Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports.

A systematic review was performed to compare adverse maternal and neonatal outcomes among pregnant patients with gunshot wounds (GSW) to the abdominopelvic vs other region(s) at > 20 weeks gestation. A search of Medline Ovid, Elsevier Embase, EBSCO CINAHL, and Cochrane Library in July 2022 and reference searches resulted in 1742 studies, which were screened. The 41 included studies reported outcomes for 59 pregnant patients with GSW, of which 31 (52.5%) had an isolated abdominopelvic GSW and 28 (47.5%) had an extremity, thorax, head/neck, back/spine, poly-site, or other/unknown GSW. Stillbirth occurred in 26.7% of abdominopelvic GSW and 26% of non-abdominopelvic GSW. Maternal death occurred in 3.7% of abdominopelvic GSW and 10.7% of non-abdominopelvic GSW. Neonatal death occurred in 9.1% of abdominopelvic GSW and 5.3% of non-abdominopelvic GSW. Further research is needed to standardize the approach for the evaluation and management of patients with GSW in pregnancy.

Increasing Clinician-Scientist Workforce Diversity through the National Institute of General Medical Sciences' Medical Scientist Training Program.

The National Institute of General Medical Sciences Medical Scientist Training Program (MSTP) has been successful in producing clinician-scientists, with a majority of graduates pursuing research-related careers. However, there are a number of areas of continuing concern for the program. In particular, women and individuals from certain racial and ethnic backgrounds remain persistently underrepresented in MSTPs relative to the average college-aged U.S. population and to students receiving life sciences bachelor's degrees. The authors, who include leaders of NIGMS, identify a number of challenges and opportunities for enhancing diversity, equity and inclusion in the MSTPs and suggest strategies for addressing them.

Point-of-care ultrasound findings in the diagnosis and management of Superior Mesenteric Artery (SMA) syndrome.

Superior mesenteric artery (SMA) syndrome is a potentially fatal condition that can be difficult to diagnose for emergency medicine physicians due to its rarity and vague gastrointestinal symptom presentation. Patients arriving at the emergency department (ED) with this condition may encounter delays in proper supportive care and treatment. We present the case of a 21-year-old female who was seen in the ED for nausea, non-bloody vomiting, and rapid weight loss. Through point-of-care ultrasound (POCUS) findings, she was diagnosed with SMA syndrome and received appropriate, supportive care for her condition before catastrophic complications could occur. This case demonstrates the utility of POCUS in SMA syndrome and the importance of considering this diagnosis despite its rarity.

Developing interagency collaboration to address the opioid epidemic: A scoping review of joint criminal justice and healthcare initiatives.

BACKGROUND: With the current opioid epidemic impacting well over half of all counties across the United States, initiatives that encourage interagency collaboration between first responder organizations appear necessary to comprehensively address this crisis. Police, fire, and emergency medical services (EMS) are in a unique position to identify substance users and provide necessary resources to initiate treatment, yet there is not sufficient evidence of joint collaborative programs between law enforcement/first responders and healthcare providers. METHODS: In this scoping review we examine the current state of joint criminal justice and healthcare interventions, specifically, opioid and substance use pre-arrest initiatives via emergency first responders and police officers. We relied on data from the last 10 years across three major databases to assess the extent of criminal justice (CJ) and healthcare collaborations as a response to individuals with opioid use disorder (OUD). We specifically focused on interventional programs between criminal justice first responders (pre-arrest) and healthcare providers where specific outcomes were documented. RESULTS: We identified only a small number (6) of studies involving interventions that met this criteria, suggesting very limited study of joint interagency collaboration between law enforcement first responders and healthcare providers. Most had small samples, none were in the southern states, and all but one were initiated within the last 5 years. CONCLUSIONS: Although studies describing joint efforts of early intercept criminal justice responses and healthcare interventions were few, existing studies suggest that such programs were effective at improving treatment referral and retention outcomes. Greater resources are needed to encourage criminal justice and healthcare collaboration and policies, making it easier to share data, refer patients, and coordinate care for individuals with OUD.

Using database linkages to measure innovation, commercialization, and survival of small businesses.

