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Choe AI, Kamath A, Slanetz P, Swanson J, Lee JT, Yen SPF, DeBenedectis CM, Gould JE, Rozenshtein A. "What Program Directors Think" VI: Results of the 2024 Survey of the APDR Part 1. Acad Radiol 2025:S1076-6332(25)00091-1. [PMID: 39924376 DOI: 10.1016/j.acra.2025.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/26/2025] [Accepted: 01/27/2025] [Indexed: 02/11/2025]
Abstract
RATIONALE AND OBJECTIVES The Association of Program Directors in Radiology (APDR) surveys its members for data gathering on educational practices and challenges in radiology residency training including changes in the residency application process. MATERIALS AND METHODS This was an observational, cross-sectional study using a Web-based survey. Members of the 2022-2023 Annual Survey Committee developed survey questions resulting in 40 items, including demographic data. The survey was distributed by email to all active members of the APDR in January and February of 2024. In this paper, analysis of the radiology program directors' (PD) use of information in the supplemental application to the Electronic Residency Application Service® (ERAS), including the latest changes in preference signaling is presented. RESULTS Responses were collected electronically, tallied using Qualtrics software, tabulated or summarized. The total survey response rate was 31% (84/247). The results of this survey were presented at the annual Association of University Radiologists meeting in Boston, MA (April 2024). CONCLUSION Survey results find preference signaling in ERAS® useful and support the recent increase in the number of signals using the two-tiered system. PDs see no significant difference in applicant competitiveness in the gold and silver signal cohorts. Other information in the ERAS supplemental application, such as applicants' geographic preferences and meaningful experiences, are most impactful on an applicants' chances of receiving an interview in the absence of a preference signal.
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Bishop LR, Swanson J, Kiptui F, Shufflebarger EF, Crosby JC, Heimann MA, Greene C, Kilgore A, Davis WR, Griesmer K, Shaw C, Crognale D, Larrison MC, Burleson SL. Development and Implementation of a Context-Specific Multi-modal Point-of-Care Ultrasound Curriculum for a Kenyan Family Medicine Residency Program. Cureus 2024; 16:e75655. [PMID: 39803102 PMCID: PMC11725304 DOI: 10.7759/cureus.75655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2024] [Indexed: 01/16/2025] Open
Abstract
Access to diagnostic imaging is significantly limited in much of the world, and sub-Saharan Africa is no exception. Clinician-performed point-of-care ultrasound (POCUS) may provide increased access to diagnostic imaging for many patients in low-resource settings, but training in this modality is limited. We describe the development and implementation of a context-specific, multi-modal pilot POCUS curriculum involving hands-on instruction, in-person and online didactics, asynchronous online image review, and quantitative evaluation. The curriculum was specifically designed for family medicine residents at a rural Kenyan training hospital. This evidence-based training curriculum was designed for integration into a residency curriculum to train Kenyan family medicine physicians to achieve competence in POCUS use and develop the local expertise and leadership necessary to reproduce the training at other institutions. The curriculum was designed specifically for this Kenyan context; however, we provide a detailed description of all curricular elements and review the evidence informing those elements in order to facilitate reproduction at other similar institutions and settings to improve access to POCUS training. We trained eight family medicine resident participants, all of whom strongly agreed with the utility of the curriculum and its component parts. All eight trainees met quantitative competency measures by written evaluations, direct observation, structured clinical exams, image review, and overall numbers of POCUS exams. A total of 1029 ultrasound scans were performed by the participants in the first year of implementation, averaging 128 scans per participant. No participant fully completed the required number of 165 scans for each application; however, most participants are continuing to add to their numbers as planned. Many of these scans were performed under direct faculty supervision to allow for real-time assessment and feedback, and the rest were asynchronously reviewed. All participants also passed all five observed standardized clinical evaluations (OSCEs), demonstrating their competency to perform, record, and interpret images in a timely and accurate manner. We describe many of the logistical requirements and challenges we experienced, as well as our methods of adapting to or overcoming them. Our curriculum is an effective means of developing POCUS competence in an African setting. Our data and experience with implementation may help establish or expand POCUS into medical training in other institutions in sub-Saharan Africa, improving access to this vital diagnostic tool.
