The Benefits of Earning an MSN Degree

(Gloucestercitynews.net)(December 30, 2019)–The profession of nursing is one of the most popular healthcare professions in the United States. In fact, the

American Association of Colleges of Nursing

reports that there are 3.8 million licensed registered nurses (RNs) nationwide. Of that number, 84.5% are currently actively employed in nursing.

Even so, there is a widely accepted consensus that there exists a very real shortage of nurses in the workforce. This fact might lend itself to being an explanation as to why more and more students are applying to nursing school each year.

With figures and facts like that, those who wish to pursue a job in nursing might find themselves looking for ways to stand out from the crowd and make the most of their career. This is especially true for those who might not want to work as a general staff-nurse for the entirety of their career.

One of the best ways to broaden your possibilities when it comes to your career in nursing is to earn a Master of Science in Nursing, or MSN degree.

What is an MSN?

There are four types of degrees that fall into the category of Master of Science in Nursing. These are:

RN to MSN

BSN to MSN

ADN to MSN

ASN to MSN

As you can gather from the names, each type of program is designed to meet a nurse wherever they may be in regards to education level. The length and difficulty of each degree will be determined by the degree(s) already possessed by the student. Generally speaking, an MSN can take up to two years to earn.

While earning an MSN, nurses complete core nursing classes and clinical studies in addition to classes and study related to specific specializations. This is one of the main attractions of the MSN degree on the whole. The ability to specialize in a particular area of nursing isn’t really available to those who choose to stop their education at the bachelor level.

The goal of the degree is to prepare nurses for advanced practice roles within the various specializations in healthcare. Some of the more common specializations that you can select from include:

Gerontology

Midwifery

Nurse Anesthetist

Neonatal Nurse Practitioner

Family Nurse Practitioner

Orthopedics

Psychiatric Nurse Practitioner

Clinical Nurse Specialist

Nurses should consider an MSN as a stepping stone by which they can open up multiple different opportunities for their careers, especially if they want to go for further education.

Why Get an MSN?

Beyond the obvious benefits of being able to specialize in a particular area and advance a nursing career, there are many reasons why a nurse should consider going for an MSN. Not least of these reasons is the appeal of earning a higher salary.

For example, if you decide to work as a nurse anesthetist, you could find yourself earning

over $150,000 a year

. While that number refers to the highest earners with an MSN, on average a nurse will earn $12,000 more than those who only have a BSN.

Furthermore, anyone who desires to go on to earn any of the most advanced degrees offered in the nursing world should look into earning an MSN their first step. It is essential for a nurse to have an MSN if they hope to go on to earn a doctorate or a PhD in nursing. These degrees are more focused on the development and implementation of positive change in the nursing and healthcare communities on a grand scale.

Other career path options that become available to nurses with an MSN aren’t necessarily limited to direct-patient care. With an MSN degree, a nurse can choose to go into the administrative or clinical research sides of healthcare.

The benefits of earning an MSN degree aren’t limited to the individual nurse, either. Many experts credit the shortage of nurses in the workforce in part to a similar shortage of nurse educators. As leaders, nurses can act as educators and mentors, helping to advance the next generation of nurses as well.

Because of the skills gained through an MSN program, nurses become more equipped with the knowledge and abilities needed to act in more leadership-related roles. A community-wide effort by existing nurses to help further the careers of others can only help boost the healthcare industry on the whole and can contribute to the end of the nursing shortage.

How to Earn an MSN

The first step to take toward getting an MSN is to earn a Bachelor of Science in Nursing. This is your typical bachelor’s degree in nursing that can be earned by completing a four-year university course. More and more people looking to become nurses are opting to attend a four-year college for their initial nursing degree as opposed to going for a two-year degree, or an Associates Degree in Nursing (ADN).

If you are in the latter group and only have an ADN, you would need to find a bridge program, such as an RN-to-BSN program, so that you can complete your bachelor’s. After thism, you can then look into earning your MSN.

The good news is that once you have a BSN, there are several options that you can decide between for your MSN.

Online BSN to MSN programs

are great for nurses who are trying to maintain a full-time job while working toward their degree.

If the thought of online education doesn’t appeal to you, there are a vast amount of more traditional programs to choose from to earn an MSN.

Whatever your career aspirations are, a Masters of Science in Nursing can be extremely beneficial to reaching them. Not only that, but more nurses possessing such degrees can only lead to better and brighter things in the world of healthcare.

With so many accredited programs out there designed to meet nurses where they already are at in their education, anyone who wants to earn an MSN is sure to find the right degree that will help them make the most of their career in nursing.

CHOP RESEARCHING HAND/ARM DISORDERS & TREATMENTS

PHILADELPHIA PA–Orthopedic clinicians at Children\’s Hospital of Philadelphia (CHOP) are actively researching a range of hand and arm disorders and treatments. Orthopedic doctors regularly collaborate with The Center for Applied Genomics at CHOP, one of the world\’s largest genetics research programs and the only center at a pediatric hospital to have large-scale access to state-of-the-art throughput genotyping technology.

