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practice variation

Emily E Burns, Laura J Carter, Dana W Kolpin, Jane Thomas-Oates, Alistair B A Boxall
Many studies have quantified pharmaceuticals in the environment, few however, have incorporated detailed temporal and spatial variability due to associated costs in terms of time and materials. Here, we target 33 physico-chemically diverse pharmaceuticals in a spatiotemporal exposure study into the occurrence of pharmaceuticals in the wastewater system and the Rivers Ouse and Foss (two diverse river systems) in the city of York, UK. Removal rates in two of the WWTPs sampled (a conventional activated sludge (CAS) and trickling filter plant) ranged from not eliminated (carbamazepine) to >99% (paracetamol)...
March 3, 2018: Water Research
Morgan Lawley, Jessica W Wu, Victor M Navas-López, Hien Q Huynh, Matthew W Carroll, Min Chen, Pavel Medvedev, Andrew S Day, Séamus Hussey, Rotem Sigall-Boneh, Arie Levine, Eytan Wine
OBJECTIVES: Exclusive enteral nutrition (EEN) is an effective induction treatment for pediatric Crohn disease. Given the center-based variation in use and diversity in practice we constructed a survey aimed at sharing experience and strategies in administering EEN, stimulating further research, and optimizing therapy. METHODS: This survey was constructed after consultation with experts and designed to address key knowledge gaps. The survey was disseminated through the Paediatric IBD Porto Group of ESPGHAN, Canadian Children IBD Network, selective experts, and was sent twice through the PEDGI-BB...
March 14, 2018: Journal of Pediatric Gastroenterology and Nutrition
Erika Virmani, Julian M Rotter, Andre Mähringer, Tobias von Zons, Adelheid Godt, Thomas Bein, Stefan Wuttke, Dana D Medina
Controlled on-surface film growth of porous and crystalline frameworks is a central requisite for incorporating these materials into functional platforms and operational devices. Here, we present the synthesis of thin zirconium-based metal-organic framework (MOF) films by vapor-assisted conversion (VAC). We established protocols adequate for the growth of UiO-66, UiO-66(NH2 ), UiO-67, and UiO-68(NH2 ) as well as the porous interpenetrated Zr-organic framework (PPPP-PIZOF-1) as highly oriented thin films. Through the VAC approach, precursors in a cast solution layer on a bare gold substrate are reacting to form a porous continuous MOF film, oriented along the [111] crystal axis by an exposure to a solvent vapor under elevated temperatures of 100 °C and 3 h reaction times...
March 15, 2018: Journal of the American Chemical Society
Zaiyang Long, Donald J Tradup, Pengfei Song, Scott F Stekel, Shigao Chen, Katrina N Glazebrook, Nicholas J Hangiandreou
Because of the rapidly growing use of ultrasound shear wave elastography (SWE) in clinical practices, there is a significant need for development of clinical physics performance assessment methods for this technology. This study aims to report two clinical medical physicists' tasks: (a) acceptance testing (AT) of SWE function on ten commercial ultrasound systems for clinical liver application and (b) comparison of SWE measurements of targets across vendors for clinical musculoskeletal application. For AT, ten GE LOGIQ E9 XDclear 2...
March 15, 2018: Journal of Applied Clinical Medical Physics
D J Murphy, A Aghayev, M L Steigner
Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the varied manifestations of vascular disease. Vascular imaging encompasses a wide variety of pathology. Designing vascular imaging protocols can be challenging owing to the non-uniform velocity of blood in the aorta, differences in cardiac output between patients, and the effect of different disease states on blood flow. In this review, we provide the rationale behind-and a practical guide to-designing and implementing straightforward vascular computed tomography (CT) and magnetic resonance imaging (MRI) protocols...
March 14, 2018: Insights Into Imaging
David L Chan, Lesley Moody, Eva Segelov, David Metz, Jonathan Strosberg, Nick Pavlakis, Simron Singh
<br>Objectives: There is no consensus regarding optimal follow-up in resected GEP-NETS. We aimed to perform a practice survey to ascertain follow-up patterns by health care practitioners and highlight areas of variation that may benefit from further quantitative research. METHODS: A web-based survey targeted at NET health care providers in Australia, New Zealand, Canada and the United States was developed by a steering committee of medical oncologists and a research methodologist...
