano-filled sealants, and unfilled sealants. Five teeth were reserved for examination under a scanning electron microscope (SEM). The samples were thermocycled (5-55°C, 1-minute dwell time) for 1000 cycles and immersed in 0.2% fuchsine solution for 24 hours. Teeth were sectioned buccolingually. Microleakage was assessed qualitatively and quantitatively by means of dye penetration and SEM. Data were analyzed using chi-square, Kruskal-Wallis, and Bonferroni-corrected Mann-Whitney U tests.Results: Qualitative microleakage assessment showed that flowable composite and nanofilled flowable composite had almost no microleakage (P<0.001). Regarding quantitative scores, the nanofilled flowable composite and unfilled fissure sealant showed the lowest and the highest rate of microleakage, respectively. No statistically significant difference was found between the two flowable composites (P=0.317). Filled resin-based sealant had significantly lower microleakage than unfilled resin-based sealant (P<0.001). CONCLUSION: Use of flowable and nanofilled flowable composites (but not unfilled resin-based fissure sealant) is recommended for sealing of pits and fissures of molars.

Designing an iPad App to Monitor and Improve Classroom Behavior for Children with ADHD: iSelfControl Feasibility and Pilot Studies.

Children with Attention Deficit/Hyperactivity Disorder (ADHD) receive approximately 80% of instruction in the general education classroom, where individualized behavioral management strategies may be difficult for teachers to consistently deliver. Mobile device apps provide promising platforms to manage behavior. This pilot study evaluated the utility of a web-based application (iSelfControl) designed to support classroom behavior management. iSelfControl prompted students every 'Center' (30-minutes) to self-evaluate using a universal token-economy classroom management system focused on compliance, productivity, and positive relationships. Simultaneously, the teacher evaluated each student on a separate iPad. Using Multi Level Modeling, we examined 13 days of data gathered from implementation with 5th grade students (N = 12) at a school for children with ADHD and related executive function difficulties. First, an unconditional growth model evaluated the overall amount of change in aggregated scores over time as well as the degree of systematic variation in scores within and across teacher-student dyads. Second, separate intercepts and slopes were estimated for teacher and student to estimate degree of congruency between trajectories. Finally, differences between teacher and student scores were tested at each time-point in separate models to examine unique 'Center' effects. 51% of the total variance in scores was attributed to differences between dyads. Trajectories of student and teacher scores remained relatively stable across seven time-points each day and did not statistically differ from each other. On any given day, students tended to evaluate their behaviors more positively (entered higher scores for themselves) compared to corresponding teacher scores. In summary, iSelfControl provides a platform for self and teacher evaluation that is an important adjunct to conventional classroom management strategies. The application captured teacher/student discrepancies and significant variations across the day. Future research with a larger, clinically diagnosed sample in multiple classrooms is needed to assess generalizability to a wider variety of classroom settings.

Dancer perceptions of the cognitive, social, emotional, and physical benefits of modern styles of partnered dancing.

OBJECTIVE: To study dancers' perceptions of the physical, cognitive, affective, and social benefits of partnered dancing. METHOD: 225 dancers (71% female) were recruited through a community ballroom dance center and completed an online survey designed to measure their perceptions of the physical, cognitive, affective, and social benefits of modern, partnered dance styles (swing, Lindy Hop, and ballroom dancing). Subgroups were formed for analyses. For one set of analyses, groups based on length of dance participation were formed: experienced (dancing for more than 2 years) or novice (dancing for less than a year) dancers. For another set of analyses, groups based on frequency of dance practice were formed: committed (dancing at least one or more times per week) or occasional (dancing two or fewer times per month). RESULTS: The majority of participants reported perceived benefits in physical fitness, cognition, affect, and social functioning. Experienced dancers reported significantly greater self-perceived physical, social, and cognitive benefits than novice dancers. Committed dancers were more likely than occasional dancers to report improvements in physical fitness, U=6942, z=2.38, r=0.16, p<0.05. A Mann-Whitney test indicated that self-reported improvements in mood (i.e., feeling less depressed and more happy) were greater for women than for men, U=3945, z=-3.07, r=0.20, p<0.001. Length and frequency of dance participation significantly predicted perceived physical benefits [Χ(2) (1,6)=35.463, p <0.001, R(2)=0.16] and social benefits [Χ(2) (1,6)=15.776, p<0.05, R(2)=0.07], but not cognitive benefits. CONCLUSIONS: Results suggest that participation in partnered dance styles is associated with perceived improvements in physical fitness, cognitive functioning, social functioning, mood, and self-confidence, and that perceived benefits may increase as individuals dance more frequently and over longer periods of time.

The Healthy for Life Taekwondo Pilot Study: A Preliminary Evaluation of Effects on Executive Function and BMI, Feasibility, and Acceptability.

There is growing consensus that exercise improves cognitive functioning, but research is needed to identify exercise interventions that optimize effects on cognition. The objective of this pilot study was to evaluate Taekwondo implemented in public middle school physical education (PE). Two classes were randomly assigned to either: five sessions per week of PE or three sessions of PE and two sessions of Taekwondo. In PE sessions, evidence-based curriculum to address the Presidential Core Fitness Guidelines and California Physical Fitness Tests was implemented. Taekwondo sessions included traditional techniques and forms taught in an environment emphasizing respect and self-control. Sixty students were evaluated at baseline and during the last week of the intervention (nine months later). Differences in mean residualized change scores for parent-rated inhibitory behavioral control yielded a significant, large effect size (d =.95, p =.00), reflecting greater improvement among Taekwondo students. Results from an executive function computer-administered task revealed greater accuracy on the congruent trial (d = 2.00, p = .02) for Taekwondo students. Differences in mean residualized change scores for BMI z scores yielded a moderate, non-significant effect size (d = - .51, p = .16). The majority of Taekwondo students reported positive perceptions of Taekwondo and perceived self-improvement in self-control and physical fitness. Results suggest that Taekwondo is an exercise program that improves cognitive functioning and is both feasible and acceptable to implement in a public school setting.