Identifying Protective Factors in Response to Discriminatory Experiences among Pregnant African American Woman

Adverse maternal-fetal health outcomes, such as low birth weight and preterm delivery, are disproportionately more likely among African-Americans than Non-Hispanic Whites. Experiences of discrimination have been hypothesized as a contributing factor to the large discrepancies in maternal-fetal health outcomes. It is well understood that with increased levels of self-reported discrimination, there are lower ratings of physical and mental health, and higher reporting rates of depressive symptoms; this relationship is stronger in women. In addition to this, skin tone has long been a marker for social class and opportunity, but research on skin tone as a risk factor for African Americans has been less extensive. How skin tone modulates the experience of discrimination for African American women and subsequent maternal-fetal health outcomes still remains a topic of interest. Variations in skin complexion have been implicated in affecting protective factors such as self-esteem and mastery. We aim to identify themes in an interview survey that explores the relationship between self-perceived complexion and the aforementioned protective factors that African American women possess in response to discriminatory experiences. In this project, we propose to complete an exploratory interview among pregnant African American women concerning protective factors in response to discriminatory experiences. Factors to be addressed include reflections on previously encountered discriminatory experiences, self-perceived complexion, mastery, and self-esteem

A prospective analysis of glove perforation in primary and revision total hip and total knee arthroplasty.

Literature in regard to glove perforation rates in revision total joint arthroplasty (TJA) is scarce. Our purpose was to determine the incidence of perforation in revision TJA. Gloves from all scrubbed personnel were tested based on the American Society for Testing and Materials. A total of 3863 gloves were collected from 58 primary and 36 revision arthroplasty cases. Surgeons had a 3.7% outer-glove perforation rate in primary TJA compared with 8.9% in revision TJA. When both gloves were perforated, the outer-glove perforation was recognized intraoperatively 100% of the time, and the inner-glove perforation was noted only 19% of the time. The surgeon has the highest rate of glove perforation. Outer-glove perforations should prompt careful inspection of the inner glove

SGLT2 Inhibitors in Patients with Diabetes and Cardiovascular Disease

Problem Definition: Multiple studies (e.g. EMPA-REG, CANVAS) demonstrate that SGLT2 Inhibitors (Inh) improve cardiac outcomes in patients with Type II Diabetes (DM2) with comorbid Cardiovascular Disease (CVD) including Heart Failure and Coronary Artery Disease. SGLT2 Inhibitors are considered standard of care for patients with DM2 and CVD. Based on literature published in European Journal of Preventative Cardiology and JACC HF, our prediction is that physicians at Thomas Jefferson University Hospital Ambulatory Practices (TJUH) under-utilize SGLT2 Inh for patients with co-morbid CVD and DM2. Aims for Improvement: Within the Jefferson Healthcare System, we sought to determine: Future Interventions The percentage of patients with an indication for an SGLT2 Inhibitor who were actually being prescribed this. How often providers within the Jefferson system were prescribing these medications, and what the barriers to prescribing are. With this information, we hoped to increase the percentage of (qualifying) patients who are on these medications as part of standard of care by 20% within one year of intervention

OncoLog Volume 49, Number 12, December 2004

Advances in Prostate Cancer Treatment Everyday Drugs Show New Promise for Cancer Are COX-2 Inhibitors Safe? House Call: Myths & Facts about Cancer Prevention DiaLog: Neoadjuvant Trials in Prostate Cancer, by Paul Mathew, MD, Assistant Professor, Department of Genitourinary Medical Oncologyhttps://openworks.mdanderson.org/oncolog/1135/thumbnail.jp

Comparing and Contrasting E-learning Systems’ Adoption in Tanzania: The Experience from Students-Instructors of Eight Universities

Students and instructors contrasting interests were major adoption block in e-learning systems in the world’s universities and Tanzania in particular. This paper aimed to examine aspects in which students-instructors are similar and different in e-learning systems’ adoption in Tanzania’s universities. This paper uses results from two empirical models which were developed from two sample of 1,005 students and 86 instructors from eight universities in Tanzania. Specifically, it intends to achieve the following objectives: (1) to determine common and contrasting factors affecting students-instructors in e-learning systems adoption (2) to examine common hypotheses and their strengths (3) to deduce a unified model (view). Results showed that there were considerable common interests between these two key stakeholders (instructors and students) in e-learning systems however there were also contrasting interests too, this implied that specific and common interests shall always be considered in adopting and measuring these systems. These findings will help policy makers in their plan and strategy for e-learning systems’ adoption and measuring in universities in Tanzania especially in environment where both instructors and students need optimal e-learning systems. The novelty of this research lies in identified common core factors between students and instructors with their corresponding common hypotheses strengths

