Early Placement Research Articles

Properties of Modern Flowable Fill Incorporating Rapid-Setting Cements: Laboratory and Field Studies of Dry Placement Method

Timely maintenance and rehabilitation is critical to ensuring the long-term sustainability of transportation infrastructure. Full-depth pavement repairs represent a significant investment of both time and money, but such repairs become necessary where localized pavement failures have occurred as a result of inadequate performance of the underlying support system. Subsurface layers are traditionally repaired using compacted lifts of aggregate. While this approach is relatively inexpensive, it is labor-intensive, time-consuming, and can lead to premature repair failure if the layer is not adequately constructed. Rapid-setting (RS) flowable fill provides a backfilling material option that flows under gravity to fill subsurface voids, self-consolidates, and sets rapidly to facilitate the early placement of surfacing material. The dry placement method is a novel technique in which the blended RS flowable fill is placed in its dry state and water is added without mixing. The performance of three commercially available RS flowable fill materials placed using the dry method was investigated using both laboratory and accelerated full-scale vehicle trafficking. Results from these experiments indicate that reduced repair time and in-place cost, as compared to traditional repair techniques, can be achieved when flowable fill containing RS cement is employed using the dry placement method.

Using Storytelling to Teach Tłichǫ Language and Culture to Young Children in the Canadian Northwest Territories

AbstractReanna, Janet, and Jaimyka are early childhood educators who are recent graduates of the Early Learning and Child Care (ELCC) Diploma program in Aurora College in the Northwest Territories of Canada. They used storytelling and related follow‐up activities to teach their Indigenous language, Tłichǫ, in their early childhood field placements in daycares and a kindergarten classroom. They describe their storytelling experiences and then they, their instructor, Erica, and a university researcher who supports collaborative action research with northern educators, Shelley, reflect on what we have all learned from this experience. We begin by introducing Reanna, Janet and Jaimyka.

Percutaneous cholecystostomy in elderly patients with acute cholecystitis: Factors influencing mortality, morbidity, and length of hospital stay.

Acute cholecystitis (AC) is increasingly common and imposes a burden on healthcare systems, particularly in the elderly population. While laparoscopic cholecystectomy (LC) is the definitive treatment, percutaneous cholecystostomy (PC) is often preferred based on various factors. The treatment of elderly patients requires a multidisciplinary approach that carefully assesses surgical risks due to age-related changes and comorbidities. This retrospective study evaluates factors affecting mortality, morbidity, and hospital stay in elderly patients diagnosed with AC who presented to the emergency department and underwent PC. This retrospective study, conducted between January 2013 and January 2021, included patients aged 70 years and older with grade 2 and 3 AC, as classified by the Tokyo Guidelines, who underwent PC. Data on laboratory parameters, comorbidities, and outcomes were collected and analyzed. Among the 76 included patients, complications occurred in 7.9% of cases, with catheter replacement being the most common complication. In-hospital mortality was 5.2%. Factors influencing hospital stay included intervention timing and serum albumin levels. Placement of percutaneous cholecystostomy within the first three days of hospitalization has been shown to shorten the length of hospital stay. Personalized treatment strategies are essential for managing AC in elderly patients. Early placement of PC may reduce hospital stays and associated costs. Further research and updated guidelines are necessary to optimize outcomes in this demographic group.

THE ROLE OF HOUSING IN LONG-TERM NURSING HOME UTILIZATION IN THE UNITED STATES: AN INTEGRATIVE REVIEW

Abstract Given the growing housing crisis, researchers increasingly point to housing as a possible risk factor for nursing home (NH) utilization, yet the exact pathways from housing to NH utilization are unclear. The purpose of this integrative review was to develop an understanding of how housing acts as a mechanism that impacts NH utilization in the United States. Five databases were searched in April 2024 and 16 total articles were included. This review highlights four pathways for this relationship: 1) Financial Asset vs. Burden, represents how some leverage home equity to help finance necessary NH placements, while for others the cost-burden of housing may lead to early nursing home placements; 2) Access to Affordable Housing, represents how the supply of affordable housing impacts the ability of NH residents to return to community living; 3) (Mis)match Between Needs and Housing, represents how functional needs rapidly evolve, leading to housing transitions and NH placements; and 4) Compounding Systemic Inequities, represents how systemic inequities in access to affordable, quality housing lead to disparities in NH placement for socio-economically marginalized older adults. The results from this review provide evidence of the relationship between housing and NH utilization across these four pathways; however, due to weak quality of evidence, and limited methodological diversity, more research is needed to strengthen this evidence. Clinicians, researchers, and policymakers should still recognize the importance of housing in NH utilization and seek to target policies and interventions towards improving housing conditions for those at risk for NH placement.

