Search

BACKGROUND: Telehealth use during family-centered rounds in the neonatal intensive care unit has been shown to shorten length of hospitalization and improve breastfeeding outcomes. For families who speak languages other than English, access to and use of telehealth technologies can be impeded by lack of interpreter services. We aim to evaluate the feasibility of telehealth use during family-centered rounds in the neonatal intensive care unit for families who speak languages other than English. METHODS: In this study proposal, we will conduct an intervention evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to assess the feasibility of telehealth use during family-centered rounds among families who speak languages other than English in a single-arm feasibility trial. We will provide language-appropriate materials to assist parents with accessing the telehealth technology and bring interpreters into the telehealth encounter directly with neonatal providers. All eligible infants whose families speak languages other than English in a single-site level 4 neonatal intensive care unit during the study period will be included. These families can participate in hospital rounds via telehealth, in-person, or not participate in hospital rounds. We will examine feasibility objectives that assess parental uptake of telehealth for rounds, parental participation in rounds, presence of a certified medical interpreter, telehealth technical issues, and parental survey response rates. We will conduct a mixed methods implementation evaluation using the RE-AIM framework. Exploratory outcomes include parent attendance, length of hospitalization of the infant, human milk feeding, frequency of medical error, parent-reported experience, parental comfort with their childs care, and parental quality of life will be collected. DISCUSSION: This study will aid in understanding gaps to telehealth care in languages other than English. We believe this approach will improve health outcomes for hospitalized premature infants, understanding of medical conditions, improve parental quality of life, and reduce inequities in access to healthcare via telehealth technologies. TRIAL REGISTRATION: NCT05917899 Limited English Proficiency Virtual Family-Centered Rounds, first posted June 26, 2023, last update posted November 11, 2024.

Patients with hereditary spherocytosis (HS) often require red blood cell transfusions for the treatment of hemolytic anemia. Iron overload is a known complication of frequent transfusions. Deferasirox, an oral iron chelator, can cause transient elevations in serum aminotransferase levels. There have been a few cases demonstrating Deferasirox-associated liver injury in patients with sickle cell anemia and thalassemia. In this case report, we present a 13-year-old male with transfusion-dependent HS treated with Deferasirox who presented with jaundice and was found to have evidence of acute hepatocellular injury.

The clinical implications and prognostic outcomes associated with tumor upstaging in invasive melanoma have not been well established. To determine the frequency of tumor upstaging in invasive melanoma, identify risk factors, and assess its impact on clinical management and outcomes. A retrospective study using data from a statewide Surveillance Endpoints and End Results-affiliated cancer registry between 2014 and 2018 was performed. Multivariable hazard models were used to determine factors associated with upstaging and overall/melanoma-specific mortality. Of 4391 cases of invasive melanoma, 9.4% were upstaged. Significant risk factors on univariate analysis included older age, male sex, non-White race, head/neck location, larger clinical size, incisional and/or punch biopsy method, and increasing time between biopsy and surgical excision. Significant risk factors on multivariable analysis included head/neck location and higher pathologic T stage. Tumor upstaging dictated a change in clinical management in over half of cases; however, only 37.4% fulfilled the recommendation for additional treatment. Upstaged melanomas experienced higher overall (36.0% versus 19.5%; P <.001) and melanoma-specific (9.0% versus 2.9%; P <.001) mortality compared to non-upstaged tumors. Single-center retrospective study. Tumor upstaging in invasive melanoma is associated with worse survival outcomes, possibly due to shortfalls in clinical management. [ABSTRACT FROM AUTHOR]

As a consequence of both warming temperatures and over a century of fire suppression, wildfires in the historically frequent-fire forests of the western US have increased both in size and intensity, resulting in large patches of high severity fire that are well outside the historic range of variation. Postfire fuels research has often focused on such high severity patches because of the risk of both type conversion and repeated high severity fire. Yet a substantial portion of any given wildfire will likely still have burned at low to moderate severity. These areas generally retain live mature trees and surface fuels, suggesting that wildfire effects may be in keeping with some forest restoration goals. To better understand the range of postfire fuels conditions across severity classes and how well those conditions align with restoration targets, we sampled three wildfires in mixed conifer forests and giant sequoia groves of the southern Sierra Nevada. These wildfires appear to have met short-term restoration goals for surface fuel reduction, with burned areas having 79.5 % less fuels than unburned areas. Fine woody debris and litter and duff declined with severity, while coarse woody debris was more variable. Small tree density targets were roughly met after low and moderate severity fire, but large tree densities tended to be lower than restoration targets, possibly due to high levels of recent tree mortality. For long-term management, restoration plans set targets for the proportions of the landscape that should be in different fuel load categories, reflecting patterns shaped by many frequent and patchy fires. Observed post-wildfire surface fuels outside of groves were overwhelmingly in the lowest fuels category across severity classes, which is in keeping with short-term goals to reduce surface fuels but is not necessarily contributing to the heterogeneity desired at landscape scales. Surface fuels within giant sequoia groves were higher than those outside groves and therefore more closely matched long-term management targets for variation in fuel loads. However, for a highly valued species that has recently seen substantial losses to high severity fire, managers may find that these higher fuel loads are not desirable even in a landscape context. In summary, low and moderate severity wildfire appear to have beneficial effects in terms of meeting several management goals, however, the large amount of standing postfire fuels, the relative dearth of large trees, and the potential lack of postfire fuel heterogeneity may still pose potential management concerns. • Fine fuels declined with severity, while coarse fuels were more variable. • Low and moderate severity wildfire effects align with short-term management goals. • Abundant standing fuels and lack of heterogeneity may reduce long-term resilience. • Sequoia groves carried higher surface fuel loadings than non-grove areas. • Large tree densities tended to fall below management targets even in control areas. [ABSTRACT FROM AUTHOR]

