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Background: Lumbar microdiscectomy is a surgical procedure that is frequently used in the treatment of symptomatic lumbar herniation. Differences in outcomes following primary and revision lumbar microdiscectomy have been previously studied, with reports of comparably satisfactory results from the Spine Patient Outcomes Research Trial. In this study, we further investigate these outcomes, including length of stay, bleeding events, and durotomy. We hypothesized that length of stay, incidence of bleeding events, and dural tear would be greater in the revision cohort. Methods: The ACS-National Surgical Quality Improvement Program database was queried for patients undergoing single-level primary and revision lumbar microdiscectomy between 2019 and 2022. Eligibility for inclusion was determined by age >18 years and current procedural terminology codes 63030 and 63042. Patients with preoperative sepsis or cancer were excluded. Length of stay, wound infection, bleeding events requiring transfusion, cerebrospinal fluid leak, dural tear, and neurological injury were compared between the cohorts. Multivariable Poisson regression adjusted for demographics and comorbidities, including age, sex, race, body mass index, diabetes, smoking, and hypertension, was used to determine if revision was predictive of complications. Results: A total of 37,669 patients were included, of whom 3,635 (9.6%) required revision surgery. Patients in the revision cohort were older (54.25 ± 15.7 vs. 50.85 ± 16.0 years, P < 0.001) and had higher proportions of male (59.0% vs. 55.7%, P < 0.001) and non-Hispanic White patients (82.0% vs. 77.4%, P < 0.001). Length of stay (1.11 ± 2.5 vs. 1.58 ± 2.7, P < 0.001) and rates of wound infection (2.1% vs. 1.4%, P = 0.002) and bleeding events requiring transfusion (1.3% vs. 0.7%, P < 0.001) were greater in the revision cohort compared to primary patients. Differences in cerebrospinal fluid leak (0.2% vs. 0.1%, P = 0.116), dural tear complication (0.01% vs. 0.01%, P = 0.092), and neurological injury (0.008% vs. 0.006%, P = 0.691) between the revision and primary cohorts were nonsignificant. Poisson log-linear regression adjusted for demographics and comorbidities demonstrated revision as a significant predictor for length of stay (χ2 = 462.95, P < 0.001), wound infection (χ2 = 9.22, P = 0.002), and bleeding events (χ2 = 9.74, P = 0.002), while it was a nonsignificant predictor of cerebrospinal fluid leak (χ2 = 2.61, P = 0.106), dural tear (χ2 = 2.37, P = 0.123), and neurological injury (χ2 = 0.229, P = 0.632). Conclusion: Revision surgery was a significant predictor of increased length of stay, wound infection, and bleeding events requiring transfusion. Surgeons and patients alike should be aware of increased risk for complications following revision lumbar microdiscectomy compared to primary discectomy.

Abstract Background Diagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland. Methods This was a cross-sectional study. We invited PCPs from the Swiss practice-based research network “Sentinella” to collect data on the first 5 daily ultrasounds they ordered or performed themselves. Participating PCPs collected data for 3 months – divided into 4 groups to account for seasonal differences. Results Out of 188 PCPs invited, 81.9% provided data through an initial questionnaire. 46.8% provided data on 1616 ultrasounds. 56.5% of PCPs had access to ultrasound machines, while 29.8% had completed formal training. 77% of the reported ultrasounds were self-performed; 27% of the reported scans (35% of all self-performed scans) were performed by PCPs with incomplete or no formal training. The main areas of interest were the abdominal (57.9%) and the musculoskeletal (22%) region. 36.9% of reported examinations were sPOCUS exams. Among PCPs with access to US machines, the percentages of referred examinations were similar for sPOCUS (11.9%) and non-sPOCUS (11.3%) indications. However, some sPOCUS musculoskeletal ultrasounds were often referred (e.g. tendon/ligament/muscle injuries or cutaneous/subcutaneous tumour). Conclusion Most Swiss PCPs had access to ultrasound equipment and performed a majority of both sPOCUS and non-sPOCUS scans themselves, often without or with incomplete training. This reflects the fact that POCUS was only recently introduced in Switzerland. There is a need for easily accessible POCUS training programs aimed at PCPs in Switzerland. Training courses for PCPs should focus on abdominal and musculoskeletal ultrasound, because these were the most common sites for scans, and because some sPOCUS musculoskeletal examinations showed a particularly high percentage of referral.

