Promoting Science Literacy and Awareness across the Globe: the Role of Scientists as Science Ambassadors

Science literacy has many personal and societal benefits that allows for better informed decision-making. Although the importance of science literacy is recognized globally, there are many challenges associated with its promotion. Scientists are more frequently engaging with nonscientific audiences through public outreach activities and with increasing support from institutions and professional societies. This is especially true regarding microbiologists and other related professionals since the start of the global 2019 coronavirus disease pandemic heightened the need to convey novel and rapidly evolving scientific information to lay audiences. The means by which professionals engage with these audiences affect the efficacy of the relay of scientific information. One method of engagement is the "ambassador approach," which aims to establish dialogue among different groups of people and scientists. In this perspective article, we discuss this approach, highlighting activities for the promotion of science literacy organized by the American Society for Microbiology Ambassador Program and similar programs of other scientific societies. We discuss the benefits and challenges of implementing an ambassador approach, propose potential improvements that could be made to existing programs promoting science literacy, and ultimately advocate for increased implementation of science ambassador programs.

Identifying candidates for one-night stay robot assisted simple prostatectomy: Single center analysis

Introduction & Objectives: Since COVID-19 global pandemic started, increasing importance was given to same-day discharge (SDD) protocols to minimize viral exposure, reducing healthcare costs without compromising patients' safety. While SDD protocols have been applied for robotic radical prostatectomy, literature is still lacking studies evaluating the feasibility of meeting SSD criteria for patients who underwent RASP. Our aim was to evaluate the feasibility and safety of hospital discharge 24h after surgery. Our secondary endpoint was to assess predictors of successful discharge on 1st postoperative day (POD). Material(s) and Method(s): Patients with allergy to local anesthetics, those scheduled for concomitant surgical procedures and those with severe comorbidities (ASA score 3-4) were excluded from the analysis. Outcomes of this study were: Postoperative Hb drop, 30-day post-surgical readmission, any post-discharge complication, postoperative, time to flatus and consequent regular diet restoration, PSA, flowmetry parameters and validated questionnaires. The SDD criteria included: stable postoperative hemoglobin and vital signs, tolerance of clear liquids, pain control with oral medications and no perioperative complications requiring a prolonged hospitalization (Clavien >1). Result(s): Demographics and baseline values of 63 consecutive patients were reported in Table 1. Perioperative outcomes were shown in table 2. No perioperative complications were reported, median DELTAHb was 2.2 mg/dl, vital signs were stable for every patient. Overall, 55 (87%) patients passed flatus within 24 hours from surgery, and regular diet was restored;7 patients (11%) needed opioids for pain control. Two thirds of patients (n=42, 67%) met the criteria for SDD. At logistic regression analysis, patient's age was the only independent predictor of one night stay (OR 0.89;95% CI 0.80 - 0.98 p=0.02;Table 3). Patients younger than 60 met 24 hours discharge criteria in 90%, while those older than 70 in 50% of cases. Conclusion(s): In a selected cohort of patients with negligible comorbidities profile, discharge within 24h from RASP seems a safe and feasible option in 67% of cases. Patient' age was the only predictor of successful 1 night stay after RASP in our series. [Table presented]Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Realizing the Goals of the Advancing American Kidney Health Initiative: Toward a Better Future for Kidney Disease Research Funding.

The Executive Order on Advancing American Kidney Health aimed to slow the progression of kidney disease, increase access to kidney transplantation, and expand home dialysis. In order to support the kidney health strategy laid out by the Advancing American Kidney Health, the National Institutes of Health, the National Institute of Diabetes, and Digestive, and Kidney Diseases, as well as other funding agencies must dedicate robust research funding to kidney disease. Currently, federal research investment for kidney health is less than 1% of Medicare fee-for-service expenditures for Americans with kidney disease. To address disparities in federal research funding, nephrology organizations are working together to advocate for increased federal commitment to kidney disease research. Underfunding of kidney disease research impedes scientific opportunities and innovation and prevents the collaboration of young investigators with research faculty that can accelerate the exodus of talent within the nephrology research workforce. This review provides an overview of the current state of federal research funding for kidney disease within the United States. In addition, we discuss ongoing advocacy efforts and programs that aim to increase federal funding for kidney-related research and accelerate the development of new and better therapies.

