Deanspivey3031

CRM is contextualized within the current landscape of cultural sensitivity training in medical education. The authors provide 2 clinical vignettes to demonstrate how CRM can unveil more nuanced understandings of health disparities than existing cultural training. As institutions work toward diversity, equity, justice, and antioppression, CRM provides a novel framework for redesigning medical education that better acknowledges and incorporates the unique knowledge of minoritized learners.The first trivalent and pentavalent tricarbabismatranes were synthesized by the reaction of N(CH22-LiC6H4)3 with BiCl3 and subsequent reaction with XeF2, respectively. The trivalent bismatrane was easily oxidized by air, while the pentavalent bismatrane difluoride was relatively stable to air. A similar pentavalent bismatrance dichloride was prone to C-Cl bond reductive elimination even at room temperature.

Readmission is an important metric for surgical quality of care. This study aimed to develop a validated risk model that reliably predicts readmission after panniculectomy using the American College of Surgeons National Surgical Quality Improvement Program database.

The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients who had undergone panniculectomy from 2005 to 2018. The outcome of interest was 30-day readmission. The cohort was divided randomly into 70 percent development and 30 percent validation groups. Independent predictors of 30-day readmission were identified using multivariable logistic regression on the development group. The predictors were weighted according to beta coefficients to generate an integer-based clinical risk score predictive of readmission, which was validated against the validation group.

For the model selection, 22 variables were identified based on criteria of p < 0.05 percent and complete data availability. Variables included in the development model included inpatient surgery, hypertension, obesity, functional dependence, chronic obstructive pulmonary disease, wound class greater than or equal to 3, American Society of Anesthesiologists class greater than 3, and liposuction. Receiver operating characteristic curve analysis of the validation group rendered an area under the curve of 0.710, which demonstrates the accuracy of this prediction model. The predicted incidence within each risk stratum was statistically similar to the observed incidence in the validation group ( p < 0.01), further highlighting the accuracy of the model.

The authors present a validated risk stratification model for readmission following panniculectomy. Prospective studies are needed to determine whether the implementation of the authors' clinical risk score optimizes safety and reduces readmission rates.

Risk, III.

Risk, III.The present review documents the current knowledge and hypotheses on how polyphenols-saliva interactions may modulate the bioaccessibility or bioavailability of nutrients and highlights research prospects in the field. After an updated description of the different classes of dietary polyphenols and their modifications by food processing or digestion, an overview of interactions between salivary proteins and polyphenols (with an emphasis on tannins) is provided. In vitro studies show that the solubility of salivary protein-tannin complexes in gastric conditions depends on the degree of tannin polymerization, while complexes are partly solubilized by bile salts. Salivary proteins-polyphenols interactions may affect digestive processes. For example, polyphenols can bind to and inhibit salivary amylase, with downstream consequences on starch digestion. Some salivary proteins (PRPs) prevent tannin-induced reduced protein digestibility, probably through binding tannins before they interact with digestive proteases. Salivary proteins may also act as scavenger molecules to limit the intestinal uptake of tannins.

This study was designed to increase our understanding of parents' experiences managing the needs of their children with cystic fibrosis (CF) and to identify potential gaps in services.

We used grounded dimensional analysis of anonymous survey data obtained from a quality improvement initiative conducted by the Cystic Fibrosis Foundation (CFF). The Patient and Family Experience of Care (PFEC) survey was administered continuously at 125 CF care centers throughout the United States in 2017. The subsample of data for this study was completed by 80 parents/caregivers of children with CF (younger than 18 years).

Two unifying themes emerged from parents' survey responses (1) parents' expertise expands continually as they learn and adapt to changes in their children's maturity or health and (2) parental expertise is sometimes visible or invisible to clinicians. Parents' expertise evolved with their children's development. Visible to care teams was at-home care, e.g., respiratory treatments and medications. Less visible were intangible management activities, e.g., social processes, emotions, and concerns that were omnipresent for parents but seldom disclosed to or seen/recognized by clinicians. Themes, such as the quality of encounters with care teams, progressive nature of CF, and hope derived from advances in research, were associated with specific contextual factors.

The findings expand our understanding of lived parental experiences of CF across childhood and offer direction for future quality improvement and research. Online parent surveys offer a valuable tool to identify unmet needs across subgroups of families affected by chronic childhood health conditions.

