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The Lancet. Microbe Mar 2022
Topics: Pandemics
PubMed: 35261993
DOI: 10.1016/S2666-5247(22)00040-4 -
Journal of Minimally Invasive Gynecology May 2023To demonstrate the surgical techniques for improving safety in robotic-assisted abdominal cerclage via broad ligament window dissection.
STUDY OBJECTIVE
To demonstrate the surgical techniques for improving safety in robotic-assisted abdominal cerclage via broad ligament window dissection.
DESIGN
Stepwise demonstration with narrated video footage.
SETTING
An academic tertiary care hospital. Our patient is a 32-year-old G8P2143, with a history of pregnancy loss at 19 and 23 weeks and 1 failed vaginal cerclage, presented to us at 13 weeks and 5 days for abdominal cerclage. We have completed a total of 5 successful procedures with this technique on pregnant patients ranging from 9 to 14 weeks.
INTERVENTIONS
Abdominal cerclage during pregnancy can be very risky and challenging to perform; however, it offers an increased success rate for continuing pregnancy [1]. Excessive bleeding and the rupture of membrane during the procedure could lead to pregnancy loss and a failed abdominal cerclage [2,3]. Therefore, seeking a feasible and safer technique would be preferable for the surgeons to decrease surgical risk and complications. We have developed a trans-broad ligament technique that would allow for the bilateral uterine vessels to be clearly exposed, thereby reducing the possibility of accidental damage to a major vessel and eliminating the risk of blind needle placement piercing through the amniotic sac resulting in rupture of membrane and subsequent pregnancy loss [4,5]. A dense adhesion band from the anterior uterus to the anterior abdominal wall was carefully taken down using the monopolar scissors. The assistant gently performed a digital vaginal examination to assist with the creation of a bladder flap. The bladder was carefully dissected off the lower uterine segment and uterus using the monopolar scissors. Bilateral uterine vessels were further skeletonized and exposed anteriorly using blunt dissection and the monopolar scissors. On the right, a window was created in the broad ligament using the monopolar scissors. The right uterine vessels were then further dissected and lateralized, creating a small window medial to the uterine vessels at the level of the internal cervical os. The mersilene tape was guided through the window from anterior to posterior. In a similar fashion, a window was created on the left; the mersilene tape was then guided from posterior to anterior. The mersilene tape was completely placed around the cervix circumferentially at the level of the internal cervical os, medial to the uterine vessels. Both ends of the mersilene tape were then pulled gently, while ensuring that the tape was lying flat on the anterior of the uterus. The tape was then tied anteriorly at the 12 o'clock position in an appropriate tension. A 2-0 silk was then sutured to the tails of the tape to ensure that it would remain in the correct location and prevent the loosening of the knot of mersilene tape. The pelvis was copiously irrigated, and hemostasis was assured. The fetal heart rate was 126 bpm, and patient was discharge next day. A healthy baby, 6 pounds 14 ounces, was delivered by cesarean section at 36 weeks 5 days because of early contractions and pain (Supplemental Appendix 1-4).
CONCLUSION
Robotic-assisted abdominal cerclage via broad ligament window dissection offers a possibly feasible and safe technique for surgeons seeking to reduce risks, although further research is needed.
Topics: Humans; Pregnancy; Female; Adult; Laparoscopy; Broad Ligament; Cerclage, Cervical; Robotic Surgical Procedures; Cesarean Section
PubMed: 36764647
DOI: 10.1016/j.jmig.2023.02.004 -
American Journal of Surgery Jun 2022
Topics: Breast Feeding; Female; Humans; Social Support; Surgeons
PubMed: 35027170
DOI: 10.1016/j.amjsurg.2021.12.037 -
Clinical Child Psychology and Psychiatry Apr 2023Anxiety disorders are among the most common psychiatric disorders in childhood and can develop as early as the preschool years. Therefore, providing young children who...
BACKGROUND
Anxiety disorders are among the most common psychiatric disorders in childhood and can develop as early as the preschool years. Therefore, providing young children who display early signs of anxiety with skills to prevent the development of later psychopathology is invaluable. The current study evaluates the effectiveness of Fun FRIENDS, an anxiety prevention and resilience program for young children.
