Urban Institutions Research Articles

I can get off this bus and do something important for myself. The city as a space for adult learning in the perspective of local urban elites

In this article explores small cities as the a potential for adult learning. By referencing social capital theory, habitus and cultural capital, we open a discussion on the role of physical, social and symbolic space. The results are based on the technique of walking interviews with small city residents of cities in Poland. The study shows that the basis of learning mechanisms included visiting local authorities, meetings of hobbyists, local urban projects, urban institutions and storytelling city spaces that induced storytelling of the city. The results inform us about the advantages that of elites have in shaping lifelong learning offers. They create their city's narrative of their city by deciding which symbols, people, spaces and institutions are significant. We conclude that the reception of educational content is influenced by the use patterns of use of public spaces. These are culturally and economically determined and can reinforce inequalities in access to learning. However, they still hold there is still great potential for learning in them.

Đorđe Alfirević and Sanja Simonović Alfirević: Principles of residential space configuration, Institute of Architecture and Urban and Spatial Planning of Serbia and Faculty of Architecture of the University of Belgrade, Belgrade, 2023

Đorđe Alfirević and Sanja Simonović Alfirević: Principles of residential space configuration, Institute of Architecture and Urban and Spatial Planning of Serbia and Faculty of Architecture of the University of Belgrade, Belgrade, 2023

Concordance of breast cancer services in an urban tertiary care institute in India to EUSOMA guidelines: An audit of Indian breast cancer practices.

The provision of breast cancer care tends to vary substantially from one breast unit to another. To provide state-of-the-art patient-centered care to women diagnosed with breast cancer, adoption and adherence to structured treatment algorithms, protocols, and international guidelines are essential. In this review, we endeavor to audit breast cancer care at our tertiary cancer center against published EUSOMA guidelines. This was a retrospective study with an observational design. All patients who completed recommended treatment for breast diseases at our institute from January 1, 2018 to December 31, 2018 were included and evaluated. Data were retrieved from patient e-prescriptions and medical records. Analysis was performed using Microsoft Office 2010 to measure how our practices compared to EUSOMA quality indicators (QIs). Clinical assessments, imaging, and preoperative work-up of breast cancer patients met EUSOMA standards. Prognostic and predictive characterization of tumors was performed in all cases. Surgical management of invasive cancer and ductal carcinoma in situ (DCIS) was in accordance with the guidelines. Adherence to postoperative radiation and adjuvant endocrine therapy was adequate. More mastectomies were performed in patients with invasive cancers measuring <3 cm. Overtreatment was avoided in every other subgroup. Adjuvant and neoadjuvant chemotherapy and targeted adjuvant therapy were adequately utilized unlike neoadjuvant targeted therapy. Minimal attrition was noted in patient follow-up. This extensive audit has set a benchmark for future annual audits and helped highlight areas where improvement of service delivery is needed.

Risk Factors Associated with Pyogenic Spinal Infections among Intravenous Drug Users and Nonusers.

To identify the differences in patient factors, presentation, treatment course, and outcomes of intravenous drug users (IVDA) vs. nonusers (non-IVDA) presenting with pyogenic spinal infections. Study Design/Setting. Retrospective case series. We identified all cases involving spinal infections at our institution between May 2017 and January 2023. Postsurgical infections were excluded, and patients were separated into IVDA and non-IVDA groups. The patient charts were reviewed and analyzed for statistical or clinically significant differences using RStudio (2019 version 3.6.2). Our institutional review board approved this study, IRB# 2020-277, iRISID-2023-1384. Fifty patients (29 males and 21 females) with primary pyogenic spinal infections were included in our study. There were fourteen patients (28.0%) in the IVDA group. The mean age in the IVDA group was 50.6 vs. 61.9 years (p < 0.05) in the non-IVDA group. The average length of stay (LOS) in the IVDA group was 15.8 vs. 14.0 days (p = 0.54) in the non-IVDA group, with no significant difference in readmissions or disposition. Twenty-three non-IVDA patients were diagnosed with diabetes, while eight IVDA patients had a psychiatric diagnosis (other than substance abuse). There were no significant differences in microbial isolate or the duration of antibiotics. In our study population, there is a high incidence of intravenous drug abuse (IVDA), psychiatric disease, diabetes, and chronic kidney disease. Analysis shows a trend of two distinct patient populations. Patients without a history of IVDA were significantly older than those with IVDA and significantly more likely to have medical comorbidities including hyperlipidemia, diabetes, chronic kidney disease, and malignancy than those with IVDA history. Patients with IVDA were younger with significantly higher rates of smoking and psychiatric disorders. IVDA patients struggled to receive continued psychiatric/addiction treatment after discharge, an area for significant improvement. Due to a small sample size and single urban institution setting, this study may be underpowered to demonstrate differences in healthcare resource consumption.

