Tracheal Agenesis: One Hospital's Nursing Experience With This Rare Airway Anomaly Case Report.

BACKGROUND: Tracheal agenesis is a rare and often fatal congenital anomaly that occurs early in fetal development. Tracheal agenesis occurs in one in 50,000 to 100,000 live births. This case study describes the nursing aspect of caring for this type of patient. CLINICAL FINDINGS: Airway anomalies in neonates can be diagnosed immediately at birth or later when the infant develops respiratory distress or respiratory failure. Diagnosis and management of tracheal agenesis is difficult and a complex problem requiring a multidisciplinary medical team's expert approach for its treatment. PRIMARY DIAGNOSIS: Respiratory distress syndrome versus tracheoesophageal fistula was suspected. INTERVENTIONS: The infant quickly decompensated, requiring intubation and eventual transfer to our tertiary care center for further evaluation of a possible airway anomaly. Because of deteriorating status, surgery was performed, and it was discovered the patient had tracheal agenesis, requiring the development of a 3-dimensional trachea specific for this patient. OUTCOMES: This article describes the nursing aspect of caring for this type of patient. PRACTICE RECOMMENDATIONS: This article describes the success of nursing interventions and teamwork among nursing and the multidisciplinary team for the successful discharge of this patient home to her family.

Gendered Consequences of COVID-19 Among Professional Tennis Players.

The COVID-19 pandemic increased the risk of travelling, working, and participating in public events. To test whether there were gendered differences in the response to COVID-19, we examine the behavior of male and female professional tennis players. We use data from major tennis tournaments which included a rather large number of athletes withdrawing from play. After controlling for past performance, wealth, and other relevant player attributes, we find that female tennis players were more likely to withdraw. This suggests that high-earning women may have greater risk aversion, especially related to COVID-19, than their male counterparts. Importantly, women were more risk-averse when it comes to international travel.

Telemedicine versus in-Person Primary Care: Impact on Visit Completion Rate in a Rural Appalachian Population.

INTRODUCTION: The use of telemedicine increased during the global Coronavirus disease 2019 (COVID-19) pandemic. Rural populations often struggle with adequate access to care while simultaneously experiencing multiple health disparities. Yet, telemedicine use during the COVID-19 pandemic has been understudied on its effect on visit completion in rural populations. The primary purpose of this study is to understand how telemedicine delivery of family medicine care affects patient access and visit completion rates in a rural primary care setting. METHODS: We performed a retrospective cohort study on primary care patient visits at an academic family medicine clinic that serves a largely rural population. We gathered patient demographic and visit type and completion data on all patients seen in the West Virginia University Department of Family Medicine between January 2019 and November 2020. RESULTS: The final sample included 110,999 patient visits, including 13,013 telemedicine visit types. Our results show that telemedicine can increase completion rates by about 20% among a sample of all ages and a sample of adults only. Working-aged persons are more likely to complete telemedicine visits. Older persons with higher risk scores are more likely to complete their visits if they use telemedicine. CONCLUSIONS: Telemedicine can be a tool to improve patient access to primary care in rural populations. Our findings suggest that telemedicine may facilitate access to care for difficult-to-reach patients, such as those in rural areas, as well as those who have rigid work schedules, live longer distances from the clinic, have complex health problems, and are from areas of higher poverty and/or lower education.

Early Salivary miRNA Expression in Extreme Low Gestational Age Newborns.

Background: MicroRNAs (miRNA) are small non-coding RNAs that regulate gene expression playing a key role in organogenesis. MiRNAs are studied in tracheal aspirates (TA) of preterm infants. However; this is difficult to obtain in infants who are not intubated. This study examines early salivary miRNA expression as non-invasive early biomarkers in extremely low gestational age newborns (ELGANs). Methods: Saliva was collected using DNA-genotek swabs, miRNAs were analyzed using RNA seq and RT PCR arrays. Salivary miRNA expression was compared to TA using RNA seq at 3 days of age, and longitudinal changes at 28 days of age were analyzed using RT PCR arrays in ELGANs. Results: Approximately 822 ng of RNA was extracted from saliva of 7 ELGANs; Of the 757 miRNAs isolated, 161 miRNAs had significant correlation in saliva and TA at 3 days of age (r = 0.97). Longitudinal miRNA analysis showed 29 miRNAs downregulated and 394 miRNAs upregulated at 28 days compared to 3 days of age (adjusted p < 0.1). Bioinformatic analysis (Ingenuity Pathway Analysis) of differentially expressed miRNAs identified organismal injury and abnormalities and cellular development as the top physiological system development and cellular function. Conclusion: Salivary miRNA expression are source for early biomarkers of underlying pathophysiology in ELGANs.