Pediatric gastrostomy tube referral patterns and postoperative use: A single-center experience.

Practice variability exists regarding the timing of gastrostomy tube (GT) placement in patients unable to maintain adequate oral nutrition. We sought to assess patient factors predictive of longer surgical GT use to inform patient selection. We conducted a single-center, retrospective cohort study including children ≤18 years who underwent surgical GT placement from June 1, 2018 to June 1, 2021 at a children's hospital. Bivariate and logistic regression analyses were performed to assess the impact of referral patterns, operative indications, and patient comorbidities on the length of GT use. Four hundred fifty-eight children underwent GT placement. Median age at placement was 5 months (interquartile range [IQR]: 2-12) and 52% were male. Fifty-six percent were referred from a neonatal intensive care unit;/cardiovascular intensive care unit provider before initial hospital discharge and 19% were outpatient referrals. Forty-six percent were premature and 50% exhibited oropharyngeal dysphagia. The median duration of nasogastric feeding before GT placement was 36.5 days (IQR: 16-64). In those with GT removal (n = 140), the median duration of use was 269 days (IQR: 144-474), with 23% of the cohort no longer utilizing the GT within 12 months of placement. Patients with congenital lung disease (odds ratio [OR]: 3.03, p = 0.002) and genetic anomalies excluding isolated Trisomy 21 (OR: 3.57, p = 0.003) were more likely to require prolonged GT use. Nearly a quarter of children attain full oral feeding within a year of GT placement. The identified factors predictive of prolonged GT use suggest early placement in these patients. Continuing nasogastric feeds in other patients may decrease the morbidity of unnecessary GT placement.

"Busting the hidden curriculum" a realist and innovative perspective to foster professional behaviors.

Contemporary health professions education has long delineated the desired attributes of medical professionalism in the form of standard curricula and their role in forming professional behaviors (PBs) among aspiring doctors. However, existing research has shown the contradictory and powerful role of hidden curriculum (HC) in negatively influencing medical students' PBs through unspoken or implicit academic, cultural, or social standards and practices. These contrasting messages of formal curricula and HC lead to discordance and incongruence in future healthcare professionals developing professional identity formation. There is little research on PB modifying educational strategies and their determinants that medical schools adopt to bust the impact of HC. Consequently, it is unclear how the right PBs can be influenced, entrenched, and inculcated in undergraduate medical students, especially in their early clinical placements. The lack of such insight highlights a critical gap in the literature, nudging educators to take a realist stance to deal with this problem. Behavior psychology stresses shaping medical students' values and beliefs as salient mediators that influence intentions to pursue future PBs. Curiosity prevails about what would guide the educational interventions to target this behavior change. To help understand this concept, we present our design-based innovative perspective about PROfessionalism in Partnership for Education Research (PROPER) shaped by pluralistic theoretical models in the context of two European medical schools with diverse medical students, highlighting its non-parochial and transferable nature.

Enhancing Fieldwork Supervision During Early Childhood Inclusive Practicum Placements

This manuscript outlines a collaborative initiative among four state universities to enhance practicum and field-based experiences for early childhood education (ECE) candidates. Grounded in research highlighting the impact of early childhood experiences, the collaboration addresses challenges in the ECCE workforce by fostering inclusive decision-making and engagement with ECCE partners. Through dialogue and partnership, the initiative aims to ensure comprehensive training and support for future early childhood educators. It highlights the evolution of practicum experiences, emphasizing collaborative relationships between novice teachers, mentor teachers, and university supervisors. Key components include the creation of universal training modules and an open-source platform to house training materials. The manuscript concludes with recommendations for enhancing practicum experiences and addressing workforce challenges, emphasizing ongoing collaboration and partnership in promoting high-quality early childhood education.

