Background:
Forty percent of physicians anticipate becoming parents during residency. This often occurs in the absence of clear parental leave and breastfeeding policies, which may adversely impact ...parental and child health or jeopardize residents’ board eligibility, fellowship, and job prospects. This study reports on the current status of parental leave and breastfeeding policies across all specialties.
Methods:
Twenty-six specialties recognized by the Accreditation Council for Graduate Medical Education were included. The maximum leave allowed in 2020 and breastfeeding accommodations during board examinations were collected for each specialty. Change in leave since 2006, 2018, and breastfeeding accommodations were analyzed by specialty.
Results:
In 2020, the median time allowed for parental leave without the extension of training was 5 weeks, and there was no significant difference between 2006, 2018, and 2020 (
p
= 0.58). In 2020, plastic surgery and obstetrics/gynecology provided the longest parental leave at 12 weeks. Surgical specialties provided 1 additional week of leave as compared to medical specialties after adjusting for year (
p
= 0.02). Twenty-one specialties (81 percent) allowed additional time for lactation during board examinations; however, only seven (27 percent) guaranteed a private location to pump.
Conclusions:
There has been little improvement in parental leave allowances since 2006, and the current median, 5 weeks, falls short of guidelines recommending 6 to 12 weeks following the birth of a child. Starting in July of 2021, the Accreditation Council for Graduate Medical Education will require medical boards to provide a minimum of 6 weeks of leave. Ongoing improvement in culture and policy are needed to support residents and their families.
Purpose: Anterior tibialis tendon transfer (ATTT) is a procedure, which is used to treat recurrent clubfoot with dynamic supination, but there are a wide variety of guidelines or strategies for the ...procedure. In this study, members of the Pediatric Orthopaedic Society of North America (POSNA) were surveyed in order to determine the varied methods used in the execution of ATTT. Methods: The survey was designed using Research Electronic Data Capture (REDCap) survey software. It consisted of fifteen initial questions, some of which were associated with conditional follow-up questions that appeared if the respondent selected a specific answer choice, with a potential total of 22 questions. The survey was approved by the Evidence Based Practice Committee of POSNA, and was subsequently distributed to their 1370 members. Results: Of POSNA's 1,370 members, 239 survey responses were received, making the response rate 17.5%. The survey terminated early for respondents who indicated that they either do not treat clubfoot or do not perform ATTT; thus, 228 respondents filled out the survey in its entirety. The survey respondents reached a relative consensus (>66.7%) on a small number of topics, such as the use of the Ponseti treatment method for clubfoot (94%), transfer of the anterior tibialis tendon to the lateral cuneiform (77%), use of button fixation (68%), transfer of only the whole anterior tibialis tendon (79%), and the use of an ankle foot orthoses (94%) among those who reported using braces for post-operative care. Additionally, the majority of surgeons agreed on the age range of surgery (61-63%), two-incision technique (63%), use of pre-operative x-rays (63%), use of post-operative bracing (58%), and of not using physical therapy (62%) or pre-operative gait analysis (63%). However, the remaining survey questions revealed a marked amount of variability in the performance of ATTT. Conclusion: Many of the survey questions garnered varied responses, which suggests differing opinions of POSNA members regarding how and when ATTT should be performed for recurrent clubfoot with dynamic supination and no deformity. This calls attention to inconsistencies in treatment practices, and may lead to further studies examining ways to maximize the efficacy of the procedure. Significance: The variability in the usage of ATTT illustrates an important area of inconsistency in the practice of the Ponseti method.
Purpose:
The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes.
...Methods:
This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress.
Results:
Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management.
Conclusions:
In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.
