Attitudes and values towards decisions at the margin of viability among expectant mothers at risk for preterm birth.

AIM: To explore how expectant mothers at risk for preterm birth would like to be involved in decision-making at the margin of viability and what they would base their decisions on. METHODS: This cross-sectional observational study included a mixed-methods post-hoc analysis alongside a previously reported randomised clinical trial. Expectant mothers between 280/7 and 366/7 weeks' gestation who were hospitalised for risk of preterm birth responded to written case vignettes of an impending preterm birth at the margin of viability. Participants responded to closed and open-ended questions that were theoretically coded for attitudes and values towards shared decision-making. RESULTS: Sixty-four expectant mothers were included in the analysis, 36 provided written perspectives. Decision-making was perceived as an enormous burden and a potential source of guilt and regret. Weighing personal values in terms of 'fighting for the baby' and 'quality of life' were used to inform the decision-making process. Explicitly stating that any decision is a good decision, empowerment through co-constructing shared decisions rather than simply presenting choices, sharing the clinicians' personal views, and honest, and empathetic counselling were perceived as supportive. CONCLUSION: Mothers at risk for preterm birth provided specific insights into their decision-making patterns that may be helpful to clinicians.

Spirituality and Religion in Canadian Psychiatric Residency Training: Follow-up Survey of Canadian Psychiatry Residency Programs.

OBJECTIVE: This study assesses the availability and nature of psychiatry resident training in religion and spirituality across Canada. Evidence shows that religious and spiritual topics are important to psychiatric patients and that psychiatrist competence in approaching these topics is correlated to whether they have had previous training in them. Prior studies have shown a lack of training in religion and spirituality in Canadian psychiatry programs and recommended incorporation into psychiatry residency curricula. METHOD: A survey was conducted, asking questions about the amount and type of training in religion and spirituality that was accessible to psychiatry residents in the 17 psychiatry residency programs in Canada. One response was sought from each institution by reaching out to the institutions' program directors and requesting that a knowledgeable faculty member complete the survey. RESULTS: Out of 14 responding psychiatric residency programs, 2 reported no training opportunities in religion or spirituality, 4 reported only voluntary training opportunities that were largely resident directed, and 8 reported mandatory training. CONCLUSIONS: The number of Canadian psychiatry residency programs providing mandatory training in religion and spirituality has increased since the prior published survey in 2003 and there are fewer programs reporting no training at all. However, overall, Canadian psychiatry institutions still place less emphasis on religious/spiritual education than recommended by the international psychiatric community. Several Canadian institutions report well-received implementation of curricula on religion and spirituality that could inform other Canadian institutions.

Design and in-vitro testing of a portable patient isolation chamber for bedside aerosol containment and filtration.

The emergence of the SARS-CoV-2 pandemic has imposed a multitude of complications on healthcare facilities. Healthcare professionals had to develop creative solutions to deal with resource shortages and isolation spaces when caring for COVID positive patients. Among many other solutions, facilities have utilized engineering strategies to mitigate the spread of viral contamination within the hospital environment. One of the standard solutions has been the use of whole room negative pressurization (WRNP) to turn a general patient room into an infection isolation space. However, this has not always been easy due to many limitations, such as direct access to the outdoors and the availability of WRNP units. In operating rooms where a patient is likely to go through aerosol-generating procedures, other solutions must be considered because most operating rooms use positive pressure ventilation to maintain sterility. The research team has designed, built, and tested a Covering for Operations during Viral Emergency Response (COVER), a low-cost, portable isolation chamber that fits over a patient's torso on a hospital bed to contain and remove the pathogenic agents at the source (i.e., patient's mouth and nose). This study tests the performance of the COVER system under various design and performance scenarios using particle tracing techniques and compares its efficiency with WRNP units. The results show that COVER can dramatically reduce the concentration of particles within the room, while WRNP is only effective in preventing the room-induced particles from migrating to adjacent spaces.

Mechanisms of Deterrence: Federal Immigration Policies and the Erosion of Immigrant Children's Rights.

