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"Hodges, Shannon"
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Observations of infant conflict and avoidance in San Martin titi monkeys (Plecturocebus oenanthe)
Conflict between caregivers and infants typically centers on disagreements over the amount and frequency of care provided. Prior research has identified many variables that impact patterns of mother–infant conflict. These include wide-ranging factors such as individual temperament, reproductive status, and availability of resources. By contrast, no studies have investigated the variables that influence father–infant conflict. To better understand the nature of caregiver–infant conflict in a species with obligate biparental care, I observed two groups of San Martin titi monkeys inhabiting disturbed secondary forest fragments in the San Martín region of Peru. Using instantaneous focal sampling of infants, I recorded physical conflict between infants and caregivers and instances of infant avoidance (leaving the infant) by adult males. I summarized data as the percentage of records in which these activities occurred for each focal day and report the estimates for caregivers. I further calculated mean percentages by month of infant age to assess the relative timing of infant conflict, for each group and age/sex class, and infant avoidance by males. Percentages of conflict and avoidance were markedly higher in the larger group living in a smaller habitat than in the other group. This pattern occurred across all age/sex classes. In both groups, the greatest amount of infant conflict occurred with siblings. I discuss the substantial variation in conflict and avoidance in relation to the various socioecological conditions that may have played a role. This study provides an in-depth description and exploration of parent–offspring and sibling conflict, which has not been examined previously in this species.
Journal Article
101 careers in counseling
This comprehensive and easy-to-use guide is an invaluable resource to help you choose a rewarding counseling career that best suits your interests, strengths, and personality. Exploring a wealth of career opportunities in both traditional and non-traditional settings, including the most exciting emerging fields, this useful reference describes the many benefits found in the work of a professional counselor. Each career listing includes an overview, salary range, employment prospects, best and most challenging aspects of the job, and educational and licensing requirements. In addition, the book helps guide you through financing your education and the job search process. As a special feature, chapters include profiles of actual counselors and their work, providing an insightful insider's perspective on their profession.
eBook
The counseling practicum and internship manual : a resource for graduate counseling students
\"The intention of this book is to offer a counselor's practicum and internship manual targeted at and to be used specifically in graduate counselor education programs. Written by a professional counselor and counselor educator who has supervised numerous professional counselors in the field as well as graduate counseling students, it strives to make a distinction between the counseling profession and the related fields of psychology and social work. Of the three professions, counseling is the only one that trains students primarily in the practice of counseling. Although psychology and social work programs certainly do an excellent job in educating and training future psychologists and social workers, counseling is an ancillary, as opposed to a primary, function for professionals in those fields. This text is written for students in graduate counseling programs\"-- Provided by publisher.
Book
Factors associated with complete outward migration of postoperative epidural analgesia catheters placed for oncologic surgery: A 10-year single-center retrospective study
After study (PA12-1095) approval by our institutional review board, we reviewed incidences of complete outward migration to determine factors associated with postoperative epidural catheter migration at a cancer treatment center from 2005 to 2014. In summary, complete outward epidural migration was associated with, in descending order of magnitude: catheter fixation method, thoracic versus lumbar catheter insertion level, larger insertion needle size, shorter catheter depth, male gender, shorter durations, lower BMI, and increased age, but not with volume of infusion. Factor Overall epidural catheter cases Cases without catheter migration Cases with catheter migration Migration rate, % Univariate analysis (migrated vs not migrated) Multivariate analysis (migrated vs not migrated) P value Odds ratio 95% Confidence interval P value Odds ratio 95% Confidence interval Age, mean (range), y 56.5 (1–94) 56.5 (1–94) 57.9 (5–89) 0.0040 1.007 1.002–1.011 0.0004 1.009 1.004–1.014 Gender ratio, male: female 1.0: 1 1.0: 1 1.5: 1 <0.0001 1.328 1.159–1.521 0.0001 1.354 1.161–1.578 Body mass index, mean, kg/m2 28.1 28.2 27.3 <0.0001 1.024 1.012–1.035 <0.0001 1.030 1.016–1.044 Catheter insertion depth, mean (SD), cm 5.7 (1.7) 5.7 (1.7) 4.5 (2.3) <0.0001 1.458 1.402–1.517 <0.0001 1.454 1.397–1.512 Duration of catheter insertion, mean, d 4.6 (SD, 2.0; range 1–17) 4.6 (SD, 2.0; range 1–17) 4.4 (SD, 2.0; range 1–16) 0.0047 1.055 1.017–1.095 <0.0001 1.085 1.044–1.128 Volume, mean (range), mL/day 472.2 (21.7–5056.0) 472.2 (21.7–5056.0) 473.2 (56.8–4078.2) 0.9439 1.000 0.99997–1.00003 Thoracic catheters, no. 17,598 16,699 899 5.1 0.0049 1.573 1.144–2.163 Lumbar catheters, no. 1239 1198 41 3.3 17-gauge Tuohy needles, no. 11,743 11,082 661 5.6 <0.0001 1.457 1.263–1.681 18-gauge Tuohy needles, no. 7094 6815 279 3.9 Tegaderm (3 M, St. Paul, MN, USA, no. 18,482 17,549 933 5.0 0.0084 2.643 1.247–5.602 Duoderm (ConvaTec, Berkshire, UK), no. 355 348 7 2.0 Total catheters, no. 18,837 17,897 940 5.0 Table 1 Factors associated with complete outward migration of postoperative epidural analgesia catheters.
