Muscle activity prior to experiencing the rubber hand illusion is associated with alterations in perceived hand location.

The rubber hand illusion (RHI) is a perceptual illusion in which one is made to feel that a hand-shaped object is part of their body. This illusion is believed to be the result of the integration of afferent information. However, there has been an increasing amount of evidence that suggests efferent information plays a role in this illusion as well. Previous research has found that individuals who are afflicted by pathological lack of movement experience the RHI more vividly than control participants. Whereas individuals who move their hands more than the general population (i.e. professional pianists) experience the RHI less vividly than control participants. Based upon the available evidence it would seem that muscle activity prior to experiencing the RHI should be associated with how vividly one experiences different indices of the illusion. In the present study we tested this possibility by having participants perform a maximum voluntary muscle contraction task prior to experiencing three variants of the RHI (moving active, moving passive and classic). It was found that electromyographic features known to be indicative of muscle fatigue exhibited a positive association with proprioceptive drift when stimulation was synchronous or visual movement only (with the exception of the passive moving RHI synchronous condition). More work is needed to better characterize the muscular processes associated with experiencing the RHI.

Ultrasound assessment of peripheral intravenous catheters by nurses in the pediatric intensive care unit.

OBJECTIVE: Establish the feasibility of pediatric intensive care unit (PICU) nurse-directed ultrasound assessment (UA) of peripheral intravenous (PIV) catheters, compare the results of UA to traditional assessment (TA), and determine PIV survival after UA. DESIGN: Prospective observational cohort study. SETTING: PICU within a children's hospital. PATIENTS: PICU patients with a PIV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eight nurses performed UA on 131 PIVs in 85 patients. Median age was 3.0 years (IQR 1.0-13.8) and median weight was 15.0 kg (IQR 9.6-59.3). The most common PIV location was the arm (43%) and extravasation occurred in 15% of PIVs. Agreement between TA and UA was moderate with a Kappa of 0.47 (95% CI 0.28-0.66). Nursing confidence in the UA was significantly higher than TA (92% vs 21% very confident, p < 0.0001). In 106 PIVs with a UA that indicated the PIV was intravascular (i.e. negative UA), the median survival was 50.0 h (IQR 21.8-100.3). CONCLUSIONS: Nurses can perform UA of PIV status in PICU patients and express greater confidence in the findings of UA than TA. Further study is necessary to determine the impact of UA on the rate of PIV complications.

An Overview of Strategies to Improve Vaccination Compliance before and during the COVID-19 Pandemic.

The debate on vaccination mandate was fuelled over the past two years by the COVID-19 pandemic. This study aimed at overviewing vaccination strategies and corresponding vaccine coverages for childhood vaccinations before the pandemic and for SARS-CoV-2 in high-income countries. A qualitative comparison was also performed between the two contexts: unlike for childhood vaccinations, only one European country (Austria) imposed generalised COVID-19 mandates, most countries preferring targeted mandates for higher-risk categories (Italy, Greece) or workers in key public services (Finland, Australia, New Zealand, UK, Germany). Many countries (Norway, Sweden, Netherlands, Portugal, Spain) confirmed their traditional voluntary vaccination approach also for COVID-19, while others (Slovenia and Hungary), historically relying on compulsory vaccination strategies, surprisingly opted for voluntary SARS-CoV-2 vaccination, with unsatisfactory results in terms of immunisation rates. However, no tangible relationship was generally found between vaccination policies and immunisation coverages: data show that, unlike some countries with mandates, countries where vaccinations are merely recommended could achieve higher coverages, even beyond the recommended 95% threshold. The COVID-19 experience has enriched pre-existent vaccination strategy debates by adding interesting elements concerning attitudes towards vaccines in a novel and unexplored context. Interpreting the available results by considering the different cultural contexts and vaccine hesitancy determinants can help to better understand the complexity of the relationship between policies and achieved coverages.

Individual Differences in Cognitive Constructs: A Comparison Between American and Chinese Culture Groups.

