A New Normal: A Case Study on Changing Strategies in Technology Engagement at an Academic Health Sciences Library

As academic libraries shift services to meet the changing needs of patrons after the COVID-19 pandemic, educational technologies and services to support them require updating. Patrons using technology that was once associated with hands-on learning and in-person interactions are preferring flexible and hybrid iterations. In this case study, the authors describe and analyze the pivot of three technology services at the Spencer S. Eccles Health Sciences Library in the post-COVID-19 environment. Technologies discussed include a multimedia studio, virtual reality (VR), and a three-dimensional (3D) printing service. This case study utilizes available usage stats and survey data to demonstrate and provide rationale for the changing strategy in services for each technology "hub." The multimedia studio has been dismantled in favor of the equipment being available for checkout, VR is now available in a staff-supported classroom, and a 3D printing service has been fully automated through an online submission platform. These examples, and the rationale behind changing them, can help offer ideas for other libraries to help find solutions that meet the demands of a changing learning environment.

Short-term risk prediction after major lower limb amputation: PERCEIVE study

BACKGROUND

The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery.

METHODS

The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance.

RESULTS

Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679).

CONCLUSION

Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.

20. Cost-Effectiveness of Recombinant Zoster Vaccine for Vaccinating Immunocompromised Adults Against Herpes Zoster in the United States

Background

Individuals who are immunocompromised (IC) due to disease or therapy are at increased risk of herpes zoster (HZ), with HZ cases in IC populations also resulting in increased health care resource use and costs as compared with the immunocompetent population. This study assesses the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in IC adults aged ≥ 18 years in the United States (US).

Methods

A Markov model with a one-year cycle length was developed to follow a hypothetical cohort of one million IC individuals for a 30-year time horizon. The model estimates health and cost outcomes associated with RZV versus no vaccine. The base-case analysis considered hematopoietic stem cell transplant (HSCT) recipients who were assumed to remain IC for five years post-transplant. Second-dose compliance was assumed to be 100%, with efficacy and waning inputs based on clinical trial data. Epidemiological, cost, and utility inputs were obtained from standard US sources and published literature. Costs and quality-adjusted life-years (QALYs) were discounted at 3% per year. Sensitivity, threshold, and scenario analyses were conducted, including scenarios of four other IC conditions.

Results

In the modeled hypothetical cohort of one million HSCT recipients, RZV resulted in 116,790 fewer HZ cases and 21,446 fewer postherpetic neuralgia cases versus no vaccine, 5,545 fewer QALYs lost and a societal cost-savings of &5.4 million. The number needed to vaccinate to prevent one HZ case was estimated to be 9. HSCT population results were shown to be robust in sensitivity and threshold analyses. In scenario analyses, RZV was cost saving for renal transplant recipients. Incremental cost-effectiveness ratios for other IC populations were &33,268 per QALY gained for human immunodeficiency virus, &67,682 for breast cancer, and &95,972 for Hodgkin lymphoma.

Conclusion

Results suggest that RZV is a cost-effective option for vaccinating US IC adults for the prevention of HZ and associated complications.

Disclosures

Desmond Curran, PhD, The GSK group of companies (Employee, Shareholder) Ahmed Salem, MSc, The GSK group of companies (Employee) Stéphane Lorenc, NA, GSK group of companies (Consultant) Brandon Patterson, PharmD, PhD, GSK group of companies (Shareholder) Justin Carrico, BS, GSK group of companies (Consultant)RTI Health Solutions (Employee) Katherine A. Hicks, MS, BSPH, GSK group of companies (Consultant)RTI Health Solutions (Employee) Elizabeth M. La, PhD, The GSK group of companies (Employee, Shareholder) Sara Poston, PharmD, The GSK group of companies (Employee, Shareholder) Christopher F. Carpenter, MD, MHSA, GSK group of companies (Consultant)

Game-Based Quality Improvement Teaching: Using Taters in Nursing Education

BACKGROUND

Quality improvement (QI) is difficult to teach in the classroom; therefore, nursing students are often under-prepared to participate in such projects after graduation. The Plan-Do-Study-Act method is commonplace in QI instruction and is often used in nursing. This study proposed and evaluated a gameful learning approach to improve understanding and engagement of a QI process using Potato Head figures.