Here, we report the results of an outcomes evaluation of the Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Programs at the National Institute of General Medical Sciences (NIGMS). Since the programs' inception, assessments of the SBIR/STTR programs at several federal agencies have utilized surveys of former grantees as the primary source of data. Response rates have typically been low, making non-response bias a potential threat to the validity of some of these studies' results. Meanwhile, the availability of large publicly-available datasets continues to grow and methods of text mining and linking databases continue to improve. By linking NIGMS grant funding records, U.S. Patent and Trademark Office data, and business intelligence databases, we explored innovation, commercialization and survival for recipients of NIGMS SBIR/STTR funding. In doing so, we were able to more completely assess several key outcomes of the NIGMS SBIR/STTR program. Our evaluation demonstrated that the NIGMS program performed above baseline expectations along all dimensions, and comparably to other federal agency SBIR/STTR grant programs. In addition, we show that the use of extant data increasingly is a viable, less expensive, and more reliable approach to gathering data for evaluation studies.

An image-based method to measure joint deformity in inflammatory arthritis: development and pilot study.

Quantifying joint deformity in people with rheumatoid (RA) and psoriatic arthritis (PsA) remains challenging. Here, we demonstrate a new method to measure bone erosions and abnormal periosteal growths, based on the difference between a predicted healthy and actual diseased joint surface. We optimized the method by creating and measuring artificial bone erosions and growths. Then we measured 46 healthy and diseased patient surfaces. We found average sensitivity errors of ≤0.27 mm when measuring artificial erosions and growths. Patients had significantly more bone erosion than healthy subjects. Surface based outcomes are a novel way to interpret and quantify bone changes in PsA and RA.

Transient Secondary Hypothyroidism and Thyroid Hormone Replacement Therapy in Pediatric Postoperative Cardiopulmonary Bypass.

BACKGROUND: To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients. METHODS: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered. RESULTS: 1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), "other" (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing. CONCLUSIONS: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.

Biventricular Repair of Pulmonary Atresia After Fontan Palliation.

Fontan palliation is used when biventricular repair (BVR) is not possible. Early outcomes are acceptable; however, the long-term sequelae include protein-losing enteropathy, declining functional status, increased pulmonary vascular resistance, heart failure, and hepatic and renal dysfunction. These adverse events are characteristic of persistent venous hypertension and may be avoided if restoring biventricular circulation is possible. Arrhythmias are a common adverse event, particularly in patients with an atriopulmonary connection, which may lead to acute decompensation and early death. We describe a 30-year-old woman who underwent successful BVR for pulmonary atresia with intact ventricular septum and demonstrate that where favorable anatomy exists with a failing Fontan, BVR should be considered.

Surgical Treatment of Neonate With Congenital Left Main Coronary Artery Atresia.

Left main coronary artery atresia (LMCAA) is a rare congenital malformation with a nonspecific and varied clinical presentation. Ventricular dysfunction and mitral insufficiency are expected ischemic consequences in the neonatal period. Left internal mammary artery (LIMA) bypass grafting (CABG) is uncommon because of the technical difficulties in performing this procedure in neonates. We describe LMCAA revascularization with a LIMA graft and mitral valve repair in a 7-week-old neonate with successful outcome 1 year postoperatively.

Mental and physical attributes defining world-class Norwegian athletes: content analysis of interviews.

This study reports the results of a content analysis of interviews with 28 Norwegian world-class athletes and 28 controls, matched for gender, age, and type of sport. Semi-structured interviews explored their perceptions of their best performance. The interviews were analyzed using the ATLAS.ti and yielded 20 higher-order codes. Nine higher-order codes were categorized as inner-oriented, five were categorized as outer-oriented, and six were a combination of inner- and outer-oriented. Statistical analysis, using the Mann-Whitney test, showed significant group differences for seven higher-order codes: (a) two outer-oriented codes relating to "mastery--achievements" and "training--outer"; and (b) five inner-oriented codes relating to "mental preparation," "self-reliance," "training--inner," "wholeness," "performance--inner," and "growth orientation." These findings highlight the importance of both inner- and outer-oriented development for high-level achievement in sports--the "mental game" is as important as the physical game, both during training and competitions. Previously published quantitative data reported higher levels of brain integration, faster habitation to a loud tone, and higher ego and moral development in these world-class athletes. These findings are interpreted in light of a Unified Theory of Performance, which proposes that higher mind-brain development provides a basis for higher performance in any activity.

Higher psycho-physiological refinement in world-class Norwegian athletes: brain measures of performance capacity.

