Assessing stimulus preference using response force in a conjugate preparation: A replication and extension.

The current study examined 98 participants' preferences for five pictorial stimuli. The researchers used a verbal multiple-stimulus-without-replacement (VMSWO) preference assessment with each participant to identify high-preference and low-preference pictorial stimuli. Next, participants viewed each pictorial stimulus in a randomized order on a computer while using a hand dynamometer that measured the amount of force they exerted to increase or maintain the visual clarity of each image. The results indicate that over 75% of participants' force response ranks corresponded with participants' VMSWO high-preference stimuli, VMSWO low-preference stimuli, or both. The results of the current study provide further evidence for the use of conjugate schedules in the assessment of stimulus preference with potential for use as a reinforcer assessment. Implications along with directions for future research and limitations of the findings are discussed.

Evaluating the network adequacy of vision care services for children in Arizona: A cross sectional study.

Background: Vision challenges are among the most prevalent disabling conditions in childhood, affecting up to 28% of school-age children. These issues can impact the development, learning, and literacy skills of affected children. While vision problems are correctable with timely diagnosis and treatment, insufficient networks can impede children's access to comprehensive, and high-quality care. Objective: The study aims to determine where pediatric vision care network adequacy exists in the state of Arizona and where there are gaps in receiving vision care for children. Methods: This cross-sectional study assessed the adequacy of pediatric vision care networks in Arizona through a "secret shopper" phone survey. Calls were made to practices that accept Arizona's Medicaid program, Arizona Health Care Cost Containment System (AHCCCS) and/or commercial insurance. Providers were contacted following a standardized script to schedule routine appointments on behalf of 10 and 3-year-old patients enrolled in either Medicaid or commercial health insurance plans. The study examined various components of children's access to vision care services, including the reliability of provider directory information, time until the next available appointment, bilingual service offerings, ages served, region of practice and types of care available. Results: A total of 556 practices in Arizona were evaluated through simulations as patients on AHCCCS, and 510 practices were assessed through simulations as patients with commercial health insurance plans. The average wait time for the next available appointment was 13 days for both insurance types. Alarmingly, up to 74% of vision care practices in Arizona do not serve children covered by AHCCCS. Furthermore, only 41% provide services to children 5 years and younger. Conclusions: Our findings underscore the need to improve access to vision care services for children in Arizona, especially racial/ethnic minorities, low-income groups, and rural residents.

Case report: Dendritic cell-cytokine induced killer cell therapy in subjects with chronic lymphocytic leukemia and peritoneal cancer.

This study aimed to characterize the safety and efficacy of DC-CIK therapy in two patients with previously treated chronic lymphocytic leukemia or peritoneal cancer, respectively. Participants had received conventional chemotherapy treatment for their specific cancers, and in addition, 1-2 treatments of DC-CIK therapy were administered to subjects over the course of 1 year. Subject A received an initial dosage of 3 intravenous infusions of DC-CIK therapy on three successive days and a repeat dosage 6 months later. Subject B received an initial dosage of 3 intravenous infusions of DC-CIK therapy on three successive days and received further chemotherapy after approximately 1 year. No treatment-related adverse events were reported, and both patients experienced favorable outcomes from the treatment, including enhanced treatment response, increased chemotherapy tolerance, and prolonged survival in comparison to typical 5-year survival rates.

SOX9-positive pituitary stem cells differ according to their position in the gland and maintenance of their progeny depends on context.

Stem cell (SC) differentiation and maintenance of resultant progeny underlie cell turnover in many organs, but it is difficult to pinpoint the contribution of either process. In the pituitary, a central regulator of endocrine axes, adult SCs undergo activation after target organ ablation, providing a well-characterized paradigm to study an adaptative response in a multi-organ system. Here, we used single-cell technologies to characterize SC heterogeneity and mobilization together with lineage tracing. We show that SC differentiation occurs more frequently than thought previously. In adaptative conditions, differentiation increases and is more diverse than demonstrated by the lineage tracing experiments. Detailed examination of SC progeny suggests that maintenance of selected nascent cells underlies SC output, highlighting a trophic role for the microenvironment. Analyses of cell trajectories further predict pathways and potential regulators. Our model provides a valuable system to study the influence of evolving states on the mechanisms of SC mobilization.

Predicting alternate light absorption in areas of trauma based on degree of skin pigmentation: Not all wavelengths are equal.

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n = 2777, 11.2%; 450 nm: n = 2747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n = 2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

Predictors for Telephone Outreach Post-hospital Discharge.

