MS-123: Robert D. Hanson Papers

This collection is mainly comprised of letters and telegrams of the immediate Hanson family during WWII (1942-1946, with gaps), though there is a selection of letters to members of the family from other authors and a small group of letters written from 1904-1924 to Elizabeth and Henry Hanson from Elizabeth’s parents F. V. N. (Franklin Verzelius Newton) and L. T. ( Laura Trimble) Painter. In the sub-series of other letters addressed to Robert Hanson there are several letters pertaining to Robert’s admission to law school, the bar, and the army in addition to personal correspondence. Special Collections and College Archives Finding Aids are discovery tools used to describe and provide access to our holdings. Finding aids include historical and biographical information about each collection in addition to inventories of their content. More information about our collections can be found on our website http://www.gettysburg.edu/special_collections/collections/.https://cupola.gettysburg.edu/findingaidsall/1111/thumbnail.jp

Escape Room: A Competency Validation Approach

Goal The purpose of the evidence-based practice initiative is to enhance annual competencies of clinical staff in the medical/surgical areas through innovative validation methods. Methods • Clinical Nurse Educators (CNEs) identified need for change with clinical staff annual competencies. • CNEs brainstormed new concepts for creating competencies. • In collaboration with the Unit Based Practice Councils (UBPC), a learning needs assessment was conducted in each of the four units. • Unit-based competencies were identified. • The concept of an escape room activity was adapted and tailored to meet the needs of competency validation (Figure 1). • A set up of different competency skill stations were designed separately for both Registered Nurses (RNs) and Clinical Partners (CPs). • Groups of 6 to 8 staff participated and completed the activity within a one and a half hour time frame. • A pre-test and post-test were conducted to measure knowledge before and after completion of the activity and an evaluation was completed by all staff. • A scale evaluation was used from very dissatisfied to very satisfied and for the 180 submitted evaluations 100% answered very satisfied. Outcomes • A total number of 120 RNs and 45 CPs completed the activity. • Total of 29 RN and 10 CP sessions were conducted over a period of 4 months. • RNs completed twelve and CPs completed five competencies. • The pre-test average scores measuring knowledge for the RNs were only 50% and post-test increased to 91%. The CPs pretest average scores were 42%and posttest increased to 92% (Figure 2). • Staff evaluations determined a 100% satisfaction rate. Discussion • The innovative method for measuring competency of RNs and CPs in the medical-surgical areas was initiated by the exploration of non-traditional strategies for engaging the team through active learning. • The nurse educators searched for modalities to demonstrate competency, improve nurse satisfaction, bridge the generational gaps of the staff, while saving cost associated with annual education. • The escape room competency validation approach proved to be a successful method where staff demonstrated skill proficiency and teamwork in an entertaining setting. • Staff felt glad to show competency in their role and reinforce current knowledge. Implications for Practice • Staff competency is essential to provide adequate care to patients. • Validation of staff’s ability to perform skills within their role has traditionally been designed based on staff’s lack of proficiency in performing a designated skill. • Clinical nurse educators need to find new learning strategies to engage clinical staff in active learning while increasing their level of competence. • Overall, increased competency and satisfaction may positively reflect an improvement of clinical outcomes

Adherence to Behavioral Targets and Treatment Attendance During a Pediatric Weight Control Trial

Objective: Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children\u27s adherence to a range of behaviors relevant for weight maintenance over long-term follow-up. Design and Methods: Overweight children (N = 101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up. Results: Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally focused MT group. Conclusions: Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children\u27s sustained weight control

Exploring Graduate Student Mental Health and Service Utilization by Gender, Race, and Year in School

Objective: The current study explored differences in mental health problems, services utilization, and support of graduate students by gender, race/ethnicity, and year in school. Participants: Participants consisted of 734 graduate students from a large, Midwestern university. Methods: Graduate students answered a series of questionnaires in fall 2021 assessing their mental health, services utilization, and perception of services. Results: Women (vs men) and participants in their second year and beyond (vs first year) reported greater mental health problems, negative impact of the pandemic, and more services utilization. White (vs non-White) participants reported greater negative impact of the pandemic, greater services utilization, and less financial strain. Finances, lack of knowledge about resources, and inadequate communication from the university about services were reported as treatment barriers. Conclusion: Graduate students struggle with mental health, and universities may need to improve communication with and tailor their services to graduate students specifically to better support them

What constitutes clinically significant binge eating? Association between binge features and clinical validators in college-age women

Objective: To investigate the association between binge features and clinical validators. Method: The Eating Disorder Examination assessed binge features in a sample of 549 college-age women: loss of control (LOC) presence, binge frequency, binge size, indicators of impaired control, and LOC severity. Clinical validators were self-reported clinical impairment and current psychiatric comorbidity, as determined via a semistructured interview. Results: Compared with women without LOC, those with LOC had significantly greater odds of reporting clinical impairment and comorbidity (ps \u3c 0.001). Among women with LOC (n = 252), the indicators of impaired control and LOC severity, but not binge size or frequency, were associated with greater odds of reporting clinical impairment and/or comorbidity (ps \u3c 0.05). Dicussion: Findings confirm that the presence of LOC may be the hallmark feature of binge eating. Further, dimensional ratings about the LOC experienceand possibly the indicators of impaired controlmay improve reliable identification of clinically significant binge eating. (c) 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013