This study tested the hypothesis that the degree of psycho-physiological development is related to performance level in world-class athletes. We compared physiological and psychological patterns of 33 Norwegian world-class athletes to patterns in 33 average performing athletes. The subjects were matched for gender, age, and type of sport. Electroencephalography activity was recorded to measure brain integration; skin conductance was recorded to measure habituation to a loud stimulus; and paper-and-pencil tests were given to assess self-development, moral development, and frequency of peak experiences. A factor analysis (varimax rotation) reduced the eight variables to three factors that together accounted for 65.3% of the total variance: (1) physiological integration--brain integration and habituation rates, (2) self- and moral development, and (3) peak experiences. A MANOVA conducted on the factor scores showed a significant main effect for the experimental group collapsing across the three factors (P<0.0001). Individual ANOVAs showed significantly higher values for development (P=0.021) and physiological integration (P<0.0001) factor scores for the world-class athletes. The above measures can be seen as different expressions of an underlying dimension--human development. These data support the concept that higher psycho-physiological growth underlies higher performance.

Sedation, analgesia, and monitoring.

Endoscopic procedures are common and sedation is frequently used to minimize anxiety and discomfort, reduce the potential for physical injury during the procedure, and improve overall patient tolerability and satisfaction. In this article, the authors review the variety of options for sedation and analgesia available to the gastroenterologist or surgical endoscopist.

Evaluation of percutaneous endoscopic feeding tube placement in obese patients.

BACKGROUND: Percutaneous endoscopic feeding tube placement is generally safe and effective for establishing enteral access. In certain subpopulations, such as obese patients, substantial data are limited. This study evaluates the success rate and potential for late complications with placement of feeding tubes in obese patients. METHODS: The Medical University of South Carolina endoscopy database was queried for adult patients with a body mass index >or=30 kg/m(2) who had undergone percutaneous endoscopic gastrostomy, percutaneous endoscopic gastrojejunostomy, and direct percutaneous jejunostomy placement procedures between the years 2000 and 2006. RESULTS: Sixty-seven subjects met the inclusion criteria. Percutaneous endoscopic feeding tube placement was successful in 60 of 67 individuals (89.6%) with an average procedure time of 15.5 minutes (range, 5-70 minutes). Postplacement complications occurred in 26 of 59 subjects (44.1%) and included peristomal pain (8.5%), cellulitis (8.5%), inadvertent removal (6.8%), peritubular leak (6.8%), nausea (3.4%), and hemoperitoneum (3.4%). In multivariable logistic regression analysis, weight >250 pounds (>113 kg) predicted a significantly increased likelihood of complications (adjusted odds ratio = 3.86; 95% confidence interval, 1.02-14.57). Other covariates did not significantly affect the complication rate. CONCLUSIONS: Percutaneous enteral access device placement in obese patients is generally safe, and a body mass index >or=30 kg/m(2) alone should not be a procedural contraindication. Adherence to safe enteral access placement techniques and close periprocedure follow-up should occur in obese patients, especially those weighing >250 pounds (>113 kg). More research is needed to fully evaluate the efficacy of enteral access in this population.

Evaluation of a new technique for endoscopic nasojejunal feeding-tube placement.

OBJECTIVES: Multiple techniques for endoscopic nasojejunal tube (NJT) placement exist. However, poor experience with these techniques has limited more routine practice of NJT placement for many endoscopists. We evaluated endoscopic NJT placement with a new stiff jejunal (J)-tube method (push technique). METHODS: The GI Tract database at the Medical University of South Carolina was queried for NJT-placement procedures. Records of 42 patients who had undergone NJT placement by using the push technique between the years 2001 and 2004 at our institution were reviewed for information regarding procedure success and tube-related outcomes. RESULTS: The push technique of NJT placement was successful in 41 of 42 patients (97.6%), with an average procedure time of 11.6 minutes (range, 5-50 minutes). Negative outcomes occurred in 61% of properly positioned NJTs and included inadvertent tube removal by the patient or the staff (42.1%), dislodging (10.5%), clogging (5.3%), and kinking (5.3%). The average longevity of the NJT was 7.8 days (range, 1-37 days). Most patients were ultimately converted to a percutaneous enteral access device or to oral feedings. CONCLUSIONS: Endoscopic placement of NJT by using the push technique is an efficient, reliable method of accessing the small bowel for enteral nutrition.

