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Atypical fibroxanthoma and pleomorphic dermal sarcoma are on a spectrum of cutaneous tumors that present as ulcerated lesions in older adults. We present an 84-year-old man with pleomorphic dermal sarcoma, initially presenting as a bleeding lesion of the cheek that progressed to an eroded nodule.

Background: Speech and language therapists (SLTs) use videofluoroscopic swallow study (VFSS) results to manage dysphagia. Yet, in some services only doctors can directly request a VFSS, potentially creating workflow inefficiencies and delaying patient access to VFSS. An alternative model, where SLTs directly refer patients for VFSS, is used in many services in the UK and Australia. However, processes for implementing and sustaining this model have not been reported. Aims: To evaluate the implementation of an SLT-led inpatient VFSS referring model using the Consolidated Framework for Implementation Research (CFIR) to ascertain implementation barriers, facilitators and critical sustainability factors. Methods & Procedures: This implementation evaluation examined stakeholder perceptions of implementing the SLT-led VFSS referring model via interviews of (1) SLTs who treat and refer inpatients for VFSS; (2) doctors who manage and refer inpatients for VFSS; (3) radiologists; and (4) trained VFSS referring SLTs. The CFIR was used to prospectively guide implementation planning, evaluation and outcome reporting, regarding barriers, facilitators and sustainability factors. Outcomes & Results: Implementation facilitators were (1) the advantage of SLT-led VFSS referring over the standard model (doctors referring), in promoting high-quality VFSS referrals; (2) compatibility of the model with the SLT skill set; (3) supportive communication networks between staff groups; and (4) engaging stakeholders throughout implementation. Adequate availability of trained VFSS referring SLTs was both a barrier and a facilitator of implementation. It was also a critical sustainability factor, along with ongoing staff education and outcome monitoring. Conclusions & Implications: The CFIR supported systematic evaluation of implementation facilitators and barriers, and adjustment of factors critical for implementing and sustaining the new model. Findings may assist other organizations to establish the SLT-led VFSS referring model.

Background: Videofluoroscopic swallow studies (VFSS) are integral to diagnosing and supporting dysphagia management. However, in many countries, only doctors are authorized to complete medical imaging request forms, in accordance with radiation safety regulations. This can impact workflow and timely access to VFSS. Enhanced scope of practice (ESP) models of care exist, where speech and language therapists (SLTs) are authorized to complete VFSS request forms. However, formal evaluations of these ESP models are currently lacking. Aims: The primary aim of this study was to examine service outcomes regarding the safety and efficiency of SLTs completing VFSS request forms compared with the medical referring model (standard care). The secondary aim was to ascertain the impacts on SLTs' daily workflow and the utility of training for SLTs to complete VFSS requests. Methods & Procedures: The study involved a mixed-method design. First, referrals completed using standard care versus those completed under the new SLT-led VFSS referring model were compared for efficiency (days to request completion, number of contacts between staff to complete requests and delay to VFSS appointments) and safety (compliance with radiation safety standards for requests, adverse events and change to dysphagia management to justify radiation exposure). Semi-structured interviews were then conducted with SLT referrers (n = 7) exploring the impacts of the model on daily workflow and the utility of training. Outcomes & Results VFSS inpatient requests were examined across a 3-month period (n = 61 requests) using the standard model, and for 6 months (n = 109 requests) following the introduction of SLT-led VFSS referring. Regarding efficiency, there was no significant difference between the two models, with most request forms taking less than or equal to 1 day to be completed. Adherence to radiation safety requirements was significantly greater in the SLT-led VFSS referring model compared with the standard model (p < 0.001) in relation to the overall requisite clinical information being documented on the request forms. No adverse events occurred and 100% of VFSSs led to changed dysphagia management. Interviews of VFSS referring SLTs revealed that completing requests was not complex or onerous, and that the training equipped them well to undertake the role. Conclusions & Implications: The SLT-led VFSS referring model was feasible for SLTs and resulted in satisfactory efficiency and greater adherence to radiation safety requirements for VFSS request forms than the standard model. Improved information on VFSS request forms provides clearer justification for the radiation procedure and helps optimize the diagnostic yield of VFSS. The evidence supports further widespread adoption of this model.

