This study was conducted to examine the relationship between physician assistant (PA) educational program length and PA programs' 5-year average Physician Assistant National Certifying Examination ...(PANCE) first-time pass rates.
This was a retrospective correlational study that analyzed previously collected data from a nonprobability purposive sample of accredited PA program Web sites. Master's level PA programs (n = 108) in the United States with published average PANCE scores for 5 consecutive classes were included. Provisional and probationary programs were excluded (n = 4). Study data were not normally distributed per the Kolmogorov-Smirnov test, P = .00.
There was no relationship between program length and PANCE pass rates, ρ (108) = -0.04, P = .68. Further analyses examining a possible relationship between program phase length (didactic and clinical) and PANCE pass rates also demonstrated no differences (ρ 107 = -0.05, P = .60 and ρ 107 = 0.02, P = .80, respectively).
The results of this study suggest that shorter length PA programs perform similarly to longer programs in preparing students to pass the PANCE. In light of rapid expansion of PA educational programs, educators may want to consider these findings when planning the length of study for new and established programs.
Pediatric upper extremity injuries Carson, Sarah; Woolridge, Dale P; Colletti, Jim ...
The Pediatric clinics of North America,
02/2006, Letnik:
53, Številka:
1
Journal Article
Recenzirano
The pediatric musculoskeletal system differs greatly from that of an adult. Although these differences diminish with age, they present unique injury patterns and challenges in the diagnosis and ...treatment of pediatric orthopedic problems.
How much to cut and to remain, as well as when to cut is an important decision-making issue in forest management. Unlike forest age, forest stock and harvest levels are applicable to both plantations ...and natural forests. This paper investigates the optimal forest stock and harvest with the consideration of both timber and non-timber benefits. The impacts of the discount rate, silvicultural cost, marginal timber benefit, and marginal non-timber benefit on the optimal forest stock and harvest are also examined. The results indicate that forest stock should be thickened when non-timber benefits are valued in addition to timber. The optimal steady state stock increases with a decrease in the discount rate, or an increase in marginal non-timber benefit. However, the impacts of the discount rate, marginal timber benefit, and marginal non-timber benefit on the optimal steady state harvest are ambiguous. In addition, a decrease in the discount rate has the same effect on the optimal steady state stock and harvest as an increase in the ratio of marginal non-timber benefit to marginal timber benefit. These theoretical results are illustrated through an empirical example of the US coniferous forests.
Carboxyalkyl peptides containing a biphenylylethyl group at the P1‘ position were found to be potent inhibitors of stromelysin-1 (MMP-3) and gelatinase A (MMP-2), in the range of 10−50 nM, but poor ...inhibitors of collagenase (MMP-1). Combination of a biphenylylethyl moiety at P1‘, a tert-butyl group at P2‘, and a methyl group at P3‘ produced orally bioavailable inhibitors as measured by an in vivo model of MMP-3 degradation of radiolabeled transferrin in the mouse pleural cavity. The X-ray structure of a complex of a P1‘-biphenyl inhibitor and the catalytic domain of MMP-3 is described. Inhibitors that contained halogenated biphenylylethyl residues at P1‘ proved to be superior in terms of enzyme potency and oral activity with 2(R)-2-(4‘-fluoro-4-biphenylyl)ethyl-4(S)-n-butyl-1,5-pentanedioic acid 1-(α(S)-tert-butylglycine methylamide) amide (L-758,354, 26) having a K i of 10 nM against MMP-3 and an ED50 of 11 mg/kg po in the mouse pleural cavity assay. This compound was evaluated in acute (MMP-3 and IL-1β injection in the rabbit) and chronic (rat adjuvant-induced arthritis and mouse collagen-induced arthritis) models of cartilage destruction but showed activity only in the MMP-3 injection model (ED50 = 6 mg/kg iv).
AIMIn patients with progressive, metastatic neuroendocrine tumors (NET), intra-arterial radionuclide infusions with high activities of In-DTPA-octreotide and more recently with non-carrier added ...(nca) Lu-DOTA,Tyr-octreotate have been performed with encouraging results. However, the affinity profiles (IC50) of these radiopeptides for human sst2 receptors are markedly different (In-DTPA-octreotide, 22 ± 3.6 nM and nca Lu-DOTA,Tyr-octreotate, 1.5 ± 4.0 nM). The total administered activity is determined by organ dose limits (kidneys and bone marrow), and our aim therefore was to compare and evaluate the therapeutic efficacy of both radiopeptides in metastatic NETs.
METHODSThirty patients with gastroenteropancreatic (GEP) somatostatin-positive NETs with liver metastases confirmed on biopsy and In-pentetreotide scan were included. They were treated with In-DTPA-octreotide (n = 17) or nca Lu-DOTA,Tyr-octreotate (n = 13). Blood samples were collected 2, 4, 8, and 24 hours postadministration to calculate residence time in blood and in red marrow. The maximum percentage uptake in organs and tumors was estimated by region of interest analysis, and tumor dosimetry calculations were performed using OLINDA/EXM/ 1.0 software.
RESULTSncaLu-DOTA,Tyr3-octreotate blood radioactivity, expressed as a percentage of the injected dose, was significantly lower than In-DTPA-octreotide (P < 0.05), as clearly depicted from the time-activity curves; the background-corrected tumor uptake was significantly higher than In-DTPA-octreotide but without any significant difference in other organs (spleen, kidneys, and liver).