Epidemiology of plasmid lineages mediating the spread of extended-spectrum beta-lactamases among clinical Escherichia coli

The prevalence of extended-spectrum beta-lactamases (ESBLs) among clinical isolates of Escherichia coli has been increasing, with this spread driven by ESBL-encoding plasmids. However, the epidemiology of ESBL-disseminating plasmids remains understudied, obscuring the roles of individual plasmid lineages in ESBL spread. To address this, we performed an in-depth genomic investigation of 149 clinical ESBL-like E. coli isolates from a tertiary care hospital. We obtained high-quality assemblies for 446 plasmids, revealing an extensive map of plasmid sharing that crosses time, space, and bacterial sequence type boundaries. Through a sequence-based network, we identified specific plasmid lineages that are responsible for the dissemination of major ESBLs. Notably, we demonstrate that IncF plasmids separate into 2 distinct lineages that are enriched for different ESBLs and occupy distinct host ranges. Our work provides a detailed picture of plasmid-mediated spread of ESBLs, demonstrating the extensive sequence diversity within identified lineages, while highlighting the genetic elements that underlie the persistence of these plasmids within the clinical E. coli population

An experimental model of chronic severe mitral regurgitation

OBJECTIVE: To develop a minimally invasive, reproducible model of chronic severe mitral regurgitation (MR) that replicates the clinical phenotype of left atrial (LA) and left ventricular dilation and susceptibility to atrial fibrillation. METHODS: Under transesophageal echocardiographic guidance, chordae tendinae were avulsed using endovascular forceps until the ratio of regurgitant jet area to LA area was ≥70%. Animals survived for an average of 8.6 ± 1.6 months (standard deviation) and imaged with monthly transthoracic echocardiography (TTE). Animals underwent baseline and preterminal magnetic resonance imaging. Terminal studies included TTE, transesophageal echocardiography, and rapid atrial pacing to test inducibility of atrial tachyarrhythmias. RESULTS: Eight dogs underwent creation of severe MR and interval monitoring. Two were excluded-one died from acute heart failure, and the other had resolution of MR. Six dogs underwent the full experimental protocol; only one required medical management of clinical heart failure. MR remained severe over time, with a mean terminal regurgitant jet area to LA area of 71 ± 14% (standard deviation) and regurgitant fraction of 52 ± 11%. Mean LA volume increased over 130% (TTE: 163 ± 147%, CONCLUSIONS: Within the 6 dogs that successfully completed the full experimental protocol, this model replicated the clinical phenotype of severe MR, which led to marked structural and electrophysiologic cardiac remodeling. This model allowed for precise measurements at repeated time points and will facilitate future studies to elucidate the mechanisms of atrial and ventricular remodeling secondary to MR and the pathophysiology of valvular atrial fibrillation

Enrichment of CpG island shore region hypermethylation in epigenetic breast field cancerization

While changes in DNA methylation are known to occur early in breast carcinogenesis and the landscape of breast tumour DNA methylation is profoundly altered compared with normal tissue, there have been limited efforts to identify DNA methylation field cancerization effects in histologically normal breast tissue adjacent to tumour. Matched tumour, histologically normal tissue of the ipsilateral breast (ipsilateral-normal), and histologically normal tissue of the contralateral breast (contralateral-normal) were obtained from nine women undergoing bilateral mastectomy. Laser capture microdissection was used to select epithelial cells from normal tissue, and neoplastic cells from tumour for genome-scale measures of DNA methylation with the Illumina HumanMethylationEPIC array. We identified substantially more CpG loci that were differentially methylated between contralateral-normal and tumour (63,271 CpG loci q \u3c 0.01), than between ipsilateral-normal and tumour (38,346 CpG loci q \u3c 0.01). We identified differential methylation in ipsilateral-normal relative to contralateral-normal tissue (9,562 CpG loci p \u3c 0.01). In this comparison, hypomethylated loci were significantly enriched for breast cancer-relevant transcription factor binding sites including those for ESR1, FoxA1, and GATA3 and hypermethylated loci were significantly enriched for CpG island shore regions. In addition, progression of shore hypermethylation was observed in tumours compared to matched ipsilateral normal tissue, and these alterations tracked to several well-established tumour suppressor genes. Our results indicate an epigenetic field effect in surrounding histologically normal tissue. This work offers an opportunity to focus investigations of early DNA methylation alterations in breast carcinogenesis and potentially develop epigenetic biomarkers of disease risk

Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial

The results of the American College of Surgeons Oncology Group Z0011 (ACOSOG Z0011) trial were first reported in 2005 with a median follow-up of 6.3 years. Longer follow-up was necessary because the majority of the patients had estrogen receptor–positive tumors that may recur later in the disease course (the ACOSOG is now part of the Alliance for Clinical Trials in Oncology)