In this commentary, we highlight the US government's proposed changes to the Flores Settlement Agreement, a federal legal settlement from the 1990s that ensures that child welfare principles are applied to immigrant children.We describe how Flores should be understood as mitigating child trauma by ensuring a baseline standard of treatment of immigrant children. We outline how children experience trauma throughout the migration course and argue that the proposed changes decrease standards of care through indefinite child detention, separation, and delicensing immigrant child detention facilities.We draw on the Adverse Childhood Experiences Study to consider the effect these multiplying forms of trauma may have on children.

Acute Airway Inflammation Caused By Incomplete Ingestion of Extended-Release Diltiazem: A Case Report.

BACKGROUND: Diltiazem in its extended-release formulation is widely prescribed and is generally well-tolerated. Currently, there are no published case reports of localized inflammation related to extended-release diltiazem causing either significant pill esophagitis or airway inflammation when swallowed incompletely. CASE REPORT: We present a case of an 85-year-old female who reported difficulty swallowing roughly 18 h after incomplete ingestion of an extended-release diltiazem tablet. She had mild stridor and visible right-sided neck swelling on examination. Imaging revealed a large inflammatory mass, which was believed to be a subacute to chronic neoplastic process when reviewed both by radiology and otolaryngology. Two days after presentation, however, the patient's symptoms and the inflammatory mass had resolved entirely. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Extended-release diltiazem can cause an inflammatory mass when ingested incompletely, leading to possible acute airway compromise. Any invasive airway intervention should be approached with caution, given the degree of acute inflammation. Even in patients who do not require intervention, close observation until clinical improvement is warranted in symptomatic patients with a history of recent incomplete ingestion of extended-release diltiazem.

The Americleft Project: Comparison of Ratings Using Two-Dimensional Versus Three-Dimensional Images for Evaluation of Nasolabial Appearance in Patients With Unilateral Cleft Lip and Palate.

This study was conducted to determine if nasolabial appearance is rated with comparable results and reliability on 3-dimensional stereophotogrammetric facial images versus standard clinical photographs (2-dimensional). Twenty-seven consecutively treated patients with repaired complete unilateral cleft lip and palate were selected. Six trained and calibrated raters assessed cropped 2- and 3-dimensional facial images. Nasolabial profile, nasolabial frontal, and vermillion border esthetics were rated with the 5-point scale described by Asher-McDade using the modified Q-sort method. Cropped 3-dimensional images were available for viewing by each rater, allowing for complete rotational control for viewing the images from all aspects. Two- and three-dimensional ratings were done separately and repeated the next day.Interrater reliability scores were good for 2-dimensional (κ = 0.607-0.710) and fair to good for 3-dimensional imaging (κ = 0.374-0.769). Intrarater reliability was good to very good for 2-dimensional (κ = 0.749-0.836) and moderate to good for 3-dimensional imaging (κ = 0.554-0.855). Bland-Altman analysis showed satisfactory agreement of 2- and 3-dimensional scores for nasolabial profile and nasolabial frontal, but more systematic error occurred in the assessment of vermillion border.Although 3-dimensional images may be perceived as more representative of a direct clinical facial evaluation, their use for subjective rating of nasolabial aesthetics was not more reliable than 2-dimensional images in this study. Conventional 2-dimensional images provide acceptable reliability while being readily accessible for most cleft palate centers.

The MIDAS touch: Frameworks for procedural model innovation and validation.

Background: Simulation-based procedural practice is crucial to emergency medicine skills training and maintenance. However, many commercial procedural models are either nonexistent or lacking in key elements. Simulationists often create their own novel models with minimal framework for designing, building, and validation. We propose two interlinked frameworks with the goal to systematically build and validate models for the desired educational outcomes. Methods: Simulation Academy Research Committee and members with novel model development expertise assembled as the MIDAS (Model Innovation, Development and Assessment for Simulation) working group. This working group focused on improving novel model creation and validation beginning with a preconference workshop at 2023 Society for Academic Emergency Medicine Annual Meeting. The MIDAS group sought to (1) assess the current state of novel model validation and (2) develop frameworks for the broader simulation community to create, improve, and validate procedural models. Findings: Workshop participants completed 17 surveys for a response rate of 100%. Many simulationists have created models but few have validated them. The most common barriers to validation were lack of standardized guidelines and familiarity with the validation process.We have combined principles from education and engineering fields into two interlinked frameworks. The first is centered on steps involved with model creation and refinement. The second is a framework for novel model validation processes. Implications: These frameworks emphasize development of models through a deliberate, form-follows-function methodology, aimed at ensuring training quality through novel models. Following a blueprint of how to create, test, and improve models can save innovators time and energy, which in turn can yield greater and more plentiful innovation at lower time and financial cost. This guideline allows for more standardized approaches to model creation, thus improving future scholarship on novel models.

