Outcomes in Blunt vs Penetrating Pelvic Vascular Injuries.

OBJECTIVES: The purpose of this study is to determine if there is a difference in outcomes for patients with blunt and penetrating vascular injuries of the pelvis. METHODS: Data were abstracted from the Trauma Quality Improvement Program database from 2011 to 2015. Patients >18 years with hypogastric, iliac, uterine, or ovarian arterial or venous injuries were included. Individuals with an AIS head or chest score >3 were excluded. RESULTS: Of the 2559 patients included, the mean age was 43 years (±19), 75.25% were male, and 32.6% had a comorbidity. 64.9% presented with blunt injury (mean ISS of 23 (±12)). 74.9% experienced a complication. The median hospital length of stay (LOS) and ICU LOS were 10 days and 4 days, respectively. 6.7% had an adverse discharge. Mortality occurred in 8.3%. On bivariate analysis, patients who sustained blunt trauma were older (51 vs 31 years), female (32.7% vs 10.1%), had a higher ISS (25.71 vs 17.65), and had a longer hospital LOS (16.65 vs 13.88). Patients with penetrating trauma had an increased chance of complications (78.4% vs 73.0%) and mortality (10.7% vs 7.0%). Multivariate analysis revealed in patients with blunt injuries have more complications (OR: 1.950 CI: 0.886-4.291 P = .097), a lower ISS (OR: 0.919, CI: 0.908-0.930, P < .001, were more likely to have an adverse discharge (OR: 2.05, CI: 1.62-2.60, P = .000), and had a higher risk of mortality (OR: 4.08 CI: 2.78-6.41 P < .000). CONCLUSION: Patients with blunt pelvic vessel injuries are at risk for an increased number of complications and have a higher risk of mortality. Those who survive are more likely to have an adverse discharge.

Effect of Age Alone on Outcome of Acute Surgical Conditions Among Healthy Patients (Non-smokers, Non-obese, and No Comorbid Conditions).

BACKGROUND: The impact of age alone in relation to postoperative outcomes needs to be further elucidated. This study investigated whether increasing age was associated with increased morbidity and mortality for patients with no comorbidities undergoing acute care surgery (ACS). METHODS: The 2016-2018 National Surgical Quality Improvement Project database was used to identify adult patients who underwent ACS performed on an urgent/emergent basis. Patients overweight or with pre-existing medical comorbidities were excluded. Patients were divided into age groups in decades. The association between outcomes and the different age groups, other patient characteristics, and perioperative factors was examined by multivariate logistic regression. RESULTS: 22,770 patients were identified, of which 73.5% were appendectomies, and 21.6% were open procedures. Increasing age correlated with higher unadjusted complication rates and mortality. Multivariate analyses revealed that compared to patients ≤ 30 years old, mortality was not different for patients 31-60 years old, but it was higher for the age groups > 61 years old. Patients aged 51-60 and from 71 and above were associated with higher risks of complications. Subset analysis on octogenarians revealed a 1.14-fold higher odds of mortality for every year of increasing age. Preoperative risk factors including open procedure, wound class, and American Society of Anesthesiology (ASA) class were also associated with greater risks of mortality in octogenarians. CONCLUSION: Patients older than age 50 were at higher risk for postoperative complications, and mortality significantly increased for each decade past 60 years old in healthy individuals.

Can the 5-item Modified Frailty Index Predict Outcomes in Geriatric Trauma? A National Database Study.

