University of Phoenix

We describe our longitudinal experience with patients who underwent surgical treatment for Tarlov cysts. General and disease-specific validated outcome measures were used to assess health-related quality of life through 2 years postoperatively. Patients who underwent surgical treatment for sacral Tarlov cysts between 2008 and 2023 were included. Demographics and cyst characteristics were documented. End points were the disease-specific Tarlov Quality-of-Life Scale and general health-related quality-of-life measures including the Oswestry Disability Index, visual analog pain Scales, and Short-Form 36. Patients completed survey measures preoperatively and at 3, 6, 12, and 24 months after surgery. Data were obtained from 417 patients with an average age of 52.5 ± 11.2 years, and 91.1% was female. Patients reported significant improvement in the Tarlov Cyst Quality of Life (3.2 ± 0.1 to 2.1 ± 0.1, P < .001), visual analog pain scales at rest (4.5 ± 0.1 to 2.3 ± 0.1, P < .001) and upon activity (5.7 ± 0.2 to 3.1 ± 0.1, P < .001), and the Oswestry Disability Index (45.5 ± 0.8 to 31.6 ± 1.0, P < .001). Patients also reported improvement on 7 of the 8 Short Form 36 scales: Physical Functioning, Physical Limitations, Bodily Pain, Vitality, Social Functioning, Emotional Limitations, and Mental Health ( P < .001 for all models). There was significant improvement from the 1 to 2 years for physical functioning ( P = .040) and social functioning ( P = .016). The median tolerated sitting time increased from 15 min preoperatively to 45 minutes at 2 years postoperatively. This study, to our knowledge, is the first to demonstrate significant improvement in patients surgically treated for Tarlov cysts using general and disease-specific health-related quality-of-life scales for 2 years after surgery. Our results suggest that patients may continue to improve for up to 2 years after surgery in some domains.

Surgeons pursuing improvement in the aesthetic outcomes of their cleft lip repairs may benefit from a granular scale evaluating individual objectives of the repair. A working group of 9 surgeons convened to develop an assessment scale for nasolabial aesthetics after unilateral cleft lip repair. The group identified objectives of the repair that could be evaluated using two-dimensional facial photographs. Scale items were developed to appraise success or failure in achieving each objective. Scale items were iteratively tested and refined. The scale was subsequently implemented as part of a Continuing Medical Education course that included self-evaluation and peer-to-peer education, culminating in the formation of individual plans for improvement. Twelve distinct objectives of unilateral cleft lip repair were identified, of which 10 could be evaluated using photographs routinely obtained in clinical practice. A comprehensive scale was developed, incorporating these 10 objectives. Each scale item takes the form of a binary (yes/no) question evaluating a specific aesthetic concept, with accompanying reference images. Intrarater reliability for each item ranged from moderate to substantial (kappa value, 0.57 to 0.81). Interrater reliability ranged from fair to substantial (kappa value, 0.27 to 0.81). When implemented in a Continuing Medical Education course, the scale enabled surgeons to identify specific opportunities for improvement in their repair and specific surgical maneuvers to adopt in pursuit of these improvements. A new scale for evaluating outcomes of unilateral cleft lip repair is presented. The scale provides specific, actionable evaluations for individual objectives of the repair.

Transient pain and ocular inflammation may occur with ophthalmic surgery. Pain is an important determinant of patient satisfaction, and inflammation can increase the risk for suboptimal visual outcomes. Topical anti-inflammatory therapies can reduce the incidence of postoperative pain and inflammation but have many limitations, including nonadherence and significant potential side effects such as cataract formation and intraocular pressure elevation. There is unmet need for a therapy that provides anti-inflammatory and analgesic activity while overcoming the limitations of topical therapy. The intracanalicular dexamethasone insert (DEX) overcomes many of the limitations of topical therapy. DEX is a fluorescent yellow cylindrical-shaped polyethylene glycol-based hydrogel insert incorporating 0.4mg preservative-free dexamethasone. The insert was designed based on human anatomy and measurements of the canalicular system and continuously releases a tapered dose of dexamethasone over approximately 30days onto the surface of the eye. The insert is completely resorbable and does not require removal. DEX was approved by the US Food and Drug Administration for the treatment of pain (in 2018) and inflammation (in 2019) following ocular surgery; in 2021, the treatment of ocular itching associated with allergic conjunctivitis was added as an indication. We present a comprehensive review of the current therapeutic landscape for management of postoperative pain and inflammation following cataract surgery, including the limitations of topical eye drop medications. We review data from the key phase2 and 3 clinical trials that supported the approval and label expansion for DEX. We also summarize the broader literature of smaller studies evaluating the role of DEX in controlling postoperative pain and inflammation for a variety of ophthalmic surgery beyond cataract surgery as well as in management of ocular itching associated with allergic conjunctivitis.

