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Purpose: This paper explores who among the AACSB categorization of academics conducts the scholarship of teaching and learning (SoTL) research within business schools and how AACSB-accredited business schools capture SoTL research as part of their portfolio of intellectual contributions. Design/methodology/approach: This study adopts a qualitative-method research design by collecting primary data through surveys, semi-structured interviews and secondary data in policy documents focused on AACSB-accredited business schools in Canada and the United States. Findings: The findings establish that scholarly and practice academics who possess rigorously acquired research skills due to their terminal degrees are most likely to conduct SoTL research. The results also reveal an even split among respondents regarding whether their AACSB-accredited business school captures SoTL with their journal ranking frameworks. Practical implications: Based on the findings, two recommendations are offered to foster more SoTL research at AACSB-accredited schools. First, higher education leaders (e.g. business school deans) can further inculcate a culture of SoTL research at the department and institutional levels by creating communities of practice (CoPs). Second, AACSB-accredited business schools could adopt more inclusive journal ranking frameworks to capture better and incentivize SoTL research. Originality/value: This is the first known study to explore how AACSB Standards 3 and 8 are implemented and operationalized regarding SoTL research. Understanding how these standards are adopted and implemented could help institutional leaders, standard setters and administrators better facilitate SoTL research.

This study examined cultural specificity in how interpretations about peer provocation are associated with revenge goals and aggression. The sample consisted of young adolescents from the United States (369 seventh graders; 54.7% male; 77.2% identified as White) and from Pakistan (358 seventh graders; 39.2% male). Participants rated their interpretations and revenge goals in response to six peer provocation vignettes and completed peer nominations of aggressive behavior. Multigroup structural equation models (SEMs) indicated cultural specificity in how interpretations were related to revenge goals. Interpretations that a friendship with the provocateur was unlikely were uniquely related to revenge goals for Pakistani adolescents. For U.S adolescents, positive interpretations were negatively related to revenge but self-blame interpretations were positively related to vengeance goals. Revenge goals were related to aggression similarly across groups.

Purpose: This study explores the implementation of two Association to Advance Collegiate Schools of Business (AACSB) standards by business schools across Canada and the US. First, this study examines how teaching effectiveness is defined and measured in light of Standard 7 (Teaching Effectiveness and Impact). Second, this study explores the value of research on teaching and learning in relation to Standard 8 (Impact of Scholarship). Design/methodology/approach: This study adopts a thematic analysis framework based on data obtained from an online survey, semi-structured interviews, and policy documents. Findings: The results reveal that business schools rarely define teaching effectiveness; instead, they adopt various measures to evaluate teaching effectiveness. The results reveal that research on teaching and learning alone usually does not lead to tenure; however, it is valued if part of a portfolio that includes discipline-specific research. Lastly, this research highlights a stigma associated with research on teaching and learning relative to discipline-specific research. Practical implications: This study introduces a comprehensive and integrated teaching evaluation framework that can be adopted to define teaching effectiveness and elevate the teaching function. In addition, the authors argue that business schools should nurture a niche set of academics that holds PhDs in their respective disciplines and are education experts to increase the production of research-informed instructional strategies curated for business schools. Originality/value: This is the first study to explore how AACSB standards related to teaching effectiveness and research on teaching and learning are interpreted and implemented at AACSB accredited business schools.

Understanding the development and structure of people's concepts of national groups can contribute to an understanding of their behavior in the political arena, including perhaps the recent rise in nationalism and anti-immigrant sentiment. Here, we provide a developmental investigation of concepts of national groups in a sample of 5- to 8-year-old Canadian children (N = 79). Using an extensive battery of measures, we assessed the extent to which children conceive of national groups as socially constructed versus as having deeper, perhaps biological, "essences" that shape their members' physical and psychological makeup. At younger ages, Canadian children tended to essentialize national groups, including in a biological sense. At older ages, the biological conception of national groups subsided, but children continued to view these groups as meaningful and informative. A statistical comparison with 5- to 8-year-old American children's responses to the same measures (N = 70; using data from Hussak & Cimpian, 2019) revealed a great degree of overlap, despite substantial differences between the two countries in how national identity is conceived and described. These findings add an important piece to our understanding of the development of concepts of national groups.

BACKGROUND: The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device. METHODS: This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV). RESULTS: A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001). CONCLUSIONS: Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject. [ABSTRACT FROM AUTHOR]

Background Medium vessel occlusions (MeVOs) comprise a large proportion of all stroke events. We performed a multicenter study of MIVI Q catheters, a novel design that optimizes suction forces without an increase in lumen diameter, for the treatment of MeVOs, aiming to evaluate its efficacy and safety. Methods Databases of two US and two UK centers were retrospectively reviewed for MeVO patients (M2- M3, anterior cerebral artery (ACA), or posterior cerebral artery (PCA)) treated with Q catheters. Outcomes were assessed as successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2b), first pass effect (FPE), and modified FPE (mFPE) as single pass achieving mTICI ≥2c and mTICI≥2b, respectively, and 90 day modified Rankin Scale (mRS) score. Results 69 patients were included (median age 71 years, IQR 56--82.5; 52.2% men). Median National Institutes of Health Stroke Scale (NIHSS) score at admission was 14, and Alberta Stroke Program Early CT Score (ASPECTS) was 9. Primary (without large vessel occlusion (LVO)) and secondary (with LVO) MeVOs represented 47.8% and 52.2% of cases, respectively. Q catheters used were Q3 (47.8%), Q4 (33.3%), Q5 (10.1%), and Q6 (8.7%). mTICI≥2b was achieved in 92.8% of patients, with FPE in 47.8%, and mFPE in 68.1%. Two (2.9%) intraprocedural complications (symptomatic intracranial hemorrhage) occurred. 50% (27/54) achieved an mRS score of ≤2 at the 90 day follow-up. The median NIHSS at admission was significantly higher in secondary than in primary MeVOs (19.5 vs 12, P=0.009). The rate of mRS ≤2 at 90 days was significantly higher in primary than in secondary MeVOs (77.3% vs 31.3%, P=0.002). Conclusions Treatment of MeVO patients with Q catheters resulted in optimal angiographic and clinical outcomes. Although angiographic results were similar between primary and secondary MeVOs, the former had less severe presenting NIHSS and better outcomes at 90 days than the latter. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is associated with high rates of readmission following endovascular interventions and contributes to a significant hospital readmission burden. Quality metrics like hospital readmissions affect hospital performance, but must adjust to local trends. Our primary goal was to evaluate risk factors and readmission rates post-percutaneous peripheral intervention in a US-Mexico border city, at a single tertiary university hospital. We performed a retrospective review of patients with PAD undergoing first time peripheral intervention from July 2015 to June 2020. Among 212 patients, 58% were readmitted with median 235-day follow-up (inter-quartile range (IQR) 42–924); 35.3% of readmissions occurred within 30 days, and 30.2% of those were within 7 days. Median time to readmission was 62 days. Active smokers had 84% higher risk of readmission (hazard ratio (HR) 1.84, 95% CI 1.23–2.74, P <.01). Other significant factors noted were insurance status—Medicaid or uninsured (HR 1.94, 95% CI 1.22–3.09), prior amputation (HR 1.69, 95% CI 1.13–2.54), heart failure, both preserved (HR 4.35, 95% CI 2.07–9.16) and reduced ejection fraction (HR 1.88, 95% CI 1.14–3.10). Below the knee, interventions were less likely to be readmitted (adjusted HR.64, 95% CI 0.42–.96). Readmission rates were unrelated to medication adherence. [ABSTRACT FROM AUTHOR]

