Pediatric testicular torsion: does patient transfer affect time to intervention or surgical outcomes at a rural tertiary care center?

Background: Testicular torsion (TT) is a urologic emergency that requires prompt surgical intervention. In rural Appalachia, patients are often transferred from surrounding communities due to lack of urologic care. We hypothesized that those transferred would have delayed intervention and higher rates of orchiectomy when compared to those who presented directly to our hospital. Methods: We performed a retrospective review of patient charts with an ICD-9 diagnosis of TT from 2008 to 2016. Patients met inclusion criteria if diagnosis was confirmed by operative exploration. We compared rate of testicular loss and time until surgical intervention between groups. Results: Twenty-three patients met inclusion criteria (12 transferred, 11 direct). Patient demographics did not significantly differ between groups. Transferred patients had a higher orchiectomy rate (33% v 22%,p = 0.41) although this was not statistically significant. Time to surgery from symptom onset was significantly longer in those transferred (12.9 h) compared to those not transferred (6.9 h, p = 0.02). Distance of transfer was not correlated with time of delay (r2 = 0.063). Conclusions: Transferred patients with TT have numerically higher rates of orchiectomy which may reach significance in an appropriately powered study, and relative delays in surgical intervention. This study highlights the need for improved access to urologic care in rural areas

Dysfunctional Voiding: Does a validated urine color scale correlate with dysfunctional voiding severity score?

Introduction Dysfunctional voiding (DV), defined as abnormal coordination between the urinary sphincter and the detrusor muscle in a neurologically intact individual, affects approximately 40% of patients that populate pediatric urology clinics. Improper hydration affects the specific gravity and concentration of urinary irritants, resulting in symptoms similar to those seen in DV patients. Methods Herein, we administered a validated DV survey (the Dysfunctional Voiding Symptom Score [DVSS]) and a validated dehydration severity chart (the Urine Color Chart [UCC]) to toilet trained pediatric patients and compared DV patients to patients presenting with non-urologic concerns. Data was analyzed on an item-for-item basis and by the total DVSS and UCC between the two groups. A total of 29 DV pediatric patients and 21 non-urologic pediatric patients were recruited from 2016 to 2018. Results Both patient groups were equivalent with regards to age, sex, height, weight, and BMI. The DV population had significantly higher scores in 7 out of 10 individual items within the DVSS when compared to those presenting for non-urologic complaints (p \u3c 0.05). In addition, DV patients had significantly higher total scores on the DVSS than non-urologic patients (p = 0.0004). No significant difference was noted in UCC scores between patient groups (p = 0.753). Regression analysis showed that within the dysfunctional voiding group, there was a linear relationship between DVSS and UCC scores. Conclusion The present study suggests the DVSS results yield significantly different results for DV patients when compared to age, sex, and BMI matched children with no urologic complaints. The UCC does not reliably vary between DV and non-urologic patients; however, there appears to be a linear relationship between DVSS and UCC scores within the DV cohort. Further studies may elucidate a validated metric by which DV and non-urologic pediatric patients may be differentiated

Traditional methods for managing illness in newborns and infants in an Arab society

Aim: This study explored self‐management practices in relation to traditional methods for managing illness in newborns and infants and the implications of these practices on infant health. Background: Self‐medication with folk remedies is believed to have short‐ and long‐term impacts on well‐being. Little is known about how mothers in Arab societies used their traditional beliefs and practices in self‐managing their newborns’ and infants’ health. Methods: Data were collected from five focus groups using open‐ended questions with 37 mothers. Participants were selected using snowball sampling and were recruited from four different cities in Jordan between June 2016 and August 2016. Ethical approval: All identifying information regarding the study participants has been omitted, and this study was approved by the Academic Research Committee at the University of Jordan. Findings: Mothers were more willing to try herbal remedies, traditional massage and certain foods to self‐manage their infants’ health. Folk remedies were not restricted to traditions handed down through generations, but included a representation of newly emerged trends towards ‘safety’ or ‘nature’. Conclusions: While the use of folk remedies have been handed down generations as customs, today, virtual support groups and social media provide modern resources for folk remedies’ promotion in care and self‐management. Implications for nursing and health policy: Nursing and health policymakers can use our findings for planning and developing strategies and health policies that increase public awareness about adverse health effects associated with herbal remedies. Such strategies are likely to be facilitated through partnerships between nursing and midwifery education institutions, antenatal clinics and social media in the region

