Topical negative pressure wound therapy to prevent wound complications following caesarean delivery in high-risk obstetric patients: A randomised controlled trial.

BACKGROUND AND AIMS: We investigated whether the use of a prophylactic negative pressure wound therapy (NPWT) system in women undergoing caesarean would decrease wound complications in a high-risk population. MATERIALS AND METHODS: A randomised controlled trial was performed. Women with risk factors for wound complications undergoing caesarean delivery were randomised to a standard dressing or NPWT placed over their caesarean wound. We standardised the closure of the subcutaneous fat and skin layers, both with Vicryl. Patients were followed for wound complications for up to 6 weeks after their caesareans. The incidence of wound complications was the primary outcome. The single-use NPWT system, PICO, was provided by Smith and Nephew for use in this trial. The trial was registered on clinicaltrials.gov, # NCT03082664. RESULTS: We report here on 154 women randomised to either a standard dressing or to the NPWT. Wound complication rates were equivalent between groups, with 19.4 and 19.7% (P = 0.43) of women with follow-up information available experiencing wound complications. CONCLUSION: We found no difference in wound complications in women with risk factors treated with a prophylactic NPWT system or standard wound dressing at the time of caesarean birth.

Trapped by a first hypothesis: How rudeness leads to anchoring.

In this article we explore the effect of encounters with rudeness on the tendency to engage in anchoring, one of the most robust and widespread cognitive biases. Integrating the self-immersion framework with the selective accessibility model (SAM), we propose that rudeness-induced negative arousal will narrow individuals' perspectives in a way that will make anchoring more likely. Additionally, we posit that perspective taking and information elaboration will attenuate the effect of rudeness on both negative arousal and subsequent anchoring. Across four experimental studies, we test the impact of exposure to rudeness on anchoring as manifested in a variety of tasks (medical diagnosis, judgment tasks, and negotiation). In a pilot study, we find that rudeness is associated with anchoring among a group of medical students making a medical diagnosis. In Study 1, we show that negative arousal mediates the effect of rudeness on anchoring among medical residents treating a patient, and that perspective taking moderates these effects. Study 2 replicates the results of Study 1 using a common anchoring task, and Study 3 builds on these results by replicating them in a negotiation setting and testing information elaboration as a boundary condition. Across the four studies, we find consistent evidence that rudeness-induced negative arousal leads to anchoring, and that these effects can be mitigated by perspective taking and information elaboration. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Emirates Mars Mission (EMM) Emirates Mars InfraRed Spectrometer (EMIRS) Instrument.

The Emirates Mars Mission Emirates Mars Infrared Spectrometer (EMIRS) will provide remote measurements of the martian surface and lower atmosphere in order to better characterize the geographic and diurnal variability of key constituents (water ice, water vapor, and dust) along with temperature profiles on sub-seasonal timescales. EMIRS is a FTIR spectrometer covering the range from 6.0-100+ µm (1666-100 cm-1) with a spectral sampling as high as 5 cm-1 and a 5.4-mrad IFOV and a 32.5×32.5 mrad FOV. The EMIRS optical path includes a flat 45° pointing mirror to enable one degree of freedom and has a +/- 60° clear aperture around the nadir position which is fed to a 17.78-cm diameter Cassegrain telescope. The collected light is then fed to a flat-plate based Michelson moving mirror mounted on a dual linear voice-coil motor assembly. An array of deuterated L-alanine doped triglycine sulfate (DLaTGS) pyroelectric detectors are used to sample the interferogram every 2 or 4 seconds (depending on the spectral sampling selected). A single 0.846 µm laser diode is used in a metrology interferometer to provide interferometer positional control, sampled at 40 kHz (controlled at 5 kHz) and infrared signal sampled at 625 Hz. The EMIRS beamsplitter is a 60-mm diameter, 1-mm thick 1-arcsecond wedged chemical vapor deposited diamond with an antireflection microstructure to minimize first surface reflection. EMIRS relies on an instrumented internal v-groove blackbody target for a full-aperture radiometric calibration. The radiometric precision of a single spectrum (in 5 cm-1 mode) is <3.0×10-8 W cm-2 sr-1/cm-1 between 300 and 1350 cm-1 over instrument operational temperatures (<∼0.5 K NE Δ T @ 250 K). The absolute integrated radiance error is < 2% for scene temperatures ranging from 200-340 K. The overall EMIRS envelope size is 52.9×37.5×34.6 cm and the mass is 14.72 kg including the interface adapter plate. The average operational power consumption is 22.2 W, and the standby power consumption is 18.6 W with a 5.7 W thermostatically limited, always-on operational heater. EMIRS was developed by Arizona State University and Northern Arizona University in collaboration with the Mohammed bin Rashid Space Centre with Arizona Space Technologies developing the electronics. EMIRS was integrated, tested and radiometrically calibrated at Arizona State University, Tempe, AZ.

