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The objective of this study was to better understand the variability that exists in the contemporary pediatric cervical spine (c-spine) clearance protocols and how this variability affects clinical practice and outcomes.Pediatric c-spine injury is a rare but potentially devastating event. In the adult population, validated tools, such as the National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian C-spine Rule, are available to aid in safely clearing the c-spine clinically while reducing the utilization of radiography. In the pediatric population, no standardized, validated tool exists, leading to variability in protocols that are put to use.A systematic literature search was conducted in Cochrane, Embase, PubMed/MEDLINE, and Web of Science electronic databases from January 1, 2009 until April 30, 2021. Data were extracted from studies that met inclusion criteria. Quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.There were 19 studies included in this systematic review. From these 19 studies, there were 16 unique protocols, 12 of which (75%) utilized some or all NEXUS criteria. Of the protocols that provided a detailed imaging algorithm (N=14), 12 (85.7%) utilized x-rays as the initial imaging modality. Indications for computed tomography and magnetic resonance imaging varied widely across the protocols. The rate of x-rays, computed tomography, and magnetic resonance imaging utilization ranged from 16.7% to 97.8%, 5.4% to 100%, and 0% to 100%, respectively. Ten studies evaluated the efficacy of protocol implementation, with 9 (90%) of these studies showing an overall reduction of imaging rates in the postprotocol period. No clinically significant missed injuries were reported in the included studies.Details of c-spine clearance protocols differed significantly across the included studies, but many applied some or all NEXUS criteria. Overall, while variable, protocols served to safely treat pediatric patients without missing any clinically significant c-spine injuries, while reducing radiation exposure.

Brazilians represent a growing proportion of immigrants in the USA. Little is known about their health or healthcare utilization after their arrival. This study aimed to gather formative data to understand the needs of Brazilian immigrant women to guide public health interventions. We conducted five focus groups with Brazilian women born in Brazil (n = 47) and 13 key informant interviews with representatives from Brazilian-serving organizations. Participants were recruited from churches and social service organizations in the Greater Boston area. Findings revealed that mental health was the most pressing health priority; many attributed high levels of anxiety and depression to worries about undocumented status, separation from social networks, and strenuous work schedules. Occupational health issues were frequently mentioned, including musculoskeletal complaints, skin rashes, and respiratory problems. Domestic violence was also a concern, and many women feared reporting to police due to undocumented status. Most reported good access to medical care and described the quality of healthcare services as superior to that available in Brazil. However, many reported challenges with interpersonal communication with providers, dissatisfaction with a perceived unwillingness from providers to order medical tests or prescribe treatment, and limited access to mental health services. There was agreement that effective intervention strategies should use social media, radio, and group education in churches.

Background Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. Study Design We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c Results Six hundred and twenty-one patients (aged 46.7 ± 10.6 years; 30% on insulin; BMI 49.8 ± 8.3 kg/m2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. Conclusions This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.

Shared decision-making (SDM) is recommended for prostate cancer screening, but little is known about how this process is perceived by patients and providers. SDM is especially important for African American men, who are at high risk for the disease.To evaluate agreement in SDM ratings among patients, providers, and objective observers.African American men ages 45-70 were recruited from primary care practices to participate in a study evaluating a decision aid (DA). Immediately after using the DA, patients proceeded to primary care appointments. Afterwards, patients and physicians completed surveys assessing perceptions about SDM. Clinical visits were also audio-recorded and coded to assess SDM.Mean scores on SDM measures among patients were 73.2 (SD = 27.5, 95% CI 55.71-90.62), 83.1 among physicians (SD = 7.8 95% CI 78.14-88.06), and 67.1 among objective raters (SD = 36.8 95% CI 43.72-90.45). Among patient-provider dyads, mean agreement was 49.9%.Patients, physicians, and objective observers perceived SDM differently. Understanding discordant experiences of SDM is vital for improving clinical guidance about SDM especially among African Americans who have historically faced healthcare discrimination and mistrust. DAs, particularly for African American men, should incorporate strategies to empower patients to advocate for their communication needs and preferences.Clinical trials identifier number: NCT02787434.

Objective To understand the frequency and nature of postinterview communication as it relates to the rules and regulations of the American Urological Association Urology Residency Match, as well as the impact of such communication on the outcomes of the match. Methods An anonymous, electronic survey questionnaire was sent to all applicants to a single urology residency training program during the 2017 American Urological Association match cycle. The survey was administered 1 month after the release of match results and queried applicants regarding their experiences with postinterview communication. Results Of 231 surveys sent, 78 were returned completed for a 34% response rate. Among respondents, 47 (60%) reported receiving postinterview communication from at least one residency program, 20 (26%) were asked to reveal where they would be ranking a program on their rank list, and 15 (19%) reported that postinterview communication caused them to rank a program higher than initially planned, or to keep the program ranked at #1 if currently ranked there. Postinterview communication via telephone was associated with significantly increased odds of matching at the contacting program (odds ratio 20.0, 95% confidence interval 2.12-188.66, P = 0.003). Conclusion Postinterview communication between applicants and urology residency programs is prevalent, with numerous violations of the rules of the match. Prohibited communication may impact the rank lists of urology applicants.