• Climate messages had modest positive effects on public support for climate action. • There was heterogeneity in message effects across the 23 countries investigated. • There was no evidence indicating the messages were polarizing or had backfire effects. • The Urgency & Generational message had the strongest effects globally. • This message had marginally stronger effects among more developed countries. Climate change communication campaigns can reach many audiences cost-effectively. However, some climate messages may not work universally as there may be heterogeneity in message effects across audiences. An online experiment (N = 57,968) across 23 countries found that three climate messages had modest positive effects on support for climate action. An "Urgency & Generational" message had the strongest effect overall and had, on average, stronger effects in countries with lower baseline support for climate action (e.g., developed countries, democratic countries). While the size of this message's positive effects varied across countries, effects were positive across all audience subgroups investigated and there was no evidence of backfire effects. For instance, this message had positive effects across the political spectrum and effects were marginally stronger among the political Right. Although the average message effects were small, the results indicate that, when deployed at a large scale, climate change messages have the potential to strengthen public support for climate action. [ABSTRACT FROM AUTHOR]

Iatrogenic injury to the ilioinguinal nerve and its branches during anterior inguinal hernia repair is a cause of chronic inguinal pain in up to 12 % of patients undergoing this operation. The risk of nerve injury is high, given the nerves' relatively small caliber and strictly-confined space through which they pass. In the current report, we describe using a novel fluorescence imaging system developed to detect nerve autofluorescence in a 66-year-old man who presented with a left-sided Type II inguinal hernia and underwent inguinal hernioplasty. Under general anesthesia, a left inguinal hernioplasty with mesh was performed using the Lichtenstein technique through an anterior approach. During surgery, a Dendrite® Imaging camera (Dendrite® Imaging, Germany) was employed to allow the surgical team to alternate freely between standard operating room (white) light and near-ultraviolet light (NUVL), specifically to enhance visualization of the ilioinguinal nerve and its branches. Under white light, neither the ilioinguinal nerve nor any of its branches were clearly visible. However, under NUVL, all fluoresced brightly and were easily avoided throughout the course of the hernia repair. The operation proceeded with no intraoperative or postoperative complications. In this case, autofluorescence of the ilioinguinal nerve and its branches under NUVL utilizing a novel, hand-held fluorescent camera during hernia repair aided in their visualization and appeared to help prevent nerve injury. New intraoperative technology that allows nerves to auto-fluoresce intra-operatively under NUVL warrants larger series and comparative trials to evaluate its efficacy at reducing iatrogenic nerve injury during inguinal hernioplasties. • Iatrogenic injury to the ilioinguinal nerve is a common source of chronic post-operative pain after inguinal hernia repair • Using novel imaging technology, nerves auto-fluoresce in near-ultraviolet light • During inguinal hernia repair, using the Dendrite® imaging system facilitated visualization of all nerves in the surgical field. • Iatrogenic nerve injury was avoided. [ABSTRACT FROM AUTHOR]

Collaborating with climate justice practitioners, we conducted a nationally representative survey of U.S. adults (n = 1011) to measure and explore predictors of Americans' climate justice beliefs and intentions to engage in related behaviors. We find that only about one-third of Americans have heard of climate justice, but about half of Americans support climate justice goals once they are explained. Support for climate justice is predicted by many factors, including views about global warming, perceptions of climate and racial injustice, cultural worldviews, and demographics including racial identity, gender, and political party/ideology. Our study suggests a need to build public awareness of the term "climate justice," the disproportionate harms of climate change, and how climate justice initiatives will address these harms. Our study also illustrates how researchers might incorporate practitioner perspectives in national and international studies on climate justice. • Researchers and climate justice practitioners co-developed CJ support measures in a nationally representative U.S. survey. • Relatively few Americans (34 %) are aware of CJ, but about half support CJ after reading a brief description. • Global warming views, climate and racial injustice perceptions, cultural worldviews, and demographics predict CJ support. • Awareness of CJ does not predict support for it, but people who are aware of CJ may be slightly more likely to act on it. • Research-practitioner collaboration is possible not only at the local level but also at the national level. [ABSTRACT FROM AUTHOR]