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Background: Adenomyosis is a disease where ectopic endometrial glands affect the muscular wall of the uterus. It is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified- International Federation of Gynaecology and Obstetrics). Aims and objectives were to diagnose adenomyosis accurately with help of data of clinical findings and imaging modalities. Methods: It was a retrospective study done at tertiary hospital, Junagadh from June 2022 to November 2022. The HPE reports and case records of all the hysterectomy specimen were reviewed. Data regarding age, parity, symptoms, obstetric history, examinations, co-morbidities, investigation findings and treatment modalities were noted. They were tabulated and analysed. Results: Out of the 50 patients, 30 patients (60%) were in the age group of 41-50 years. The prevalence of adenomyosis in our study was only 6% in post-menopausal women when compared to the age group 41-50 years (60%). Multiparous women had 92% incidence of adenomyosis. 62% had menstrual disturbances. Dysmenorrhea and dyspareunia were the next common symptoms. Fibroid was the commonest associated pathology 44%. 32% had endometrial hyperplasia, whereas 68% had no pathology. Imaging picked up only 36% of cases contrary to 28% of clinical diagnosis and was raised to 64% with gross examination of specimen and 100% with HPE. Conclusions: Better modality to diagnose adenomyosis is clinical presentation. USG failed to diagnose all the cases. Gold standard modality is histopathological examination.

Background The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs). Objective To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19. Design Retrospective cohort. Setting Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN). Target population Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020. Measurements We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs. Results Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p Limitations Results are limited by available documentation and do not capture communication between providers and patients. Conclusion Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.

Objective Challenging patient encounters contribute to physician burnout, though little is known about how these impact hospitalists specifically. This study explores how hospitalists characterize challenging patient encounters and their impact on hospitalist well-being to inform organizational efforts. Methods We conducted a qualitative, descriptive study with 15 physician hospitalist faculty at two locations, a tertiary academic and safety-net hospital, utilizing a conceptual framework based on the Stanford Wellness Framework for physician resilience around challenging patient encounters. Results Two themes emerged: feelings of helplessness and time-consuming encounters. Helplessness was associated with systems issues, misaligned patient/provider goals, and violence. Time-consuming encounters were due to systems issues, misaligned goals requiring prolonged conversations, and patient factors. These factors were found to negatively impact hospitalist well-being. Resilience strategies included developing and teaching empathy and seeking expert/colleague opinion through debriefing, peer-to-peer interactions, and external resources. Conclusions Organizational strategies to support hospitalists in the context of challenging patient encounters require a multifaceted approach: improved system processes, fostering a local culture of empathy-building, and supporting peer-to-peer relationships and debriefing mechanisms. Practice implications Enhanced communication around system process improvements and culture of wellness, in addition to communication skills and mindfulness, could improve hospitalist well-being.

Coronavirus disease 2019 (COVID-19) pandemic has forced providers to rapidly adopt telehealth tools to reduce staff exposure to ill persons, preserve personal protective equipment, and minimize impact of patient surges on facilities. Remote patient monitoring (RPM) can be used to monitor high-risk patients from their homes and open up hospital bed availability. The authors describe a pilot program to evaluate the impact of RPM in postdischarge monitoring of COVID-19 patients. High-risk patients discharging from the hospital received a wearable vital sign monitoring device to be worn for 8 consecutive days, allowing real-time data transmission to a virtual health center (VHC), which had been established prior to the pandemic, via a smart phone application. The data were monitored 24 hours a day by a VHC tech with built-in escalation protocols to a nurse and/or an attending physician if needed. Eighty patients were enrolled, 48% women with an age range of 19-83 years. Languages included Spanish (49%), English (47%), Burmese (2%), and Swahili (1%). The most common comorbidities included hypertension (48%) and diabetes mellitus (48%). Oxygen was the most common addressed need; 8% requiring new oxygen and 8% benefitting from oxygen-weaning during the RPM time period. Ten percent patients had emergency department (ED) visits and 4% were readmitted within 30 days of discharge. The authors built and deployed an RPM program for postdischarge monitoring of high-risk patients. RPM can be quickly deployed to support COVID-19 patients postdischarge and assist with hospital capacity. RPM can be rapidly and successfully deployed during the COVID 19 pandemic to aid in transitions of care.

