Surgical Site Infections in Open and Laparoscopic Operations in Rooms With Open-floor Drainage Systems.

INTRODUCTION: Surgical site infections are common postoperative complications. Some operating rooms have open-floor drainage systems for fluid disposal during endourologic cases, although nonendoscopy cases are not always allowed in these rooms. We hypothesized that operating rooms with open-floor drainage systems would not materially affect risk of surgical site infections for patients undergoing open and laparoscopic procedures. METHODS: Patients who had surgical site infections from 2016 through 2020 were identified from data of the National Surgical Quality Improvement Program. Patients without surgical incisions, with open wounds, and with surgical site infections at surgery were excluded. The primary outcome was surgical site infection occurrence within 30 days of surgery. Multilevel multivariable logistic regression was used to estimate the observed-to-expected surgical site infection ratio for each operating room (2 with and 23 without open-floor drainage systems). RESULTS: We identified 8,419 surgical cases, of which 802 (9.5%) were performed in operating rooms with open-floor drainage systems; 166 patients (2.0%) had surgical site infections. Of the surgical site infections, 7 (4.2%) occurred in operating rooms with open-floor drainage systems. Surgical specialty, American Society of Anesthesiologists physical status, higher case acuity, dyspnea, immunosuppression, longer surgical duration, and wound classification were associated with surgical site infections (P < .05 for all). The observed-to-expected ratios of surgical site infections occurring in the 2 operating rooms with open-floor drainage systems were 0.85 and 1.15. The odds ratio of surgical site infections for urologic cases performed in room with vs without open-floor drainage systems was 1.30 (P = .65). CONCLUSIONS: Urology operating room designs often include open-floor drainage systems for water-based cases. These drainage systems were not associated with an increased risk of surgical site infections.

FOXO3, estrogen receptor alpha, and androgen receptor impact tumor growth rate and infiltration of dendritic cell subsets differentially between male and female mice.

Tumors evade immune recognition and destruction in many ways including the creation of an immune-suppressive tumor microenvironment (TME). Dendritic cells (DC) that infiltrate the TME are tolerogenic, and suppress effector T cells and anti-tumor activity. Previous reports demonstrated that a key regulator of tolerance in DC is the transcription factor FOXO3. Gender disparity has been studied in cancer in relation to incidence, aggressiveness, and prognosis. Few studies have touched on the importance in relation to impact on the immune system. In the current study, we show that there are significant differences in tumor growth between males and females. Additionally, frequencies and the function of FOXO3 expressed by DC subsets that infiltrate tumors vary between genders. Our results show for the first time that DC FOXO3 expression and function is altered in females. In vitro results indicate that these differences may be the result of exposure to estrogen. These differences may be critical considerations for the enhancement of immunotherapy for cancer.

FOXO3-NF-κB RelA Protein Complexes Reduce Proinflammatory Cell Signaling and Function.

Tumor-associated myeloid cells, including dendritic cells (DCs) and macrophages, are immune suppressive. This study demonstrates a novel mechanism involving FOXO3 and NF-κB RelA that controls myeloid cell signaling and impacts their immune-suppressive nature. We find that FOXO3 binds NF-κB RelA in the cytosol, impacting both proteins by preventing FOXO3 degradation and preventing NF-κB RelA nuclear translocation. The location of protein-protein interaction was determined to be near the FOXO3 transactivation domain. In turn, NF-κB RelA activation was restored upon deletion of the same sequence in FOXO3 containing the DNA binding domain. We have identified for the first time, to our knowledge, a direct protein-protein interaction between FOXO3 and NF-κB RelA in tumor-associated DCs. These detailed biochemical interactions provide the foundation for future studies to use the FOXO3-NF-κB RelA interaction as a target to enhance tumor-associated DC function to support or enhance antitumor immunity.

Local health department factors associated with performance in the successful implementation of community-based strategies: a mixed-methods approach.

