Search

Objective: To analyze the impact of centralization on key metrics, outcomes, and patterns of care at the Irish National Center. Background: Overall survival rates for esophageal cancer in the West have doubled in the last 25 years. An international trend towards centralization may be relevant; however, this model remains controversial, with Ireland centralizing esophageal cancer surgery in 2011. Methods: All patients (n=1245) with adenocarcinoma of the esophagus or junction treated with curative intent involving surgery, including endoscopic surgery, were included (n=461 from 2000 2011, and 784 from 2012 to 2022). All data entry was prospectively recorded. Overall survival was measured (1) for the entire cohort, (2) for patients with locally advanced disease (cT2-3N0-3), and (3) for patients undergoing neoadjuvant therapy. All complications were recorded as per Esophageal Complication Consensus Group definitions, and the Clavien-Dindo severity classification. Data were analyzed using GraphPad Prism (v.6.0) for Windows and SPSS (v.23.0) software (SPSS) R Studio (R version 4.2.2). Survival times were calculated using a log-rank test and Cox regression analysis, and Kaplan-Meier curves were generated. Results: Endotherapy for cT1a/intramucosal cancer adenocarcinoma increased from 40 (9% total) to 245 (31% total) procedures between the pre-centralization and post-centralization (post-C) periods. significantly (P < 0.001) higher proportion of patients with cT2-3N0- disease in the post-C period underwent neoadjuvant therapy (66% 53%). Operative mortality was lower (P=0.02) post-C, at 2% versus 4.5%, and ZIIIa Clavien-Dindo major complications decreased from 33% to 25% (P < 0.01). Recurrence rates were lower post- (38% vs 53%, P < 0.01). Median overall survival was 73.83 versus 47.23 months in the 2012 to 2022 and 2000 to 2011 cohorts, respectively (P < 0.001). For those who received neoadjuvant therapy, the median survival was 28.5 months pre-centralization and 42.5 months post-C (P < 0.001). Conclusions: These data highlight improvements in both operative outcomes and survival from the time of centralization, and a major expansion of endoscopic surgery. Although not providing proof, the study suggests a positive impact of formal centralization with governance on key quality metrics and an evolution in patterns of care. [ABSTRACT FROM AUTHOR]

Presents the reflections of two ninth-grade students as they developed and implemented writing workshops for grade 2 and 3 classrooms. Notes that most of the mini-lessons worked, but some were not as successful. Notes the amazement of the authors regarding the positive relationships with teachers, students, and administrators that came out of the project. (RS)

Abstract Aim To highlight observations on the dilemmas of insider research. Background Researchers in qualitative research have traditionally been thought of as positioned inside or outside the social group being [...]

Background. Self-neglect is an independent risk factor for early mortality in older people and has been linked to depression and the occurrence of mental and physical decline. Sound social networks have been shown to slow the process of decline in the elderly, and currently little is known about the social networks associated with elder self-neglect. The aim of this study was to explore the social networks associated with elder self-neglect compared with a matched-control group. Methods. Ninety-one Adult Protective Services-validated cases of elder self-neglect were compared on formal and informal social network factors with 91 controls matched for age, race, gender, and socio-economic status. Results. Elders in the self-neglect group were significantly less likely to (1) Live with a spouse, (2) Live with others, (3) Have weekly contact with children or siblings, (4) Visit with neighbors and friends and (5) Participate in religious activities. Conclusions. Less adequate social resources related to family, friends, and religious affiliations are significantly associated with elder self-neglect. doi:10.1300/J084v18n04_05 KEYWORDS. Social networks, elder self-neglect, Adult Protective Services

Background: Starting in the 1990s, health care providers began prescribing opioids to patients as pain relievers, believing they were safe. However, many patients became addicted to these pills. In 2017, the US Department of Health and Human Services declared a public health emergency to fight the opioid epidemic. This crisis was prevalent in East Tennessee, where many residents were prescribed opioids. Case Presentation: Librarians at an academic medical center library in East Tennessee analyzed the health information requests related to pain, mental health, and addiction over the last fifteen years. We reviewed the pattern of requests related to these topics, the counties requesting this information, and the impact that these hospital policies had on these requests. Conclusions: From 2005 to 2014, there were few requests about mental health, pain, and substance abuse. However, once the library moved into the hospital and there was an increase in awareness of opioid addiction, requests on those topics increased. Most of the requests were about pain, with the height occurring in 2017, during which year the public health emergency to fight the epidemic was declared. Additionally, 2017 was the year the hospital implemented visitor limitations for patients with infections associated with intravenous drug use, which might explain the drastic drop in substance abuse information requests in 2018. Future outreach will target counties that have a high opioid prescription rate. [ABSTRACT FROM AUTHOR]

Binary nanoparticle superlattices are obtained by self-assembly of two different semiconductor quantum dots. The real structures are formed under a combined influence of entropic driving forces and the surface due to ligand-ligand van der Waals (VDW).