Formation and Development of Education in Nakhchivan (End of the XIX Century Before the Early XX Century)

The article discusses the development of school and pedagogical thought in Nakhchivan before and during autonomy. It has been established that, in Nakhchivan, which is an integral part of Azerbaijan, they always pay special attention to education and also take care of it. Studies show that before gaining autonomy in Nakhchivan, new types of urban and emergency educational institutions were created. It should be noted that, the enlightenment movements, science and education, the highest peak of the early twentieth century. During this period, an extensive network of the Nakhchivan education system was created and our people were involved in education. As a result, all the enlightenment captured in this period in Nakhchivan rose to the very high level achieved great success in science and education. Teachers in the social and economic recovery of the country of Nakhchivan stubborn struggle against the old educational system for the reconstruction of old schools. It is still not effective. The old form of training and education in the synopsis took the first steps towards a new one. Progressive changes in education in the development of Nakhichevan enlightening ideas and gave an impetus to the formation of a local educated class. At that time, the achievements of education and culture made basis for future success.

Assessment of the Quality of Education and Care in Selected Polish Preschools During the COVID-19 Pandemic Using the ECERS-E Scale

Objectives of the research: The aim of this project was to investigate the quality of education in Polish preschools during the COVID-19 pandemic in different social environments.&#x0D; Research methods: The study uses a pedagogical approach and the ECERS-E scale, used to both define and assess the quality of preschool institutions. The research also involved interviews with teachers.&#x0D; A short description of the context of the issue: An important goal of the research is to identify problem areas and areas that constitute resources or strengths of preschool institutions.&#x0D; Research findings: A detailed data analysis indicated differences in the quality of education and care offered to children. The preschools under study obtained the highest results for the mathematics subscale and the lowest for the diversity subscale. Importantly, in nearly 25% of them, the quality of science and environment classes was lower than the minimum. A comparative analysis of the locations of preschools revealed that rural institutions achieved lower results than urban institutions, both in the overall quality of everyday life and for all subscales. Despite the social changes taking place in Poland, research shows that the diversification of the educational environment may significantly determine school competences and achievements.&#x0D; Conclusions and recommendations: The added value of the project is showing the potential of the ECERS scale and proving that it can be used in the Polish context. This creates an opportunity to conduct comparative research on an international scale.

How a nursing navigation role enhances patient recovery across Orthopedic Integrated Pathways

Introduction: Our academic urban institution developed an integrated care pathway that has significantly improved patient transitions to outpatient rehabilitation after total joint replacement (TJR) and as patients requested, supports their earlier discharge from a hospital to home to recover. Early recovery at home has identified a need for care navigation, particularly for patients with a higher complexity of medical and social issues. Implementation of a nursing role for care navigation into our existing integrated pathways would provide support for patients receiving TJR surgery ensuring better coordination of services in their community. &#x0D; Aims, Objectives and Methodology: Our objective was to evaluate an IC nursing lead (ICL) role embedded in our existing orthopedic TJR integrated pathway to support “extended” care patients to safely discharge home. Process mapping sessions conducted in 2019-20, that included key stakeholders and patient partners, identified gaps in communication and care coordination before and after surgery affecting overall patient experience and surgical recovery.&#x0D; “Extended” care patients were identified by the orthopedic care team using a standardized referral form developed in conjunction with the ICL. Patients were contacted 1-2 weeks pre-surgery and supported at various pre-operative time points with care coordination. An in-person visit with the patient occurred on the day of surgery and prior to discharge from hospital. A standard 24-hr post-op phone call was completed once the patient returned home. The ICL could be engaged by the patient or care team at any point across the TJR journey (between consent and day of surgery, acute inpatient stay, and up to 90 days post-surgery.&#x0D; Key Findings: The ICL role, piloted in March 2022, started with gradual enrolment of patients across 2 arthroplasty surgeons. By August 2022, all 6 arthroplasty care teams (surgeons, physiotherapist practitioners, fellows, physician assistants and admins) were committed to this model of care. ICL patients were 41% male and 59% female ranging in age from 50-92 (mean age of 78). Inpatient pts represented 94% (ALOS 1-2 days). Discharge (DC) disposition patterns aligned with existing best practice guidelines. Discharge coordination made up the bulk of support (82%) provided by the ICL. Other key themes and interventions included emotional reassurance (32%), education/expectation setting (30%), information on community resources and services (18%), arrangement of homecare (6%), other miscellaneous questions (5%). The average time spent for care coordination was 90 mins per patient over the 90 day period.&#x0D; Qualitative report from ICL patients revealed improved patient experience with the degree of detail and support provided. "I'm so glad I can call you. I don't always know who to talk to when I have questions". "It's so good to have someone pick up the phone when I need an answer when everything is closed".&#x0D; Conclusions: Early findings highlight the benefits of an ICL in improving care quality of patients undergoing TJR and enabling coordinated transitions post discharge from hospital through to their recovery at home. As hospital stays for TJR becoming exceedingly shorter this type of role becomes even more critical, especially with increased patient needs in the aftermath of COVID-19.&#x0D; &#x0D;