Background: Nocturnal enuresis, also called bedwetting, is involuntary urination while asleep after the age at which bladder control usually begins. Bedwetting in children and adults can result in emotional stress. Little is known about toilet training in pre-modern societies, but attitudes toward training in recent history have fluctuated substantially, and may vary across cultures and according to demographics. Treatments range from behavioral therapy, such as bedwetting alarms, to medication, such as hormone replacement, and even surgery such as urethral dilatation. Since most bedwetting is simply a developmental delay, most treatment plans aim to protect or improve self-esteem. Treatment guidelines recommend that the physician counsel the parents, warning about psychological consequences caused by pressure, shaming, or punishment for a condition children cannot control. Bedwetting is the most common childhood complaint. Children may face certain risks associated with training, such as slips or falling toilet seats, and toilet training may act in some circumstances as a trigger for abuse. Aims: The aim of this study is to assess the prevalence of nocturnal enuresis and its associated factors among school going children in selected rural areas of Vadodara. Methods: A descriptive research design was carried out for this study. The sample size of the study is 500. Participants were selected using stratified sampling technique. The tool is consists of two parts. First part consist of demographic data of the sample and second part consist of assertiveness self-assessment questionnaire. Results: While assessing the associated factors of nocturnal enuresis in school going children, 15% children are having mild nocturnal enursesis,77%children are having moderate nocturnal enuresis and 8% children are having severe nocturnal enuresis. While assessing the association, there are three demographic variables age, sex and education of father has no significant association. So H0 has been rejected and H1 is accepted. Conclusion: The present study concluded that majority of the children’s is having moderate level of nocturnal enuresis (77%) and minority of the children’s is having severe level of nocturnal enuresis (8%).

Objective- To study ocular involvement and outcome in these patients after rigorous medical-surgical management. A Retrospective Study carried out at GMERS Hospital, Gotri. All patients Method– admitted from April 2021 to August 2021, with past history of Covid-19 and biopsy proven Mucormycosis have been included in the study and were subjected to complete history taking, ophthalmological examination and imaging studies. All patients were treated by multidisciplinary approach with Intravenous Amphotericin B (IVAMB) and Transcutaneous Retrobulbar Amphotericin B (TRAMB) +/- Exenteration depending on the extent of involvement. Statistical analysis was done using Binomial test and P value

Background-Amniotic fluid surrounding the fetus is an important biophysical marker of fetal wellbeing. As per definition of liquor amnii, amniotic fluid index less than 5 cm is known as oligohydramnios. Oligohydramnios is commonly observed obstetric problem in term pregnancy which is associated with meconium-stained liquor, abnormal fetal heart rate, low APGAR score, NICU admission, birth asphyxia and increasing chances of caesarean birth. Objective:To study the pathophysiology of oligohydramnios and fetomaternal outcome in women with singleton pregnancy with AFI

The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.