Feasibility of a Supervised Virtual Exercise Program for Women on Hormone Therapy for Breast Cancer

Introduction/Purpose Adjuvant endocrine therapy significantly improves survival in women with hormone receptor-positive breast cancer and is typically administered for 5 yr or longer. Adverse treatment side effects, including arthralgias, reduce treatment adherence and physical activity levels. Aerobic and resistance exercise is one strategy to decrease treatment side effects and improve treatment adherence. This study aimed to explore the feasibility of a virtually delivered exercise program for women receiving adjuvant endocrine therapy as part of breast cancer treatment. Methods This is a single-arm pilot study with recruitment by self-referral or oncologist referral of female breast cancer survivors. To adapt to coronavirus disease 2019 (COVID-19) restrictions, a supervised strength and aerobic group exercise program was delivered virtually twice weekly via Zoom over 6 wk. Feasibility was evaluated based on a priori targets specific to program recruitment (>30% recruitment ratio), transition to virtual delivery (>75%), attendance (>70% virtual session attendance), attrition (<30% dropout), and fidelity of group belongingness (average score >= 15 on belongingness questionnaire) at the end of the program. Physical function (30-s chair stand test), quality of life RAND Short-Form 36-item test, and medication adherence (Voils Domains of Subjective Extent of Nonadherence) were assessed at baseline and 6 wk. Results A total of 24 participants completed the program. All feasibility measures were met. Statistically significant changes were found in physical function (P < 0.001), self-reported energy/fatigue (P < 0.001), emotional well-being (P < 0.001), and pain (P = 0.01). There was also a positive trend toward improvement in patient-reported medication adherence (17%). Conclusion A 6-wk supervised strength and aerobic group exercise intervention delivered virtually was feasible and improved physical function, energy/fatigue, emotional well-being, and pain. The trend toward improvement in adherence to adjuvant endocrine therapy should be explored further. These findings provide preliminary data to inform a future appropriately powered trial on exercise and physical function using a virtual platform that has the potential for greater reach.

ESTABLISHING THE SAFETY OF OUTPATIENT RETROPERITONEAL SACROSPINOUS LIGAMENT FIXATION - A RETROSPECTIVE REVIEWAT A LARGE ACADEMIC HEALTHCARE CENTER

