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Don\u27t Blame the Duodenoscope Elevator, the Channels Are Contaminated as Well: A Systematic Review and Meta-Analysis
No full textIntroduction: The elevator mechanism has been suggested as the main reason for multiple outbreaks associated with contaminated reusable patient-ready duodenoscopes. The elevator is difficult to clean even with all precautions, and specially designed brushes are recommended for proper cleaning. However, the narrow channels of the duodenoscope might pose a risk of contamination since they are prone to scratches by the insertion of various accessories creating space for microbes to hide. Our aim is to estimate the contamination rate beyond the elevator of duodenoscopes based on currently available literature. Methods: We searched PubMed, Web of Science, and Embase from January 1, 2010, until October 10, 2020, for studies investigating contamination rates of reprocessed duodenoscope channels and areas beyond the elevator. A random-effects model (REM) based on the proportion distribution was used to calculate the pooled total contamination rate beyond the elevator of reprocessed duodenoscopes. The meta-package (metafor) in RStudio version 3.6.2 was used to conduct the statistical analyses. Heterogeneity between the included studies was analyzed using the inconsistency index (I2) statistics. Publication bias was assessed using the funnel plot and Egger’s regression test. Results: Eight studies including 215 positive cultures from 2,001 samples fulfilled the inclusion criteria. Four studies (50%) originated from the US, 3 studies (37.5%) originated from Europe (Italy, Netherlands, and Austria), and 1 study (12.5%) was conducted in Taiwan. See table 1 for baseline characteristics of the included studies. The total weighted contamination rate was 14.41% ± 0.029 (95% confidence interval [Cl]: 8.70% - 20.13%), see figure 1. I2 was 96.4% indicating high heterogeneity. Egger’s regression test indicated no significant publication bias (Egger’s test of publication bias: p=0.9919). Conclusion: Our analysis indicates that 14.41% of reprocessed patient-ready duodenoscopes may be contaminated unrelated to the elevator. These findings highlight that the elevator mechanism is not the only part of the duodenoscope, which could remain contaminated even after reprocessing. Despite the role of contaminated channels has been studied, more evidence is needed to fully determine the consequences and potential link to patient-to-patient infections. Additionally, guidelines for disinfection units should recommend thorough surveillance of the endoscope channels to minimize endoscope-related infections
Hyperlipasemia and Potential Pancreatic Injury Patterns in COVID-19: A Marker of Severity or Innocent Bystander?
No full text2021 Parkview Research Repository Library Report
No full textThis report is a compilation of data regarding readership and metrics of content in the Parkview Research Repository for the year of 2021. The platform, Digital Commons, is provided by Bepress and the institutional repository is managed by the Parkview Research Library. This institutional repository (IR) was started in 2017 and is accessible worldwide
Introduction to the special issue on communication technologies and relationships
No full textAbstract
This introduction to a special Technology and Relationships issue of the Journal of Social and Personal Relationships introduces the collection of articles. It describes the editorial development of the issue, identifies how the articles are organized into three clusters reflecting the developmental arc of relationships, provides a precis of each article, and ends with reflections on a question (is technology beneficial or detrimental?) and two noteworthy aspects of the collection (theory and methodology)
The Relationship between Dark Triad Personality Traits and Sexting Behaviors among Adolescents and Young Adults across 11 Countries.
Get PDFBACKGROUND: Sexting is an increasingly common phenomenon among adolescents and young adults. Some studies have investigated the role of personality traits in different sexting behaviors within mainstream personality taxonomies like Big Five and HEXACO. However, very few studies have investigated the role of maladaptive personality factors in sexting. Therefore, the present study investigated the relationship between Dark Triad Personality Traits and experimental (i.e., sharing own sexts), risky (i.e., sexting under substance use and with strangers), and aggravated sexting (i.e., non-consensual sexting and sexting under pressure) across 11 countries.
METHODS: An online survey was completed by 6093 participants (Mage = 20.35; SDage = 3.63) from 11 different countries which covered four continents (Europe, Asia, Africa, and America). Participants completed the Sexting Behaviors Questionnaire and the 12-item Dark Triad Dirty Dozen scale.