Physiological patterns during practice of the Transcendental Meditation technique compared with patterns while reading Sanskrit and a modern language.

This study tested the prediction that reading Vedic Sanskrit texts, without knowledge of their meaning, produces a distinct physiological state. We measured EEG, breath rate, heart rate, and skin conductance during: (1) 15-min Transcendental Meditation (TM) practice; (2) 15-min reading verses of the Bhagavad Gita in Sanskrit; and (3) 15-min reading the same verses translated in German, Spanish, or French. The two reading conditions were randomly counterbalanced, and subjects filled out experience forms between each block to reduce carryover effects. Skin conductance levels significantly decreased during both reading Sanskrit and TM practice, and increased slightly during reading a modern language. Alpha power and coherence were significantly higher when reading Sanskrit and during TM practice, compared to reading modern languages. Similar physiological patterns when reading Sanskrit and during practice of the TM technique suggests that the state gained during TM practice may be integrated with active mental processes by reading Sanskrit.

Autonomic and EEG patterns distinguish transcending from other experiences during Transcendental Meditation practice.

This study compared EEG and autonomic patterns during transcending to "other" experiences during Transcendental Meditation (TM) practice. To correlate specific meditation experiences with physiological measures, the experimenter rang a bell three times during the TM session. Subjects categorized their experiences around each bell ring. Transcending, in comparison to "other" experiences during TM practice, was marked by: (1) significantly lower breath rates; (2) higher respiratory sinus arrhythmia amplitudes; (3) higher EEG alpha amplitude; and (4) higher alpha coherence. In addition, skin conductance responses to the experimenter-initiated bell rings were larger during transcending. These findings suggest that monitoring patterns of physiological variables may index dynamically changing inner experiences during meditation practice. This could allow a more precise investigation into the nature of meditation experiences and a more accurate comparison of meditation states with other eyes-closed conditions.

Cortical plasticity, contingent negative variation, and transcendent experiences during practice of the Transcendental Meditation technique.

This study investigated effects of transcendent experiences on contingent negative variation (CNV) amplitude, CNV rebound, and distraction effects. Three groups of age-matched subjects with few (<1 per year), more frequent (10-20 per year), or daily self-reported transcendent experiences received 31 simple RT trials (flash (S(1))/tone (S(2))/button press) followed by 31 divided-attention trials - randomly intermixed trials with or without a three-letter memory task in the S(1)-S(2) interval). Late CNV amplitudes in the simple trials were smallest in the group with fewest, and largest in the group with most frequent transcendent experiences. Conversely, CNV distraction effects were largest in the group with fewest and smallest in the group with most frequent transcendent experiences (the second group's values were in the middle in each case). These data suggest cumulative effects of transcendent experiences on cortical preparatory response (heightened late CNV amplitude in simple trials) and executive functioning (diminished distraction effects in letter trials).

Can an electronic device improve mood and well-being, and decrease anxiety?

This study used a double-blind crossover design to investigate the effect of a small electronic device, the Quantum Companion, on mood, quality of life and anxiety levels. Thirty-four subjects were stratified on age, sex, and current stress levels and randomly assigned to receive either a placebo or a Quantum Companion, and then after a two week "recovery period," the other instrument. Standardized tests were administered before and after each two-week experimental period, along with an open ended questionnaire of other life-events during the past two weeks. The two weeks with the placebo were marked by (1) more immediate positive and fewer immediate negative effects, (2) greater reductions in anxiety, and (3) nonsignificant improvement in mood and quality of life, compared to the two-week Quantum Companion periods. This study brings out the power of a placebo for changing mood, and the importance of using rigorous designs to test claims.

Pure consciousness: distinct phenomenological and physiological correlates of "consciousness itself".

This paper explores subjective reports and physiological correlates of the experience of "consciousness itself"--self awareness isolated from the processes and objects of experience during Transcendental Meditation practice. Subjectively, this state is characterized by the absence of the very framework (time, space, and body sense) and content (qualities of inner and outer perception) that define waking experiences. Physiologically, this state is distinguished by the presence of apneustic breathing, autonomic orienting at the onset of breath changes, and increases in the frequency of peak EEG power. A model, called the junction point model, is presented that integrates pure consciousness with waking, dreaming, or sleeping. It could provide a structure to generate a coherent program of research to test the full range of consciousness and so enable us to understand what it means to be fully human.