Previous studies on human cognition show that people with different cultural backgrounds may differ in various ways. However, there are other unexplored possibilities for cultural differences including degree of handedness thought to reflect hemispheric coordination, reliance on verbal versus visual representation in problem solving, and working memory capacity both spatial and operational. We assessed each of these using the Edinburgh scale, a validated scale of style of processing, and two automatic working memory span tasks. Participants were either native Chinese students (who spoke Mandarin) or American students. Data showed that culture impacted the set of measures but gender did not and these factors did not interact. Chinese and American students showed the largest difference in their operational working memory. We also examined the pattern of correlations among the measures across the two groups and found differences due to cultural group as well.

Comparison of electromagnetic guided imagery to standard confirmatory methods for ascertaining nasogastric tube placement in children.

PURPOSE: Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube. DESIGN AND METHODS: Pediatric Intensive Care Unit (PICU) patients were enrolled if they had an NGT order during the study period of April 2014 through December 2016. Patients were included if they were one through 18 years of age. An EMD trained nurse inserted the NGT using EMD guidance. An insertion questionnaire, confirming if the nurse determined the NGT to be gastric per EMD, was completed immediately after NGT placement and before confirmation via either pH testing or radiographic imaging. RESULTS: Forty-five patients were enrolled in the study. Nurses reported, based on EMD, that 86.7% (n = 39) of placements were gastric. Overall agreement between EMD guided tube placement and pH testing was 58% (n = 26). The marginal distribution was significantly different between the two methods (p = .0029). When compared to radiographic confirmation, sensitivity of the pH method was 32% (95% confidence interval [CI]: 17%-51%) compared with 85% (95% CI 69%-95%) for the EMD method. CONCLUSIONS: EMD guidance was superior to pH testing when compared with radiographic confirmation of nasogastric tube placement in children. PRACTICE IMPLICATIONS: EMD guided NGT placement is a potentially viable method for confirming nasogastric tube placement in children when done by appropriately trained clinicians. More research on EMD guided NGT placement in children is needed before any practice recommendation can be made.

Outcomes following adoption of a standardized protocol for abscess drain management in pediatric appendicitis.

BACKGROUND/PURPOSE: Though evidence-based clinical pathways for the diagnosis and treatment of pediatric appendicitis have been established, protocols guiding management of percutaneous abscess drains are lacking. We hypothesized a drain management protocol utilizing drain output and clinical factors instead of fluoroscopic drain studies would reduce interventional radiologic procedures without adversely impacting clinical outcomes. METHODS: A standardized protocol was uniformly adopted at a tertiary-care children's hospital in April 2016. A retrospective chart review included all cases of appendicitis requiring abscess drainage by interventional radiology three years pre- and postprotocol implementation. RESULTS: Fifty-eight patients (preprotocol = 39, postprotocol = 19) underwent percutaneous abscess drainage, of whom 52 (preprotocol = 34, postprotocol = 18) required a drain. Baseline demographics and clinical presentation were similar across groups. Following protocol implementation, total number of IR procedures decreased from 2.4 to 1.3 per patient (p = 0.004). There was no significant difference in the number of postprocedure diagnostic imaging studies, readmissions, or inpatient days, and there was a trend towards a decrease in number of drain days (10.7 to 5.7, p = 0.067). CONCLUSION: A standardized protocol for management of abscess drains for complicated appendicitis reduced the number of IR procedures without a negative impact on clinical outcomes or increase in alternative imaging studies. This approach may decrease radiation exposure, anesthetic administration, and resource utilization. TYPE OF STUDY: Treatment study (retrospective comparative study). LEVEL OF EVIDENCE: Level III.

Perceptual Validation of Nonlinear Postural Predictors of Visually Induced Motion Sickness.