IntroductionVisuocognitive performance is closely related to expertise in chess and has been scrutinized by several investigations in the last decades. The results indicate that experts’ decision-making benefits from the chunking process, perception and visual strategies. Despite numerous studies which link these concepts, most of these investigations have employed common research designs that do not use real chess play, but create artificial laboratory conditions via screen-based chess stimuli and obtrusive stationary eye tracking with or without capturing of decision-making or virtual reality settings.MethodsThe present study assessed the visuocognitive performance of chess novices, intermediates and experts in a real chess setting. Instead of check detection, find-the-best-move tasks or to distinguish between regions of a chessboard that were relevant or irrelevant to the best move in previous studies, we introduced n-mate tasks and sequentially manipulated their difficulty. Due to the complexity of the tasks, we monitored players’ visual strategies in a fine-graded initial phase (different time intervals instead of analysing a fixed number of first fixations) of task-solving and for complete trials, employing non-obtrusive mobile eye tracking, multi-sensor observation and full-automatic annotation of decision-making.ResultsThe results revealed significant expertise-dependent differences in visuocognitive performance based on a circumstantial spatial and temporal analysis. In order to provide more detailed results, for the first time the analyses were performed under the special consideration of different time intervals and spatial scalings. In summary, experts showed a significantly higher number of fixations on areas of interest and empty squares between pieces in the task processing than less-skilled players. However, they had a strikingly low total number of fixations on the whole board and in complete trials.DiscussionAs a conclusion, experts apply different visual search strategies in problem-solving. Moreover, experts’ visuocognitive processing benefits from stored chunks of mating constellations.

Abstract Background Primary care professionals could play a key role in health promotion implementation. A fundamental aspect that might affect the willingness of primary care professionals to strengthen health promotion, and about which we do not yet know much, are professional beliefs. Therefore, we conducted a quantitative survey to (1) compare professional beliefs and the willingness to work more in health promotion between five major primary care professions, and (2) investigate associations between professional beliefs and the willingness to work more in health promotion. Methods A large-scale cross-sectional study based on a nation-wide web-based survey of primary care professionals in Switzerland was conducted from January to July 2022. The survey was addressed to pharmacists, physicians, medical practice assistants, nurses, and physiotherapists working in primary care in Switzerland. Differences between groups were tested using T-tests and Chi-square tests. Multivariable logistic regression analyses were used to evaluate the association between variables related to professional beliefs and the willingness to work more in health promotion. Results The responses of 4’063 primary care professionals were used for analysis. Most primary care professionals revealed a salutogenetic attitude towards their primary care tasks. Members of all professions showed high awareness of their tasks in tackling increased risks of disease (80.2% of all participants). Especially allied health professionals wished to see a greater role of prevention in primary care (pharmacists: 72.4%, medical practice assistants: 63.9%, nurses: 75.6%, physiotherapists: 73.9% versus physicians: 46.9%). All professional groups showed a high willingness to work more in health promotion (88% of all participants). Salutogenetic beliefs of primary care professionals and their willingness to work more in health promotion are strongly associated. Participants agreeing that health promotion should play a greater role or that preventive consultations should be offered in primary care, are more willing to work more in health promotion compared to participants who disagree with these ideas. Conclusions Both affiliation to allied primary care professions and salutogenetic professional beliefs are associated with higher willingness to work more in health promotion. The high willingness provides evidence of a large, yet untapped potential. Promoting salutogenetic beliefs might further increase the willingness to engage in health promotion.