Introduction: With the strain placed on the medical system by the ongoing surges of the Covid-19 pandemic, inpatient surgery is often suspended, and same day discharge rates are increasing. Sacrospinous ligament fixation (SSLF) is an apical suspension procedure performed retroperitoneally;retroperitoneal hemorrhage and nerve injury are potential severe complications. Given these risks, providers vary in their preference for same day discharge vs. routine overnight admission after this procedure. Objective: To establish the safety of outpatient SSLF and evaluate the frequency of complications identified during the hospital stay. Methods: This is a retrospective cohort study of women who underwent SSLF by Urogynecologists at our large, academic institution between March 2018 and October 2021. Patients were identified from the Gynecologic Enhanced Recovery Surgical database, which includes all surgical patients in the department of OBGYN. The data was collected from the electronic medical record (EMR) to track compliance and outcomes in real time for quality improvement purposes during implementation of our enhanced recovery protocol. Institutional IRB approval was obtained. Descriptive statistics were performed. Student's t-test and two-sample tests-of-proportions were used, with a p-value <0.05 denoting statistical significance. Results: A total of 165 patients underwent SSLF;23 were outpatient, and 142 were admitted for at least one night. Over 90% of patients in both groups identified as white, non-Hispanic, and English-speaking. The mean BMI for both groups was 28.8 kg/m2. The outpatient group was younger (57.9 years compared to 64.7 years;P = 0.0051);outpatients were more likely to have commercial insurance (P = 0.0143) and inpatients to have Medicare (P = 0.0282). Almost double the proportion of those in the inpatient group had anxiety and depression, but this did not achieve statistical significance. Outpatients were more likely to be never smokers (P = 0.0175) and use narcotics preoperatively (P = 0.0385). They had a lower mean ASA score (P = 0.0067), Charleston Comorbidity Index score (P = 0.0452), total length of surgery (P < 0.001), total length of anesthesia (P < 0.001), and estimated blood loss (P = 0.0142). Those who went home the same day were more likely to have been the first case (P = 0.0123), and same-day discharge rates increased significantly after the onset of the Covid-19 pandemic (P = 0.0039). Both complications that required operative intervention were identified in the post-anesthesia care unit on the day of surgery. Notably, 30-day post-operative complications were proportionally lower in the outpatient group, but this did not achieve significance. Most of the complications were urinary tract infections, including the sole complication identified in the outpatient group. Conclusions: With the ongoing Covid-19 pandemic and rapidly evolving practice patterns, it is important to establish the safety of outpatient surgery. Our study demonstrates that outpatient SSLF is safe for appropriately selected patients after routine post-operative monitoring including serial vital signs and assessment of neuropathic pain. Severe complications requiring reoperation can often be identified immediately after surgery. Thirty-day post-operative complication rates did not significantly differ between patients undergoing outpatient versus inpatient SSLF.

Black Patients with Cancer and COVID-19 More Likely to Have Treatment Disruptions Than White Patients

The article discusses results of a study conducted by of the American Society of Clinical Oncology (ASCO) on COVID-19 in Oncology Registry that were presented during the 2022 ASCO meeting. Topics discussed include that in America African-American patients with cancer and COVID-19 were more likely to have delays or disruptions in cancer treatment during the pandemic, discussed reasons by Dr. Jessica Islam for delay in treatment and also discussed second analysis on rural versus urban patients.

Influence of vitamin D levels on outcomes and nosocomial COVID-19 infection in patients undergoing total knee arthroplasty- a cohort study.

Purpose: This study aimed to audit the effects of vitamin D3 on the early functional outcomes, the incidence of nosocomial COVID-19 infection and complications in patients undergoing elective Total Knee Arthroplasty (TKA). Methods: This was a retrospective study involving patients undergoing primary unilateral TKA between January 2020 to May 2021 operated by a single surgeon using a single implant. Participants were divided into two cohorts, Deficient-vitamin D3 level <20 ng/ml and Sufficient-vitamin D3 level ≥20 ng/ml. Assessment for Knee Society Score and Oxford Knee Score (OKS) was done preoperatively and one year after TKA. Nosocomial COVID-19 infection rate, 30-day re-admissions and complications were noted during the study. Results: 235 patients were divided into 2 cohorts matched by age, gender and ASA grades. 74 patients belonged to the deficient group and 161 belonged to the sufficient group. The mean preoperative scores in the sufficient group were higher than the deficient group (OKS = 15.74 vs 12.95; KSS = 88.91vs 85.62). Similarly, the one-year postoperative scores in the sufficient group were significantly higher (OKS = 36.54 vs 35.16; KSS = 164.01 vs 161.22). A linear correlation was present between preoperative score (r = 0.273) & post-operative scores (r = 0.141) with serum vitamin D3 levels. Vitamin D3 deficient individuals had higher nosocomial COVID-19 infection rate (10.81% vs 4.96%,p = 0.16). The incidence of complications like DVT, embolism, stroke, infection and fracture were not statistically different in the two groups. Conclusion: Vitamin D positively influences the outcomes of TKA and protects against nosocomial COVID-19 infection in patients undergoing elective TKA.