METHOD

An observational design was utilized. Following classroom activity, students self-selected to join focus groups to discuss gameful learning experiences in learning QI techniques. Transcripts were analyzed using thematic analysis.

RESULTS

Overall, learners found the activity was effective in teaching QI. Positive and negative themes were identified, including fun and competitive, interactive and communication, and teamwork; disconnection between QI topic and game, and unclear instruction, respectively.

CONCLUSION

Using gameful learning helped students understand and engage with QI projects that may translate to clinical practice for new graduate nurses. [J Nurs Educ. 2021;60(10):590-593.].

Developing a web-based toolkit for new mothers about postpartum pelvic floor health in collaboration with a professional medical association

Background:

Few electronic resources are available for new mothers with concerns about changes in their pelvic floor following childbirth. Patients may struggle when seeking authoritative information regarding pelvic floor conditions online given the sensitivity of the topic as well as the inadvertent connection to obscene or demeaning content found online. A health sciences librarian partnered with the Motherhood and Pelvic Health Study, an interdisciplinary research group, to provide expert searching skills for a particularly challenging health condition that patients struggle to find useful information on.

Case Presentation:

A custom rubric was developed to evaluate existing information products, which included criteria for cultural sensitivity, conflicts of interest, and other red flags. This evaluation process enabled the research team to identify top-tier evidence-based materials that were culturally congruent. This collaborative evaluation process led to the creation of a web-based toolkit resource for new mothers concerned about changes in their pelvic floor. The toolkit connects women to pertinent information on a national health organization's patient portal, supplemented by videos created by the team to serve as models of communication for women and health care providers.

Conclusion:

When developing a web-based resource, health sciences libraries can partner with research teams to find, evaluate, and disseminate information. Culturally congruent toolkits such as this one can improve access to health information and lead to improved health outcomes. To ensure that the information highlighted in toolkits is both culturally congruent and authoritative, research teams should form advisory committees and partner with relevant professional medical associations.

Pod save you: assisting the transition to audio-based asynchronous learning

Background:

In 2017, an academic health sciences library in Utah developed a multimedia studio for students, faculty, and academic staff. Educational projects needing video, audio, and lecture capture could utilize a one-button studio for recording video sessions, microphones for audio, and various screen capture software for lectures. Since the pandemic, this service has seen rapid growth due to academic lectures going exclusively online. In response, the library launched a dedicated podcasting suite to accommodate the increase in students and faculty needing to record lectures or podcasts for others in the medical profession.

Description:

This article will outline the process of creating the podcasting suite and provide equipment rosters and methods other libraries may consider for establishing their own studio. Administrating duties of the studio will also be included, such as handling reservations and user assessment. An instructional guide for users is also included to assist patrons in accomplishing their podcast creations.

Conclusion:

Podcasts created in the space range from topics about teaching strategies in medicine to diagnoses and treatments of skin disorders. A podcasting suite is another way libraries can provide valuable services for asynchronous learning and student projects. Students, staff, and faculty have appreciated the ease of the service and the support behind it. A feedback loop was developed to further improve the space to meet the needs of users.

New nurses apply only basic source evaluation criteria but realize their skills are lacking: More sophisticated approaches to teaching evaluation skills are required

BACKGROUND

While information evaluation is an essential component of evidence based practice, it remains unclear how nurses perceive their own source evaluation skills and what evaluation criteria they typically apply.

OBJECTIVES

This study aims to determine nurses' self-reported confidence in their evaluation skills and their actual source evaluation ability. The findings will guide information literacy instruction.

METHODS

A questionnaire asked recently graduated nurses from four institutions in the Intermountain West (USA) to rate their confidence in evaluating information and to provide examples of evaluation criteria they typically applied. The quality of these criteria was rated by nursing librarians, then compared with reported confidence in evaluation, years employed as a nurse and highest degree level.

RESULTS

While nurses' self-reported confidence levels about source evaluation largely matched their ability, their evaluation criteria showed a low level of sophistication and did not match the recommended criteria by professional organizations. Graduate education, not years of work experience, was predictive of the quality of criteria used by nurses, suggesting the importance of more instruction on source evaluation for nursing students.