Earlier preoperative percutaneous intercostal cryoanalgesia improves recovery after pectus excavatum surgery

Background and aimsMinimally invasive repair of pectus excavatum is associated with intense postoperative pain. We aimed to evaluate the effectiveness of percutaneous intercostal cryoanalgesia according to the different timing of...

Safety and Efficacy of Early Primary Stent Placement for Hepatic Artery Stenosis in Liver Transplant Recipients

To evaluate the outcomes of early primary stent placement (within 30 days of liver transplantation) for hepatic artery stenosis (HAS). Patients who underwent liver transplantation between 02/2001 and 02/2024 were evaluated for hepatic artery stenosis. Patients who underwent primary stent placement were selected and stratified based on the time from anastomosis to intervention. Early intervention were defined as primary stent placement within 30 days of surgical anastomosis. Kaplan-Meyer analysis was performed for primary patency. HAS occurred in 83/779 (11%) patients (Median Age 55 (Interquartile Range: 48 - 63), 27 (48%) females) with 56 patients meeting inclusion criteria. Stent placement performed within 0-6 days of the anastomosis in 11 (20%), 7-14 days in 11 (20%), 15-30 days in 7 (12%), 31-70 days in 9 (16%) and >70 days in 18 (32%) patients. Technical success was 100%. Primary patency rates were 89%, 87%, and 87% at 1, 3, and 5 years, respectively. Primary assisted patency rates were 100% at 1, 3, and 5 years. Early interventions at 0-6 days, 7-14 days, and 15-30 days showed primary patency rates of 100%, 90%, and 86% respectively at 1 year (p = 0.58). There was no difference in primary patency between the early (<30d) and late (>30d) cohorts (p = 0.88). There was 1 Grade 4 adverse event. There were no cases of anastomotic rupture, hepatic artery dissection, or graft failure. Hepatic artery stent placement within 30 days of liver transplantation is safe and technically successful with excellent long-term primary patency.

Subthalamic Nucleus Deep Brain Stimulation for Meige Syndrome: Long-Term Outcomes and Analysis of Prognostic Factors.

The aim of this study was to explore the impacts of subthalamic nucleus deep brain stimulation (STN-DBS) on both motor and nonmotor symptoms in individuals with Meige syndrome, as well as further investigates prognostic factors for long-term postoperative outcomes. We retrospectively reviewed a consecutive cohort of patients with intractable Meige syndrome who underwent STN-DBS at our center from January 2016 to July 2023. Motor function, quality of life, neuropsychological status, and mood state were evaluated with standardized scales at baseline and every 3 to 6 months thereafter. Univariate and multivariate linear regression analyses were used to determine independent risk factors that affect long-term motor function after STN-DBS. Fifty-five patients were ultimately analyzed with a mean follow-up of 62.1 ± 25.7 months. At the final postoperative assessment, movement and disability scores of the Burke-Fahn-Marsden Dystonia Rating Scale demonstrated improvements of 61% (P < .001) and 57% (P < .001), respectively. Postoperative scores on the 36-item Short-Form General Health Survey showed significant improvement from baseline. Global cognitive function and neuropsychological status remained stable during continuous neurostimulation. Multivariate linear regression analysis revealed that longer disease duration (standardized β coefficient = -0.294, 95% CI -0.039 to -0.007, P = .006), older age at surgery (standardized β coefficient = -0.382, 95% CI -0.014 to -0.004, P = .001), and smaller volume of tissue activated within the sensorimotor subregion of STN (standardized β coefficient = 0.309, 95% CI 0.001-0.004, P = .004) were independently correlated with poorer long-term motor performance. Bilateral STN-DBS is an effective, safe, and promising treatment option for Meige syndrome, which can improve motor function and quality of life without cognitive and mood side effects. Early diagnosis, prompt intervention, and accurate lead placement in the dorsolateral STN are crucial to optimize long-term therapeutic outcomes.