Background: Speech-language therapists (SLTs) seek a range of educational opportunities for training in adult videofluoroscopic swallow studies (VFSS). However, variable training methods and/or unequal access to training can influence VFSS practice. Aims: To document current SLT needs and barriers to VFSS training and to determine if a new beginner-level VFSS eLearning program would assist to meet their training needs. The program incorporated multimedia modules on preparing, conducting, interpreting and reporting VFSS. Methods & Procedures: SLTs with limited experience in adult VFSS completed surveys relating to VFSS training experience and barriers, and perceived changes in knowledge, skills and confidence on core VFSS module topics pre- (n = 36) and post- (n = 32) eLearning training. Outcomes & Results: Inconsistent access to VFSS training opportunities and time-related work pressures were reported as the greatest training barriers. SLTs viewed the eLearning program as a suitable option for VFSS training. Post-training, participants perceived they gained confidence, as well as improved knowledge and skills in all VFSS aspects along with generalised benefits for dysphagia management. SLTs indicated that key benefits of the eLearning program were its comprehensive content and self-directed learning with multimedia tools, which afforded theoretical and practical learning opportunities. Conclusions & Implications: The eLearning program offered SLTs free access to beginner-level adult VFSS training, meeting many identified training needs and providing a foundation from which to develop further practical knowledge and skills within a VFSS clinic setting.

This study used action research methodology to examine the development of sustainability leadership in a graduate leadership course. The research investigated the impact of this leadership course, which was designed using transformative learning theory with attention to integrating thematic content, multiple and nondominant perspectives, a participatory process, and a contextual place-based approach. Grounded theory was used to explore if and how students' understanding of sustainability leadership changed, and the pedagogical strategies that were most influential to their learning. Results revealed that students came to understand sustainability leadership as: the facilitation of a shared process, a process of emergence, and a way of being. Key pedagogical strategies that stood out as being most influential to students' learning of sustainability leadership including: creating a sense of community, learning from peers, and case-in-point experiential learning. These results point to key pedagogical elements that may support the development of sustainability leadership in higher education courses.

The NCCN Guidelines for Head and Neck (H&N) Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the H&N, and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding evaluation and treatment of nasopharyngeal carcinoma.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the head and neck (H&N), and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding the increase in human papillomavirus-associated oropharyngeal cancer and the availability of immunotherapy agents for treatment of patients with recurrent or metastatic H&N cancer.

Background and Aims Diet plays an integral role in the modulation of the intestinal environment, with the potential to be modified for management of individuals with inflammatory bowel disease [IBD]. It has been hypothesised that poor 'Western-style' dietary patterns select for a microbiota that drives IBD inflammation and, that through dietary intervention, a healthy microbiota may be restored. This study aimed to systematically review the literature and assess current available evidence regarding the influence of diet on the intestinal microbiota composition in IBD patients, and how this may affect disease activity. Methods MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library were searched from January 2013 to June 2023, to identify studies investigating diet and microbiota in IBD. Results Thirteen primary studies met the inclusion criteria and were selected for narrative synthesis. Reported associations between diet and microbiota in IBD were conflicting due to the considerable degree of heterogeneity between studies. Nine intervention studies trialled specific diets and did not demonstrate significant shifts in the diversity and abundance of intestinal microbial communities or improvement in disease outcomes. The remaining four cross-sectional studies did not find a specific microbial signature associated with habitual dietary patterns in IBD patients. Conclusions Diet modulates the gut microbiota, and this may have implications for IBD; however, the body of evidence does not currently support clear dietary patterns or food constituents that are associated with a specific microbiota profile or disease marker in IBD patients. Further research is required with a focus on robust and consistent methodology to achieve improved identification of associations. [ABSTRACT FROM AUTHOR]

