Objectives Evaluate ovarian morphology using 3-dimensional MRI in adolescent girls with and without PCOS. Compare the utility of MRI versus ultrasonography (US) for diagnosis of PCOS Design Cross-sectional Setting Urban academic tertiary-care children’s hospital Patients Thirty-nine adolescent girls with untreated PCOS and 22 age/BMI-matched controls. Intervention MRI and/or transvaginal/transabdominal US Main Outcome Measure Ovarian volume (OV); follicle number per section (FNPS); correlation between OV on MRI and US; proportion of subjects with features of polycystic ovaries on MRI and US. Results MRI demonstrated larger OV and higher FNPS in subjects with PCOS compared to controls. Within the PCOS group, median OV was 11.9 (7.7) cm3 by MRI, compared with 8.8 (7.8) cm3 by US. Correlation coefficient between OV by MRI and US was 0.701. Due to poor resolution, FNPS could not be determined by US or compared with MRI. ROC curve analysis for MRI demonstrated that increasing volume cut-offs for polycystic ovaries from 10cm3 to 14cm3, increased specificity from 77% to 95%. For FNPS on MRI, specificity increased from 82% to 98% by increasing cut-offs from ≥12 to ≥17. Using Rotterdam cut-offs, 91% of subjects with PCOS met polycystic ovary criteria on MRI, while only 52% met criteria by US. Conclusions US measures smaller OV than MRI, cannot accurately detect follicle number, and is a poor imaging modality for characterizing polycystic ovaries in adolescents with suspected PCOS. For adolescents in whom diagnosis of PCOS remains uncertain after clinical and laboratory evaluation, MRI should be considered as a diagnostic imaging modality.

Maternal history of thyroid disease can cause congenital hypothyroidism due to thyroid-stimulatng hormone (TSH) blocking antibodies. No guidelines exist regarding testing beyond the newborn screen. TSH and T4 levels exhibit significant fluctuations after birth which complicates testing. A total of 561 newborns with thyroid function testing done for maternal history of thyroid disease in the newborn nursery were identified retrospectively via chart review, and thyroid disease status was assessed in 352. Newborn screening data were also obtained. Of these infants, 7 had hypothyroidism with 3 having negative newborn screens. No cases of neonatal graves were identified. The 3 infants with negative newborn screens had TSH levels ranging from 6.58 to 28.4 prior to treatment with levothyroxine. All required treatment beyond age 3 years, despite trial off levothyroxine. Infants with maternal history of thyroid disease may require additional testing beyond the newborn screen. However, providers can consider delaying test until after thyroid levels are more stable.

Background: Neonatal growth measurements (weight, length, head circumference) are used to assess fetal growth, determine neonatal and surveillance needs, and as a baseline for future growth monitoring. Measurements are often inaccurate and unreliable. To develop interventions for promoting evidencebased practice (EBP), we need to understand the knowledge, attitudes, practice behaviors, and bases of practice knowledge for neonatal growth measurement. A valid and reliable instrument did not exist. Aims: To develop and test the psychometric properties of the Neonatal Growth Measurement Survey (NGMS), we aimed to determine if it was a valid and reliable survey of neonatal growth measurement knowledge, attitudes, practice behaviors, and bases of practice knowledge. Methods: The survey included knowledge, attitude, practice behavior, and bases of practice knowledge questions constructed from best evidence and an EBP questionnaire. Content validity was assessed by seven clinical experts. A revised survey was pilot tested with a convenience sample of 20 neonatal nurses each from two mother-baby units and two NICUs. The same online survey was distributed twice 4 weeks apart to assess reliability. Data were analyzed for test-retest reliability and internal consistency. Results: The NGMS was validated to adequately represent the characteristics and constructs of neonatal growth measurement knowledge, attitudes, practice behaviors, and bases of practice knowledge. Sixty-two nurses completed the survey twice. Knowledge: Mean 83.9% agreement between responses from both survey administrations. Pearson correlation for total correct knowledge scores between time 1 and time 2 was .64. Cronbach's alpha was .37 for time 1 and .32 for time 2, indicating the scale did not measure a single construct. Attitudes: Mean Spearman's correlation between times was .51. Cronbach's alpha was .89 for time 1 and .88 for time 2. Practice behaviors: Agreement between time 1 and time 2 responses for head circumference (n=49): instruments 87.75%, techniques 91.94-100%; weight (n=62): instruments 91.94-100%, techniques 75.81-100%; length (n=49): instruments 87.75%, techniques 69.39-100%. Bases of practice knowledge: Mean Spearman's correlation between times was .44. Cronbach's alpha was .83 for time 1 and .84 for time 2. Conclusions: The NGMS was validated by content experts. Overall reliability was adequate, and suggested areas for further refinement. Clinical Implications: A refined NGMS will be used for a national study to understand current practices and barriers to EBP in order to develop nursing interventions to improve neonatal growth measurement accuracy and reliability.

Emergency medical identification (EMI) comes in many forms, including jewelry, wallet cards, shoelace tags, seatbelt covers, on smart phones and more recently, tattoos. While some forms of EMI are free of cost, others are expensive with annual membership fees to provide comprehensive medical information 24/7 to emergency personnel. EMI is vital for patients with chronic and/or hidden conditions like seizure disorders, cardiac disease, allergies, adrenal insufficiency (AI), and diabetes. Having EMI improves access to life saving medical care in life-threatening situations.The idea for a medic alert system and a medical identification bracelet dates back to the 1950s, when the daughter of Doctor Marion Collins had a life-threatening reaction to tetanus antitoxin. His daughter survived, but after the incident, Dr. Collins and his wife would pin a note to their daughters coat or wrap a paper bracelet around her wrist when she would travel away from them (MedicAlert Foundation, 2020). Dr. Collins and his daughter designed the first medic alert bracelet and soon after, the MedicAlert Foundation was created. It is now an international, non-profit organization dedicated to providing vital information to health responders during emergency situations and to providing EMI education and resources to first responders, health professionals and patients. Prior to this system being available, people with conditions like diabetes and epilepsy were put in jail as drunks and died due to lack of treatment (Hildreth, 1964).Although EMI has been available for over 50 years, patients and health professionals do not use it to its fullest potential. A survey of emergency room staff and ambulance personnel in the United Kingdom found that 99% of respondents had heard of medical identification worn on the body but only 71% of emergency room staff routinely searched for it. If medical identification was found, only 17% of the emergency room staff used the emergency helpline associated with the medical identification (Morton, Murad, Omar, & Taylor, 2002).Many patients with chronic or hidden conditions do not have any EMI. Rushworth, Chrisp, and Torpy (2019), using data from MedicAlert,