Pediatric Ultrasound Appendicitis Score for the Diagnosis of Acute Appendicitis to Reduce Computed Tomography Scan Utilization.

BACKGROUND: Acute appendicitis is one of the most common reasons for pediatric surgical consultation in the emergency room. Although acute appendicitis is a clinical diagnosis, the use of imaging in the emergency department to assist with the diagnosis is very common. Ultrasound is frequently utilized in pediatrics because of the radiation risks associated with computed tomography (CT) scan. The risks of radiation in the pediatric population are much more significant than in adults. Reasons for this include smaller size so there is a relative higher radiation dose than for larger adults, radiosensitive organs such as thyroid, bone marrow, and gonads, and radiation exposure earlier in life allows for more time that a radiation induced cancer could develop. The risks of radiation from imaging are increased with cumulative dosing. METHODS: The purpose of this study was to incorporate the pediatric appendicitis score (PAS) and standardized ultrasound scoring system to provide a combined score that would assist with the clinical diagnosis of acute appendicitis and avoid the need for a CT scan. RESULTS: The presented data shows that for scores of 7 or more, the specificity and sensitivity is 90% and 90.2%, respectively for the diagnosis of acute appendicitis. DISCUSSION: This study validates the combined score, shows the specific cutoffs, and initiates the discussion that CT scan may not always be required for diagnosing acute appendicitis if this scoring system is used.

The contributions of gender identification and gender ideologies to the purposes of social media use in adolescence.

Gender differences in adolescent social media use are often documented in the research literature, yet few studies delve into why they occur. Accordingly, we investigated whether gender identification and gender ideologies are associated with five major purposes of social media use in adolescence (emotion and activity bonding with friends, social compensation, appearance validation, and bullying). Participants were 309 cisgender U.S. high school students (Mage = 15.74; 59% girls; 53% white) primarily using Instagram and Snapchat but also TikTok (more popular with girls) and Discord (more popular with boys) in 2019. Girls reported greater use of social media for emotion bonding, appearance validation, and social compensation compared to boys, who reported greater competitive activity bonding. Girls and boys did not differ in their use of social media for bullying. In linear regressions, masculinity ideology predicted purposes associated with girls (appearance validation, social compensation), as well as those associated with boys (competitive activity bonding), regardless of gender. Femininity ideology uniquely predicted emotion bonding and social compensation but only mediated the effect of gender for the latter. Findings illustrate that gender is important for understanding uses and gratifications of social media in adolescence, but traditional masculinity ideology is similar across genders and relates to multiple functions of social media in boys' and girls' lives. More work is needed to conceptualize gender beliefs and values in Gen Z, given recent challenges to gender binary ideology and low reliability of the scales in this study, which were developed before social media.

Enhanced Recovery After Bariatric Surgery: Feasibility and Outcomes in a National Bariatric Centre.

PURPOSE: This study aimed to assess outcomes of bariatric surgical procedures after the implementation of an enhanced recovery after bariatric surgery protocol in the National Bariatric Centre in Ireland. MATERIALS AND METHODS: Data on consecutive bariatric procedures performed over a 36-month period was prospectively recorded. ERABS interventions utilized included preoperative counselling, shortened preoperative fasts, specific anaesthetic protocols, early postop mobilization and feeding, and extended post-discharge thromboprophylaxis. RESULTS: A total of 280 primary bariatric procedures were performed over a 36-month period. The primary procedures were laparoscopic sleeve gastrectomy (57.5%), laparoscopic one anastomosis gastric bypass (33.2%) and laparoscopic Roux-en-Y gastric bypass (9.3%). Mean (SD) age was 48 (± 10) years, mean (SD) preoperative BMI 49.5 (± 9) kg/m2 and 68% were female. Median ASA score was 3, and median OSMRS also 3. Over 50% of patients had a diagnosis of hypertension or OSA, and over one-third had a diagnosis of type 2 diabetes mellitus or dyslipidemia. All procedures were completed laparoscopically and 29 patients underwent a simultaneous procedure. The mean (SD) length of stay was 2.3 (± 1.4) days (median 2 days, range 2-47 days). Overall postoperative morbidity rate was 10.0% (n = 29). The 30-day readmission and reoperation rates were 3.6% and 2.5% respectively. There was no mortality recorded in this series. CONCLUSION: Implementing an ERABS protocol was feasible, safe, associated with low morbidity, no mortality, acceptable LOS and low readmission and reoperation rates. Although patients with obesity have a spectrum of disease-related complications, this should not preclude the use of an ERABS protocol in bariatric surgery.

The Roles of Self-Socialization and Parent Socialization in Toddlers' Gender-Typed Appearance.

Children's gender-stereotypical dress and appearance might be one of the first representations of children's emerging sense of gender identity. Gender self-socialization theories posit that as children become more aware of gender categories, they become motivated to adhere to gender stereotypes, such as by expressing interest in dressing in feminine or masculine ways. Socialization theories predict that children's gender-typed appearance reflects parents' choices. For example, gender-traditional parents might dress their children in gender-stereotypical ways. At the same time, dressing in gender-stereotypical ways might contribute to children's growing awareness of gender categories. The current study investigated the factors associated with gender-typed appearance among 175 (87 girls, 88 boys) Mexican American, Dominican American, and African American 2-year-olds. We examined both child and parent contributions to early gender-typed appearance. To measure children's early conceptual understanding of gender categories, we assessed children's use and recognition of gender verbal labels. To examine the influence of parent socialization, we assessed mothers' gender-role attitudes. Children's gender-typed appearance was observed and coded during an assessment. Surprisingly, mothers' gender-role attitudes were not significantly associated with toddlers' gender-typed appearance. However, toddlers' gender labeling was associated with their gender-typed appearance, suggesting that self-socialization processes can be found as early as 24 months of age.

Knowledge of local anesthetic use among dermatologists.

BACKGROUND: Local anesthesia is widely used in general dermatology practices. The onus is on the practitioner to have a sound knowledge of the pharmacology and dosing of any drug used, including local anesthesia. The dermatologist should also be aware of the signs, symptoms, and management of toxicity of local anesthetic use. The level of knowledge of dermatologists on this topic has not been previously assessed. OBJECTIVE: To assess levels of knowledge of local anesthetic pharmacology, local anesthetic systemic toxicity (LAST), and the management of the latter of dermatologists. METHODS: A survey designed to test knowledge of absolute dosing limits; calculation of patient-specific dosing using clinical vignettes; and awareness of the signs, symptoms, and management of LAST was distributed electronically to the membership of three professional dermatological organizations in the United Kingdom and Ireland, including one specialist dermatologic surgery group. RESULTS: Knowledge of local anesthetic use of dermatologists was comprehensive enough to practice safely, without necessarily being entirely accurate. Awareness of the signs and symptoms of local anesthetic toxicity was good, but awareness of the specific agent now recommended for the management of LAST in official guidelines was poor. CONCLUSIONS: Knowledge of local anesthetic dosing and toxicity is reasonable among dermatologists. Awareness of the guidelines for management of LAST, released by the American and Great Britain and Ireland associations of anesthetists, and in particular the use of lipid emulsion in this setting, could be improved.