METHOD
Fifty-seven kindergartners across three classrooms participated in a 15-week anxiety prevention program and teachers completed a behavioral screening measure and anxiety questionnaire at pre, post, 3 month, and 10-month follow-up assessment points.
RESULTS
Anxiety positively correlated with emotional symptoms peer difficulties, and total difficulties at pre-intervention. Anxiety symptoms decreased from pre-intervention to follow-up. Additionally, prosocial behaviors improved and moderated the relationship between pre-and post-intervention anxiety symptoms.
CONCLUSIONS
These findings yield promising implications regarding the effectiveness of prevention and intervention programs on increasing social emotional skills and reducing anxiety symptoms in young children.
Topics: Humans; Child; Child, Preschool; Anxiety; Anxiety Disorders; Emotions; Schools
PubMed: 35996946
DOI: 10.1177/13591045221121595 -
JAMA Network Open Jul 2023Taxes on sweetened beverages are being implemented around the globe; an understanding of these taxes on individual-level behavior is necessary.
IMPORTANCE
Taxes on sweetened beverages are being implemented around the globe; an understanding of these taxes on individual-level behavior is necessary.
OBJECTIVE
To evaluate the degree to which the sweetened beverage tax in Philadelphia, Pennsylvania, was associated with changes in beverage prices and individual-level purchasing over time at a national pharmacy chain in Philadelphia compared with Baltimore, Maryland.
DESIGN, SETTING, AND PARTICIPANTS
Using a difference-in-differences approach and generalized linear mixed models, this cohort study examined beverage purchases made by loyalty cardholders at a national chain pharmacy retailer with stores in Philadelphia and Baltimore (control city) from before tax to after tax. Beverage sales (in US dollars) were linked by unique loyalty card numbers to enable longitudinal analyses. Data were collected from January 1, 2015, through December 31, 2017 (2 years before tax and 1 year after tax); data analyses were conducted from January through October 2022.
EXPOSURE
Implementation of Philadelphia's 1.5 cents/oz tax on sweetened beverages.
MAIN OUTCOMES AND MEASURES
The outcomes were the change in mean beverage price per-ounce and mean beverage volume purchased per cardholder transaction. Individual-level point-of-sale scanner data from all beverage purchases were analyzed.
RESULTS
A total of 1188 unique beverages were purchased from the same stores before tax and after tax. There were 231 065 unique cardholders in Philadelphia and 82 517 in Baltimore. Mean prices of taxed beverages (n = 2 094 220) increased by 1.6 (95% CI, 1.3-2.0) cents/oz (106.7% pass-through) in Philadelphia compared with Baltimore from before tax to after tax. Philadelphia cardholders purchased 7.8% (95% CI -8.1% to -7.5%) fewer ounces of taxed beverages and 1.1% (95% CI, 0.6%-1.7%) more ounces of nontaxed beverages per transaction. Taxed beverages made up a smaller percentage of cardholders' overall beverage purchases after tax (-13.4% [95% CI, -14.2% to -12.6%]), while nontaxed beverages made up a larger share (9.3% [95% CI, 7.7%-10.7%]).
CONCLUSIONS AND RELEVANCE
In this longitudinal cohort study of the Philadelphia beverage tax, the tax was completely passed through to prices and was associated with a 7.8% decline in ounces of taxed beverages purchased at a national pharmacy chain.