Predictors of mortality in chronic subdural hematoma evacuation.

Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhages, particularly in the elderly. Despite extensive research regarding cSDH diagnosis and treatment, there is conflicting data on predictors of postoperative mortality (POM). We conducted a large retrospective review of patients who underwent a cSDH evacuation at a single urban institution between 2015 and 2022. Data were collected from the electronic medical record on prior comorbidities, anticoagulation use, mental status on presentation, preoperative labs, and preoperative/postoperative imaging parameters. Univariate and multivariate analyses were conducted to analyze predictors of mortality. Mortality during admission for this cohort was 6.1%. Univariate analysis showed the mortality rate was higher in those presenting with a history of dialysis. In addition, those who presented with altered mental status, were intubated, and lower GCS scores had higher rates of POM. Usage of Coumadin was correlated with higher rates of POM. Examination of preoperative labs showed that patients who presented with anemia or thrombocytopenia had higher POM. Imaging data showed that cSDH volume and greatest dimension were correlated with higher rates of POM. Finally, patients that were not extubated postoperatively had higher rates of POM. Multivariate analysis showed that only altered mental status and being not being extubated postoperatively were correlated with a higher risk of mortality. In summation, we demonstrated that altered mental status and failure to extubate were independent predictors or mortality in cSDH evacuation. Interestingly, patient age was not a significant predictor of mortality.

Ethics of Care Leadership, Racial Inclusion, and Economic Health in the Cities: Is There a Female Leadership Advantage?

AbstractGrowing evidence suggests the presence of a female leadership advantage (FLA), such that women leaders tend to be associated with more effective outcomes in uncertain conditions. However, mechanisms linking women's leadership to effective outcomes are less well understood. We integrate FLA insights with ethics of care philosophical framework to conceptualize how women leaders achieve effective outcomes in the context of the urban revitalization crisis in the United States. We propose and empirically test the mediating role of ethics of care leadership in the relationship between women mayors and economic health of their cities. We used data from the Urban Institute that includes 272 United States cities and measures of variables in our conceptual model at five points in time spanning 36 years (n = 1185 city-year observations). We capture ethics of care leadership focused on racial inclusion with an index measure of a city’s racial spatial segregation, homeownership gap, poverty gap, and education gap, and we capture economic health with an index measure of a city’s employment growth, unemployment rate, housing vacancy rate, and median family income. We found that female-led cities were associated with better economic health, and this association was mediated by female-led cities’ association with greater racial inclusion. Ethics of care leadership appears to be one pathway through which a FLA manifests itself in the context of the urban revitalization crisis. This underscores the importance of city leadership that balances social and economic prerogatives. Implications are discussed.

