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We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.

Background: Breast conservation therapy has become a preferred method of treating early-stage breast cancer. As care continues to evolve, certain lesions allowed less invasive treatment options. A simplified explanation of early breast cancer care is detection, biopsy, surgery, and adjuvant therapy. The authors look to challenge that algorithm for a specific type of disease., Methods: A retrospective review was performed to identify all subcentimeter breast cancer that underwent surgery after core biopsy. These cases (n = 115) were analyzed for biopsy technique and outcome of final surgical excision to find when no residual disease was found on final pathology, potentially rendering the surgical resection an unneeded procedure., Results: The authors found that 17 of 115 patients (14.8%) who underwent biopsy for subcentimeter breast cancer had no residual disease found on final surgical resection. Although the subsets were small, the largest core needle resulted in negative pathology two of three times, while the smallest gauge, never resulted in negative resection at time of surgery., Conclusions: Nearly, fifteen percent of patients were found to have no residual disease on final surgical pathology. These results were obtained when the radiologist was simply trying to get tissue diagnosis. The authors postulate that this percentage could be even higher if protocols were initiated to biopsy these small lesions with larger core biopsies and possibly alleviate the need for formal surgery in these specific, small lesion., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Some level of vulnerability characterizes the daily experiences of humans. Particularly for young persons, major structural conditions are frequently linked with high vulnerability. Infrequently explored are everyday or normative routines of children that appear less challenging on the surface but may interfere with resiliency and the positive outcomes that may be achieved in the face of challenge. In linking social conditions of ethnically diverse children with emotional and physical distress, sex-linked empirical findings indicate that family-level helping behavior may be perceived and experienced as overwhelming for young, primary-school girls.

This research examined associations between physical maturation and adolescent-perceived family hassles within a sample of urban African American families who resided in high-risk communities. The purpose of the study was to examine the relations between physical maturation and youths' perceptions of their family context and the associated daily stresses experienced. The participants were 251 parent-son dyads who were interviewed separately. The combination of quantitative and qualitative results extends the literature on physical development and urban African American populations by indicating that parents are most aware of pubertal changes during early puberty. The findings suggested that adolescent-perceived hassles are indications of parental monitoring and more adaptive parenting strategies are needed for high-risk neighborhoods.

As the US population becomes more diverse in the 21st century, researchers face many conceptual and methodological challenges in working with diverse populations. We discuss these issues for racially and ethnically diverse youth, using Spencer's phenomenological variant of ecological systems theory (PVEST) as a guiding framework. We present a brief historical background and discuss recurring conceptual flaws in research on diverse youth, presenting PVEST as a corrective to these flaws. We highlight the interaction of race, culture, socioeconomic status, and various contexts of development with identity formation and other salient developmental processes. Challenges in research design and interpretation of data are also covered with regard to both assessment of contexts and developmental processes. We draw upon examples from neighborhood assessments, ethnic identity development, and attachment research to illustrate conceptual and methodological challenges, and we discuss strategies to address these challenges. The policy implications of our analysis are also considered.

This study examined the relationship of perceived parenting practices to anger and coping in a sample of 70 African-American adolescents. Regression analyses reveled that perceptions of parental strictness were negatively related to anger temperament, anger-out, and avoidance (all p<0.05), and was positively associated with engaging in demanding activities (p<0.02). Additionally, perceptions of parental involvement were positively related to seeking diversions (p<0.04), and perceptions of parental autonomy granting were negatively related to anger-out (p<0.02). These findings highlight the potential importance of the perceived parent-adolescent relationship for African-American adolescents., (Copyright 2002 The Association for Professionals in Services for Adolescents. Published by Elsevier Science Ltd.)

The transition to topical anesthesia and clear corneal cataract surgery can be made safe, effective, and less stressful through proper preparation and training as a surgical team. Sharing experiences with other practices will help in this process, as will visiting other practices and seeing them in action.

A framework that emphasizes and integrates individuals' intersubjective experiences with Bronfenbrenner's ecological systems theory (PVEST) is introduced and compared with self-organizational perspectives. Similarities, differences and advantages of each framework are described. In a demonstration of PVEST's utility, a subset of data from the 3rd year of a longitudinal study (14- to 16-year-old middle adolescent African-Americans) is used for examining an achievement variable: negative learning attitude. Explored separately by gender, a regression model that contained risk, stress, and a reactive coping variable for the prediction of negative learning attitudes was investigated. For boys, stress was an independent stressor across steps independent of the other variables entered; social support variable, perceived unpopularity with peers, that was a significant predictor of girls' negative learning attitude. Particularly for boys, the findings suggest critically important roles for teachers and peers in the negative learning attitude of midadolescent economically disadvantaged African-American students.

In certain simple rotations of objects, the orientation of the axis and planes of rotation can determine whether people are able to visualize the motion or perceive it as simple and coherent. This finding affords the opportunity to investigate the spatial reference systems used to define the orientation of the axis and planes of rotation. The results of two experiments suggest that the permanent environment is the primary reference system, apart from the rotating object, used for this purpose. Subjects also were able to use a local spatial environment to determine the orientation of the motion; some subjects were particularly adept at this. The viewer perspective, in contrast, was irrelevant as a reference system in these experiments. These results argue strongly for the primacy of environmental reference systems in the perception and imagination of orientation and extend the set of findings common between the comprehension of rotational motion and orientation-sensitive form perception.

We report the case of a 27-year-old man with bilateral chylothorax. The patient presented with shortness of breath and bilateral pleural effusions three days after a motor vehicle accident. The diagnosis was established when tube thoracostomy revealed chylous drainage. During hospitalization approximately 8 L of chyle were removed. Bilateral chylothorax secondary to blunt trauma has rarely been reported. The etiology, pathogenesis, clinical presentation, and recommended therapy are reviewed.