Virtual reality (VR) technology has become increasingly prevalent in our society and has been used for a myriad of applications ranging from psychotherapy to training members of the military. However, one issue that arises from the use of VR is motion sickness, thus making predictors and indicators of motion sickness desirable. To date, a number of indicators of motion sickness have been derived based on nonlinear characteristics of human motion recorded using motion capture systems. While it is known that nonlinear measures can be used to predict motion sickness, it is not known whether people are perceptually sensitive to these particular nonlinear parameters. The aims of this study included establishing whether individuals consistently sort phase plots of sick and well individuals' postural motion without being explicitly told to do so; determining what nonlinear movement parameters could be used to represent these judgments; and assessing the stability of nonlinear measures found to be successful at predicting motion sickness by Smart et al. (2014). Through two methods of analysis (perceptual and quantitative), this research demonstrated that participants can indeed sort the graphic depictions of sick and well participants' postural motion and seem to be perceptually sensitive to nonlinear parameters (normalized path length, path length, elliptical area) that are known to be predictive of motion sickness.

Exploring the possible health consequences of job insecurity: a pilot study among young workers / Las posibles consecuencias de la inseguridad laboral para la salud: estudio piloto entre jóvenes trabajadores

OBJECTIVE: Socio-economical changes in Europe are leading to the rise of new issues regarding the labour market and health of young workers. Job insecurity is a widely studied phenomenon that involves an increasing number of young workers. We investigated its association with mental health and hazardous behaviours. METHOD: In this pilot study, 504 subjects aged between 18 and 40 were interviewed. STROBE guidelines were used. Socio-economic factors were evaluated. Adapted forms of validated scales were used to assess depression, anxiety disorder, alcohol and drug abuse and smoking habit. Univariate and multivariate analyses were performed. RESULTS: Job insecurity appeared to be partially connected with the type of employment. Most respondents with a permanent contract felt their situation was secure, while this proportion was reduced when referring to temporary jobs and other kinds of contract (p <0.001). Job security perception was associated with depression, anxiety, alcohol abuse and smoking habit (p <0.001). CONCLUSIONS: Job security perception appears to be the most important predictive factor for the presence of depression and anxiety symptoms, alcohol consumption and smoking habit compared to other socio-economic factors under study

OBJETIVO: Los cambios socioeconómicos en Europa están provocando el surgimiento de nuevas cuestiones sobre la salud de los trabajadores jóvenes. La inseguridad laboral es un fenómeno que involucra una cantidad creciente de trabajadores jóvenes. Nuestro estudio tiene como objetivo investigar la asociación entre inseguridad laboral y salud mental y comportamientos peligrosos. MÉTODO: En este estudio piloto fueron entrevistados 504 sujetos con edades comprendidas entre 18 y 40 años. Se evaluaron los factores socioeconómicos. Se usaron formas adaptadas de escalas validadas para evaluar la depresión, la ansiedad, el abuso de alcohol y drogas, y el hábito de fumar. Se realizaron análisis univariados y multivariados. RESULTADOS: La mayoría de los encuestados con contrato permanente consideró que su situación era segura, mientras que esta proporción se redujo al referirse a trabajos temporales y otros tipos de contrato (p <0,001). La percepción de la seguridad laboral se asoció con la depresión, la ansiedad, el abuso de alcohol y el hábito de fumar (p <0,001). CONCLUSIONES: La percepción de la seguridad laboral parece ser el factor predictivo más importante para la presencia de síntomas de depresión y ansiedad, el consumo de alcohol y el hábito de fumar, en comparación con otros factores socioeconómicos en estudio

The association of adverse life events with children's emotional overeating and restrained eating in a population-based cohort.