OBJECTIVES: We examined which local health department (LHD)-level factors contributed to successful implementation of policy, systems, and environmental change strategies in Minnesota. METHODS: We used a retrospective mixed-methods design to evaluate the relationship between the Statewide Health Improvement Plan (SHIP) grant initiative and key predictor variables (2009-2011). We obtained quantitative capacity data for 91 cities and counties in Minnesota; in addition, we conducted 15 key informant interviews to examine factors that facilitated and acted as barriers to LHD performance. RESULTS: Grantee performance was distributed as follows: exceeds expectations (29.7%), meets expectations (55.0%), and is approaching expectations (15.3%). Organizational quality improvement (QI) maturity was strongly positively associated with grantee performance on SHIP. Organizations with high QI maturity, effective leadership, efficient decision-making, and successful regional or cross-jurisdictional partnerships were more likely to be rated as exceeding expectations. CONCLUSIONS: This study successfully translated practice-based research findings into tangible outcomes, including new system-level performance measures for local public health and recommendations for shaping the statewide initiative examined in this study. The approach taken in this study to systematically monitor communications, dissemination, and translation may be a model for others.

Satisfaction and public health cost of a statewide influenza nurse triage line in response to pandemic H1N1 influenza.

BACKGROUND: The 2009 H1N1 pandemic strained healthcare systems. There was a need for supportive services, rapid antiviral access, and minimization of unnecessary healthcare contacts particularly face-to-face interactions. In response, the Minnesota Department of Health (MDH) launched a telephone-based nurse triage line (NTL) called the Minnesota FluLine coordinating all major MN healthcare systems with NTLs to form a single toll-free number triage service. Callers were evaluated for symptoms of influenza-like illness (ILI) and were prescribed an antiviral if indicated, using nurse administered protocols. METHODS: To determine caller outcomes, associated healthcare seeking, and satisfaction a telephone survey of Minnesota FluLine callers was conducted using a 5% random sample of those who completed the protocol and those who did not. RESULTS: Of 6,122 callers with ILI who began the nurse protocol administered by the contract NTL, 1,221 people were contacted for the survey and 325 agreed to participate; response rate was 26%. Of those who completed the nurse protocol 73% said they would have sought healthcare without the Minnesota FluLine, 89% reported the service was moderately or very helpful, and 91% reported being satisfied or very satisfied. Of those not completing the protocol, 50% reported the service was moderately or very helpful and 50% reported being satisfied or very satisfied. 72% of qualitative responses to open-ended questions were positive regarding the MN FluLine. Cost to MDH for operating the Minnesota FluLine service was $331,226 to service 27,391 callers ($12.09/call). DISCUSSION: The Minnesota FluLine diverted patients with mild ILI symptoms away from acute care visits at low cost and had a high rate of satisfaction among callers. Early intervention likely prevented morbidity and possibly additional cases. NTLs are powerful and flexible tools for pandemic response and should be considered as an important tool for future emergency responses.

Survey of handwriting instruction practices of elementary teachers and educational programs: implications for occupational therapy.

ABSTRACT The purpose of this study was to investigate perceptions of elementary school teachers on training in handwriting instruction received during their education, as well as their current classroom practices. The quantity and quality of training in handwriting instruction provided by baccalaureate degree-granting teacher education programs in North Carolina was also examined. An online survey was administered to each population identified to inquire about handwriting instruction practices. Results from 505 teachers and 16 professors indicated that while handwriting instruction content is valued by both teachers and professors, varied levels of training were provided to the teachers. Implications for occupational therapy practice are discussed including strategies for school-based therapists.

Comparison of the intakes of sugars by young children with and without dental caries experience.

BACKGROUND: Relationships among sugars and dental caries in contemporary societies are unclear. The authors describe young children's intakes of nonmilk extrinsic (NME) and intrinsic/milk sugars and relate those intakes to dental caries. METHODS: The authors conducted cross-sectional analyses of dietary data collected from the Iowa Fluoride Study using three-day diaries for subjects at ages 1, 2, 3, 4 and 5 years and for subjects aged 1 through 5 years according to dental caries experience at 4.5 to 6.9 years of age. They categorized foods and beverages as containing NME or intrinsic/milk sugars. RESULTS: Subjects' total, NME, food NME and intrinsic/milk sugars intakes at ages studied did not differ between subjects with and without caries experience. Beverage NME sugars intakes at age 3 years predicted caries (P < .05) in logistic regression models adjusted for age at dental examination and for fluoride intake. CONCLUSIONS: Dental caries is a complex, multifactorial disease process dependent on the presence of oral bacteria, a fermentable carbohydrate substrate and host enamel. A simple NME-intrinsic/milk sugars categorization appears insufficient to capture the complex dietary component of the caries process. CLINICAL IMPLICATIONS: Cariogenicity is more likely a function of the food and/or beverage vehicle delivering the sugar and the nature of exposure-that is, frequency and length of eating events-than of the sugar's categorization.