CONCLUSIONS

Nursing educators, including librarians, need to teach evaluation skills at the undergraduate level. Further investigation into building evaluation skills in nurses is warranted.

Touring a Data Curation Network Primer: A Focus on Neuroimaging Data

This video article provides an introduction to a data primer which leads data curators through the process of preparing a neuroimaging dataset for submission into a repository. A team of health sciences librarians and informationists created the primer which is focused on data from functional magnetic resonance images that are saved in either DICOM or NIfTI formats. The video walks through a flowchart discussing the process of preparing data sets to be deposited into a repository, key curatorial questions to ask for data that is highly sensitive, and how to suggest edits to this and other primers. The primer grew out of a data curation workshop hosted by the Data Curation Network.

Vitamin D deficiency predicts latent TB reactivation independent of preventive therapy: a longitudinal study

BACKGROUND: Vitamin D deficiency is associated with progression of latent tuberculosis (TB) infection to active disease. The impact of preventive therapy on this association is unknown.METHOD: Serum 25-hydroxyvitamin D (25(OH)D) levels were retrospectively linked to adults diagnosed with latent TB between April 2010 and January 2019 in a hospital in London, UK. Individuals in the cohort who progressed to active TB were identified by matching to a national notification register. A logistic regression model was used to examine baseline vitamin D deficiency and use of preventive therapy with subsequent incidence of TB disease.RESULTS: Of 1509 latently infected individuals with 3902 patient-years of follow-up, 687 (45.5%) were identified as vitamin D deficient and 691 (45.8%) individuals had a LTBI regimen prescribed. There were 29 (1.9%) instances of TB reactivation. On multivariate analysis, profound (<25 nmol/L) vitamin D deficiency (aHR 5.68, 95%CI 2.18-14.82; P = 0.0003) and the absence of preventive therapy (aHR 3.84, 95%CI 1.46-10.08; P = 0.006) were associated with progression to active TB disease. There was no evidence that preventive therapy modified the association between vitamin D status and TB reactivation.CONCLUSION: Our results show an independent association between vitamin D deficiency and progression from latent TB infection to active disease.

The gut microbiome and inflammation in obsessive-compulsive disorder patients compared to age- and sex-matched controls: a pilot study

OBJECTIVE

To compare the gut microbiome profile (by way of taxon analysis and indices of β- and α-diversity) and inflammatory markers (C-reactive protein [CRP], interleukin-6[IL-6] and tumour necrosis factor-α [TNF-α]) of obsessive-compulsive disorder (OCD) outpatients and non-psychiatric community controls.

METHODS

We collected morning stool and blood samples from 21 non-depressed, medication-free OCD patients and 22 age- and sex-matched non-psychiatric community controls. Microbiota analysis was performed using Illumina sequencing of the V3 region of 16S rRNA; serum CRP samples were analysed using immunoturbidimetry and plasma IL-6/TNF-α were examined by high-sensitivity ELISA. Multiple comparisons were corrected for using the false discovery rate (α = 0.05).

RESULTS

Compared to controls, the OCD group presented lower species richness/evenness (α-diversity, Inverse Simpson) and lower relative abundance of three butyrate producing genera (Oscillospira, Odoribacter and Anaerostipes). Compared to controls, mean CRP, but not IL-6 and TNF-α, was elevated OCD patients. CRP revealed moderate to strong associations with psychiatric symptomatology.

CONCLUSION

To our knowledge, this is the first investigation of the gut microbiome in OCD. In addition, our findings lend further support for the potential association of inflammation and OCD. These results suggest the gut microbiome may be a potential pathway of interest for future OCD research.