Fruit and Vegetable Intake in Adults with Sickle Cell Disease

Introduction Patients with sickle cell disease (SCD) experience frequent disruptions to their daily lives from vaso-occlusive pain episodes and chronic organ complications, such as stroke. These acute and chronic complications negatively impact patients' ability to continue their educational and occupational obligations, making them vulnerable to socioeconomic challenges (PMID 30540112). In children with SCD, individual-level socioeconomic distress was associated with poor diet quality (PMID 34811867). In the non-SCD literature, food insecurity is characterized by a low fruit and vegetable diet intake and a greater risk of chronic kidney disease (PMID 24434743). The association of individual level socioeconomic distress with fruit and vegetable intake and, in turn, of fruit and vegetable intake with kidney function in adults with SCD is unclear. Methods We prospectively surveyed adults with SCD to investigate the association between individual level socioeconomic distress, fruit and vegetable intake, and kidney function. Between July 2022 and June 2023, we enrolled 81 adults with a diagnosis of SCD from an outpatient clinic at a Sickle Cell Center in an urban academic institution. We assessed fruit and vegetable intake using the National Cancer Institute's All Day Screener, a validated tool that estimates daily intake of fruit and vegetables. Markers of socioeconomic distress were measured using a modified short quantitative survey created by adapting the Centers for Disease Control's Behavioral Risk Factor Surveillance System Questionnaire. The distressed community index (DCI), a composite indicator that estimates the economic well-being of a community, was determined for each patient's residential address. The data were analyzed using descriptive statistics, and the association of fruit and vegetable intake with body mass index and kidney function was determined using linear regression, adjusting for age, sex, and SCD genotype. Results The median age of the cohort was 38 years (interquartile range [IQR], 31 - 45 years), 60% were female, 74% had Hb SS or Sβ 0-thalassemia genotype, and 47% were on hydroxyurea therapy. The median BMI of the cohort was 25 kg/m 2 (IQR, 21 - 30 kg/m 2). With respect to socioeconomic indicators, 33% (25/75) had high school or less education, 80% (59/74) did not own their residence, 48% (37/77) were unemployed or unable to work, and 71% (49/69) had income of &amp;lt; $35,000/year. The median DCI for our cohort was 90.8 (IQR, 68.9 - 94.9) with 65% (52/81) living in a distressed community (DCI &amp;gt; 80). The median fruit and vegetable servings consumed by the cohort was 1.95 serving sizes per day (IQR 1.05-3.04 servings), which is lower than the Centers for Disease and Control (CDC) Prevention daily dietary recommendation of 5 servings per day, and below the national and state-level (Illinois) average of 2.6 servings per day in the general population (PMID 34990439). Only 15% (11/75) of our cohort met the CDC daily recommendations of fruits and vegetables. Baseline demographics, including age, sex, SS/Sβ 0-thalassemia genotype, and hydroxyurea therapy use, were not different between those that met versus did not meet the daily fruit and vegetable intake requirements (Table). Similarly, we did not observe any differences in the socioeconomic indicators, DCI score, or proportion of patients living in a distressed tier in these two groups. On multivariable analyses, lower fruit and vegetable intake was associated with higher body mass index (natural log β 0.08 ± 0.03; P = 0.001) and higher urine albumin to creatinine ratios (natural log β 0.41 ± 0.2; P = 0.045). We did not observe any association of fruit and vegetable intake with systolic or diastolic blood pressure or with estimated glomerular filtration rate. Discussion In this prospective, cross-sectional study, adults with SCD experienced a high burden of socioeconomic distress. Although we did not observe an association between socioeconomic indicators and fruit and vegetable intake, only 15% of our cohort met the daily fruit and vegetable intake recommendations. Lower fruit and vegetable intake was associated with higher body mass index and albuminuria. Our findings highlight the need for further investigation to better understand barriers to a healthy diet in people with SCD. Furthermore, strategies to increase fruit and vegetable intake may represent a modifiable risk factor to improve SCD-related health.