Topics: Humans; Longitudinal Studies; Philadelphia; Cohort Studies; Beverages; Taxes; Pharmacy
PubMed: 37440231
DOI: 10.1001/jamanetworkopen.2023.23200 -
Cancer May 2022
Topics: Bisexuality; HIV Infections; Homosexuality, Male; Humans; Male; Medicaid; Neoplasms; United States
PubMed: 35285936
DOI: 10.1002/cncr.34167 -
Stroke Aug 2019Background and Purpose- Predicting safe extubation represents a clinical challenge in acute stroke patients. Classical respiratory weaning criteria have not proven... (Observational Study)
Observational Study
Background and Purpose- Predicting safe extubation represents a clinical challenge in acute stroke patients. Classical respiratory weaning criteria have not proven reliable. Concerning the paramount relevance of postextubation dysphagia in this population, criteria related to airway safety seem to perform better, but diagnostic standards are lacking. We compare clinical and instrumental swallowing examination tools to assess extubation readiness and propose a simple Determine Extubation Failure in Severe Stroke score for decision making. Methods- Data of 133 orally intubated acute stroke patients were prospectively collected in this observational study. Classical extubation criteria, a modified semiquantitative airway score, and an oral motor function score were assessed before extubation. A 3-ounce water swallow test and validated 6-point fiberoptic endoscopic dysphagia severity scoring were performed thereafter. Association of demographic and clinical parameters with extubation failure (EF) was investigated. Independent predictors of EF were translated into a point scoring system. Ideal cutoff values were determined by receiver operator characteristics analyses. Results- Patients with EF (24.1% after 24±43 hours) performed worse in all swallowing assessments (P<0.001). Fiberoptic endoscopic dysphagia severity scoring was the only independent predictor of EF (adjusted odds ratio, 4.2; P<0.007) with optimal cutoff ≥5 (sensitivity 84.6% and specificity 76.5%). Restricting regression analysis to parameters collected before extubation, a 4-item Determine Extubation Failure in Severe Stroke score (duration of ventilation, the examination of oral motor function, infratentorial lesion, and stroke severity) was derived. The score demonstrated excellent discrimination (area under the curve 0.89; 95% CI, 0.83-0.95) and calibration (Nagelkerkes R=0.54) with an ideal cutoff ≥4 (sensitivity: 81.3% and specificity: 78.2%). Conclusions- Risk of EF is strongly correlated with postextubation dysphagia severity in stroke. Fiberoptic endoscopic examination of swallowing best predicts necessity of reintubation but requires a trial of extubation. The Determine Extubation Failure In Severe Stroke score is based on easy to collect clinical data and may guide extubation decision making in critically ill stroke patients.
Topics: Aged; Aged, 80 and over; Airway Extubation; Critical Illness; Deglutition; Female; Humans; Male; Middle Aged; Risk Factors; Stroke
PubMed: 31280655
DOI: 10.1161/STROKEAHA.118.024643 -
Food Research International (Ottawa,... Jul 2024The presence of contaminants in cacao-derived products, especially in chocolates, has raised concerns regarding food safety and human health. The study assessed the...
The presence of contaminants in cacao-derived products, especially in chocolates, has raised concerns regarding food safety and human health. The study assessed the concentration variation of 16 elements in 155 chocolate samples from the US market by cacao content and country of geographic origin. The study further examined the potential health risks posed by toxic metals and determined the contribution of essential elements to the Daily Recommended Intake (DRI), estimated based on an ounce (∼28.4 g) of daily chocolate consumption. Dark chocolates with ≥50 % cacao exhibited consecutively increasing mean levels from 1.2 to 391 µg/kg for U, Tl, Th, As, Pb, Se, Cd, and Co. Similarly, Ni, Sr, Cu, Mn, Zn, Fe, Ca, and Mg had mean concentrations from 4.0 to 1890 mg/kg. Dark chocolates sourced from Central and South America exhibited the highest mean levels of Cd, and South America samples also contained elevated Pb, whereas those from West Africa and Asia had low Cd and Pb, respectively. Cacao contents showed increasingly strong association with Cd, Co, Mn, Sr, Ni, Cu, Zn, and Mg (r = 0.60-0.84), and moderately with Se, Fe, As, and Tl (r = 0.35-0.49), indicating these elements are primarily derived from cacao beans. Weak association of cacao contents with Pb, Th, and U levels (r < 0.25), indicates post-harvest contaminations. Hazard Quotient (HQ) > 1 was found only for Cd in 4 dark chocolates, and Hazard Index (HI) > 1 for cumulative risk of Cd, Pb, Ni, As, and U was found in 33 dark chocolates, indicating potential non-carcinogenic risks for 15 kg children but none for 70 kg adults. Dark chocolate also substantially contributed to 47-95 % of the DRI of Cu for children and 50 % for adults. Dark chocolates also provided notable Fe, Mn, Mg, and Zn contributions to the DRI. These essential elements are recognized to reduce the bioavailability of toxic metals such as Cd, Pb, or Ni, thereby potentially lowering associated health risks. This study informs consumers, food industries, and regulatory agencies to target cacao origins or chocolate brands with lower toxic metal contents for food safety and minimizing adverse health effects.