For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-relatedbleeding, was tested for superiority. Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.).

Takotsubo Cardiomyopathy (TTC) is an acute heart condition in which physical or emotional stress causes left ventricular dysfunction. Psychiatric comorbidities have been linked to the precipitation of this condition, but large-scale data are limited. The goal of this study was to analyze the associations between TTC and various psychiatric conditions using nationally representative data. A retrospective observational cohort study was conducted using the Nationwide Inpatient Sample (NIS) database from 2016-2022. ICD-10 code I51.81 was used to identify hospitalized patients ≥18 years with a primary diagnosis of TTC. In addition, ICD-10 codes were used to identify patients diagnosed with various psychiatric comorbidities. A total of 291,600 patients had a primary diagnosis of TTC. The mean age was 67.1 ± 14.26 years and 82.04% of the population was female. The following four psychiatric comorbidities were found to have significant associations with TTC: nicotine dependence (17.48% of patients; p<0.001; OR 1.08; 95% CI, 1.06-1.11), depressive disorders (19.20% of patients; p<0.001; OR 1.46; CI 95%, 1.43-1.49), anxiety (24.25% of patients; p<0.001; OR 1.83; CI 95%, 1.80-1.87), and PTSD (2.91% of patients; p<0.001; 1.25 OR; CI 95%, 1.18-1.31). No significant associations were found for dementia, alcohol related disorders, substance use other than tobacco and alcohol, manic disorders, or schizophrenia. In this large, nationally representative sample, nicotine dependence, anxiety, depression, and PTSD were significantly associated with TTC. These findings highlight the importance of incorporating psychiatric health practices into the field of cardiology.

In basketball, quadriceps strains and contusions are common due to the muscle’s role in knee extension and hip flexion, with the rectus femoris most prone to injury because it crosses both joints, making it vulnerable to eccentric loading. The purpose of this study was to describe the epidemiology of quadriceps injuries in National Basketball Association (NBA) players, assess changes in player performance statistics after injury, and to determine factors that were associated with a greater or equal player efficiency rating (PER) and usage percentage (USG%) 1 year and 2 years after a quadriceps injury. Quadriceps muscle injury data from the 2015 to 2020 NBA seasons were extracted using a publicly available database. Injury characteristics and player demographics were evaluated with descriptive statistics. PER, USG%, points per game (PPG), and minutes per game (MPG) were calculated for the season prior, 1 season after, and 2 seasons after injury. A Poisson logistic regression analysis was performed to identify risk factors associated with greater or equal PER and USG% at 1 year and 2 years after injury. A total of 116 quadriceps muscle injuries were sustained among 89 NBA players. Contusion was the most common injury type, and the majority of injuries resulted in less than ten games missed. PER at 1 year after injury (15.8; P = 0.015) was significantly lower than baseline PER (16.5), but recovered at 2 years post-injury (16.8; P = 0.166). Older age was associated with a relative risk of having a decreased USG% (relative risk [RR] 0.83; 95% confidence interval [CI] 0.76–0.90) and a decreased PER (RR 0.75; 95% CI 0.64–0.88) at 1 year after injury, but these associations were not significant at 2 years after injury (P = 0.084 and P = 0.431, respectively). Contusions are the most common quadriceps muscle injury sustained by NBA players. Older age may be associated with decreased usage and efficiency one year after injury. NBA players are likely to return to baseline PER and USG% statistics at two years post injury.