187. Risk Factors and Outcomes of Patients with Serratia Bacteremia at an Academic Medical Center

Abstract Background The majority of reported Serratia infective endocarditis (SIE) in recent years are healthcare-associated. At our urban institution with a high prevalence of people who inject drugs (PWID), we noted an increasing number of Serratia bacteremias (SB) and SIE over the past decade. Our study describes patient factors associated with SB and SIE. Methods We evaluated charts of patients with SB at our institution between 2010 and 2022 to determine risk factors and clinical outcomes. Results There were 157 episodes of SB in 153 patients. The majority were male (57%), white (57%) with a mean age 53. The most common source of infection was catheter- line-associated infection (CLABSI) (27%), followed by primary bacteremia (19%). Twenty-six % were PWID with younger mean age (41 years). PWID had lower mortality than non-PWID (23% vs 44%, p=0.023). Sixty-nine (46%) were admitted to the intensive care unit (ICU) with significantly higher mortality associated with ICU admission (48% vs 8%, p=0.015). Echocardiograms were performed in 59% (93/157) of SB episodes and 14% had SIE (13/93). Most SIE (69%) occurred after 2017 with 89% in PWID (8/9). The most common comorbidity with SIE was injection drug use (IDU) (69%). All non-IDU SIE were CLABSI-related; 75% had hemodialysis catheters. Tricuspid valves were infected in 46%. Sixty-two % of those with SIE had septic emboli. Most SIE (69%) required ICU admission. Overall mortality was 31%. Only 2% (3/153) of patients with SB developed antibiotic resistance on therapy. Clinical worsening or failure occurred in 20% (32/157). Only 5% (7/157) had microbiologic recurrence within 30 days. 32% of discharged patients re-presented to the hospital within 30 days. Almost all deaths (92%) occurred during initial admission. Conclusion Patients with SB were quite ill with a high rate of in-hospital mortality; over half of the patients had antibiotic exposures prior to developing SB or presented within 90 days of a prior hospitalization. The majority of SB were line-associated, including all episodes of non-IDU SIE. IDU was the second most common comorbidity and PWID with SB had a higher rate of SIE, with most IDU-associated SIE diagnosed after 2017. This aligns with other recent studies documenting the increased prevalence of SB, especially in PWID. Disclosures Madeline King, PharmD, La Jolla: Advisor/Consultant|Shionogi: Advisor/Consultant

Hygienic assessment of sanitary and epidemiological well-being in modern urban educational institutions

Introduction. The restructuring of general education has led to the problem of overcrowding of schools, which in turn has caused the formation of a number of hygiene problems. Despite the active material and technical equipment of urban schools, the relevance of maintaining safe teaching conditions remains in general education. &#x0D; Materials and methods. The assessment of sanitary and epidemiological well-being in ten urban educational institutions was carried out according to the methodology of the Federal State Educational Institution ROSHUMZ-34-2016 “Algorithm for determining the level of sanitary and epidemiological &#x0D; well-being of an educational institution”. The intensification of the educational process was assessed according to the Federal Law ROSHUMZ-16-2015 “Hygienic assessment of the intensity of students’ learning activities”. &#x0D; Results. The leading factors that worsen the sanitary and epidemiological state of urban educational institutions were non-compliant with the hygienic requirements of the school environment and its premises, material and technical equipment, microclimate, lighting and the mode of management of training. The duration of extracurricular activities exceeded the standards by 1.8 times. In urban schools, the intensity of the educational process (class 3.1) was formed due to intellectual, sensory loads, monotony and the mode of academic work (class 3.1). It is necessary to regulate the volume of the academic load and introduce methods that allow quantifying the intensification of the educational process by analyzing the intensity of educational work. &#x0D; Limitations. The study on the assessment of the sanitary and epidemiological well-being in urban educational institutions was limited by the fact that the sample was represented by 10 urban schools, which does not allow them to be fully extrapolated to the total population of urban students. At the same time, the new type of schools included in the research with a design capacity of 1300 people could improve the indicators of sanitary and epidemiological safety, since modern newly built schools had good and new equipment, whereas in cities there are schools of the old type, where the learning conditions, the material and technical fund can be much worse. &#x0D; Conclusion. The data obtained emphasize the urgency of the need for continuous monitoring of educating conditions and the management of the educational process, taking into account modern risks that contribute to reducing the sanitary and epidemiological well-being in urban schools.

Correlations Between Anxiety and/or Depression Diagnoses and Dysphagia Severity.

An increased prevalence of mood and anxiety disorders in patients with dysphagia has been noted previously, but whether dysphagia severity may be exacerbated by anxiety and depression has never been studied before. The purpose of this study is to identify the effect of pre-existing diagnosis of anxiety and/or depression (anxiety/depression) on the Eating Assessment Tool (EAT-10), a validated patient-reported outcome measure for dysphagia. We hypothesized that patients with dysphagia and normal instrumental evaluation have higher EAT-10 score in the presence of pre-existing anxiety and depression. A retrospective chart review was conducted of patients seen at the multi-disciplinary dysphagia clinic of an urban academic institution. EAT-10 scores and pre-existing diagnoses of anxiety/depression were collected at the first visit with laryngologists. The two-sample t-test was used to compare mean EAT-10 scores between the anxiety/depression and no anxiety/depression groups, stratified by swallowing dysfunction etiology. The study included 290 consecutive patients seen starting in January 2018. In this cohort, 60 (21%) had pre-existing anxiety, 49 (17%) depression, and 36 (12%) both. Overall, 59 patients had normal swallowing based on instrumental swallowing testing (flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, esophagram, or esophagoscopy). Among those, mean EAT-10 score was significantly higher in patients with anxiety and/or depression (n = 30) (14.63, SD = 11.42) compared to those with no anxiety and/or depression (n = 29) (8.93, SD = 6.59) (p = 0.023). While anxiety/depression may aggravate dysphagia in patients with normal swallowing function, this correlation may not hold in those with objective swallowing dysfunction. 4 Laryngoscope, 134:2115-2120, 2024.