CONCLUSIONSUsing Lu-DOTA,Tyr-octreotate, a 3-fold higher absorbed dose to tumor tissue was achieved compared with In-DTPA octreotide. Residence time of nca Lu-DOTA,Tyr-octreotate results in a significantly higher absorbed dose to bone marrow compared with In-DTPA-octreotide. However, a drawback of In-DTPA-octreotide therapy is that the number of administrations would need to be almost doubled to achieve an equal therapeutic outcome as compared with Lu-DOTA,Tyr-octreotate.
MRI evaluation of primary cervical lymphoma has not been reported. We report such a case of primary cervical lymphoma, a lesion well seen and well delineated from normal tissue by MRI. Although ...primary lymphoma of the cervix is a rare entity, the disease does exist and can be well demonstrated by MRI. We evaluated the MR appearance of this lesion with both nonenhanced and gadolinium-enhanced imaging.
The role of anxiety/depression in the progression of youth externalizing problems to future high risk behaviors has been disputed in the literature. Mixed support exists for a multiple problem ...hypothesis (i.e., co-occurring anxiety/depression leads to more high risk behaviors) and a protective hypothesis (i.e., anxiety/depression buffers this progression). The present study compared these two hypotheses in a sample of 124 African-American single mother families by examining mother report of externalizing problems and anxiety/depression at an initial timepoint and youth report of high risk behaviors fifteen months later. Results support the multiple problem hypothesis: In the context of high levels of externalizing problems, high levels of anxiety/depression were associated with more youth engaging in high risk behavior across the 15 month follow-up than were low levels of anxiety/depression. The findings suggest it is important to consider multiple domains of youth problem behaviors to conceptualize and prevent high risk behaviors.
The primary objective of this study was to evaluate the tolerance and toxicity of radiation therapy (RT) and capecitabine in patients with advanced, unresectable pancreatic carcinoma. To control ...micrometastatic disease, combination chemotherapy (gemcitabine and cisplatin) before and after combined modality therapy (CMT) was planned.
Patients with unresectable or metastatic pancreatic cancer were eligible. Gemcitabine 1000 mg/m2 and cisplatin 35 mg/m2 were administered on Days 1 and 8 of a 21-day cycle for two cycles. RT was then given to a dose of 50.4 Gy in 1.8 Gy fractions. Patients were treated with capecitabine 1330 mg/m2 daily during RT. After CMT, two additional cycles of gemcitabine and cisplatin completed the treatment.
Twenty-three patients were treated. Eighteen patients completed CMT. One patient was removed from study during CMT for toxicity issues. Treatment delays and dose reductions were common during the final two cycles of gemcitabine and cisplatin as a result of myelosuppression. Median survival was 10.1 months (95% confidence interval CI = 7.6, 13.7) for all 23 patients and 12.8 months (95% CI = 8.2, 18.9) for 18 patients without metastasis.
Combined modality therapy with RT and capecitabine was well tolerated. Chemotherapy after CMT was difficult to complete owing to cumulative myelosuppression. Survival, response, and toxicity were comparable to infusional 5-fluorouracil and RT.
Abstract
The effects of injecting tumescence containing phenylephrine in pediatric burn patients are unknown, but anecdotally our clinicians note a high incidence of hypertension requiring treatment. ...This study sought to determine whether tumescence with phenylephrine was associated with hypertension requiring treatment in our pediatric burn patients. This was a retrospective cohort study of pediatric burn patients who underwent tangential excision with split-thickness autografting, excision alone, or autografting alone from 2013 to 2017. Records were reviewed for hypertensive episodes, defined as ≥2 consecutive blood pressure readings that were >2 SD above normal. Published intraoperative age- and sex-adjusted standards were used to define reference values. Parametric and nonparametric tests were used when appropriate. In total, 258 operations were evaluated. Mean patient age was 7.6 ± 5.2 years, and 64.7% were male. Patients were predominately white (69.8%). Overall, there was a 62.8% incidence of hypertension. On univariate logistic regression analysis, duration of operation, estimated blood loss, treated TBSA, and weight-adjusted volume of tumescence were significant predictors of intraoperative hypertension (P < .01). On multivariate analysis, weight-adjusted volume of tumescence alone was significantly associated with the presence of hypertension with an odds ratio of 2.0 (95% confidence interval: 1.33–3.04). Of the 162 operations which exhibited at least one episode of significant hypertension, 128 cases (79%) were treated. Intraoperative administration of phenylephrine-containing tumescence in pediatric burn patients is associated with clinically significant hypertension requiring treatment. This practice should be conducted with caution in pediatric burn operations until its clinical implications are defined.
Many open questions remain to be elucidated about the diagnosis, treatment and prognosis of medullary thyroid cancer (MTC). The most intriguing concerns the outcome of MTC patients after surgery. ...Great importance is usually given to serum calcitonin (Ct) and carcinoembryonic (CEA) levels. It is commonly believed that the higher are the levels of these tumor markers and their kinetics (double time and velocity of markers levels) the worst is the prognosis. However, this is not the rule, as there are huge MTC metastatic deposits characterized by low serum Ct and CEA levels, and this condition is not closely related to the outcome of the disease during post-surgical follow-up. A series is reported here of patients who have these characteristics, as well as a description of their prognosis and clinical outcome.
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