Objective To understand the urology Match process from the perspective of residency program directors, with a particular focus on the role of postinterview communication. Recent surveys of urology applicants revealed that postinterview communication from programs often violates the rules of the American Urological Association Urology Residency Matching Program (the “Match”), and that such communication may influence applicant rank lists. Methods An anonymous, electronic survey seeking information regarding postinterview communication during the Match was sent to all program directors of urology residency programs participating in the 2017 AUA Match cycle. Results Of 138 surveys sent, 84 were completed for a 61% response rate. Among respondents, 97.6% percent of programs received postinterview communication from applicants, 76.2% of programs received an informal commitment from an applicant, and 38.3% failed to match an applicant who made an informal commitment. Most program directors (81.7%) responded that promises by applicants did not influence their rank list, and 57.1% state that participating in a second look does not have the potential to influence an applicant's rank order. Cumulatively, 76.2% of program directors felt that it was appropriate for applicants to cancel an interview if they provided 2 or more weeks’ notice. Conclusion The current study suggests that urology program directors do not ascribe significant value to continued contact with applicants after the interview, regardless of whether such contact is in the form of postinterview communication or in the form of second-look visits.

To compare endourology versus pediatric urology exposure to pediatric stone cases during fellowship, comfortability in treating pediatric stone cases, and access to pediatric surgical equipment.A survey was distributed to all pediatric urology fellowship programs and the Endourological Society. Age was stratified into12 months old, 12 months-4 years, 5-12 years, and 13-18 years. Exposure and comfortability performing extracorporeal shock wave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) were assessed across age groups. Exposure was assessed as 'yes/no' and comfortability was scaled from 1-5 ('would not do' to 'very comfortable').Seventy-two surveys met inclusion criteria, with 23 (31.9%) from pediatric urologists and 49 (68.1%) by endourologists. During fellowship, pediatric urologists had more exposure to SWL in toddlers (p = 0.03) and school age children (p = 0.045), URS in toddlers (p = 0.012) and school age children (p = 0.002), and PCNL in infants (p = 0.031) and school age children (p = 0.025) compared to endourologists. Pediatric urologists were significantly more comfortable performing SWL in toddlers (p = 0.04), URS in toddlers (p = 0.04) and school age children (p = 0.04), and PCNL in school age children (p = 0.02) compared to endourologists. Endourologists were significantly more uncomfortable than pediatric urologists in performing URS in toddlers (p = 0.03) and PCNL in infants (p = 0.04) and school age children (p = 0.03). There were no differences in availability of pediatric equipment.Pediatric urologists, have significantly more exposure than endourologists during fellowship and are more comfortable performing surgical treatment for urolithiasis in most pediatric ages. Endourology fellowships may benefit from greater exposure to pediatric patients with stones.

Motivational interviewing (MI), a patient-centered counseling technique, has been effective for modifying personal health behaviors. MI has most often been taught during clinical training. This study describes a brief interactive student-developed workshop designed to train first-year medical students in this communication skill.

Let me start autobiographically as well. Leo Marx's The Machine in the Garden had a profound influence on me in graduate school, along with Raymond Williams's The Country and the City; together, they got me to think about the machine and the city more than the country and the garden, and to ask why realistic fiction that depicted urbanization and industrialization in the US seemed somehow un-American in the critical tradition. Since then I have rediscovered

This essay argues that Guantanamo lies at the heart of the American Empire. The legal status of the prisoners there must be understood in the context of an imperial history that dates back to the U.S. occupation of Cuba in 1898. This history explains how the U.S. Naval Station, Guantanamo Bay, Cuba, has become an ambiguous space, both inside and outside national and juridical borders and how this ambiguity reinforces the harsh penal regime. The essay argues that the legacies of U.S. imperialism inform key contemporary debates about Guantanamo: the question of national sovereignty, the codification of the prisoners as "enemy combatants," and the uncertainty about whether the U.S. Constitution holds sway there. Turning to the 2004 Supreme Court decision, Rasul v. Bush, the essay argues that the justices are not only interested in restraining executive power to bring Guantanamo within the rule of domestic law; they also show concern with the scope of U.S. power in the world and the extent to which the judiciary should accompany or limit U.S. military rule abroad. A close reading of the Supreme Court's decision and dissent shows that the logic and rhetoric of Rasul v. Bush rely on and perpetuate the imperial history the decision also elides. In concert other recent decisions about civil liberties and national security, Rasul v. Bush contributes to the global expansion of U.S. power by reworking the earlier history of imperial rule. The Court's legal decisions respond to the changing demands of empire today by creating new categories of persons before the law that extend far beyond Guantanamo Bay, Cuba.

This response endorses the call for international perspectives on American Studies, while it explores some of the potential pitfalls in the way that Professor Kadir formulates this project: the danger of reproducing the nationalist divisions between inside and outside and reifying the international; the problem of restoring a white male canon; and the trap of an exceptionalism paradigm, which criticizes the USA on the grounds of not living up to its own ideals. Reinterpreting some of the examples about the Puritans and William James, the article suggests alternative ways of decentering the USA by locating the migration of people, culture, capital and weapons in the transnational routes of empire and resistance.

