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Purpose : Emerging data suggests improved obstetric outcomes with frozen embryo transfer (FET) in an ovulatory or natural cycle (NC-FETs), as compared to programmed endometrial preparation. The objective of this study is to better understand practice patterns and provider attitudes regarding the use of NC-FETs in the United States (U.S.). Methods : In this cross-sectional study, an anonymous 22-question survey was emailed to 441 U.S. Assisted Reproductive Technology (ART) clinics to assess the utilization of NC endometrial preparation for FET, protocols used, restrictions to offering NC-FET, and providers' perspectives on advantages and disadvantages of NC-FET. Descriptive statistics were used to analyze survey responses. Result(s): The survey response rate was 49% (216/441). Seventeen percent of responding clinics did not offer NC-FET. Of the clinics that did not offer NC-FET, 65% had only 1–2 physicians in their practice. Common reasons for not offering NC-FET included "lack of timing predictability for transfer" (81%) and "increased burden on staff/laboratory personnel on holidays and weekends" (54%). Of clinics offering NC-FET, 76% reported < 25% of cycles used the NC for endometrial preparation. Over half (52%) of clinics that offered NC-FET reported having eligibility restrictions for NC-FET. Reported benefits of NC-FET were "patient satisfaction" (18%), "decreased cost of medications" (18%), and "avoidance of intramuscular progesterone" (17%). The attitude towards NC-FET in their clinics was reported as positive by 65% of respondents. Conclusion: NC-FETs are offered by most U.S. ART clinics but are used only in the minority of FET cycles for endometrial preparation, and use is often restricted. [ABSTRACT FROM AUTHOR]

Background/Objective: Catheter-associated urinary tract infections (CAUTIs) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2–5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. Despite the heightened risk of CAUTI occurrence for the neuro-critically ill, there is little data on specific characteristics of CAUTIs and risk factors among this population. The aim of this study was to identify characteristics and risk factors associated with CAUTI development in the neuro-critical patient population. Methods: In this retrospective single-center case–control study in a tertiary care dedicated 30-bed neuroICU, approximately 3 controls (exact ratio—3.2) were randomly selected for each CAUTI case between January 1st, 2016 and December 31st, 2018. Demographic, clinical and laboratory data were collected, including prospectively collected data pertaining to urinary and bowel function. Descriptive and multivariate logistic regression analysis was conducted to identify common patient characteristics, CAUTI risk factors and duration from catheterization to developing a CAUTI (Time-to-CAUTI). Results: Of 3045 admissions during the study period, 1045 (34.30%) had a urinary catheter at some point during their admission. Of those, 45 developed a CAUTI, yielding a CAUTI incidence rate of 1.50%, corresponding to 4.49 infections/1000 catheter days. On average, CAUTI patients were older as compared to controls (66.44 years of age vs 58.09 years; p < 0.0001). In addition to old age, other risk factors included female gender (75.60% female vs 24.20% males in case group, p < 0.0001), increased neuroICU length of stay (18.31 in cases vs. 8.05 days in controls, p = 0.0001) and stool incontinence (OR = 3.73, p = 0.0146). CAUTI patients more often carried a primary diagnosis of SAH, and comorbidities of hypertension (HTN), vasospasm and diabetes. Time-to-CAUTI was 6 days on average, with an earlier peak for patients requiring two or more catheter placements. Presence of stool incontinence was significantly associated with CAUTI occurrence. Conclusion: Stool incontinence, older age, female sex, longer neuroICU LOS and presence of comorbidities such as HTN and diabetes were associated with CAUTI development in the neuro-critically ill population. Average Time-to-CAUTI after catheter placement was 6 days with earlier occurrence if more frequent catheterizations. Colonization of urinary catheters without infection might contribute to CAUTI diagnosis. Prospective research is needed to determine impact of prevention protocols incorporating these factors. [ABSTRACT FROM AUTHOR]