Patients with severe calcific native aortic valve stenosis (AS) who require valve replacement have two options, surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). TAVR was approved in late 2011 for extremely high-risk patients and was subsequently approved for high-risk (2012), intermediate-risk (2016), and low-risk (2019) patients. In 2019, TAVR procedures surpassed SAVR procedures for the first time in the United States. The approach to anesthesia for this procedure has also evolved. Initially, general anesthesia (GA) was preferred, but currently, conscious sedation (CS) is favored. This review aims to clarify the indications and contraindications for both approaches, as well as the advantages of one approach over the other. Recent studies show that conscious sedation has better outcomes in terms of all-cause mortality, procedure complications such as stroke, myocardial infarction, infection requiring antibiotics, acute kidney injury, and the need for inotropes or vasopressors. [ABSTRACT FROM AUTHOR]

Simple Summary: Alterations in two or more of the tumor suppressors TP53, RB1, and PTEN enrich for prostate cancers with an aggressive disease course which benefits from combination chemotherapies, but with poor survival. This signature could aid in patient selection for clinical trials that study novel therapies aimed towards these aggressive tumors. We assess the operational characteristics of staining tumor tissues, studying DNA obtained from the tumor directly, or studying DNA from tumor cells circulating in the blood to detect this signature. We encountered various challenges that limited the number of evaluable samples for all three assays in each patient. Overall, tissue staining had a higher detection rate and the shortest turnaround times, making it an attractive choice for use in clinical trials. There were operational barriers to accurately detecting the signature in tumor DNA as well as difficulty detecting sufficient tumor content in circulating tumor DNA. Aggressive-variant prostate cancers (AVPCs) are a subset of metastatic castrate-resistant prostate cancers (mCRPCs) characterized by defects in ≥ two of three of TP53, RB1, and PTEN (AVPCm), a profile linked to lineage plasticity, androgen indifference, and platinum sensitivity. Men with mCRPC undergoing biopsies for progression were assessed for AVPCm using immunohistochemistry (IHC), next-generation sequencing (NGS) of solid tumor DNA (stDNA), and NGS of circulating tumor DNA (ctDNA) assays in CLIA-certified labs. Biopsy characteristics, turnaround times, inter-reader concordance, and inter-assay concordance were assessed. AVPCm was detected in 13 (27%) patients via IHC, two (6%) based on stDNA, and seven (39%) based on ctDNA. The concordance of the IHC reads between pathologists was variable. IHC had a higher detection rate of AVPCm+ tumors with the shortest turnaround times. stDNA had challenges with copy number loss detection, limiting its detection rate. ctDNA detected the greatest proportion of AVPCm+ tumors but had a low tumor content in two thirds of patients. These data show the operational characteristics of AVPCm detection using various assays, and inform trial design using AVPCm as a criterion for patient selection or stratification. [ABSTRACT FROM AUTHOR]

Islamophobia and a lack of legitimacy heavily impact Muslim-led nonprofits and limit their relationships with philanthropy in the United States, resulting in an anemic, continually underfunded sector. This article explores that disconnect within a discussion of the Year of Learning, a unique series of virtual workshops that brought together foundations and nonprofits serving the Muslim American community. Among the barriers to more effective relationships that emerged from the workshops were the presence of Islamophobia within society at large and philanthropy in particular, a hesitance among U.S. foundations to fund faith-based work, and a lack of capacity among Muslim-led nonprofits. Also evident was limited knowledge in the philanthropic community about the issues facing Muslim Americans and the nonprofits that serve them. Several avenues emerged for foundations and Muslim nonprofits seeking to engage to work together more closely and create a larger space for Muslim voices in discussions of diversity, equity, and inclusion for racialized communities. [ABSTRACT FROM AUTHOR]

This case study examines three nonprofit leaders' (Shariq Siddiqui, Roohi Younus and Dilnaz Waraich) attempt to bring together Muslim nonprofit leaders and help them build meaningful collaborations. They kickstarted the Community Collaboration Initiative (CCI), an initiative that uses third-party facilitation to build collaboration among Muslim nonprofit organizations and to educate foundations and donors about the challenges Muslim organizations face in the United States. It serves as an educational resource to examine (1) the collaboration process, (2) trust-building during collaboration, and (3) the challenges of building collaboration. This case study also provides a resource needed to make Muslim-American organizations more visible in nonprofit and public affairs courses, as well as introduce culturally competent funding for nonprofit organizations that is relevant to students planning to work in foundations and related areas. [ABSTRACT FROM AUTHOR]

Background Dolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs. We compared triple therapy (TT (DAPT plus oral anticoagulation)) and DAPT alone in patients with DVBFAs treated with FD. Methods Retrospective comparison of DAPT and TT in patients with DVBFAs treated with FD at eight US centers. Results The groups (DAPT=13, TT=14) were similar in age, sex, clinical presentation, baseline disability, and aneurysm characteristics. Radial access use was significantly higher in the TT group (71.4% vs 15.3%; P=0.006). Median number of flow diverters and adjunctive coiling use were non-different between groups. Acute ischemic stroke rate during the oral anticoagulation period was lower in the TT group than the DAPT group (7.1% vs 30.8%; P=0.167). Modified Rankin Scale score decline was significantly lower in the TT group (7.1% vs 69.2%; P=0.001). Overall rates of hemorrhagic complications (TT, 28.6% vs DAPT, 7.7%; P=0.162) and complete occlusion (TT, 25% vs DAPT, 54.4%; P=0.213) were non-different between the groups. Rate of moderate-to-severe disability at last follow-up was significantly lower in the TT group (21.4% vs 76.9%; P=0.007). Conclusions Patients with DVBFAs treated with FD in the TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients in the DAPT group. [ABSTRACT FROM AUTHOR]

Background Few studies have explored the association between stroke thrombectomy (ST) volume and hospital accreditation with clinical outcomes. Objective To assess the association of ST case volume and accreditation status with in-hospital mortality and home discharge disposition using the national Medicare Provider Analysis and Review (MEDPAR) database. Methods Rates of hospital mortality, home discharge disposition, and hospital stay were compared between accredited and non-accredited hospitals using 2017-2018 MEDPAR data. The association of annual ST case volume with mortality and home disposition was determined using Pearson's correlation. Median rate of mortality and number of ST cases at hospitals within the central quartiles were estimated. Results A total of 29 355 cases were performed over 2 years at 847 US centers. Of these, 354 were accredited. There were no significant differences between accredited and non-accredited centers for hospital mortality (14.8% vs 14.5%, p=0.34) and home discharge (12.1% vs 12.0%, p=0.78). A significant positive correlation was observed between thrombectomy volume and home discharge (r=0.88; 95% CI 0.58 to 0.97, p=0.001). A significant negative relationship was found between thrombectomy volume and mortality (r=-0.86; 95% CI -0.97 to -0.49, p=0.002). Within the central quartiles, the median number of ST cases at hospitals with mortality was 24/year, and the median number of ST cases at hospitals with home discharge rate was 23/year. Conclusion A higher volume of ST cases was associated with lower mortality and higher home discharge rate. No significant differences in mortality and discharge disposition were found between accredited and non-accredited hospitals. [ABSTRACT FROM AUTHOR]

