North American Academic Institutions Research Articles

Addition of cribriform pattern 4 and intraductal prostatic carcinoma into the CAPRA-S tool improves post-radical prostatectomy patient stratification in a multi-institutional cohort

AimsPre-surgical risk classification tools for prostate cancer have shown better patient stratification with the addition of cribriform pattern 4 (CC) and intraductal prostatic carcinoma (IDC) identified in biopsies. Here, we...

North and South: Naming practices and the hidden dimension of global disparities in knowledge production

SignificanceContemporary social sciences aim to be diverse and inclusive, but traces of the historical dominance of Western European and North American academic institutions persist in scientific practices. One such practice is the phrasing of article titles. Our analysis shows that articles studying the global North are systematically less likely to mention the name of the country they study in their title compared to articles on the global South. This constitutes, potentially, an unwarranted claim on universality and may lead to lesser recognition of global South studies. Social and behavioral scientists must reflect on the phrasing of their article titles to avoid reproducing harmful relations of intellectual domination which limit inclusivity and constitute a barrier to the generalizability of scientific knowledge.

Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: a retrospective cohort study

BackgroundThe objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya.MethodsThe Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10–19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined.ResultsThere were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning.ConclusionsA considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.

Characteristics of clinical trials evaluating cardiovascular therapies for Coronavirus Disease 2019 Registered on ClinicalTrials.gov: a cross sectional analysis

Morbidity and mortality associated with COVID-19 has increased exponentially, and patients with cardiovascular (CV) disease are at risk for poor outcomes. Several lines of evidence suggest a potential role for CV therapies in COVID-19 treatment. Characteristics of clinical trials of CV therapies related to COVID-19 registered on ClinicalTrials.gov have not been described.MethodsClinicalTrials.gov was queried on August 7, 2020 for COVID-19 related trials. Studies evaluating established CV drugs, other fibrinolytics (defibrotide), and extracorporeal membrane oxygenation were included. Studies evaluating anti-microbial, convalescent plasma, non-colchicine anti-inflammatory, and other therapies were excluded. Trial characteristics were tabulated from study-specific entries.ResultsA total of 2,935 studies related to COVID-19 were registered as of August 7, 2020. Of these, 1,645 were interventional studies, and the final analytic cohort consisted of 114 studies evaluating 10 CV therapeutic categories. Antithrombotics (32.5%; n = 37) were most commonly evaluated, followed by pulmonary vasodilators (14.0%; n = 16), renin-angiotensin-aldosterone system-related therapies (12.3%; n = 14), and colchicine (8.8%; n = 10). Trials evaluating multiple CV therapy categories and CV therapies in combination with non-CV therapies encompassed 4.4% (n = 5) and 9.6% (n = 11) of studies, respectively. Most studies were designed for randomized allocation (87.7%; n = 100), enrollment of less than 1000 participants (86.8%; n = 99), single site implementation (55.3%; n = 63), and had a primary outcome of mortality or a composite including mortality (56.1%; n = 64). Most study populations consisted of patients hospitalized with COVID-19 (81.6%; n = 93). At the time of database query, 28.9% (n = 33) of studies were not yet recruiting and the majority were estimated to be completed after December 2020 (67.8%; n = 78). Most lead sponsors were located in North America (43.9%; n = 50) or Europe (36.0%; n = 41).ConclusionsA minority (7%) of clinical trials related to COVID-19 registered on ClinicalTrials.gov plan to evaluate CV therapies. Of CV therapy studies, most were planned to be single center, enroll less than 1000 inpatients, sponsored by European or North American academic institutions, and estimated to complete after December 2020. Collectively, these findings underscore the need for a network of sites with a platform protocol for rapid evaluation of multiple therapies and generalizability to inform clinical care and health policy for COVID-19 moving forward.