Abstract Background Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP. Methods The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors’ GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen’s kappa (κ) coefficients for each category of cardiovascular problems. Results We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32). Conclusions Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes.

AbstractCreating an inclusive experience for students in Higher Education is important for their engagement, belonging, and attainment. There are multiple ways of approaching inclusive teaching and there are specific considerations to be addressed when considering a Psychology curriculum. Although pedagogical resources discuss the benefits and abstract processes of creating inclusive curricula, there are little concrete examples of how to meaningfully engage in this process. We therefore present six case studies focusing on subject areas in psychology as well as specific approaches that have been adopted. In reflecting on our approaches, we offer the following suggestions to colleagues and give examples of concrete ways in which we have adopted them: (1) Consider and acknowledge your own positionality, and provide a framework for students to do the same; (2) Integrate lived experiences to content, particularly those with an applied focus; (3) Acknowledge that certain groups are underrepresented but strive to include research and theories from these groups where it is available; and, (4) Create diversity-centred learning objectives to structure an inclusive approach to content and assessment. We hope these reflections present a starting point for rich discussion about best practise in inclusive education as well as a resource for other educators.

Infants can help and share in the second year of life. However, there is limited knowledge as to variability in these behaviors as a function of target (e.g., caregiver vs. unfamiliar adult) and the influence of caregiver support on infant prosocial behavior. Infants (N = 268, 124 female) at 1-2 years of age (M = 1.47, SD = 0.27) and again at 2-3 years of age (M = 2.48, SD = 0.26) participated in a helping task (with the caregiver or unfamiliar experimenter), a sharing task (with either target), and a free-play observation with their primary caregiver from which caregiver support was coded. The racial and ethnic composition of the sample consisted of 3% Asian, 10% Black, 20% Hispanic, 59% White, 1% mixed race, and 6% "other." Median family annual income was $50,000 to $59,000, and median caregiver education level was "some college." Infant helping favored caregivers at both time points. However, infant sharing did not differ by target for 1-2-year-olds, but 2-3-year-olds shared more with their caregivers than an unfamiliar experimenter. Additionally, infants' behaviors antecedent to the act of helping or sharing (e.g., latency to respond, checking behaviors, and looking duration toward the target) differed by target. Concurrent relations between caregiver support and helping and sharing were moderated by age and differed by time point. Caregiver support for 1-2-year-olds also longitudinally predicted an age-moderated relation with 2-3-year-olds' helping toward an unfamiliar experimenter. Theoretical implications for the role of socialization in the emergence of helping and sharing behaviors are discussed.

In this contribution to the special issue on the Nobel Symposium on Dark Matter (NS 182), I review some recent theoretical and experimental progress, as well as some current challenges, in searching for dark matter particles below the proton mass with low-threshold direct-detection experiments. We now have several detection concepts for probing sub-GeV dark matter, and several technologies exist that can measure the small signals that such particles would produce in the detector. We have also made significant progress in calculating the dark matter interaction rates in crystals. In addition, we have discovered new signals for dark matter, and I will focus on the boosted dark matter component that is produced in the Sun. I will also discuss a recent (unsuccessful) attempt to probe, for the first time, the ‘Migdal’ effect in liquid xenon in a neutron scattering experiment. Moreover, I will highlight the discovery of several novel experimental backgrounds that mimic the expected dark matter signal; however, other backgrounds remain to be understood. Finally, I will discuss an exciting new detector concept, the dual-sided Charge-Coupled Device (CCD).

Abstract Oscura is a planned light-dark matter search experiment using Skipper-CCDs with a total active mass of 10 kg. As part of the detector development, the collaboration plans to build the Oscura Integration Test (OIT), an engineering test with 10% of the total mass. Here we discuss the early science opportunities with the OIT to search for millicharged particles (mCPs) using the NuMI beam at Fermilab. mCPs would be produced at low energies through photon-mediated processes from decays of scalar, pseudoscalar, and vector mesons, or direct Drell-Yan productions. Estimates show that the OIT would be a world-leading probe for mCPs in the ∼MeV mass range.