PurposeTo characterize and analytically validate the MSDA Test, a multi-protein, serum-based biomarker assay developed using Olink®PEA methodology.Experimental designTwo lots of the MSDA Test panel were manufactured and subjected to a comprehensive analytical characterization and validation protocol to detect biomarkers present in the serum of patients with MS. Biomarker concentrations were incorporated into a final algorithm used for calculating four Disease Pathway scores (Immunomodulation, Neuroinflammation, Myelin Biology, and Neuroaxonal Integrity) and an overall Disease Activity score.ResultsAnalytical characterization demonstrated that the multi-protein panel satisfied the criteria necessary for a fit-for-purpose validation considering the assay’s intended clinical use. This panel met acceptability criteria for 18 biomarkers included in the final algorithm out of 21 biomarkers evaluated. VCAN was omitted based on factors outside of analytical validation; COL4A1 and GH were excluded based on imprecision and diurnal variability, respectively. Performance of the four Disease Pathway and overall Disease Activity scores met the established acceptability criteria.Conclusions and clinical relevanceAnalytical validation of this multi-protein, serum-based assay is the first step in establishing its potential utility as a quantitative, minimally invasive, and scalable biomarker panel to enhance the standard of care for patients with MS.What is known and what is new in your work?What’s knownMultiple sclerosis (MS) has a complex disease course with variable clinical outcomes; early diagnosis and treatment are critical to management of MS.One key focus in MS research is the identification of biomarkers in biological fluids, such as cerebrospinal fluid or blood, to track pathogenesis, disease activity, and disease progression, which may lead to individualized disease management and improved quality of care.There currently are no validated clinical tests that leverage multiple blood biomarkers to track disease activity or progression in patients with MS.What’s newThe MS Disease Activity (MSDA) Test is a multi-protein, serum-based biomarker assay designed to quantitatively measure disease activity using the protein levels of biomarkers present in the serum of patients with MS.In this study, we evaluated 21 biomarkers, 18 of which were selected for inclusion in the MSDA Test, and extensively characterized the MSDA Test (individual biomarkers and algorithmic scores) by establishing the accuracy, precision, sensitivity, and robustness of the assay.This study serves as a critical first step in the validation of this multi-protein, serum-based assay, which will be a quantitative, minimally invasive, and scalable tool to improve MS disease management.Clinical relevanceMultiple sclerosis (MS) is a chronic, neurodegenerative, immune-mediated disease of the CNS. MS has a complex disease course with variable clinical outcomes. Although many treatments are effective in early stages of the relapsing/remitting form of the disease, early diagnosis and treatment are critical to managing disease activity and slowing disease progression. One of the major areas of focus in MS research is the identification of biomarkers in biological fluids, such as cerebrospinal fluid or blood, to track pathogenesis, disease activity, and disease progression, which can lead to individualized disease management and improved quality of care. Currently, there are no validated clinical tests that leverage multiple blood biomarkers to track disease activity or progression in patients with MS. Herein, we describe the analytical characterization and validation of a multi-protein, serum-based assay panel developed using Olink®PEA methodology. We demonstrate the extensive characterization of this multi-protein, serum-based assay and establish its accuracy, precision, sensitivity, and robustness. This report will be followed by a complementary clinical validation study investigating the correlation between the proteomic assay results and relevant clinical and radiographic endpoints for patients with MS.

In a continuing effort to provide innovative formats of presenting medical information in a digestible and comprehensive manner, infographics were created and included in select standard letters created by the Medical Information team. Qualitative and quantitative feedback on the ease of comprehension, flow, layout, and value of infographics within Standard Response Documents (SRDs) was obtained from healthcare professionals (HCPs). A qualitative survey (n = 47) was conducted to assess the ease of comprehension and effectiveness of infographics. The qualitative market research consisted of 25 individual 60-min phone interviews with HCPs focused around two SRDs. It was found that 87% (n = 41) of respondents agreed or strongly agreed that the infographic was easy to comprehend. Additionally, 85% (n = 40) of the respondents agreed or strongly agreed that the infographic was useful in answering their product question. It was found that most HCPs (20/25) appreciated the presentation of the infographics and found them visually appealing. Additionally, most agreed that the infographic provided content that was sufficient in addressing their product inquiries and impactful for clinical decision making. Infographics have proved to be a valuable resource within response letters to address HCP inquiries and provide an option to pharmaceutical companies to evolve the way medical information is presented.

Additional file 2. Pre-post questionnaires.

Additional file 1. Discussion board prompts.

Additional file 4. Focus group consent script and discussion guide.

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P 50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

Additional file 3. Institutional elective evaluation form.

As coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2), became a pandemic, hospitals activated Hospital Incident Command Systems (HICS). At our institution, we included a role of Physician Clinical Support Supervisor (PCSS) in the HICS structure. The PCSS role was filled by physicians who served hospital leadership positions, such as Physician Advisor, Medical Staff leadership, Chief Quality Officer, and Chief Medical Informatics Officer. In an effort to summarize the lessons learned by implementation of the PCSS role during the COVID-19 pandemic, we evaluated a PCSS working Microsoft Teams™ spreadsheet and the experience of physicians in the PCSS role. Through efficient daily 2-way communication between frontline providers, HICS, and hospital leadership, the PCSS role facilitated rapid change and improved support for frontline staff, patients and families, and the health-care system. We recommend including the role of PCSS in HICS structure in the event of future pandemics or other crises.