Purpose: Although supported by most men and women, paternity leave is heavily underused across industries owing in part to external pressures and inconsistent availability. The goal of this study was to assess the use of paternity leave in radiation oncology (RO) practices and identify any associated barriers.Methods and Materials: A 36-item survey was distributed via e-mail to 536 male domestic RO attending and resident physicians. Questions assessed paternity leave policies, use, and departmental support. Data were collected using Research Electronic Data Capture from January to February 2021. Descriptive statistics were obtained for analysis, and logistic regression was performed to analyze the association between practice type and presence of policy.Results: The survey response rate was 20% (n = 108), with 98% of participants completing all applicable questions. Respondents included 63 attending physicians (58%) and 45 resident physicians (42%). The median age of all respondents was 35 years. Among all participants, 51 (47%) stated their practice had a formal paternity leave policy. The median time allowed for leave was 4 weeks (range, 0.5 weeks to unlimited), whereas the median time taken was 2 weeks (range, 0.5-12 weeks). Sixteen men felt pressure to take less leave than what was allowed by their policy, and 46% of men stated that in retrospect, they would have taken more time off for paternity leave.Conclusions: To the authors' knowledge, this is the first study to investigate the use of paternity leave in RO practices in the United States. Integrating expanded family leave policies, including specifically allowing for paternity leave and accompanying these policies with cultural changes acknowledging the importance of family leave, would be beneficial to improving quality of life and work-life balance for parents. [ABSTRACT FROM AUTHOR]

Background: The demand for health care in the United States is increasing because of an aging population and an increase in the number of individuals insured. This has led to requests to revamp the primary care infrastructure fundamentally. Local Problem: The optimal use of nurse practitioners (NPs) and physician assistants (PAs) is still a subject of debate, but recently, it was reported that for many medical conditions, NP and PA-managed care outcomes are consistent with physician-managed care outcomes. Methods: Radiologists' productivity was measured according to relative value units (RVUs)/shift and professional billing changes. Patient care metrics measured were prescribed protocol to patient appointment lead time and number of same-day prescribed imaging protocol changes. Interventions: The focus was on radiologists' productivity and patient care for three months before and three months after integrating NP and PA into our abdominal radiology consult service. Results: We observed significant increases in the mean RVUs/shift (15.2 6 0.9 vs. 6.2 6 1.8; p = .02), studies read per shift (10.160.5 vs. 4.461.5; p = .003), revenue per shift hour ($756.20655.40 vs. $335.40632.60; p = .007), and protocol prescription to patient appointment lead time (39.3 6 6.7 days vs. 16.3 6 2.9 days; p = .005) and saw significant decreases in the mean prescribed CT (19.3 60.6 vs. 3.36 0.6; p = .001) and MRI (11.7 60.6 vs. 8.30 6 0.12; p = .011) same day protocol changes in NP and PA integrated workflow. Conclusions: These findings suggest that NP and PA can be effectively integrated into the abdominal radiology consult service, increasing radiologists' productivity and enhancing clinical care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this pilot study was to determine the impact of including peers with typically developing language (TDL) in language intervention sessions for preschool children with diagnosed developmental language disorder (DLD). Method: To measure peer effects, participants received 8 weeks of group language intervention in their neighborhood head start. Twenty children with DLD were randomly assigned to one of two conditions. Children in the experimental condition received language intervention with a peer with TDL; children in the control condition received language intervention with another peer with DLD. Pre- and posttest measures of language (semantics, syntax, morphology, and narrative) were collected. Teachers, speech-language pathologists, and assessors were blind to study condition. Results: All children in the study showed gains from pre- to posttest; there were no statistically significant differences between conditions. However, effect size estimates (Cohen's d) indicated that the children in the experimental condition showed an advantage over the control condition in syntax, morphology, and narrative. Conclusions: This study provides preliminary evidence that children with DLD show increased gains in language when paired with peers with TDL. This finding supports previous research in educational literature, suggesting that children's development is influenced by the skills of their peers. Additional research is warranted to further explore and understand the role of peers for children with DLD. [ABSTRACT FROM AUTHOR]

Objective To evaluate the safety and effectiveness of the Flow Redirection Endoluminal Device (FRED) flow diverter in support of an application for Food and Drug Administration approval in the USA. Methods 145 patients were enrolled in a prospective, single-arm multicenter trial. Patients with aneurysms of unfavorable morphology for traditional endovascular therapies (large, wide-necked, fusiform, etc) were included. The trial was designed to demonstrate noninferiority in both safety and effectiveness, comparing trial results with performance goals (PGs) established from peer-reviewed published literature. The primary safety endpoint was death or major stroke (National Institutes of Health Stroke Scale score ≥4 points) within 30 days of the procedure, or any major ipsilateral stroke or neurological death within the first year. The primary effectiveness endpoint was complete occlusion of the target aneurysm with ≤50% stenosis of the parent artery at 12 months after treatment, and in which an alternative treatment of the target intracranial aneurysm had not been performed. Results 145 patients underwent attempted placement of a FRED device, and one or more devices were placed in all 145 patients. 135/145 (93%) had a single device placed. Core laboratory adjudication deemed 106 (73.1%) of the aneurysms large or giant. A safety endpoint was experienced by 9/145 (6.2%) patients, successfully achieving the safety PG of <15%. The effectiveness PG of >46% aneurysm occlusion was also achieved, with the effectiveness endpoint being met in 80/139 (57.6%) Conclusion As compared with historically derived performance benchmarks, the FRED flow diverter is both safe and effective for the treatment of appropriately selected intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic caused disruptions in treatment for cancer. Less is known about its impact on new cancer diagnoses, where delays could cause worsening long-term outcomes. This study quantifies decreases in encounters related to prostate, lung, bladder and colorectal cancers, procedures that facilitate their diagnosis, and new diagnoses of those cancers in the COVID era compared to pre-COVID era.Methods: All encounters at Veterans' Affairs facilities nationwide from 2016 through 2020 were reviewed. The authors quantified trends in new diagnoses of cancer and in procedures facilitating their diagnosis, from January 1, 2018 onward. Using 2018 to 2019 as baseline, reductions in procedures and new cancer diagnoses in 2020 were estimated. Calculated absolute and percentage differences in annual volume and observed-to-expected volume ratios were calculated. Heat maps and funnel plots of volume changes were generated.Results: From 2018 through 2020, there were 4.1 million cancer-related encounters, 3.9 million relevant procedures, and 251,647 new cancers diagnosed. Compared to the annual averages in 2018 through 2019, colonoscopies in 2020 decreased by 45% whereas prostate biopsies, chest computed tomography scans, and cystoscopies decreased by 29%, 10%, and 21%, respectively. New cancer diagnoses decreased by 13% to 23%. These drops varied by state and continued to accumulate despite reductions in pandemic-related restrictions.Conclusion: The authors identified substantial reductions in procedures used to diagnose cancer and subsequent reductions in new diagnoses of cancer across the United States because of the COVID-19 pandemic. A nomogram is provided to identify and resolve these unmet health care needs and avoid worse long-term cancer outcomes.Lay Summary: The disruptions due to the COVID-19 pandemic have led to substantial reductions in new cancers being diagnosed. This study quantifies those reductions in a national health care system and offers a method for understanding the backlog of cases and the resources needed to resolve them. [ABSTRACT FROM AUTHOR]

