•A significant decline in pediatric surgery cases in general surgery was identified.•Though meeting the set minimum, case variety was extremely limited.•Two case classification categories for surgery ...residents with zero logged cases.•Limited case numbers and case variety is diminishing the experience for residents.
The Accreditation Council for Graduate Medical Education (ACGME) regulates the general surgery residency curriculum. Case volume remains a priority as recent concerns surrounding a lack of proficiency for certain surgical cases have circulated. We hypothesize that there is a significant decrease in pediatric surgery case numbers during general surgery residency despite residents meeting the minimum case requirements.
We reviewed publicly available ACGME case reports for general surgery residency from 1999 to 2018. Cases are classified as Surgeon Chief or Surgeon Junior. Analyzed data included case classifications, number of residents, and number of residency programs. Simple linear regression analysis was performed.
We identified a significant decrease in total number of logged pediatric surgery cases over the past 20 years (p<0.001). Nearly 60% of cases were logged under a single category – inguinal/umbilical hernia. From the past five years, pyloric stenosis was the only other category with an average of greater than two cases logged (range 2.1–2.8).
We identified a significant decrease in total pediatric surgery case numbers during general surgery residency from 1999 to 2018. Though meeting set requirements, overall case variety was limited. With minimal number of cases required by the ACGME, graduating general surgery residents may lack proficiency in simple pediatric surgery cases.
The current study was designed to determine the construct and predictive validity of the Race-Based Traumatic Stress Symptom Scale (RBTSSS) using structural equation modeling (SEM) and confirmatory ...factor analysis (CFA) with Black adults. The study involved 527 Black American adults who completed the RBTSSS and various measures of psychological functioning. Analyses included CFA, test of measurement invariance across gender and socioeconomic status, and test of predictive validity employing canonical correlation analysis (CCA). Two separate CCAs were conducted: one for the total sample of participants completing both measures and one with a subset of the sample identified as meeting criteria for race-based stress-trauma. The structure of the RBTSSS was confirmed through tests of the first order model and construct invariance using CFA. A second order SEM supported the RBTS construct. Canonical correlation analyses indicated that the RBTSS scales were significantly associated with psychological outcomes, including anxiety, depression, and loss of emotional and behavioral control. The analyses found support for the construct and predictive validity for the RBTSSS for Blacks.
In the new millennium, counseling psychologists have answered the call to address oppression related to intersectional identities. We have played a major role in the development of practice ...guidelines and policies, as well as in the application of ethical principles in cultural contexts. The Counseling Psychologist has served to disseminate information addressing needs and interventions for diverse communities. In this article, we review the history and impact of our efforts to ameliorate oppression. The pressing challenges of economic and educational disparities are highlighted along with how counseling psychologists are uniquely situated to meet the needs of the underserved. Our research, training, and practice are anchored in methodological pluralism, global helping paradigms, participatory engagement, and the promotion of liberation and radical healing. We offer recommendations to deconstruct current models and reconstruct a decolonized approach, embrace interdisciplinary collaboration to fight cultural encapsulation, strengthen prevention and advocacy, train a culturally diverse workforce, and prioritize intersectional research.
The aim of this study was to evaluate the utility of cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI for patients with low-grade prostate cancer (PCa).
This ...three-center retrospective study included patients who underwent prostate MRI from 2017 to 2021 with known low-grade PCa (Gleason score 6) without prior treatment. Patient-level highest Prostate Imaging Reporting & Data System (PI-RADS®) score and pathologic diagnosis within 1 year after MRI were used to evaluate the diagnostic performance of prostate MRI in detecting clinically significant PCa (csPCa; Gleason score ≥ 7). The metrics AIR, CDR, and CDR adjusted for pathologic confirmation rate were calculated. Radiologist-level AIR-CDR plots were shown. Simulation AIR-CDR lines were created to assess the effects of different diagnostic performances of prostate MRI and the prevalence of csPCa.
A total of 3,207 examinations were interpreted by 33 radiologists. Overall AIR, CDR, and CDR adjusted for pathologic confirmation rate at PI-RADS 3 to 5 (PI-RADS 4 and 5) were 51.7% (36.5%), 22.1% (18.8%), and 30.7% (24.6%), respectively. Radiologist-level AIR and CDR at PI-RADS 3 to 5 (PI-RADS 4 and 5) were in the 36.8% to 75.6% (21.9%-57.5%) range and the 16.3%-28.7% (10.9%-26.5%) range, respectively. In the simulation, changing parameters of diagnostic performance or csPCa prevalence shifted the AIR-CDR line.
The authors propose CDR and AIR as performance metrics in prostate MRI and report reference performance values in patients with known low-grade PCa. There was variability in radiologist-level AIR and CDR. Combined use of AIR and CDR could provide meaningful feedback for radiologists to improve their performance by showing relative performance to other radiologists.
To report cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI performed for clinical suspicion of prostate cancer (PCa).
This retrospective single-institution, ...three-center study included patients who underwent MRI for clinical suspicion of PCa between 2017 and 2021. Patients with known PCa were excluded. Patient-level Prostate Imaging-Reporting and Data System (PI-RADS) score was extracted from the radiology report. AIR was defined as number of abnormal MRI (PI-RADS score 3-5) / total number of MRIs. CDR was defined as number of clinically significant PCa (csPCa: Gleason score ≥7) detected at abnormal MRI / total number of MRI. AIR, CDR, and CDR adjusted for pathology confirmation rate were calculated for each of three centers and pre-MRI biopsy status (biopsy-naive and previous negative biopsy).