Experimental Measurements of Ultrasound Attenuation in Human Chest Wall and Assessment of the Mechanical Index for Lung Ultrasound

Knowledge of the acoustic attenuation characteristics of the chest wall is necessary to estimate the acoustic exposure at the pleural surface during lung ultrasound and is useful in the prediction of bio-effects (e.g., pulmonary capillary hemorrhage) and the development of safe, effective lung imaging. Currently, this property is not well characterized in humans. The aim of this work was to characterize ultrasonic attenuation in human chest wall such that the ultrasound exposures of the lung can be estimated for clinically relevant conditions. In this study, we experimentally measured ultrasound transmitted through the intercostal tissue of 15 human cadaver chest wall samples relative to ultrasound transmitted through saline to determine attenuation coefficients for each sample. A GE Vivid 7 diagnostic ultrasound machine (GE Vingmed, Horten, Norway) and 3 S and 5 S phased array probes were used at center frequencies from 1.6 to 5 MHz. The chest wall samples varied in thickness from 2.3-5.5 cm with a median thickness of 3.8 cm. The frequency-normalized attenuation coefficient was approximately 1.44 dB/cm/MHz based on a linear best fit through all attenuation measurements. Attenuation characteristics varied appreciably between samples, and the sample-averaged linear attenuation coefficient was 1.43 ± 0.32 (mean ± standard deviation) dB/cm/MHz. This attenuation is higher than that previously measured in mammalian chest wall samples (1.1-1.3 dB/cm/MHz for mice and rats) and is much greater than that used by the mechanical index (0.3 dB/cm/MHz). Mechanical index values calculated using saline values de-rated by 0.3 dB/cm/MHz were up to 1.2 MPa/MHz^1/2 greater than those calculated using the measured through-tissue ultrasound waves. We conclude that the mechanical index overestimates exposures for lung ultrasound and thus may not be an appropriate dosimetry metric for pulmonary ultrasound.

Co-creation of a sport-specific anterior cruciate ligament injury risk reduction program for women: A concept mapping approach

OBJECTIVES

To engage physiotherapists experienced in female elite sport and athletes to co-create a sport-specific anterior cruciate ligament (ACL) injury risk reduction program.

DESIGN

Concept Mapping.

METHODS

The Concept Systems Global MAX™ web platform was used to collect and analyse data from 27 context and content experts (22 physiotherapists, 5 athletes). Participants brainstormed statements representing the critical elements that should be included in an ACL injury risk reduction program for women playing elite Australian Football (AF).

RESULTS

Twenty-two participants brainstormed 56 statements that were synthesised and edited to 62 statements. Statements were sorted into clusters by twenty-three participants and rated on importance and feasibility using six-point scales. Multidimensional scaling and cluster analysis identified a 5-cluster solution as follows: Football-specific preparation (15 statements); Movement skills (17 statements); Strength and conditioning (15 statements); Individual preparation (7 statements); and Education (8 statements). Calculation of mean ratings for each cluster and statement identified the Movement skills cluster as most important (mean=3.61 out of 5) and the Football-specific preparation cluster as most feasible (3.75 out of 5). By contrast, the Individual preparation cluster was rated the least important (mean=2.9 out of 5), and the least feasible (3.12 out of 5), to include in the program.

CONCLUSIONS

The five clusters of critical elements to include in an ACL injury risk reduction program for women playing elite AF, in order of most to least importance were: movement skills, football-specific preparation, education, strength and conditioning and individual preparation.

Using Information Practices of Nurses to Reform Information Literacy Instruction in Baccalaureate Nursing Programs

Abstract Objective - Seeking information is a key element of evidence based practice and successful healthcare delivery. Significant literature exists on both the information seeking behaviour of professional nurses and information literacy teaching methods, but scarce evidence connects nurses’ information behaviour and environments with their education. This study sought to use data from nursing alumni to answer the following research questions: What are the current information practices of professional bachelor’s-prepared nurses? How do recently-graduated nurses suggest that their education could have better prepared them to find and evaluate information in the workplace? Methods - The researchers conducted a descriptive study using a 59-item survey instrument with a variety of question formats including short-answer, multiple choice, Likert, and open response. The researchers distributed the survey to baccalaureate nursing alumni who graduated in 2012-2017 from four universities in the state of Utah in the United States. Results - Nurses seek practical information primarily to provide informed patient care, while also clarifying medical situations and expanding their health care knowledge. They frequently consult nursing colleagues and physicians when seeking information. The majority of nurses consult electronic health records daily. Respondents described time as the biggest barrier to accessing information. They requested authentic, clinically-focused scenarios, training on freely-accessible resources, and more explicit teaching of lifelong learning skills, such as critical thinking. Conclusion - Information literacy education should prepare student nurses for the fast-paced information environment they will face in the workplace. This means incorporating more patient-focused scenarios, freely available quality resources, and time-based activities in their education. The researchers suggest areas to prepare nurses for information seeking, including problem-based clinical scenarios, building guides with databases accessible for free or little cost, and added emphasis on critical thinking and self-motivated learning.