Establishing a Standardized Method for the Effective Intraoperative Collection and Biological Preservation of Brain Tumor Tissue Samples Using a Novel Tissue Preservation System: A Pilot Study.

BACKGROUND: Glioblastoma (GB) is an aggressive tumor showing extensive intertumoral and intratumoral heterogeneity. Several possible reasons contribute to the historical inability to develop effective therapeutic strategies for treatment of GB. One such challenge is the inability to consistently procure high-quality biologically preserved specimens for use in molecular research and patient-derived xenograft model development. No scientifically derived standardized method exists for intraoperative tissue collection specifically designed with the fragility of RNA in mind. METHODS: In this investigation, we set out to characterize matched specimens from 6 GB patients comparing the traditional handling and collection processes of intraoperative tissue used in most neurosurgical operating rooms versus an automated resection, collection, and biological preservation system (APS) which captures, preserves, and biologically maintains tissue in a prescribed and controlled microenvironment. Matched specimens were processed in parallel at various time points and temperatures, evaluating viability, RNA and protein concentrations, and isolation of GB cell lines. RESULTS: We found that APS-derived GB slices stored in an APS modified medium remained viable and maintained high-quality RNA and protein concentration for up to 24 hours. CONCLUSIONS: Our results showed that primary GB cell cultures derived in this manner had improved growth over widely used collection and preservation methods. By implementing an automated intraoperative system, we also eliminated inconsistencies in methodology of tissue collection, handling and biological preservation, establishing a repeatable and standardized practice that does not require additional staff or a laboratory technician to manage it.

Expanding access to HPV vaccination in South Carolina through community pharmacies: A geospatial analysis.

OBJECTIVE: Human papillomavirus (HPV)-associated cancer rates are higher in rural areas. Despite the preventive benefits of HPV vaccination, uptake is lower among rural populations. Community-based pharmacies with a strong presence in rural communities may be ideal for improving HPV vaccination access. Our objective was to determine whether spatial access to pharmacies among adolescents and young adults in South Carolina varied by rurality and geographic access to primary care providers. METHODS: Geographic information systems methods were used to evaluate spatial access to community-based pharmacies among persons aged 10-24 years in South Carolina census tracts (CTs). CTs were categorized as metropolitan, micropolitan, or small-town and isolated rural CTs using rural-urban commuting area codes and as health provider shortage areas (HPSAs) or not. Descriptive and spatial statistics were calculated to compare access across CT groupings and to evaluate geospatial clustering. RESULTS: Areas of highest access clustered among the metropolitan CTs. Whereas spatial access was higher in metropolitan than micropolitan CTs, there was no difference in spatial access between metropolitan and small-town and rural CTs. In general, HPSA-designated areas had lower spatial access to pharmacies than non-HPSA-designated areas. However, in micropolitan areas, there was no difference in spatial access to pharmacies based on HPSA designation. CONCLUSION: Spatial access to pharmacies among small town and rural areas was comparable to urban areas as was HPSA-designated micropolitan areas and non-HPSA micropolitan areas. This suggests that pharmacies are equally accessible to both urban and rural populations in South Carolina, but additional research is needed to identify effective strategies to promote the uptake of and the availability of HPV vaccination in pharmacies (e.g., insurance coverage) and to ensure patients are educated on the benefits of HPV vaccinations and its availability in nonprimary care settings.

Explaining the spatial variation in American life expectancy.

Since 1980, average life expectancy in the United States has increased by roughly five years; however, in recent years it has been declining. At the same time, spatial variation in life expectancy has been growing. To explore reasons for this trend, some researchers have focused on morbidity factors, while others have focused on how mortality trends differ by personal characteristics. However, the effect community characteristics may play in expanding the spatial heterogeneity has not yet been fully explored. Using a spatial Durbin error model, we explore how community and demographic factors influence county-level life expectancy in 2014, controlling for life expectancy in 1980 and migration over time, and analyzing men and women separately. We find that community characteristics are important in determining life expectancy and that there may be a role for policy makers in addressing factors that are associated with lower life expectancy in some regions.

A collaborative approach to advance student research at the University of Southern California.

The continued advancement of oral health and science relies upon the cultivation of a student's interest in research. The Student Research Group at the Ostrow School of Dentistry of the University of Southern California is working to increase student involvement in research and develop future academic leaders. This study aims to, through student surveys, quantitatively evaluate students' involvement in research, students' interest in participating in research and to identify specific barriers students feel challenge their ability to participate in research.