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Kittelson DB, Swanson J, Aldridge M, Giannelli RA, Kinsey JS, Stevens JA, Liscinsky DS, Hagen D, Leggett C, Stephens K, Hoffman B, Howard R, Frazee RW, Silvis W, McArthur T, Lobo P, Achterberg S, Trueblood M, Thomson K, Wolff L, Cerully K, Onasch T, Miake-Lye R, Freedman A, Bachalo W, Payne G. Experimental verification of principal losses in a regulatory particulate matter emissions sampling system for aircraft turbine engines. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2021; 56:63-74. [PMID: 35602286 PMCID: PMC9118390 DOI: 10.1080/02786826.2021.1971152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 07/30/2021] [Indexed: 06/15/2023]
Abstract
A sampling system for measuring emissions of nonvolatile particulate matter (nvPM) from aircraft gas turbine engines has been developed to replace the use of smoke number and is used for international regulatory purposes. This sampling system can be up to 35 m in length. The sampling system length in addition to the volatile particle remover (VPR) and other sampling system components lead to substantial particle losses, which are a function of the particle size distribution, ranging from 50 to 90% for particle number concentrations and 10-50% for particle mass concentrations. The particle size distribution is dependent on engine technology, operating point, and fuel composition. Any nvPM emissions measurement bias caused by the sampling system will lead to unrepresentative emissions measurements which limit the method as a universal metric. Hence, a method to estimate size dependent sampling system losses using the system parameters and the measured mass and number concentrations was also developed (SAE 2017; SAE 2019). An assessment of the particle losses in two principal components used in ARP6481 (SAE 2019) was conducted during the VAriable Response In Aircraft nvPM Testing (VARIAnT) 2 campaign. Measurements were made on the 25-meter sample line portion of the system using multiple, well characterized particle sizing instruments to obtain the penetration efficiencies. An agreement of ± 15% was obtained between the measured and the ARP6481 method penetrations for the 25-meter sample line portion of the system. Measurements of VPR penetration efficiency were also made to verify its performance for aviation nvPM number. The research also demonstrated the difficulty of making system loss measurements and substantiates the E-31 decision to predict rather than measure system losses.
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Wallace DW, Burleson SL, Heimann MA, Crosby JC, Swanson J, Gibson CB, Greene C. An adapted emergency department triage algorithm for the COVID-19 pandemic. J Am Coll Emerg Physicians Open 2020; 1:1374-1379. [PMID: 32838392 PMCID: PMC7436476 DOI: 10.1002/emp2.12210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/21/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic, with its public health implications, high case fatality rate, and strain on hospital resources, will continue to challenge clinicians and researchers alike for months to come. Accurate triage of patients during the pandemic will assign patients to the appropriate level of care, provide the best care for the maximum number of patients, rationally limit personal protective equipment (PPE) usage, and mitigate nosocomial exposures. The authors describe an adapted COVID-19 pandemic triage algorithm for emergency departments (EDs) guided by the best available evidence and responses to prior pandemics, with recommendations for clinician PPE use for each level of encounter in the setting of an ongoing PPE shortage. Our algorithm adheres to Centers for Disease Control and Prevention guidelines and supports discharge of patients with mild symptoms coupled with explicit and strict return precautions and infection control education.
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Amoon AT, Swanson J, Vergara X, Kheifets L. Relationship between distance to overhead power lines and calculated fields in two studies. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:431-443. [PMID: 32066122 DOI: 10.1088/1361-6498/ab7730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is some evidence that both distance from transmission lines and measured or calculated magnetic fields are associated with childhood leukemia. Because distance is a key component when calculating the magnetic field generated by power lines, distance from lines and calculated fields based on lines tend to be highly correlated. Socioeconomic status (SES) and dwelling type are also associated with magnetic field exposure. We used exposure data from two large studies of childhood leukemia and other cancers, in the US and the UK, to describe a relationship between distance and magnetic fields across the population within 100 meters (m) of power lines as a whole and evaluate potential modifiers such as SES and type of dwelling. There were 387 subjects living within 100 m of an overhead power line. There was no significant difference in mean calculated fields or distance to 200+ kV lines within 100 m by study. Within the range where the power-line field is expected to be significant compared to other sources, which we take as 100 m, distance to high-voltage lines predicted magnetic field (MF) variation in both studies better than other functions of distance tested in both linear and logistic regression. There were no differences between high and low SES or dwelling types (single-family home versus other). In conclusion, we found that calculated fields do appear to diminish linearly with increasing distance from overhead power lines, up to 100 m, particularly those 200+ kV and above. These results are stronger in the UK study. Within 100 m, distance to high-voltage lines continues to be highly correlated with calculated MFs and each can be a proxy for the other.