Commercial farmers have been using polyethylene plastic mulch since the 1950s. Despite the affordability and effectiveness of polyethylene mulch, the disposal process is financially and ...environmentally costly. Biodegradable plastic mulches, an ecologically sustainable alternative to polyethylene mulch films, were introduced in the 1980s. Biodegradable plastic mulches can be tilled into the soil or composted at the end of the season, reducing the labor and environmental costs associated with plastic removal and disposal. However, research results are mixed as to the effectiveness, degradability and ease-of-use of biodegradable plastic mulches. In 2008–2012, researchers, funded by a USDA Specialty Crop Research Initiative grant, conducted surveys and focus groups in three different agricultural regions of the USA to better understand the barriers and bridges to the adoption of biodegradable plastic mulches for specialty crop production systems. Data on the experiences and views of specialty crop growers, agricultural extension agents, agricultural input suppliers, mulch manufacturers and other stakeholders showed that the major adoption barriers were insufficient knowledge, high cost and unpredictable breakdown. The major bridges to adoption were reduced waste, environmental benefits and interest in further learning. These findings are discussed with reference to the classic innovation diffusion model, specifically work on the innovation–decision process and the attributes of innovations. The study results can be used to guide the activities of those involved in the design, development and promotion of biodegradable plastic mulches for US specialty crop production systems.
Magnesium isotopic compositions are reported for twenty‐four international geological reference materials including igneous, metamorphic and sedimentary rocks, as well as phlogopite and serpentine ...minerals. The long‐term reproducibility of Mg isotopic determination, based on 4‐year analyses of olivine and seawater samples, was ≤ 0.07‰ (2s) for δ26Mg and ≤ 0.05‰ (2s) for δ25Mg. Accuracy was tested by analysis of synthetic reference materials down to the quoted long‐term reproducibility. This comprehensive dataset, plus seawater data produced in the same laboratory, serves as a reference for quality assurance and inter‐laboratory comparison of high‐precision Mg isotopic data.
Les compositions isotopiques du magnésium sont fournies pour vingt‐quatre matériaux géologiques de référence internationaux, comprenant des roches ignées, métamorphiques et sédimentaires, ainsi qu'une phlogopite et des serpentines. La reproductibilité à long terme de la détermination isotopique du Mg, basée des analyses sur quatre ans d’échantillons d'olivine et d'eau de mer, était ≤ 0.07% (2s) pour δ26Mg et ≤ 0.05% (2s) pour δ25Mg. La précision a été testée par l'analyse de matériaux de référence synthétiques jusqu’à la reproductibilité à long terme indiquée. Cette base de données complète, ainsi que des données d'eau de mer produites dans le même laboratoire, servent de référence pour l'assurance qualité et la comparaison inter‐laboratoires de haute précision des données isotopiques du Mg.
BACKGROUND:Idiopathic talipes equinovarus (ITEV) is a prevalent structural deformity of the foot and ankle in children. The disease-specific instrument (DSI) has commonly been used as an outcomes ...metric in these patients. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to examine the quality of life across various medical conditions. PROMIS has been validated for multiple conditions; however, no studies have evaluated the use of the PROMIS in children with ITEV.
METHODS:A prospective analysis was performed whereby the 2 questionnaires were mailed out to the parents of 91 patients, aged 5 to 17 years, with ITEV. Construct validity of the PROMIS Parent Proxy Profile short forms version was assessed by comparing its domains of Mobility, Fatigue, Pain Interference, and Pain Intensity to the DSI Function domain and PROMIS domains of Anxiety, Depressive Symptoms, Peer Relationships, and Pain Intensity to DSI Satisfaction domain.
RESULTS:Thirty-one complete responses (34% response rate) were returned. The patients’ current mean age was 8.8 years, 7 were female individuals, and 12 had unilateral ITEV. Bivariate correlation analysis, using Spearman correlation coefficients, demonstrated a moderate positive correlation between the DSI Function domain and the PROMIS Mobility domain (rs=0.52) and a moderate negative correlation between the DSI Function domain and the PROMIS Pain Interference domain (rs=−0.56), as well as the PROMIS Pain Intensity domain (rs=−0.75). A fair negative correlation (rs=−0.38) with PROMIS Fatigue domain was found. Correlations between the DSI Satisfaction domain and the PROMIS domains were fair or had little relationship.
CONCLUSIONS:These results provide support for the validity of the PROMIS Mobility, Pain Interference, and Pain Intensity domains in this population, however there are no items in PROMIS that can assess overall satisfaction, as with the DSI.
LEVEL OF EVIDENCE:Level II—prospective comparative study.