Virtual Reality Distraction Is No Better Than Simple Distraction Techniques for Reducing Pain and Anxiety During Pediatric Orthopaedic Outpatient Procedures: A Randomized Controlled Trial.

In-office procedures can be painful and anxiety-provoking for pediatric patients. Minimizing such pain and anxiety in children improves the patient experience and promotes a rewarding and productive patient-caregiver-provider relationship, which may for some young patients be their first memorable encounter with the healthcare system. Although virtual reality (VR) techniques have proven to be helpful in minimizing pain and anxiety during procedures in pediatric intensive care settings, it remains unclear how VR affects objective and subjective measures of pain and anxiety in children undergoing in-office orthopaedic procedures such as cast removal or percutaneous pin removal after fracture healing. Is a VR gaming simulation more effective than either of two forms of noninteractive visual distraction (VR goggles or tablet computer displaying a noninteractive video) for reducing (1) objective measures of pain and anxiety and (2) subjective measures of pain and anxiety in children undergoing in-office cast removal or percutaneous pin removal? This study was a randomized controlled trial with two parallel, separately analyzed cohorts: children undergoing in-office cast removal or in-office percutaneous pin removal at a single urban tertiary institution. We approached eligible patients who were scheduled to undergo outpatient cast or percutaneous pin removal and who met prespecified inclusion criteria. We enrolled until 105 patients were available for analysis in each of the cast removal and pin removal cohorts. Of note, the study institution was in an urban epicenter of the coronavirus-19 pandemic, and clinical research was paused sporadically, which resulted in a longer-than-expected enrollment period. In the cast removal cohort, all patients were eligible for inclusion and were enrolled and randomized into one of three groups: VR gaming simulation (n = 37), VR goggles with a noninteractive video (n = 36), or a tablet computer with the same noninteractive video (n = 40). Eleven percent (4), 8% (3), and 3% (1) withdrew from each of the three intervention groups, respectively. In the pin removal cohort, all patients were eligible for inclusion and were enrolled and randomized into the same three groups (37, 44, and 41 patients, respectively). In the pin removal group, 14% (5), 18% (8), and 10% (4) withdrew from each of the three intervention groups, respectively. In all, 235 patients were enrolled in the study and 210 patients (mean ± SD age 9 ± 3 years; 48% [100] girls) were included in the final analyses. There were no clinically important differences in age, gender, preprocedure pain, or anxiety among the intervention groups. Primary outcomes included preprocedure-to-maximum heart rate increase (objective measure) and preprocedure and postprocedure pain and anxiety using a VAS (subjective measures). One-way ANOVA and Bonferroni-adjusted pairwise comparisons were used to calculate between-group differences for the primary outcomes. There were no intervention-level groupwise differences between VR goggles with an interactive game, VR goggles with a noninteractive video, or the tablet computer with the same video in preprocedure-to-maximum heart rate increase in the cast removal cohort (18 ± 21 bpm versus 14 ± 11 bpm versus 20 ± 16 bpm, respectively; largest mean difference -6 bpm [95% CI -16 to 3]; p = 0.36) or pin removal cohort (27 ± 20 bpm versus 23 ± 12 bpm versus 24 ± 19 bpm, respectively; largest mean difference 4 bpm [95% CI -7 to 14]; p = 0.99). Similarly, there were no intervention-level groupwise differences in preprocedure to postprocedure VAS pain in the cast removal cohort (1 ± 1 versus 1 ± 2 versus 0 ± 2, respectively; largest mean difference 0 points [95% CI 0 to 1]; p = 0.89) or pin removal cohort (0 ± 3 versus 2 ± 3 versus 0 ± 3 points, respectively; largest mean difference 1 point [95% CI 0 to 3]; p = 0.13). Finally, there were no intervention-level groupwise differences between the same intervention groups in preprocedure to postprocedure VAS anxiety in the cast removal cohort (-2 ± 2 versus -1 ± 2 versus -1 ± 2 points, respectively; largest mean difference -1 point [95% CI -2 to 1]; p = 0.63) or pin removal cohort (-3 ± 3 versus -4 ± 4 versus -3 ± 3 points, respectively; largest mean difference -1 point [95% CI -2 to 1]; p = 0.99). During in-office cast and pin removal in pediatric patients, simple distraction techniques such as tablet video viewing are as effective as higher-fidelity VR headset video and interactive games in minimizing objective measures of procedural pain and subjective measures of pain and anxiety. Because of these findings and because of the associated costs, implementation logistics, and variable tolerance by young patients, widespread use of VR distraction techniques in the pediatric orthopaedic outpatient setting is unnecessary. Level I, therapeutic study.