March 14, 2018: Neuroendocrinology
John D Pauling, Lesley Ann Saketkoo, Marco Matucci-Cerinic, Francesca Ingegnoli, Dinesh Khanna
RP is the most common manifestation of SSc and a major cause of disease-related morbidity. This review provides a detailed appraisal of the patient experience of SSc-RP and potential implications for disease classification, patient-reported outcome instrument development and SSc-RP clinical trial design. The review explores the clinical features of SSc-RP, the severity and burden of SSc-RP symptoms and the impact of SSc-RP on function, work and social participation, body image dissatisfaction and health-related quality of life in SSc...
March 12, 2018: Rheumatology
F L Chan, R House, I Kudla, J C Lipszyc, N Rajaram, S M Tarlo
Background: 3D printers emit potentially hazardous ultrafine particles and volatile organic compounds. Workers using 3D printing technologies may be at risk of respiratory illness from occupational exposure. Aims: To assess whether 3D printing is associated with health effects in occupational users. Methods: This was a preliminary survey. Workers in 17 companies using 3D printing, including commercial prototyping businesses, educational institutions and public libraries, in the Greater Toronto Area, Canada, were asked to complete survey questionnaires concerning demographic, occupational and health information...
March 10, 2018: Occupational Medicine
Kai Lv, Chu-Ting Yang, Yi Liu, Sheng Hu, Xiao-Lin Wang
To aid the design of a hierarchically porous unconventional metal-phosphonate framework (HP-UMPF) for practical radioanalytical separation, a systematic investigation of the hydrolytic stability of bulk phase against acidic corrosion has been carried out for an archetypical HP-UMPF. Bulk dissolution results suggest that aqueous acidity has a more paramount effect on incongruent leaching than the temperature, and the kinetic stability reaches equilibrium by way of an accumulation of a partial leached species on the corrosion conduits...
March 14, 2018: Nanomaterials
Goutham Rao, Paul Epner, Victoria Bauer, Anthony Solomonides, David E Newman-Toker
Diagnostic error is a serious public health problem to which knowledge gaps and associated cognitive error contribute significantly. Identifying diagnostic approaches to common problems in ambulatory care associated with more timely and accurate diagnosis and lower cost and harm associated with diagnostic evaluation is an important priority for health care systems, clinicians, and of course patients. Unfortunately, guidance on how best to approach diagnosis in patients with common presenting complaints such as abdominal pain, dizziness, and fatigue is lacking...
June 27, 2017: Diagnosis
Steffi L Colyer, Polly M McGuigan
Textile electromyography (EMG) electrodes embedded in clothing allow muscle excitation to be recorded in previously inaccessible settings; however, their ability to accurately and reliably measure EMG during dynamic tasks remains largely unexplored. To quantify the validity and reliability of textile electrodes, 16 recreationally active males completed two identical testing sessions, within which three functional movements (run, cycle and squat) were performed twice: once wearing EMG shorts (measuring quadriceps, hamstrings and gluteals myoelectric activity) and once with surface EMG electrodes attached to the vastus lateralis, biceps femoris and gluteus maximus...
March 2018: Journal of Sports Science & Medicine
Sukanya Srinivasan, Lisa Schlar, Stephanie E Rosener, Daniel J Frayne, Scott G Hartman, Michael A Horst, Jessica L Brubach, Stephen Ratcliffe
BACKGROUND: Preterm birth, birth defects, and unintended pregnancy are major sources of infant and maternal morbidity, mortality, and associated resource use in American health care. Interconception Care (ICC) is recommended as a strategy to improve birth outcomes by modifying maternal risks between pregnancies, but no established model currently exists. The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network developed and implemented a unique approach to ICC by assessing mothers during their baby's well-child visits (WCVs) up to 24 months...
March 2018: Journal of the American Board of Family Medicine: JABFM
Arvind Sehgal, Patrick J McNamara
Whereas association between a patent ductus arteriosus (PDA) and neonatal morbidities has been well described, consensus has not been reached on whether the relationship is causal, on benefit of (or lack of) treatment, on factors guiding the 'need to treat', and on treatment strategies. Trials to date have primarily focused on the narrow outcome of successful ductal closure. Evidence from several retrospective studies has suggested that management may be modified with increased use of conservative treatment...