RESULTS: Hierarchical regression analyses showed that sharing own sexts was positively predicted by Machiavellianism and Narcissism. Both risky and aggravated sexting were positively predicted by Machiavellianism and Psychopathy.
CONCLUSIONS: The present study provided empirical evidence that different sexting behaviors were predicted by Dark Triad Personality Traits, showing a relevant role of Machiavellianism in all kinds of investigated sexting behaviors. Research, clinical, and education implications for prevention programs are discussed
Evaluation of intravenous immunoglobulin (IVIG) utilization after the implementation of indication and dosing protocol at a community health system.
No full text2021 ASHP Midyear Clinical Meeting / Poster
Objective: This study was conducted to evaluate the patient landscape of IVIG use within our community health system, both before and after protocol implementation. Our goals were to identify potential changes with the indication for use along with any prescribed dosing decreases while under protocol
Comparison of Standard Dose vs Higher Dose Low Molecular Weight Heparin and Unfractionated Heparin for DVT Prophylaxis in COVID-19 Patients
No full text2021 ASHP Midyear Clinical Meeting / Virtual / Poster # 1121810
Objective: To evaluate whether higher dose VTE prophylaxis results in a significant reduction in VTE events without significant increase in bleeding risk when compared to standard dose VTE prophylaxis in patients with COVID-19 infectio
Implementation and Outcomes Assessment of a 4-factor prothrombin complex concentrate (4F-PCC) Tiered Fixed Dosing Protocol in a Health System.
No full text2021 ASHP Midyear Clinical Meeting / Poster
The aim of this study was to evaluate compliance to the newly implemented fixed dosing protocol while assessing for the need for repeat doses of 4F-PCC and the need for further invasive intervention to reverse the bleeding
A Framework of High-Stakes Algorithmic Decision-Making for the Public Sector Developed through a Case Study of Child-Welfare
No full textProceedings of the ACM on Human-Computer Interaction
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Algorithms have permeated throughout civil government and society, where they are being used to make high-stakes decisions about human lives. In this paper, we first develop a cohesive framework of algorithmic decision-making adapted for the public sector (ADMAPS) that reflects the complex socio-technical interactions between human discretion, bureaucratic processes, and algorithmic decision-making by synthesizing disparate bodies of work in the fields of Human-Computer Interaction (HCI), Science and Technology Studies (STS), and Public Administration (PA). We then applied the ADMAPS framework to conduct a qualitative analysis of an in-depth, eight-month ethnographic case study of algorithms in daily use within a child-welfare agency that serves approximately 900 families and 1300 children in the mid-western United States. Overall, we found that there is a need to focus on strength-based algorithmic outcomes centered in social ecological frameworks. In addition, algorithmic systems need to support existing bureaucratic processes and augment human discretion, rather than replace it. Finally, collective buy-in in algorithmic systems requires trust in the target outcomes at both the practitioner and bureaucratic levels. As a result of our study, we propose guidelines for the design of high-stakes algorithmic decision-making tools in the child-welfare system, and more generally, in the public sector. We empirically validate the theoretically derived ADMAPS framework to demonstrate how it can be useful for systematically making pragmatic decisions about the design of algorithms for the public sector
Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia.
Get PDFBACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl).
METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed.
RESULTS: TCB correlated with SB (r = 0.82, p \u3c 0.05) in the cohort (n = 350) and in population subsets (r = 0.81-0.9, p \u3c 0.001). Black infants with gestational age (GA) \u3e35 weeks and chronological age (CA) \u3e3 days recorded strongest correlation (r = 0.9, p \u3c 0.001) followed by Blacks, and non-Black infants with CA \u3e3 days and GA \u3e35 weeks. ΔTSB was positive in Blacks, and in infants with CA \u3c3 \u3edays, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p \u3c 0.001] had positive, while CA [beta (SE) =-1.74 (0.36), p \u3c 0.001], DC + status [beta (SE) =-0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =-0.84 (0.21), p \u3c 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was \u3eWhites, Hispanics and Asians.
CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific