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As the incidence of late preterm births continues to rise, health care providers need to be aware of this population's unique needs. This review focuses on the additional risks late preterm infants encounter related to unconjugated hyperbilirubinemia and the importance of breastfeeding support and follow-up. Additional, population-based studies concentrating on the late preterm infant are needed to determine more clearly the incidence of hyperbilirubinemia, with specific levels documented; incidence of ED visits and rehospitalizations related to hyperbilirubinemia; and incidence of bilirubin neurotoxicity with both short- and long-term follow-up. It is also important to study these outcomes in relation to the nature and degree of risk associated with early discharge, insufficient follow-up, and breastfeeding. Future research is needed to develop evidence-based recommendations for optimal discharge timing, counseling, and postdischarge follow-up of late preterm infants, particularly those who are breastfed, to promote safe patient care. [ABSTRACT FROM AUTHOR]

Background: Leukoreduction software uses conservative algorithms in order to assure with 95% confidence that each plateletpheresis component meets the current American leukoreduction standard. The software may "flag" a component indicating additional testing is required to confirm the residual WBC count. A number of factors not directly related to the WBC count contributes to the flag rate. Study: Our objectives were to calculate the overall flag rate in plateletpheresis components drawn at our blood centers; to verify the percentage of these flagged components that indeed have 35 × 10[sup 6] residual WBCs; to evaluate the cost of retesting the flagged components; and, to estimate costs associated with proposed changes in leukoreduction standards. Residual WBCs in flagged platelet components were quantitated by a flow cytometry method (at an average cost of $35 per test). The average plateletpheresis price used in estimated revenue calculations was a conservative $475 per component. Results: In four consecutive months of operation we collected 9,474 plateletpheresis components; 4.2% of these components were "flagged" by the leukoreduction apheresis software. Quantitative flow cytometry confirmed 93% (372 of 401) of the flagged components had < 1 × 10[sup 6] residual WBCs, 4% (16 of 401) 1 but < 5 × 10[sup 6] residual WBCs, and 3% (13 of 401) 5 × 10[sup 6] residual WBCs per platelet component. In other words, 97% of the flagged plateletpheresis components passed the existing American leukoreduction standard. Extrapolating to a per year basis (401 flags in 4 months x 3 = 1203 flags per year), our blood center spends an additional $42,000 in test costs to determine the number of flagged components that indeed contain 5 × 10[sup 6] residual WBCs. These additional testing costs are independent of routine QC, lot qualification, validation, and expensive maintenance contracts for testing equipment. If both pre-storage (within 72 hour) and universal leukoreduction are mandated, all flagged components would most likely be lost due to process time constraints. Loss of all flagged components would approximate a $571,000+ per year revenue loss in our blood center. Conclusion: Retesting of flagged plateletpheresis components and implementation of proposed leukoreduction mandates are costly. [ABSTRACT FROM AUTHOR]

Background: Unplanned extubation (UE) is an important quality metric in the neonatal ICU that is associated with hypoxia, bradycardia, and risk for airway trauma with emergent re-intubation. Initial efforts to reduce UE in our level 4 neonatal ICU included standardized securement of the endotracheal tube (ETT) and requiring multiple providers to be present for ETT adjustments and patient positioning as phase 1 interventions. After an initial decline, the UE rate plateaued; an internal retrospective review revealed that the odds of UE were 2.9 times higher in the setting of an ETT tip at or above T1 (high ETT) on chest radiograph just prior to UE. The team hypothesized that advancing ETT tips to below T1 would reduce UE risk in infants of all gestational ages., Methods: Over a period of 32 months, we compared pre-intervention and post-intervention UE rates in our neonatal ICU after a 2-step initiative that focused initially on ETT securement and assessment, with a subsequent addition of a single intervention to advance ETT tips below T1. To determine if the decrease in UE rate could be secondary to our intervention, data were analyzed from 3 cohorts: a control group of 40 infants with 185 chest radiographs and no UEs, 46 infants with chest radiographs prior to 58 UE events before the intervention, and 37 infants with chest radiographs prior to 48 UE events following the intervention., Results: Advancing ETT tips below T1, in addition to the use of a standard UE-prevention bundle, led to a significant decrease in the UE rate from 1.23 to 0.91 UEs per 100 ventilator days, with 14% of postintervention UEs attributed to ETT advancement., Conclusions: High ETTs are significantly associated with UEs in the neonatal ICU. Optimizing ETT position may be an underrecognized driver in the provider's toolbox to reduce UEs. Because ETT repositioning carries risk of UE, extra caution should be taken during advancement., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

Reef Check Australia (RCA) has collected data on benthic composition and cover at >70 sites along >1000km of Australia's Queensland coast from 2002 to 2015. This paper quantifies the accuracy, precision and power of RCA benthic composition data, to guide its application and interpretation. A simulation study established that the inherent accuracy of the Reef Check point sampling protocol is high (<±7% error absolute), in the range of estimates of benthic cover from 1% to 50%. A field study at three reef sites indicated that, despite minor observer- and deployment-related biases, the protocol does reliably document moderate ecological changes in coral communities. The error analyses were then used to guide the interpretation of inter-annual variability and long term trends at three study sites in RCA's major 2002-2015 data series for the Queensland coast., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Children and young people require ease of access to their school nurse. Alongside this, school nurses are charged with the need to work smarter, being cost-effective and timely in response. School nursing teams across the country provide access through text messaging, however, there is presently no access provided to young people to have a consultation as a web-based chat facility. Using digital media, Doncaster school nurses have worked closely with young people to redesign and launch a totally interactive web- based clinic facility. This allows for improved access, reduction in travel costs and consultations to take place outside of the traditional times for accessing school nurses. This paper discusses a pilot project around the establishment of an e-clinic connecting young people and school nurses. It outlines the journey towards providing this innovative service in an attempt to provide cost-effective, timely services while reducing the barriers for service users.