BACKGROUND: Frailty results in increased vulnerability to adverse outcomes following trauma. We investigated the association between the 5-item modified frailty index (mFI-5) and outcomes in geriatric trauma patients. METHODS: The 2011-2016 Trauma Quality Improvement Program database was used to study outcomes in patients ≥ 65 years old. The mFI-5 was measured and categorized into no frailty (mFI-5 = 0), moderate frailty (mFI-5 = 0.2), and severe frailty (mFI-5 ≥ 0.4). Multivariable logistic regression analyses were performed to identify independent factors of mortality and complications. RESULTS: 26,963 cases met the inclusion criteria, of whom 25.5% were not frail, 38% were moderately frail, and 36.6% were severely frail. Mean age (± SD) was 76 ± 7 years, 61.5% were male, and 97.8% sustained blunt injuries. Median Injury Severity Score (ISS) was 17 (IQR = 10-26), and the median Glasgow Coma Scale was 15 (IQR = 12-15). Overall mortality was 30.6%. Factors independently associated with mortality were age (OR = 1.07 per year, 95%CI 1.06-1.07), blunt trauma (OR = 1.44, 95%CI 1.19 -1.75), ISS (OR = 1.04 per unit increase in ISS, 95%CI 1.03-1.04), and severe frailty (OR = 1.23, 95%CI 1.15-1.32). Interestingly, male sex and GCS appeared to be protective factors with OR of 0.88 (95%CI 0.83 - 0.93) and 0.89 per point change in GCS (95%CI 0.88-0.9), respectively. Moderate (OR = 1.27, 95%CI 1.19-1.25) and severe frailty (OR = 1.49, 95%CI 1.-1.59) were significantly associated with in-hospital complications. CONCLUSION: Moderate and severe frailty were significant predictors of complications. Only severe frailty was associated with short-term mortality. The mFI-5 can be used as an objective measure to stratify risks in geriatric trauma.

Complications After Inpatient Laparoscopic Cholecystectomy: Effect of Surgeon Experience, Procedure Volume, and Other Surgeon-Based Characteristics.

BACKGROUND: Previous studies have examined how factors such as gender, education, type of training (MD or DO), and experience of the treating surgeon affect patient outcomes. We investigated patient complications after elective laparoscopic cholecystectomy based on surgeon characteristics. METHODS: A Medicare database was used to identify surgeon-specific data. The main outcome measure was the adjusted complication rates (ACR) for individual surgeons as reported by the ProPublica Surgeon Scorecard. Surgeon gender, type of training, medical school rank, years since graduation, procedure volume, and teaching status of the primary hospital affiliation were assessed for any association with increased ACR using logistic regression analysis. We explored the associations among procedure volume, years of experience, and ACR using Spearman correlation. RESULTS: 1107 predominantly male (94.6%) surgeons were included. 94.4% were MDs and 34.5% were affiliated with teaching hospitals. Mean length of practice was 24 ± 9 years, and median surgeon procedure volume was 28 (IQR = 23, 37). Overall median ACR was 4.3%. Multivariate analysis demonstrated that surgeon gender (P = .71), medical school rank, type of training (P = .68), or hospital affiliation (P = .77) did not have a significant impact on ACR. Increased surgeons' years in practice (r = -.028, P = .35) and increased surgeon procedure volume (r = -.021, P = .49) were negatively associated with increased ACR. CONCLUSION: Surgeon gender, type of training, medical school rank, or hospital affiliation had no impact on complications after laparoscopic cholecystectomy. Surgeon experience and procedure volume may have clinical implications for patient outcomes. Further studies to elucidate factors associated with surgeon quality and patient outcomes are necessary.

Expansion of Human Papillomavirus-Specific T Cells in Periphery and Cervix in a Therapeutic Vaccine Recipient Whose Cervical High-Grade Squamous Intraepithelial Lesion Regressed.

Advances in high-throughput sequencing have revolutionized the manner with which we can study T cell responses. We describe a woman who received a human papillomavirus (HPV) therapeutic vaccine called PepCan, and experienced complete resolution of her cervical high-grade squamous intraepithelial lesion. By performing bulk T cell receptor (TCR) ß deep sequencing of peripheral blood mononuclear cells before and after 4 vaccinations, 70 putatively vaccine-specific clonotypes were identified for being significantly increased using a beta-binomial model. In order to verify the vaccine-specificity of these clonotypes, T cells with specificity to a region, HPV 16 E6 91-115, previously identified to be vaccine-induced using an interferon-γ enzyme-linked immunospot assay, were sorted and analyzed using single-cell RNA-seq and TCR sequencing. HPV specificity in 60 of the 70 clonotypes identified to be vaccine-specific was demonstrated. TCR ß bulk sequencing of the cervical liquid-based cytology samples and cervical formalin-fixed paraffin-embedded samples before and after 4 vaccinations demonstrated the presence of these HPV-specific T cells in the cervix. Combining traditional and cutting-edge immunomonitoring techniques enabled us to demonstrate expansion of HPV-antigen specific T cells not only in the periphery but also in the cervix. Such an approach should be useful as a novel approach to assess vaccine-specific responses in various anatomical areas.