Pulmonary Capillary Hemorrhage Induced by Super Sonic Shear Wave Elastography in Rats

The occurrence of the pulmonary capillary hemorrhage (PCH) bioeffect of diagnostic ultrasound in rats was investigated for a SuperSonic Imagine shear wave elastography system (Aixplorer, Supersonic Imagine, Aix-en-Provence, France). The elastography imaging repeated at 1 Hz and consisted of widely spaced B-mode image pulses, supersonic push (SSP) pulses and shear wave imaging (SWI) pulses. Groups of rats anesthetized with ketamine and xylazine, or with ketamine only, were imaged on their right side in a warm water bath for one frame, 30 s and 300 s. The image focus and region of interest were adjusted to give exposure only with the background B-mode imaging, or primarily with the SSP and SWI pulses. A sham group had only low power aiming scans. The lungs were removed 5 min after exposure and evaluated for PCH area and volume. The B mode was notably ineffective and produced significant PCH only at the maximum 0 dB output. The SSP pulses together with the SWI pulses produced significant PCH for 300 s, 30 s and even single image exposures. Peak rarefactional pressure amplitude PCH thresholds for 300 s exposure were the same with or without the B-mode pulses at 1.5 MPa (in situ mechanical index, MI_IS = 0.67). A 30 s duration resulted in a slightly increased threshold of 1.7 MPa (MI_IS = 0.76). The omission of xylazine from the anesthetic, which reduces the sensitivity of rat lung to PCH occurrence, resulted in an increased threshold of 2.1 MPa (MI_IS = 0.94). The unique SSP pulses were much more effective than the B mode, but thresholds were comparable to previous results with other diagnostic ultrasound modes on other systems.

Pulmonary Capillary Hemorrhage Induced by Acoustic Radiation Force Impulse Shear Wave Elastography in Ventilated Rats

OBJECTIVES

Diagnostic ultrasound (DUS) imaging can induce pulmonary capillary hemorrhage (PCH), possibly related to the ultrasonic radiation surface pressure arising from reflection at the lung blood-air interfaces. Acoustic radiation force impulse (ARFI) elastography is a relatively new DUS mode with high-energy "push pulses" used to move tissue and generate shear waves. The objective of this study was to characterize PCH induced by the ARFI elastographic mode for comparison with other previously tested DUS modes.

METHODS

Pulmonary capillary hemorrhage induction was examined for ARFI elastographic frames with 5.7-MHz push pulses (Acuson S3000; Siemens Medical Solutions, Mountain View, CA), which had a derated PRPA of 2.6 MPa. Groups of rats with tracheal tube placement had no ventilation (spontaneous breathing), intermittent positive pressure ventilation (IPPV), or IPPV plus 8 cm H₂ O of positive end-expiratory pressure (PEEP). Exposure was to 1 or 20 manually triggered image frame acquisitions. The PCH area was measured on the lung surface.

RESULTS

All 20-frame exposure groups, and even the single-frame group, had significant PCH relative to shams. Single-frame exposures produced significantly less PCH (P = .002) than 20-frame exposures in rats with a tracheal tube only (spontaneous breathing). The PEEP inhibited the PCH and produced about half of the PCH area induced for IPPV without PEEP (P = .014).

CONCLUSIONS

The PCH results were comparable with those from a previous study using B-mode or color Doppler exposure for 5 minutes; however, these modes delivered many more pulses for continuous imaging frames, suggesting that the ARFI elastographic frames were individually much more effective.