Contemporary Management of Blunt Thoracic Aortic Injury: Results of an EAST, AAST and SVS survey by the Aortic Trauma Foundation

Objective: To determine contemporary management practices for blunt thoracic aortic injury (BTAI) among trauma and vascular surgeons.Methods: A survey of Eastern Association for the Surgery of Trauma, American Association for the Surgery of Trauma and Society of Vascular Surgeons (SVS) membership regarding BTAI care was conducted.Results: 404 respondents included trauma (52.5%), vascular (42.6%) and other specialty providers (4.5%) primarily from North American (90.6%) academic teaching institutions (71.0%) / American College of Surgeons Level I trauma centers (58.9%). Most respondents managed one to fi ve BTAIs annually (71.6%). Preferred diagnostic modality was computed tomographic angiography (CTA) (99.8%), after which respondents stated they preferred to utilize personal knowledge of the literature and experience (50.5%), the SVS guidelines (27.4%) or institution specifi c guidelines (12.8%) to guide subsequent management. Respondents primarily agreed on the treatment of intimal tears (SVS G1) with medical management. For intramural hematoma (SVS G2), management choice was divided between medical 46.6%) and thoracic endovascular aortic repair (TEVAR) (46.3%). Both groups defi ned TEVAR as treatment of choice for hemodynamically stable patients with pseudoaneurysm (SVS G3) (93.5%) and rupture (SVS G4) (82.2%), although a greater number of trauma surgeons preferred open repair (20.4%) than vascular counterparts (4.1%) in stable G4 patients. Preferred medical management goals varied between mean arterial pressure (37.3%) and systolic blood pressure (62.3%) targets. Preferences also varied in adjuncts for open repair (left heart bypass 56.5%; clamp and sew 46.1%; cerebrospinal fl uid (CSF) drainage 48.5%) and TEVAR (percutaneous puncture for arterial access 58.4%; open vascular exposure 65.5%, intravascular ultrasound 36.1%, CSF drainage 28.9%). Outpatient follow-up timing (2 weeks 37.0%, 1 month 37.2%) and initial type (clinical exam 36.6%, CTA 48.3%) also varied.Conclusions: The survey of trauma and vascular surgeons illustrates controversy regarding SVS G2 treatment, surgical adjuncts and follow-up. Additional study is required to identify optimal BTAI management.

Validation of Fistula Risk Score calculator in diverse North American HPB practices

BackgroundFistula Risk Score (FRS) is a previously developed tool to assess the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD). MethodsProspectively collected databases from 4 university affiliated and non-affiliated HPB centers in United States and Canada were used. The influence of individual baseline characteristics, FRS and FRS group on CR-POPF was assessed in univariate and multivariate analyses. FRS calculator performance was assessed using a C-statistic. Results444 patients were identified. Pathology, soft pancreas texture and pancreatic duct size were associated with CR-POPF rates (p < 0.001 for each); EBL was not (p = 0.067). The negligible risk group consisted of 50 (11.3%) patients, low risk of 118 (26.6%), moderate 234 (52.7%) and high risk group of 42 (9.5%) patients. The overall rate of CR-POPF was 20%. Of the patients in the negligible risk group, 2% developed CR-POPF, 13.6% of the low risk, 23.1% moderate and 42.9% in the high risk group (p < 0.001). Overall C-statistic was 0.719. ConclusionFRS is robust and able to stratify the risk of developing CR-POPF following PD in diverse North American academic and non-academic institutions. The FRS should be used in research and to guide clinical management of patients post PD in these institutions.

