Olympus (United States)

This manuscript provides a history of efforts by the American Public Health Association (APHA) Maternal and Child Health Section (MCH Section) Gun Violence Prevention Workgroup (GVP Workgroup) to promote gun violence prevention (GVP) as a key public health priority both within the MCH Section and APHA, and nationally. The MCH Section established a gun violence prevention workgroup in response to the murders of twenty first-grade children and six adults at Sandy Hook Elementary School. This article presents an overview of the accomplishments and challenges of the MCH Section GVP Workgroup in a context of ever-increasing gun violence. As of 2020, firearms became the leading cause of death for U.S. children and teens. Over the past decade, a small group of volunteers helped maintain GVP as one of the top priorities of both the MCH Section and APHA. Endorsement by the MCH Section and APHA leadership facilitated MCH Section GVP Workgroup efforts including organizing a national conference, developing scientific sessions for APHA annual meetings, establishing coalitions, and providing ongoing education and outreach to APHA members. The MCH Section GVP Workgroup helped to both elevate and maintain focus on GVP as a top priority of the MCH Section and APHA, indirectly impacting national efforts to promote a public health approach to GVP. The ongoing epidemic of firearm violence highlights the importance of continuing and strengthening this work. Individuals at other national, state or local organizations might look to the efforts and accomplishment of the MCH Section GVP Workgroup in pursuing critical issues within their own organizations.

Several clinical procedures utilize duodenoscopes, which are processed for reuse after the procedures are completed. However, infection outbreaks due to improper duodenoscope processing occur frequently. To address this, we aimed to assess the contamination rates of duodenoscopes after reprocessing in nonoutbreak settings. Prospective study in 16 clinical sites in the United States. We sampled and cultured reprocessed duodenoscopes following the FDA/CDC/ASM guideline; "Duodenoscope Surveillance Sampling and Culturing - Reducing the Risks of Infection." High-concern (HC) organisms were those highly associated with disease, including gram-negative rods, Staphylococcus aureus, Staphylococcus lugdunensis, β-hemolytic Streptococcus, Enterococcus spp, and yeasts. We evaluated duodenoscopes with ≥1 CFU of organisms after reprocessing. The reprocessing environments were also sampled and cultured. We assessed 859 newer-model (NM) duodenoscopes (TJF-Q180V) and 850 older-model (OM) duodenoscopes (TJF-160F/VF); of these, 35 NM samples (4.1%) and 56 OM samples (6.6%) were contaminated with HC organisms. We detected and classified the HC organisms as gastrointestinal (45.4%), human origin (16.7%), environmental (24.1%), waterborne (13.0%), and unidentified (0.9%). We detected an overall HC contamination rate of 5.3% in nonoutbreak settings. Although the relationship between endoscopic contamination and the occurrence of infections remains unclear, attempts should continue to be made to further reduce contamination rates. Additional improvements to the manufacturer's instructions for use, human factors during the reprocessing procedure, ongoing training programs, cleanliness of reprocessing environments, and the design of the distal end of the duodenoscope should be considered.

There is variation in polypectomy techniques for resection of small polyps. Aim was to compare techniques for 4 to 6 mm polyps for recurrent adenoma, efficiency, and adverse events and to establish methodological factors for definitive trial. The study was a randomized controlled trial. Outpatients with ≥1, 4 to 6 mm polyps were randomized to cold forceps (CF), cold snare (CS), and hot snare (HS). Polypectomy site was marked with SPOT to assess for recurrence at the original polypectomy site during surveillance colonoscopy. To assess feasibility of a definitive trial we measured (1) rates of patient refusal, participation, ineligibility; (2) retention; (3) recurrent neoplasia; and (4) sample size for a definitive trial. Three hundred fifty-three patients were randomized to 1 of the 3 polypectomy techniques, of whom 260 (73.6%) completed the initial colonoscopy (mean age 57 y, 50.4% women), with 91, 87, and 82 patients randomized to CF, CS, and HS polypectomy, respectively. Mean time for polyp resection for CF, CS, and HS were 198.8, 58.5, and 96.8 seconds, respectively, with CS and HS requiring less time than CF (P<0.001). One hundred sixty-four (63.1%) completed surveillance colonoscopy. Polyp recurrences were 9 (14.5%) with CF, 5 (9.6%) with CS, and 0 (0%) with HS. Although the recurrence relative risks with CF and CS polypectomy were 1.84 and 1.65 as compared with HS, respectively, neither was statistically significant. CS and HS polypectomy require less time than CF. HS polypectomy may have a lower risk for recurrent neoplasia. High attrition rate is a challenge in conducting randomized controlled trial with polyp recurrence as endpoint.

Abstract RNP granules are membrane-less compartments within cells, formed by phase separation, that function as regulatory hubs for diverse biological processes. However, the mechanisms by which RNAs and proteins interact to promote RNP granule structure and functionin vivoremain unclear. InXenopus laevisoocytes, maternal mRNAs are transported as large RNPs to the vegetal hemisphere of the developing oocyte, where local translation is critical for proper embryonic patterning. Here, we demonstrate that vegetal transport RNPs represent a new class of cytoplasmic RNP granule, termed Localization-bodies (L-bodies). We show that L-bodies are multiphase RNP granules, containing a dynamic protein-containing phase surrounding a non-dynamic RNA-containing substructure. Our results support a role for RNA as a critical scaffold component within these RNP granules and suggest thatcis-elements within localized mRNAs may drive subcellular RNA localization through control over phase behavior.