Assessing the needs of children, young people and families is a fundamental part of the school nurse's role. This article describes a project in Doncaster that has enabled a partnership working with children, young people, families, school nurses and school staff aimed at providing improved services throughout the primary and secondary school day.

Purpose: A quality controlled mammography screening programme was initiated at the end of 2003 in Bavaria, a region with 12.5 million inhabitants, and transferred over to the national screening programme at the end of 2006. The purpose of this study was to evaluate immediate population-based consequences of mammography screening on breast cancer therapy., Methods: Data from 75 475 breast cancer cases, diagnosed between 2000 and 2008 and registered in one of the 6 Bavarian clinical cancer registries were analysed. 51.4% of these patients were between 50 and 69 years of age and therefore the target population for screening. Trends of prognostic factors and standard therapies were calculated for 3 age groups (≤49 years, 50-69 years, ≥70 years) by means of annual percentages as well as 95%-confidence intervals for the percent difference between 2000 and 2008 (year of diagnosis). For interpretation of therapy trends, logistic regression models were calculated., Results: Therapy trends showed that the increasingly favourable stage distribution may have resulted in the reduction of more radical surgical methods such as mastectomy (2000: 32.6%; 2008: 19.6%) or axillary dissection (89.0% vs. 37.0%), especially for women aged 50-69. An increase of radiation therapies (59.7% vs. 66.6%) can be explained to some extent by the increase in breast conserving surgeries. The shift to more favourable prognostic factors led, in accordance with the guidelines, to an increase of the proportion of singular endocrine therapies (28.5% vs. 40.7%), a decrease of chemotherapies (20.4% vs. 13.1%) and therefore to more gentle systemic therapies overall. These trends strengthened in the years following the introduction of screening, with a simultaneous rise of screening participants in the target population., Conclusion: The introduction of mammography screening in Bavaria has already shown the expected trend towards more favourable prognostic factors. Among other things, this could be a reason for the increasing use of more gentle therapies. Whether the screening in Bavaria leads to a mortality reduction, has to be analysed on the basis of an initial comparison of participation status followed by the trends in mortality thereafter., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: The purpose of this study was to evaluate the clinical outcome of all-arthroscopic repair of degenerative subscapularis tendon tears and post-operative structural integrity using magnetic resonance imaging with a short-term follow-up., Methods: Twenty-one patients were treated all-arthroscopically for a full-thickness degenerative subscapularis tendon tear. Median patient age was 55 years (range, 41-69). Median follow-up was 25 months (range, 15-44). Patients were evaluated prior to surgery and at follow-up: active range of motion, VAS pain, Simple Shoulder Test (SST), and the Disabilities of the Arm, Shoulder, and Hand score (DASH). At final follow-up, the Constant-Murley score was evaluated., Results: Mean active range of motion showed significant post-operative improvement (p < 0.001). VAS pain improved from 8.3 (SD ± 1.3) pre-operatively to 2.7 (SD ± 1.8) post-operatively (<0.001); SST increased from 20 % (SD ± 26) pre-operatively to 83 % (SD ± 27) post-operatively (<0.001); DASH scores improved 67 (SD ± 19) to 18 (SD ± 21) post-operatively (<0.001). Post-operative Constant-Murley score was 79 (SD ± 12). Two patients had failure of the repair on post-operative MRI. Twelve cases (57 %) showed post-operative progression of fatty muscle infiltration., Conclusion: All-arthroscopic repair is an effective treatment modality for degenerative subscapularis tendon tears with an anterosuperior tear pattern with good clinical results and high patient satisfaction. Although there was a high tendon-to-bone healing rate, fatty muscle infiltration was progressive in more than half of the patients., Level of Evidence: Therapeutic case series, Level IV.

Tramp ants are an outstanding group of organisms that have a definitive and important role in carrying pathogens. The purpose of this study was to develop a microbiological sterile technique of collecting ants from contaminated areas. The traps were composed of Petri dishes containing culture media, and were tested to verify the applicability of the system. A positive correlation between the microorganism growth and the presence of ants inside or around traps was observed. The technique described demonstrated to be useful to collect ants from different environments, helping the surveillance of pathogenic microorganisms that are of public health concern.

As the incidence of late preterm births continues to rise, health care providers need to be aware of this population's unique needs. This review focuses on the additional risks late preterm infants encounter related to unconjugated hyperbilirubinemia and the importance of breastfeeding support and follow-up. Additional, population-based studies concentrating on the late preterm infant are needed to determine more clearly the incidence of hyperbilirubinemia, with specific levels documented; incidence of ED visits and rehospitalizations related to hyperbilirubinemia; and incidence of bilirubin neurotoxicity with both short- and long-term follow-up. It is also important to study these outcomes in relation to the nature and degree of risk associated with early discharge, insufficient follow-up, and breastfeeding. Future research is needed to develop evidence-based recommendations for optimal discharge timing, counseling, and postdischarge follow-up of late preterm infants, particularly those who are breastfed, to promote safe patient care.

This paper describes the development of an interdisciplinary, interinstitutional seminar in palliative care for South Dakota students in medicine, nursing, pharmacy, chaplaincy, and social work. Student outcomes from six seminars conducted during 2001-2004 are reported, and recommendations for future educational efforts are outlined.