Academic productivity in the field of ecology

AbstractAlthough the broad field of ecology and its role in understanding the distribution and diversity of life on earth is a central part of the natural sciences, there is currently no comprehensive ranking of academic institutions for this discipline, which has quadrupled in research volume and visibility over the past three decades. We assessed scholarly productivity in the field of ecology for 316 North American academic institutions between the years 2000 and 2014. We present institutional rankings of productivity in terms of number of publications, number of citations, and Hirsch's h index, a measure that integrates productivity and impact. For the top‐ranked institutions, we also calculated hm, an h‐based metric used to compare productivity across institutions of different sizes. In addition, we analyzed the effect of institution size on h index, publication rate, and number of citations. We found that scholarship in ecology is not significantly different between public and private universities, and from institutions ranging in size from extremely large to relatively small. Many of the institutions in the “ecology top 20” are widely considered as being among North America's elite schools. However, there are several smaller institutions that have very high research productivity and impact in ecology with an apparently very strong ecology faculty. Administrators, faculty, prospective faculty, and students use institutional rankings, along with other data, to make decisions about programs in which to invest or participate. Relative institutional strength in the field of ecology, however, has not been previously measured, perhaps because faculty with expertise in ecology are often dispersed through multiple academic units of a university. Thus, our findings fill an important gap for ecology as a discipline.

Survey of In-House Coverage by Pediatric Intensivists

To characterize the current state of 24/7 in-hospital pediatric intensivist coverage in academic PICUs, including perceptions of faculty and trainees regarding the advantages and disadvantages of in-hospital coverage. Cross-sectional observational study via web-based survey. PICUs at North American academic institutions. Pediatric intensivists, pediatric critical care fellows, and pediatric residents. None. A total of 1,323 responses were received representing a center response rate of 74% (147 of 200). Ninety percent of respondents stated that in-hospital coverage is good for patient care, and 85% stated that in-hospital coverage provides safer care. Sixty-three percent of intensivists stated that working in in-hospital models limits academic productivity, and 65% stated that in-hospital models interfere with nonclinical responsibilities. When compared with intensivists in home coverage models, intensivists working in in-hospital models generally had more favorable perceptions of the effects of in-hospital on patient care (p < 0.0001) and faculty quality of life. Physician burnout was measured with the abbreviated Maslach Burnout Inventory. Although 57% of intensivists responded that working in in-hospital models increases burnout risk, burnout scores were not different between coverage models. Seventy-nine percent of intensivists currently working at institutions with in-hospital coverage stated that they would prefer to work in an in-hospital coverage model, compared with 31% of those working in a home coverage model (p < 0.0001). Although concerns exist regarding the effect of 24/7 in-hospital coverage on faculty, the majority of pediatric intensivists and critical care trainees responded that in-hospital coverage by intensivists is good for patient care. The majority of intensivists also state that they would prefer to work at an institution with in-hospital coverage. Further research is needed to objectively delineate the effects of in-hospital coverage on both patients and faculty.

Naturopathic practice at north american academic institutions: description of 300,483 visits and comparison to conventional primary care.

This study collected patient visit data to explore similarities and differences between conventional and naturopathic primary care (PC). Administrative data from practice management software systems from the main teaching clinics of four of the eight accredited North American naturopathic academic institutions were abstracted into an integrated database containing five years (2006–2010) of visit, patient, laboratory, and prescribing data. Descriptive analyses of healthcare services were compared to the National Ambulatory Medical Care Survey (NAMCS). Over the five-year period, 300,483 patient visits to naturopathic doctors occurred at clinics, excluding visits at clinics operated by the schools in community settings. Patients were 69% female; mean age was 39 (SE 0.09). Older adults (>65) comprised 9% of the population and children (<16) comprised 8%. Comparing academic naturopathic clinics to national conventional PC (NAMCS), we found more patients paid out of pocket at naturopathic clinics (50 vs. 4%) and naturopathic clinics more frequently offered discounted care (26 vs. 0.3%). There was a 44% overlap in the most frequent 25 diagnoses for PC at conventional community clinics. Overall, these data suggest substantial similarities in care offered by academic naturopathic clinics, at which most Naturopathic Doctor (ND) students are trained, and by conventional PC practices.

Transforming serials: The revolution continues. Proceedings of the North American Serials Interest Group, Inc. 17th Annual Conference, June 20-23, 2002, the College of William and Mary, Williamsburg, Virginia. Edited by Susan L Scheiberg and Shelley Neville.

