Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and...Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.展开更多
Description: The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the ben...Description: The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.展开更多
Objective： To help readers around the world comprehensively understand the development of the journal and evolution of cooperation study, we employed a bibliometrics analysis for the Journal of American College Healt...Objective： To help readers around the world comprehensively understand the development of the journal and evolution of cooperation study, we employed a bibliometrics analysis for the Journal of American College Health. Methods： One-thousand-one-hundred-forty-three articles published in this journal from 1994 were analyzed using the bibliometrics and visualization software CiteSpace. Results： The annual number of published articles and cited studies increased. The published studies by RP Keeling and H Wechsler were at the forefront. ＂College student＂ and ＂alcohol＂ were prevalent key- words. University of Wisconsin and Harvard University were the institutional leaders of contributions. Conclusions： This journal provides an important platform for sharing research achievements and promoting cooperation in this field. The level of articles published is continually improving. A research cooperative network promoted by famous scholars and institutions is developing. However, crossregional and international cooperation is relatively limited.展开更多
The thesis is just trying to analyze American college slang from sub-cultural perspective on the basis of combining linguistic knowledge,the knowledge of American slang and American college slang with the knowledge of...The thesis is just trying to analyze American college slang from sub-cultural perspective on the basis of combining linguistic knowledge,the knowledge of American slang and American college slang with the knowledge of subculture,which is helpful for English learners to learn American English better.展开更多
Awareness of differences between American and Chinese college students is surely important for us in international communication. The historical, social, economic, linguistic and spiritual contexts of China and Americ...Awareness of differences between American and Chinese college students is surely important for us in international communication. The historical, social, economic, linguistic and spiritual contexts of China and America are profoundly different. Consequently, college students have shaped their lives and their identities in profoundly different ways, for example, academic studies, independence, teacher-student relationships, and life on campus. Though college students in different countries, he or she has their own mind and spirit with the cultural context in unique ways. We should respect their culture. Knowing the differences will help us communicate and understand the American college students better. Furthermore, we can learn from other’s strong points to offset our weakness. This paper discusses the differences between American and Chinese college students, it includes two parts, first one is a brief introduction, and second one is giving some ideas on differences between American and Chinese college students.展开更多
BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS re...BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.展开更多
文摘Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.
文摘Description: The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.
基金supported and funded by MOE(Ministry of Education in China)the research projects of Humanities and Social Sciences(No.13YJCZH239)+1 种基金National Natural Science Foundation of China(No.71403155)supported by Shanxi Federation of Social Science Cirdes(No.SSKLZDKT2014084)
文摘Objective： To help readers around the world comprehensively understand the development of the journal and evolution of cooperation study, we employed a bibliometrics analysis for the Journal of American College Health. Methods： One-thousand-one-hundred-forty-three articles published in this journal from 1994 were analyzed using the bibliometrics and visualization software CiteSpace. Results： The annual number of published articles and cited studies increased. The published studies by RP Keeling and H Wechsler were at the forefront. ＂College student＂ and ＂alcohol＂ were prevalent key- words. University of Wisconsin and Harvard University were the institutional leaders of contributions. Conclusions： This journal provides an important platform for sharing research achievements and promoting cooperation in this field. The level of articles published is continually improving. A research cooperative network promoted by famous scholars and institutions is developing. However, crossregional and international cooperation is relatively limited.
文摘The thesis is just trying to analyze American college slang from sub-cultural perspective on the basis of combining linguistic knowledge,the knowledge of American slang and American college slang with the knowledge of subculture,which is helpful for English learners to learn American English better.
文摘Awareness of differences between American and Chinese college students is surely important for us in international communication. The historical, social, economic, linguistic and spiritual contexts of China and America are profoundly different. Consequently, college students have shaped their lives and their identities in profoundly different ways, for example, academic studies, independence, teacher-student relationships, and life on campus. Though college students in different countries, he or she has their own mind and spirit with the cultural context in unique ways. We should respect their culture. Knowing the differences will help us communicate and understand the American college students better. Furthermore, we can learn from other’s strong points to offset our weakness. This paper discusses the differences between American and Chinese college students, it includes two parts, first one is a brief introduction, and second one is giving some ideas on differences between American and Chinese college students.
文摘BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