Acoustic Fountains and Atomization at Liquid Surfaces Excited by Diagnostic Ultrasound

Pulmonary capillary hemorrhage (PCH) has been found in mammalian lungs exposed to diagnostic ultrasound (DUS), although the mechanism is poorly understood. This work investigates acoustic atomization and fountains at liquid-air interfaces subjected to DUS, which has been suggested as a possible PCH damage mechanism. Primarily using a SuperSonic Imagine Aixplorer DUS machine (SuperSonic Imagine, Aix-en-Provence, France), blood and water surfaces were excited in vitro by DUS and recorded with a high-speed camera. The surface was driven by B-mode, color Doppler, pulsed Doppler, and shear wave elastography imaging modes with center frequencies from 5.0-7.2 MHz and mechanical indexes (MI) up to 1.7. Fountains and atomization were only observed for SWE, for MI as low as 1.0. A comparison of the SWE waveforms with the surface dynamics suggests that fountains and atomization were driven by push-pulses and depended on pulse duration and intensity. However, we conclude that atomization and fountaining are unlikely primary mechanisms behind all DUS-induced PCH because neither phenomenon occurred for traditional diagnostic imaging modes.

Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups

Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).

Library as the Technology Hub for the Health Sciences

Academic health sciences libraries have an important role in facilitating the use of technology in health sciences curricula. Serving as a technology hub, the library supports, advocates, and provides access to new technologies. The library introduces many faculty and students to new technology tools, techniques, and equipment for new multimedia creation. As the technology hub grows and expands, library personnel can provide expertise, which demonstrates the library's value in leading the exploration of new technology, including Do-It-Yourself multimedia tools, virtual reality, virtual anatomy, and 3D printing.

Endovascular aneurysm sealing for infrarenal abdominal aortic aneurysms: 30-day outcomes of 105 patients in a single centre

OBJECTIVE

Endovascular aneurysm sealing (EVAS) has been proposed as a novel alternative to endovascular aneurysm repair (EVAR) in patients with infrarenal abdominal aortic aneurysms (AAA). The early clinical experience, technical refinements, and learning curve of EVAS in the treatment of AAA at a single institution are presented.

METHODS

One-hundred and five patients were treated with EVAS between March 2013 and November 2014. Prospective data were recorded on consecutive patients receiving EVAS. Data included demographics, preoperative aneurysm morphology, and 30-day outcomes, including rates of endoleak, limb occlusion, reintervention, and death. Postoperative imaging consisted of duplex ultrasound and computed tomographic angiography.

RESULTS

The mean age of the cohort was 76 ± 8 years and 12% were female. Adverse neck morphology was present in 72 (69%) patients, including aneurysm neck length <10 mm (20%), neck diameter >32 mm (18%), β-angulation >60° (21%), and conical aneurysm neck (51%). There was one death within 30 days. The incidence of Type 1 endoleak within 30 days was 4% (n = 4); all were treated successfully with transcatheter embolisation. All four proximal endoleaks were associated with technical issues that resulted in procedure refinement, and all were in patients with adverse proximal aortic necks. The persistent Type 1 endoleak rate at 30 days was 0% and there were no Type 2 or Type 3 endoleaks. Angioplasty and adjunctive stenting were performed for postoperative limb stenosis in three patients (3%).

CONCLUSIONS

EVAS appears to be associated with reasonable 30-day outcomes despite the necessity of procedural evolution in the early adoption of this technique. EVAS appears to be applicable to patients with challenging aortic morphology and endoleak rates should reduce with procedural experience. The utility of EVAS will be defined by the durability of the device in long-term follow-up, although the absence of Type 2 endoleaks is encouraging.

Current endovascular management of acute type B aortic dissection - whom should we treat and when?

Aortic dissection is the most common of the acute aortic syndromes, once initiated, intimal disruption can propagate in an anterograde or retrograde fashion, and the resulting false lumen may compress the ostia of aortic branches or cause aortic expansion and eventual rupture. Acute complicated type B dissection most often requires immediate interventional treatment, whereas uncomplicated dissection has classically been managed with medical therapy alone. The first line management of complicated acute and aneurysmal chronic type B dissections has shifted toward minimally invasive endovascular treatment. To give an overview of the contemporary management of acute type B dissection, clinical manifestations, aims of management, and therapeutic options are discussed in the context deciding which patients require intervention and when.