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DeBenedectis CM, Heitkamp DE, England E, Gaviola GC, Hirsch JA, Ho CP, Jay AK, Kagetsu N, Kalia V, Milburn J, Ong S, Paladin AM, Patel MD, Swanson J, Sarkany DS. A Program Director's Guide to Cultivating Diversity and Inclusion in Radiology Residency Recruitment. Acad Radiol 2020; 27:864-867. [PMID: 31473056 DOI: 10.1016/j.acra.2019.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
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Figueroa L, McClure EM, Swanson J, Nathan R, Garces AL, Moore JL, Krebs NF, Hambidge KM, Bauserman M, Lokangaka A, Tshefu A, Mirza W, Saleem S, Naqvi F, Carlo WA, Chomba E, Liechty EA, Esamai F, Swanson D, Bose CL, Goldenberg RL. Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reprod Health 2020; 17:19. [PMID: 32000798 PMCID: PMC6993413 DOI: 10.1186/s12978-020-0854-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Oligohydramnios is a condition of abnormally low amniotic fluid volume that has been associated with poor pregnancy outcomes. To date, the prevalence of this condition and its outcomes has not been well described in low and low-middle income countries (LMIC) where ultrasound use to diagnose this condition in pregnancy is limited. As part of a prospective trial of ultrasound at antenatal care in LMICs, we sought to evaluate the incidence of and the adverse maternal, fetal and neonatal outcomes associated with oligohydramnios. Methods We included data in this report from all pregnant women in community settings in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo (DRC) who received a third trimester ultrasound as part of the First Look Study, a randomized trial to assess the value of ultrasound at antenatal care. Using these data, we conducted a planned secondary analysis to compare pregnancy outcomes of women with to those without oligohydramnios. Oligohydramnios was defined as measurement of an Amniotic Fluid Index less than 5 cm in at least one ultrasound in the third trimester. The outcomes assessed included maternal morbidity and fetal and neonatal mortality, preterm birth and low-birthweight. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models using general estimating equations to account for the correlation of outcomes within cluster. Results Of 12,940 women enrolled in the clusters in Guatemala, Pakistan, Zambia and the DRC in the First Look Study who had a third trimester ultrasound examination, 87 women were diagnosed with oligohydramnios, equivalent to 0.7% of those studied. Prevalence of detected oligohydramnios varied among study sites; from the lowest of 0.2% in Zambia and the DRC to the highest of 1.5% in Pakistan. Women diagnosed with oligohydramnios had higher rates of hemorrhage, fetal malposition, and cesarean delivery than women without oligohydramnios. We also found unfavorable fetal and neonatal outcomes associated with oligohydramnios including stillbirths (OR 5.16, 95%CI 2.07, 12.85), neonatal deaths < 28 days (OR 3.18, 95% CI 1.18, 8.57), low birth weight (OR 2.10, 95% CI 1.44, 3.07) and preterm births (OR 2.73, 95%CI 1.76, 4.23). The mean birth weight was 162 g less (95% CI -288.6, − 35.9) with oligohydramnios. Conclusions Oligohydramnos was associated with worse neonatal, fetal and maternal outcomes in LMIC. Further research is needed to assess effective interventions to diagnose and ultimately to reduce poor outcomes in these settings. Trial registration NCT01990625.
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Zengotita FE, Emerson HP, Stanley FE, Dittrich TM, Richmann MK, Reed D, Swanson J. Potential for biocolloid transport of cesium at high ionic strength. CHEMOSPHERE 2019; 235:1059-1065. [PMID: 31561295 DOI: 10.1016/j.chemosphere.2019.06.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
In subsurface repositories, active bacterial populations may directly influence the fate and transport of radionuclides including in salt repository systems like the Waste Isolation Pilot Plant in Carlsbad, NM. This research quantified the potential for transport and interaction between Chromohalobacter sp. and Cs in a high ionic strength system (2.6 M NaCl) containing natural minerals. Mini-column experiments showed that Chromohalobacter moved nearly un-retarded under these conditions and that there was neither association of Cs with microbes nor dolomite despite changes in bacterial metabolic phases. Growth batch experiments that monitored the potential uptake of Cs into the microbes confirmed results in column experiments where intracellular uptake of Cs by Chromohalobacter was not observed. These results show that Cs may be highly mobile if released in high ionic strength systems and/or carbonate minerals with negligible inhibition by these microbes.
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Zammert M, Buric D, Yazdchi F, Madou ID, Manca C, Woo S, Morth K, Bentain-Melanson M, Aranki S, Rawn J, Pelletier M, Shekar P, Kaneko T, Swanson J, Shook D, Varelmann D. The influence of enhanced recovery after cardiac surgery on 30-day readmission rate, hospital and ICU length of stay. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Varelmann D, Shook D, Buric D, Yadzchi F, Madou ID, Morth K, Bentain-Melanson M, Woo S, Manca C, Aranki S, Rawn J, Pelletier M, Shekar P, Kaneko T, Swanson J, Zammert M. Enhanced recovery after cardiac surgery: fluid balance and incidence of acute kidney injury. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bauserman M, Nathan R, Lokangaka A, McClure EM, Moore J, Ishoso D, Tshefu A, Figueroa L, Garces A, Harrison MS, Wallace D, Saleem S, Mirza W, Krebs N, Hambidge M, Carlo W, Chomba E, Miodovnik M, Koso-Thomas M, Liechty EA, Esamai F, Swanson J, Swanson D, Goldenberg RL, Bose C. Polyhydramnios among women in a cluster-randomized trial of ultrasound during prenatal care within five low and low-middle income countries: a secondary analysis of the first look study. BMC Pregnancy Childbirth 2019; 19:258. [PMID: 31331296 PMCID: PMC6647057 DOI: 10.1186/s12884-019-2412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/15/2019] [Indexed: 01/13/2023] Open
Abstract
Background In many low and low-middle income countries, the incidence of polyhydramnios is unknown, in part because ultrasound technology is not routinely used. Our objective was to report the incidence of polyhydramnios in five low and low-middle income countries, to determine maternal characteristics associated with polyhydramnios, and report pregnancy and neonatal outcomes. Methods We performed a secondary analysis of the First Look Study, a multi-national, cluster-randomized trial of ultrasound during prenatal care. We evaluated all women enrolled from Guatemala, Pakistan, Zambia, Kenya and the Democratic Republic of Congo (DRC) who received an examination by prenatal ultrasound. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models with general estimating equations to control for cluster-level effects. The diagnosis of polyhydramnios was confrimed by an U.S. based radiologist in a majority of cases (62%). Results We identified 305/18,640 (1.6%) cases of polyhydramnios. 229 (75%) cases were from the DRC, with an incidence of 10%. A higher percentage of women with polyhydramnios experienced obstructed labor (7% vs 4%) and fetal malposition (4% vs 2%). Neonatal death was more common when polyhydramnios was present (OR 2.43; CI 1.15, 5.13). Conclusions Polyhydramnios occured in these low and low-middle income countries at a rate similar to high-income contries except in the DRC where the incidence was 10%. Polyhydramnios was associated with obstructed labor, fetal malposition, and neonatal death. Trial registration NCT01990625, November 21, 2013.
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Swanson J, Kheifets L, Vergara X. Changes over time in the reported risk for childhood leukaemia and magnetic fields. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:470-488. [PMID: 30736028 DOI: 10.1088/1361-6498/ab0586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There have been many studies from 1979 to the present reporting raised risks for childhood leukaemia with exposure to power-frequency magnetic fields. There are also suggestions that the reported risk has been decreasing. We examine trends in the risk over time from all available studies. For 41 studies, we combine reported risks using inverse-variance weighting, drawing risk estimates from previous pooled analyses where possible for greater consistency. We examine the cumulative risk for studies published up to each successive calendar year for all studies and for various subsets, and test for a trend over the period. The cumulative relative risk has indeed declined, for our most rigorous analysis from a maximum 2.44 in 1997 to 1.58 in 2017, but not statistically significantly when tested as a linear trend. We find suggestions of higher risks in studies looking at higher exposures and in studies with better quality exposure assessment. We conclude that there is a decline in reported risk from the mid 1990s to now, which is unlikely to be solely explained by improving study quality but may be due to chance, and an elevated risk remains.