Current hand and arm research includes:

Long-term follow-up of gunshot wounds to the hand or upper extremity in children

Pink pulseless hand (prospective study)

Diagnostic utility of MRI scans in pediatric wrist injury

Outcomes of reconstruction of congenital hand anomalies such as syndactyly

Unstable supracondylar humerus fractures: experience with the “suprone” technique

Validation and integrated use of a simulated pediatric distal radius fracture reduction model

Functional outcomes of displaced distal radius fractures in children

Shoulder instability in adolescents

With research, orthopedic leaders at CHOP hope to be able to improve surgical techniques, range of motion and quality of life for children with hand and arm disorders.

For an appointment/referrals with the Hands and Arms Disorder department call

215-590-1527

USDA Approves Plans for Domestic Production of Hemp by Louisiana, NJ, and Ohio and Three Indian Tribes

(December 28, 2019)–The U.S. Department of Agriculture (USDA) has approved the first set of plans submitted by states and Indian tribes for the domestic production of hemp under the U.S. Domestic Hemp Production Program. The plans were submitted by the states of Louisiana, New Jersey, and Ohio, and the Flandreau Santee Sioux, Santa Rosa Cahuilla, and La Jolla Band of Luiseno Indian Tribes.

image courtesy of

https://www.agriculture.com/

The Agriculture Improvement Act of 2018 (2018 Farm Bill) directed USDA to develop a regulatory oversight program for hemp and include provisions for USDA to approve hemp production plans submitted by states and Indian tribes. Accordingly, on October 31, 2019, USDA issued an

interim final rule

establishing the U.S. Domestic Hemp Production Program and the provisions for USDA to approve submitted plans. State and tribal plans provide details on practices and procedures that enable hemp producers in their jurisdictions to operate according to their individual plans and in compliance with federal laws.

To produce hemp, growers must be licensed or authorized under a state, tribe, or USDA production program. The program a grower is licensed under depends on the location of the hemp growing facility. If a state or tribe has an approved plan or is in the process of developing a plan, growers must apply and be licensed or authorized under its hemp program. If a state or tribe does not have a plan and does not intend to have a plan, growers can apply for a license from USDA.

USDA continues to receive and review plans from states and Indian tribes and maintains a list of all on our website, along with approved plans. To check the status of a plan or to review approved plans, visit:

Status of State and Tribal Hemp Production Plans

For additional information about the program and the provisions of the interim final rule, visit the

U.S. Domestic Hemp Production Program

web page.

For information or questions related to a specific plan, please contact the applicable state or tribe.

DOWN THE SHORE: Shore Medical Center Joins the Penn Cancer Network

From left, Lori Gustave, of the University of Pennsylvania Health System, Dr. James M. Pond, medical director of the Cancer Program and Cancer Committee chairman at Shore Cancer Center, Joy Sutter, of Penn Medicine, and Joseph Johnston, of Shore Cancer Center, celebrate the new agreement. (Photo courtesy Shore Medical Center)

SOMERS POINT NJ–Shore Medical Center in Somers Point and Penn Medicine announced Tuesday that the Shore Cancer Center is now a member of the Penn Cancer Network.

The agreement brings expanded access to the highest quality cancer care for patients across southeast New Jersey, according to a press release.

The Penn Cancer Network is a select group of community hospitals throughout Pennsylvania, New Jersey and Delaware collaborating with Penn Medicine’s Abramson Cancer Center to provide excellence in cancer care throughout the region.

Penn’s Cancer Network hospitals are recognized for their excellence in patient care and a commitment to improving the health and well-being of their community.

“This is an historic announcement for Shore and our community. On behalf of our Board of Trustees, physicians, clinical and support staff, I want to let those patients who are battling cancer in our community know that we are doing everything we can to help you,” Ron Johnson, president and CEO of Shore Medical Center, said in the release. “We joined the Penn Center Network so our patients continue to receive the best possible care close to home, right here in Somers Point.”

David Hughes, Shore’s chief development officer and chief financial officer, said, “My family has a long history with the Shore Cancer Center. My father in-law Dr. George Mckeon, was an ED doctor at Shore Medical Center and World War II veteran who was wounded storming the beaches of Normandy. He settled in Somers Point with his wife who he met while attending medical school in Ireland.”

Hughes continued, “The Cancer Center now sits on the site of our family’s former home site and medical practice. I believe in the team at Shore Cancer Center, and we are so proud to have such great partners in Penn Medicine. The partnership with Penn Medicine will help us further our reach into the community, and garner additional support that will have a direct impact on cancer patient care.”