Physical activity and physical function improved following a community-based intervention in older adults in Georgia senior centers.

We evaluated a community-based physical activity intervention in Georgia senior centers. Participants were a convenience sample that completed the pre-test only (n = 592), or the pre-test, the intervention, and a post-test (n = 418, 98% aged 60 and older, mean age = 75, 83% female, 56% black). The 4-month physical activity intervention, based on the Health Belief Model, included 16 sessions that focused on educator-led chair exercises, promotion of walking, using a pedometer, and recording daily steps. Pre- and post-tests assessed physical activity and physical function, categorized as poor, moderate, or good (Short Physical Performance Battery). Following the intervention, participants improved their physical function (good physical function at pre-test vs. post-test: 16.5% vs. 25.3%, P < or = 0.001), increased minutes of physical activity by 26% (P < or = 0.001) and step counts by 29% (P < or = 0.0001, sub-sample, n = 95), and decreased reports of "it's not safe" as a barrier to physical activity (P < or = 0.05). Increased physical activity (P < or = 0.01) was associated with improved physical function following the intervention. The results of this evaluation provide an evidence base for the effectiveness of this community intervention for improving physical activity and physical function in older adults.

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers.

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.

Relationship among respondent ethnicity, ethnic identity, acculturation, and homeless status on a homeless population's functional status.

This study investigated the relationship of homeless status, ethnic identity, respondent ethnicity (African American, Latino, Native American, and Anglo), and Latino, Anglo, and Mexican American orientation on the functional impairment (Behavior and Symptom Identification Scale, BASIS-32; S. V. Eisen, 1996) of 355 homeless men and women who were interviewed in Pomona, California. Multivariate analyses of variance results indicated that respondent ethnicity was related to several BASIS-32 subscales. Specifically, Anglo and African American homeless adults had greater functional impairment than did Latino or Native American respondents. In addition, high Anglo orientation among chronically homeless Latino respondents, with low ethnic identity was associated with higher levels of functional impairment on the BASIS-32 Psychosis subscale. The implications of these findings are discussed.

The role of neurotrophins in the maintenance of the spinal cord motor neurons and the dorsal root ganglia proprioceptive sensory neurons.

The aim of this study was to approach the question of neuronal dependence on neurotrophins during embryonic development in mice in a way other than gene targeting. We employed amyogenic mouse embryos and fetuses that develop without any skeletal myoblasts or skeletal muscle and consequently lose motor and proprioceptive neurons. We hypothesized that if, in spite of the complete inability to maintain motor and proprioceptive neurons, the remaining spinal and dorsal root ganglia tissues of amyogenic fetuses still contain any of the neurotrophins, that particular neurotrophin alone is not sufficient for the maintenance of motor and proprioceptive neurons. Moreover, if the remaining spinal and dorsal root ganglia tissues still contain any of the neurotrophins, that particular neurotrophin alone may be sufficient for the maintenance of the remaining neurons (i.e., mostly non-muscle- and a few muscle-innervating neurons). To test the role of the spinal cord and dorsal root ganglia tissues in the maintenance of its neurons, we performed immunohistochemistry employing double-mutant and control tissues and antibodies against neurotrophins and their receptors. Our data suggested that: (a) during the peak of motor neuron cell death, the spinal cord and dorsal root ganglia distribution of neurotrophins was not altered; (b) the distribution of BDNF, NT-4/5, TrkB and TrkC, and not NT-3, was necessary for the maintenance of the spinal cord motor neurons; (c) the distribution of BDNF, NT-4/5 and TrkC, and not NT-3 and Trk B, was necessary for the maintenance of the DRG proprioceptive neurons; (d) NT-3 was responsible for the maintenance of the remaining neurons and glia in the spinal cord and dorsal root ganglia (possibly via TrkB).

Effects of racial match on Asian American mental health consumer satisfaction.

This study investigated the effects of consumer-provider racial match on consumer service satisfaction and treatment outcomes (i.e., Client Satisfaction Questionnaire and GAF-Posttest) of 96 outpatient consumers, 66 of whom were adults and 30 of whom were parent/caregivers of child consumers. Data was obtained by telephone interviews over a 6-week period. After controlling for four other variables, client satisfaction was higher for racially matched consumers. Racially matched child consumers also had higher GAF-Posttest scores. Implications of these findings are discussed.