Using a Powered Bone Marrow Biopsy System Results in Shorter Procedures, Causes Less Residual Pain to Adult Patients, and Yields Larger Specimens

<p>Abstract</p> <p>Background</p> <p>In recent years, a battery-powered bone marrow biopsy system was developed and cleared by the U.S. Food and Drug Administration to allow health care providers to access the bone marrow space quickly and efficiently. A multicenter randomized clinical trial was designed for adult patients to determine if the powered device had advantages over traditional manually-inserted needles in regard to length of procedure, patient pain, complications, user satisfaction, and pathological analysis of the specimens.</p> <p>Methods</p> <p>Adult patients requiring marrow sampling procedures were randomized for a Manual or Powered device. Visual Analog Scale (VAS) pain scores were captured immediately following the procedure and 1 and 7 days later. Procedure time was measured and core specimens were submitted to pathology for grading.</p> <p>Results</p> <p>Ten sites enrolled 102 patients into the study (Powered, n = 52; Manual, n = 50). Mean VAS scores for overall procedural pain were not significantly different between the arms (3.8 ± 2.8 for Powered, 3.5 ± 2.3 for Manual [p = 0.623]). A day later, more patients who underwent the Powered procedure were pain-free (67%) than those patients in the Manual group (33%; p = 0.003). One week later, there was no difference (83% for Powered patients; 76% for Manual patients.) Mean procedure time was 102.1 ± 86.4 seconds for the Powered group and 203.1 ± 149.5 seconds for the Manual group (p < 0.001). Pathology assessment was similar in specimen quality, but there was a significant difference in the specimen volume between the devices (Powered: 36.8 ± 21.2 mm³; Manual: 20.4 ± 9.0 mm³; p = 0.039). Two non-serious complications were experienced during Powered procedures (4%); but none during Manual procedures (p = 0.495).</p> <p>Conclusions</p> <p>The results of this first trial provide evidence that the Powered device delivers larger-volume bone marrow specimens for pathology evaluation. In addition, bone marrow specimens were secured more rapidly and subjects experienced less intermediate term pain when the Powered device was employed. Further study is needed to determine if clinicians more experienced with the Powered device will be able to use it in a manner that significantly reduces needle insertion pain; and to compare a larger sample of pathology specimens obtained using the Powered device to those obtained using traditional manual biopsy needles.</p

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The synergy between scientists and experienced educators : an examination of dialogues for professional development opportunities within a team of university instructors who prepare pre-service secondary STEM teachers at an RU/VH research university

textProfessional development is an essential component to maintaining quality teaching in mathematics and science (Monk, 1994; Milken, 2000; Loucks-Horsley et al, 2003). University mathematics and science faculty have been subject to criticism regarding professional development and teaching practices (CSMEE, 2000; NRC, 1999; NSES, 1996). Undergraduate students in secondary pre-service Science, Technology, Engineering, and Mathematics (STEM) teacher training programs adopt the models that they have experienced as learners in the university setting (NRC, 1999). This qualitative case study followed a team of three research faculty, one lecturer, one master teacher, and two graduate teaching assistants who team taught an upper level inquiry- based science research methods science course in a STEM teacher preparation program in the College of Natural Sciences at a large public Midwestern research university. Course instructor dialogue between members was recorded, transcribed and triangulated with teaching sequences, course materials, and student interaction during two semesters. The study detailed how faculty members’ and graduate teaching assistants’ content knowledge, pedagogical content knowledge, attitudes and beliefs about teaching and learning were confronted, challenged, and transformed using interdependent disquisition via regular weekly meetings and team teaching practices. Examples of actual dialogue and meeting characteristics are presented compared and discussed against best practices in science education. Four themes emerged from the data: (1) students’ inquiries drive the conversation, (2) confrontations sort out what works from what doesn’t, (3) leadership seems to contribute to learning opportunities for the team and (4) humor indicates the divergent creative abilities of the members of the team and engaging in humorous episodes facilitates learning between team members. Students were directly connected to team members’ developmental processes. This analysis suggests that measurable professional development opportunities exist in team meetings for science faculty and graduate teaching assistants when team teaching inquiry based undergraduate science courses.Curriculum and Instructio

RECOVER: The Reassessment Campaign on Veterinary Resuscitation (MLA poster)

The Reassessment Campaign on Veterinary Resuscitation (RECOVER) is a large scale project to create CPR and first aid guidelines for the veterinary profession (https://veccs.org/recover-cpr/). The content on this site pertains to the search strategy performed by information specialists for this project

RECOVER (The REassessment Campaign On VEterinary Resuscitation) Worksheets and Search Strategies 2019-2022

Welcome to the repository of search strategies for the RECOVER project. The RECOVER project is an evidence-based approach to creating veterinary CPR guidelines which involves veterinarians, veterinary technicians and information specialists from around the world. Inside there are the original worksheets from the original [RECOVER project][1] in 2012, A Prisma-S template for the RECOVER search strategy ([based on version 1.0 from June 2019][2]), a workflow for the search strategy development, [PRESS][3] form checklist template and the search strategies developed for at least all the priority one questions in each domain

Identification of metabolic pathways contributing to ER+ breast cancer disparities using a machine-learning pipeline

Abstract African American (AA) women in the United States have a 40% higher breast cancer mortality rate than Non-Hispanic White (NHW) women. The survival disparity is particularly striking among (estrogen receptor positive) ER+ breast cancer cases. The purpose of this study is to examine whether there are racial differences in metabolic pathways typically activated in patients with ER+ breast cancer. We collected pretreatment plasma from AA and NHW ER+ breast cancer cases (AA n = 48, NHW n = 54) and cancer-free controls (AA n = 100, NHW n = 48) to conduct an untargeted metabolomics analysis using gas chromatography mass spectrometry (GC–MS) to identify metabolites that may be altered in the different racial groups. Unpaired t-test combined with multiple feature selection and prediction models were employed to identify race-specific altered metabolic signatures. This was followed by the identification of altered metabolic pathways with a focus in AA patients with breast cancer. The clinical relevance of the identified pathways was further examined in PanCancer Atlas breast cancer data set from The Cancer Genome Atlas Program (TCGA). We identified differential metabolic signatures between NHW and AA patients. In AA patients, we observed decreased circulating levels of amino acids compared to healthy controls, while fatty acids were significantly higher in NHW patients. By mapping these metabolites to potential epigenetic regulatory mechanisms, this study identified significant associations with regulators of metabolism such as methionine adenosyltransferase 1A (MAT1A), DNA Methyltransferases and Histone methyltransferases for AA individuals, and Fatty acid Synthase (FASN) and Monoacylglycerol lipase (MGL) for NHW individuals. Specific gene Negative Elongation Factor Complex E (NELFE) with histone methyltransferase activity, was associated with poor survival exclusively for AA individuals. We employed a comprehensive and novel approach that integrates multiple machine learning and statistical methods, coupled with human functional pathway analyses. The metabolic profile of plasma samples identified may help elucidate underlying molecular drivers of disproportionately aggressive ER+ tumor biology in AA women. It may ultimately lead to the identification of novel therapeutic targets. To our knowledge, this is a novel finding that describes a link between metabolic alterations and epigenetic regulation in AA breast cancer and underscores the need for detailed investigations into the biological underpinnings of breast cancer health disparities

Cosmology Intertwined : A Review of the Particle Physics, Astrophysics, and Cosmology Associated with the Cosmological Tensions and Anomalies

Contribution to Snowmass 2021. 224 pages, 27 figures. Accepted for publication in JHEApPeer reviewe