Introduction: While there is anecdotal evidence that the coronavirus disease 2019 (COVID-19) pandemic altered perioperative decision-making in patients requiring posterior cervical fusion (PCF), a national-level analysis to examine the significance of this hypothesis has not yet been conducted. This study aimed to determine the potential differences in perioperative variables and surgical outcomes of PCF performed before vs. during the COVID-19 pandemic. Methods: Adults who underwent PCF were identified in the 2019 (prepandemic) and 2020 (intrapandemic) NSQIP datasets. Differences in 30-day readmission, reoperation, and morbidity were evaluated using multivariate logistic regression. On the other hand, differences in operative time and relative value units (RVUs) were estimated using quantile regression. Furthermore, the odds ratios (OR) for length of stay (LOS) were estimated using negative binomial regression. Secondary outcomes included rates of nonhome discharge and outpatient surgery. Results: A total of 3,444 patients were included in this study (50.7% from 2020). Readmission, reoperation, morbidity, operative time, and RVUs per minute were similar between cohorts (p>0.05). The LOS (OR 1.086, p

Abstract The reach of sub-GeV dark-matter detectors is at present severely affected by low-energy events from various origins. We present the theoretical methods to compute the single- and few-electron events that arise from secondary radiation emitted by high-energy particles as they pass through detector materials and perform a detailed simulation to quantify them at (Skipper) CCD-based experiments, focusing on the SENSEI data collected at Fermilab near the MINOS cavern. The simulations account for the generation of secondaries from Cherenkov and luminescent recombination radiation; photo-absorption in the bulk, backside layer, pitch adapter, and epoxy; the photon reflection and refraction at interfaces; thin-film interference; the roughness of the interfaces; the dynamics of charges produced in the highly doped CCD-backside-layers; and the partial charge collection on the CCD backside. We consider several systematic uncertainties, notably those stemming from the backside modeling, which we estimate with a “fiducial” and an “extreme” charge-diffusion model, with the former model being preferred due to better agreement with partial-charge collection data. We find that Cherenkov photons constitute about 30% of the observed single-electron events for both diffusion models; radiative recombination contributes negligibly to the event rate for the fiducial model, although it can dominate over Cherenkov for the extreme model. We also estimate the fraction of 2-electron events that arise from 1-electron event coincidences in the same pixel, finding that the entire 2-electron rate can be explained by coincidences of radiative events and spurious charge. Accounting for both radiative and non-radiative backgrounds, we project the sensitivity of future Skipper-CCD-based experiments to different dark-matter models. For light-mediator models with dark-matter masses of 1, 5, and 10 MeV, we find that future experiments with 10-kg-year exposures and successful background mitigation could have a sensitivity that is larger by 9, 3, and 2 orders of magnitude, respectively, when compared to an experiment without background improvements.

Abstract Political polarization in the United States goes beyond divided opinions on key political issues, extending to realms of culture, lifestyle, and social identity once thought to be apolitical. Using a sample of 1 million Twitter bios, this study investigates how users’ partisan self-presentation on social media tends to include cultural as well as political markers. Representing the text in Twitter bios as semantic networks, the study reveals clear partisan differences in how users describe themselves, even on topics that seem apolitical. Consequently, active Twitter users’ political alignments can be statistically inferred from the non-political references in their bios, even in the absence of explicitly partisan language. These findings offer further evidence of partisan polarization that is aligned with lifestyle preferences. Further research is needed to determine if users are aware of that alignment, which might indicate the politicization of lifestyle preferences. The findings also suggest an under-recognized way social media can promote polarization, not through political discourse or argument, but simply in how users present cultural and lifestyle preferences on those platforms.