Peri-Operative Urodynamic Assessment has Poor Predictive Value for Developing Post-Operative Urinary Retention

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk. Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a Urologist. Patient records were retrospectively reviewed and assessed whether pre-operative PVR cutoffs or urinary retention scores were associated with developing POUR. Proportions were evaluated with the chi square test, while continuous variables were evaluated by logistic regression analysis. Receiver-operator characteristic (ROC) curves were utilized to determine the efficacy of using urodynamic variables as a predictor of developing POUR. Results: Two hundred and fifty-two (252) male patients were reviewed who had a mean age of 64.9 years and mean BMI 30.8 kg/m2. The overall rate of POUR was 5.2%; the rate of protocol-driven catheterization was higher (19.8%). Patient urinary retentions scores were not associated with the risk of POUR. Elevated pre-operative PVR (\u3e10 cc) alone and in combination with a history of urologic disease was significantly associated with POUR (p \u3c 0.001 and p = 0.001, respectively). However, both had low positive-predictive values (10.5 and 18.2%, respectively), despite high negative predictive values (99.2 and 97.9%, respectively). Utilization of PVR resulted in moderate sensitivity (91.6%) and low specificity (72.1%) with an AUC of 0.694. Discussion: Urodynamic measurements and patient urinary retention scores, as part of institutional pre-operative screening, have limited value in determining risk of POUR. False-positive rates of up to ~90% were observed with correspondingly low specificity. The authors call into question the utility of obtaining these measurements pre-operatively, particularly as they have no modifiable impact on institutional post-operative catheterization protocol

Revision total knee arthroplasty in the young patient: is there trouble on the horizon?

BACKGROUND: The volume of total knee arthroplasties, including revisions, in young patients is expected to rise. The objective of this study was to compare the reasons for revision and re-revision total knee arthroplasties between younger and older patients, to determine the survivorship of revision total knee arthroplasties, and to identify risk factors associated with failure of revision in patients fifty years of age or younger. METHODS: Perioperative data were collected for all total knee arthroplasty revisions performed from August 1999 to December 2009. A cohort of eighty-four patients who were fifty years of age or younger and a cohort of eighty-four patients who were sixty to seventy years of age were matched for the date of surgery, sex, and body mass index (BMI). The etiology of failure of the index total knee arthroplasty and all subsequent revision total knee arthroplasties was determined. Kaplan-Meier survival curves were used to evaluate the timing of the primary failure and the survivorship of revision knee procedures. Finally, multivariate Cox regression was used to calculate risk ratios for the influence of age, sex, BMI, and the reason for the initial revision on survival of the revision total knee arthroplasty. RESULTS: The most common reason for the initial revision was aseptic loosening (27%; 95% confidence interval [CI] = 19% to 38%) in the younger cohort and infection (30%; 95% CI = 21% to 40%) in the older cohort. Of the twenty-five second revisions in younger patients, 32% (95% CI = 17% to 52%) were for infection, whereas 50% (95% CI = 32% to 68%) of the twenty-six second revisions in the older cohort were for infection. Cumulative six-year survival rates were 71.0% (95% CI = 60.7% to 83.0%) and 66.1% (95% CI = 54.5% to 80.2%) for revisions in the younger and older cohorts, respectively. Infection and a BMI of ≥40 kg/m2 posed the greatest risk of failure of revision procedures, with risk ratios of 2.731 (p = 0.006) and 2.934 (p = 0.009), respectively. CONCLUSIONS: The survivorship of knee revisions in younger patients is a cause of concern, and the higher rates of aseptic failure in these patients may be related to unique demands that they place on the reconstruction. Improvement in implant fixation and treatment of infection when these patients undergo revision total knee arthroplasty is needed. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence

UR-159 - A Systematic Literature Review on Dark Web

The dark web is often discussed in taboo by many who are unfamiliar with the subject. However, this paper takes a dive into the skeleton of what constructs the dark web by compiling the research of published essays. The Onion Router (TOR) and other discussed browsers are specialized web browsers that provide anonymity by going through multiple servers and encrypted networks between the host and client, hiding the IP address of both ends. This provides difficulty in terms of controlling or monitoring the dark web, leading to its popularity in criminal underworlds. In this work, we provide an overview of data mining and penetration testing tools that are being widely used to crawl and collect data. We compare the tools to provide strengths and weaknesses of the tools while providing challenges of harnessing massive data from dark web using crawlers and penetration testing tools including machine learning (ML) techniques. Despite the effort to crawl dark web has progressed, there are still rooms to advance existing approaches to combat the ever-changing landscape of the dark web