Our objective is to describe the implications, anticipated and perceived, by providers in a level-IV neonatal intensive care unit (NICU) with immediate patient access to inpatient notes and test ...results in the wake of the 21st Century Cures Act (CCA).
Using a mixed-method approach in February 2021, a preimplementation survey of neonatologists, neonatal fellows, nurse practitioners, and neonatal nurses reported their perspectives on the new 21st CCA and how they anticipated that it would change their practices, and the experience of families in the NICU. In the follow-up to implementation, a postsurvey was completed by staff reporting their experiences in July 2021. Thematic analysis was performed.
In the preimplementation survey, staff reported the greatest perceived benefits of the changes to be an increase in families' ability to be part of the care team and prepare questions, and faster discussion of results by the care team. Also, staff's highest concerns were that family members may incorrectly interpret results delivered electronically without the context provided by the care team and be overwhelmed by the amount of information available. In the postimplementation survey, staff reported that the Act had less impact on their practice than they had anticipated preimplementation.
To maximize benefits and limit burdens to families and staff, care teams should consider a thoughtful approach to information sharing with family members in compliance with the 21st CCA.
· The impact of the 21 CCA on the NICU has not been studied.. · NICU staff have significant concerns related to the release of results to families.. · This study highlights the need to set expectations and provide family-centered care..
In nineteenth-century England, the industrialization of heat and light rendered fire-gazing increasingly obsolete. Fire-gazing is a form of flame-based reverie that typically involves a solitary ...viewer who perceives animated, moving images dissolving into and out of view in a wood or coal fire. When fire-gazing, the viewer may perceive arbitrary pictures, fantastic landscapes, or more familiar forms, such as the faces of friends and family. This article recovers fire-gazing as an early and more intimate animation technology by examining remediations of fire-gazing in print. After reviewing why an analysis of fire-gazing requires a joint literary and media history approach, I build from Michael Faraday’s mid-nineteenth-century theorization of flame as a moving image to argue that fire-gazing must be included in the history of animation technologies. I then demonstrate the uneasy connections that form between automatism, mechanical reproduction, and creativity in Leigh Hunt’s description of fire-gazing in his 1811 essay ‘A Day by the Fire’. The tension between conscious and unconscious modes of production culminates in a discussion of fireside scenes of (re)animation in Charles Dickens’s Our Mutual Friend (1864–65), including those featuring one of his more famous fire-gazers, Lizzie Hexam. The article concludes with a brief discussion of the 1908 silent film Fireside Reminiscences as an example of the continued remediations of fire-gazing beyond the nineteenth century.
The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US ...anesthesiology residents' training experience in regional anesthesia and pain medicine.
Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates.
Data were available for 1631 residents who graduated from 129 training programs. Regional anesthesia as a portion of the overall anesthesiology residents' training experience remains unchanged since 1990. The distribution of regional anesthesia training has shifted from neuraxial to peripheral blocks. All residents at the 10th percentile and above achieved the benchmark for spinal, epidural, and peripheral nerve block anesthetics and for new pain evaluations.
The focus of US anesthesiology resident training in regional anesthesia and pain medicine has changed over the past 15 years by shifting from neuraxial to peripheral nerve block techniques. Previous training deficits have resolved for spinal anesthesia and peripheral nerve block. Procedural experience in pain medicine overwhelmingly involves epidural and facet injections.
Optogenetic techniques are described as “revolutionary” for the unprecedented causal control they allow neuroscientists to exert over neural activity in awake-behaving animals. In this article, I ...demonstrate by means of a case study that optogenetic techniques will only illuminate causal links between the brain and behavior to the extent that their error characteristics are known and, further, that determining these error characteristics requires (1) comparison of optogenetic techniques with techniques having well-known error characteristics (methodological pluralism) and (2) consideration of the broader neural and behavioral context in which the targets of optogenetic interventions are situated (perspectival pluralism).
Hardware implanted during primary total joint arthroplasty carries a serious risk for periprosthetic joint infection (PJI). The formation of bacterial biofilms, which are highly tolerant of ...antibiotics and host immunity, is recognized as being a major barrier to treatment. It is not known whether some components and their surface features are more prone to biofilm than others. This study attempted to map biofilm on different components and features of orthopedic hardware recovered during revision. Implant surface culture (ISC) was used on 53 components from 14 hip and knee revisions. ISC achieves a thin agar coating over components, followed by incubation and observation for colony outgrowth over 9 days. Recovered organisms were identified by selective culture and 16s rRNA sequencing. Outcomes were compared with clinical culturing and PJI diagnosis based on 2013 Musculoskeletal Infection Society criteria. ISC paralleled clinical culturing with a sensitivity of 100% and a specificity of 57.1%. When compared to Musculoskeletal Infection Society criteria, sensitivity remained at 100% while specificity was 80%. Biofilm accumulation was patchy and heterogeneous throughout different prostheses, though notably the non‐articulating surfaces between the tibial tray and polyethylene insert showed consistent growth. On individual components, ridges and edges consistently harbored biofilm, while growth elsewhere was case dependent. ISC successfully identified microbial growth with high sensitivity while also revealing that biofilm growth was commonly localized to particular locations. Understanding where biofilm formation occurs most often on implanted hardware will help guide debridement, retention choices, and implant design.