Joseph Johnston, director of Oncology Services at Shore Cancer Center, said the Penn Cancer Network offers a host of benefits that amount to a tremendous clinical advantage.

“Our partnership with Penn includes clinical research, community and patient education, disease-specific program development, patient access, professional education for nurses and physicians, and quality and safety,” Johnston said.

Robert Vonderheide, director of the Abramson Cancer Center of the University of Pennsylvania, said, “Providing the highest quality cancer care and expanding access for patients across the region – and beyond – is a chief priority of the Penn Cancer Network.”

How to Use CBD oil for Better Sleep

Gloucestercitynews.net

(December 28, 2019)–It might come as a surprise but according to certain reports, more than 70 million Americans suffer from chronic sleep disorders. To put it the other way, a good lot of people are exhausted from personal and professional pressures of life, which often results in insomnia and other mental as well as emotional disorders.

There are many medical treatments available for getting you better sleep but most people do not recommend taking any sleep disorder medicines due to their addictive effects. This would be the moment where

top rated UK CBD oil brands

must enter your life.

Yes, currently, it’s the most natural treatment for insomnia and quite affordable as well.

If you or someone you know is suffering from sleeping problems, then CBD oil is just the thing for you! Of course, you would want to learn more about the use of

CBD oil for better sleep

and here it is!

First things first, let’s learn a bit about CBD oil

CBD oil is made from one of the 80 cannabinoids extracted from the cannabis plant. However, it is not the same as other compounds derived from the same plant. Unlike other compounds of this plant, CBD doesn’t contain tetrahydrocannabinol (THC), which is primarily responsible for creating the ‘high’ in the brain. Yes, people get stoned due to its presence in marijuana and hashish. Since CBD doesn’t contain it, it is known to be a non-intoxicating or non-psychoactive substance.

In the United States, CBD or hemp oil has been excluded from the list of ‘controlled substance.’ This means that it’s legal to use CBD products as long as they are legal in your state. As per the 2018 Farm Bill, it has been made legal in all 50 states across America. So, unless your local laws disapprove of it, consuming CBD is absolutely all right!

So, what is CBD oil used for?

CBD oil has been in use since centuries dating back to 1200 A.D, where it was first mentioned that it can successfully treat people suffering from sleep disorders. Today, CBD oil used for the treatment of issues like anxiety, depression, chronic pain, epilepsy, inflammation, constipation, and in some cases, cancer.

There have been cases across the US where people successfully healed themselves with a daily dosage of CBD oil. So, anyone who is suffering from sleeping disorders must give it a try.

Can CBD oil impact the quality of your sleep?

Studies have shown that CBD, in fact, does help in improving the quality of your sleep. It can readily shift your body from REM to NREM sleep (as mentioned by the World Health Organization). As per experts, CBD oil can contribute in preventing the breakdown of a chemical neurotransmitter in the brain which affects the mental and emotional state of the body. It allows the sleep-promoting chemical to flow freely through your body and

makes you sleepy

without getting you high.

There is still a lack of conclusive research on the matter but there are some studies support the issue. In a

2019 study

, it was concluded that patient suffering from anxiety as well as sleep disorders showed improvement after a month of 25 milligrams (mg) of the CBD.

According to another

study

, it was revealed that CBD was capable of successfully treating RBD. CBD is also known to heal day-time excessive sleeping and grogginess.

How does CBD oil help in improving your sleep?

There are many direct and indirect ways that contribute in helping you sleep better after you consume CBD oil in your system. Here’s how it happens.

CBD helps in reduction of anxiety

: This means that CBD helps in regulation of cortisol, the stress hormone. It balances the serotonin level as well. When a person feels less-stressed, he or she sleeps better. According to a number of

studies

, CBD can successfully treat anxiety-related disorders and thus, improves the quality of sleep.

2. Relaxed muscles: As per certain

studies

, CBD treats movement disorders as well. It reduces muscle tremors which are often the result of anxiety disorder and keeps the person awake during the night. It helps in the treatment of insomnia as well.

3.Decreases restlessness: People who suffer from sleeping disorders have a habit of being restless all through the night and sometimes during the day as well. Those who suffer from REM sleep disorder which gives rise to nightmares and restlessness have shown positive signs of improvement in their sleeping patterns.

4.Relief from PTSD and trauma: Sleep disturbances and REM cycles often affect the mental health of patients. Sleeping problems might also be the result of post-traumatic stress disorder, also known as PTSD and trauma. A daily dosage of CBD oil reduces anxiety and depression related to PTSD and thus improves the quality of sleep.

5.Chronic pain: Those who suffer from chronic pain in joints or muscles always have a hard time sleeping. Since CBD oil has successfully proven to heal body pains. When pain is reduced from the body, it indirectly helps people sleep better during the night.