Biopolymeric sustainable materials and their emerging applications

Advancements in polymer science and engineering have helped the scientific community to shift its attention towards the use of environmentally benign materials for reducing the environmental impact of conventional synthetic plastics. Biopolymers are environmentally benign, chemically versatile, sustainable, biocompatible, biodegradable, inherently functional, and ecofriendly materials that exhibit tremendous potential for a wide range of applications including food, electronics, agriculture, textile, biomedical, and cosmetics. This review also inspires the researchers toward more consumption of biopolymer-based composite materials as an alternative to synthetic composite materials. Herein, an overview of the latest knowledge of different natural- and synthetic-based biodegradable polymers and their fiber-reinforced composites is presented. The review discusses different degradation mechanisms of biopolymer-based composites as well as their sustainability aspects. This review also elucidates current challenges, future opportunities, and emerging applications of biopolymeric sustainable composites in numerous engineering fields. Finally, this review proposes biopolymeric sustainable materials as a propitious solution to the contemporary environmental crisis. © 2022 Elsevier Ltd.

Cybernetic exchanges in online events: Seven types of conversation in the ASC2020 Global Conversation

As the first large online event of the American Society for Cybernetics, the ASC2020 Global Conversation offered an opportunity to develop new online types of cybernetic conversations on cybernetics, in cybernetic formats. This article discusses the design decisions that led to a particular organizational structure of the event, and observations on how the event unfolded from this organizational structure. Based on observations made throughout the event as well as its preparation stage, the article maps seven different types of conversations taking place before and during the event and discusses opportunities and constraints encountered in relation to each identified type. As online conferences have proliferated exponentially due to the impact of COVID-19, this article aims to contribute a cybernetic perspective to the broader discourse on scholarly international exchange in online media, and offers a new perspective on how such conversations might be designed in a cybernetic manner. © 2021 Intellect Ltd Article.

COVID-19 in the perioperative setting: A review of the literature and the clinical landscape.

The COVID-19 pandemic has dramatically affected societies and healthcare systems around the globe. The perioperative care continuum has also been under significant strain due to the pandemic-tasked with simultaneously addressing surgical strains and backlogs, infection prevention strategies, and emerging data regarding significantly higher perioperative risk for COVID-19 patients and survivors. Many uncertainties persist regarding the perioperative risk, assessment, and management of COVID-19 survivors-and the energy to catch up on surgical backlogs must be tempered with strategies to continue to mitigate COVID-19 related perioperative risk. Here, we review the available data for COVID-19-related perioperative risk, discuss areas of persistent uncertainty, and empower the perioperative teams to pursue evidence-based strategies for high quality, patient-centered, team-based care as we enter the third year of the COVID-19 pandemic.