Topics: Metals, Heavy; Risk Assessment; Chocolate; Humans; Cacao; Food Contamination; United States; Trace Elements; Recommended Dietary Allowances
PubMed: 38763644
DOI: 10.1016/j.foodres.2024.114360 -
Journal of Orofacial Orthopedics =... Sep 2022To evaluate the force decay over time of latex and non-latex orthodontic elastics subjected to either static or dynamic stretching under simulated intraoral conditions.
PURPOSE
To evaluate the force decay over time of latex and non-latex orthodontic elastics subjected to either static or dynamic stretching under simulated intraoral conditions.
MATERIALS AND METHODS
Four types of elastics (1/4-inch 4.5 ounces and 1/4-inch 6.5 ounces, each latex and non-latex) were subjected to either static stretching to 3 times internal diameter (ID) or dynamic stretching from 3 to 4.5 times ID in artificial saliva at 37 °C for 24 h. Forces generated by the elastics were measured at 0, 1, 2, 4, 8, 12, and 24 h. Differences among elastic types, time points, and between stretching regimens were tested for statistical significance (P < 0.05).
RESULTS
Both stretching regimens caused rapid force decay in all elastic types, which was significantly higher in the non-latex elastics than in the latex elastics. In contrast, there were no differences between elastic types made of the same material. With both stretching regimens, the force decay was significant only after the first hour for the latex elastics, whereas it remained significant up to 24 h for the non-latex elastics. All elastic types generated significantly lower forces after dynamic stretching than after static stretching with 70.2, 68.8, and 66.1% of the initial force remaining after 4, 8, and 24 h for latex elastics and 48.0, 40.8, and 29.5% for non-latex elastics.
CONCLUSION
Latex elastics retained significantly more force over time than their non-latex equivalents. Because of the higher force decay in a dynamic environment, it is important that non-latex elastics be changed more frequently.
Topics: Dental Materials; Dental Stress Analysis; Elasticity; Humans; Latex; Materials Testing; Orthodontic Appliances; Stress, Mechanical
PubMed: 34185101
DOI: 10.1007/s00056-021-00319-w -
Dermatitis : Contact, Atopic,...Childhood sun exposure is associated with development of future skin cancers. Sunscreens are an important tool to prevent harmful ultraviolet rays.
BACKGROUND
Childhood sun exposure is associated with development of future skin cancers. Sunscreens are an important tool to prevent harmful ultraviolet rays.
OBJECTIVES
The aims of the study are to evaluate sunscreens targeted to children and to analyze cost, marketing claims, ingredients, and allergens to help consumers select products.
METHODS
The top 50 pediatric sunscreens across retailers were analyzed for their cost, marketing claims, ingredients, vehicles, and containers. Ingredients were compared with the American Contact Dermatology Society 2020 Core Allergen List.
RESULTS
The mean price was $6.20 per ounce (range, $0.25-$39.98). The mean sun protection factor was 48.5 (range, 30-100; SD, 48.5). There was a mean of 17.5 ingredients and a mean of 1.1 allergens in products. On average, products marketed as "sensitive skin" were not only significantly more expensive ($8.90 vs $3.50 per ounce, P = 0.01) but also were significantly more likely to not contain any allergens (36.0%, n = 18 vs 12%, n = 6; P = 0.05). Products with mineral-only UV blockers were significantly less likely to have any allergen when compared with products that had chemical UV blockers (5.6%, n = 1 vs 94.4%, n = 17; P = 0.02).
CONCLUSIONS
The current market of pediatric sunscreens varies significantly in price, marketing claims, and active ingredients. Products marked as suitable for sensitive skin had significantly fewer allergens, but a majority of these products still had at least one allergen. Many sunscreens contain contact allergens, which is an important selection consideration.
Topics: Humans; Child; Sunscreening Agents; Allergens; Marketing; Pharmaceutical Vehicles; Costs and Cost Analysis
PubMed: 35951431
DOI: 10.1097/DER.0000000000000929