A 23-year analysis of litigation in orthopedic elbow surgery.

BACKGROUND: The reasons for malpractice litigation in elbow surgery are not well understood. The aim of this study is to report the most frequently litigated surgeries of the elbow and analyze the reasons for litigation and case outcomes. METHODS: A retrospective review of the Westlaw legal database was performed, and all federal and state jurisdiction litigation cases involving the elbow from 2000 to 2023 were queried. Cases were excluded if they did not involve an orthopedic surgeon, nor primary elbow injury or procedure. Cases were reviewed for demographic information, surgical procedure based on reference Current Procedural Terminology codes, complications, symptoms, and reasons for litigation. Quantitative information, including settlement and indemnity cost to the defendant orthopedic surgeon, was analyzed. Cases were subdivided based on United States Census Bureau regions and states to assess regional frequency of litigation with analyses of variance. RESULTS: There were 59 cases meeting inclusion criteria from 2000 to 2023. The most litigated cases involved were ulnar nerve transposition/release and open reduction and internal fixation of the proximal radius and/or ulna at the elbow. The most litigated complication was claimed nerve damage (46%) and permanent disability (27%). Of the total cases, the most frequently litigated symptoms were nerve damage (46%) and loss of function (37%), whereas the least frequent was postoperative stiffness (2%). The Pacific region demonstrated the highest litigation rate (20%), whereas the East South Central, Mountain, and New England regions had the lowest litigation rate (3% each). A favorable verdict was given to the defendant orthopedic surgeon in 59% of the cases. The average loss incurred through settlement was $245,590, whereas the average indemnity paid through verdict was $523,334. CONCLUSION: Operative fixation of the proximal ulna/radius and ulnar nerve release/transposition are the most litigated procedures of the elbow. Litigation is most associated with nerve injury. Across Census Bureau regions, there is no significant difference in monetary cost incurred through settlements and verdict losses. Although a majority of litigated cases are won by the defending orthopedic surgeon, thorough informed consent and perioperative expectation management may mitigate litigation risk.

Antiviral activity of salt-coated materials against SARS-CoV-2.

The SARS-CoV-2 pandemic demonstrated the importance of human coronaviruses and the need to develop materials to prevent the spread of emergent respiratory viruses. Coating of surfaces with antiviral materials is a major interest in controlling spread of viruses, especially in high-risk or high-traffic areas. A number of different coatings for surfaces have been proposed, each with their own advantages and disadvantages. Here we show that simple salt coating on a range of surfaces, including a novel biomass aerogel can reduce the infectivity of SARS-CoV-2 placed onto the surface. This suggests that a simple to apply coating could be applied to a range of materials and have an antiviral effect against SARS-CoV-2, as well as other potential emerging viruses.

Experimental study of the purification performance of a MopFan-based photocatalytic air cleaning system.

Severe acute respiratory syndrome coronavirus (SARS-CoV)-2, the virus that causes the coronavirus disease (COVID)-19, is primarily transmitted through respiratory droplets which linger in enclosed spaces, often exacerbated by HVAC systems. Although research to improve HVAC handling of SARS-CoV-2 is progressing, currently installed HVAC systems cause problems because they recirculate air and use ineffective filters against virus. This paper details the process of developing a novel method of eliminating air pollutants and suspended pathogens in enclosed spaces using Photocatalytic Oxidation (PCO) technology. It has been previously employed to remove organic contaminants and compounds from air streams using the irradiation of titanium dioxide (TiO2) surfaces with ultraviolet (UV) lights causing the disintegration of organic compounds by reactions with oxygen (O) and hydroxyl radicals (OH). The outcome was two functional prototypes that demonstrate the operation of PCO-based air purification principle. These prototypes comprise a novel TiO2 coated fibre mop system, which provide very large surface area for UV irradiation. Four commercially accessible materials were used for the construction of the mop: Tampico, Brass, Coco, and Natural synthetic. Two types of UV lights were used: 365 nm (UVA) and 270 nm (UVC). A series of tests were conducted that proved the prototype's functionality and its efficiency in lowering volatile organic compounds (VOCs) and formaldehyde (HCHO). The results shown that a MopFan with rotary mop constructed with Coco fibres and utilising UVC light achieves the best VOC and HCHO purification performance. Within 2 h, this combination lowered HCHO by 50% and VOCs by 23% approximately.

Epithelial/mesenchymal heterogeneity of high-grade serous ovarian carcinoma samples correlates with miRNA let-7 levels and predicts tumor growth and metastasis.