"Which Clinic? Pre-Covid or Post-Covid?": Immigration Policy Uncertainty, Immigrant Serving Organization, and the Response to COVID-19.

BACKGROUND: This article examines how immigration policy uncertainty during the Trump presidency shaped how immigrant serving organizations (ISOs) responded to the needs of immigrant community members in the first six months of the COVID-19 pandemic. METHODS: We draw on semi-structured interviews conducted over the summer of 2020 with 31 directors and program coordinators of ISOs and health clinics in three southern states (KY, NC, SC). RESULTS: Responding to anti-immigrant policies laid the groundwork for organizations to respond quickly and nimbly to COVID-19 related upheavals. However, organizational flexibility may signal organizational precarity, especially given the long-term impacts of both Trump administration immigration policies and the COVID-19 pandemic. DISCUSSION: Our findings underline how ISOs facilitate access to health and social services for immigrant families. Our findings suggest that this organizational adaptability may signal a relationship between organizational precarity and immigration policy uncertainty that could have an impact well beyond the pandemic.

Brokering Resources during a Pandemic: Exploring How Organizations and Clinics Responded to the Needs of Immigrant Communities during COVID-19.

Though COVID-19 has had sweeping implications, many immigrant groups in the United States have been disproportionately affected. The purpose of the present study is to explore the impact of COVID-19 on immigrant communities and how local immigrant-serving organizations (ISOs) have responded during the pandemic. The authors conducted in-depth qualitative interviews with executive directors and program coordinators of 31 ISOs and health clinics in Kentucky, North Carolina, and South Carolina. Findings highlight the needs of immigrants and refugees during the pandemic, including economic burden, lack of information, and limited access to testing and treatment for COVID-19. The authors find that ISOs have responded to these needs by providing basic supports, partnering with other local organizations to channel needed resources to immigrant communities, and collaborating with state-level entities to improve outreach, testing, and treatment. The authors also identify mechanisms that enabled the organizations to make nimble accommodations during the pandemic as well as the burden and compromises that these organizations have experienced. The authors argue that ISOs represent an important aspect of safety nets available for immigrants and provide insights into how other organizations can prepare for public health crises like COVID-19 in the future.

Development and efficacy testing of a portable negative pressure enclosure for airborne infection containment.

OBJECTIVES: To overcome the shortage of personal protective equipment and airborne infection isolation rooms (AIIRs) in the COVID-19 pandemic, a collaborative team of research engineers and clinical physicians worked to build a novel negative pressure environment in the hopes of improving healthcare worker and patient safety. The team then sought to test the device's efficacy in generating and maintaining negative pressure. The goal proved prescient as the US Food and Drug Administration (FDA) later recommended that all barrier devices use negative pressure. METHODS: Initially, engineers observed simulations of various aerosol- and droplet-generating procedures using hospital beds and stretchers to determine the optimal working dimensions of the containment device. Several prototypes were made based on these dimensions which were combined with filters and various flow-generating devices. Then, the airflow generated and the pressure differential within the device during simulated patient care were measured, specifically assessing its ability to create a negative pressure environment consistent with standards published by the Centers for Disease Control and Prevention (CDC). RESULTS: The portable fans were unable to generate any airflow and were dropped from further testing. The vacuums tested were all able to generate a negative pressure environment with the magnitude of pressure differential increasing with the vacuum horsepower. Only the 3.5-horsepower Shop-Vac, however, generated a -3.0 pascal (Pa) pressure gradient, exceeding the CDC-recommended minimum of -2.5 Pa for AIIRs. CONCLUSION: A collaborative team of physicians and engineers demonstrated the efficacy of a prototype portable negative pressure environment, surpassing the negative pressure differential recommended by the CDC.