This article is a first day of class exercise that presents a controversial contemporary economic policy as the entry point for the study of principles of macroeconomics. The process and tools for critical thinking are presented and used to assess the macroeconomic outcomes of the (2017) Tax Cuts and Jobs Act (TCJA). Critical thinking involves a two-stage process for testing propositions about the economic system, one logical and the other empirical. The exercise introduces students to primary data sites, statistical analysis, and the use of critical thinking to make inferences about hypotheses associated with the impacts of the TCJA. The outcomes are, first and foremost, student appreciation and empowerment to self-test propositions about macroeconomic policies and their effects. Second, they will (should) understand the relevance of macroeconomic policy in affecting the material well-being of their lives. Third, students will have the expectation that macroeconomics is about active student learning from the outset, and that each day will be filled with discovery. Together, these outcomes create a classroom learning environment where students, working with the teacher, play a pivotal role in the educational process.

<b>Purpose:</b> To evaluate the performance of a new peripheral sampling needle in patients. <b>Methods:</b> A new flexible 21G peripheral TBNA needle (PeriFLEX, Olympus Respiratory America, Redmond, WA, USA) was provided to experienced interventional bronchoscopy centers in Canada (3), Europe (2), and the US (4). Between November 2016 and September 2017, physicians at each site were asked to use the needle with their standard peripheral sampling techniques and, after each use, complete an evaluation form rating needle performance. <b>Results:</b> A total of 109 targets were sampled by 23 physicians in 109 patients. The needles were used in the following lung regions: 35 in the RUL, 28 in the LUL, 17 in the RML, 14 in the RLL, and 14 in the LLL. Based on imaging, targets were on average 2.9 cm ± 1.5 cm in length and 1.7 cm ± 1.6 cm from the pleura, with 49.1% of targets within 1cm of the pleura. Physicians rated the ability of the PeriFLEX needle to reach the desired target location as “Excellent” 70.6% and “Good” 22.0% of the time. The accessibility of the 63 upper lobe targets was rated as “Excellent” 76.2% of the time compared to 62.2% for the 45 middle / lower lobe targets. Of the collected samples, 73.8% were rated as “Average” and 20.4% were rated as “Large”. In addition to the PeriFLEX needle, physicians used a radial EBUS probe, forceps, cytology brush, and BAL / washing in 89.0%, 67.9%, 45.0%, and 44.0% of cases, respectively. One patient experienced bleeding, which resolved after wedging the bronchoscope. <b>Conclusions:</b> In this evaluation, the PeriFLEX needle reached a variety of peripheral target locations and collected adequate sample material. Further evaluations are warranted.

To determine whether gastroenterologists would be willing to accept the "predict, resect, and discard" strategy for diminutive colorectal polyps and identify potential barriers to implementation in clinical practice. The ASGE recently published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document on managing diminutive colorectal polyps using the "predict, resect, and discard" strategy. However, there is no data on whether gastroenterologists would accept this paradigm shift. We performed a random survey of gastroenterologists at a national meeting. Awareness of and willingness to adopt the "predict, resect, and discard" practice, reasons for not utilizing it, and whether a financial incentive would be persuasive in implementing the practice were assessed. A total of 105 gastroenterologists were surveyed. Seventy-six (72%) were aware of the PIVI statement and 64 (61%) stated they would be willing to implement this in practice. Medical-legal concerns (85%) and lack of financial incentives (32%) were the 2 most commonly cited barriers to implementation. Greater than 50% of those resistant to performing the service would be willing do so if given a financial incentive, with ∼50% of gastroenterologists who cited an appropriate incentive preferring >$75 to do so. Of these, private practice gastroenterologists and those who had financial interest in sending polyps to pathology were the most likely to request this amount. Approximately two-thirds of gastroenterologists are willing to adopt the "predict, resect, and discard" strategy for managing diminutive colon polyps. Medical-legal concerns and lack of financial incentives are the primary barriers to implementation.

This paper proposes an optimal Admission Control (AC) policy for wireless Body Area Networks (BANs). We mathematically formulate an AC problem that captures BAN-specific characteristics such as ultra-low power consumption of sensor nodes and QoS-sensitive heterogeneous traffic types. Traffic QoS requirements along with physical BAN sensor limitations such as buffer size and energy consumption are used to determine a data flow's connection parameters. If unable to admit the new flow, the Hub initially considers adjusting some of the existing (or new) flows to free up enough bandwidth. Adjustment of a flow does not violate its QoS requirements but comes at the cost of extra energy consumption. We propose an efficient scheme that traverses viable adjustment options until the least costly is found. When adjustment does not suffice, a combination of adjusting a set of flows and terminating some of the existing ones is considered. A bandwidth-efficient algorithm is proposed that chooses to terminate the least number of flows that have lower priory than the one requesting to join. For medical-grade traffic, simulation results show a 27% increase in the number (and close to 2 levels increase in a defined priority metric) of admitted flows, at a diminutive 3% cost on the nodes' energy consumption.