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David Sussman, James E Paul Department of Anesthesia, McMaster University, Hamilton, ON, Canada Purpose: The primary objective of this study was to assess anesthesia residents' opinions and perceptions on wellness/burnout, fatigue, education, and patient safety after the initiation of a reduced call model (16-hour call). Methods: A prospective cohort study was conducted at three time points during the 2013–2014 academic year. A web-based questionnaire consisting of 23 questions was electronically distributed to all anesthesia residents from postgraduate years (PGY) 1 to 5 who were part of the active call roster (n=84) at McMaster University in Hamilton, Ontario. Descriptive summaries were calculated, counts and percentages were used for categorical variables, and answers to open text questions were reviewed for themes. Results: A response rate of 67% was obtained for this study. A majority of anesthesia residents (65%) approved of 16-hour call, felt that their overall quality of life as a senior resident (PGY3 or greater) or junior resident (PGY2 and below) had improved (73% and 55%, respectively), and reported overall feeling less fatigued. Most respondents indicated that the quality of education remained unchanged (47%), or had improved (31%). And most felt better prepared for the royal college exam (52%). Most felt patient safety had improved or was unchanged (both 48%). Conclusion: The study demonstrates that 16-hour call improved resident wellness, reduced burnout and fostered an environment where residents are less fatigued and more satisfied with their educational experience promoting an environment of patient safety. Overall, the anesthesia residency group demonstrated that not only is 16-hour call preferred but beneficial. Keywords: resident wellness, reduced call model, duty hours, patient safety, cohort study, fatigue

Background Despite a rising incidence of inflammatory bowel disease ( IBD) in Hispanics in the United States, there are no studies examining the relationship between immigrant generation and IBD onset among Hispanics. Aims To determine whether age of IBD diagnosis, time from immigration to IBD diagnosis and IBD phenotype, differed across immigration periods in South Florida Cuban immigrants. Methods This was a cohort of consecutively identified Cuban-born adults who developed IBD in the United States and were followed in gastroenterology ( GI) clinic. We divided time cohorts of immigration by historical relevance: before 1980, 1980-1994 and 1995-to-present. We examined differences across time cohorts in diagnosis age, time from immigration to IBD diagnosis, and IBD phenotype (ie, IBD type, disease location). Results A total of 130 Cuban patients with IBD were included. Age of IBD diagnosis was older in Cubans arriving before 1980 than in those arriving between 1980-1994 or after 1995 (44.7 vs 33.79 and 33.71, respectively, P<.0001). Time between immigration and diagnosis was shorter in patients arriving to the US after 1980 (31.77 years, Standard deviation ( SD) 12.83 (<1980) vs 17.13 years, SD 8.55 (1980-1994) and 8.30 years, SD 4.72 (1995-to-present). IBD phenotype, including type of IBD, disease location and surgeries, did not differ significantly across time cohorts. Conclusions Our study describes changing patterns of IBD onset following immigration in Cubans, suggesting that environmental changes either in the United States, Cuba or both are resulting in faster IBD onset in younger immigrant generations. These studies can inform the search for environmental triggers that may result in IBD. [ABSTRACT FROM AUTHOR]

Background: Adherence and persistence rates of anticholinergic (ACH) therapies have been well described. To date, few studies describe these metrics for mirabegron in patients with overactive bladder.Methods: This retrospective analysis of MarketScan® database assessed adherence and persistence of patients receiving either mirabegron or ACH. Study eligibility required an index date (first prescription filled) between July 2012 and June 2013 with 12 months of continuous enrolment preindex date and 12 months of follow-up. Adherence was defined as a proportion of days covered of ≥ 80% among patients with at least 2 fills of index medication. Persistence measures included treatment failure described as either treatment discontinuation (medication supply gap ≥ 30 days) or switching to a different medication. A medication supply gap of ≥ 45 days was used as a sensitivity analysis.Results: The mean age of mirabegron users (n = 4037) was 67 years and 43% were ACH naïve while the mean age of ACH users was 62 years (n = 67,943). Over the 12-month follow-up period, 44% of patients treated with mirabegron and 31% of patients treated with ACH were adherent to their indexed medications. Treatment failure was 81% for mirabegron and 88% for ACH. Most mirabegron treatment failures were because of treatment discontinuation (67%) versus switching to ACH therapy (14%). The ACH discontinuation rate was 84% and treatment switching rate was 4%. The mean (standard deviation) time to treatment failure was 143 (130) days for mirabegron and 69 (69) days for ACH. Adherence and persistence patterns were similar in the sensitivity analysis using a ≥ 45-day supply gap threshold.Conclusions: This real-world study demonstrated low adherence and persistence to mirabegron similar to ACH therapies. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to psychological trauma, impacts up to 20 % of soldiers returning from combat-related deployment. Advanced neuroimaging holds diagnostic and prognostic potential for furthering our understanding of its etiology. Previous imaging studies on combat-related PTSD have focused on selected structures, such as the hippocampi and cortex, but none conducted a comprehensive examination of both the cerebrum and cerebellum. The present study provides a complete analysis of cortical, subcortical, and cerebellar anatomy in a single cohort. Forty-seven magnetic resonance images (MRIs) were collected from 24 soldiers with PTSD and 23 Control soldiers. Each image was segmented into 78 cortical brain regions and 81,924 vertices using the corticometric iterative vertex based estimation of thickness algorithm, allowing for both a region-based and a vertex-based cortical analysis, respectively. Subcortical volumetric analyses of the hippocampi, cerebellum, thalamus, globus pallidus, caudate, putamen, and many sub-regions were conducted following their segmentation using Multiple Automatically Generated Templates Brain algorithm.Results: Participants with PTSD were found to have reduced cortical thickness, primarily in the frontal and temporal lobes, with no preference for laterality. The region-based analyses further revealed localized thinning as well as thickening in several sub-regions. These results were accompanied by decreased volumes of the caudate and right hippocampus, as computed relative to total cerebral volume. Enlargement in several cerebellar lobules (relative to total cerebellar volume) was also observed in the PTSD group.Conclusions: These data highlight the distributed structural differences between soldiers with and without PTSD, and emphasize the diagnostic potential of high-resolution MRI. [ABSTRACT FROM AUTHOR]