Background: Transforming the culture of STEM higher education to be more inclusive and help more students reach STEM careers is challenging. Herein, we describe a new model for STEM higher education transformation, the Sustainable, Transformative Engagement across a Multi-Institution/Multidisciplinary STEM, (STEM)2, "STEM-squared", Network. The Network embraces a pathways model, as opposed to a pipeline model, to STEM career entry. It is founded upon three strong theoretical frameworks: Communities of Transformation, systems design for organizational change, and emergent outcomes for the diffusion of innovations in STEM education. Currently composed of five institutions—three private 4-year universities and two public community colleges—the Network capitalizes on the close geographic proximity and shared student demographics to effect change across the classroom, disciplinary, institutional, and inter-institutional levels. Results: The (STEM)2 Network has increased the extent to which participants feel empowered to be change agents for STEM higher education reform and has increased collaboration across disciplines and institutions. Participants were motivated to join the Network to improve STEM education, to improve the transfer student experience, to collaborate with colleagues across disciplines and institutions, and because they respected the leadership team. Participants continue to engage in the Network because of the collaborations created, opportunities for professional growth, opportunities to improve STEM education, and a sense that the Network is functioning as intended. Conclusion: The goal to increase the number and diversity of people entering STEM careers is predicated on transforming the STEM higher education system to embrace a pathways model to a STEM career. The (STEM)2 Network is achieving this by empowering faculty to transform the system from the inside. While the systemic transformation of STEM higher education is challenging, the (STEM)2 Network directly addresses those challenges by bridging disciplinary and institutional silos and leveraging the reward structure of the current system to support faculty as they work to transform this very system. [ABSTRACT FROM AUTHOR]

As governments with limited fiscal resources seek to invest in the "best" programs to prevent crime, they often first try to identify the true costs of crime to guide these decisions. Contingent valuation (CV) is a common survey method used to elicit how much the public is willing to pay (WTP) to reduce a particular crime. We utilize one of the first datasets in criminal justice that includes open-ended WTP data gathered from a survey using factorial design and random assignment. WTP figures are then input into a formula which also takes into account 1) the number of households and 2) the number of crimes "avoided," which is calculated based upon the percentage crime reduction presented to survey respondents. Drawing upon data from a representative sample of the United States, we assess how sensitive respondents are to crime type, crime reduction percentages, program types, and framing. Results demonstrate that in general, open-ended WTP surveys elicit highly skewed responses and that respondents are more willing to pay for crime reduction programs with a higher number of individual components. However, respondents are not sensitive to crime reductions or several other survey framing techniques. Importantly, due to these highly skewed WTP values and lack of responsivity to crime control percentages, final cost of crime numbers vary widely – potentially altering policy decisions driven by these methods. We conclude with a discussion of the appropriateness of these methods for accurately estimating the costs of crime. [ABSTRACT FROM AUTHOR]

This note summarizes extant research on civil legal aid, which includes provision of legal services for indigent and low-income individuals, and its applications for DV and IPV victims, and concludes with suggestions for improving service delivery and research in the field. Results of searches of online databases for peer-reviewed and non-peer reviewed articles, reports, analyses, and evaluations of civil legal aid in the United States were analyzed and critically assessed. Civil legal aid is a promising but underfunded and underexplored avenue for responding to and reducing domestic violence (DV), intimate partner violence (IPV), and their devastating effects. Providing civil counsel in divorce, custody, and protective order proceedings can significantly improve outcomes for DV and IPV victims and their children as well as serve as a cost-effective strategy for reducing violence and generating positive social returns. [ABSTRACT FROM AUTHOR]

Objectives: Although the Patient Centered Medical Home is a considered an optimal model for care, some children still do not receive care in this model. Beyond the clinical and practitioner factors known to affect having a medical home, family and environmental risks [referred to as adverse childhood experiences (ACE)] may also be associated with having a medical home. This study's purpose was to examine whether family and environment risks are associated with children having a medical home. Methods: Data from the nationally representative, cross-sectional 2011-2012 National Survey of Children's Health telephone survey were used (N = 95,677). Analyses were conducted to describe the sample characteristics and determine the association between family and environmental risks and whether a child has a medical home. A subset of risks were modeled from the seminal study of ACEs. Results: Nearly one-quarter of parents reported that their children experienced at-least one ACE. Compared to children who experienced no ACEs, children who experienced at least one ACE, or other family and environmental risks, had lower odds of having a medical home than those whom did not. Logistic regressions showed that cumulative ACEs (odds ratio (OR) 0.76; 95 % confidence interval (CI) 0.65-0.90) as well as other family and environmental risks (OR 0.36, 95 % CI 0.26-0.51) were related to lower odds of having a medical home. Conclusions: This study suggests that family and environmental risks, including ACEs, impact parental report of a child having a medical home and that a dosage effect may exist. ACEs and other risk factors must be considered when providers care for children at-risk of experiencing negative events, particularly multiple negative events. [ABSTRACT FROM AUTHOR]