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Singhapricha T, Minkhorst O, Moran T, Swanson J, Shayne P. Predictors of an Initial Academic Position in Emergency Medicine. West J Emerg Med 2019; 20:127-131. [PMID: 30643615 PMCID: PMC6324707 DOI: 10.5811/westjem.2018.10.39096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/26/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Each year, emergency medicine (EM) residency graduates enter a variety of community and academic positions. For some training programs, the potential for an academic career is a consideration during the interview process; however, no studies have looked at factors that might predict an academic career. Our goal was to identify variables present during the EM application cycle that predict an initial academic position. Methods We retrospectively reviewed application materials from 211 EM graduates at Emory University from 2003–2013. We analyzed biographical variables, board scores, personal statements, and both undergraduate and medical school research experience and publications. An academic position was defined as working at a site with residents rotating in the emergency department, full or part-time appointment at a medical school, or a position with research required for promotion. We used a logistic regression model to determine the impact of these predictors on obtaining an initial academic position. Results A total of 79 (37%) graduates initially chose an academic job, and 132 (63%) took a community position. We identified the following statistically significant variables: younger age (odds ratio [OR] [0.79], 95% confidence interval [CI] [0.67–0.93], p=0.01); undergraduate publications (OR [1.41], 95% CI [1.08–1.83], p=0.01); and medical school publications (OR [3.39], 95% CI [1.66–6.94], p<0.001). Of note, mention of an academic career in the personal statement showed no statistical correlation (p = 0.41). Conclusion Younger age, and undergraduate and medical school publications were the variables most associated with an initial academic position. As this is a single-institution study, more studies are needed to validate these findings.
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Teare L, Martin N, Elamin W, Pilgrim K, Tredoux T, Swanson J, Hoffman P. Acinetobacter - the trojan horse of infection control? J Hosp Infect 2018; 102:45-53. [PMID: 30594610 DOI: 10.1016/j.jhin.2018.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Five cases of multi-resistant Acinetobacter baumanii (MRA) producing OXA-23 and OXA-51 occurred in a regional burn intensive care unit (BICU). Three were repatriated from other parts of the world (Dubai and Mumbai) and colonized on admission. Despite optimal precautions, two patients acquired MRA. Both had been nursed in the same room. METHODS Multi-disciplinary outbreak investigation of MRA in a regional BICU. FINDINGS The mechanism of transfer for the first case is thought to have been contaminated air from theatre activity releasing MRA bacteria into the communal corridor. No MRA patients went to theatre between the first and second acquired cases. The mechanism of transfer for the second case is thought to have been via a shower unit that was decontaminated inadequately between patients. CONCLUSION In an outbreak where contact precautions and environmental cleaning are optimal, it is important to give careful consideration to other mechanisms of spread. If there is a failure to do this, it is likely that the true causes of transmission will not be addressed and the problem will recur. It is recommended that burn theatres within burn facilities should be designed to operate at negative pressure; this is the opposite of normal operating theatre ventilation. Where showers are used, both the shower head and the hose should be changed after a patient with a resistant organism. The role of non-contact disinfection (e.g. hydrogen peroxide dispersal) should be reconsidered, and constant vigilance should be given to any 'trojan horse' item in the room.
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Swanson J, Bunch KJ. Reanalysis of risks of childhood leukaemia with distance from overhead power lines in the UK. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:N30-N35. [PMID: 29844249 DOI: 10.1088/1361-6498/aac89a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Our previous study of childhood leukaemia and distance to high-voltage overhead power lines in the UK has been included in an international pooled analysis. That pooled analysis used different distance categories to those we did, which has focussed attention on the effect of that choice. We re-analyse our previous subjects, using finer distance categories. In the 1960s and 1970s, when we principally found an elevated risk, the risk did not fall monotonically with distance from the power line but had a maximum at 100-200 m. This weakens the evidence that any elevated risks are related to magnetic fields, and slightly strengthens the evidence for a possible effect involving residential mobility or other socioeconomic factors.