OBJECTIVE: Life adversities are recognized risk factors for eating disorders, in adolescents and adults, but whether such adversities are also associated with particular eating behaviors earlier in life is still unclear. Our aim was to assess whether experiencing adverse life events in early childhood is associated with emotional overeating and restrained eating at age 10. METHODS: Emotional overeating and restrained eating were assessed in 4,653 10-years-old children using the mother-reported Children's Eating Behavior Questionnaire and Dutch Eating Behavior Questionnaire. Mothers also reported on 24 different life events during childhood, those with moderate or severe impact being categorized as adverse life events. Regression analyses were performed to investigate relationships between adverse life events and eating behaviors in the total sample. RESULTS: Adjusted for covariates, adverse life events were associated with more emotional overeating and restrained eating in children (p-values for trend <.01). Specifically, mothers who reported that their child experienced 3+ adverse life events, also reported significantly higher emotional overeating (B = 0.20; 95% confidence interval [CI], 0.06-0.33) and restrained eating (B = 0.21; 95% CI, 0.08-0.33) in their children relative to children who did not experience adverse life events. These results did not differ by sex. DISCUSSION: Our results based on mother-reported data suggest that children's experiences of life adversities are associated with emotional overeating and restrained eating at age 10 years. We recommend future prospective studies using multi-informant assessments of both adverse life events and eating behaviors to further describe the nature and developmental course of this relationship.

A new strategy to promote flu vaccination among health care workers: Molinette Hospital's experience.

RATIONALE, AIMS, AND OBJECTIVES: Seasonal flu represents a major public health issue, especially for health care workers (HCWs). WHO highlights the need of higher awareness and flu vaccine coverage among HCWs. In Europe the coverage is less than 30-40%. Italy reports some of the lowest rates. The paper aims to illustrate the 2017/2018 flu vaccination campaign within Molinette, the third Italian hospital for dimensions, to provide inputs about strategies for increasing HCWs coverage. The campaign objective was to increase the administered doses at least of 30%. METHODS: The intervention included informational material, direct educational sessions for workers, extension of the access time to Occupational Medicine Service, elimination of the reservation requirement, composition of "moving vaccination units" (MVUs), and organisation of vaccination sessions within departments. RESULTS: In 2017/2018, 593 doses were administered. The doses percentage change between 2017/2018 and 2016/2017 vaccination seasons was +46.06%, while it was +84.74% compared with the previous 5-year period mean. The majority was administered by Occupational Medicine Service, while 6.75% by MVUs. Among the total doses, 72.68% were administered to workers, 13.49% to residents, 6.75% to students, and 7.08% to "other". So, 7.68% of total workforce was vaccinated. Only 0.3% of vaccinated people presented mild adverse reactions. CONCLUSIONS: A combined campaign, that includes actions for education, increase of awareness, improved access to facilities and active offers to workers has potentiality but there is still work to do. The vaccination increase was determined mostly by the re-organization of the occupational medicine, while the MVUs were useful to HCWs of detached offices.

Exploring the possible health consequences of job insecurity: a pilot study among young workers.

OBJECTIVE: Socio-economical changes in Europe are leading to the rise of new issues regarding the labour market and health of young workers. Job insecurity is a widely studied phenomenon that involves an increasing number of young workers. We investigated its association with mental health and hazardous behaviours. METHOD: In this pilot study, 504 subjects aged between 18 and 40 were interviewed. STROBE guidelines were used. Socio-economic factors were evaluated. Adapted forms of validated scales were used to assess depression, anxiety disorder, alcohol and drug abuse and smoking habit. Univariate and multivariate analyses were performed. RESULTS: Job insecurity appeared to be partially connected with the type of employment. Most respondents with a permanent contract felt their situation was secure, while this proportion was reduced when referring to temporary jobs and other kinds of contract (p <0.001). Job security perception was associated with depression, anxiety, alcohol abuse and smoking habit (p <0.001). CONCLUSIONS: Job security perception appears to be the most important predictive factor for the presence of depression and anxiety symptoms, alcohol consumption and smoking habit compared to other socio-economic factors under study.

A Pilot Study of Partner Chair Massage Effects on Perinatal Mood, Anxiety, and Pain.