How to use CBD oil for sleep

Everyone has a different body type. Thus, there are a variety of CBD products, such as gummies, creams, sprays, vapes, and capsules that help one person in a far better way than the other. However, CBD oil has proven to have a great effect on most people dealing with sleeping disorders. A spoonful of CBD oil put under your tongue slowly releases its effect on your body slowly, thus, helping you sleep for a longer time than usual. The best time to consume CBD oil is an hour or so before bed time.

How much CBD should one use for the treatment of sleeping disorder

Since CBD is not regulated by the Food and Drug Administration (FDA) right now, this means that there is no guideline for a definite dosage of CBD oil. On the basis of studies, a higher dosage of CBD oil has proven far more healing than smaller ones. An optimal dosage of CBD oil anyway depends on height, gender, weight, and other deciding factors.

It is important to consult your doctor or a medical professional about the dosage of the oil. It is recommended to have a talk with your regular doctor, if possible since he or she knows all about your medical history and can decide the most suitable dosage for you.

Closing thoughts about cbd & sleep

When compared to other sleeping aids, CBD products are considered to be safer and more effective than the traditional medicines. It is natural and quite an affordable way to say goodbye to your sleeping disorders however slowly. However, there is still a lot of research needed to completely accept the therapeutic effects of CBD oil.

Nonetheless, people who are suffering from disturbing sleeping patterns can surely rely on this safe, effective, and non-addictive form of medication.

images courtesy of unsplash.com and pinterest.com

University of Washington: SAD lights push back depression during dark days

SAD is a subset of depression that can be marked by feeling blue and tired, craving carbs, and having less interest in socializing.

Getty Images

About ten percent of those who live in the Northwest suffer from SAD, according to UW Medicine experts.

For Robert, * it was getting just too hard to get out of bed in the morning during the winter months.

Finally, his partner, who lives near Skagway, Alaska, suggested using a seasonal affective disorder light, otherwise known as a SAD light, to deal with his sleepiness and mild depression.

“This worked far better than expected. I would even call it life changing,” said Robert, a Seattle resident and software engineer, who, like others living in the Northwest, endures many dark months in a place where sunlight barely limps pass the eight-hour mark in December.

Most of us struggle to get out of bed, but for Robert, the task was particularly hard, especially when the sun wasn’t rising until well after he was on his way to work.

“I had extreme trouble waking up in the morning,” he said. “Drinking coffee would boost my energy for an hour or so, but I could not sustain my energy throughout the workday.”

Then, on the recommendation of his doctor and his roommate, he bought a SAD light. The struggle to get out of bed and the need for coffee stopped.

While Robert’s experience might be dramatic, it is not surprising, said

Dr. Nina Maisterra

, of the UW Medicine Belltown Clinic, who has recommended SAD lights to her patients who struggle with depression or lack of energy during the winter.

About ten percent of people living in the Northwest suffer from SAD, according to UW Medicine’s

Dr. David Avery

, a professor emeritus at the University of Washington School of Medicine. Avery has studied diminished daylight and its effect on people for the last three decades. For his patients, Avery suggests working at controlling their wake and sleep times, and keeping active socially but avoiding what resembles “jet lag” during the weekends, such as staying up late and sleeping in.

SAD is generally classified as a subset of depression, It can be marked by feeling blue and tired, craving carbohydrates and feeling less interest in socializing. Research has linked SAD to changes in circadian rhythms and serotonin levels, Maisterra said.

Treatments may include cognitive behavioral therapy that’s focused specifically on SAD; medications known as serotonin-reuptake inhibitors, which work by increasing the levels of a nerve-cell signal in the brain; and light boxes. These are used either as dawn simulators or as a daily exposure that mimics being outdoors in the sun.

“It’s effective for some people. It’s just like many treatments, sometimes you have to use a combination of therapies,” Maisterra said.

Robert started using his SAD light in August. He sets the timer to go on 30 minutes before he actually wishes to rise in the morning. He reads in bed, the timer goes off, the light turns off, and it’s time to get up.

His co-workers are beginning to ask about using the light, now that winter is coming in.

“I tell them to test it out,” he said. “It’s easy to buy online and doesn’t really require any lifestyle changes to use.”

*Robert asked that only his first name be used for this article.

Combating the effects of gloomy weather

How to Choose High Quality CBD Oil

Gloucestercitynews.net (December 28, 2019)–CBD industry is expected to grow by $ 1 billion in 2020. It is one of the top players in the health and wellness industry as well. This is no wonder because people across America have realized the therapeutic effects of CBD products.

Even though the research on the health benefits of CBD is fancy, there are numerous cases of common people who have successfully improved their lives with daily dosage of CBD oil. Intrigued to try CBD oil to heal your mind and body? Well, go ahead but keep in mind to choose the

best quality of CBD oil

for consumption.

Now, the question is how to choose high-quality CBD oil? There are a few things you can do to be assured that the CBD oil or any other product for that matter, is of great quality and worth trying.