The Relevance of Political Stability on FDI: A VAR Analysis and ARDL Models for Selected Small, Developed, and Instability Threatened Economies

This paper studies the relevance of political stability on foreign direct investment (FDI) and the relevance of FDI on economic growth, in three panels. The first panel contains 11 very small economies ; the second contains five well- developed and politically stable economies with highly positive FDI net inflows, while the third is a panel with economies that are prone to political violence or targeted by the terrorist attacks. We employ a Granger causality test and implement a vector autoregressive (VAR) framework within the panel setting. In order to test the sensitivity of the results and avoid robust errors, we employ an ARDL model for each of the countries within every panel. Based upon our results, we conclude that there is a long- term relationship between political stability and FDI for the panel of small economies, while we find no empiric evidence of such a relationship for both panels of larger and more developed economies. Similarly to the original hypothesis of Lucas (1990), we find that FDI outflows tend to go towards politically less stable countries. On the other hand, the empiric methodology employed did not find such conclusive evidence in the panels of politically more developed countries or in the small economies that this paper observes

Segmental Distribution of Hepatocellular Carcinoma Correlates with Microvascular Invasion in Liver Explants Undergoing Transplantation

Introduction: Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients is a poor prognostic factor after liver transplantation and/or resection. Any correlation between MVI and segmental location of HCC has yet to be studied. Our aim is to evaluate the segmental location of HCC and any correlation with the presence of MVI, portal vein thrombosis (PVT) in explanted livers, and the recurrence of HCC after transplantation. Another objective of the study is to assess the treatment history (ablation or transarterial chemoembolization (TACE)) and size of the tumor with respect to the risk of MVI. Methods: A single center, retrospective chart review, including 98 HCC patients, aged 18 years and older who had liver transplantation in our institute between 2012 and 2017. We reviewed the radiological images of the HCC tumors, the pathological findings of the explanted livers, and the follow-up imaging after transplantation. Results: 98 patients with the diagnosis of HCC underwent liver transplantation between 2012 and 2017. The mean age of the cohort was 63 +/- 8.2. Males represented 75% and Caucasian race represented 75% of the cohort. The most common etiology of cirrhosis was chronic hepatitis C virus infection followed by alcohol abuse and nonalcoholic steatohepatitis (NASH) with percentages of 50%, 23%, and 10%, respectively. Microvascular invasion was found in 16% of the patients while PVT and the recurrence of HCC were found in 17% and 6 % of the cohort, respectively. MVI was found in 10 single HCC and 6 multifocal HCC. Right lobe HCC had more MVI when compared to the left and multilobar HCC, with percentages of 11%, 2%, and 3%, respectively. Localization of HCC in segment 8 was associated with the highest percentage of MVI when compared to all other segments. The risk of MVI in segment 8 HCC was 3.5 times higher than the risk from the other segments (p=0.002) while no vascular invasion was found in segments 1, 3, and 5. The risk of vascular invasion in untreated HCC is 3 times the risk in treated HCC (P=0.03). Conclusion: Our data indicate that the risk of microvascular invasion is highest in tumors localized to segment 8. The size and number of HCC tumors were not associated with an increased risk of microvascular invasion

1-{1-[2,8-Bis(trifluoro­meth­yl)-4-quin­olyl]-5-methyl-1H-1,2,3-triazol-4-yl}ethanone

There are two independent mol­ecules in the asymmetric unit of the title compound, C16H10F6N4O. The triazole ring is not coplanar with the quinoline ring system; the dihedral angle between the two planes being 74.47 (12) and 63.97 (13)° in the two mol­ecules. The crystal structure is characterized by inter­molecular C—H⋯F, C—H⋯N and C—H⋯O hydrogen bonding. Weak intra­molecular C—H⋯F inter­actions are observed. Disorder is observed in two F atoms of one of the trifluoro­methyl groups of one independent mol­ecule [occupancy ratios 0.77 (3):0.23 (3) and 0.77 (4):0.23 (4)] and in all three F atoms of one of the trifluoro­methyl groups of the second independent mol­ecule [occupancy ratios 0.520 (14):0.480 (14), 0.615 (17):0.385 (17) and 0.783 (11):0.217 (11)]. The O atom is also disordered over two positions with occupancies of 0.60 (13) and 0.40 (13) in the first mol­ecule