These proceedings have also been published in The Serials Librarian, Volume 44, Nos. 1/2 and 3/4. The book comprises 43 chapters covering the preconference programmes, plenary sessions, concurrent sessions and workshops that took place at the conference. There is also a summary of the conference poster sessions, a list of the conference registrants, and the volume concludes with an index. A useful feature is the summary at the beginning of each chapter. As the annual conference of the North American Serials Interest Group, the presenters and recorders were mostly from North American academic institutions. The issues under discussion, though, are those faced by librarians internationally.

Sustaining Activism: A Brazilian Women’s Movement and a Father-Daughter Collaboration by Jeff Rubin and Emma Sokoloff-Rubin

Reviewed by: Sustaining Activism: A Brazilian Women’s Movement and a Father-Daughter Collaboration by Jeff Rubin and Emma Sokoloff-Rubin Charmain Levy Rubin, Jeff, and Emma Sokoloff-Rubin — Sustaining Activism: A Brazilian Women’s Movement and a Father-Daughter Collaboration. Durham: Duke University Press, 2013. Pp. 200. This book presents both an ethnographical research of the women’s movement in rural Southern Brazil and a biography of Jeff Rubin and his daughter Emma during the 2000s, in which the authors are as much the subjects of the book as the Brazilian women’s movement. It is a fascinating story of their collaboration over a number of years (Emma as a child, teenager and finally adult scholar) studying this very important movement in terms of agrarian reform and women’s rights in Latin America. Half of the book is written in Jeff’s voice and the other written under Emma’s plume. Through observatory participation, formal and informal discussions with rank and file and interviews, the father-daughter duo capture and retell the life stories of individual activists in the Brazilian rural women’s movement. These are anthropologically romantic stories that will surely charm first year students of sociology, anthropology and development studies. Our university youth will definitely connect to Emma’s story as a young researcher lucky enough to have a father to take her on his field research trips and treat her as a scholarly equal. The book demonstrates to aspiring researchers the pleasures and satisfaction of field research and the challenges of making sense of so much data and using it to contribute to the advancement of knowledge in North American academic institutions or as Jeff puts it “bringing the knowledge and spirit home to the United States”. Throughout the book, the authors transmit the “enchantment” of this movement to its readers. In terms of research methodology, the book is a rich source for students of anthropology, offering gems of advise such as the advantages of bringing along family members which makes scholars look more human and accessible to their subjects of research and thus opens the way to frank and intimate discussions with people who these Americans would otherwise have nothing in common. Jeff explains in great detail how he gained access to the movement’s local leadership and rank and file over a number of years in the context of an important grant he received from MacArthur Foundation. Another appealing aspect of this book is its reflections on gender issues involving poor rural women in the South that demonstrate to young female [End Page 585] students that the struggle for differentiated recognition of both productive and reproductive work is far from over and there is still a need for feminism around the world. The examples of inequality, confinement, drudgery and lack of options among rural young women will certainly touch students at a personal level. It offers an example of a different feminist movement, one that is rural and tackles both class and gender issues. It is unlike the urban feminist movement which most are more familiar. The main story of the book deals with the trajectory of this social movement and important issues of its radicalisation and the institutionalisation of the struggle of some of its leaders. It delves into the splits within the movement around ideological paths the movement leadership took in the late 1990s. Although Jeff is very sceptical of these choices and documents the personal effects it had on local rank and file, he only analyses it through the eyes and voices of his informants forgoing social movement theories on the issue. For example, the authors tell the story of local movement leaders who decide to work for government and are pushed out of the movement due to an internal movement policy that forbids leaders to straddle positions in the movement and in government. The authors portray this difficult moment for these leaders but do not reflect upon the outcome in other movements that have permitted this situation and in general both the positive and negative impacts on the social movement itself and what is has achieved in recent years. Too often in their account of internal movement disputes and power...

