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Exploring Child Behavior Change Post-Anesthesia
No full textChildren frequently undergo procedures with anesthesia, an anxiety-provoking time for families. Unfortunately, there is limited research on the peri-anesthesia experience in families with language barriers. Research gaps include factors of child behavioral change post-anesthesia. The purpose of this pilot project is to explore post-anesthesia behavior change among children ages 7-12 years in Spanish-speaking families and to determine feasibility of a study protocol for this population. Research questions are: What types of behavior change occur, is there a correlation between anesthesia duration and behavior change, and is there a correlation between premedication and behavior change. Participants will be enrolled at the pre-anesthesia clinic visit in a large pediatric specialty center. Of 4 study time points (pre-anesthesia, day of procedure, telephone follow-up at 2 and 4 weeks after anesthesia), this project will focus on the follow-up visits, utilizing the Post Hospitalization Behavior Questionnaire (PHBQ), medical record reviews, and cognitive interviews. Certified medical language services will be utilized for each visit. At 2 weeks post-anesthesia, there were 19 participants, and there were 16 participants at 4 weeks. Parent responses indicate postoperative behavior change from 2 to 4 weeks post anesthesia in the form of disinterest in surroundings, needing help doing things, difficulty for their child to talk to them, bad dreams, and trouble falling to sleep. There was no significant correlation between anesthesia and behavior change (p=.968). There was no significant correlation between premedication and behavior change (p=.945). Cognitive interviews reveal no reported parental difficulties with the PHBQ. These results could be used to inform anticipatory guidance for families during the peri-anesthesia experience
Combined action observation and mental imagery versus neuromuscular electrical stimulation as novel therapeutics during short-term knee immobilization
No full textLimb immobilization causes rapid declines in muscle strength and mass. Given the role of the nervous system in immobilization-induced weakness, targeted interventions may be able to preserve muscle strength, but not mass, and vice versa. The purpose of this study was to assess the effects of two distinct interventions during 1 week of knee joint immobilization on muscle strength (isometric and concentric isokinetic peak torque), mass (bioimpedance spectroscopy and ultrasonography), and neuromuscular function (transcranial magnetic stimulation and interpolated twitch technique). Thirty-nine healthy, college-aged adults (21 males, 18 females) were randomized into one of four groups: immobilization only (n = 9), immobilization + action observation/mental imagery (AOMI) (n = 10), immobilization + neuromuscular electrical stimulation (NMES) (n = 12), or control group (n = 8). The AOMI group performed daily video observation and mental imagery of knee extensions. The NMES group performed twice daily stimulation of the quadriceps femoris. Based on observed effect sizes, it appears that AOMI shows promise as a means of preserving voluntary strength, which may be modulated by neural adaptations. Strength increased from PRE to POST in the AOMI group, with +7.2% (Cohen's d = 1.018) increase in concentric isokinetic peak torque at 30 degrees/s. However, NMES did not preserve muscle mass. Though preliminary, our findings highlight the specific nature of clinical interventions and suggest that muscle strength can be independently targeted during rehabilitation. This study was prospectively registered: ClinicalTrials.gov NCT05072652. What is the central question of this study? Action observation and mental imagery (AOMI) may be a possible and potentially promising rehabilitation strategy via facilitation of neural adaptations, whereas neuromuscular electrical stimulation (NMES) may augment muscle strength and mass via peripheral mechanisms. We compared the ability of these interventions to distinctly preserve strength versus mass during one week of knee joint immobilization. What is the main finding and its importance? Effect sizes suggested that AOMI preserved voluntary strength, and may be used therapeutically to target neural adaptations during immobilization
Investigating the Differential Impact of Hydrocortisone on Depressive Symptoms: A Double-Blind, Placebo-Controlled, Crossover Study
No full textResearch Question: The study investigates: "Will depressed patients experience a reduction in depressive symptoms, measured by the Quick Inventory of Depressive Symptomatology (QIDS), when treated with hydrocortisone as opposed to a placebo?"Background and Significance: Major depressive disorder (MDD), characterized by altered cortisol levels, has been a subject of extensive research. Recent studies, such as those conducted using the UK Biobank data, have shown that both systemic and inhaled glucocorticoid use is associated with changes in brain volume and white matter microstructure, impacting cognitive and emotional outcomes. This study is an interim, secondary analysis of a double-blind, placebo-controlled clinical trial with treatment crossover, examining the effects of hydrocortisone on the human hippocampus (NCT03896659). This manuscript is focusing on an