Before anything else, you should know these things about CBD

CBD or Cannabidiol is derived from the cannabis plant, yes, the parent plant of marijuana. Before you question the legality of it, you should know that CBD, unlike its siblings, is non-psychoactive in nature. This means that it doesn’t comprise or encircles only traces of THC, which is basically the high-inducing compound.

You should know that CBD is also excluded from the list of ‘controlled substances’ in America. Under the 2018 Farm Bill (passed in December last year), CBD is now legal across all 50 states. However, you must learn about local laws of your state as well.

Why is CBD oil a hit among people?

CBD oil is an amazing supplement and considered to be a great alternative form of medication for people suffering from illnesses, such as anxiety, depression, skin problems, indigestion, even cancer.

Here’s a list of diseases that CBD oil is known to treat naturally-

Stress

Depression

Anxiety

Sleep disorders

Epilepsy

Bipolar disorder

Cancer (in some cases)

Inflammation

Skin problems

Indigestion

Hair fall

Migraines

Heart disease

Blood pressure

Parkinson’s disease

Restlessness

Fatigue

Irritability

There are no conclusive studies on humans about the positive benefits on CBD oil on people’s health. However, there are countless anecdotes across the country about people who have healed and still are healing with the help of CBD oil and other products.

Now that you’ve gathered all the necessary information about CBD oil, it’s time to learn about the product that suits you.

Things to keep in mind before buying CBD oil

There are plenty of CBD oil available in the market at affordable prices. However, everybody responds differently to different products. Thus, it is important to do thorough research on the products before you pick the

best CBD oil

for you.

So, are there any signs of quality CBD oil that you can use to determine whether it’s reliable or not? Whether you are a rookie or an expert in buying CBD oil, here are the following points that you must keep in mind to get the best quality of CBD oil-

1. Do your research: The first thing to do before buying a CBD oil is to do a thorough research. Do not incline toward the companies that sell CBD oil at a low price. Understand all the terms related with CBD oil, such as full-spectrum, pure oil, interaction with Endocannabinoid system, THC, etc. Once you learn about the necessary information on the same, go ahead and buy the product.

2. Packaging: Once you are through with the research part, head over to the label of the CBD product you are thinking to buy. Learn the terminology of what is written on the label both at the time of order and delivery. Also, make sure that the material is made of dark ember glass which is impenetrable. A good packaging helps the product to last for long and guarantees a good quality.

3. THC content: According to Federal Law in the United States, the concentration of THC in CBD products shouldn’t go beyond 0.3%. If it is over the limit, then it is absolutely illegal to sell or purchase the same. It is imperative to check the THC content of the CBD oil before buying it, or it might cause more harm than benefit.

4. Make sure that it is third-party lab tested: You might have heard about the phrase ‘third-party lab tested’ but what does it really mean? Well, for starters, it is crucial to know this before buying CBD oil. The quality and dosage of CBD oil is yet not regulated by FDA and the government. The product is tested for purity and quality in private labs. The report worked out by these labs includes content like date of publication, synchronicity with the product label, certificate of analysis, and accreditation. So, make sure that product is tested by a reputable lab party, such as, Think20 Labs.

5. Be assured that CBD oil is additive-free: When it comes to buying CBD oil, fewer additives, the better it is. CBD oil shouldn’t comprise of anything apart from its main ingredients, such as essential oils and cannabinoids. The more natural it is, the more effective it will be for your problem.

6. The knowledge of hemp-growing standards: If you do not find any indication of growing standards in the product, don’t trust its quality. If you are not able to verify the hemp-growing standards, in most cases, it means that the hemp has come into contact with toxic chemicals, such as pesticides and fertilizers. This will directly affect the quality of the CBD oil.

7. Place of manufacture: Make sure that the product is grown and manufactured in a place where selling and buying of CBD is legal. It is also important to understand that the company you are buying the product from sources its material from the states where the Farm Bill 2018 is applied and accepted. Also, make sure that the company you are buying CBD oil from is quite transparent in terms of money-back guarantee and return policy.

8. Learn how CBD oil is extracted: If you think that learning about the extraction process of the CBD oil isn’t important to know about the quality of the product, listen to this. There are various methods of extracting CBD oil that determine the quality of the end product. The best way to extract CBD is via CO2 at a given temperature and pressure. CO2 is a natural solvent, thus, the end product is generally of high quality and pure in nature. In fact, extraction process also helps in changing the genetic structure of the entire product.

Closing thoughts

At the end of the day, it is important to know why you want to buy CBD oil in the first place. So, the type and quality of the CBD oil also depend on the problem you want to buy it for. For instance, for skin problems, like acne, it is recommended to buy topical ointments of the extremely high quality. In order to treat body pains, it is recommended to

buy full-spectrum CBD oil

. Nevertheless, the quality, potency, and transparency are the top things one must keep in mind before buying CBD oil.

images courtesy of unsplash.com and pinterest.com

\’Nipple By Number\’ Device Helps Plastic Surgeons Perform 3D Nipple Tattoos

Newswise —

December 26, 2019 –

Three-dimensional tattoos offer a new alternative for creating a natural-looking nipple after breast reconstruction.