Chart Rounds in the Digital Age: A Survey of North American Institutions

Purpose/Objective(s): In light of public concerns regarding the quality of radiation treatment delivery, we surveyed the utilization of “chart rounds” or peer-review quality assurance meetings, within North American academic institutions.

A Survey of Obstetric Perianesthesia Care Unit Standards

Although obstetric patients are generally healthy, population risk is increasing because of increases in maternal age, obesity, and rates of multifetal pregnancies, and complications may occur in the immediate postoperative period. In this study, we sought to identify the current level of recovery care for obstetric patients in North American academic institutions after either general or major neuraxial anesthesia for cesarean delivery. A survey of obstetric anesthesia recovery practices was delivered electronically to 135 obstetric anesthesiology directors of North American academic institutions from June to October, 2007. Surveys were completed electronically and anonymously. The response rate was 54.8% (74 of 135). Respondents reported a median of 2550 deliveries per year (interquartile range [IQR] 2000, 4000), with 30% delivered by cesarean delivery (IQR 25.5%, 32.5%) and 5% of cesarean deliveries performed under general anesthesia (IQR 4%, 8%). Most institutions recovered postcesarean patients in either an obstetric perianesthesia care unit or a labor, delivery, and recovery room. Recovery care was staffed solely by perinatal nurses, rather than dedicated perianesthesia care unit nurses in most institutions. Forty-five percent (28 of 62) of institutions had no specific postanesthesia recovery training for nursing staff providing postcesarean care for patients recovering from neuraxial or general anesthesia. Forty-three percent (29 of 67) of respondents rated the recovery care provided to cesarean delivery patients as lower quality than care given to general surgical patients. Respondents who relied solely on perinatal nurses to provide postanesthesia care were most likely to perceive that postanesthetic care for cesarean delivery was of lower quality than that given to general surgery patients (P = 0.008). Guidelines put forth by the American Society of Anesthesiologists Task Force on Postanesthetic Care and the American Society of PeriAnesthesia Nurses apply to all postoperative patients regardless of their recovery locations. Results from this survey suggest that the level of care provided for postanesthesia recovery from cesarean delivery in North American academic institutions may not meet these guidelines.

In the Name of Global Health: Trends in Academic Institutions

This paper describes accelerating development of programs in global health, particularly in North American academic institutions, and sets this phenomenon in the context of earlier programs in tropical medicine and international health that originated predominantly in Europe. Like these earlier programs, the major focus of the new global health programs is on the health needs of developing countries, and perhaps for this reason, few similar programs have emerged in academic institutions in the developing countries themselves. If global health is about the improvement of health worldwide, the reduction of disparities, and protection of societies against global threats that disregard national borders, it is essential that academic institutions reach across geographic, cultural, economic, gender, and linguistic boundaries to develop mutual understanding of the scope of global health and to create collaborative education and research programs. One indication of success would be emergence of a new generation of truly global leaders working on a shared and well-defined agenda--and doing so on equal footing.

Ra&amp;#237;ces hisp&amp;#225;nicas y culturas americanas. Folkloristas de Norteam&amp;#233;rica en el Centro de Estudios Hist&amp;#243;ricos

This article studies some key initiatives taken up in the «Centro de Estudios Historicos» in the field of folkloristic research. Their authors were North American researchers whose field labour -sponsored by North American academic institutions- was made in close contact with their Spanish pairs of the «Junta de Ampliacion de Estudios e Investigaciones Cientificas».