interim secondary analysis of a larger trial. While the main study is interested in understanding whether hydrocortisone has a differential effect on the hippocampus of depressed versus non-depressed individuals, we are investigating if depressed patients will experience a reduction in depressive symptoms, measured by the Quick Inventory of Depressive Symptomatology (QIDS), when treated with hydrocortisone as opposed to a placebo. A meta-analysis highlighted the importance of HPA axis dysregulation in the onset and maintenance of depressive symptoms, suggesting that targeting this dysregulation could advise therapeutic strategy. The manipulation of cortisol levels has been shown to have a significant impact on depression symptoms. According to DeBattista et al. (2000), acute hydrocortisone infusion significantly reduced the severity of depression in patients with major depression, suggesting that cortisol modulation may be of therapeutic benefit in depression.Materials and Methods: This study is an interim, secondary analysis of an NIH-funded (5R01MH115932-05) double-blind, placebo-controlled clinical trial with treatment crossover, examining the effects of hydrocortisone on the human hippocampus (NCT03896659). Eligible participants were allocated into two groups based on their baseline QIDS-C: the ¿depressed¿ arm (QIDS-C 11-20), consisting of individuals diagnosed with Major Depressive Disorder (MDD), and the ¿healthy control¿ arm (QIDS-C ? 5), individuals with no history of MDD diagnosis. Of the 54 potentially eligible participants, 12 participants were lost to follow up or screen failed. Therefore, a total of 42 participants were included in this study. For each group, participants were randomized by a statistician to receive either hydrocortisone (160 mg tablet) or a matching placebo tablet for three days, followed by MRI and cognitive testing, with a subsequent washout period and treatment cycle repeat. The study was conducted over a total of five visits.Results: Building on existing research indicating altered brain structures and cognitive functions in glucocorticoid users, this study's preliminary insights suggest a nuanced response to hydrocortisone in the modulation of depressive symptoms. The expected outcomes, based on initial data, indicate that depressed patients might exhibit a more significant change in QIDS scores following hydrocortisone treatment compared to placebo, aligning with clinical trial findings. However, our results revealed no significant difference in QIDS-C scores when treated with hydrocortisone versus the placebo among the depressed cohort.Conclusion: This study aims to augment the understanding of cortisol's role in depression. While final results are pending, the interim secondary analysis may enhance understanding of the role cortisol plays in depression. Our results highlight the complexity of the HPA axis feedback mechanism and its role in depression. This is further supported by evidence suggesting variability in glucocorticoid receptor sensitivity among individuals. Additionally, both high and low cortisol states have been associated with depressive disorders. The study's design is anticipated to yield robust, generalizable data, influencing future clinical practices and psychoneuroendocrinology research
Treatment Failure After Repair of Displaced Femoral Neck Fractures in Young and Middle-aged Adults: An Analysis of 555 Cases Treated at 27 Level One Trauma Centers
No full textResearch Question: In middle-aged adults (ages 50 to 59 years), what factors contribute to the failure of operative repair in the treatment of displaced femoral neck fractures (FNFs) as compared to similar treatments in young adult patients (ages 18 to 49 years)? Further, does the likelihood of a successful reparative outcome vary with increasing age by decade of life?Background and Significance: Displaced FNFs in elderly patients (e.g. = 60 years) are typically treated with arthroplasty (surgical replacement) given that these procedures generally have predictable, positive results in this age group. Young adult patients are usually treated with operative repair because outcomes of arthroplasty in this population have not been favorable and revision surgeries are required. These polarized findings have created a grey area within which an under-studied “middle-aged” group resides. The primary focus of our research has been to compare clinical results in this middle-aged cohort to a recent database consisting of the outcomes of similar injuries in patient populations stratified by decade of life. As such, we attempt to identify risk factors that could predict which patients might fail reparative treatment and be better suited to undergo replacement.Materials and Methods: A retrospective study of patients 18 to 59 years old treated for a displaced femoral neck fracture (FNF) with surgical repair between 2005 and 2017 at 27 different Level 1 trauma centers in North America was conducted. A database of 555 patients was sorted by decade of life and patients cohorts were evaluated for demographics, pre-existing medical problems, injury mechanism and pattern, treatment methods, follow-up, and overall outcomes.Results: Overall treatment failure was observed in 48% of hips. Complications and the need for major secondary surgeries increased exponentially with age by decade of life (P=0.004). FNFs resulting in nonunion/failed fixation were