PURPOSE OF STUDY: The specific aims of this study were to examine whether sociodemographic variables and medical-surgical diagnoses were associated with telephone follow-up (TFU) reach rates, emergency department visits, and hospital readmissions. PRIMARY PRACTICE OF SETTING: Acute care inpatient units in an academic medical center. METHODOLOGY AND SAMPLE: A correlational design was utilized, and a prospective medical record review of patients was conducted while implementing face-to-face prehospital discharge meeting interventions. The study sample (N = 176) included adult patients in two neurosurgical wards who were admitted between June 2016 and September 2016. Parametric and nonparametric tests were used to explore the balance between the intervention group receiving a face-to-face prehospital discharge meeting and comparison group receiving standard prehospital discharge care. Bivariate statistics were employed to determine associations between variables. RESULTS: A total of 15 sociodemographic and medical-surgical variables were used to correlate TFU reach rates, emergency department (ED) visits, and readmission rates. Educational attainment (p = .002), employment status (p = .014), parental status (p = .010), and hospital service (p = .039) had significant differences between the intervention and comparison groups. Results demonstrated an improved reach rate for the intervention group but despite the differences in the groups, phi and Cramer's V coefficients did not correlate any associations with TFU reach rate, ED visits, and readmission rates with sociodemographic and surgical variables. This outcome affirmed that despite the similarities and differences in the sample, a face-to-face meeting prehospital discharge is an effective intervention to improve telephone outreach. IMPLICATIONS TO CASE MANAGEMENT PRACTICE: There is a need to determine the most cost-effective way to increase TFU reach rates to prevent subsequent ED visits and hospital readmissions. There is also a need to develop a tool that can predict the hardest-to-reach patients posthospital discharge, so that case managers can meet those patients before leaving the hospital. In addition, it is important to identify alternative methods of "face-to-face" interactions during the COVID-19 pandemic crises. Case managers must explore ways with caution to leverage secured digital technology to bridge the gap of communicating with patients and family members when hospital visitations are limited.

Hook of Hamate Fractures in Major and Minor League Baseball Players.

PURPOSE: The purpose of this study was to describe an approach to surgical management of the hook of hamate fractures in professional baseball players. METHODS: A retrospective chart review was performed on Major and Minor League Baseball players who underwent surgical excision for the hook of hamate fracture between the years 2003 and 2019 by a single surgeon. Patient demographics, the mechanism and timing of the injury, diagnostic and operative details, postoperative complications, and timeline to return to baseball activities were recorded. RESULTS: A total of 145 professional baseball players affiliated with 17 Major League Baseball organizations were studied, with the majority of athletes playing at the Minor League Baseball level (91.7%). Subacute or chronic patterns of injury (81.7%) were found to be more common than acute patterns based on radiographic and intraoperative findings. Two patients reported transient numbness in the fourth and fifth digits after surgery, 6 patients reported pisotriquetral pain when returning to a hitting program, and 1 patient developed heterotopic ossification after surgery. All complications resolved during a strength and conditioning program. On average, players in our cohort began a hitting program at 4.6 weeks after surgery and were released into full baseball activities at 7.1 weeks after surgery. CONCLUSIONS: Surgical excision remains an effective method of management, with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Level IV.

The calcium binding protein S100ß marks hedgehog-responsive resident vascular stem cells within vascular lesions.

A hallmark of subclinical atherosclerosis is the accumulation of vascular smooth muscle cell (SMC)-like cells leading to intimal thickening. While medial SMCs contribute, the participation of hedgehog-responsive resident vascular stem cells (vSCs) to lesion formation remains unclear. Using transgenic eGFP mice and genetic lineage tracing of S100ß vSCs in vivo, we identified S100ß/Sca1 cells derived from a S100ß non-SMC parent population within lesions that co-localise with smooth muscle α-actin (SMA) cells following iatrogenic flow restriction, an effect attenuated following hedgehog inhibition with the smoothened inhibitor, cyclopamine. In vitro, S100ß/Sca1 cells isolated from atheroprone regions of the mouse aorta expressed hedgehog signalling components, acquired the di-methylation of histone 3 lysine 4 (H3K4me2) stable SMC epigenetic mark at the Myh11 locus and underwent myogenic differentiation in response to recombinant sonic hedgehog (SHh). Both S100ß and PTCH1 cells were present in human vessels while S100ß cells were enriched in arteriosclerotic lesions. Recombinant SHh promoted myogenic differentiation of human induced pluripotent stem cell-derived S100ß neuroectoderm progenitors in vitro. We conclude that hedgehog-responsive S100ß vSCs contribute to lesion formation and support targeting hedgehog signalling to treat subclinical arteriosclerosis.

"Reclaiming Control" Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault.

Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients (N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.

Quantifying the Degree of Bruise Visibility Observed Under White Light and an Alternate Light Source.