BACKGROUND: Women worldwide experience perinatal mood, anxiety, and pain contributing to pregnancy and birth challenges, maternal and infant bonding, and childhood development. Perinatal women seek massage therapy for relaxation, pain management, and emotional support, but may encounter socioeconomic barriers. Prior studies demonstrated improved perinatal health by teaching partners of pregnant women a side-lying massage. PURPOSE: This study examined health effects to perinatal mood, anxiety, and pain, by teaching partners of pregnant (PG) women a chair massage. SETTING: Participant's homes in Tucson, Arizona, USA. PARTICIPANTS: Twelve PG women with minor mood, anxiety, and pain: 67% white, 33% Hispanic, college educated, married, aged 32 years (± 3.86 SD), 67% expecting a first child, annual incomes ≤ $50,000 (33%), > $50,000 (67%). RESEARCH DESIGN: A pre/postintervention pilot study in a single group for eight weeks. INTERVENTION: Twice weekly partner-delivered chair massage and its relation to perinatal mood, anxiety, and pain. MAIN OUTCOME MEASURES: Pre/poststudy perinatal massage effects were measured with the Edinburgh Depression Scale (mood), the STAI-AD (anxiety), and the VAS (pain). Weekly text messaging tracked dose and frequency, follow-up surveys measured sustainability, and birth outcomes were acquired by texting. RESULTS: Study retention was 86%, protocol compliance 94%, with couples averaging 10-minute, twice weekly chair massage over the eight-week study period. Paired-sample t tests indicated statistically significant improvements to perinatal mood and anxiety, Cohen's d, a large strength of effect size (p = .012, d = 0.87; p = .004, d = 1.03). A trend was observed for reduced pain, with a medium strength of effect size (p = .071; d = 0.58). Follow-up surveys indicated most couples were sustaining at least weekly massage. Birth outcomes showed healthy infants with no complications, mean birth weight of 7.26 pounds, and mean gestation of 39 weeks. CONCLUSION: This is the first evidence of partner chair massage as safe and effective complementary home management of perinatal mood, anxiety, and pain.

What is the most useful tool in HPV vaccine promotion? Results from an experimental study.

Introduction: Human papillomavirus infection (HPV) affects 70-80% of female population throughout the lifetime, exposing them to the risk of developing genital warts and cervical cancer. Despite these correlated risks and the demonstrated efficacy of the vaccine, coverage rates for two-three doses are around 70% in Italy and 67% in Piemonte (below the expected 95%). Aim of the study is to investigate whether this situation is due to a lack of information and awareness among young adults. Results: Students showed increased knowledge after the intervention and more than 90% found the 3 informative materials as sources of useful information. After the intervention students would strongly recommend HPV vaccination (OR = 3.45; p < 0.001). Discussion: Higher rates of correct answers after the distribution of informative material underline the importance of knowledge delivery. Differences among the kind of material were reported; it appears that a combination of leaflet's positive features, such as clarity and intelligibility, and article's completeness of information represents the best solution to reach communication goals in vaccination campaigns targeted on educated populations. Methods: Researchers conducted an experimental study on a large population of undergraduate students from University of Turin. Participants' knowledge about HPV was assessed with questionnaires before and after the examination of 3 different kinds of informative material (journal article describing HPV infection, gynecologist video-interview and institutional leaflet about HPV prevention) on HPV and vaccine. Differences among groups were explored by using univariate tests, differences in pre- post- knowledge were assessed with McNemar tests. Relevant associations were searched with logistic regression models.

Staying Alert? Neural Correlates of the Association Between Grit and Attention Networks.

Recent research has demonstrated that heightened motivational levels promote enhanced attention capabilities. However, the relation between attentional systems and the trait-based ability to sustain a motivational state long-term is less understood. Grit refers to one's ability and willingness to pursue long-term goals despite setbacks. This report presents the results of two studies conducted to examine the relation between facets of Grit-Consistency and Perseverance and attention networks, assessed using the Attention Network Test (ANT). Across both studies Grit-Perseverance was related to performance on the ANT. In Study 1, Grit-Perseverance was negatively related to alerting indicating that individuals who were high on Perseverance were more likely to show a smaller alerting effect. In particular, Grit-Perseverance was negatively correlated with reaction times in the no cue trials. In Study 2, we assessed ERP components associated with attention networks. Individuals with higher scores on Grit-Perseverance were more likely to demonstrate smaller mean difference in N1 amplitudes for double cue relative to no cue trials, suggesting an attenuated alerting effect. Our findings indicate that individuals high on Grit-Perseverance may have enhanced sustained attention. Specifically individuals with high Grit-Perseverance appear to exhibit a more efficient alerting system in the no cue trials. Implications of high levels of Grit on cognitive performance are discussed.