For most women, accessing this option means finding a tattoo artist with the skill to create these detailed tattoos. Now a new device called Nipple By Number® enables plastic surgeons to perform realistic-looking 3D

nipple tattoos as an in-office procedure, reports a paper in the January issue of

Plastic and Reconstructive Surgery®

the official medical journal of the

American Society of Plastic Surgeons

(ASPS).

\”Nipple by Number® is a simple stencil device that allows consistent, realistic 3D tattooing of the nipple-areola complex [NAC] to complete breast reconstruction,\” comments lead author Solomon Azouz, MD, of Mayo Clinic Arizona, Scottsdale. \”It allows plastic surgeons to perform this sought-after procedure in a safe, reliable, and more- affordable manner, without the need for special training or experience.\”

For most patients, mastectomy results in loss of the NAC – the nipple and surrounding tissue.

Breast reconstruction

has important benefits after mastectomy, but the surgical options for NAC reconstruction are limited.

In recent years, 3D breast tattoos have emerged as a new approach to creating a natural-appearing nipple and areola. Developed by skilled tattoo artists, these techniques use subtle effects of light and shadow to create realistic-looking 3D NAC tattoos.

But 3D nipple tattoos may be difficult to access for most patients. Relatively few artists can perform these sophisticated tattoos. Patients and surgeons may have concerns about verifying the artist\’s skill, or about visiting a tattoo parlor to have the procedure performed. In a survey, Dr. Azouz and colleagues found that less than one-fourth of plastic surgery offices can perform 3D nipple tattoos, or even refer patients to a qualified tattoo artist. National average out-of-pocket costs range from $640 for unilateral to $956 for bilateral breast tattoos.

The Nipple By Number device was developed to provide plastic surgeons with a way of performing 3D nipple tattoos as an office procedure. Itself created by 3D printing, the simple device consists of removeable stencil layers with customizable holes to provide a guide for well-controlled and precise tattooing.

\”The device allows a more facile and efficient approach by allowing those not skilled in the freehand artistic techniques of light and shadow to create a 3D recreation of the NAC,\” Dr. Azouz and coauthors write. The stencil includes openings to guide placement of highlights and shadows to create the illusion of a projecting nipple, and even the tiny Montgomery glands surrounding the nipple. In patients whose reconstruction includes a raised nipple, the device can also be used to create \”4D\” tattoos.

Women have the natural appearance of their nipple restored based on preoperative photographs, or choose from a catalog of NAC designs. The authors note that the Nipple By Number device not only provides a guide for performing tattoos, but may also shorten the learning curve for surgeons or other professionals to gain the technical and artistic skills needed to provide high-quality results with 3D nipple tattooing.

Dr. Azouz and colleagues hope their tool will help make the option of 3D nipple tattooing more widely available to women who have undergone breast reconstruction. The authors conclude: \”The Nipple By Number device will decrease the number of patients who are left to independently find a safe and skilled tattoo artist to complete their breast reconstruction and aid more plastic and reconstructive surgery practices in providing this important service.\”

Click here to read \”A Nipple-Areola Stencil for Three-Dimensional Tattooing: Nipple by Number\”

DOI: 10.1097/PRS.0000000000006398

# # #

Plastic and Reconstructive Surgery®

is published in the Lippincott portfolio by

Wolters Kluwer

About

Plastic and Reconstructive Surgery

For more than 70 years,

Plastic and Reconstructive Surgery®

(

http://www.prsjournal.com/

) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons,

Plastic and Reconstructive Surgery®

brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The

American Society of Plastic Surgeons

is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2018 annual revenues of €4.3 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit

http://healthclarity.wolterskluwer.com

and follow us on

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@WKHealth

Former Nurse with Secret Video Recordings of Hundreds of UPMC Carlisle Patients

Press Release

HARRISBURG – Attorney General Josh Shapiro today announced

criminal charges

against a Franklin County man who surreptitiously videotaped 206 patients at UPMC Carlisle, including nearly two dozen minors. The charges against Michael Bragg (photo) follow his arrest in April by the Office of Attorney General for producing and possessing child pornography and

aggravated indecent assault against two children.

Of the victims, Shapiro said Bragg, 39 — in addition to videotaping hundreds of patients without consent — sexually assaulted a nude, intubated and unconscious woman in the hospital’s emergency room, and touched the breasts of another emergency room patient.