A systematic approach to chronic abnormal uterine bleeding.

The care you provide to women of childbearing age who are bleeding gets an assist from an established classification system of 9 causes and a range of therapies.

Cervical Funneling: Potential Pitfall of Point-of-Care Pelvic Ultrasound.

Though point-of-care ultrasound applications continue to expand, there are findings that are not within the scope of emergency ultrasound. It is important for emergency physicians to be aware of incidental findings that can be identified on comprehensive ultrasounds performed by other imaging departments in order to fully understand the limitations of bedside ultrasound. In this case, a gravid patient presented to the emergency department with pelvic cramping and vaginal bleeding. Point-of-care transabdominal pelvic ultrasound examination was performed and demonstrated cervical funneling. In the appropriate patient, cervical insufficiency due to cervical funneling may be an indication for cerclage in a pregnant patient.

Managing the Complex Issues of Pediatric Nonaccidental Trauma: A Simulation-Based Case of a Critically Injured Child.

INTRODUCTION: Trainees generally have insufficient training in managing critically ill and injured pediatric patients due to limited exposure to such patients. Patient simulation experiences allow trainees to learn management skills needed in such a crisis. Herein, we describe a case regarding a critically injured pediatric patient. This case requires trainees to use teamwork skills, medical knowledge, and technical skills to manage the patient. METHODS: We developed a team-based simulation regarding the resuscitation of a critically injured child-a toddler with multiple injuries, all requiring emergent care. The case was developed for senior medical students and residents and can be completed in a single 1-hour session, including a debriefing period. We also address psychosocial issues of managing a critically injured child by having the mother and her boyfriend present for part of the case. The team must address the underlying issue of suspected nonaccidental trauma while managing a medical resuscitation. RESULTS: We have performed this scenario with a cohort of 100 trainees. Through direct observations, all teams have been able to manage the patient successfully. The average response to the effectiveness of the case in terms of developing pediatric resuscitation skills was very positive, with scores of 6.7 on a scale of 1 to 7. DISCUSSION: Medical simulation has been demonstrated to be a valuable tool for assessing the knowledge and skills of trainees. This pediatric simulation improved learners' general understanding of managing a pediatric resuscitation. Accordingly, this case has been incorporated as part of resident and medical student training.

Hyperkalemic Arrest: Developing Team Cognition.

INTRODUCTION: Critical events are frequently managed by individuals with different skill sets, funds of knowledge, and experiences who form ad hoc teams on a daily basis without any previous practice together. Such groups' spontaneity of formation puts a premium on individuals' ability to understand team cognition and work together. Team cognition can be thought of as an analogue of individual cognition and is revealed during functional interactions of team members working interdependently on a shared goal. This simulation helps trainees develop and practice team-training skills in order to better form ad hoc teams and manage critical events. METHODS: This simulation can be applied to senior medical students and residents and focuses on the management of an accidental administration of potassium leading to hyperkalemic arrest. The simulation takes 10 minutes to complete and, when coupled with a debriefing session, can be accomplished in under 45 minutes. RESULTS: Twenty-two trainees, consisting of five teams of four to five residents, participated in this simulation. Each team showed varying levels of team cognition, and most successfully managed the hyperkalemic arrest; both of these points were reviewed at length during the debriefing. The trainees gave the simulation high ratings in terms of its effectiveness for team training, with a score of 6.7 on a scale of 1-7. DISCUSSION: Medical simulations have been very productive in providing learners with opportunities to manage critical events. With the exploding practice of interdisciplinary medicine, we believe simulation-based training should be implemented to develop team cognition and practice team training.