most affected by age (4th vs 5th vs 6th decade groups had nonunion/failed fixation in 38%, 48%, and 57% of hips, respectively; P<0.001). The rates of osteonecrosis were also increased in older patients (4th, 5th, and 6th decade groups had ON in 9%, 20%, and 27% of hips, P<0.001). The 6th decade group and their injuries were similar to the younger groups for most variables evaluated; however, treatments varied widely between the 6th decade group and the younger groups, including reduction type (open vs. closed), reduction quality, and construct type (cannulated screws (CS) vs. fixed angle devices (FADs)).Conclusion: Displaced FNFs in young and middle-aged adults are a challenging clinical problem with a high rate of treatment failure. Major complications and the need for complex reconstructive surgery increased exponentially by decade of life, with the patients in their 6th decade experiencing failed fixation/nonunion and osteonecrosis at the highest rate seen among patients in the decades studied. Interestingly, treatments provided to the 6th decade group studied were quite different compared to those provided to the younger patients. Above all, we expect the results from this study to assist with surgical decision making and improve outcomes in patients presenting with displaced FNFs
Congo-Sao Francisco craton in Paleoproterozoic-Mesoproterozoic supercontinent Nuna
No full textThe location of the Congo-Sao Francisco (CSF) craton, one of the largest cratons in Proterozoic paleogeography, has been poorly constrained for the supercontinent Nuna interval (ca. 1800-1300 Ma). Initial models of Nuna suggested that the CSF craton was part of the Atlantica continent, together with Amazonia, West Africa, and perhaps Rio de la Plata, as a separate continental block from other Nuna constituents. In other Nuna models the CSF craton has been placed adjacent to Baltica and Siberia, the core of Nuna, based mainly on ages of mafic magmatism and sparse paleomagnetic data. Through a geochemical, geochronological and paleomagnetic study of the WNW-trending Virei mafic dykes, which extend outward from the Mesoproterozoic Kunene Igneous Complex in southwest Angola, we provide a U-Pb baddeleyite age of 1385 +/- 5 Ma, geochemical signatures, and a robust Mesoproterozoic paleomagnetic pole to test the CSF craton's placement within Nuna. Including our new pole with quality-filtered poles from the other cratons during the Nuna interval, we propose a refined Nuna model with (1) southwest Congo / west Siberia cratonic connection at 1700-1500 Ma, (2) proximity of Amazonia and West Africa cratons, and (3) connection of southwest Congo craton with northwest West Africa at 1380 Ma. Our proposed 1500-1380 Ma reconstructions are further supported by matching large igneous province (LIP) records from these crustal blocks. The new 1385 Ma Virei pole, when considered relative to an earlier CSF pole at ca. 1500 Ma, requires substantial azimuthal rotation (similar to 85 degrees) of CSF in the intervening time interval. To accommodate both the matching LIP records and paleomagnetic data from CSF and neighboring cratons in Nuna, we propose an interval of transform motion near the supercontinent's periphery prior to more widespread mid-Mesoproterozoic supercontinental breakup
Occupational Turnover Factors for Certified Registered Nurse Anesthetists: A Scoping Review
No full textThe objective of this scoping review is to understand the extent and type of evidence related to occupational turnover factors for certified registered nurse anesthetists (CRNA) in the United States. Demand for anesthesia services is increasing dramatically. CRNAs provide a significant number of anesthetics each year and are crucial to accessible anesthesia in the U.S. Understanding occupational turnover factors for CRNAs is vital to providing cost effective, reliable anesthesia services for Americans. Studies relevant to CRNA turnover in the U.S. were included for this review. Due to differences in education, scope of practice, and practice environment, studies involving nurse anesthetists outside the U.S. were excluded. Studies with mixed provider populations including physicians, registered nurses, other advanced practice providers, and students were also excluded. Five studies were included for data extraction. All the studies employed electronic or mailed questionnaires. Common factors associated with occupational turnover were compensation, retirement, job satisfaction, and burnout. Findings suggest that occupational turnover factors are multifactorial and include broad concepts such as job satisfaction, burnout, and organizational climate
Analyzing Google Search Trends for Migraine Surgery and Nurtec in Response to Public Announcements