Total joint arthroplasty is a common surgical procedure resulting in improved quality of life; however, a leading cause of surgery failure is infection. Periprosthetic joint infections often involve ...biofilms, making treatment challenging. The metabolic state of pathogens in the joint space and mechanism of their tolerance to antibiotics and host defenses are not well understood. Thus, there is a critical need for increased understanding of the physiological state of pathogens in the joint space for development of improved treatment strategies toward better patient outcomes. Here, we present a quantitative, untargeted NMR-based metabolomics strategy for Pseudomonas aeruginosa suspended culture and biofilm phenotypes grown in bovine synovial fluid as a model system. Significant differences in metabolic pathways were found between the suspended culture and biofilm phenotypes including creatine, glutathione, alanine, and choline metabolism and the tricarboxylic acid cycle. We also identified 21 unique metabolites with the presence of P. aeruginosa in synovial fluid and one uniquely present with the biofilm phenotype in synovial fluid. If translatable in vivo, these unique metabolite and pathway differences have the potential for further development to serve as targets for P. aeruginosa and biofilm control in synovial fluid.
Early bacterial survival in the postsurgical joint is still a mystery. Recently, synovial fluid-induced aggregation was proposed as a potential mechanism of bacterial protection upon entry into the ...joint. As synovial fluid is secreted back into the joint cavity following surgery, rapid fluctuations in synovial fluid concentrations, composition, and viscosity occur. These changes, along with fluid movement resulting from postoperative joint motion, modify the environment and potentially affect the kinetics of aggregate formation. Through this work, we sought to evaluate the influence of exposure time, synovial fluid concentration, viscosity, and fluid dynamics on aggregation. Furthermore, we aimed to elucidate the primary mechanism of aggregate formation by assessing the interaction of bacterial adhesins with the synovial fluid polymer fibrinogen. Following incubation under each simulated postoperative joint condition, the aggregates were imaged using confocal microscopy. Our analysis revealed the formation of two distinct aggregate phenotypes, depending on whether the incubation was conducted under static or dynamic conditions. Using a surface adhesin mutant, we have narrowed down the genetic determinants for synovial fluid aggregate formation and identified essential host polymers. We report here that synovial fluid-induced aggregation is influenced by various changes specific to the postsurgical joint environment. While we now have evidence that select synovial fluid polymers facilitate bridging aggregation through essential bacterial adhesins, we suspect that their utility is limited by the increasing viscosity under static conditions. Furthermore, dynamic fluid movement recovers the ability of the bacteria with surface proteins present to aggregate under high-viscosity conditions, yielding large, globular aggregates.
Infection is a major complication of knee and hip joint replacement surgery, which is used to treat arthritis or joint damage. We have shown that Staphylococcus aureus, a common bacterial pathogen, aggregates upon contact with synovial fluid. Within seconds, the bacterial cells interact with synovial fluid polymers in the joint fluid through their cell wall adhesins. The rapid formation of these aggregates likely aids in early bacterial survival in the joint, potentially contributing to the likelihood of developing an infection. By strengthening our basic understanding of the mechanics of synovial fluid aggregate formation under clinically relevant conditions, we hope to expand the knowledge of how to prevent or disrupt aggregation and reduce and more successfully treat these joint infections.
Summary
‘Physical literacy’ (PL) education—that is, teaching foundational skills, attitudes, behaviors and knowledge about lifelong involvements in physical activities, is an important aspect for ...health promotion among children. Universities have been playing a critical role by teaching future PL professionals. Additionally, various universities have offered university-based PL programming for neighborhood children as a way of public health promotion service and community engagement. However, this additional role of universities and the ways of promoting the quality of this type of health promotion service programming have not been investigated in the current research literature. Therefore, the purpose of this study was to identify the practicable strategies to enhance the quality of university-based PL programming for children from the perspectives of community stakeholders. Overall, 24 community stakeholders who held professional positions that are related to PL education participated in a 90-min focus group interview. This grounded theory study identified that university-based PL programming for children should be (i) inclusive, (ii) collaborative, (iii) welcoming and (iv) responsive. Practical suggestions and recommendations were also provided. This study has provided empirical knowledge to prioritize aspects for the future actions in planning and implementing university-based PL programming for children and informed for further cross-cultural comparisons amongst the perspectives of participants, university service providers and community stakeholders. The knowledge acquired from this research will also be translated to university service providers who operate similar type of health promotion service programming to the public.
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