Aortic Surgery and Deep-Hypothermic Circulatory Arrest: Anesthetic Update.

Aortic arch surgery has become increasingly complex, and novel surgical approaches have been utilized. Efforts aimed at improving neurological outcomes in this patient population have been numerous, with varying degrees of success. This article summarizes the anesthetic considerations for procedures on the aortic arch, including evidence-based outcomes with respect to temperature management, perfusion strategies, hemodynamic goals, adjunct agents, and neuromonitoring.

Isosulfan Blue Dye Anaphylaxis Presenting as Impaired Ability to Ventilate via a Laryngeal Mask Airway.

A 44-year-old woman presented for sentinel node biopsy and segmental mastectomy. After anesthetic induction, a laryngeal mask airway was placed, and ventilation was satisfactory. Three minutes after isosulfan blue dye injection, ventilation became difficult. The laryngeal mask airway was removed, and an endotracheal tube was easily placed. Twenty minutes later, she became hypotensive and unresponsive to phenylephrine, ephedrine, and vasopressin. With erythema and swelling in her arm and chest, low-dose epinephrine was titrated until her mean arterial blood pressure stabilized. Serum tryptase was increased to 27.2 µg/L (normal 0.4-10.9 µg/L).

Obstacles encountered in developing an adult congenital heart disease program.

More adults than children are now living in the United States with congenital heart disease (CHD). To accommodate the needs of this burgeoning population, there are an increasing number of centers providing care for adults with CHD. We sought to identify pertinent obstacles encountered in the development of a newly established adult CHD program. A survey regarding CHD knowledge, insurance, and cardiovascular counseling was provided to new clinic patients aged ≥18 years. Crosstab correlations were performed to identify relations among categorical variables. Of 145 subjects (54% women; mean age 31 ± 11 years), 84% had at least moderately complex CHD. Household income was <$40,000 for 51% of subjects. There were a significantly greater number of adults, aged 30 to 54 years, with public insurance compared with the national average (p = 0.005). Of 83% of subjects reporting CHD knowledge, 71% correctly identified their defect. Self-reported CHD knowledge correlated positively with higher education (p = 0.019), higher income (p = 0.036), health maintenance organization or preferred provider organization insurance (p = 0.01), and higher level of CHD complexity (p = 0.012); however, none of these factors significantly affected correct identification of one's CHD. In fact, patients with the most complex disease were the least likely to correctly identify their defects. In general, cardiovascular and sexual health screening was lacking. In conclusion, adult patients with CHD require robust ancillary services and special attention to lifelong insurance and counseling. Implementation of a health-care strategy to identify patients' needs can help to overcome socioeconomic obstacles and contribute to the success of the newly established adult CHD program.

Microbial composition affects the functioning of estuarine sediments.

Although microorganisms largely drive many ecosystem processes, the relationship between microbial composition and their functioning remains unclear. To tease apart the effects of composition and the environment directly, microbial composition must be manipulated and maintained, ideally in a natural ecosystem. In this study, we aimed to test whether variability in microbial composition affects functional processes in a field setting, by reciprocally transplanting riverbed sediments between low- and high-salinity locations along the Nonesuch River (Maine, USA). We placed the sediments into microbial 'cages' to prevent the migration of microorganisms, while allowing the sediments to experience the abiotic conditions of the surroundings. We performed two experiments, short- (1 week) and long-term (7 weeks) reciprocal transplants, after which we assayed a variety of functional processes in the cages. In both experiments, we examined the composition of bacteria generally (targeting the 16S rDNA gene) and sulfate-reducing bacteria (SRB) specifically (targeting the dsrAB gene) using terminal restriction fragment length polymorphism (T-RFLP). In the short-term experiment, sediment processes (CO2 production, CH4 flux, nitrification and enzyme activities) depended on both the sediment's origin (reflecting differences in microbial composition between salt and freshwater sediments) and the surrounding environment. In the long-term experiment, general bacterial composition (but not SRB composition) shifted in response to their new environment, and this composition was significantly correlated with sediment functioning. Further, sediment origin had a diminished effect, relative to the short-term experiment, on sediment processes. Overall, this study provides direct evidence that microbial composition directly affects functional processes in these sediments.