Mid term outcomes of a novel metaphyseal porous titanium cone in revision total knee arthroplasty

IntroductionBone loss is present in all revision total knee arthroplasties. Metaphyseal cones allow surgeons to negotiate loss of femoral and tibial bone stock while obtaining stable bony fixation. This study examines the mid-term functional and radiographic outcomes in patients undergoing revision total knee arthroplasty (rTKA) utilizing a novel metaphyseal cone system. MethodsThis multicenter retrospective study examined all patients who received a porous, titanium tibial or femoral cone at four academic urban tertiary care institutions and presented for a minimum two-year follow-up. Patient demographics, indications for revision surgery, knee range-of-motion (ROM), re-revision rates, radiographic measurements, bone defect per AORI classification, and implant osseointegration were evaluated according to the Knee Society total knee arthroplasty (TKA) radiographic evaluation system. ResultsOne-hundred and four patients received 128 cone implants (84 tibial, 44 femoral cones; 24 patients with simultaneous ipsilateral tibial and femoral cones; 104 rTKA) with mean follow-up of 32.75 ± 6.54 months. The pre-operative main revision indications were aseptic loosening 36 (34.61 %), periprosthetic infection (PJI) 23 (22.11 %) and instability 18 (17.3 %). Thirteen rTKA underwent re-revision surgery: 3 for acute PJI, 4 for chronic PJI, 5 for instability, and 1 for mechanical failure of a hinged system. At most recent radiographic follow-up available, all unrevised cones had evidence of osteointegration and no visible implant migration.All-cause re-operation free survivorship was 87.5 % (91/104), and all-cause cone implant survivorship was 96.09 % (123/128 cones) at 2-year follow-up. ConclusionThis study demonstrates excellent mid-term outcomes of a novel porous, titanium metaphyseal cone in patients with large bone defects undergoing complex revision TKA. Level of evidenceIV, case series.

An explicit approach to liminality as an inclusive approach to librarian support for graduate student researchers

PurposeThe purpose of this paper is to provide readers with a deeper theoretical understanding of liminality, its utility in understanding the experiences of graduate student researchers and how being explicit about the liminal nature of the graduate student experience can be especially impactful for students from marginalized communities.Design/methodology/approachThis conceptual paper examines liminality as an essential component of researcher identity development and how an awareness of this liminality relates to effective and inclusive librarian support of graduate student researchers. The authors explore the affective and academic implications of operating in this liminal state and how direct acknowledgment of this inbetweenness, especially within the spaces of classroom instruction and research consultations, can be leveraged as an inclusive practice. The authors ground this exploration in critical pedagogy.FindingsGraduate student researchers often operate in an unacknowledged liminal state, which causes students to question the importance of their previous knowledge and life experiences and feel discouraged and uncertain about their potential place in academia. This is particularly damaging to students from communities that have been traditionally marginalized and excluded from higher education.Originality/valueThe authors are liaison librarians to education and health sciences at a large, minority-serving, urban research institution in the western USA and draw on their experience supporting students in disciplines that include many students returning to graduate studies after substantial professional experience. This work makes a contribution to library and information studies by focusing on the concept of liminality. The authors offer a conceptual perspective on liminality relative to librarians and their support role in the graduate student experience.

Feasibility and Utility of Posttraumatic Stress Disorder Screening Among Postpartum Patients at an Urban Safety-Net Institution.

Posttraumatic stress disorder (PTSD) is underdiagnosed peripartum. We administered a primary care screening tool and a pregnancy-related PTSD screening tool to postpartum patients presenting to our urban safety-net institution within 6 months of delivery, between August 2021 and February 2022. Our primary outcome was prevalence of positive PTSD screening results. Most patients (364/376, 96.8%) completed screening. Thirty (8.4%) had a positive score on at least one instrument, and seven of these 30 (23.3%) did not have a positive postpartum depression screening result. Among patients with a positive score, the majority (66.7%) obtained behavioral health follow-up. We found that routine PTSD screening for postpartum patients is feasible and identified patients at risk for PTSD. Obstetric practitioners should consider integrating PTSD screening into routine care.