The findings expand our understanding of lived parental experiences of CF across childhood and offer direction for future quality improvement and research. Online parent surveys offer a valuable tool to identify unmet needs across subgroups of families affected by chronic childhood health conditions.Cochrane reviews are known to be a high-quality source of evidence synthesis supporting health care decisions. In a recently conducted study, we analyzed the trends in epidemiology and reporting of published systematic reviews over the last 20 years. This sample of 1132 systematic reviews included 84 Cochrane reviews. CX5461 We have learned several peculiarities of Cochrane reviews that are worth being discussed in more detail due to their practical implications. Methodologists, clinicians and health care professionals should be aware of these limitations (1) Cochrane reviews are not identified as systematic reviews in title, (2) Cochrane reviews do not always follow PRISMA reporting guidelines, (3) Some updates are only available via the Cochrane Library, and (4) Indexing of Cochrane reviews in PubMed may be suboptimal.

The purpose of this study was to assess the prevalence of child behavior, academic and sleep concerns, and parent stress and depression symptoms during COVID-19; to test associations of parent-child well-being with child school format; and to examine effect moderation by child race/ethnicity and material hardship.

A total of 305 English-speaking parents of elementary school-age children completed online surveys regarding demographics, child school format, behavior, learning-related experiences, sleep, and parent stress and depression symptoms. Multivariable linear and logistic regression analyses examined associations of school format with child and parent outcomes.

Children were aged 5.00 to 10.99 years, with 27.8% underrepresented minority race/ethnicity. Per parental report, 27.7% attended school in-person, 12.8% hybrid, and 59.5% remote. In multivariable models, compared with children receiving in-person instruction, children receiving remote instruction exhibited more hyperactivity (β 0.94 [95% cong in-person instruction. Children with material hardships showed more behavior challenges overall but less associated with school format. Therefore, planning for a return to in-person learning should also include consideration of family supports.

The authors analyze the outcomes of simultaneous vascularized lymph node transplant and lymphovenous bypass for treatment of primary and secondary lymphedema. To the best of their knowledge, this is the largest study to date with long-term outcome data of this novel approach.

Three hundred twenty-eight patients who underwent physiologic surgical treatment over a 5.5-year period were evaluated using a prospective database and chart review. Preoperative characteristics, operative details, and postoperative outcomes (volume difference change, Lymphedema Life Impact Scale score) were assessed. Statistical analysis including multivariate regression was performed.

Two hundred twenty patients (67.1 percent) underwent simultaneous vascularized lymph node transplant and lymphovenous bypass. Mean body mass index was 26.9 ± 4.7 kg/m 2 . Ninety-two patients (41.8 percent) had lymphedema of the lower extremity, 121 (55.0 percent) had upper extremity involvement, and seven had lymphedema of upper and lower extremitieutic, III.Despite active efforts to improve access to health care for people who live in rural communities, the need for developing a physician workforce that is committed to rural practice, and with the professional and personal skills that will best fit with the needs of the rural community, is only increasing over time. Supporting and solidifying the rural graduate medical education landscape must be a crucial piece of any plan to address gaps in rural health care. Embracing creative solutions that address the most important barriers to this development has high potential for meeting the health care needs of rural communities, with emphasis on the rural community stakeholders assuming the central role in planning efforts. In particular, essential innovations include developing a culture of learning in rural settings using concepts of a teaching health neighborhood and advancing interprofessional models of care; incorporating concepts of "place-based training" with focus on relational connectedness; enhancing a spectrum of potential partnerships, including rural and urban regional entities, the Health Resources and Services Administration, and other federal agencies (e.g., the Indian Health Service and Veterans Health Administration among others) to support the ability of rural health entities to embrace medical education; and advocating for federal and state funding initiatives to ensure the sustainability of training programs in rural communities. Although not sufficient to guarantee improved access to health care and better health outcomes among rural communities, robust collaborations to develop interprofessional training and enhancement of the entire pipeline of health professions training and practice holds significant promise for improving the health of rural populations.Clean pump oil is critical to the performance and longevity of oil-sealed vacuum pumps. Cold traps charged with cryogens can protect pump oil from solvent contamination but are subject to operator error. Notably, cold traps with evaporated or warmed cryogens do not protect the vacuum pump. Here, we report an open source device to automatically protect oil-sealed vacuum pumps from cold trap warming and facilitate the daily maintenance of cold traps.