Using learner-centered education to improve fruit and vegetable intake in California WIC participants.

OBJECTIVE: To examine the effectiveness of learner-centered education in conveying the message to change participants' fruit and vegetable consumption. DESIGN: Focus groups were conducted with sites participating in the Finding the Teacher Within (FTW) program and comparison sites 4-6 months after participants attended the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) fruit and vegetable class. SETTING: Six California WIC agencies. PARTICIPANTS: Sixty predominantly Latina mothers with young children, 30 from 3 participating intervention agencies and 30 from 3 comparison agencies, participated in focus groups. Each agency independently recruited mothers for participation. Apart from selecting only mothers, no other exclusion criteria were applied. INTERVENTION: An FTW learner-centered fruit and vegetable class. ANALYSIS: An analytic team independently reviewed transcripts and coded themes. The long-table analytic approach was used to categorize results. Results from intervention and comparison groups were compared and ranked to create a textual summary. RESULTS: The most significant difference between the intervention and comparison groups' reports was that intervention participants identified more value, importance, and relevance of the fruit and vegetable information and adopting new fruit and vegetable practices after attending the class. CONCLUSIONS AND IMPLICATIONS: California WIC demonstrated that messages delivered through this process can be retained and integrated into family life practices.

Nitrogen and phosphorus enrichment alter the composition of ammonia-oxidizing bacteria in salt marsh sediments.

Ammonia oxidation is a central process in the nitrogen cycle. Particularly in marine and estuarine environments, few experiments have been conducted to tease apart the factors influencing their abundance and composition. To investigate the effect of nitrogen and phosphorus availability on ammonia-oxidizing bacteria (AOB), we conducted a nutrient enrichment experiment in a Maine salt marsh and sampled sediment communities in three seasons over 2 years. We assessed community composition using terminal restriction fragment length polymorphism analysis and sequencing of cloned fragments of the ammonia monooxygenase (amoA) gene. Almost all of the amoA sequences fell within the marine and estuarine-specific Nitrosospira-like clade. Applied separately, nitrogen and phosphorus significantly altered AOB composition; however, together the nutrients had an interactive effect, and composition did not change. In contrast, nutrient enrichment did not alter AOB abundance. Furthermore, the response of AOB composition to nutrient enrichment varied over time. We conclude that closely related taxa within the marine/estuarine-specific Nitrosospira-like clade vary in their preference for nutrient concentrations, and this preference may depend on other temporally variable abiotic factors. Finally, AOB composition was highly variable within and across years even in untreated plots. Further studies are needed to test how these different aspects of compositional variability in AOB communities influence nitrogen cycling.

B-type natriuretic peptide in the emergency diagnosis of critical heart disease in children.