BACKGROUND: Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS). METHODS: Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales. RESULTS: Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values. IMPLICATIONS FOR PRACTICE: Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.

Alternate Light Source Findings of Common Topical Cosmetics and Three Removal Methods.

INTRODUCTION: Alternate light sources (ALSs) are a tool used by forensic nurses to aid in the physical examination of patients. Prior research has shown some topical makeup products absorb alternate light similar to the absorption noted in bruises. Therefore, the purposes of this study were (a) to further examine the ALS findings of multiple brands and types of makeup products and (b) to compare the efficacy of three methods of makeup removal. METHODS: Fourteen makeup products were applied to the forearms of 100 healthy adult volunteers with varying skin tones and then assessed under white light, six alternate light wavelengths, and three color filters, producing 19 total wavelength-and-filter combinations. The results were recorded before and after removal procedures by forensic nurse examiners who were blinded to the removal method. A three-arm randomized controlled trial of makeup removal methods (soap and water, isopropyl alcohol swab, makeup removal wipe) was conducted with the participants. RESULTS: All 14 makeup products produced absorption in at least 10% of the observations. Fluorescence was observed in more than 10% of the observations for only two products. After product removal, four products continued to produce statistically significant absorption findings when viewed under an ALS. One product produced significant fluorescence after removal procedures. There were no statistically significant differences between the removal methods noted in any of these analyses. CONCLUSION: Our findings support the importance of using alternate light as one component of a comprehensive forensic examination, including history taking and physical examination.

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial.

Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350-535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35-6.56; 450 nm: OR = 4.08, 95% CI: 3.36-4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37-3.70; fat: OR = 1.21, 95% CI: 1.09-1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.

Face-to-Face Meetings with Neurosurgical Patients Before Hospital Discharge: Impact on Telephone Outreach, Emergency Department Visits, and Hospital Readmissions.

The Johns Hopkins Community Health Partnerships (JCHiP) was developed in 2010 within the Johns Hopkins Health Systems. As part of JCHiP, the Patient Access Line call center was created. The average telephone reach rate at The Johns Hopkins Hospital in 2014 was only 53%. In a population of adult neurosurgical patients, this study aimed to: determine the impact of face-to-face meetings with neurosurgical patients before hospital discharge on telephone follow-up (TFU) reach rates, and determine the association between TFU reach rates and subsequent emergency department (ED) visits and hospital readmission rates. This quasi-experimental study used a posttest-only research design with a comparison group. Two adult inpatient neurosurgical units at the Johns Hopkins Hospital were selected as the intervention and comparison groups. A convenience sampling technique was used. Face-to-face meetings pre hospital discharge resulted in a TFU reach rate of 97.7% on the intervention unit while the comparison unit had only a 76.1% TFU reach rate (P < .001). Reached patients had fewer ED visits (7.8%) than not reached patients (17.4%); however, the difference was not statistically significant (P = .138). Reached patients also had fewer hospital readmissions (3.3%) than not reached patients (8.7%); this also was not statistically significant (P = .214). This study demonstrated that face-to-face meetings with neurosurgical patients prior to discharge increased TFU rates. Results were statistically significant. ED visits and hospital readmissions were also reduced in reached patients and the findings were clinically significant.

The Best Practice for Increasing Telephone Outreach: An Integrative Review.

PURPOSE OF STUDY: Many hospitals established telephone follow-up (TFU) programs to improve care transitions and reduce hospital readmissions. However, there is a lack of knowledge on how to increase the outreach of TFU programs. This integrative review aims to answer the clinical practice question, "What is the best practice for increasing telephone follow-up reach rates post-hospital discharge?" PRIMARY PRACTICE SETTING: The primary setting evaluated in this review was hospital-based phone call programs that are conducting post-hospital discharge TFU. METHODOLOGY: In this integrative review, we searched studies published between January 2003 and November 2017. We searched 5 electronic databases including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane. The Johns Hopkins Nursing Evidence-Based Practice model was used to critically analyze and synthesize the selected articles. RESULTS: Nine articles were reviewed, and this study uncovered that pre-hospital face-to-face meeting might increase TFU reach rates. However, most studies calculated reach rates using only frequencies/percentages. This contributed to our low-quality rating on most of the reviewed studies. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This review identified that TFU, as a component of a care coordination program, may reduce hospital readmissions and control health care utilization. However, few studies (n = 2) used TFU reach rates as a major study outcome to determine the impact of face-to-face meetings on phone outreach. Therefore, the evidence is limited to inform case management practice to increase phone outreach post-hospital discharge. It is recommended to conduct further research and test different methods that may increase phone outreach.