This study discusses important aspects of policy modeling based on a leader-follower game of policymakers. We specifically investigate non-cooperation between policymakers and the jurisdictional scope of regulation via bi-level programming. Performance-based environmental policy under the Clean Power Plan in the United States is chosen for our analysis. We argue that the cooperation of policymakers is welfare enhancing. Somewhat counterintuitively, full coordination among policymakers renders performance-based environmental policy redundant. We also find that distinct state-by-state regulation yields higher social welfare than broader regional regulation. This is because power producers can participate in a single power market even under state-by-state environmental regulation and arbitrage away the CO2 price differences by adjusting their generation across states. Numerical examples implemented for a stylized test network illustrate the theoretical findings. [ABSTRACT FROM AUTHOR]

Identifying the potential for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) reinfection is crucial for understanding possible long-term epidemic dynamics. We analysed longitudinal PCR and serological testing data from a prospective cohort of 4,411 United States employees in 4 states between April 2020 and February 2021. We conducted a multivariable logistic regression investigating the association between baseline serological status and subsequent PCR test result in order to calculate an odds ratio for reinfection. We estimated an odds ratio for reinfection ranging from 0.14 (95% CI: 0.019 to 0.63) to 0.28 (95% CI: 0.05 to 1.1), implying that the presence of SARS-CoV-2 antibodies at baseline is associated with around 72% to 86% reduced odds of a subsequent PCR positive test based on our point estimates. This suggests that primary infection with SARS-CoV-2 provides protection against reinfection in the majority of individuals, at least over a 6-month time period. We also highlight 2 major sources of bias and uncertainty to be considered when estimating the relative risk of reinfection, confounders, and the choice of baseline time point and show how to account for both in reinfection analysis. Identifying the potential for SARS-CoV-2 reinfection is crucial for understanding possible long-term epidemic dynamics. Analysis of a seroepidemiological cohort suggests that primary infection with SARS-CoV-2 protects against reinfection in the majority of individuals, at least over a six month period. [ABSTRACT FROM AUTHOR]

Background The purpose of this cross-sectional study was to determine the percentage of the US population with 60 min ground or air access to accredited or statedesignated endovascular-capable stroke centers (ECCs) and non-endovascular capable stroke centers (NECCs) and the percentage of NECCs with an ECC within a 30 min drive. Methods Stroke centers were identified and classified broadly as ECCs or NECCs. Geographic mapping of stroke centers was performed. The population was divided into census blocks, and their centroids were calculated. Fastest air and ground travel times from centroid to nearest ECC and NECC were estimated. Results Overall, 49.6% of US residents had 60 min ground access to ECCs. Approximately 37.7% (113 million) lack 60 min ground or air access to ECCs. Approximately 84.4% have 60 min access to NECCs. Ground-only access was available to 77.9%. Approximately 738 NECCs (45.4%) had an ECC within a 30 min drive. Conclusion Nearly one-third of the US population lacks 60 min access to endovascular stroke care, but this is highly variable. Transport models and planning of additional centers should be tailored to each state depending on location and proximity of existing facilities. [ABSTRACT FROM AUTHOR]

Background and study aims: Endoscopic submucosal dissection (ESD) is commonly used in Asia for resection of large non-pedunculated colorectal polyps (LNPCPs) and early (T1) colorectal cancers. It allows for en bloc removal and is often curative. We describe outcomes of colorectal ESD from a United States (US) academic medical center and compare this to international experiences. Methods: Retrospective review was performed of colonic lesions referred to the University of Chicago Medical Center for ESD from 2012 to 2020. Clinical and procedural data were collected. Results: The study included 78 lesions with mean size of 29.7 mm (range 10–100 mm). The overall en bloc resection rate was 73.1% (n = 57). Between the first and second half of the study, it improved from 61.5 to 84.6% (p = 0.02). Histology showed adenocarcinoma in fifteen lesions (19.2%). Of all neoplastic lesions (n = 68), resection with negative margins (R0) was achieved in 54 cases (79.4%). Adverse events occurred in 9 cases (11.5%), but most (n = 6, 66.7%) were successfully treated endoscopically. Follow-up endoscopy was performed in 46 patients (59.0%) at a mean interval of 6.8 months (SD ± 5.0 months) with two case of recurrent lesion (4.3%). Conclusions: This study shows successful colorectal ESD outcomes at a US tertiary center. The en bloc resection rate was lower than other cohorts, but a learning curve was demonstrated. The R0 resection, lesion recurrence, and adverse event rates were similar to other non-Asian experiences, but not as favorable as in Asia [Fuccio et al. in Gastrointest Endosc 86:74–86.e17, 2017]. Increased ESD training in the US can help optimize utilization and outcomes. [ABSTRACT FROM AUTHOR]

To study the epidemiology of inpatient open globe injuries (OGI) in the United States (US). This was a retrospective cohort study of patients with a primary diagnosis of OGI in the National Inpatient Sample (NIS) from 2009 to 2015. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance, and income were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi-square tests, ANCOVA, and Tukey tests. A total of 6,821 US inpatient hospital discharge records met inclusion/exclusion criteria. The estimated national prevalence of OGI during the 5-year period from 2009 to 2015 was 34,061 (95% confidence interval [CI] 31,445–36,677). The overall annual prevalence rate was 1.58 per 100,000 per year (CI 1.56–1.59). Overall, average annual prevalence rates were highest among patients 85 years or older (7.72, CI 6.95–8.49), on Medicare (3.92, CI 3.84–4.00), males (2.28, CI 2.25–2.30), African Americans (2.38, CI 2.32–2.44), and Native Americans (1.80, CI 1.62–2.00). OGI rates were lowest among Whites (1.21, CI 1.19–1.22), females (0.89, CI 0.87–0.91), those with private insurance (0.84, CI 0.82–0.86), and Asians (0.69, CI 0.64–0.74). Being in the lowest income quartile was a risk factor for OGI (p <.05). Inpatient OGIs disproportionately affected those over 85, young males, elderly females, patients of African-American descent, on Medicare, and in the lowest income quartile. Additionally, children and young children had lower rates of OGI compared to adolescents. Further studies should delineate causes for socioeconomic differences in OGI rates to guide future public health measures. [ABSTRACT FROM AUTHOR]

Background The Woven EndoBridge (WEB) device is approved in the USA for treatment of unruptured wide-neck bifurcation aneurysms. However, the safety and effectiveness of the WEB device in the treatment of ruptured intracranial aneurysms is not clear. We aim to evaluate the perioperative safety and effectiveness of the WEB device in patients with ruptured intracranial aneurysms. Methods This retrospective study, conducted at eight centers in the USA, included patients with ruptured intracranial aneurysms treated with the WEB device in the setting of subarachnoid hemorrhage (SAH). Safety outcomes included intraoperative complications such as vessel perforation, thromboembolic events, and postoperative hemorrhagic or thromboembolic complications based on radiologic imaging. The primary effectiveness outcome was adequate (complete and neck remnant) aneurysm occlusion, according to the Raymond--Roy classification. Results A total of 91 patients with 94 ruptured intracranial aneurysms were included (mean age 57.7±15.2 years; 68.1% women; 82.9% wide necked). Aneurysms were located in the anterior communicating artery (42/94, 44.6%), middle cerebral artery (16/94, 17%), and basilar artery (15/94, 16%). Adequate occlusion was achieved in 48.8% (41/84) and 80.0% (40/50) at discharge and last follow-up (mean of 3.4 months), respectively. At discharge, procedural-related morbidity was 3.3% (3/91) and there was no procedure-related mortality. No re-rupture or delayed aneurysm rupture was observed. Conclusions This study demonstrates the perioperative safety and effectiveness of the WEB device for the treatment of patients with ruptured intracranial aneurysms in the setting of SAH, with low periprocedural morbidity and mortality. Long-term follow-up is warranted. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice. Methods: Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories. Results: Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 (P = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 (P < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 (P < 0.001). For cranial (P = 0.245), peripheral nerve (P = 0.16), pediatrics (P = 0.34), and endovascular (P = 0.48) cases, the volumes dropped but were not statistically significant decreases. Conclusion: The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience. [ABSTRACT FROM AUTHOR]