OBJECTIVE: The initial presentation of congenital and acquired heart disease in children can present a diagnostic challenge. We sought to evaluate B-type natriuretic peptide as a marker of critical heart disease in children at presentation in the acute care setting. METHODS: A cohort of 33 pediatric patients with newly diagnosed congenital or acquired heart disease had B-type natriuretic peptide levels obtained on hospital admission after evaluation in an acute care setting. Patients were admitted from March 2005 through February 2007. A noncardiac cohort of 70 pediatric patients who presented with respiratory or infectious complaints had B-type natriuretic peptide levels obtained during emergency department evaluation. A comparison of B-type natriuretic peptide results was performed. RESULTS: Cardiac diagnoses included cardiomyopathy (14), left-sided obstructive lesions (12), anomalous left coronary artery from the pulmonary artery (4), total anomalous pulmonary venous return (2), and patent ductus arteriosus (1). Cardiac cohort mean age at presentation was 33.6 months. The 33 patients with new cardiac diagnoses had a mean B-type natriuretic peptide level of 3290 pg/mL (SD: +/-1609; range: 521 to >5000 pg/mL). The 70 noncardiac patients' mean age at presentation was 23.1 month, and mean B-type natriuretic peptide level was 17.4 pg/mL (SD: +/-20; range: <5 to 174 pg/mL). CONCLUSIONS: B-type natriuretic peptide levels were markedly elevated at presentation in the acute care setting for all patients in this cohort of children with newly diagnosed congenital or acquired heart disease. B-type natriuretic peptide levels from noncardiac patients were significantly lower, with no overlap to the cardiac disease group. B-type natriuretic peptide level can be useful as a diagnostic marker to aid in the recognition of pediatric critical heart disease in the acute care setting.

Testing the functional significance of microbial composition in natural communities.

Ecologists have long studied the relationship between biotic composition and ecosystem functioning in larger organisms; however, only recently has this relationship been investigated widely in microorganisms. Recent studies are reviewed within a framework of three experimental approaches that are often used to study larger organisms: environmental treatment, common garden, and reciprocal transplant experiments. Although the composition of microorganisms cannot be easily manipulated in the field, applying these approaches to intact microbial communities can begin to tease apart the effects of microbial composition from environmental parameters on ecosystem functioning. The challenges in applying these approaches to microorganisms are highlighted and it is discussed how the experimental approach and duration affects a study's interpretation. In general, long-term environmental treatment experiments identify correlative relationships between microbial composition and ecosystem functioning, whereas short-term common garden experiments demonstrate that microbial composition influences ecosystem functioning. Finally, reciprocal transplants simultaneously test for interactive effects of the environment and composition on functioning. The studies reviewed provide evidence that, at least in some cases, microbial composition influences ecosystem functioning. It is concluded that whole-community experiments offer a way to test whether information about microbial composition will help predict ecosystem responses to global change.

Novel candidate targets of beta-catenin/T-cell factor signaling identified by gene expression profiling of ovarian endometrioid adenocarcinomas.

The activity of beta-catenin (beta-cat), a key component of the Wnt signaling pathway, is deregulated in about 40% of ovarian endometrioid adenocarcinomas (OEAs), usually as a result of CTNNB1 gene mutations. The function of beta-cat in neoplastic transformation is dependent on T-cell factor (TCF) transcription factors, but specific genes activated by the interaction of beta-cat with TCFs in OEAs and other cancers with Wnt pathway defects are largely unclear. As a strategy to identify beta-cat/TCF transcriptional targets likely to contribute to OEA pathogenesis, we used oligonucleotide microarrays to compare gene expression in primary OEAs with mutational defects in beta-cat regulation (n = 11) to OEAs with intact regulation of beta-cat activity (n = 17). Both hierarchical clustering and principal component analysis based on global gene expression distinguished beta-cat-defective tumors from those with intact beta-cat regulation. We identified 81 potential beta-cat/TCF targets by selecting genes with at least 2-fold increased expression in beta-cat-defective versus beta-cat regulation-intact tumors and significance in a t test (P < 0.05). Seven of the 81 genes have been previously reported as Wnt/beta-cat pathway targets (i.e., BMP4, CCND1, CD44, FGF9, EPHB3, MMP7, and MSX2). Differential expression of several known and candidate target genes in the OEAs was confirmed. For the candidate target genes CST1 and EDN3, reporter and chromatin immunoprecipitation assays directly implicated beta-cat and TCF in their regulation. Analysis of presumptive regulatory elements in 67 of the 81 candidate genes for which complete genomic sequence data were available revealed an apparent difference in the location and abundance of consensus TCF-binding sites compared with the patterns seen in control genes. Our findings imply that analysis of gene expression profiling data from primary tumor samples annotated with detailed molecular information may be a powerful approach to identify key downstream targets of signaling pathways defective in cancer cells.