BACKGROUND:The purpose of this study was to determine the early factors associated with the need for surgical interventions in patients with idiopathic clubfoot treated with the Ponseti method.
...METHODS:All patients with idiopathic clubfoot treated with Ponseti method at our institution with >3 years of follow-up were evaluated. Age at presentation, history of previous treatment, number of casts used, need for percutaneous Achilles tenotomy (PAT), age of initiation of foot abduction orthosis (FAO), compliance with FAO, and need for additional casts were recorded. Dimeglio/Bensahel and Catterall/Piriani scores were recorded at initial presentation, at initiation of FAO, at 1, 2, 3 years of follow-up, and at the most recent follow-up.
RESULTS:Since 2000, 86 patients (134 feet) had >3 years of follow-up from time of initial presentation, and 43 of these feet (32%) had undergone surgery beyond a PAT. Patients who were noncompliant with the FAO were 7.9 times more likely to need surgery than those who were compliant confidence interval (CI), 2.8-22.0; P<0.001. Female patients were 5.4 times more likely to need surgery than male patients (CI, 1.8-16.6; P=0.003). For every 1 point increase in Dimeglio/Bensahel score at presentation, patients were 1.3 times more likely to need surgery (CI, 1.0-1.5; P=0.033). For every 1 point increase in Dimeglio/Bensahel score at initiation of the FAO, patients were 1.5 times more likely to need surgery (1.1-2.0, P=0.005). Moreover, for each additional cast required before the initiation of the FAO, patients were 1.5 times less likely to need surgery (CI, 1.1-2.7; P=0.030). No other variable significantly contributed to predicting the need for surgery.
CONCLUSIONS:There are early factors that can be used to predict increased risk for surgical intervention in patients undergoing treatment for idiopathic clubfoot. Female patients and those patients with higher Dimeglio/Bensahel scores at presentation and at initiation of the FAO are at increased risk for needing surgical intervention. Noncompliance with the FAO is associated with the highest risk for surgical intervention.
LEVEL OF EVIDENCE:Level III.
With more effective antiretroviral therapy (ART), people with HIV (PWH) are living longer and have more chronic diseases, including diabetes mellitus (DM). The prevalence of DM has been estimated in ...PWH previously, however there is less research regarding DM control. Our objectives were to determine the prevalence of DM and DM control and determine factors associated with DM control in a large urban cohort of PWH in care. We examined DC Cohort participants aged ≥18 years old to determine DM prevalence and to assess DM control (HbA1c measurement <7.0%). Demographic, clinical, and HIV-related factors associated with DM control were identified using multivariate logistic regression. The cohort of 5876 participants was predominantly male (71.3%), Non-Hispanic Black (78.1%) and had a median age of 52.0 years. DM prevalence was 17.4% (1023/5876). Among participants with recent HbA1c data available (39.9%) the proportion with DM control was 60.0% (245/408). In multivariate analysis, higher BMI (aOR: 0.47; 95% CI 0.28, 0.79) and use of non-insulin DM medication (aOR 0.43, 95% CI 0.25, 0.73) or insulin (aOR 0.010, 95% CI 0.04,0.24) compared to no medication use. Our findings suggest that individuals on medication for their DM likely need enhanced support to reach their treatment goals.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The 2011 annual meeting of the Children’s Tumor Foundation, the annual gathering of the neurofibromatosis (NF) research and clinical communities, was attended by 330 participants who discussed ...integration of new signaling pathways into NF research, the appreciation for NF mutations in sporadic cancers, and an expanding pre-clinical and clinical agenda. NF1, NF2, and schwannomatosis collectively affect approximately 100,000 persons in US, and result from mutations in different genes. Benign tumors of NF1 (neurofibroma and optic pathway glioma) and NF2 (schwannoma, ependymoma, and meningioma) and schwannomatosis (schwannoma) can cause significant morbidity, and there are no proven drug treatments for any form of NF. Each disorder is associated with additional manifestations causing morbidity. The research presentations described in this review covered basic science, preclinical testing, and results from clinical trials, and demonstrate the remarkable strides being taken toward understanding of and progress toward treatments for these disorders based on the close interaction among scientists and clinicians.
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