Patient-derived samples present an advantage over current cell line models of high-grade serous ovarian cancer (HGSOC) that are not always reliable and phenotypically faithful models of in vivo HGSOC. To improve upon cell line models of HGSOC, we set out to characterize a panel of patient-derived cells and determine their epithelial and mesenchymal characteristics. We analyzed RNA and protein expression levels in patient-derived xenograft (PDX) models of HGSOC, and functionally characterized these models using flow cytometry, wound healing assays, invasion assays, and spheroid cultures. Besides in vitro work, we also evaluated the growth characteristics of PDX in vivo (orthotopic PDX). We found that all samples had hybrid characteristics, covering a spectrum from an epithelial-to-mesenchymal state. Samples with a stronger epithelial phenotype were more active in self-renewal assays and more tumorigenic in orthotopic xenograft models as compared to samples with a stronger mesenchymal phenotype, which were more migratory and invasive. Additionally, we observed an inverse association between microRNA let-7 (lethal-7) expression and stemness, consistent with the loss of let-7 being an important component of the cancer stem cell phenotype. We observed that lower let-7 levels were associated with the epithelial state and a lower epithelial mesenchymal transition (EMT) score, more efficient spheroid and tumor formation, and increased sensitivity to platinum-based chemotherapy. Surprisingly, in these HGSOC cells, stemness could be dissociated from invasiveness: Cells with lower let-7 levels were more tumorigenic, but less migratory, and with a lower EMT score, than those with higher let-7 levels. We conclude that let-7 expression and epithelial/mesenchymal state are valuable predictors of HGSOC proliferation, in vitro self-renewal, and tumor burden in vivo.

Atuação de enfermeiros em espaços escolares / The nurse's activities in school spaces

Objective:to understand the role of nurses in school spaces. The research population was composed of nine registered nurses in the Primary Care Network of a municipality in the Northeast Region of Brazil. Methods:a qualitative, exploratory and descriptive study. The contact withthe participating nurses was accomplished through a semi-structured individual interview, applied in an in-depth way. The content was analyzed in three steps: pre-analysis, material exploration and treatment of the obtained results and possible interpretations. Results:it was identified that health work in schools was carried out sporadically between the health and education sectors, and there was difficulty related to the resistance of the school's management to receiving health professionals; as opposedto the timetable between the functioning of the basic unit of health and some schools in the night shift; the structure of some schools, absence of guidance from the school that is unaware of the existence of available health staff to carry out actions inschools, among others. Conclusion:the training of health professionals and education is necessary, as a way to develop differentiated skills to carry out actions essential to the Family Health Strategy.

Objetivo:compreender aatuação de enfermeiros em espaços escolares. Compuseram a população da pesquisa nove enfermeiras cadastradas na Rede de Atenção Básica de município da Região Nordeste do Brasil. Métodos:estudo com abordagem qualitativa, do tipo exploratório e descritivo.O contato com as enfermeiras participantes foi efetivado por meio de entrevista individual semiestruturada, aplicada de modo aprofundado. O conteúdo foi analisado em três etapas: pré-análise, exploração do material e tratamento dos resultados obtidos e possíveis interpretações. Resultados:identificou-se que o trabalho de saúde nas escolas era realizado esporadicamente entre os setores de saúde e educação, existindo dificuldade relacionada à resistência da direção da escola em receber os profissionais de saúde; à diferença de horários entre o funcionamento da unidade básica de saúde e algumas escolas no turno da noite; à estrutura de algumas escolas, ausência de orientação da própria escola que desconhece a existência de equipe de saúde disponível para realizar ações nas escolas, entre outras. Conclusão:a capacitação dos profissionais da saúde e educação faz-se necessária, como forma de desenvolver habilidades diferenciadas para realização de ações essenciais à Estratégia Saúde da Família.

Conhecimento das gestantes acerca das medidas de alívio da dor durante o parto / Knowledge of pregnant women about measures of pain relief during childbirth

Objetivou-se analisar o conhecimento das gestantes primíparas acerca de métodos de alivio da dor no primeiro estágio do parto. Trata-se de estudo exploratório e transversal. Foram entrevistadas 49 gestantes cadastradas na rede municipal de Palmas, Tocantins. Os dados foram processados no programa estatístico Epi Info, versão 3.3 de 2004. A análise foi através de estatística descritiva simples. Os resultados mostram gestantes com 25,04 ±5,71 anos de idade, com parceiro fixo, ensino médio completo, renda média de 1473,14 ±936,18 e 7,02 ±2,03 consultas pré-natal, encontravam-se com 34,8±3,42 semanas de gestação. 100% afirmaram que o tema não foi abordado no acompanhamento pré-natal. 75,5% das gestantes foram classificadas com nenhum conhecimento. Concluiu-se que as gestantes apresentam necessidades de ter conhecimento sobre os métodos de alivio a dor, para o exercício do processo de parir de forma humanizada