Comparative Analysis of Early Versus Late Feeding Post-percutaneous Endoscopic Gastrostomy Tube Placement: A Systematic Review and Meta-Analysis.

In clinical practice, tube feedings have been delayed after the percutaneous endoscopic gastrostomy (PEG) tube placement. Previous studies, including a meta-analysis in 2008, have shown that it is safe to start tube feeding ≤ 4h of PEG tube placement. However, it is still a common practice to delay the initiation of tube feeding up to 24h after PEG tube placement. We have performed an updated analysis of studies comparing early versus delayed tube feedings following PEG placement. Major databases like PubMed, EMBASE, and Web of Science were searched in June 2022 for randomized controlled trial (RCT) studies reporting on comparative outcomes with early (< or = 4h) versus delayed (> 4h) feeding after PEG tube placement in adult patients. The primary outcomes in our study include complication rates and mortality rates within 72h of the procedure. The outcomes were reported as pooled odds ratio (95% confidence interval (CI) (Moole et al. in Indian J Gastroenterol. 35:323-330, 2016), p value, I2 values). A total of 212 individuals in the early feeding group and 215 individuals in the late feeding group were analyzed from six studies. The pooled odds ratio of total complication events between early and late feed groups was 0.86 (CI 0.51-1.45, p = 0.58). The pooled odds ratio of fever, vomiting, and local infection was 0.94 (CI 0.186-4.74, p = 0.94), 1.0 (CI 0.38-2.65, p = 0.9), and 1.25 (0.36-4.3, p = 0.72), respectively, between early and late feeding post-PEG tube placement. In conclusion, this meta-analysis confirms that early feeding ≤ 4h after PEG placement does not increase the odds of poor outcomes or mortality, and it is a well-tolerated, safe, and effective alternative to delayed feeding. Furthermore, early feeding may decrease hospital stays and healthcare costs.

Early placement of a non-invasive, pressure-regulated, fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study

BackgroundSince current fascial traction methods involve invasive procedures, they are generally employed late in the management of the open abdomen (OA). This study aimed to evaluate early versus late placement...

Real-world evidence comparing early and late pancreatic stent placement to prevent post-ERCP pancreatitis

Abstract Background and study aims Pancreatic stenting effectively lowers the occurrence of post-ERCP pancreatitis (PEP) and reduces its severity. However, limited research has been conducted to determine the optimal timing for pancreatic stent placement. Our objective was to evaluate whether early pancreatic stent placement (EPSP) is more effective than late pancreatic stent placement (LPSP) in preventing PEP among patients with naive papilla. Patients and methods We conducted a retrospective cohort study that analyzed 590 patients with difficult biliary cannulation using the pancreatic guidewire technique, who were divided into EPSP and LPSP groups. In the EPSP group, a pancreatic stent was placed immediately before/after endoscopic retrograde cholangiography (ERC) or endoscopic sphincterotomy (EST). Conversely, in the LPSP group, a pancreatic stent was placed after partial/all completion of major endoscopic procedures. Results From November 2017 to May 2023, 385 patients were in the EPSP group and 205 in the LPSP group. EPSP was associated with a decreased PEP occurrence compared with LPSP (2.9% vs. 7.3%; P = 0.012). Similarly, hyperamylasemia was lower in the EPSP group (19.7% vs. 27.8%; P = 0.026). Furthermore, sensitivity analysis using multivariable analysis and propensity score–matched (PSM) analysis also validated these findings. Conclusions Early pancreatic stent placement reduced the incidence of PEP and hyperamylasemia compared with late pancreatic stent placement. Our findings favor pancreatic stenting immediately before/after ERC or EST.