Phenotyping patients undergoing colectomy to anticipate clinical trajectory

Background High-risk surgeries account for 12% of the cases performed but represent 80% of the postoperative mortality [1]. The ASA (American Society of Anesthesiology) score, used since 1941, categorizes risk based on patient's comorbidities [2]. Such stratification is of utmost importance, enabling therapeutic decision making, distribution of resources, decision sharing with patients, and billing. By exploiting clinical databases, risk scores could become automatically extracted from medical records, personalized for different populations, and quickly provide insights on several outcomes. By clustering a population with unsupervised artificial intelligence (AI) algorithms, we can create subgroups without specifying how to subdivide them. By identifying discriminative features, the AI creates subgroups from which we extract the typical profile, or phenotype, before describing the associated outcomes [3]. This recent approach identified subgroups among covid-19 and septic patients [3, 4]. The objective of this project is to export this concept for the first time to a surgical population and, considering the democratization of “Enhanced Recovery after Surgery” protocol, to identify phenotypes and associated outcomes in a population undergoing colectomy [5]. Methods Using the patient data warehouse (PDW) from University of California in Los Angeles (UCLA), we retrospectively extracted all surgical cases containing “colectomy” in the procedure name, which occurred between 2013, inception of the database, and November 2021 [6]. Institutional Review Board of UCLA waived the need for patient's consent. We selected 56 relevant variables, including demographic data, comorbidities, and medication. Unsupervised K-means clustering was applied to the data, and the optimal number of phenotypes was determined based on discrimination of significant binary outcomes, including mortality, intensive care unit (ICU) length of stay (LOS) over 10 days, and hospital LOS over 20 days. Continuous data, including age and preoperative vitals were normalized with a min-max algorithm before clustering. A random forest plot algorithm was used to identify the 15 most relevant features linked to mortality and compare the clustering results in a restricted set. Results We identified three major phenotypes in the population (N=2273) based on the major characteristics described in Table 1, with an overall mortality of 0.08%. Despite being younger (average age: 52), phenotype 1 had the highest in-hospital mortality risk with 3.4% (15/437) and had longer ICU LOS (10.1% stayed > 10d), and hospital LOS (26.7% stayed >20d). This subgroup mostly contained patients undergoing urgent surgery (90%) with intestine obstruction (26%). While phenotypes 2 and 3 both were elective and included most cancer cases, mortality and LOS varied significantly between groups (mortality: 0.06% vs 2.1%;ICU>10d: 0.5% vs 7.2%;hospital LOS>20d: 2.4% vs 11.3% ). Phenotype 2 was generally younger (57 vs 62 years old) and presented less comorbidities (see Figure 1). Cases lengths were similar across all groups, and phenotype 3 received more intravenous fluids. In this cohort, phenotype 1 (19.5% of procedures) accounted for 83.3% of deaths, 74,5% of prolonged ICU LOS, and 68,4% of prolonged hospital LOS. Clustering on the restricted feature built after random forest plot algorithm provided similar results. Discussion and conclusion By identifying 3 phenotypes in the colectomy population, we could discriminate patients' outcome and trajectory of care. We confirmed that despite having few comorbidities, the highest risk of complication and prolonged ICU/hospital LOS correlates with urgent surgeries. In other words, urgency seems more correlated to adverse outcomes than comorbidities or ASA score. These results confirm the effectiveness of clustering the surgical population for risk stratification. While these analyses were limited by the low number of deaths, LOS insights were of great interest. Accumulating more data will be interesting to further phenotype patients undergo ng urgent colectomy, or to personalize risk stratification for other surgeries. (Table Presented).

Evaluation of the Effectiveness of Autologous Bone Marrow Mesenchymal Stem Cells in the Treatment of Chronic Low Back Pain Due to Severe Lumbar Spinal Degeneration: A 12-Month, Open-Label, Prospective Controlled Trial

Background: Regenerative medicine interventions are applied to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous/allogenic biologics and it continues to expand. The anti-inflammatory, immunomodulatory, and regenerative properties of bone marrow mesenchymal stem cells (BM-MSCs), and investigation into their therapeutic efficacy and safety in patients with severe chronic low back pain, have not been demonstrated in controlled studies. Multiple pain generators have been hypothesized to be responsible in severe spinal degeneration and it is difficult to identify a single pain generator;consequently, resulting in inadequate therapeutic results. Objectives: The study was undertaken to evaluate the effectiveness of autologous bone marrow MSCs in the treatment of chronic low back pain due to severe lumbar spinal degeneration with involvement of multiple structures. Study Design: Prospective, open-label, nonrandomized, parallel-controlled, 2-arm exploratory study. Setting: A private, specialized, interventional pain management and regenerative medicine clinic. Methods: The treatment group patients received a one-time bone marrow concentrate injection into spinal structures (i.e., discs, facets, spinal nerves, and sacroiliac joints), along with conventional treatment, whereas, the control group received conventional treatment with nonsteroid antiinflammatory drugs, over-the-counter drugs, structured exercise programs, physical therapy, spinal injections and opioids, etc., as indicated. Outcomes Assessment: Outcomes were assessed utilizing multiple instruments, including the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS-11), EuroQOL 5-Dimensional Questionnaire (EQ-5D-3L), Global Mental Health (GMH), and Global Physical Health (GPH). Multiple outcomes were assessed with primary outcomes being minimal clinically important differences (MCID) in ODI scores between the groups and/or a 2-point reduction in pain scores. In the study group, total nucleated cells, colony forming units-fibroblast, CD34-positive cell numbers and platelets were also recorded, along with post-procedure magnetic resonance imaging changes. Outcomes were assessed at 1, 3, 6, and 12 months. Results: Significant improvement was achieved in functional status measured by ODI, pain relief measured by NRS-11, and other parameters measured by EQ-5D-3L, GMH, and GPH, in the study group relative to the control group at all time periods. The results showed significant improvements at 12-month follow-up with 67% of the patients in the study group achieving MCID utilizing ODI when compared to 8% in the control group. Greater than 2-point pain reduction was seen in 74% of the patients at 3 months, 66% of the patients at 6 months, and 56% of the patients at 12 months. Both MCID and pain relief of 2 points were significantly different compared to the control group. Opioid use decreased in the investigational group, whereas, there was a slight increase in the control group. Age, gender, opioid use, and body mass index did not affect the outcomes in the stem cell group. Limitations: Single center, nonrandomized study. Conclusions: The first available controlled study utilizing BM-MSCs in severe degenerative spinal disease with interventions into multiple structures simultaneously, including disc, facet joints, nerve roots, and sacroiliac joint based on symptomatology, showed promising results.

