Documenting the NICU design dilemma: parent and staff perceptions of open ward versus single family room units

Objective: With neonatal intensive care units (NICUs) evolving from multipatient wards toward family-friendly, single-family room units, the study objective was to compare satisfaction levels of families and health-care staff across these differing NICU facility designs. Study Design: This prospective study documented, by means of institutional review board-approved questionnaire survey protocols, the perceptions of parents and staff from two contrasting NICU environments. Result: Findings showed that demographic subgroups of parents and staff perceived the advantages and disadvantages of the two facility designs differently. Staff perceptions varied with previous experience, acclimation time and employment position, whereas parental perceptions revealed a naiveté bias through surveys of transitional parents with experience in both NICU facilities. Conclusion: Use of transitional parent surveys showed a subject naiveté bias inherent in perceptions of inexperienced parents. Grouping all survey participants demographically provided more informative interpretations of data, and revealed staff perceptions to vary with position, previous training and hospital experience

Diversity Of Diagnoses And Student Learning Experiences In An On-Campus School Psychology Assessment Center: Future Directions And Focus

School Psychology Assessment Centers (SPAC) developed at the University-level are crucial in developing competent school psychologists. While many models on how to develop mental health centers are in existence, a new model exists for creating a SPAC on a University campus that is specifically designed to serve the diverse surrounding community and postsecondary students (see Ellis-Hervey et al., 2016). The community’s needs were reviewed, including missing service links in the region, and identification of potential clients who would benefit most from services provided. Senior students who work with clients in the SPAC gain assessment skills and build supervision skills through close interactions and consultation with junior students. New goals of the SPAC is to develop and implement academic, behavioral, social skills and therapy/counseling services

Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes.

Diuretic-based antihypertensive therapy is associated with the development of diabetes but with improved clinical outcomes. It has been proposed that the duration of clinical trials has been too short to detect the adverse effects of diabetes. We assessed the long-term mortality rate of subjects in the Systolic Hypertension in the Elderly Program (n = 4,732) who were randomized to stepped-care therapy with 12.5 to 25.0 mg/day of chlorthalidone or matching placebo. If blood pressure remained above the goal, atenolol or matching placebo was added. At a mean follow-up of 14.3 years, cardiovascular (CV) mortality rate was significantly lower in the chlorthalidone group (19%) than in the placebo group (22%; adjusted hazard ratio [HR] 0.854, 95% confidence interval [CI] 0.751 to 0.972). Diabetes at baseline (n = 799) was associated with increased CV mortality rate (adjusted HR 1.659, 95% CI 1.413 to 1.949) and total mortality rate (adjusted HR 1.510, 95% CI 1.347 to 1.693). Diabetes that developed during the trial among subjects on placebo (n = 169) was also associated with increased CV adverse outcome (adjusted HR 1.562, 95% CI 1.117 to 2.184) and total mortality rate (adjusted HR 1.348, 95% CI 1.051 to 1.727). However, diabetes that developed among subjects during diuretic therapy (n = 258) did not have significant associations with CV mortality rate (adjusted HR 1.043, 95% CI 0.745 to 1.459) or total mortality rate (adjusted HR 1.151, 95% CI 0.925 to 1.433). Diuretic treatment in subjects who had diabetes was strongly associated with lower long-term CV mortality rate (adjusted HR 0.688, 95% CI 0.526 to 0.848) and total mortality rate (adjusted HR 0.805, 95% CI 0.680 to 0.952). Thus, chlorthalidone-based treatment improved long-term outcomes, especially among subjects who had diabetes. Subjects who had diabetes associated with chlorthalidone had no significant increase in CV events and had a better prognosis than did those who had preexisting diabetes

Proximal wrist extensor tendinopathy

Proximal wrist extensor tendinopathy, which is also known as tennis elbow, is pain at or just distal to the lateral humeral epicondyle within the proximal wrist extensor tendon. It occurs commonly in certain athletes but can also occur in people with jobs that require repetitive movements of the hand and upper limb. In most cases the tendon involved shows no signs of inflammation or tendonitis, but instead shows fibroblasts, vascular hyperplasia, and disorganized collagen. Diagnosis is often made by history and physical exam alone. Most people respond to conservative measures including activity modification, analgesics, manipulation of tissue, and exercise. In some cases, an injection of corticosteroid or botulinum toxin may be used. Surgery is rarely needed

Probable haloperidol decanoate-induced fever in an African American with benign ethnic neutropenia: A case report

We present a case in which a patient developed fever and leukocytosis subsequent to each monthly haloperidol decanoate injection, an adverse reaction that does not meet the diagnostic criteria of neuroleptic malignant syndrome (NMS) or any previously reported adverse reaction for this medication. A patient being treated with haloperidol decanoate for psychosis experienced a fever within 3 days of injection and leukocytosis along with swelling, pain, and a knot feeling at the injection site. This recurred after each injection for several months. Muscle rigidity or changes in vital signs other than temperature were not noted. Temperature and injection site reactions resolved with administration of acetaminophen and ibuprofen. The elevation in temperature was discovered as a result of universal twice daily temperature monitoring implemented due to the COVID-19 pandemic. Reports of fever with antipsychotics are typically associated with NMS or heat stroke; the details of this case do not meet the clinical criteria for either. Similar reactions are reported for other antipsychotics, such as clozapine and olanzapine, but not for haloperidol. The recommendation was to discontinue use of the medication due to an unclear mechanism of the reaction

Colossal Aggregations of Giant Alien Freshwater Fish as a Potential Biogeochemical Hotspot

The ubiquity and fascinating nature of animal aggregations are widely recognised. We report here consistent and previously undocumented occurences of aggregations of a giant alien freshwater fish, the Wels catfish (Silurus glanis). Aggregative groups were on average composed of 25 (±10 SD, ranging from 15 to 44) adults with estimated average total biomass of 651 kg (386 – 1132) and biomass density of 23 kg m−2 (14 – 40). Aggregations always occurred within the same location. No foraging, reproductive or anti-predator behaviour were observed during the aggregations. A mass-balance model estimated that these colossal aggregations of an alien species can locally release, through excretion only, up to 70 mg P m−2 h−1 and 400 mg N m−2 h−1, potentially representing the highest biogeochemical hotspots reported in freshwater ecosystems and another unexpected ecological effect of alien species

From colonial categories to local culture: Evolving state practices of ethnic enumeration in Oceania, 1965-2014

Numerous scholars have examined how governments in particular times and places have classified their populations by ethnicity, but studies that are both cross-national and longitudinal are rare. Using a unique database of census questionnaires, we examine state practices of ethnic enumeration over a 50-year period (1965–2014) in the 24 countries and areas that comprise Oceania. The region’s extraordinary linguistic and cultural diversity, combined with its complex colonial history and indigenous politics, make it an ideal site for comparative analyses. We find a shift from biological conceptions of difference to a more cultural understanding of group identity, exemplified by a sharp rise in language questions and the decline of race-based inquiries. While local identity labels have largely displaced colonial categories, the imprimatur of previous regimes still lingers, particularly in Melanesia. These shifts in official constructions of ethnoracial differences reflect a gradual lessening of colonial influences on demographic practices