Background Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts. Methods A needs assessment identified four common barriers to early discharge: (1) lack of communication between nurses, case managers, and teams about discharge planning; (2) obtaining home services, equipment, and oxygen early in the morning; (3) arranging transportation to facilities earlier in the day; and (4) communicating discharge expectations with patients and family members. Using the MFI, we tested and implemented interventions in three key areas: education, process changes, and audit and feedback. Key interventions included an educational campaign on the safety implications of reducing emergency department boarding time, an afternoon huddle with MDs and case managers, and a Web-based dashboard to provide real-time discharge by noon (DBN) audit and feedback. Results The DBN rate increased from a baseline of 10.4% to an average of 19.7% during a 24-month time frame, with significant improvements in average length of stay (5.88 to 5.60) and length of stay index (1.18 to 1.10) ( p 0.05). Conclusion Improving hospital throughput is becoming imperative, and a structured approach to improvement can lead to rapid and sustainable results.

BACKGROUND Hospitalists frequently work on diverse projects, but often do not have the training and experience necessary to translate projects into peer-reviewed publications and grants. OBJECTIVE Describe implementation and effect of a works-in-progress (WIP) series on progress and training in scholarly work. DESIGN Cross-sectional survey. SETTING Urban academic medical center. INTERVENTION A weekly WIP session, named Incubator, serving as a forum where researchers, clinicians, and educators meet to review and provide feedback on projects underway across the Division of Hospital Medicine. MEASUREMENTS We surveyed presenters at Incubator to evaluate the impact of Incubator on scholarly activities. Responses were based on Kirkpatrick's 4-level training hierarchy: (1) Reaction: participants' satisfaction; (2) Learning: knowledge acquisition; (3) Behavior: application of skills; and (4) Results of projects. We compared responses between researchers and nonresearchers using χ2 tests. RESULTS Of 51 surveys completed (response rate 70%), 35 (69%) projects were nonresearcher led. Reaction, behavior change, and results were all positive, with >90% respondents reporting a positive outcome in each category, a high rate of publication/funding, and 35% reporting learning as a result of Incubator. Comparison of researchers and nonresearchers revealed no significant differences, except nonresearchers reported significantly more favorable results in behavior and mentoring (P < 0.05). DISCUSSION A regularly scheduled, researcher-led WIP session within a largely clinically oriented hospital medicine division can provide a venue for feedback that may promote progress and practical training in scholarly projects. In addition to robust career mentorship programs and protected time, a WIP can be an adjunct to improve scholarly output among academic hospitalists. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine

The SARS-CoV-2 (COVID-19) pandemic is the largest mass effect incident in a century, requiring hospitals to consider how best to adapt the Hospital Incident Command System for a sustained pandemic. Given the scope of the pandemic a central position is required to improve the flow of information to providers, the flow from providers to the Incident Commander, and the overall coordination between diverse service lines and specialties. We describe a novel position, the Physician Clinical Support Supervisor, a position that has three primary functions during disaster operations: liaison, coordinator, and advocate. This role proved critical in day-to-day operations and facilitated highly effective communication up and down the chain of command, created a single point-person to coordinate multiple service lines and specialties, and served as a primary advocate for front-line workers and command.

Purpose of study Miscommunications during the complex process of discharging patients from acute care facilities can lead to adverse events, patient dissatisfaction, and delays in discharge. Brief multidisciplinary discharge rounds (MDRs) can increase communication between stakeholders and shorten a patient's length of stay (LOS). At our tertiary academic medical center, case managers (CMs) have historically been assigned patients by physical unit location rather than by provider teams caring for patients. As a result, medicine teams often interact with several unit-based CMs due to lack of geographically cohorted patients, leading to inefficiency and fragmentation in discharge planning communication. Our aim was to implement and evaluate the impact of multidisciplinary, team-based discharge planning rounds (MDR) for general medicine patients. Primary practice setting A tertiary academic medical center. Methodology and sample Using the model for continuous improvement, we implemented and optimized MDR on 2 of 4 internal medicine resident ward teams that care for general internal medicine patients, including creation of a multidisciplinary team, improving physician continuity. Results During the pilot, 1,584 patients were discharged from all medicine teams-825 from pilot teams and 759 from control teams. The proportion of patients with discharge before noon (DBN) orders was 41.2% on pilot versus 29.6% on control teams. Length of stay was 92.2 hr versus 97.2 hr, and 30-day readmission rate was 16.0% versus 18.3% for the pilot versus control teams, respectively. After the pilot concluded, we continued to have resident continuity on pilot teams but returned to the unit-based CM model. During this time, the proportion of DBN orders and LOS were similar between the pilot and control teams (29.0% vs. 24.3% and 95.8 hr vs. 96.6 hr, respectively). The 30-day readmission rate was 12.6% compared with 18.9% for the pilot versus control teams. Implications for case management practice Our team-based MDR pilot improved interdisciplinary relationships and communication and resulted in shorter LOS, earlier discharge times, and lower 30-day readmissions.

Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation. We received 61 responses from 115 institutions (53% response rate). Forty-seven (77%) "strongly agreed" or "agreed" that early discharge was a priority. "Discharge by noon" was the most cited goal (n = 23; 38%) followed by "no set time but overall goal for improvement" (n = 13; 21%). The majority of respondents reported early discharge as more important than obtaining translators for non-English-speaking patients and equally important as reducing 30-day readmissions and improving patient satisfaction. The most commonly reported factors delaying discharge were availability of postacute care beds (n = 48; 79%) and patient-related transport complications (n = 44; 72%). The most effective early discharge initiatives reported involved changes to the rounding process, such as preemptive identification and early preparation of discharge paperwork (n = 34; 56%) and communication with patients about anticipated discharge (n = 29; 48%). There is a strong interest in increasing early discharges in an effort to improve hospital throughput and patient flow.

Objectives To evaluate the feasibility and effect of a pharmacist-led transitions-of-care (TOC) pilot targeted to patients at high risk of readmission on process measures, hospital readmissions, and emergency department (ED) visits. Setting Academic medical center in Colorado. Practice description Pharmacists enrolled patients identified as high risk for readmission in a TOC pilot from July 2014 to July 2015. The pilot included medication reconciliation, medication counseling, case management or social work evaluation, a postdischarge telephone call, and an expedited primary care follow-up appointment. Practice innovation Implementation and evaluation of the pharmacist-led TOC pilot program with risk score embedded into the electronic health record. Evaluation Comparison of TOC-related process measures and clinical outcomes between pilot patients and randomly matched control patients included readmissions or ED visits at 30 and 90 days. Results We enrolled 34 pilot patients and randomly matched them to 34 control patients. The intervention took an average of 57.1 minutes for pharmacists to deliver. More pilot patients had a case management or social work note compared with control patients (88% vs. 59%; P = 0.006 [statistically significant]). Readmission rates in pilot versus nonpilot patients, respectively, were 18% versus 24% (P = 0.547) at 30 days and 27% versus 39% (P = 0.296) at 90 days. The composite outcome of a readmission or ED visit in pilot versus nonpilot patients was 24% versus 30% (P = 0.580) at 30 days and 36% versus 49% (P = 0.319) at 90 days. Conclusion A pharmacist-led TOC pilot demonstrates potential for reducing hospital readmissions. The intervention was time intensive and led to creation of a TOC pharmacist role to implement medication-related transitional care.

Background Neurodevelopmental learning and attentional disorders (NLAD) such as dyslexia, dyscalculia and attention deficit hyperactivity disorder (ADHD) affect at least 6% of the adult population or more. They are associated with atypical cognitive patterns in early and adult life. The cognitive patterns of affected individuals in late life have never been described. One main challenge is detecting individuals in clinical settings during which mild cognitive changes could be confounding the clinical presentation. This is a critical research gap because these conditions interact, across the life course, with an individual’s risk for dementia. Also, learning disabilities which present in childhood pose persistent cognitive differences in areas involving executive function, reading and math. Clinicians lack tools to detect undiagnosed neurodevelopmental in adults with memory disorders. The majority of patients presenting at memory clinics today come from a generation during which NLAD were not yet clinically recognized. In this study, we hypothesized that a self-report scale can detect NLAD in a memory clinic population. Methods We developed a self-report, retrospective childhood cognitive questionnaire including key attributes adapted from prior validated measures. 233 participants were included in the primary analysis. Results Confirmatory Factor Analysis resulted in a best-fit model with six labelled factors (Math, Language, Attention, Working Memory, Sequential Processing, and Executive Function) and 15 total question items. The model demonstrated unidimensionality, reliability, convergent validity, discriminant validity, and predictive validity. Using 1.5 standard deviations as the cut-off, subjects were categorized into: Normal (n = 169), Language (n = 10), Math (n = 12), Attention (n = 10) or Other/Mixed (n = 32). Conclusion A self-report measure can be a useful tool to elicit childhood cognitive susceptibilities in various domains that could represent NLAD among patients in a memory clinic setting, even in the presence of mild cognitive impairment.