Background: An estimated 25,000 infants are born to mothers diagnosed with hepatitis B virus (HBV) each year in the United States. Administration of the birth dose HBV vaccine prevents transmission during delivery. Despite national guidelines promoting vaccination within 24 hours of birth, fewer than 70% of infants receive the dose in their first 3 days of life. To improve compliance with national recommendations, Northwestern Medicine implemented a bundled care initiative in the well newborn nursery, entitled the 24-hour baby bundle (24-HBB). Purpose: Evaluate the 24-HBB's effect on improving time to HBV vaccine administration. Methods: The 24-HBB was created by an interdisciplinary team and implemented on February 17, 2020. Bundled care begins at 23 hours of life, starting with the HBV vaccine, followed by bath, weight, and congenital heart disease screening, and ending with metabolic screening. We conducted a retrospective cohort study of 22,057 infants born at Northwestern Medicine Prentice Women's Hospital in Chicago, Illinois. Our sample included preintervention birthdates between February 16, 2019, and January 16, 2020, and postintervention birthdates between March 17, 2020, and February 16, 2021, with a 2-month washout education period between January 17, 2020, and March 16, 2020. Results: Hepatitis B virus immunization within 24 hours increased significantly from 43.83% to 66.90% (P < .0001). In addition, overall hepatitis B immunization prior to discharge significantly increased after implementation of the 24-HBB (98.18% vs 98.82%, P < .0001). Implications for Practice and Research: The 24-HBB is effective at increasing rates of HBV immunization within 24 hours of birth. Newborn nurseries may benefit from similar initiatives to prevent hepatitis B infection, satisfy national recommendations, and promote childhood vaccination compliance. [ABSTRACT FROM AUTHOR]

PurposeTo implement an accelerated five-dimensional (5D) echo-planar J-resolved spectroscopic imaging sequence combining 3 spatial and 2 spectral encoding dimensions and to apply the sequence in human brain.MethodsAn echo planar readout was used to acquire a single spatial and a single spectral dimension during one readout. Nonuniform sampling was applied to the two phase-encoded spatial directions and the indirect spectral dimension. Nonlinear reconstruction was used to minimize the ℓ1-norm or the total variation and included a spectral mask to enhance sparsity. Retrospective reconstructions at multiple undersamplings were performed in phantom. Ten healthy volunteers were scanned with 8× undersampling and compared to a fully sampled single slice scan.ResultsRetrospective reconstruction of fully sampled phantom data showed excellent quality at 4×, 8×, 12×, and 16× undersampling using either reconstruction method. Reconstruction of prospectively acquired in vivo scans with 8× undersampling showed excellent quality in the occipito-parietal lobes and good quality in the frontal lobe, consistent with the fully sampled single slice scan.ConclusionBy utilizing nonuniform sampling with nonlinear reconstruction, 2D J-resolved spectra can be acquired over a 3D spatial volume with a total scan time of 20 min, which is reasonable for in vivo studies.

PurposeTo implement a 5D (three spatial + two spectral) correlated spectroscopic imaging sequence for application to human calf.Theory and methodsNonuniform sampling was applied across the two phase encoded dimensions and the indirect spectral dimension of an echo planar-correlated spectroscopic imaging sequence. Reconstruction was applied that minimized the group sparse mixed ℓ2,1-norm of the data. Multichannel data were compressed using a sensitivity map-based approach with a spatially dependent transform matrix and utilized the self-sparsity of the individual coil images to simplify the reconstruction.ResultsSingle channel data with 8× and 16× undersampling are shown in the calf of a diabetic patient. A 15-channel scan with 12× undersampling of a healthy volunteer was reconstructed using 5 virtual channels and compared to a fully sampled single slice scan. Group sparse reconstruction faithfully reconstructs the lipid cross peaks much better than ℓ1 minimization.ConclusionCOSY spectra can be acquired over a 3D spatial volume with scan time under 15 min using echo planar readout with highly undersampled data and group sparse reconstruction.

Sustainability is becoming increasingly relevant in higher education, as the need to address complex cultural and ecological problems intensifies. How sustainability is taught has a profound influence on the kind of learning that takes place and the impact it has in the world. Sustainability pedagogy is offered as a tool for creating transformational sustainability learning that is thematic and cocreated, critically questions dominant norms and incorporates diverse perspectives, is active, participatory and relational, and is grounded in a specific place. This pedagogical design draws on the wisdom of ecological systems, recognizing that ecological systems are our best teachers for creating sustainable and regenerative systems. This article connects this pedagogical model with Okanagan indigenous teachings about the whole self, to explore how the whole self can be intentionally included in an ecological design process to promote transformational learning.