Urging American studies as a field to address the current international crisis, Kaplan analyzes the dramatic shift in contemporary public discourse from the denial to the embrace of the notion of the American Empire. She traces two dominant narratives, one that loudly champions U.S. military supremacy and another that reluctantly accepts the "white man's burden" as the last best cure of global anarchy, both of which take American exceptionalism to new heights. Since the American Empire is "out of the closet," as its proponents claim, American studies scholars and teachers must go beyond the methodology of exposure to recast these debates about empire in transnational, historical, and comparative contexts. They should muster the authority of their discipline to challenge current efforts to redefine the multiple meanings of America both at home and abroad. She offers two key examples. One explores how the adoption of the word "homeland" imposes an illusion of national consensus and homogeneity, which underwrites resurgent nativism and anti-immigrant sentiment. She concludes with the pressing case of the prisoners held at the U.S. naval base at Guantanamo Bay Cuba, to argue that this imperial location lies at a historical crossroad, where U.S. intervention in the Caribbean meets U.S. intervention in the Middle East, and where nineteenth-century imperialism leads to the American Empire of the twenty-first.

THE SPANISH-CUBAN-AMERICAN war of 1898 was one of the first wars in history to be filmed. Yet despite its participation in the birth of American cinema, the war disappeared as a subject from the later archives of filmmaking. No major films chronicle the three-month war in Cuba or the subsequent three-year war in the Philippines, although films have been made about virtually every other war in American history. My paper is about that duality, about the formative presence and telling absence of this pivotal war in the history of American film. I argue that the so-called Spanish-American War, with its evocations of an American empire, surfaces at key moments of innovation in the development of American cinema: from the earliest organization of the industry in the 1890s to the emergence of narrative in story films in the first decade of the twentieth century to D. W. Griffith's The Birth of a Nation (1915) and Oscar Micheaux's response, Within Our Gates (191920). (A longer version of this paper extends to Orson Welles's Citizen Kane [1941], based on the career of William Randolph Hearst, whose newspaper empire was built on his proactive endorsement of the war.) Allusions to the Spanish-American War, I will show, appear both at moments of cinematic innovation and at threshold periods of international crisis, when the question of American involvement in European wars was under intense debate and the global role of the US was hanging in the balance (The Birth of a Nation in the beginning of World War I and Citizen Kane in World War II). If "race movies," as Michael Rogin contends, "provide the scaffolding for American film history,"' I argue that imperial films provide the submerged foundation on international terrain for a history that charts not only the internal bonds of national unity but also the changing borders between the domestic and the foreign.

IV lipid emulsion (ILE) therapy is emerging as a potential antidote for lipophilic drug toxicities in both human and veterinary medicine. ILE has already gained acceptance in human medicine as a treatment of local anesthetic systemic toxicity, but its mechanism of action, safety margins, and standardized dosing information remains undetermined at this time. Experimental and anecdotal use of ILE in the human and veterinary literature, theorized mechanisms of action, current dosing recommendations, potential adverse effects, and indications for use in human and veterinary emergency medicine are reviewed herein.

In a speech urging the US to annex the Philippines in 1900, Senator Albert Jeremiah Beveridge asked: "What does all this mean for every one of us?" and then readily answered: "It means opportunity for all the glorious young manhood of the republic-the most virile, ambitious, impatient, militant manhood the world has ever seen" (qtd. in Paterson 391). Not specifying the opportunities for particular actions, Beveridge implied tautologically that the empire offered the arena for American men to become what they already were, to enact their essential manhood before the eyes of a global audience. Although the Spanish-American War was viewed as a chivalric liberation of Cuba and the Philippines from a tyrannical oldworld empire, Beveridge voiced an accompanying narrative: he welcomed the war's conquests as a rescue mission for American manhood, from the equally threatening forces of a modem industrial democracy. A similar rescue mission was conducted on the pages of the popular historical romance, where thinly veiled American heroes pursued chivalric adventures in bygone eras. In the opening scene from the 1898 best-seller, When Knighthood Was in Flower, the heroine declares passionately upon her first sight of the hero fighting a duel: "For once I have found a real live man, full of manliness" (Major 27). In these novels, settings from European and American history function as the fictional equivalent of the Philippines for Beveridge, as the site where a man can reassert his "militant manhood," and where a woman serves as the eyes of the world. Many contemporary readers linked the jingoistic clamor for foreign wars to what William Dean Howells called the "hor

This study evaluated the accomplishment of the Nursing Outcomes Classification (NOC) outcome "Health Seeking Behavior" in 5 nurse-managed clinics. Nurse practitioners and registered nurses rated patients on 11 indicators of health seeking behaviors, and recorded their level of knowledge of the patient. A total of 556 evaluations were collected. Health seeking behavior scores were lowest in a rural county school-based clinic and highest in a federally qualified health center. Ratings increased with nurses' knowledge of patients and for older patients.