Competency based surgical training uses proficiency of technical skills to quantify surgical competency. We believe this is an over simplification of what is required to be a competent surgeon. This work aims to illuminate the attributes of a mature, competent, thinking surgeon. A bespoke (or custom) tailor is highly trained craftsman who produces unique items of clothing to the customers' requirements. This paper uses the practice of expert bespoke tailoring as a metaphor for illuminating surgical training and practice. A sustained and evolving dialogue with a single eminent tailor identified a number of emergent themes. A three-year iterative process included wide reading, interviews, observation, discussion and reflection. These emergent themes have produced a provisional working framework for exploring non-technical domains of surgical competence. Surgical practice is a complex process, which interweaves non-technical and technical elements in a seamless harmonious marriage of physical and mental processes. These processes need to be more clearly defined to allow the most effective training of future surgeons in the limited time now available. We discuss the benefits of illuminating these hidden facets of surgical practice, pointing out the limitations of defining competency in terms of knowledge acquisition and technical skills. If we are to train balanced, thinking surgeons for future surgical practice, and the training of future surgeons, has to be viewed as a complex integrated process rather than a collection of isolated domains. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to investigate urine cytokine and chemokine levels in symptomatic ketamine abusers compared with age-matched controls. Methods: Midstream urine specimens were collected in a prospective study of 23 ketamine abusers and 27 controls who had never used ketamine. Their basic demographic and urinary symptoms were compared. The urine was analyzed by a multiplex panel screen for 19 cytokines/chemokines: EGF, GM-CSF, GRO, IL-1Ra, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p40, IL-12p70, IP-10, MCP-1, MIP-1b, sCD40L, sIL-2Ra, VEGF, MCP-4, and TARC using Luminex™ xMAP® technology. Protein concentration values were normalized to urine creatinine concentrations. Results: Mean age of the control group was 21.1 ± 4.3 years ( n = 27) and of the ketamine group was 20.6 ± 3.7 years ( n = 23). All participants were women. The urine cytokine analysis showed a significant elevation in EGF levels in the ketamine group with lower urinary tract symptoms (LUTS) compared with the control group ( p < 0.005). Levels of the remaining 18 proteins tested were not different from control values. Conclusions: Urinary EGF levels were increased among symptomatic ketamine abusers. This suggests inflammation and epithelial repair may play a role in ketamine-associated LUTS, and this may in turn help in understanding the pathophysiology of this disease entity, leading to better treatment options. [ABSTRACT FROM AUTHOR]

The Patient-Centered Medical Home (PCMH) is a model of care that has been promoted as a way to transform a broken primary care system in the US. However, in order to convince more practices to make the transformation and to properly reimburse practices who are PCMHs, valid and reliable data are needed. Data that capture patient experiences in a PCMH is valuable, but which instrument should be used remains unclear. Our study aims to compare the validity and reliability of two national PCMH instruments. Telephone surveys were conducted with children who receive care from 20 pediatric practices across Florida ( n = 990). All of the children are eligible for Medicaid or the Children's Health Insurance Program. Analyses were conducted to compare the Consumer Assessment of Health Plan Survey-Patient-Centered Medical Home (CAHPS-PCMH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN) medical home domain. Respondents were mainly White non-Hispanic, female, under 35 years old, and from a two-parent household. The NS-CSHCN outperformed the CAHPS-PCMH in regard to scale reliability (Cronbach's alpha coefficients all ≥0.81 vs. 0.56-0.85, respectively). In regard to item-domain convergence and discriminant validity the CAHPS-PCMH fared better than the NS-CSHCN (range of convergence 0.66-0.93 vs. 0.32-1.00). The CAHPS-PCMH did not correspond to the scale structure in construct validity testing. Neither instrument performed well in the known-groups validity tests. No clear best instrument was determined. Further revision and calibration may be needed to accurately assess patient experiences in the PCMH. [ABSTRACT FROM AUTHOR]

Ludwig angina is a rare but potentially lethal infection of the submandibular space that can cause significant upper airway obstruction. We report a case of undiagnosed Ludwig angina that progressed rapidly to death. Ludwig angina was suspected after post-mortem computed tomography (PMCT) found swollen mylohyoid muscle with stranding in subcutaneous fat, thickening of deep fascia, and local lymphadenopathy. Subsequently, an autopsy revealed woody induration of the submental region and liquefactive necrosis of the mylohyoid muscle, confirming the diagnosis. It is likely that the dental abscess identified on PMCT was the source of infection. Multiple invasive medical procedures were performed on the subject by the ambulance crew prior to his death. PMCT assisted further in determining procedural success. [ABSTRACT FROM AUTHOR]

At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities. [ABSTRACT FROM AUTHOR]