University of Tennessee, Knoxville and eCareerFit.Com, Knoxville, TN 37996, USA. jlounsbury@utk.edu University of Tennessee, Knoxville, TN 37996, USA. nfoster3@utk.edu University of Tennessee, Knoxville, TN 37996, USA. hpatel21@utk.edu University of Tennessee, Knoxville, TN 37996, USA. pcarmody@utk.edu Resource Associates and eCareerFit.Com, Knoxville, TN 37920, USA. lucygibson@resourceassociates.com University of Tennessee, Knoxville, TN 37996, USA. drstairs@att.net

Drawing on Holland's vocational theory, Schneider's Attraction-Selection-Attrition model, and the Big Five/narrow traits model of personality, the present study identified key Big Five and narrow personality traits that both distinguish scientists from members of other occupations and related these to their career satisfaction. A sample of 2,015 scientists had significantly higher levels of openness, intrinsic motivation, and tough-mindedness, and significantly lower levels of assertiveness, conscientiousness, emotional stability, extraversion, optimism, and visionary style than a sample of nonscientists (n = 78,753). Seven traits were significantly correlated with the career satisfaction of scientists: agreeableness/teamwork, assertiveness, emotional stability, extraversion, openness, optimism, and work drive. Based on these results, a psychological profile of scientists was presented. Findings were discussed in terms of the functional value and person–occupation fit of these traits for the work of scientists. Implications were described for the recruitment, selection, management, and promotion of scientists, as well as their training, development, coaching, counseling, and mentoring.

Background: The purpose of the study was to determine the prevalence of oral squamous cell carcinoma (OSCC) at specific anatomic sites or within specific age or gender groups and the correlation between various forms of tobacco usage in South Gujarat population. Methodology: The study covers the period from January 2016 to January 2018. OSCC cases who reported to the Bharat Cancer Hospital and Research Centre, Saroli, Surat, Gujarat, were analyzed for age, sex, site, and habits. The findings were formulated to chart the prevalence in South Gujarat population. Results: The study revealed that males represented a higher proportion than females, i.e., 79% of males and 21% of females, with the highest incidence of OSCC developing in the fourth and fifth decades of life, whereas recently a shift was also observed in terms of age group as 23 patients were falling into younger age group (20–30 years), which is an alarming factor. Overall, the most common site was buccal mucosa followed by tongue and lower alveolus. Smokeless tobacco habit was more prevalent than smoking tobacco habit. Conclusion: Close follow-up and education about the harmful and carcinogenic effects of tobacco and alcohol should be provided on a larger scale and broader population.

BACKGROUND: Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and risk factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia.METHODS: We did an international, multicentre study of community-dwelling, adult patients admitted to hospital with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investigators from 222 hospitals in 54 countries to gather point-prevalence data for all patients admitted with these characteristics during 4 days randomly selected during the months of March, April, May, and June in 2015. We assessed prevalence of MRSA pneumonia and associated risk factors through logistic regression analysis.FINDINGS: 3702 patients hospitalised with pneumonia were enrolled, with 3193 patients receiving microbiological tests within 24 h of admission, forming the patient population. 1173 (37%) had at least one pathogen isolated (culture-positive population). The overall prevalence of confirmed MRSA pneumonia was 3·0% (n=95), with differing prevalence between continents and countries. Three risk factors were independently associated with MRSA pneumonia: previous MRSA infection or colonisation (odds ratio 6·21, 95% CI 3·25-11·85), recurrent skin infections (2·87, 1·10-7·45), and severe pneumonia disease (2·39, 1·55-3·68).INTERPRETATION: This multicountry study shows low prevalence of MRSA pneumonia and specific MRSA risk factors among community-dwelling patients hospitalised with pneumonia.FUNDING: None.