Background Little is currently known about the effects of the coronavirus (COVID-19) pandemic on neurointerventional (NI) procedural volumes or its toll on physician wellness. Methods A 37- question online survey was designed and distributed to physician members of three NI physician organizations. Results A total of 151 individual survey responses were obtained. Reduced mechanical thrombectomy procedures compared with pre- pandemic were observed with 32% reporting a greater than 50% reduction in thrombectomy volumes. In concert with most (76%) reporting at least a 25% reduction in non- mechanical thrombectomy urgent NI procedures and a nearly unanimous (96%) cessation of non- urgent elective cases, 68% of physicians reported dramatic reductions (>50%) in overall NI procedural volume compared with pre- pandemic. Increased door- to- puncture times were reported by 79%. COVID-19- positive infections occurred in 1% of physician respondents: an additional 8% quarantined for suspected infection. Sixty- six percent of respondents reported increased career stress, 56% increased personal life/family stress, and 35% increased career burnout. Stress was significantly increased in physicians with COVID- positive family members (P<0.05). Conclusions This is the first study designed to understand the effects of the COVID-19 pandemic on NI physician practices, case volumes, compensation, personal/family stresses, and work- related burnout. Future studies examining these factors following the resumption of elective cases and relaxing of social distancing measures will be necessary to better understand these phenomena. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the issue of global imbalances by exploring, in a historical context, the interconnections between the United States current account imbalances and the processes underlying allocative inefficiency, financialisation and austerity politics. Research Design & Methods: A comprehensive review of published studies is the research methodology used in this article. Published secondary data from both governments and international institutions are presented and discussed. Findings: The study find that the deep nature of the current imbalances and economic crisis in the United States could adversely affect the rest of the world. Although the IMF and other institutions of global governance have now questioned the effectiveness of neoliberal policies, the severe measures the IMF advocates in response to current account deficits could presage yet another era of anti-growth austerity measures in the United States. Implications/Recommendations: There are features of the current account US imbalances situation that have the potential to exacerbate negative trends and to further fuel adverse economic and political outcomes. The study suggests that a coordinated, US-led international response to a future global recession could be even more deficient than the current response to climate change. Contribution: The paper makes a contribution to the literature on the failures of global governance and critically examines the economic risks of the current situation that are being compounded by the political approach of the Trump Administration, which characterises US trade partners as adversaries in need of coercion through tariffs and strident rhetoric. [ABSTRACT FROM AUTHOR]

Purpose: The study investigates the amplitude and direction of the movement of information between spot and futures indices. The study progresses to account for the investor's heterogeneity and compare the evolving structure of investors in emerging and developed economies. Further, the structural linkages in terms of returns and variance have been explored for the futures indices to contribute to meteor shower literature as explained by Engle et al. (1990); Yarovaya et al. (2017). Design/methodology/approach: To facilitate the purpose, the Indian and Chinese markets were selected to represent emerging economies and the United States for developed one. The bivariate wavelet cum BEKK-GARCH (1,1) model was estimated. Findings: For the developed markets, like the United States, the spot market improves its information transmission role with time horizon while exactly opposite holds for the Chinese market. A bidirectional overnight information spillover was found for all three pairs. The Indian futures market was vulnerable to bad news from the other two markets. Evidence suggesting the dominance of institutional investors in the Chinese futures market and retail investors in the Indian futures market is found. Originality/value: The spot–futures relation has been studied on both the time and frequency domains considering different investment horizons. Due consideration has been taken to account for the overlapping trading hours. [ABSTRACT FROM AUTHOR]

Introduction: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. Methods: We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD‐9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. Results: A total of 129 090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N = 13 460). Over the last decade, the prevalence of cannabis use increased by 10‐fold, from 2.2% in 2005 to 21.2% in 2014. Conclusion: Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use. [ABSTRACT FROM AUTHOR]

Background/Aims: Seasonal variation has previously been reported in relation to the incidence of non-variceal upper gastrointestinal bleeding; however, the impact of seasonal variation on variceal bleeding is not known. Methods: We conducted a cross-sectional study using the Nationwide Inpatient Sample database from 2005 to 2014. International Classification of Diseases, Clinical Modification- 9th Revision codes were used to identify patients hospitalized with a primary or secondary diagnosis of esophageal variceal hemorrhage. The data were analyzed based on the month of hospitalization. Our primary aim was to assess seasonal variations in variceal bleeding-related hospitalizations. The secondary aims were to assess the impact of seasonal variation on outcomes in variceal bleeding including in-hospital mortality and healthcare resource utilization. Results: A total of 348,958 patients hospitalized with esophageal variceal bleeding were included. The highest number of hospitalizations was reported in December (99.3/day) and the lowest was reported in June (90.8/day). In-hospital mortality was highest in January (11.5%) and lowest in June (9.8%). There was no significant difference in hospital length of stay or total hospitalization costs across all months in all years combined. Conclusions: There appears to be a seasonal variation in the incidence and mortality of variceal hemorrhage in the United States. December was the month with the highest number of daily hospitalizations while the nadir occurred in June. [ABSTRACT FROM AUTHOR]

During a surveillance study of patients in a long-term care facility and the affiliated acute care hospital in the United States, we identified a Clostridioides difficile strain related to the epidemic PCR ribotype (RT) 027 strain associated with hospital outbreaks of severe disease. Fifteen patients were infected with this strain, characterized as restriction endonuclease analysis group DQ and RT591. Like RT027, DQ/RT591 contained genes for toxin B and binary toxin CDT and a tcdC gene of identical sequence. Whole-genome sequencing and multilocus sequence typing showed that DQ/RT591 is a member of the same multilocus sequence typing clade 2 as RT027 but in a separate cluster. DQ/RT591 produced a similar cytopathic effect as RT027 but showed delayed toxin production in vitro. DQ/RT591 was susceptible to moxifloxacin but highly resistant to clindamycin. Continued surveillance is warranted for this clindamycin-resistant strain that is related to the fluoroquinolone-resistant epidemic RT027 strain. [ABSTRACT FROM AUTHOR]

In October 2018, the Infectious Diseases Society of America (IDSA) Board of Directors (BOD) decided to develop a 2019 IDSA Strategic Plan. The IDSA BOD has invested in strategic planning at regular intervals as part of an ongoing process to review and to renew the vision and direction of IDSA. Herein, the 2018–2019 strategic planning process and outcomes are described. The 2019 IDSA Strategic Plan presents 4 key initiatives: (1) optimize the development, dissemination, and adoption of timely and relevant ID guidance and guidelines that improve the outcomes of clinical care; (2) quantify, communicate, and advocate for the value of ID physicians to increase professional fulfillment and compensation; (3) facilitate the growth and development of the ID workforce to meet emerging scientific, clinical, and leadership needs; and (4) develop and position a new tool to serve as the leading US benchmark to measure and drive national progress on antimicrobial resistance. The BOD looks forward to developing, implementing, assessing, and advancing the 2019 IDSA Strategic Plan working with member volunteers, Society partners, and IDSA staff. [ABSTRACT FROM AUTHOR]