Introduction: Chronic myelomonocytic leukemia (CMML) is a hematologic disorder that is an overlap syndrome between myelodysplastic syndromes and myeloproliferative neoplasms, and can be associated with autoimmune and inflammatory diseases. This study aimed to describe kidney involvement in patients with CMML, their treatments, and outcomes. Methods: We conducted a French and American multicenter retrospective study in 15 centers, identifying patients with CMML with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities. Results: Sixteen patients (males, n = 14; median age 76.5 years [71.9–83]) developed a kidney disease 6 months [1.6–25.6] after the diagnosis of CMML. At the time of kidney disease diagnosis, median urinary protein-to-creatinine ratio was 2 g/g [1.25–3.4], and median serum creatinine was 2.26 mg/dl [1.46–2.68]. Fourteen patients (87.5%) underwent a kidney biopsy, and the 2 main pathological findings were lysozyme nephropathy (56%) and renal infiltration by the CMML (37.5%). Ten patients received a new treatment following the CMML-associated kidney injury. Among patients with monitored kidney function, and after a median follow-up of 15 months [9.9–34.9], 4 patients had CKD stage 3, 4 had CKD stage 4, 1 had an end-stage kidney disease. In our patient series, 2 patients evolved to an acute myeloid leukemia (AML), and 5 died. Compared with 116 CMML controls, patients who had a kidney involvement had a higher monocyte count (P < 0.001), had more CMML-1 (P = 0.005), were more susceptible to develop an AML (P = 0.02), and were more eligible to receive a specific hematologic treatment, with hydroxyurea, or hypomethylating agents (P < 0.001), but no survival difference was seen between the 2 groups (P = 0.6978). Conclusion: In this cohort of patients with CMML with a kidney injury, the 2 most frequent renal complications were lysozyme-induced nephropathy and renal infiltration by the CMML. Kidney involvement should be closely monitored in patients with CMML.

"Future Girls of STEM" is a university-sponsored, summer camp outreach program that was designed and implemented by an all-female faculty group to increase young girls' interest in pursuing future careers in science, technology, engineering, and mathematics (STEM). This paper discusses the logistics and results of the pilot Future Girls of STEM camp, which was held in the summer of 2019 for seven to twelve-year-old girls. The four-day summer camp featured female engineers from local industry, who shared personal stories of their careers and helped campers work through engineering and leadership activities. Researchers assessed whether completing the activities increased participants' understanding of, interest in, and self-efficacy in engineering topics, majors, and careers. Results showed an increased interest and self-reported understanding of engineering topics after participants completed the camp, as well as high self-efficacy throughout the camp experience. The Future Girls of STEM program, and its hands-on, interactive activities, can be transferred to other locations or universities with varying resources available.

Summary: Background: Matrix metalloproteinases (MMPs) are implied in blood–brain barrier degradation and haemorrhagic transformation following ischaemic stroke, but their local relevance in the hyperacute disease phase is unknown. We aimed to examine ultra-early MMP-9 and MMP-2 release into collateral blood vessels, and to assess its prognostic value before therapeutic recanalisation by endovascular thrombectomy (EVT). Methods: We report a cross-sectional proof-of-concept study including patients undergoing EVT for large-vessel ischaemic stroke at the University Hospital Würzburg, Germany. We obtained liquid biopsies from the collateral circulation before recanalisation, and systemic control samples. Laboratory workup included quantification of MMP-9 and MMP-2 plasma concentrations by cytometric bead array, immunohistochemical analyses of cellular MMP-9 and MMP-2 expression, and detection of proteolytic activity by gelatine zymography. The clinical impact of MMP concentrations was assessed by stratification according to intracranial haemorrhagic lesions on postinterventional computed tomography (Heidelberg Bleeding Classification, HBC) and early functional outcome (modified Rankin Scale, mRS). We used multivariable logistic regression, receiver-operating-characteristic (ROC) curves, and fixed-level estimates of test accuracy measures to study the prognostic value of MMP-9 concentrations. Findings: Between August 3, 2018, and September 16, 2021, 264 matched samples from 132 patients (86 [65.2%] women, 46 [34.8%] men, aged 40–94 years) were obtained. Median (interquartile range, IQR) MMP-9 (279.7 [IQR 126.4–569.6] vs 441 [IQR 223.4–731.5] ng/ml, p