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Goldenberg RL, Nathan RO, Swanson D, Saleem S, Mirza W, Esamai F, Muyodi D, Garces AL, Figueroa L, Chomba E, Chiwala M, Mwenechanya M, Tshefu A, Lokangako A, Bolamba VL, Moore JL, Franklin H, Swanson J, Liechty EA, Bose CL, Krebs NF, Michael Hambidge K, Carlo WA, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Harrison MS, Koso-Thomas M, Miodovnik M, Wallace DD, McClure EM. Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG 2018; 125:1591-1599. [PMID: 29782696 DOI: 10.1111/1471-0528.15287] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries. DESIGN Cluster randomised trial. SETTING Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. MAIN OUTCOME MEASURES The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. RESULTS During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components. CONCLUSIONS Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. TWEETABLE ABSTRACT Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
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Cavanaugh S, Wei J, Law T, Dick J, Schantz P, Tsui T, Crawford S, Swanson J. EP-2184: Clinical Implementation of a Nomogram as a HDR Prostate Pre-Treatment Second Check. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Cavanaugh S, Crawford S, Dick J, Schantz P, Tsui T, Harpool K, Snyder W, Swanson J. PO-1027: Dosimetric Improvement in HDR Prostate Brachytherapy Patients using Hydrogel Spacer Implantation. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perkins H, McIlroy M, Swanson J, Kadin M. Transient LW-Negative Red Blood Cells and
Anti-LW in a Patient with Hodgkin’s Disease. Vox Sang 2017. [DOI: 10.1159/000467529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Swanson D, Lokangaka A, Bauserman M, Swanson J, Nathan RO, Tshefu A, McClure EM, Bose CL, Garces A, Saleem S, Chomba E, Esamai F, Goldenberg RL. Challenges of Implementing Antenatal Ultrasound Screening in a Rural Study Site: A Case Study From the Democratic Republic of the Congo. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:315-324. [PMID: 28655805 PMCID: PMC5487092 DOI: 10.9745/ghsp-d-16-00191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 02/21/2017] [Indexed: 12/02/2022]
Abstract
In the context of a well-resourced research project on obstetric ultrasound, we encountered major challenges, including security and maintenance of the equipment, electricity requirements, health systems integration, and a variety of other systems issues. We propose future ultrasound interventions have at minimum a functioning health system with skilled and motivated staff, access to a referral hospital capable of providing affordable and higher levels of care, and feasible transportation means. Persistent global disparities in maternal and neonatal outcomes and the emergence of compact ultrasound technology as an increasingly viable technology for low-resource settings provided the genesis of the First Look Ultrasound study. Initiated in 2014 in 5 low- and middle-income countries and completed in June 2016, the study's intervention included the training of health personnel to perform antenatal ultrasound screening and to refer women identified with high-risk pregnancies to hospitals for appropriate care. This article examines the challenges that arose in implementing the study, with a particular focus on the site in Equateur Province of the Democratic Republic of the Congo (DRC) where the challenges were greatest and the efforts to meet these challenges most illuminating. During the study period, we determined that with resources and dedicated staff, it was possible to leverage the infrastructure and implement ultrasound at antenatal care across a variety of remote sites, including rural DRC. However, numerous technical and logistical challenges had to be addressed including security of the equipment, electricity requirements, and integration of the intervention into the health system. To address security concerns, in most of the countries field sonographers were hired and dispatched each day with the equipment to the health centers. At the end of each day, the equipment was locked in a secure, central location. To obtain the required power source, the DRC health centers installed solar panels bolted on adjacent poles since the thatch roofs of the centers prohibited secure roof-top installation. To realize the full value of the ultrasound intervention, women screened with high-risk pregnancies had to seek a higher level of care at the referral hospital for a definitive diagnosis and appropriate care. While the study did provide guidance on referral and systems management to health center and hospital administration, the extent to which this resulted in the necessary structural changes varied depending on the motivation of the stakeholders. In order for such an intervention to be scaled up and sustained as part of a health system's general services, it would require considerable effort, political will, and financial and human resources. Preliminary results from the study indicate that taking routine antenatal ultrasound screening to scale is not warranted. Lessons learned in implementing the study, however, can help inform future studies or programs that are considering use of ultrasound or other imaging technology for other applications in low-resource settings.
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Mcclure E, Goldenberg R, Swanson D, Saleem S, Esamai F, Garces A, Chomba E, Tshefu A, Moore J, Swanson J, Liechty E, Bose C, Krebs N, Carlo W, Koso-Thomas M, Miodovnik M, Nathan R. 3: Routine antenatal ultrasound in low/middle income countries: a cluster randomized trial. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Garza I, Swanson J. Successful Preventive Therapy in Hypnic Headache Using Hypnotics: A Case Report. Cephalalgia 2016; 27:1080-1. [PMID: 17645753 DOI: 10.1111/j.1468-2982.2007.01364.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bunch KJ, Swanson J, Vincent TJ, Murphy MFG. Epidemiological study of power lines and childhood cancer in the UK: further analyses. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:437-455. [PMID: 27356108 DOI: 10.1088/0952-4746/36/3/437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report further analyses from an epidemiological study of childhood cancer and residence at birth near high-voltage power lines in the UK. These results suggest that the elevated risks for childhood leukaemia that we previously found for overhead power lines may be higher for older age at diagnosis and for myeloid rather than lymphoid leukaemia. There are differences across regions of birth but not forming any obvious pattern. Our results suggest the decline in risk we previously reported from the 1960s to the 2000s is linked to calendar year of birth or of cancer occurrence rather than the age of the power lines concerned. Finally, we update our previous analysis of magnetic fields to include later subjects.
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