Sustainability education is a growing field within higher education that fosters personal and intellectual engagement with the interconnected tensions of pressing social, ecological, economic, and political issues. Sustainability education aims to prepare learners to become creative problem solvers and active citizens who understand the relationships between and leverage points within complex systems. However, little research has been done to identify "how" to teach sustainability effectively in ways that prepare emerging leaders to address these complex problems. This paper provides an overview of an action research study that implemented the Burns model of sustainability pedagogy to embed sustainability into a university course on peer mentoring. Results show that implementing this model in the design and teaching of the course changed emerging educators' understanding of sustainability by making it more multidimensional, and that students gained an critical theory perspective of sustainability which they applied to their own educational experiences.

[Display omitted] • Patient-reported outcomes (PROs) are especially important for people who receive left ventricular assist devices (LVADs), given their lifestyle changes, LVAD-focused self-care needs and the potential for device-related adverse events. • Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental and social health measures are advantageous for use in multiple chronic illnesses because they allow comparability of experiences across diseases/conditions. • Tracking changes in PRO outcomes across time in individual patients could provide patients and clinicians with the opportunity to identify positive and negative changes and ways to address them. Study participants (n = 272) completed 12 Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental and social health measures (questionnaires) prior to implantation of a left ventricular assist device (LVAD) and again at 3 and 6 months postimplant. All but 1 PROMIS measure demonstrated significant improvement from pre-implant to 3 months; there was little change between 3 and 6 months. Because PROMIS measures were developed in the general population, patients with an LVAD, their caregivers and their clinicians can interpret the meaning of PROMIS scores in relation to the general population, helping them to monitor a return to normalcy in everyday life. [ABSTRACT FROM AUTHOR]

Despite the expert-level performance of artificial intelligence (AI) models for various medical imaging tasks, real-world performance failures with disparate outputs for various subgroups limit the usefulness of AI in improving patients' lives. Many definitions of fairness have been proposed, with discussions of various tensions that arise in the choice of an appropriate metric to use to evaluate bias; for example, should one aim for individual or group fairness? One central observation is that AI models apply "shortcut learning" whereby spurious features (such as chest tubes and portable radiographic markers on intensive care unit chest radiography) on medical images are used for prediction instead of identifying true pathology. Moreover, AI has been shown to have a remarkable ability to detect protected attributes of age, sex, and race, while the same models demonstrate bias against historically underserved subgroups of age, sex, and race in disease diagnosis. Therefore, an AI model may take shortcut predictions from these correlations and subsequently generate an outcome that is biased toward certain subgroups even when protected attributes are not explicitly used as inputs into the model. As a result, these subgroups became nonprivileged subgroups. In this review, the authors discuss the various types of bias from shortcut learning that may occur at different phases of AI model development, including data bias, modeling bias, and inference bias. The authors thereafter summarize various tool kits that can be used to evaluate and mitigate bias and note that these have largely been applied to nonmedical domains and require more evaluation for medical AI. The authors then summarize current techniques for mitigating bias from preprocessing (data-centric solutions) and during model development (computational solutions) and postprocessing (recalibration of learning). Ongoing legal changes where the use of a biased model will be penalized highlight the necessity of understanding, detecting, and mitigating biases from shortcut learning and will require diverse research teams looking at the whole AI pipeline. [ABSTRACT FROM AUTHOR]

Patient-centered care lies at the center of the Joint Commission of Pharmacy Practitioners Pharmacists' Patient Care Process and recognizes the pharmacist's responsibility for the patient's drug-related and health needs, concerns, and expectations as well as prioritizing the patient's interests before all others. Person-centered care more explicitly expands the pharmacist's understanding of the patient to a person with rights, knowledge, and experiences that extend outside of disease, illness, and pharmacotherapy. The Social Care Framework developed by the National Academies of Science, Engineering, and Medicine provides a roadmap to how pharmacists can provide community-integrated care that is consistent with person centeredness. Doing so can expand the pharmacist's role and value in a time of community-integrated care transformation. [ABSTRACT FROM AUTHOR]