A total of 9,686 examinations (8,643 unique patients) were included. AIR, CDR, and CDR adjusted for pathology confirmation rate were 45.4%, 23.8%, and 27.6% for center I; 47.2%, 20.0%, and 22.8% for center II; and 42.3%, 27.2%, and 30.1% for center III, respectively. Pathology confirmation rate ranged from 81.6% to 88.0% across three centers. AIR and CDR for biopsy-naive patients were 45.5% to 52.6% and 24.2% to 33.5% across three centers, respectively, and those for previous negative biopsy were 27.2% to 39.8% and 11.7% to 14.2% across three centers, respectively.
We reported CDR and AIR in prostate MRI for clinical suspicion of PCa. CDR needs to be adjusted for pathology confirmation rate and pre-MRI biopsy status for interfacility comparison.
A series of pleuromutilins modified by introduction of a boron-containing heterocycle on C(14) of the polycyclic core are described. These analogs were found to be potent anti-Wolbachia antibiotics ...and, as such, may be useful in the treatment of filarial infections caused by Onchocerca volvulus, resulting in Onchocerciasis or river blindness, or Wuchereria bancrofti and Brugia malayi and related parasitic nematodes resulting in lymphatic filariasis. These two important neglected tropical diseases disproportionately impact patients in the developing world. The lead preclinical candidate compound containing 7-fluoro-6-oxybenzoxaborole (15, AN11251) was shown to have good in vitro anti-Wolbachia activity and physicochemical and pharmacokinetic properties providing high exposure in plasma. The lead was effective in reducing the Wolbachia load in filarial worms following oral administration to mice.
Fifteen children with autism spectrum disorders (ASD) and twenty-one children without ASD completed six perceptual tasks designed to characterize the nature of the audiovisual processing difficulties ...experienced by children with ASD. Children with ASD scored significantly lower than children without ASD on audiovisual tasks involving human faces and voices, but scored similarly to children without ASD on audiovisual tasks involving nonhuman stimuli (bouncing balls). Results suggest that children with ASD may use visual information for speech differently from children without ASD. Exploratory results support an inverse association between audiovisual speech processing capacities and social impairment in children with ASD.
This paper describes the development and preliminary validation of the Racism-Related Coping Scale (RRCS), which we designed as a measure of the specific strategies Blacks use to deal with and resist ...racism. Factor analyses found 8 domains (59 items) of Racism-Related Coping for Blacks: Racially Conscious Action, Hypervigilance, Confrontation, Empowered Action, Resistance, Bargaining, Spiritual Coping, and Anger Regulation. Preliminary reliability and validity were assessed with a sample of Black participants (N = 307) using correlations with the Black Racial Identity Attitudes Scale (Helms & Parham, 1996), the Africultural Coping Systems Inventory (Utsey, Ponterotto, Reynolds, & Cancelli, 2000), and regression analyses with symptom scales of the Brief Symptom Inventory (Derogatis & Melisaratos, 1983). RRCS domains were correlated with Racial Identity Status Attitudes, Africultural Coping, and psychological symptoms.
Pediatric foreign body ingestion remains a common reason for emergency department (ED) visits. Button battery ingestion is an established surgical emergency, requiring immediate removal. Timing of ...removal for other foreign bodies remains controversial. We hypothesize that there is no difference in complication rate or successful removal of esophageal foreign bodies that wait until the following morning for removal.
A retrospective review for cases involving esophageal foreign body removal by pediatric surgery or pediatric gastroenterology from November 2015 to November 2019 was performed. Patients were divided into two groups based on ED arrival-daytime (05:00-16:59); nighttime (17:00-04:59). Imaging confirmed an esophageal foreign body. Data collected included basic demographics, time of presentation, time of procedure, symptoms, location of the foreign body, and complications within 30 days. Statistical analysis was performed.
After excluding button batteries, 273 children underwent esophageal foreign body removal. Two-thirds presented at night. A significant difference was identified in the median time from ED to the operating room when comparing daytime (194.8 minutes; interquartile range IQR: 108.5-347) versus nighttime groups (643 minutes; IQR: 471.5-745;
< .001). Nine children had a complication or readmission within 30 days of their procedure and 25 patients had migration of their foreign body into the stomach, both with no significant difference (
= .94;
= .98, respectively).
We found that waiting until the following morning had minimal impact on complications or success rate when removing esophageal foreign bodies. By waiting, institutions with limited personnel can keep resources and staff available for more pressing emergencies.
The paper describes the development of the Race-Based Traumatic Stress Symptom Scale (RBTSSS), a measure designed to assess the psychological and emotional stress reactions to racism and racial ...discrimination. Scale items were derived from existing measures of race-related stress and models of trauma, and were tested on a 330 racially heterogeneous (e.g., Blacks, White, Asian, and Hispanic) adult sample. Exploratory Factor Analyses with oblique rotations revealed a 52-item measure consisting of seven scales; Depression, Anger, Physical Reactions, Avoidance, Intrusion, Hypervigilance/Arousal, and Low Self-Esteem. The findings are consistent with symptom clusters associated with the conceptual model of race-based traumatic stress. The RBTSSS adds a tool to counseling assessment by providing mental health professionals a way to assess the emotional reactions of racism and racial discrimination. Implications for counseling and future research are discussed.
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