“People who were rushed to the emergency room or needed serious medical attention were violated by this man,” AG Shapiro said. “This sick sexual predator took advantage of patients when they were at their most vulnerable, in need of care. Thanks to the full cooperation of UPMC Carlisle, we identified all victims throughout this investigation.”

In April, Bragg was initially arrested by the Office of Attorney General following a search of his Buttercup Drive, Chambersburg, home where agents found secretly recorded videos of children using the bathroom there, plus other videos of child pornography. Bragg was also charged with aggravated indecent assault and indecent assault for the alleged sexual abuse of two minors.

As the investigation continued, Shapiro said agents also investigated the circumstances of videos of hospital patients in various stages of undress that were discovered on Bragg’s laptop computer, which led to today’s arrest.

“This was a complex, technical investigation which led to these charges being filed. But in the end, it was a simple case of standing up for victims, “AG Shapiro said.

The new charges against Bragg include:

1 count – aggravated indecent assault related to the vaginal penetration of a hospital patient,

1 count – indecent assault related to the fondling of a patient’s breast without consent,

19 counts – sexual abuse of children, manufacturing of child pornography

171 counts – invasion of privacy

201 counts – interception, disclosure or use of wire, electronic or oral communication, and

1 count – criminal use of a communication facility.

Bragg will be arraigned tomorrow before Magisterial District Judge Susan Day in Mount Holly Springs. Senior Deputy Attorney General Christopher Jones, Deputy Attorney General David Drumheller, and Special Agent Brittany Lauck are prosecuting this case. Homeland Security Investigations assisted in the investigation. All charges discussed are accusations. The defendant is presumed innocent unless and until proven guilty.

If you were a patient at UPMC Carlisle’s emergency room between January 2016 and April 19, 2019 — and believe you were treated by Michael Bragg — please call the Child Predator Hotline at 800-385-1044.

Exposure to Ozone Pollution or Wood Smoke Worsens Lung Health of Smokers/Former Smokers

Newswise — Over many years, exposure to the levels of ozone and other forms of pollution found in most U.S. cities and some rural communities can take a toll on a person’s health. Two studies led by Johns Hopkins researchers describe the impact of pollution on lung disease, particularly chronic obstructive pulmonary disease (COPD), in the U.S.

In one study, published Dec. 9 in

JAMA Internal Medicine

, Johns Hopkins researchers found that, among other effects, long-term ozone exposure increases the risk of lung disease — and the severity of that disease — among both former and current smokers. In another study, published Oct. 23 in

American Journal of Respiratory and Critical Care Medicine

, Johns Hopkins researchers also found that increased neighborhood use of wood as a primary heating source — which releases fine particles into the air — is associated with higher prevalence of lung disease among never-smokers in the community.

“Even if you spend very little time outside, the cumulative effect of pollution over many years seems adequate to have a negative impact on respiratory health,” says

Nadia Hansel, M.D., M.P.H.,

director of the pulmonary and critical care division, professor of medicine and associate dean for research at the Johns Hopkins University School of Medicine and author of both studies.

Ground-level, or tropospheric, ozone is formed when industrial pollutants interact with sunlight, and it is the main ingredient in the smog found around major cities. Ozone is known to irritate the lungs by increasing inflammation, and spikes of very high ozone levels — such as those that occur on hot, sunny days with heavy traffic — can exacerbate lung diseases such as asthma.

Former and current smokers are at high risk of chronic lung diseases and are particularly susceptible to environmental triggers for lung disease flare-ups. Smokers are particularly prone to COPD, a group of diseases including emphysema and chronic bronchitis, characterized by chronic and progressive lung inflammation that leads to shortness of breath and coughing.

In the new

JAMA Internal Medicine

study, Hansel and her collaborators around the country used data collected from people in several U.S. cities as part of the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) air pollution study. Participants in SPIROMICS were former and current smokers ages 40–80. The new analysis included a subset of SPIROMICS participants for whom there was available data on the previous 10 years of ozone exposure — based on where people lived. These 1,874 participants were 54% male, 79% white, 37% current smokers and had smoked an average of 50 pack-years — the equivalent of 25 cigarettes a day for two years, or five cigarettes a day for 10 years.

After adjusting for demographic and socioeconomic factors as well as smoking status and pack-years, the researchers found that people who had been exposed to higher levels of ozone over the previous 10 years were more likely to have COPD. For every 5-parts-per-billion increase in a person’s 10-year ozone exposure, they were 16% more likely to have COPD and 37% more likely to have had a severe exacerbation of the disease in the year prior to study enrollment. The same 5-parts-per-billion increase in ozone exposure was also associated with an increase in the percentage of people with emphysema and a worsening score of the St. George’s Respiratory Questionnaire, which reflects health impairment affecting quality of life.

“What really stood out was that the effect was apparent even among current heavy smokers,” says Hansel. “This means that active smoking doesn’t outweigh this effect of ozone.”