Abstract Therapeutic antibodies are widely used to treat severe diseases. Most of them alter immune cells and act within the immunological synapse; an essential cell-to-cell interaction to direct the humoral immune response. Although many antibody designs are generated and evaluated, a high-throughput tool for systematic antibody characterization and prediction of function is lacking. Here, we introduce the first comprehensive open-source framework, scifAI (single-cell imaging flow cytometry AI), for preprocessing, feature engineering, and explainable, predictive machine learning on imaging flow cytometry (IFC) data. Additionally, we generate the largest publicly available IFC dataset of the human immunological synapse containing over 2.8 million images. Using scifAI, we analyze class frequency and morphological changes under different immune stimulation. T cell cytokine production across multiple donors and therapeutic antibodies is quantitatively predicted in vitro, linking morphological features with function and demonstrating the potential to significantly impact antibody design. scifAI is universally applicable to IFC data. Given its modular architecture, it is straightforward to incorporate into existing workflows and analysis pipelines, e.g., for rapid antibody screening and functional characterization.

Study Design Retrospective cohort study. Purpose To compare the relative value units (RVUs) per minute of operative time between primary and revision surgery for adult spinal deformity (ASD). Overview of Literature Surgery for ASD is technically demanding and has high risks of complications and revision rates. This common need for additional surgery can increase the overall cost of care for ASD. RVU is used to calculate reimbursement from Medicare and to determine physician payments nationally. In calculating RVUs, the physician’s work, the expenses of the physician’s practice, and professional liability insurance. Cost effectiveness of surgeries for ASD have been evaluated, except for RVUs per minute compared between primary and revision surgery. Methods Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥18 years who underwent surgery for spinal deformity between 2011 and 2019 were identified and included. To ensure a homogenous patient cohort, those who underwent anterior-only and concurrent anterior-posterior fusions were excluded. Propensity score matching analysis was performed, and Mann-Whitney U test, Pearson chi-square test, or Fisher’s exact test were used to compare matched cohorts as appropriate. Results A total of 326 patients who underwent revision surgery were matched with 206 primary surgery patients via propensity score matching. Demographic characteristics, comorbidities, preoperative laboratory values, and readmission and reoperation rates were not significantly different between groups. The revision surgery group had significantly higher mean RVUs per minute than that of the primary surgery group (0.331 vs. 0.249, p

BackgroundWe are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians.MethodsA group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes.ResultsA total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems.ConclusionOur study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.

AbstractBackground Increasing numbers of primary care physicians (PCPs) are reducing their working hours. This decline may affect the workforce and the care provided to patients.Objectives This scoping review aims to determine the impact of PCPs working part-time on quality of patient care.Methods A systematic search was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. Peer-reviewed, original articles with either quantitative, qualitative or mixed methods designs, published after 2000 and written in any language were considered. The search strings combined the two concepts: part-time work and primary care. Studies were included if they examined any effect of PCPs working part-time on quality of patient care.Results The initial search resulted in 2,323 unique studies. Abstracts were screened, and information from full texts on the study design, part-time and quality of patient care was extracted. The final dataset included 14 studies utilising data from 1996 onward. The studies suggest that PCPs working part-time may negatively affect patient care, particularly the access and continuity of care domains. Clinical outcomes and patient satisfaction seem mostly unaffected or even improved.Conclusion There is evidence of both negative and positive effects of PCPs working part-time on quality of patient care. Approaches that mitigate negative effects of part-time work while maintaining positive effects should be implemented.