Access to on-campus contraception on college and university campuses in North Carolina

Background and ObjectiveUnintended pregnancies occur more frequently in college students and negatively affect health outcomes and educational attainment. This study examined access to on-campus contraceptives at all 4-year colleges and universities in North Carolina (NC). MethodsThis institutional review board-exempt study evaluated availability of on-campus contraceptives including condoms; hormonal contraceptives including pills, patches, and vaginal rings; medroxyprogesterone injections; implants; intrauterine devices; and emergency contraception via website review. Institutions were stratified by characteristics including size, location, type (e.g., public, private, religious affiliation, historically black colleges and universities, women’s colleges), and presence of a student health pharmacy. Comparisons were made using chi-square test or Fisher’s exact test. ResultsFifty-four 4-year colleges and universities were identified. A plurality or the majority of schools were considered small (41%) and urban (48%) and had a religious affiliation (61%). Thirty-three percent of colleges and universities had an on-campus pharmacy. The most frequent contraceptives offered were condoms (43%), oral contraceptives (33%), and medroxyprogesterone injections (22%). Emergency contraception was available at approximately one-third of colleges and universities. Six percent of institutions provided a full range of contraceptive methods. Contraceptives were offered more frequently at large, public, urban institutions, whereas religious institutions and smaller institutions were less likely to offer contraceptives. ConclusionAccess to on-campus contraception for college students in NC is lacking, and the vast majority of institutions did not provide a full range of contraceptives. Policy measures, such as enhancing reproductive health services at student health centers or increasing contraception availability directly through pharmacies, are needed to improve access for college students.

Hurdling Barriers: Exploring Inaccessibility in Higher Education Institutions for Mobility Assistive Device Users

This article explores the challenges faced by students with disabilities using mobility assistive devices (i.e. wheelchairs or crutches) in a large public sector urban higher education institution. Cities are characterized by rapid pace and complex infrastructure including buildings, roads, and public spaces that present unique obstacles that hinder these individuals' mobility and overall experience. For this qualitative study, the locale chosen was a large public sector university, and data was collected from 10 students with disabilities who use wheelchairs and other mobility assistive devices and reside in the campus student accommodation. The data was collected through in-depth interviews and analyzed using thematic analysis. The findings indicate that the infrastructure on campus is not accommodating for students with disabilities who use mobility aids, which directly and indirectly impacts their educational experiences. In addition, the university lacks a uniform policy for providing services and allocating resources for students with disabilities. The participants believe that the university is indifferent to their needs; however, the facilities and behaviors within departments vary and at times can be quiteenabling. This study contributes to the ongoing dialogue on enhancing accessibility, inclusivity, and equity within our urban educational landscapes.

Patient-reported allergies are associated with increased rate of postoperative stiffness after arthroscopic rotator cuff repair

Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within two years following arthroscopic rotator cuff repair (ARCR). Patients were retrospectively identified using Current Procedural Terminology surgical billing codes to identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), MUA, and adhesive capsulitis of the shoulder were further queried within two years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC prior to the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as presence one, two, or three or more PRAs, with subsequent MUA/LOA or diagnosis of AC within two years postoperatively. Of 7,057 patients identified in the study period, 6,583 patients were eligible for the final analysis. The mean age was 56.6±11.7 years and the mean BMI was 29.1±5.6. Overall, 19.3% of patients (n=1,271) reported at least one allergy and 7.1% (n=469) had >1 PRA. 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within two years postoperatively, while 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (OR 2.39; 95% CI [1.45-3.92]; p<.001), but not MUA/LOA (OR 1.97, 95% CI [1.26-3.61]; p=0.133). Patients with two PRAs had greater odds of being diagnosed with AC than patients with one PRA (OR: 2.74; 95% CI [1.14-5.99]; p=0.012). While this association was non-significant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI [0.96-8.80]; p=0.059) demonstrated a similar statistical trend. Patient-reported allergies are associated with increased odds of receiving a diagnosis of adhesive capsulitis within two years following arthroscopic rotator cuff repair, but were not found to be associated with return to the operating room for postoperative stiffness.