&lt;i&gt;Technology is a rapidly growing industry, attracting highly skilled individuals from various walks of life. Historically, this field was represented by a predominantly white male staff. Individuals from minority groups often find themselves at the center of token diversity.&amp;nbsp; More specifically, women in technology rarely find genuine respect in the workplace. The systemic barriers that lend to the lack of representation of women in the technology industry include gender dynamics that lean to the favor of men. The concept of gender dynamics brings unfortunate influences like stereotypes, imbalances in power, and general inequalities. Using a qualitative narrative inquiry, nine women were interviewed about their experiences working in the technology field. Within the interview transcripts, certain themes were identified: 1) token diversity, 2) gender dynamics, and 3) relationships. It was also shown that mentorship, sponsorship, and networking are important factors in fostering a sense of belonging in the workplace. These elements create opportunities for women that are essential to overcoming barriers and advancing in their technological careers.&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;/i&gt;

The cause of medical errors and adverse events in healthcare is multifactorial and includes faulty systems, processes, and conditions that can lead individuals to make mistakes. These mistakes are estimated to cause between 210,000 and 400,000 preventable deaths each year in the United States and are often caused by ineffective communication and teamwork failures among interdisciplinary team members. Effective communication is crucial, especially during critical events as this impacts health care quality and patient safety. The project's aim was to implement the identified best practice of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) 3.0 to improve communication and teamwork during critical events on a perinatal unit. This was an evidence-based practice project consisting of 2 h of TeamSTEPPS didactic and interactive instruction followed by using the TeamSTEPPS concepts during 2 h of critical event simulation training to assess the perception of communication and teamwork of a multidisciplinary team on a perinatal unit. The multidisciplinary team members included labor and delivery nurses, mother/baby nurses, hospital aides, ward clerks, obstetrical technicians, obstetricians, and midwives. Using the TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ), the perception of communication and teamwork was compared pre- and post-implementation. Communication and teamwork mean scores from pre to post increased by 61% and 56%, respectively. The mean posttest scores improved for each of the T-TPQ measures, indicating the intervention had an impact on each of the dimensions of the TeamSTEPPS approach, including team function, team leadership, situational monitoring, mutual support, and communication (p < 0.01) and Cohen's dz, of 0.82-1.32 provided evidence of a large effect. This evidence-based practice project provided clear and specific guidance for communicating and strengthening teamwork during perinatal critical events. Implementing TeamSTEPPS strategies can provide a safe environment for patients and a positive work environment where teamwork and communication are encouraged.

Introductory environmental science courses offer non-STEM students an entry point to address global challenges such as climate change and cryosphere preservation. Aligned with the International Year of Glacier Preservation and the Decade of Action for Cryospheric Sciences, this mixed-method, IRB-exempt study applied the Curriculum Redesign and Artificial Intelligence-Facilitated Transformation (CRAFT) model for course redesign. The project leveraged a human-centered AI approach to create anthropomorphized, place-based narratives for online learning. Generative AI is used to amend immersive virtual learning environments (VLEs) that animate glacial forces (water, rock, and elemental cycles) through narrative-driven virtual reality (VR) experiences. Students explored Iceland’s Jökulsárlón Glacier Lagoon via self-guided field simulations led by an imaginary water droplet, designed to foster environmental awareness and a sense of place. Data collection included a five-point Likert-scale survey and thematic coding of student comments. Findings revealed strong positive sentiment: 87.1% enjoyment of the imaginaries, 82.5% agreement on supporting connection to places, and 82.0% endorsement of their role in reinforcing spatial and systems thinking. Thematic analysis confirmed that anthropomorphic imaginaries enhanced emotional engagement and conceptual understanding of glacial processes, situating glacier preservation within geographic and global contexts. This AI-enhanced, multimodal approach demonstrates how narrative-based VR can make complex cryospheric concepts accessible for non-STEM learners, promoting early engagement with climate science and environmental stewardship.