Social Work Research on Immigrants: A Content Analysis of Leading Journals from 2007 to 2016.

International migration has emerged as one of the most controversial phenomena of the 21st century. The complexity and implications of global migrations require that social work practitioners and researchers have access to data-informed research and critical analyses. However, the content of recent social work research on international migration has not been adequately examined to assess whether and to what extent this substantive area is being addressed. This article explores how social work research published in five leading social work journals-Health & Social Work, Research on Social Work Practice, Social Service Review, Social Work, and Social Work Research-is advancing our understanding of international migration and where it may be lacking. Focusing on articles published between 2007 and 2016, the authors analyzed content addressing immigrants and refugees. The content analysis indicates that social work research is making a strong contribution in the area of mental health but is not adequately addressing critical dimensions of stratification, including race, ethnicity, and legal status. Authors also find ambiguity in how "immigrant" is defined and in the generation(s) addressed. Authors argue that maximizing social work's contributions requires offering more nuanced definitions of the immigrant populations addressed and paying greater analytical attention to dimensions of inequality.

Sialolithiasis: retrospective analysis of the effect of an escalating treatment algorithm on patient-perceived health-related quality of life.

BACKGROUND: Gland preserving techniques in the treatment of sialolithiasis have continuously replaced radical surgery. The aim of this study was to evaluate a multimodal treatment algorithm in the therapy of sialolithiasis and assess improvement of HRQoL perceived by patients. METHODS: Patients with sialolithiasis were treated by a multimodal treatment algorithm based on multiplicity of stones, stone size, affected gland, and stone position. The therapeutic spectrum ranged from conservative measures, extracorporeal shockwave lithotripsy, interventional sialendoscopy, combined endoscopic-surgical procedures to surgical gland removal as ultima ratio. Outcomes were evaluated by surgeons by means of the electronic patient record and by patients themselves using a standardized questionnaire. RESULTS: 87 patients treated for sialolithiasis were comprised in this study. The submandibular gland (SMG) was affected in 58.6% and the parotid gland (PG) in 41.4% of cases. Mean patient age was 41.67 years for SMG and 48.91 years for PG. In over 80% of cases sialolithiasis was associated with classic meal-related pain and swelling. Type and intensity of symptomatic sialolithiasis were not dependent on patient age or gender, nor could a relation between the affected gland and the occurrence of symptoms be demonstrated. Overall, 86.2% of cases were reported as cured using the multimodal step-by-step treatment algorithm. Resection of the affected gland could be dispensed in 98.9% of cases. According to patients pain could be reduced in 94.3% of cases. CONCLUSIONS: The analyzed treatment algorithm of increasing invasiveness is a favorable and effective tool to successfully treat sialolithiasis in > 86% of cases. For the first time, the present study shows that patient-perceived improvement of HRQoL due to ease of symptoms has an even higher success rate of > 94%.

The efficacy of intrathecal morphine with or without clonidine for postoperative analgesia after radical prostatectomy.

BACKGROUND: In this randomized study, we compared intrathecal (i.t.) morphine with or without clonidine and i.v. postoperative patient-controlled analgesia (PCA) morphine for analgesia after radical retropubic prostatectomy. METHODS: Fifty patients were randomly divided into three groups. They were allocated to receive i.t. morphine (4 microg/kg) (M group), i.t. morphine and clonidine (1 microg/kg) (MC group), or PCA (PCA group). Each patient was given morphine PCA for postoperative analgesia. The primary objective was the quantity of morphine required during the first 48 postoperative hours. The first request for morphine, numeric pain score at rest and on coughing, the time of tracheal decannulation and adverse effects (pruritus, postoperative nausea and vomiting, respiratory depression) were recorded. RESULTS: Morphine consumption in the first 48 h was decreased in the M and MC groups. The numeric pain score at rest and on coughing were lower in the M group until the 18th postoperative hour and until the 24th postoperative hour in the MC group. The first requests for PCA were delayed in these two groups. The need for intraoperative sufentanil was significantly lower in the MC group. CONCLUSION: IT morphine provided a significant reduction in morphine requirement during the first 48 postoperative hours after a radical prostatectomy. The addition of clonidine to i.t. morphine reduced intraoperative sufentanil use, prolonged time until first request for PCA rescue, and further prolonged analgesia at rest and with coughing.