Journal Article
Postoperative pain scores and opioid use after standard bupivacaine vs. liposomal bupivacaine regional blocks for abdominal cancer surgery: A propensity score matched study
Fascial plane blocks (FPBs) are widely used for abdominal surgery with the assumption that liposomal bupivacaine (LB) is more effective than standard bupivacaine (SB).
This was a single-institution retrospective cohort study of patients administered FPBs with LB or SB + admixtures (dexamethasone/dexmedetomidine) for open abdominal cancer surgery. Propensity score matching generated a 2:1 (LB:SB) matched cohort. Opioid use (mg oral morphine equivalents, OME) and severe pain (≥3 pain scores ≥7 in a 24-h period) were compared.
Opioid use was >150 mg OME in 19.9 % (29/146) LB and 16.4 % (12/73) SB patients (p = 0.586). Severe pain was experienced by 44 % (64/146) LB and 53 % (39/73) SB patients (p = 0.198). On multivariable analysis, SB vs LB choice was not associated with high opioid volume >150 mg or severe pain.
FPBs with standard bupivacaine were not associated with higher 72-h opioid use or more severe pain compared to liposomal bupivacaine.
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•Fascial plane blocks were performed with liposomal or standard bupivacaine.•Propensity score matching based on surgical service and gender.•No difference in opioid use or severe pain between bupivacaine formulations.•This study suggests equipoise between liposomal and standard bupivacaine.
Journal Article
Impact of Intraoperative Dexamethasone on Surgical and Oncologic Outcomes for Patients with Resected Pancreatic Ductal Adenocarcinoma
BackgroundAdministration of dexamethasone to mitigate postoperative nausea and vomiting has been suggested to improve short- and long-term outcomes after pancreatic ductal adenocarcinoma (PDAC) resection. This study aimed primarily to evaluate these hypotheses in a contemporary patient cohort treated with multimodality therapy.MethodsThe clinicopathologic and perioperative characteristics of consecutive resected PDAC patients (July 2011 to October 2018) were analyzed from a prospectively maintained database. Intraoperative administration of dexamethasone (4–10 mg) was retrospectively abstracted from the electronic medical record.ResultsThe majority of 373 patients (59.8%) received intraoperative dexamethasone. Most of these patients underwent neoadjuvant therapy (75.3%), were potentially resectable at presentation (69.7%), and underwent pancreaticoduodenectomy (79.9%). Women were more likely to receive dexamethasone than men (69.9 vs 30.1%; p < 0.001). The cohorts were otherwise clinically similar. Intraoperative dexamethasone was not associated with differences in postoperative major complications (PMCs) (21.1 vs 19.3%; p = 0.68), postoperative pancreatic fistulas (6.3 vs 6.7%; p = 0.88), or composite infectious complications (28.7 vs 24.7%; p = 0.39). Dexamethasone was not associated with any improvement in median recurrence-free survival (RFS) (17 vs 17 months; p = 0.99) or overall survival (OS) (46 vs 43 months; p = 0.90). After adjustment for clinical factors including margin status, clinical classification, tumor size, and dexamethasone, the only factors independently associated with OS were pathologic node-positivity (hazard ratio [HR], 1.80, 95% confidence interval [CI], 1.32–2.47), perineural invasion (HR, 2.02; 95% CI, 1.23–3.31), multimodality therapy (HR, 0.30; 95% CI, 0.13–0.70), and PMCs (HR, 1.64; 95% CI, 1.17–2.29) (all p < 0.006).ConclusionsDexamethasone failed to demonstrate any protective advantage in terms of mitigating short-term PMCs or infectious complications, or to confer any long-term survival benefit. Tumor biology, multimodality therapy, and PMCs remain the main prognostic factors after PDAC resection.
Journal Article
Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients
Background
Despite advances in enhanced surgical recovery programs, strategies limiting postoperative inpatient opioid exposure have not been optimized for pancreatic surgery. The primary aims of this study were to analyze the magnitude and variations in post-pancreatectomy opioid administration and to characterize predictors of low and high inpatient use.
Methods
Clinical characteristics and inpatient oral morphine equivalents (OMEs) were downloaded from electronic records for consecutive pancreatectomy patients at a high-volume institution between March 2016 and August 2017. Regression analyses identified predictors of total OMEs as well as highest and lowest quartiles.
Results
Pancreatectomy was performed for 158 patients (73% pancreaticoduodenectomy). Transversus abdominus plane (TAP) block was performed for 80% (
n
= 127) of these patients, almost always paired with intravenous patient-controlled analgesia (IV-PCA), whereas 15% received epidural alone. All the patients received scheduled non-opioid analgesics (median, 2). The median total OME administered was 423 mg (range 0–4362 mg). Higher total OME was associated with preoperative opioid prescriptions (
p
< 0.001), longer hospital length of stay (LOS;
p
< 0.001), and no epidural (
p
= 0.006). The lowest and best quartile cutoff was 180 mg of OME or less, whereas the highest and worst quartile cutoff began at 892.5 mg. After adjustment for inpatient team, only epidural use [odds ratio (OR) 0.3;
p
= 0.04] predicted lowest-quartile OME. Preoperative opioid prescriptions (OR 8.1;
p
< 0.001), longer operative time (OR 3.4;
p
= 0.05), and longer LOS (OR 1.1;
p
= 0.007) predicted highest-quartile OME.
Conclusions
Preoperative opioid prescriptions and longer LOS were associated with increased inpatient OME, whereas epidural use reduced inpatient OME. Understanding the predictors of inpatient opioid use and the variables predicting the lowest and highest quartiles can inform decision-making regarding preoperative counseling, regional anesthetic block choice, and novel inpatient opioid weaning strategies to reduce initial postoperative opioid exposure.
Journal Article