Background: Projections based on regulations curtailing asbestos use in the USA suggest that peak incidence of pleural mesothelioma would occur between 2000 and 2005 and then decline. We analyzed the National Cancer Database (NCDB) to assess current trends in disease incidence, patient demographics, cancer treatment, and survival. Methods: The NCDB was queried to identify patients diagnosed with pleural mesothelioma from 2004 through 2014. Clinical and pathologic characteristics, treatments, and survival were analyzed. Risk factors for death were identified by multivariable Cox regression. Results: A total of 20,988 patients with pleural mesothelioma were reported to the NCDB. The number of cases per year increased from 1783 to 1961, accounting for roughly 0.3% of all reported cancers each year. The proportion of elderly patients increased from 75 to 80%, but distribution by sex remained constant (20% female). The proportion of patients undergoing treatment increased from 34 to 54%. One-year survival increased from 37 to 47% and 3-year survival from 9 to 15% (p < 0.001). Factors associated with improved survival included younger age, female sex, epithelioid histology, treatment in an academic center, health insurance, higher income, and multimodality therapy. Conclusions: The annual incidence of mesothelioma has not declined this century and remains stable. Reporting of histologic and clinical staging has improved. National trends suggest that survival is slowly increasing despite an aging cohort. Multimodal therapy and treatment at academic centers are modifiable risk factors associated with improved survival. [ABSTRACT FROM AUTHOR]

Background Context: Obesity, which is currently surging to epidemic levels within the United States, has been linked to hyperostotic conditions like diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL). Excess adipose tissue and insulin-resistance may cause a systemic increase in serum levels of proinflammatory cytokines and these signals can affect bone metabolism. Spinal ligaments and discs may have receptors for these signaling molecules. Anecdotal observations at this institution suggested that there is a clinically important subset of younger patients with obesity and multilevel stenosis in the presence of unusual calcification of the spinal ligaments that is distinct from DISH.Purpose: To determine if there is an association between truncal obesity and calcifications of the spine in nonelderly adults.Study Design/setting: This is a retrospective analysis of 214 sequential trauma patients between the ages of 29 and 50. Patients' age, sex, truncal obesity, history of hypertension, and diabetes were assessed for association with ligamentous calcification of the spine.Patient Sample: Sequential trauma patients were chosen from our institution's trauma database between 2006 and 2007.Methods: Full spine computed tomography (CT) imaging was examined for bone formation in the region of the anterior longitudinal ligament (ALL) and annulus, posterior longitudinal ligament (PLL) and annulus, and the ligamentum flavum (LF). Visceral and subcutaneous abdominal fat were also evaluated. The authors report no study funding sources or conflicts of interest.Outcome Measures: Calcification of the ALL, PLL, and LF were assigned a score at each level and then combined for a total calcification score (TCS) for the entire spine. Obesity was estimated using a truncal body mass index (TBMI) by using a previously validated CT derived truncal total adiposity volume (TAV).Results: ALL calcification was associated with age, male gender, hypertension, and increased adiposity. PLL calcification was significantly associated with age and hypertension. LF calcification was only associated with increased obesity.Conclusions: In our analysis of nonelderly patients, LF calcification was independently associated with truncal obesity. This implies obesity plays a greater role in calcification than could be accounted for by simply age-related degeneration or gender. [ABSTRACT FROM AUTHOR]

Background and objective Stent-assisted coil embolization is a well-established treatment of intracranial wide-necked aneurysms. The Neuroform Atlas Stent System is a new generation microstent designed to enhance coil support, conformability, deliverability, and improve deployment accuracy. We present the 1-year efficacy and angiographic results of the Humanitarian Device Exemption (HDE) cohort from the Atlas Investigational Device Exemption (IDE) clinical trial. Method The Atlas IDE trial is a prospective, multicenter, single-arm, open-label study of unruptured wide-necked intracranial aneurysms treated with the Neuroform Atlas stent and approved coils. The primary efficacy endpoint was the rate of 12-month complete aneurysm angiographic occlusion (Raymond class I) without target aneurysm retreatment or significant parent artery stenosis (>50%) at the target location. The primary safety endpoint was the rate of major ipsilateral stroke or neurological death within 12 months. Imaging core laboratory and Clinical EventsCommittee adjudicated the primary endpoints. Results 30 patients were enrolled at eight US centers, with 27 patients completing the 12-month angiographic follow-up. The mean age was 59.4±11.8 years and 24/30 patients (80%) were women. The mean aneurysm size was 5.3±1.7 mm and the dome:neck ratio was 1.1±0.2. Procedural technical success of Neuroform Atlas Stent deployment was 100%. 27 patients completed 12-month angiographic follow-up and 30 patients completed their 6-month follow-up. When applying the last observation carried forward method, the primary efficacy endpoint was observed in 26/30 patients (86.7%, 95% CI 69.3% to 96.2%) compared with 25/27 patients (92.6%, 95% CI 75.7% to 99.1%) who completed the 12-month angiographic follow-up. The primary safety endpoint of stroke occurred in one patient (3.3%), who made a complete clinical recovery at discharge. There were no neurological deaths. Conclusion The Neuroform Atlas stent in conjunction with coils demonstrated a high rate of complete aneurysm occlusion at 12-month angiographic follow-up, with an improved safety profile in the HDE cohort. [ABSTRACT FROM AUTHOR]

Background pediatric acute ischemic stroke with underlying large vessel occlusion is a rare disease with significant morbidity and mortality. there is a paucity of data about the safety and outcomes of endovascular thrombectomy in these cases, especially with modern devices. Methods We conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017. Tesults Nineteen patients (63.2% male) with a mean (SD) age of 10.9(6) years and weight 44.6 (30.8) kg were included. Mean (SD) NIH stroke scale (NIHSS) score at presentation was 13.9 (5.7). CT-based assessment was obtained in 88.2% of the patients and 58.8% of the patients had perfusionbased assessment. All procedures were performed via the transfemoral approach. The first-pass device was stentriever in 52.6% of cases and aspiration in 36.8%. successful revascularization was achieved in 89.5% of the patients after a mean (SD) of 2.2 (1.5) passes, with a mean (SD) groin puncture to recanalization time of 48.7 (37.3) min (median 41.5). The mean (SD) reduction in NIHss from admission to discharge was 10.2 (6.2). A good neurological outcome was achieved in 89.5% of the patients. one patient had post-revascularization seizure, but no other procedural complications or mortality occurred. Conclusions endovascular thrombectomy is safe and feasible in selected pediatric patients. Technical and neurological outcomes were comparable to adult literature with no safety concerns with the use of standard adult devices in patients as young as 18 months. This large series adds to the growing literature but further studies are warranted. [ABSTRACT FROM AUTHOR]

Introduction: There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group. Methods: We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017–2018. We assessed the yields from different methods of recruitment and retention. Results: A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield. Conclusion: Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research. [ABSTRACT FROM AUTHOR]

The article discusses a study on the cases of smouldering Waldenström macroglobulinaemia (SWM) in the U.S. Topics include clinical definition of WM, diagnosis of SWM, and difference between SWM and Immunoglobulin M (IgM)-monoclonal gammopathy of undetermined significance (MGUS) and active WM. Also mentioned are the higher prevalence of SWM among males and analysis of WM patients from the Surveillance, Epidemiology and End Results (SEER) database.