Early external fixation of tibial plateau fractures is associated with an increased risk of compartment syndrome

IntroductionTibial plateau fractures are often associated with high-energy trauma necessitating external fixation as a means of temporization. There is evidence that pin placement and fracture distraction may result in transient increases in compartment pressures, and the optimal timing of external fixator placement is unknown. This study sought to determine the effect of early versus late external fixator placement on the risk of compartment syndrome after a tibial plateau fracture. MethodsThe Trauma Quality Improvement Program was retrospectively queried between 2015 and 2019 for adult patients with a tibial plateau fracture who underwent external fixator placement. Patients with concomitant tibial shaft and/or distal femur fractures, requiring lower extremity fasciotomy before external fixation, or external fixation >7 days after admission were excluded. The primary study outcome was inpatient compartment syndrome. Secondary outcomes were inpatient acute respiratory failure/unplanned intubation, surgical site infection, and venous thromboembolism (VTE). A time threshold of delayed external fixation was identified at which the odds of compartment syndrome no longer significantly decreased with increasing time using a Markov Chain Monte Carlo simulation of a restricted cubic spline model. The odds of each outcome were compared between patients who underwent early versus delayed external fixation on or after the time threshold, adjusting for potential confounding by patients, injury, and hospital characteristics. Significance was defined as p < 0.05. ResultsA threshold for delayed external fixation was identified at 28.8 h from admission. Of the 3,185 eligible patients, 2,656 (83.4 %) were classified as early external fixation and 529 (16.6 %) were classified as delayed external fixation. Delayed external fixation was associated with lower adjusted odds (aOR) of compartment syndrome (aOR: 0.31, 95 % Confidence Interval (CI): 0.13–0.74, p = 0.008) and higher aOR of acute respiratory failure/unplanned intubation (aOR: 2.13, 95 % CI: 1.13–4.0.2, p = 0.019), however no significant differences in adjusted odds of surgical site infection or VTE were observed. ConclusionPatients with tibial plateau fractures who underwent closed reduction and external fixation within 28.8 h of admission were associated with greater odds of compartment syndrome than those undergoing external fixation after this time threshold.

(295) EARLY PLACEMENT OF INFLATABLE PENILE PROSTHESIS FOLLOWING PENOSCROTAL DECOMPRESSION

Abstract Introduction Ischemic priapism is the most common form of priapism which accounts for up to 95% of the cases. Prolonged ischemic priapism is associated with a higher risk of corpus spongiosum fibrosis and the development of erectile dysfunction. Studies have shown that treatment of ischemic priapism under 12 hours has an excellent prognosis and may prevent erectile dysfunction in 100% of cases. On the other end of the spectrum, ischemic priapism &amp;gt;36 hours may lead to permanent loss of erectile function in virtually all cases. Objective One of the newer procedures applied in cases of refractory priapism is the penoscrotal decompression approach which is technically similar to the inflatable penile prosthesis insertion technique. In cases of failed distal shunting, this procedure has proven to be useful in small-scale studies. In this method, a penoscrotal incision is made followed by corporotomy and and corporal dilation. It is suggested that penoscrotal decompression may be favorable to early IPP placement from an economical standpoint. Methods In our experience, a 42-year-old individual presented with a prolonged episode of ischemic priapism for approximately 36 hours which did not achieve detumescence by conservative management. A shared decision was made to proceed with penoscrotal decompression. However, the patient was unable to achieve detumescence after the procedure. We decided to insert a three-piece IPP approximately 48 hours after the penoscrotal decompression procedure. A separate inguinal counter-incision was made for reservoir placement according to the established protocols for IPP placement. Results Penoscrotal decompression may not always provide favorable outcomes and maintaining erectile function by IPP implantation may be considered afterwards. Conclusions The insertion of the prosthesis following penoscrotal decompression is more challenging than the normal setting as the primary priapism leads to more blood clot formation and intracavernosal adhesion and fibrosis. Disclosure No.

Reduced Incidence of Pneumothorax and Chest Tube Placement following Transthoracic CT-Guided Lung Biopsy with Gelatin Sponge Torpedo Track Embolization: A Propensity Score-Matched Study.