THIS ARTICLE HAS BEEN RETRACTED Anatomic relationship between the internal jugular vein and the carotid artery in pre-school children--an ultrasonographic study.

BACKGROUND: Central venous cannulation (CVC) in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound. METHODS: Forty-five children aged 60 months and under were included prospectively and divided into three groups: Group 1: <6 months, Group 2: 7-18 months and Group 3: 19-60 months. With the head in neutral position the location of the left and right IJV was noted as anterior, anterolateral (AL), lateral or medial in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded. RESULTS: The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in Group 1, 0.95 cm in Group 2 and 3. Mean duration for localization of the vessels was 4.2 s in Group 1, 4 s in Group 2 and 4.3 s in Group 3. The differences between the groups were not significant. CONCLUSION: This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.

Anatomic relationship between the internal jugular vein and the carotid artery in preschool children--an ultrasonographic study.

BACKGROUND: Central venous cannulation in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. AIM: The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound. METHODS: Forty five children aged 60 months and under were included prospectively and divided into three groups: group 1: <6 months, group 2: 7-18 months and group 3: 19-60 months. With the head in neutral position the location of the left and right IJV was noted as anterior (A), anterolateral (AL), lateral (L) or medial (M) in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded. RESULTS: The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in group 1, 0.95 cm in group 2 and 3. Mean duration for localization of the vessels was 4.2 s in group 1, 4 s in group 2 and 4.3 s in group 3. The differences between the groups were not significant. CONCLUSION: This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.

Models in Translational Oncology: A Public Resource Database for Preclinical Cancer Research.

The devastating diseases of human cancer are mimicked in basic and translational cancer research by a steadily increasing number of tumor models, a situation requiring a platform with standardized reports to share model data. Models in Translational Oncology (MiTO) database was developed as a unique Web platform aiming for a comprehensive overview of preclinical models covering genetically engineered organisms, models of transplantation, chemical/physical induction, or spontaneous development, reviewed here. MiTO serves data entry for metastasis profiles and interventions. Moreover, cell lines and animal lines including tool strains can be recorded. Hyperlinks for connection with other databases and file uploads as supplementary information are supported. Several communication tools are offered to facilitate exchange of information. Notably, intellectual property can be protected prior to publication by inventor-defined accessibility of any given model. Data recall is via a highly configurable keyword search. Genome editing is expected to result in changes of the spectrum of model organisms, a reason to open MiTO for species-independent data. Registered users may deposit own model fact sheets (FS). MiTO experts check them for plausibility. Independently, manually curated FS are provided to principle investigators for revision and publication. Importantly, noneditable versions of reviewed FS can be cited in peer-reviewed journals. Cancer Res; 77(10); 2557-63. ©2017 AACR.

Optimizing a Query by Transformation and Expansion.

In the biomedical sector not only the amount of information produced and uploaded into the web is enormous, but also the number of sources where these data can be found. Clinicians and researchers spend huge amounts of time on trying to access this information and to filter the most important answers to a given question. As the formulation of these queries is crucial, automated query expansion is an effective tool to optimize a query and receive the best possible results. In this paper we introduce the concept of a workflow for an optimization of queries in the medical and biological sector by using a series of tools for expansion and transformation of the query. After the definition of attributes by the user, the query string is compared to previous queries in order to add semantic co-occurring terms to the query. Additionally, the query is enlarged by an inclusion of synonyms. The translation into database specific ontologies ensures the optimal query formulation for the chosen database(s). As this process can be performed in various databases at once, the results are ranked and normalized in order to achieve a comparable list of answers for a question.