Comparative Network Analysis of Preterm vs. Full-Term Infant-Mother Interactions

Several studies have reported that interactions of mothers with preterm infants show differential characteristics compared to that of mothers with full-term infants. Interaction of preterm dyads is often reported as less harmonious. However, observations and explanations concerning the underlying mechanisms are inconsistent. In this work 30 preterm and 42 full-term mother-infant dyads were observed at one year of age. Free play interactions were videotaped and coded using a micro-analytic coding system. The video records were coded at one second resolution and studied by a novel approach using network analysis tools. The advantage of our approach is that it reveals the patterns of behavioral transitions in the interactions. We found that the most frequent behavioral transitions are the same in the two groups. However, we have identified several high and lower frequency transitions which occur significantly more often in the preterm or full-term group. Our analysis also suggests that the variability of behavioral transitions is significantly higher in the preterm group. This higher variability is mostly resulted from the diversity of transitions involving non-harmonious behaviors. We have identified a maladaptive pattern in the maternal behavior in the preterm group, involving intrusiveness and disengagement. Application of the approach reported in this paper to longitudinal data could elucidate whether these maladaptive maternal behavioral changes place the infant at risk for later emotional, cognitive and behavioral disturbance

To make a difference – how GPs conceive consultation outcomes. A phenomenographic study

<p>Abstract</p> <p>Background</p> <p>Outcomes from GPs' consultations have been measured mainly with disease specific measures and with patient questionnaires about health, satisfaction, enablement and quality. The aim of this study was to explore GPs' conceptions of consultation outcomes.</p> <p>Methods</p> <p>Interviews with 17 GPs in groups and individually about consultation outcomes from recently performed consultations were analysed with a phenomenographic research approach.</p> <p>Results</p> <p>The GPs conceived outcomes in four ways: patient outcomes, GPs' self-evaluation, relationship building and change of surgery routines.</p> <p>Conclusion</p> <p>Patient outcomes, as conceived by the GPs, were generally congruent with those that had been taken up in outcome studies. Relationship building and change of surgery routines were outcomes in preparation for consultations to come. GPs made self-assessments related to internalized norms, grounded on a perceived collegial professional consensus. Considerations of such different aspects of outcomes can inspire professional development.</p

Randomized controlled field trial to assess the immunogenicity and safety of rift valley fever clone 13 vaccine in livestock

BACKGROUND:Although livestock vaccination is effective in preventing Rift Valley fever (RVF) epidemics, there are concerns about safety and effectiveness of the only commercially available RVF Smithburn vaccine. We conducted a randomized controlled field trial to evaluate the immunogenicity and safety of the new RVF Clone 13 vaccine, recently registered in South Africa. METHODS:In a blinded randomized controlled field trial, 404 animals (85 cattle, 168 sheep, and 151 goats) in three farms in Kenya were divided into three groups. Group A included males and non-pregnant females that were randomized and assigned to two groups; one vaccinated with RVF Clone 13 and the other given placebo. Groups B included animals in 1st half of pregnancy, and group C animals in 2nd half of pregnancy, which were also randomized and either vaccinated and given placebo. Animals were monitored for one year and virus antibodies titers assessed on days 14, 28, 56, 183 and 365. RESULTS:In vaccinated goats (N = 72), 72% developed anti-RVF virus IgM antibodies and 97% neutralizing IgG antibodies. In vaccinated sheep (N = 77), 84% developed IgM and 91% neutralizing IgG antibodies. Vaccinated cattle (N = 42) did not develop IgM antibodies but 67% developed neutralizing IgG antibodies. At day 14 post-vaccination, the odds of being seropositive for IgG in the vaccine group was 3.6 (95% CI, 1.5 - 9.2) in cattle, 90.0 (95% CI, 25.1 - 579.2) in goats, and 40.0 (95% CI, 16.5 - 110.5) in sheep. Abortion was observed in one vaccinated goat but histopathologic analysis did not indicate RVF virus infection. There was no evidence of teratogenicity in vaccinated or placebo animals. CONCLUSIONS:The results suggest RVF Clone 13 vaccine is safe to use and has high (>90%) immunogenicity in sheep and goats but moderate (> 65%) immunogenicity in cattle