Objectives: To evaluate the effectiveness of track embolization using gelatin sponge torpedo in reducing the incidence of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy. Methods: A retrospective single-center analysis of percutaneous computed tomography (CT)-guided transthoracic lung biopsies was performed between 2017 and 2022. After excluding the patients who received an ultrasound-guided biopsy, combined lung biopsy with ablation, fiducial placement, unsuccessful procedure due to uncooperative patient, and age under 18 years, 884 patients' clinical information was collected (667 without track embolization and 217 with track embolization). The incidence of early and late pneumothorax and chest tube placement were compared between the two groups. Propensity score matching (PSM) was applied to minimize selection bias. Univariable and multivariable analyses were performed to determine risk factors for pneumothorax. Results: After PSM, the baseline differences and all factors that could affect the incidence of pneumothorax were balanced between the track embolization group (217 patients) and the non-track embolization group (217 patients). The incidence rates of early pneumothorax (13.4% vs. 24.0% p = 0.005), late pneumothorax (11.0% vs. 18.0% p = 0.021), and chest tube placement (0.9% vs. 4.6% p = 0.036) were significantly decreased in the track embolization group. However, the success rate of tissue diagnosis yield and length of hospital stay were not significantly different between the two groups. In multivariate analysis, the risk of pneumothorax increased as the fissure was passed (OR = 3.719, p = 0.027). Conclusions: Using track embolization with a gelatin sponge torpedo significantly decreased the incidence of pneumothorax and chest tube placement following percutaneous CT-guided lung biopsy.

An Analysis of the Math Requirements of 199 CS BS/BA Degrees at 158 U.S. Universities

Dek : There is no consensus across U.S. universities as to the placement of discrete math and calculus in the CS course sequence, and indeed early placement serves as an institutional barrier which impacts students’ discovery, retention, and persistence in computing.

Investigating the difficulty level of aspects of teaching during field placement: from coursework to practice

ABSTRACT The purpose of this study was to explore whether particular aspects of quality of teaching belong to a single scale and identify those aspects which are more difficult to master for student teachers (STs) in the context of early field placement. It also examines whether these aspects could be grouped in stages according to their difficulty. The participants of the study were 154 STs enrolled in an early field placement program at the University of Cyprus. Real-time classroom observations were conducted in different subject areas, corresponding to the STs’ teaching efforts. Analysis of data using the Rasch and the Saltus models revealed that the eleven aspects of teaching are structured in four stages with a diverse transition, in terms of difficulty, from one stage to the other. Such findings stress the importance of a research-based coursework design during practice, based on the challenges STs face during early field placement.

Placement Option Influence on Education Participation for Learners with Hearing Impairments in Special Public Primary Schools in Meru and Isiolo Counties- Kenya

Globally need for education, as a measure of one's ability to function fully in today's society, is an important motivator for efforts to achieve the highest level of education in the world. The persistence underachieving of deaf students in Kenyan schools is of great concern as evidenced by final average scores in their formative and summative scores in their assessments. This study aimed to find out how placement options influence education participation for learners with hearing impairment. The study was guided by Maslows theory of motivation in learning. A phenomenological research design was utilized. The study targeted three primary schools handling learners with hearing impairments in Meru and Isiolo counties that is Kaaga, Njia, and Isiolo school for learners with hearing impairment. A thematic approach was used to analyze the qualitative data. The study revealed that the assessment of learners for placement was not effectively done. The following were some recommendations made. Parents should be made aware of the existence of EARC and its role. Learners should be assessed early enough to avoid the placement of overage learners in lower grades. The EARC should be staffed with the right and adequate personnel for effective assessment. The government should fund EARC so that the staff can effectively carry its role of sensitization and mobilization in a wide area thus helping in early identification, assessment, and placement.

Predictability in anterior aesthetic implants: assessment, planning and execution

Implant placement in the anterior maxilla has been shown to have success rates comparable to posteriorly placed implants. However, the aesthetic outcome of these implants is, unsurprisingly, of much greater importance to patients, and can provide a significant clinical challenge. Predictable outcomes are undoubtedly harder to achieve and sustain, and greater consideration must be given to the precision of implant positioning and restoration in order to achieve clinical and aesthetic success. This article discusses the many factors affecting aesthetic implant predictability, from assessment and planning, through to materials, execution and restoration, with a focus on timings and early (Type II) placement. CPD/Clinical Relevance: For the majority of clinicians, Type II methodology for anterior implants is the more appropriate choice and gives predictable and stable outcomes.