Pronounced tonsilar hypertrophy was found in two obese patients suffering from hypersomnolence, periodic attacks of apnea and disturbing snoring at night. Both patients underwent tonsillectomy. Immediately after the operation the hypersomnolence disappeared, the breathing became normal, and the disturbing snoring at night ceased. Follow-up over a period of three years did not reveal any recurrence of these symptoms, even though the patients had not lost any weight during this period. [ABSTRACT FROM AUTHOR]

A retrospective chart review of 427 eyes diagnosed with unilateral retinoblastoma was performed to determine which eyes, which patients, and when new intraocular tumours would develop after treatment. Mean follow up was 8.16 years. Twenty five (6%) of 427 unilateral retinoblastoma patients developed new intraocular tumours after treatment. Five (1%) unilateral patients who were previously treated with enucleation developed new tumours (in the fellow eye). Fifteen (24%) unilateral patients who were previously treated with external beam radiation developed new tumours (equally in either eye). New tumours did not develop in the macula of either eye. The relative risk of developing new intraocular tumours after treatment was 16% in patients diagnosed before 1 year old and 2.2% for patients diagnosed after 1 year old (p < 0.001). The mean time to onset for the development of new tumours after treatment was 0.74 years; no new tumours appeared after 7.5 years of age. Those patients who are diagnosed with unilateral retinoblastoma in the first 6 months of life and have a family history of the disease are at greatest risk of developing new intraocular tumours. [ABSTRACT FROM PUBLISHER]

Discusses the abstract of a study examining public knowledge and opinion in the United States on issues related to airbag safety. Majority who know that airbags can harm drivers seated too close to the steering wheel; High child mortality in cars with airbags; Life-saving effect of airbags among people not wearing seatbelts.

Introduction Anti-tumour necrosis factor (anti-TNF) medications have never been compared in a direct fashion under real-world circumstances. The purpose of this study was to compare healthcare utilisation and costs using insurance data for patients with Crohn's disease (CD) who newly initiated anti-TNF therapy with adalimumab (ADA) or infliximab (IFX). Methods Patients with ≥2 diagnoses of CD (ICD-9-CM: 555.XX) who initiated ADA or IFX therapy between January 2000 and March 2009 were identified from the Medstat MarketScan database. Patients had to be continuously enrolled at least 6 months before and after anti-TNF initiation. Patients with prior biologic therapy (ie, anti-TNF or natalizumab) or colitis (ICD-9-CM: 556.x) were excluded. ADA and IFX groups were matched 1:1 using a propensity score stratified by age, residence, inpatient visit utilisation and steroid use at baseline. The primary endpoint was 6-month direct cost of healthcare. The secondary endpoints compared healthcare utilisation between groups. Results After propensity matching, demographic, clinical and healthcare utilisation characteristics were similar between the ADA (n=623) and IFX (n=623) groups at baseline. During the 6-month interval following anti-TNF initiation, healthcare costs were significantly lower for ADA compared with IFX therapy (). PWE-026 Mean HealthCare Costs (Per Person) During the 6 Months After Initiating Anti-TNF Therapy (US $) Based on diagnosis of CD or related comorbidities (eg, malnutrition, anaemia, abdominal symptoms, etc). p<0.0005 vs IFX. Medical costs other than hospitalisation and outpatient visits are not shown. Both all-cause and CD-related hospitalisation decreased for both ADA and IFX groups (not shown). Emergency department (ED) use and hospitalisation in the 6-month follow-up period were similar between groups. Conclusion In this real-world analysis of patients with CD who newly initiated with ADA or IFX, ADA-treated patients had significantly lower healthcare costs. Hospitalisation and ED utilisation were similar between groups. [ABSTRACT FROM PUBLISHER]

To review and analyze the currently available MRI motion phantoms. Publications were collected from the Toronto Metropolitan University Library, PubMed, and IEEE Xplore. Phantoms were categorized based on the motions they generated: linear/cartesian, cardiac-dilative, lung-dilative, rotational, deformation or rolling. Metrics were extracted from each publication to assess the motion mechanisms, construction methods, as well as phantom validation. A total of 60 publications were reviewed, identifying 48 unique motion phantoms. Translational movement was the most common movement (used in 38% of phantoms), followed by cardiac-dilative (27%) movement and rotational movement (23%). The average degrees of freedom for all phantoms were determined to be 1.42. Motion phantom publications lack quantification of their impact on signal-to-noise ratio through standardized testing. At present, there is a lack of phantoms that are designed for multi-role as many currently have few degrees of freedom., (© 2024. The Author(s), under exclusive licence to European Society for Magnetic Resonance in Medicine and Biology (ESMRMB).)