The objective of this study was to analyze the knowledge of primiparous pregnant women about methods of pain relief in the first stage of labor. This is an exploratory and cross-sectional study. Forty-nine pregnant women registered in the municipal network of Palmas, Tocantins were interviewed. The data was processed in the statistical program Epi Info, version 3.3 of 2004. The analysis was through simple descriptive statistics. The results show pregnant women who were 25.04 ± 5.71 years old, with a fixed partner, complete high school, average income of 1473.14 ± 936.18 and 7.02 ± 2.03 prenatal consultations, were with 34.8 ± 3.42 weeks of gestation. 110% stated that the topic was not addressed in prenatal care. 75.5% of the pregnant women were classified with having no knowledge. It was concluded that the pregnant women present the need to be aware of the methods of pain relief, to exercise the process of giving birth in a humanized way

Análise do sedentarismo em estudantes universitários / Analysis of sedentary lifestyle among college students / Análisis del sedentarismo en estudiantes universitarios

O objetivo desta investigação foi analisar a prevalência de sedentarismo numa população de estudantes universitários de uma instituição de ensino superior do Piauí. Estudo transversal realizado, nos meses de abril e maio de 2011, com 101 estudantes, de ambos os sexos. Para a coleta de dados, aplicou-se um formulário estruturado abrangendo questões sociodemográficas, medidas antropométricas, taxa de glicemia capilar, circunferência da cintura, prática de atividade física, consumo de álcool e tabaco. Os dados foram analisados estatisticamente e, para a associação das variáveis, utilizou-se o teste quiquadrado. O sedentarismo esteve presente em 78(77,2%) sujeitos da amostra. Foi constatada associação estatisticamente significante entre sexo masculino e etilismo, entre tabagismo e etilismo e entre circunferência da cintura e índice de massa corporal. Estudos de intervenção devem incentivar a população jovem a fim de diminuir as chances de os mesmos apresentarem doenças crônicas na fase adulta.

This investigation aimed at analyzing prevalence of sedentary lifestyle in a population of college students from a higher education institution in the state of Piauí, Brazil. This cross-sectional study was carried out in April-May, 2011 with 101 students of both sexes. For data collection we applied a structured form covering socio-demographic aspects, anthropometric measurements, blood glucose level, waist circumference, physical activity, consumption of alcohol and tobacco. Data were statistically analyzed and the Chi-square test was used for association of variables. Sedentary lifestyle was outstanding in 78(77.2%) of the sample. We identified statistically significant association between males and alcohol consumption, smoking and alcohol consumption, and between waist circumference and Body Mass Index. Intervention studies should be encouraged with the young population to help bring down chronic diseases in adulthood.

El objetivo de esta investigación fue analizar la prevalencia de inactividad física en una población de estudiantes universitarios en una institución de educación superior de Piauí, Brasil. Estudio transversal llevado a cabo de abril y mayo de 2011, con 101 estudiantes, de ambos los sexos. Para recolectar los datos, se aplicó formulario estructurado con cuestiones sociodemográficas, medidas antropométricas, tasa de glucemia capilar, circunferencia de la cintura, práctica de actividad física, consumo de alcohol y tabaco. Los datos fueron analizados estadísticamente y, para la asociación de las variables, se utilizó la prueba de cai-cuadrado. La inactividad física estuvo presente en 78(77,2%) de la muestra. Fue constatada asociación estadísticamente significativa entre sexo masculino y etilismo, tabaquismo y etilismo, y entre circunferencia de cintura e índice de masa corporal. Los estudios de intervención deben alentar a los jóvenes para disminuir las posibilidades de los mismos de presentaren enfermedades crónicas en la edad adulta.

VER-SUS: um relato de experiência sobre uma vivência-estágio na realidade do Sistema Único de Saúde / VER-SUS: an experience report about a life experience-stage in the reality of the Unified Health System

Objetivo: relatar a experiência sobre uma vivência-estágio na realidade do Sistema Único de Saúde - SUS. Método: relato de experiência de uma Vivência-Estágio por estudantes de enfermagem, na realidade do SUS, ofertado pelo Ministério da Saúde. O estágio ocorreu nos meses de fevereiro e março de 2012, na cidade de Teresina, contando com a participação de 40 acadêmicos de diversos cursos da área da saúde. Resultados: parte dos graduandos da área da saúde não é formada para compreender o SUS. Ainda encontra-se uma barreira entre as universidades e a inserção dos alunos no âmbito do SUS. Conclusão: acredita-se que vivências como a propiciada pelo VER-SUS contribuem para a formação técnica, científica e política dos alunos, na perspectiva interdisciplinar e intersetorial. Assim, torna-se imprescindível a efetivação de políticas públicas que integrem as áreas da saúde e da educação, garantindo que práticas educativas realizadas no SUS configurem dispositivos para a análise das experiências de saúde locais.(AU)