Cost-effectiveness estimates of vaccination against rotavirus in Piedmont, Italy.

BACKGROUND: Rotavirus-induced gastroenteritis (RVGE) represents the most frequent form of severe gastroenteritis in children. In such a scenario, the availability of an efficient anti-Rotavirus (anti-RV) vaccine represents an effective prevention tool able to prevent those complications mainly linked to the moderate-severe forms of this disease, which require hospital care. The aim of the present study is to estimate the cost effectiveness of universal routine infant RV vaccination program and its budget impact on the Regional Health Service (RHS) of Piedmont, Italy, in order to evaluate the opportunity of the implementation of a national anti-Rotavirus vaccination programme. METHODS: The researchers performed a cost-effectiveness analysis comparing costs and benefits of a Rotarix two-dose vaccination versus non vaccination and a budget impact analysis (BIA), complementary to the cost-effectiveness analysis. RESULTS: Our results show that the mass implementation of an anti-RV vaccination in Piedmont, in addition to the expected public health benefits, also allows the RHS to save a considerable amount of money within a short period of time, due to the remarkable reduction of direct health costs associated with RVGE management. In fact, as the analysis shows, a universal vaccination against RV results in money-saving for the RHS already from the 2nd year (with a vaccination coverage of 50%). During the five year period, the active and free offer of the anti-RV vaccination would determine a total saving for RHS of about € 503.000. The cost-effectiveness analysis results showed a cost-saving ICER (incremental cost-effectiveness ratio) relevant to the RHS and equal to - €12.197/QALY. CONCLUSION: In conclusion the adoption of a universal preventive strategy for all the infants in the Piedmont Region may contribute significantly towards the control of RVGE incidence, thus allowing a noteworthy saving of economic and social resources for both the RHS and the general public.

The impact of intergenerational programs on children and older adults: a review.

ABSTRACTBackground:Elderly are at particular risk of social isolation. This condition significantly affects health; on the contrary, social involvement can be extremely advantageous. In this context, intergenerational programs improve interactions between different ages. Then, we conducted a review regarding intergenerational programs, to summarize the effects of these activities on both elderly and children. METHODS: Our review followed the PRISMA statements. We considered papers reporting data about intergenerational programs involving children (preschool and elementary) and elderly. RESULTS: The final selection obtained 27 sources. Ten studies evaluated children's outcomes outlining the positive impact of intergenerational programs upon children's perception of elderly. The effects on older participants were variegated considering well-being, depression, self-reported health, and self-esteem. Moreover, the retrieved studies outlined the importance of a careful organization and of a specific training for all staff members. The staff involved in similar programs appeared, overall, highly satisfied. DISCUSSION: The positive impact on children of intergenerational programs is proved at both short- and long-term. Moreover, despite the different outcomes considered and the variable results, these programs resulted overall beneficial on elderly participants. Finally, similar activities resulted feasible even in case of older adults with dementia.

Attitudes of medical doctors and nurses towards the role of the nurses in the primary care unit in Italy.