In other words, even people already at the highest risk of COPD had an increased risk with ozone exposure. Moreover, Hansel says, the effect of increasing ozone was apparent even when ozone exposure was at the low end of the spectrum, such as among people living in northeastern cities where dark winters lead to an annual ozone exposure that’s relatively low compared with that of many southwestern locales.

“I think this adds to increasing evidence that there is probably no healthy level of ozone,” she says. “There are policies that suggest we just need to reach certain targets and everything will be OK, but in my mind that is probably not enough.” Policymakers must develop ways to get ozone as low as possible, she adds, rather than aiming for a particular target number.

The Centers for Disease Control and Prevention reports that COPD costs the U.S. health care system more than $32 billion, and that there are approximately 7 million COPD-related emergency room visits in the U.S. each year. Hansel and her colleagues calculated that a 5-parts-per-billion decrease in 10-year ozone levels could reduce emergency room visits by 27%, saving a substantial amount of money on COPD care.

While the

JAMA Internal Medicine

study only measured lung health, previous research has suggested that high levels of ozone can affect cardiovascular health. So Hansel hypothesizes that long-term exposure to ambient levels of ozone may have similar effects on heart disease as it does to lung disease.

“The adverse health effects of ozone likely go beyond what we’ve identified here,” says Hansel. “And we need to keep building evidence of these effects so that it’s not debatable anymore that we need to do more to clean the air.”

In the second paper, researchers including Hansel, associate professor of medicine Meredith McCormack, M.D., M.H.S., and pulmonary and critical care medicine fellow Sarath Raju, M.D., studied data on 8,500 adults enrolled in the National Health and Nutrition Examination Surveys (NHANES), 2007–2012. Of the participants, 19.5% resided in rural areas and 29.6% in urban areas. Rural areas, with a 12.0% prevalence of COPD, had more than double the disease burden seen in urban communities, with a 5.9% prevalence.

By analyzing differences between urban and rural communities that might affect COPD risk, the team discovered that communities with a high rate of solid fuel use — either coal or wood for primary heating — were associated with COPD prevalence. A 1% increase in the number of homes using wood as the primary heating source was linked to 12% higher odds of COPD among people who have never smoked. In rural areas, 4.1% of people used wood as their primary heating source, as opposed to 0.6% in urban areas.

“Wood smoke is a household source of pollution that is associated with high levels of particulate matter and toxic gases,” says Raju, first author of the

American Journal of Respiratory and Critical Care Medicine

paper. “We hope that this paper raises awareness of the growing epidemic of rural COPD.”

The researchers are now launching further studies that aim to collect individual level — rather than community level — data on environmental exposures that might contribute to COPD. They’re also partnering with other institutions to study COPD rates and risks in rural Appalachia.

Other authors on the

JAMA Internal Medicine

paper were Han Woo, Roger Peng, Ashraf Fawzy, Nirupama Putcha and Patrick Breysse of Johns Hopkins; Laura Paulin of Dartmouth-Hitchcock Medical Center; Amanda Gassett, Kipruto Kirwa and Joel Kaufman of University of Washington; Neil Alexis of University of North Carolina at Chapel Hill; Richard Kanner, Robert Paine III and Cheryl Pirozzi of University of Utah; Stephen Peters of Wake Forest University; Jerry Krishnan of University of Illinois at Chicago; Mark Dransfield of University of Alabama, Birmingham; Prescott Woodruff of University of California, San Francisco; Christopher Cooper of University of California, Los Angeles; Graham Barr of Columbia University Medical Center; Alejandro Comellas and Eric Hoffman of University of Iowa; MeiLan Han of University of Michigan, Ann Arbor; and Fernando Martinez of Weill Cornell Medicine.

The work described in the

JAMA Internal Medicine paper

, part of the broader SPIROMICS study, was supported by the National Institutes of Health (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C, U01 HL137880, R01ES023500, K23ES025781), AstraZeneca/MedImmune, Bayer, Bellerophon Therapeutics, Boehringer Ingelheim Pharmaceuticals Inc., Chiesi Farmaceutici S.P.A., Forest Research Institute Inc., GlaxoSmithKline, Grifols Therapeutics Inc., Inkaria Inc., Novartis Pharmaceuticals Corporation, Nycomed GmbH, ProterixBio, Regeneron Pharmaceuticals Inc., Sanofi, Sunovion, Takeda Pharmaceutical Company, Theravance Biopharma, and Mylan.

Other authors of the

American Journal of Respiratory and Critical Care Medicine

paper are Emily Brigham, Nirupama Putcha and Aparna Balasubramanian of Johns Hopkins and Laura Paulin of Dartmouth-Hitchcock Medical Center. The

AJRCCM

paper was supported by the National Institutes of Health (P50MD010431, F32 ES029786-01, R21ES025840, T32 HL007534-36) and the Environmental Protection Agency (R836150).