Modeling individual development plans, mentoring support, and career preparedness relationships among Doctor of Philosophy (Ph.D.) trainees in the life sciences.

Background: As greater career development support for doctoral students and postdoctoral researchers has been emphasized, the individual development plan (IDP) has become a recommended mentoring tool. However, little is known about the effect of IDPs on mentoring and career development. This study proposed two conceptual models to examine the interrelationships among the use of IDPs, mentoring support, and career preparedness with a diverse sample of doctoral students and postdoctoral researchers in the life sciences. Methods: The data leveraged for this study was collected over a three-month period, March 2016 to June 2016, as part of a cross-sectional, online survey. The survey was distributed through social media and direct email to participants enrolled in life/biological/medical or physical/applied doctoral programs at U.S. institutions. To test the proposed conceptual models, this study employed the design-based multilevel structural equation modeling. Results: The analytic sample comprised 660 doctoral students and postdoctoral researchers in the life sciences from 91 institutions. The results suggested that 1) using the IDP could enhance mentoring support and career preparedness of doctoral students and postdoctoral researchers; 2) greater mentoring support and career preparedness would motivate mentees to continue utilizing the IDP with their principal investigator (PI) or advisor; and 3) females, postdoctoral researchers, and international scholars might need more support throughout the mentoring and career development process. Conclusions: This research demonstrated the empirical evidence an IDP has within mentorship and career preparedness, and that an IDP is an important career development tool that enhances trainees' overall career preparation.

Teacher Enrichment Initiatives: Supporting Teachers Who Are at the Frontline of Our Nation's Future.

Teachers are charged with connecting classroom science to real-world applications; however, opportunities for teachers to experience real-world applications in the life and biosciences are limited. When provided the opportunity to engage in hands-on learning experiences, teachers' capacity to connect classroom activities to real-world applications increases. Through partnerships within the local STEM Ecosystem, the Teacher Enrichment Initiatives (TEI) provides teachers with experiences that enable them to strengthen the connections between classroom science and careers. Over the course of TEI's 25+ years, these collaborations between our teachers and partners have resulted in the production of over 350 individual hands-on, inquiry-based curriculum activities. In addition, the TEI has played a pivotal role in the growth of the STEM workforce by disseminating best practices and providing teacher professional development (TPD) experiences designed to improve teacher knowledge of STEM career options and the associated educational pathways for their students while enhancing teacher professionalism. Since 2011, the TEI has hosted 15 TPD conferences and 300 workshops with over 1,800 K-12 teachers participating annually. The number of students impacted through teacher participation exceeds 300,000, covering all grade levels. To date, over 83 scientists, engineers, and STEM-career professionals have participated in TEI sponsored events.

Spatio-temporal dynamics of neocortical presynaptic terminal development using multi-photon imaging of the corpus callosum in vivo.

Within the developing central nervous system, the dynamics of synapse formation and elimination are insufficiently understood. It is ideal to study these processes in vivo, where neurons form synapses within appropriate behavioral and anatomical contexts. In vivo analysis is particularly important for long-range connections, since their development cannot be adequately studied in vitro. The corpus callosum (CC) represents a clinically-relevant long-range connection since several neurodevelopmental diseases involve CC defects. Here, we present a novel strategy for in vivo longitudinal and rapid time-lapse imaging of CC presynaptic terminal development. In postnatal mice, the time-course of CC presynaptic terminal formation and elimination was highly variable between axons or groups of axons. Young presynaptic terminals were remarkably dynamic - moving, dividing to generate more boutons, and merging to consolidate small terminals into large boutons. As synaptic networks matured, presynaptic mobility decreased. These rapid dynamics may be important for establishing initial synaptic contacts with postsynaptic partners, refining connectivity patterns or modifying synapse strength during development. Ultimately, this in vivo imaging approach will facilitate investigation of synapse development in other long-range connections and neurodevelopmental disease models.

Publisher Correction: Reply to 'A lack of evidence for six times more anxiety and depression in US graduate students than in the general population'.

In the version of this article initially published, the Editor's Note indicating that the article has been peer-reviewed was missing. The error has been corrected in the HTML and PDF versions of the article.

Intravital imaging of immune cells and their interactions with other cell types in the spinal cord: Experiments with multicolored moving cells.

Intravital imaging of the immune system is a powerful technique for studying biology of the immune response in the spinal cord using a variety of disease models ranging from traumatic injury to autoimmune disorders. Here, we will discuss specific technical aspects as well as many intriguing biological phenomena that have been revealed with the use of intravital imaging for investigation of the immune system in the spinal cord. We will discuss surgical techniques for exposing and stabilizing the spine that are critical for obtaining images, visualizing immune and CNS cells with genetically expressed fluorescent proteins, fluorescent labeling techniques and briefly discuss some of the challenges of image analysis.

Engaging the Community through Science Nights: An Elementary School Case Study.

Parental involvement increases K-12 student interest in STEM careers; however, when parents lack confidence in STEM content, or language and cultural barriers exist, parental engagement decreases. The Teacher Enrichment Initiatives (TEI) collects annual teacher feedback regarding the level of parental involvement with students during science nights, which laid the foundation for teachers to develop a science night training. Using qualitative methods, this single-case study follows elementary teachers who participated in the TEI science night training as they implement a Science Night program at a majority-minority elementary school. Data were gathered by TEI staff during the inaugural and third year of the Science Night program showing an increase in attendance from 700 (2016) to 800 (2018) and an increase in parental engagement with their student in STEM-related activities from 46% (2016) to 62% (2018). The data and follow-up summary were used by the case study school teachers to write and secure grants to support an annual Science Night program. This case study suggests Science Nights can be a mechanism to promote parental engagement with their student in hands-on STEM activities. Further, this case study suggests teacher feedback and inclusion in developing a science night model is central to successful implementation of a science night program.

Use and effectiveness of the Individual Development Plan among postdoctoral researchers: findings from a cross-sectional study.

The individual development plan (IDP) is a career planning tool that aims to assist PhD trainees in self-assessing skills, exploring career paths, developing short- and long-term career goals, and creating action plans to achieve those goals. The National Institutes of Health and many academic institutions have created policies that mandate completion of the IDP by both graduate students and postdoctoral researchers. Despite these policies, little information exists regarding how widely the tool is used and whether it is useful to the career development of PhD trainees. Herein, we present data from a multi-institutional, online survey on the use and effectiveness of the IDP among a group of 183 postdoctoral researchers. The overall IDP completion rate was 54% and 38% of IDP users reported that the tool was helpful to their career development. Positive relationships with one's advisor, confidence regarding completing training, trainees' confidence about their post-training career, and a positive experience with institutional career development resources are associated with respondents' perception that the IDP is useful for their career development. We suggest that there is a need to further understand the nuanced use and effectiveness of the IDP in order to determine how to execute the use of the tool to maximize trainees' career development.

A cross-sectional study of the use and effectiveness of the Individual Development Plan among doctoral students.