Hydraulic fracture stimulation and proppant placement increases well deliverability for shale gas reservoirs. Microseismic data, as well as completion and production diagnostics, were used to analyze the hydraulic fracture behavior of a horizontal well in the Eagle Ford Shale. The objective of this study was to understand the appropriate wellbore spacing between two wells, and the impact that a clay-rich layer, a potential fracture barr ier between two intervals, has on the slick water single-well completion method. Based on production data, the analysis described in the following sections sh ows that propped fracture half-lengths for adjacent horizontal wells is likely less than 660 feet. The microseismic results, as well as chemical fluid tracer results, suggest a larger half-length than indicated by the production data. The difference in the results suggests that the stimulated rock volume (SRV) calculated from microseismic data is not a direc t indicator of the actual drainage area of a horizontal well. The SRV may represent the volume associated with hydr aulic and/or natural fracture networks stimulated by completion fluid, and it is not a good indicator of where the proppant has been placed. Also, it was determined that there may not be a fracture barrier between t he two intervals in the Eagle Ford Shale. For the vertical well, results from the hydraulic fracture model, microseism ic data, chemical fluid tracers, and production data show that there is pressure communication between the two intervals that are separated by a clay barrier.

Background: Oral health professionals can play a vital role in battling tobacco epidemic. Hence, the current study is carried out with an objective to assess the perception and attitudes of dental professionals in Gujarat toward deaddiction services as an integral part of oral health. Methods: A pretested semi-structured questionnaire prepared with Google form was mailed to 400 dental surgeons of Gujarat state for online survey over a period of 7 months. The form was filled up by them after taking their consent. Results: Majority (96.7%) of the responding dental surgeons thought they have a leading role as a life saver for addicted patients before psychiatrist, and many (89%) of them were interested in counseling patients to quit tobacco but relatively few (59.8%) of them were actively involved in tobacco cessation counseling activities, and only 38.2% dentists refer these addictives to psychiatrists. Conclusion: Although majority of dental professionals perceived and showed a positive attitude in the role of tobacco cessation/deaddiction services but very few of them translated their attitude into practice. Being professionally respected and popularly revered, there is an urgent need that dental personnel should spearhead a national anti-tobacco crusade by delivering tobacco cessation deaddictive services in their regular preventive and therapeutic treatment modalities.

Introduction: Oral health and diseases receive little concern in India though their consequences affect the body as a whole. A prerequisite of progress towards optimal oral health is to understand where we stand today. So present study was carried out to evaluate oral hygiene awareness and associate barriers to avail oral health curative services among cross section of patients attending our centre. Materials and Methods: 276 subjects who gave informed consent were included out of 300 in this cross sectional study conducted at dental trust hospital, in Bhavnagar, Gujarat. A pretested, semi structured, self-administered questionnaire was given to each of the participant. Data so collected was calculated in terms of percentages and proportions. Results: 261 (94.5%) subjects were of the view that oral hygiene is mandatory for overall health of the body, whereas hundred ninety-five (70.7%) of the subjects visited a dentist only for symptomatic reasons. 216 (78.3%) of the subjects cleaned their teeth only once in a day and reasons for not brushing teeth twice were being lazy, tired and forgetfulness as mentioned by them. Having no serious dental problem and expensive dental treatment were marked as the major barriers in receiving oral health care services and regular visit to dentist. Conclusion: This study illustrates the peoples’ neglective attitude towards their own oral health. Although majority of the respondents were aware about the necessity to maintain oral hygiene, very few of them translated it into practice. People need to be motivated for positive oral health care seeking behaviour through various campaigns and educational interventions. Key Words: Awareness, Practices, Oral hygiene, Dental health, Gujarat

Lesson Our case highlights the difficulty of diagnosing and managing surgical pathology during the advanced stages of pregnancy.