Background: Stent retriever thrombectomy of large-vessel occlusion results in better outcomes than medical therapy alone. Alternative thrombectomy strategies, particularly a direct aspiration as first pass technique, while promising, have not been rigorously assessed for clinical efficacy in randomised trials. We designed COMPASS to assess whether patients treated with aspiration as first pass have non-inferior functional outcomes to those treated with a stent retriever as first line.Methods: We did a multicentre, randomised, open label, blinded outcome, core lab adjudicated non-inferiority trial at 15 sites (ten hospitals and four specialty clinics in the USA and one hospital in Canada). Eligible participants were patients presenting with acute ischaemic stroke from anterior circulation large-vessel occlusion within 6 h of onset and an Alberta Stroke Program Early CT Score of greater than 6. We randomly assigned participants (1:1) via a central web-based system without stratification to either direct aspiration first pass or stent retriever first line thrombectomy. Those assessing primary outcomes via clinical examinations were masked to group assignment as they were not involved in the procedures. Physicians were allowed to use adjunctive technology as was consistent with their standard of care. The null hypothesis for this study was that patients treated with aspiration as first pass achieve inferior outcomes compared with those treated with a stent retriever first line approach. The primary outcome was non-inferiority of clinical functional outcome at 90 days as measured by the percentage of patients achieving a modified Rankin Scale score of 0-2, analysed by intent to treat; non-inferiority was established with a margin of 0·15. All randomly assigned patients were included in the safety analyses. This trial is registered at ClinicalTrials.gov, number: NCT02466893.Findings: Between June 1, 2015, and July 5, 2017, we assigned 270 patients to treatment: 134 to aspiration first pass and 136 to stent retriever first line. A modified Rankin score of 0-2 at 90 days was achieved by 69 patients (52%; 95% CI 43·8-60·3) in the aspiration group and 67 patients (50%; 41·6-57·4) in the stent retriever group, showing that aspiration as first pass was non-inferior to stent retriever first line (pnon-inferiority=0·0014). Intracranial haemorrhage occurred in 48 (36%) of 134 in the aspiration first pass group, and 46 (34%) of 135 in the stent retriever first line group. All-cause mortality at 3 months occurred in 30 patients (22%) in both groups.Interpretation: A direct aspiration as first pass thrombectomy conferred non-inferior functional outcome at 90 days compared with stent retriever first line thrombectomy. This study supports the use of direct aspiration as an alternative to stent retriever as first-line therapy for stroke thrombectomy.Funding: Penumbra. [ABSTRACT FROM AUTHOR]

Purpose: To review the United States National Cancer Database (NCDB) from 2004 to 2015 and analyze survival outcomes of invasive non-urachal adenocarcinoma based on treatment modality.Methods: The NCDB 2004-2015 bladder dataset was queried for adenocarcinoma histology, excluding urachal variant, and limited to patients with clinical stage T2-T4 disease. Treatment modality was categorized as no treatment, cystectomy (partial or radical), external beam radiation therapy (EBRT), or EBRT plus cystectomy. Our primary outcome was overall survival. Cox regression (CR) and Kaplan-Meier (KM) analysis were performed.Results: 851 patients were identified with invasive (cT2-T4) adenocarcinoma of the bladder. Treatment modalities included 398 (47.8%) no treatment, 298 (35.8%) cystectomy, 124 (14.9%) EBRT, and 31 (3.7%) EBRT plus cystectomy. On KM analysis excluding those with metastatic disease, the 5-year survival was significantly better (p < 0.001) for patients who underwent cystectomy (39.6%), versus no treatment (21.0%), EBRT (18.6%), or EBRT plus cystectomy (26.9%) (log rank, p < 0.001). On CR for mortality, age (HR 1.030, p < 0.001), Charlson score 1 (HR 1.287, p = 0.034), cT4 (HR 1.768, p < 0.001), and receiving treatment at a low-volume center (HR 1.289, p = 0.026) were associated with worsened survival; however, cystectomy (HR 0.593, p < 0.001) was the only factor associated with improved survival. For those undergoing cystectomy, the mean length of stay was 8.5 days and the 30-day readmission rate was 7.0%.Conclusions: Invasive non-urachal adenocarcinoma of the bladder is a rare diagnosis. Survival benefits in patients without metastatic disease are seen only in those patients undergoing definitive surgery. [ABSTRACT FROM AUTHOR]

The U.S. Clean Power Plan stipulates a state-specific performance-based CO2 emission standard, delegating states with considerable flexibility for using either a tradable performance-based or a mass-based permit program. This paper analyzes these two standards under imperfect competitive. We limit our attention to (1) short-run analyses and (2) a situation in which all states are subject to the same type of standard. We show that while the cross-subsidy inherent in the performance- based standard might effectively reduce power prices, it could also inflate energy consumption. A dominant firm with a relatively clean endowment under the performance-based standard would be able to manipulate the electricity market as well as to elevate permit prices, which might worsen market outcomes compared to its mass-based counterpart. On the other hand, the "cross-subsidy" could be the dominant force leading to a higher social welfare if the leader has a relatively dirty endowment. [ABSTRACT FROM AUTHOR]

Background: Pneumococcal vaccine prevents pneumococcal infections by inhibiting pneumococcal colonization in the host. As pneumococcal vaccine covers limited pneumococcal serotypes, hence knowledge of prevalent pneumococcal serotypes in a population is critical to estimate the effectiveness of vaccine in that population. This is the first study from Pakistan that reports colonization rates and colonizing pneumococcal serotypes in Pakistani children during pre-vaccination era. Study design, settings and duration: A cross sectional study was conducted at PHRC Research Centre, Jinnah Postgraduate Medical Centre (JPMC), Karachi in collaboration with EPI Centre, National Institute of Child Health (NICH), Karachi during one year. Materials and Methods: The study was conducted in continuation with a previous study in which nasopharyngeal swabs of healthy children coming to NICH for the EPI vaccination were collected and cultured for the presence of S. pneumoniae. Pneumococcal isolates were stored frozen in skimmed milk tryptone glucose glycerol (STGGA) medium. These isolates were then revived and serotyped using multiplex PCR as per the recommendations of Centre for Disease Control (CDC), USA to find out if the serotypes identified are being covered by recently introduced pneumococcal vaccine. Results: Out of total, 61 (31%) pneumococcal isolates that were recovered from nasopharyngeal swabs of 192 healthy children, 58 (95.1%) isolates could be revived and were serotyped. The most prevalent serogroup in was identified to be 6A/6B/6C/6D which was isolated from 9 (15.5%) of children followed by 19F, 4 (6.9%). Both serotypes were covered by 10-valent pneumococcal vaccine. Overall 23(39.7%) isolates were covered by 10- valent vaccine and 26 (44.8%) by 13-valent pneumococcal conjugate vaccine. Predominant serotypes or serogroups in our population that were not being covered by both of these vaccines were 13F, 10F/10C/33C and 38/25F/25A, each was isolated from 4(6.9%) constituting 20.7% non-vaccine serotypes. Conclusion: Serotype coverage of PCV-10 was low in Pakistani children which could be improved by using PCV- 13. Policy message: The findings will be be helpful 1) for authorities to identify the appropriate vaccine for our population and 2) for industry to formulate a vaccine with a serotype combination that may give desired results to prevent pneumococcal infections in our population. [ABSTRACT FROM AUTHOR]