No full textBackground: Nurtec, a versatile migraine medication, has gained popularity. However, the awareness of migraine surgery remains uncertain. Methods: Following a descriptive approach, this cross-sectional study used Google Trends data as of December 1, 2023, to analyze internet search patterns. Approval from Vanderbilt University�s institutional review board and adherence to Strengthening the Reporting of Observational Studies in Epidemiology guidelines were confirmed. Monthly relative search volume (RSV) data for �migraine surgery,� �Nurtec,� and �Rimegepant� were collected from January 1, 2004, to November 11, 2023, within the United States. Statistical analysis involved determining mean monthly RSV values and percentage changes for critical periods. Results: For �Nurtec,� a significant surge in RSV occurred from March 2020 to April 2020 (344%). Additional peaks were observed from June 2020 to July 2020 (66%), October 2020 to December 2020 (169%), May 2021 to June 2021 (33%), and May 2023 to June 2023 (14%). �Migraine surgery� exhibited a notable 400% increase in RSV, from March 2005 to May 2005. However, post-2006, RSV for �migraine surgery� consistently remained low without noticeable peaks. Conclusions: The analysis of RSV trends for �Nurtec� and �migraine surgery� from 2004 to 2023 reveals the impact of pivotal events and marketing strategies on public interest. The distinct peaks in �Nurtec� RSV align with Food & Drug Administration approvals and marketing campaigns, highlighting the medication�s accessibility. Conversely, the consistently low RSV for �migraine surgery� indicates limited awareness, emphasizing the need for enhanced promotion and education regarding surgical interventions
Preparation and Attitudes of Sport Psychology Consultants toward Working with Athletes with Hidden Disabilities
No full textSport psychology consultants (SPCs) can be instrumental in helping athletes with hidden disabilities (HD) by providing psychological skills training. However, SPCs may not have the training to recognize the needs of athletes with HD or be able to change their instruction. This two-part study aimed to identify SPCs preparation and attitudes towards working with athletes with HD, and assess the potential impact of a continuing education workshop. In study one, participants agreed that athletes with HD have the right to be included in sports and do not need to have better athletic skills. Results indicated that SPCs have little specific training to prepare them to consult with athletes with HD. Students disagree that athletes with HD need to be included with non-disabled peers in sports, felt less comfortable and more concerned when consulting with athletes with HD. In study two, all the participants had a positive attitude toward working with athletes with HD. Following the workshop, the majority of participants had increased levels of comfort, confidence, knowledge, and a greater understanding of consulting with athletes with HD. Furthermore, most of the participants felt that students would benefit from increased training in this area. The findings underscore the need for improved education and training for SPCs to meet the needs of all athletes. SPCs may assist in providing a positive experience for all athletes regardless of disability. These findings offer insight into the implications of a continuing education workshop on SPCs’ knowledge, attitudes, and self-efficacy toward consulting with athletes with HD
MICROSCOPIC AND GEOCHEMICAL STUDIES OF ANCIENT, POTENTIALLY RIFT-RELATED PLUTONIC IGNEOUS ROCKS IN COLORADO
No full textThe regional geological framework of the area I am studying involves a possible major northwest-trending Cambrian to Ordovician rift zone with abundant igneous rocks in parts of Colorado. These igneous rocks may be related to large volumes of Cambrian igneous rocks located along the same trend in Southern Oklahoma and nearby parts of Texas within the large-scale Southern Oklahoma rift zone. My project focuses on plutonic igneous intrusions located in the Wet Mountains in the southern part of the Front Range in Colorado and the Powderhorn District farther west. This thesis reports the results of microscopic and geochemical studies carried out on three main intrusions in the Wet Mountains as well as important rock units within the Powderhorn District. Samples of gabbro and pyroxenite from the McClure Mountain Complex show evidence of the accumulation of crystals on the floor of the magma chamber. Trace element contents in younger nepheline-bearing syenites suggest these rocks were partly derived from more than one batch of magma injected into a single magma chamber. Nepheline syenites also present in the Powderhorn Complex have somewhat different geochemical contents from those in the McClure Mountain Complex indicating they are not directly related. A large body of carbonatite in the Powderhorn Complex formed by an intrusion of an entirely separate magma that was injected in pulses. The presence of nepheline syenites in the Colorado intrusions requires the production of silica-undersaturated magmas, which could not have been directly related to silica-oversaturated igneous rocks in the Southern Oklahoma rift zone. The Colorado intrusions may have formed in a continuation of the Southern Oklahoma rift zone but were produced by different igneous processes
The Day the Presses Stop: Social Media is Overtaking Legacy Platforms
No full textNewspapers have dominated the journalism industry for decades, capturing audiences of all kinds. With the invention of the penny press, newspapers became more accessible and could be found on every household breakfast table. Despite the introduction of competing mediums like radio or cable television, newspapers still remained. That was until the invention of the internet, which disrupted the industry like no other. The internet and social media have forced traditional news organizations to change their business models to meet the demands associated with the popular short-form, sensationalized content found on online platforms