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Loss of independence upon discharge was seen in 344 (20.5%) patients and was independently associated with an increase in LOS (incidence rate ratio [IRR] 1.44, 95% CI 1.30 to 1.59) and major complication (odds ratio [OR] 1.86, 95% CI 1.36 to 2.53). Risk factors predictive of LOI upon discharge were increasing age, cognitive impairment, use of mobility aid, and postoperative delirium. In patients ≥80 years old, 93 (18%) had LOI at 30 days. Risk factors predictive of LOI at 30 days included a preoperative mobility aid, postoperative delirium, and the need for a new mobility aid. CONCLUSIONS One of 5 older patients undergoing operation for colorectal cancer experience LOI, and risk factors include a decline in cognition and mobility. Future studies should evaluate risks for long-term LOI and explore interventions to optimize this patient population. BACKGROUND Surgeons are at high risk of developing musculoskeletal disorders. STUDY DESIGN This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed. [https://www.selleckchem.com/products/OSI-906.html Linsitinib cell line] RESULTS Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures. CONCLUSIONS This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce. BACKGROUND The presumptive overdiagnosis of papillary thyroid microcarcinoma (PTMC) has led to an emerging trend of less-extensive operation and an inclination toward active surveillance when possible. In this study, we aimed to examine the risk of advanced PTMC at presentation. STUDY DESIGN We conducted a retrospective analysis using the National Cancer Database (2010 to 2014). Patients with PTMC who underwent surgical intervention were included and patients with a history of any cancer were excluded. RESULTS A total of 30,180 adult patients with PTMC were identified; 5,628 patients (18.7%) presented with advanced features, including central lymph node (LN) metastasis (8.0%), lateral LN metastasis (4.4%), microscopic extrathyroidal extension (ETE; 6.7%), gross ETE (0.3%), lymphovascular invasion (LVI; 4.4%), and distant metastasis (0.4%). All of those features were associated with a significantly lower survival rate (p less then 0.05 each) except for microscopic ETE and LVI. There was a significant interrelation among those features, distant metastasis was associated with central LN metastasis (odds ratio [OR] 2.44; 95% CI, 1.48 to 4.23; p less then 0.001), lateral LN metastasis (OR 3.18; 95% CI, 1.77 to 5.71; p less then 0.001), and gross ETE (OR 9.91; 95% Cl, 3.83 to 25.64; p less then 0.001). In turn, nodal metastasis was associated with microscopic ETE (OR 4.23; 95% CI, 3.82 to 4.70; p less then 0.001) and LVI (OR 7.17; 95% CI, 6.36 to 8.08; p less then 0.001). CONCLUSIONS PTMC could exhibit advanced features in 19% of patients who underwent operation and some of those, such as LVI and microscopic ETE, are undetectable with preoperative workup. Clinicians need to be cognizant of this considerable risk in the era of less-aggressive management of PTMC. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a mechanical system that provides rapid and short-term support for patients with cardiac failure. In many patients, pulmonary function is also impaired, resulting in poorly-oxygenated cardiac outflow competing against well-oxygenated VA-ECMO outflow, a condition known as North-South syndrome. North-South syndrome is a primary concern because of its potential to cause cerebral hypoxia, which has a critical influence on neurological complications often seen in this patient population. In order to reduce ischemic neurological complications, it is important to understand how clinical decisions regarding VA-ECMO parameters influence blood oxygenation. Here, we studied the impacts of flow rate and cannulation site on oxygenation using a one-dimensional (1D) model to simulate blood flow. Our model was initially tested by comparing blood flow results to those observed from experimental work in VA-ECMO patients. The 1D model was combined with a two-phase flults, determining these relationships between VA-ECMO parameters and cerebral hypoxia is an important step towards future work to develop patient-specific models that clinicians can use to improve outcomes. PURPOSE A valid and reliable scale to evaluate psychosocial adjustment in adolescents with chronic disease is prudent for improving their health outcome. This study aimed to develop a Chinese version Personal Adjustment and Role Skills Scale III for Adolescents (C-PARSIII-A) with chronic disease and to examine its construct validity and reliability. DESIGN AND METHODS A cross-sectional design was conducted. A total of 145 participants were enrolled from a hospital in Taiwan. Content validity, exploratory factor analysis, and corrected item-total correlations were used to explore a factor structure with appropriate items in a C-PARSIII-A. Confirmatory factor analysis was conducted to confirm its factor structure. Cronbach's α and test-retest reliability were performed to examine the reliability. RESULTS The 18-item C-PARSIII-A with six inter-correlated factors was developed. The standardized factor loadings of each item on its corresponding factor were statistically significant and higher than 0.50; composite reliability and average variance extracted were higher than 0.70 and 0.50 respectively. The correlation coefficients among the six factors in the C-PARSIII-A ranged from 0.10 to 0.84. Cronbach α and test-retest reliability of the C-PARSIII-A were 0.86 and 0.92 respectively. CONCLUSIONS The six-factor 18-item C-PARSIII-A is supported by sufficient empirical evidence for construct validity and reliability to assess the psychosocial adjustment of adolescents with chronic disease. PRACTICE IMPLICATIONS Nurses can use the C-PARSIII-A to perform assessment and follow-up on the psychosocial adjustment of adolescents with chronic disease, as well as develop interventions.