Background: The Individual Development Plan (IDP) was introduced as a tool to aid in career planning for doctoral trainees. Despite the National Institutes of Health and academic institutions creating policies that mandate the use of IDPs, little information exists regarding the actual use and effectiveness of the career planning tool. Methods: We conducted a multi-institutional, online survey to measure IDP use and effectiveness. The survey was distributed to potential respondents via social media and direct email. IDP survey questions were formatted using a five-point Likert scale (strongly agree, agree, neutral, disagree and strongly disagree). For data analysis purposes, responses were grouped into two categories (agree versus does not agree/disagree). The data were summarized as one-way frequencies and the Pearson Chi-square test was used to determine statistical significance. Results: Usage of the IDP among doctoral students was low and the tool produces minimal effectiveness with regard to the perception of whether it is helpful to one's career development. Further, our data suggests that the IDP is most effective when doctoral students complete the tool with faculty mentors with whom they have a positive relationship. Respondents who are confident about completing their doctoral training and their post-training career plans, and who take advantage of career development resources at their institution are also more likely to perceive that the IDP is useful for their career development. Conclusion: Given the nuanced use and effectiveness of the IDP, we call for more research to determine why IDP use and effectiveness is low, exactly how IDPs are being used, and whether there are unintended negative consequences created through the use of the tool. Furthermore, we recommend an enhancement of career development infrastructure that would include mentorship training for faculty in order to provide substantially more career planning support to doctoral trainees.

Specific learning disability in mathematics: a comprehensive review.

Math skills are necessary for success in the childhood educational and future adult work environment. This article reviews the changing terminology for specific learning disabilities (SLD) in math and describes the emerging genetics and neuroimaging studies that relate to individuals with math disability (MD). It is important to maintain a developmental perspective on MD, as presentation changes with age, instruction, and the different models (educational and medical) of identification. Intervention requires a systematic approach to screening and remediation that has evolved with more evidence-based literature. Newer directions in behavioral, educational and novel interventions are described.

Nursing students' perceptions of preparation to engage in patient education.

Patient teaching is a key component of graduate nursing practice. Nurses sometimes believe that their undergraduate teaching does not prepare them to engage in effective patient teaching. In addition, nursing students often do not use teaching resources when engaging in patient teaching. The aim of this focused ethnographic study was to determine if students in a CBL/PBL based learning undergraduate nursing program engage in patient teaching when they are in the clinical area. Focus groups and shorter individual interviews were used to ensure in-depth data collection. Data saturation was reached with a sample of 28 undergraduate students. Emerging themes included: Whose responsibility? When patient teaching does happen, when patient teaching does not happen and improving the culture of patient teaching in the teaching setting. It was clear that students in this context-based learning nursing teaching program valued and were engaged in patient teaching. However, they did not necessarily feel that they had been taught the skills necessary for engaging in effective patient teaching. They also expressed concern that workplace conditions for nurses were not always conducive to patient teaching.

Maternal metabolic profile predicts high or low risk of an autism pregnancy outcome.

BACKGROUND: Currently there is no test for pregnant mothers that can predict the probability of having a child that will be diagnosed with autism spectrum disorder (ASD). Recent estimates indicate that if a mother has previously had a child with ASD, the risk of having a second child with ASD is ~18.7% (High Risk) whereas the risk of ASD in the general population is ~1.7% (Low Risk). METHODS: In this study, metabolites of the folate-dependent transmethylation and transsulfuration biochemical pathways of pregnant mothers were measured to determine whether or not the risk of having a child with autism could be predicted by her metabolic profile. Pregnant mothers who have had a child with autism before were separated into two groups based on the diagnosis of their child whether the child had autism (ASD) or not (TD). Then these mothers were compared to a group of control mothers who have not had a child with autism before. A total of 107 mothers were in the High Risk category and 25 mothers in the Low Risk category. The High Risk category was further separated into 29 mothers in the ASD group and 78 mothers in the TD group. RESULTS: The metabolic results indicated that among High Risk mothers, it was not possible to predict an autism pregnancy outcome. However, the metabolic profile was able to predict with approximately 90% sensitivity and specificity whether a mother fell into the High Risk group (18.7% risk) or Low Risk group (1.7% risk). CONCLUSIONS: Based upon these measurements it is not possible to determine during a pregnancy if a child will be diagnosed with ASD by age 3. However, differences in the folate-dependent transmethylation and transsulfuration metabolites are indicative of the risk level (High Risk of 18.7% vs. Low Risk of 1.7%) of the mother for having a child with ASD.