Providing a medical home to children with Attention-Deficit Hyperactivity Disorder (ADHD) is challenging. Little is known about the factors associated with having a medical home for these children, or how comorbidities affect having a medical home. Our study aims are: (1) identify factors associated with having a medical home and five sub-components of a medical home and (2) determine the effect of medical home on several outcomes for children with ADHD. The sample included 5,495 children with ADHD from the 2007 National Survey of Children's Health. Descriptive and multivariate analyses were conducted. Children with ADHD alone and children with ADHD plus a physical diagnosis had greater frequencies of having a medical home, or meeting the five sub-components, than children with ADHD plus a mental diagnosis. Multivariate results show that children with ADHD plus a physical and/or mental comorbidity were 24-63% more likely to be without a medical home compared to children with only ADHD. Having a medical home also had a bearing on several child health outcomes. Having a medical home was significantly associated with being less likely to have an unmet health need and having fewer missed school days; but also being less likely to have received needed mental health care ( P < .05 ). Our results suggest that there are differences in parent's perceptions of receiving care among children with ADHD. Pediatric medical home projects and policies should acknowledge that children with ADHD often have comorbidities making their care more complex. These complexities should be addressed during practice transformation and setting reimbursement policies. [ABSTRACT FROM AUTHOR]

Neurod1 is a crucial basic helix-loop-helix gene for most cerebellar granule cells and mediates the differentiation of these cells downstream of Atoh1-mediated proliferation of the precursors. In Neurod1 null mice, granule cells die throughout the posterior two thirds of the cerebellar cortex during development. However, Neurod1 is also necessary for pancreatic β-cell development, and therefore Neurod1 null mice are diabetic, which potentially influences cerebellar defects. Here, we report a new Neurod1 conditional knock-out mouse model created by using a Tg(Atoh1-cre) line to eliminate Neurod1 in the cerebellar granule cell precursors. Our data confirm and extend previous work on systemic Neurod1 null mice and show that, in the central lobules, granule cells can be eradicated in the absence of Neurod1. Granule cells in the anterior lobules are partially viable and depend on as yet unknown genes, but the Purkinje cells show defects not previously recognized. Interestingly, delayed and incomplete Tg(Atoh1-cre) upregulation occurs in the most posterior lobules; this leads to near normal expression of Neurod1 with a concomitant normal differentiation of granule cells, Purkinje cells, and unipolar brush cells in lobules IX and X. Our analysis suggests that Neurod1 negatively regulates Atoh1 to ensure a rapid transition from proliferative precursors to differentiating neurons. Our data have implications for research on medulloblastoma, one of the most frequent brain tumors of children, as the results suggest that targeted overexpression of Neurod1 under Atoh1 promoter control may initiate the differentiation of these tumors. [ABSTRACT FROM AUTHOR]

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NeuroD (otherwise known as BETA2) is a basic helixloop- helix (bHLH) transcription factor that is capable of converting embryonic epidermal cells into fully differentiated neurons in Xenopus embryos. In insulinoma cells, NeuroD can bind and activate the insulin promoter. When NeuroD is deleted in mice, the early differentiating pancreatic endocrine cells and a subset of the neurons in the central and peripheral nervous systems die, resulting in cellular deficits in the pancreatic islets, cerebellum, hippocampus and inner ear sensory ganglia. As a consequence, mice become diabetic and display neurological defects including ataxia and deafness. These gain-of-function and loss-of-function phenotypes suggest that NeuroD controls both common and distinct sets of molecules involved in cell survival and differentiation in different tissue types. In this review, we examine what is known about NeuroD and what remains to be answered. Understanding the primary function of NeuroD will be extremely valuable in the diagnosis and cure of the diseases that involve this transcription factor, which plays essential roles in the development and function of the pancreas and the nervous system. [ABSTRACT FROM AUTHOR]

The (STEM)2 Network (Sustainable, Transformative Engagement across a Multi-Institution/Multidisciplinary STEM Network) is a National Science Foundation Research Coordination Network-Undergraduate Biology Education funded project intended to bridge disciplinary and institutional silos that function as barriers to systemic change in science, technology, engineering, and mathematics (STEM) in higher education. We utilized three foundational frameworks to develop an adaptable model that we posit is applicable across contexts. The model includes a core infrastructure that, combined with intentional self-reflection, results in an adaptable design that can be tailored to individual institutions, contexts, and goals. Herein, we describe the inception of the network, the foundational theoretical frameworks that guide network development and growth, and detail network structure and operations with the intention of supporting others in creating their own networks. We share the nuts and bolts of how we developed the (STEM)2 Network, and include a supplemental network development planning guide to support others in utilizing the (STEM)2 Network model to reach their own objectives. [ABSTRACT FROM AUTHOR]