Theoretical microbubble dynamics in a viscoelastic medium at capillary breaching thresholds

In order to predict bioeffects in contrast-enhanced diagnostic and therapeutic ultrasound procedures, the dynamics of cavitation microbubbles in viscoelastic media must be determined. For this theoretical study, measured 1.5 to 7.5 MHz pulse pressure waveforms, which were used in experimental determinations of capillary breaching thresholds for contrast-enhanced diagnostic ultrasound in a rat kidney, were used to calculate cavitation nucleated from contrast agent microbubbles. A numerical model for cavitation in tissue was developed based on the Keller-Miksis equation (a compressible extension of the Rayleigh-Plesset equation for spherical bubble dynamics), with a Kelvin-Voigt constitutive relation. From this model, the bubble dynamics corresponding to the experimentally obtained capillary breaching thresholds were determined. Values of the maximum radius and temperature corresponding to previously determined bioeffect thresholds were computed for a range of ultrasound pulses and bubble sizes for comparison to inertial cavitation threshold criteria. The results were dependent on frequency, the gas contents, and the tissue elastic properties. The bioeffects thresholds were above previously determined inertial cavitation thresholds, even for the tissue models, suggesting the possibility of a more complex dosimetry for capillary injury in tissue.

A dedicated clinic for HIV-positive individuals over 50 years of age: a multidisciplinary experience

The HIV-infected population is ageing. Issues including polypharmacy and co-morbidities led us to develop a dedicated clinic for HIV-infected individuals over 50. We describe our service evaluation after two years. The over 50 clinic commenced in January 2009. The team comprises a registrar, consultant, nurse practitioner and is supported by a pharmacist and mental health services. Patients undergo a full medication and drug interactions review, neurocognitive assessment, adherence self-assessment and investigations including therapeutic drug monitoring (TDM), coronary artery calcium scores (CACS) and bone mineral density. Over two years of activity, 150 patients attended the service. Median (range) age was 58 (50-88), all were on combined antiretroviral therapy and 38% (57/150) were on ≥3 non-HIV drugs. CACS was high (>90th centile) in 14%. Thirty-eight percent had osteopaenia and 18% had osteoporosis requiring treatment. Thirteen out of 125 men had an increased prostate specific antigen, four were diagnosed with prostate cancer. Drug interaction, TDM and neurocognitive assessments were useful for several patients. Asymptomatic patients over 50 in long-term follow-up had new pathologies detected through targeted screening. The clinic has improved general practitioner (GP) liaison and facilitated closer working relationships with other specialties. Patients have reacted positively to the clinic, particularly as many do not routinely access their GP.

Differences in the clinical presentation of Trisomy 21 with and without autism

BACKGROUND

Autism occurs 10 times more often in children with Down syndrome than in the general population, but diagnosing co-occurring autism in Down syndrome with severe intellectual disability is challenging. The objective of this case-control study was to identify characteristics differentiating children with trisomy 21 with and without autism and to determine the extent to which severe cognitive impairment affects the measures of autism symptomatology.

METHOD

Twenty children with trisomy 21 and autism (cases) were compared with children with trisomy 21 without autism (controls) matched on chronologic age, race and gender. Communication, cognitive and adaptive behaviour skills were assessed with standardized instruments. Medical history was reviewed and medical records were examined for early head growth. Scores on the diagnostic algorithm of the Autism Diagnostic Interview--Revised (ADI-R) were compared after adjusting for cognitive ability as measured by the Stanford-Binet (Fifth Edition) non-verbal change sensitive score.

RESULTS

Cases performed significantly more poorly on all assessments. Mean case-control differences for matched pairs were all significant at P < 0.0001 for receptive and expressive language skills, cognitive skills and adaptive skills. Seven cases had a history of seizures compared with one control(P = 0.01). After adjusting for cognitive ability, the mean scores on the Reciprocal Social Interaction, Communication, and Restricted, Repetitive and Stereotyped Behaviours domains of the ADI-R diagnostic algorithm remained significantly higher in cases compared with controls (P < 0.0001). All participants had decreased head size consistent with Down syndrome, with no case-control differences.

CONCLUSION

Children with trisomy 21 and autism have significantly more impaired brain function than children with trisomy 21 without autism. However, the deficits in the core domains of social reciprocity and communication, and the restricted and repetitive interests are not entirely explained by the more severe cognitive impairment. This autism phenotype in children with trisomy 21 which includes an increased risk for seizures may indicate a widespread loss of functional connectivity in the brain.