AimAim of the present study was to assess the knowledge of the potential role of nurses in the primary care setting and to analyse the attitudes towards their utilization by nurses and General Practitioners (GPs) in a region of Italy. BACKGROUND: Nowadays, in Italy, the role of the nurse in primary care is still under-recognized and most primary care medical offices are managed individually by a physician. METHODS: The study consists of a questionnaire-based cross-sectional survey carried out in Piedmont, Italy, between February and September 2015.FindingsWe included 105 participants, 57 nurses and 48 physicians. The presence of a nurse working together with the GP was defined as 'useful' by 54.4% of nurses (versus 60.4% of physicians), as 'essential' by 45.6% of nurses (versus 25.0% of physicians), as 'marginal' by no nurses (versus 14.6% of physicians) and as 'unimportant' by none (P=0.002). Thus, physicians seemed to be less favorable towards a full collaboration and power-sharing with nurses. Furthermore, GPs and nurses showed a different attitude towards the role of nurses in primary care: while nurses highlighted their clinical value, physicians tended rather to recognize them a 'supportive' role. Moreover, only 20.8% of the physicians interviewed stated that they worked with a nurse. At the multivariate analysis, the age class resulted to be a significant predictor of the perception that the presence of a nurse working with the GP is essential: participants >50 years had an OR of 0.03 (P=0.028). Although the primary care organization appears still largely based on a traditional physician-centric care model, the positive attitude of nurses and young GPs towards a more collaborative model of primary care might represent a promising starting point.

HIV screening in pregnant women: A systematic review of cost-effectiveness studies.

INTRODUCTION: Vertical transmission represents the major route of HIV infection for children. However, the preventive interventions available are extremely effective. This review summarizes evidence regarding the cost-effectiveness of mother-to-child-transmission preventive screenings, to help policy makers in choosing the optimal antenatal screening strategy. METHODS: A systematic review following PRISMA guidelines was conducted, using 3 databases: PubMed, Scopus, and Cost-Effectiveness Analysis Registry. All articles regarding HIV screening to avoid vertical transmission were included. RESULTS: The review included 21 papers. Seven studies assessed the cost-effectiveness of universal antenatal screening during early gestation. Two papers considered the integration of HIV screening with other medical interventions. Eight works estimated the cost-effectiveness of HIV screening in late pregnancy. Finally, 4 papers considered the combination of multiple strategies. The selected papers focused on both developed and developing countries, with a different HIV prevalence. The characteristics and methodology of the studies were heterogeneous. However, all studies agreed about the main findings, outlining the cost-effectiveness of both universal antenatal screening and HIV rescreening in late pregnancy. Cost-effectiveness improved when HIV burden increased. The major findings were proved to be robust across various scenarios when tested in sensitivity analysis. CONCLUSIONS: The review confirmed the cost-effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost-effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high-risk groups could be a valuable option.

Effect of Radiology Study Flow on Report Turnaround Time.

OBJECTIVE: The purpose of this study was to assess the importance of relative value unit (RVU) flow and other factors in report turnaround time (TAT) in emergency radiologic operations. MATERIALS AND METHODS: RVU flow was defined as the normalized (to 60 minutes) total work RVUs for studies performed in a given time interval of 30 minutes (RVU flow 30) or 60 minutes (RVU flow 60). Twenty-five weekday emergency radiology shifts each for four radiologists were randomly selected. The institutional radiology search engine was queried to obtain the following data for each study: study completion time, work RVU, attending radiologist, and report TAT. RVU flow 30, RVU flow 60, presence of resident, and number of hours since start of shift were computed. Two separate multiple linear regression analyses were performed with RVU flow 30 or RVU flow 60 and other factors as independent variables and TAT as the dependent variable. RESULTS: The study included 7378 radiology studies from 100 weekday shifts, from which 1537 RVU flow 30 and 792 RVU flow 60 data points were generated. RVU flow 60 (p = 0.0026) and RVU flow 30 (< 0.0001) were significantly associated with radiology report TAT. One attending radiologist had statistically significant lower TAT 30 and TAT 60, whereas another had a lower TAT 30 but not TAT 60. The presence of a resident was significantly associated with reduced TAT 30 (p = 0.0005) and TAT 60 (p = 0.0028). CONCLUSION: RVU flow 60, RVU flow 30, specific attending radiologist, and presence of a resident are significantly correlated with radiology report TAT. RVU flow should be considered when evaluating radiologist and overall system performance with respect to report TAT.