March 7, 2018: Seminars in Fetal & Neonatal Medicine
Beatriz Vidondo, Bernhard Voelkl
BACKGROUND: Livestock herds are interconnected with each other via an intricate network of transports of animals which represents a potential substrate for the spread of epidemic diseases. We analysed four years (2012-2015) of daily bovine transports to assess the risk of disease transmission and identify times and locations where monitoring would be most effective. Specifically, we investigated how the seasonal dynamics of transport networks, driven by the alpine summering and traditional cattle markets, affect the risk of epidemic outbreaks...
March 13, 2018: BMC Veterinary Research
Marja Visser, Trudie Gerrits, Fulco van der Veen, Monique Mochtar
When intended parents choose to have donor sperm treatment (DST), this may entail wide-ranging and long-lasting psychosocial implications related to the social parent not having a genetic tie with the child, how to disclose donor-conception and future donor contact. Counselling by qualified professionals is recommended to help intended parents cope with these implications. The objective of this study is to present findings and insights about how counsellors execute their counselling practices. We performed a qualitative study that included 13 counsellors working in the 11 clinics offering DST in the Netherlands...
March 14, 2018: Human Fertility: Journal of the British Fertility Society
James B Wood, Gregory P Fricker, C Buddy Creech
We conducted a survey of pediatric infectious diseases providers in the Emerging Infections Network regarding the workup and treatment of children with Staphylococcus aureus bacteremia (SAB). We found significant practice variation in the management of children with SAB. These findings emphasize the need for further research to guide best practices.
March 8, 2018: Journal of the Pediatric Infectious Diseases Society
Aicha Bentaieb, Ghassan Hamarneh
It is generally recognized that color information is central to the automatic and visual analysis of histopathology tissue slides. In practice, pathologists rely on color, which reflects the presence of specific tissue components, to establish a diagnosis. Similarly, automatic histopathology image analysis algorithms rely on color or intensity measures to extract tissue features. With the increasing access to digitized histopathology images, color variation and its implications have become a critical issue...
March 2018: IEEE Transactions on Medical Imaging
Xian Zhang, Ellen E Pinderhughes
Parents raising children adopted from a different racial/ethnic group usually engage in cultural socialization-providing activities in adoptees' birth culture-hoping to instill pride and help adoptees develop a positive identity. Adoptive parents engage in a wide variety of socialization activities, yet adult adoptees have reported not having deep enough exposure from their parents. The present study explored the depth of cultural socialization in transracial adoptive families. Informed by Pinderhughes' Ethnic-Racial Socialization model, this study developed a continuum examining the depth in cultural socialization with three indicators: (1) the depth of cultural activities, (2) parents' motivation for cultural socialization, and (3) parental cultural attitudes...
March 13, 2018: Family Process
Christopher M Shea, Kea Turner, Jordan Albritton, Kristin L Reiter
BACKGROUND: Recent emphasis on value-based health care has highlighted the importance of quality improvement (QI) in primary care settings. QI efforts, which require providers and staff to work in cross-functional teams, may be implemented with varying levels of success, with implementation being affected by factors at the organizational, teamwork, and individual levels. PURPOSE: The purpose of our study was to (a) identify contextual factors (organizational, teamwork, and individual) that affect implementation effectiveness of QI interventions in primary care settings and (b) compare perspectives about these factors across roles (health care administrators, physician and nonphysician clinicians, and administrative staff)...
March 12, 2018: Health Care Management Review
Catherine M Kuza, Monica S Vavilala, Rebecca M Speck, Richard P Dutton, Maureen McCunn
BACKGROUND: Few trauma guidelines evaluate and recommend anesthesiology practices and there are no trauma anesthesia-specific guidelines. There is no information on how anesthesiologists perceive clinical practice patterns. Our objective was to understand the perceptions of anesthesiologists regarding trauma anesthesia practices. METHODS: A survey assessing anesthesia management of trauma patients was distributed to 21,491 anesthesiologists. A subset of 10 of these questions was subsequently reviewed by a trauma anesthesiology focus group through a 3-round web-based Delphi process...
March 12, 2018: Anesthesia and Analgesia
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