Paclitaxel-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents

Restenosis within bare-metal stents is often treated with repeat percutaneous coronary intervention, although subsequent recurrence rates are high, with vascular brachytherapy (VBT) affording the best results. The effectiveness of drug-eluting stents in this setting has not been established. To investigate the safety and efficacy of the polymer-based, slow-release paclitaxel-eluting stent in patients with restenotic lesions after prior stent implantation in native coronary arteries. Prospective, multicenter, randomized trial conducted between June 6, 2003, and July 16, 2004, at 37 North American academic and community-based institutions in 396 patients with in-stent restenosis of a previously implanted bare-metal coronary stent (vessel diameter, 2.5-3.75 mm; lesion length, < or =46 mm). Patients were randomly assigned to undergo angioplasty followed by VBT with a beta source (n = 201) or paclitaxel-eluting stent implantation (n = 195). Clinical and angiographic follow-up at 9 months was scheduled in all patients. Ischemia-driven target vessel revascularization at 9 months. Diabetes mellitus was present in 139 patients (35.1%). Median reference vessel diameter was 2.65 mm and median lesion length was 15.3 mm. In the VBT group, new stents were implanted in 22 patients (10.9%) and in the paclitaxel-eluting stent group, multiple stents were required in 57 patients (29.2%), with median stent length of 24 mm. Follow-up at 9 months was complete in 194 patients in the VBT group and 191 patients in the paclitaxel-eluting stent group (96.5% and 97.9%, respectively). For VBT and paclitaxel-eluting stents, respectively, the number of events and 9-month rates for ischemic target lesion revascularization were 27 (13.9%) vs 12 (6.3%) (relative risk [RR], 0.45; 95% confidence interval [CI], 0.24-0.86; P = .01); for ischemic target vessel revascularization, 34 (17.5%) vs 20 (10.5%) (RR, 0.60; 95% CI, 0.36-1.00; P = .046); and for overall major adverse cardiac events, 39 (20.1%) vs 22 (11.5%) (RR, 0.57; 95% CI, 0.35-0.93; P = .02), with similar rates of cardiac death or myocardial infarction (10 [5.2%] vs 7 [3.7%]; RR, 0.71; 95% CI, 0.28-1.83; P = .48) and target vessel thrombosis (5 [2.6%] vs 3 [1.6%]; RR, 0.61; 95% CI, 0.15-2.50; P = .72). Angiographic restenosis at 9 months was 31.2% (53 of 170 patients) with VBT and 14.5% (25 of 172 patients) with paclitaxel-eluting stents (RR, 0.47; 95% CI, 0.30-0.71; P<.001). Treatment of bare-metal in-stent restenotic lesions with paclitaxel-eluting stents rather than angioplasty followed by VBT reduces clinical and angiographic restenosis at 9 months and improves event-free survival. ClinicalTrials.gov Identifier: NCT00287573.

You can't Get There from Here, or How Do I Become a Slavic Studies Librarian?

ABSTRACT New librarians looking to enter the field of Slavic librarianship soon discover there is no clear template for how to acquire the skills and knowledge necessary to be successful in this field. This article attempts first to define those skills and knowledge, and then to map out the opportunities for acquiring them in North American institutions. Toward this goal, it summarizes and analyzes the results from a survey of the educational and experiential background and current responsibilities of 128 working Slavic librarians. It then details the North American academic institutions offering specialized training or degree programs for Slavic librarians and those institutions where the component parts are all available to be assembled by the proactive student.

Textbook of Diagnostic Imaging

Editors Charles Putman and Carl Ravin have coordinated an excellent review of diagnostic imaging utilizing the talents of 193 contributors from many North American academic institutions. authors are highly regarded authorities in their fields. Following a section on fundamentals of diagnostic imaging, the textbook is organized by an organ system approach that includes the central nervous, pulmonary, gastrointestinal, genitourinary, musculoskeletal, and cardiovascular systems. There is also a large section devoted to aspects of the female patient that includes obstetric, fetal, and gynecologic sonography as well as mammography. In general, the sections are well organized with introductory chapters covering radiological techniques for evaluation of each organ system, followed by specific disease categories. Exceptional chapters include Risks of Medical Imaging, Central Nervous System Infection, Orbital Neoplasms, Introduction to Chest Radiography, Diseases of the Mediastinum, Infectious Pneumonias, The Liver and Spleen, The Pancreas, and the entire section on the genitourinary system. There