Background: Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE.Methods: This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected.Results: 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P < 0.001).Conclusion: EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urinary incontinence is common amongst Chinese immigrants. These women are a rapidly growing population in the USA who require unique assessment tools due to language barriers. Presently, there are no Chinese language surveys to assess knowledge of urinary incontinence. Our goal was to translate and validate a urinary incontinence knowledge survey from English into Chinese. Methods: The English language Urinary Incontinence Quiz (UIQ) developed and validated by Branch et al. for the Educational Demonstration of Urinary Continence Assessment and Treatment for the Elderly program assesses general knowledge of urinary incontinence as a disease entity. We translated it into Chinese using the forward translation/back translation technique. The Chinese and English versions were then administered to bilingual volunteers in a nonrandomized order during a single encounter. Their responses were analyzed using Cohen's kappa coefficient to establish the validity of the translated knowledge survey. Results: Minimal reconciliation was needed in construction of the Chinese survey. Minor English grammatical corrections were made to the back-translated English survey. One question testing two knowledge concepts was separated into two questions to allow clear testing of both concepts individually. Twenty-one bilingual participants performed the validity testing. Over 50% (8 out of 15) of the questions showed nearly perfect agreement with a kappa coefficient >0.80, 5 out of the 15 questions showed substantial agreement with kappa coefficients between 0.61 and 0.8 and two questions showed moderate agreement with kappa coefficients between 0.4 and 0.6. Conclusions: We validated a translation of the UIQ for assessment of urinary incontinence knowledge in Chinese-speaking immigrants to the USA. [ABSTRACT FROM AUTHOR]

Introduction Patients with haemophilia are prone to medical emergencies. Emergency departments ( ED) often do not have a haematologist on-call for consultation. Aim The aim of this study was to determine the utilization of ED by patients with haemophilia. Methods Retrospective review of the 'National ED Database Sample' for years 2006-2013 was performed. Patient and hospital demographics were collected. Hospital charges were projected to national levels using discharge-weighted variables. Results During the 8-year study period, haemophilia patients made 162 982 ED visits. This represents 0.016% of total ED visits nationwide. Children utilized ED the most. More than half of patients resided in metropolitan cities; 20% had over $63 000 annual household income. Government insurances were the largest primary payers; 30% had private insurance. In the year 2012, 4488 ED visits with 21 000 diagnoses codes were recorded. Mean age was 29 years. Cardiovascular were the most frequently reported complaints followed by injuries, haemorrhages and sepsis. Seventy percent patients were treated and released from the ED. Two patients died in ED, whereas 35 after admission to hospital. Cause of death included Sepsis ( n = 26) and brain haemorrhage ( n = 4). Among children, injuries were the most frequent complaints followed by joint/soft tissue disorders; fevers and central line complications. Average charge per visit at private vs. public hospital was $2988 and $2254 respectively ( P = 0.03). National estimate of total charges was $60 million. Conclusion Patients with haemophilia have tendency to utilize ED. Hypertension was the single most common presenting complaint in adults. No deaths were reported in children from brain haemorrhage. [ABSTRACT FROM AUTHOR]

Background: Exposure to musculoskeletal ultrasound (MSUS) is now a mandatory component of physical medicine and rehabilitation (PM&R) residency training. However, reports on the extent of the implementation and efficacy of MSUS education are lacking in the literature.Objective: To determine the extent to which PM&R residencies are implementing MSUS education.Design: Cross-sectional.Setting: Institutional.Participants: Thirty-six of the 78 United States PM&R residency programs accredited by the Accreditation Council for Graduate Medical Education.Methods: All 78 programs were solicited with an online survey via the residency program director and coordinator in July 2014. The 25 questions on the survey were aimed at determining program MSUS educational characteristics and their effectiveness.Main Outcome Measures: Description of teaching methods used for MSUS, residency demographics, characteristics of MSUS faculty expertise, and faculty-perceived competency in MSUS examinations and procedures among residents. Data were analyzed using both descriptive statistics and tests for independence to identify correlations between program characteristics and resident MSUS competency.Results: A response was received from 36 of the 78 residency programs (46.2%). Of the 36 residency programs that responded, 97.2% provide exposure to MSUS (a figure that drops to 44.9% when nonrespondents are included); 61% had mandatory MSUS training (28.2% when including nonrespondents); and 44.4% had a formal curriculum (20.5% when including nonrespondents). The most common MSUS educational tools used were lecture (88.9%), outpatient clinic (86.1%), and hands-on workshops (86.1%). Sixty-one percent of responding programs evaluate residents with formal assessment tools. Overall, faculty at 38.8% and 44.4% of programs believed that at least 50% of residents who graduate are competent in diagnostic and interventional MSUS, respectively. These rates were significantly associated with the use of formal assessment.Conclusion: MSUS education is growing in PM&R, but many programs still have not adopted a formal educational curriculum. Formal assessment to evaluate resident MSUS skills significantly improves faculty-perceived MSUS competency. [ABSTRACT FROM AUTHOR]

Rationale: Consideration of lung transplantation in patients with systemic sclerosis (SSc) remains guarded, often due to the concern for esophageal dysfunction and the associated potential for allograft injury and suboptimal post-lung transplantation outcomes.Objectives: The purpose of this study was to systematically report our single-center experience regarding lung transplantation in the setting of SSc, with a particular focus on esophageal dysfunction.Methods: We retrospectively reviewed all lung transplants at our center from January 1, 2000 through August 31, 2012 (n = 562), comparing the SSc group (n = 35) to the following lung transplant diagnostic subsets: all non-SSc (n = 527), non-SSc diffuse fibrotic lung disease (n = 264), and a non-SSc matched group (n = 109). We evaluated post-lung transplant outcomes, including survival, primary graft dysfunction, acute rejection, bronchiolitis obliterans syndrome, and microbiology of respiratory isolates. In addition, we defined severe esophageal dysfunction using esophageal manometry and esophageal morphometry criteria on the basis of chest computed tomography images. For patients with SSc referred for lung transplant but subsequently denied (n = 36), we queried the reason(s) for denial with respect to the concern for esophageal dysfunction.Measurements and Main Results: The 1-, 3-, and 5-year post-lung transplant survival for SSc was 94, 77, and 70%, respectively, and similar to the other groups. The remaining post-lung transplant outcomes evaluated were also similar between SSc and the other groups. Approximately 60% of the SSc group had severe esophageal dysfunction. Pre-lung transplant chest computed tomography imaging demonstrated significantly abnormal esophageal morphometry for SSc when compared with the matched group. Importantly, esophageal dysfunction was the sole reason for lung transplant denial in a single case.Conclusions: Relative to other lung transplant indications, our SSc group experienced comparable survival, primary graft dysfunction, acute rejection, bronchiolitis obliterans syndrome, and microbiology of respiratory isolates, despite the high prevalence of severe esophageal dysfunction. Esophageal dysfunction rarely precluded active listing for lung transplantation. [ABSTRACT FROM AUTHOR]

Civic technology is a nascent force in the relationship between governments and communities. Elements of the civic technology ecosystem include open data, related information and communications technology (ICT) innovations and the organizational boundary-spanning practices of civic technology. This paper reports the results of an exploratory study of civic technology adoption by local governments in the United States. The research compares the 113 U.S. city governments recognized for their exemplary fiscal year 2012 popular annual financial reports (PAFRs) with the 49 municipalities in the U.S. state of Delaware that operate websites. Results suggest that a long term commitment to citizen involvement in government data and the size of the community are important predictors of adoption. [ABSTRACT FROM AUTHOR]