The Impact of Left Ventricle Geometry Patterns on Length of Hospital Stay in COVID-19 Patients

Objective: The coronavirus disease 2019 (COVID-19) has placed huge strains on medical systems. Therefore, it is essential to determine the predictors of the long hospital stay. We sought to investigate whether alterations in left ventricular (LV) geometry in COVID-19 patients are associated with the length of stay (LoS) and a long hospital stay. Materials and Methods: 108 consecutive hospitalized COVID-19 patients were incorporated in the study and 89 patients remained for statistical analysis. All participants underwent standard two-dimensional (2D) and Doppler echocardiographic examinations. Patients were classified according to LV geometry characteristics namely normal geometry (NG), concentric remodeling, concentric hypertrophy and eccentric hypertrophy. Results: Multiple binary logistic regression model adjusted for clinical and laboratory variables yielded significant and independent association of LV mass index (LVMI) (OR: 1.12, 95% CI: 1.06-1.19, p<0.001), 10 g/m(2) increase in LVMI (OR: 3.63, 95% CI: 2.00-6.59, p<0.001), LV geometry patterns (OR: 2.92, 95% CI: 1.46-5.34, p=0.002), and altered geometric patterns compared to NG (OR: 3.97, 95% CI: 1.08-14.5, p=0.037) with long hospital stay. Correlation analysis of LVMI and LoS demonstrated significant and moderate correlation (rho=0.58, p<0.001). Conclusion: LVMI and LV geometric patterns independently predict long hospital stays in COVID-19 patients. The significant correlation between LoS and LVMI underlies the significance of LV geometry in this infection.

Applicability evaluation of a demand-controlled ventilation system in livestock.

The distribution of agricultural and livestock products has been limited owing to the recent rapid population growth and the COVID-19 pandemic; this has led to an increase in the demand for food security. The livestock industry is interested in increasing the growth performance of livestock that has resulted in the need for a mechanical ventilation system that can create a comfortable indoor environment. In this study, the applicability of demand-controlled ventilation (DCV) to energy-efficient mechanical ventilation control in a pigsty was analyzed. To this end, an indoor temperature and CO2 concentration prediction model was developed, and the indoor environment and energy consumption behavior based on the application of DCV control were analyzed. As a result, when DCV control was applied, the energy consumption was smaller than that of the existing control method; however, when it was controlled in an hourly time step, the increase in indoor temperature was large, and several sections exceeded the maximum temperature. In addition, when it was controlled in 15-min time steps, the increase in indoor temperature and energy consumption decreased; however, it was not energy efficient on days with high-outdoor temperature and pig heat.

Day-case transurethral resection of bladder tumour (TURBT): A feasible approach in selected patients

Introduction & Objectives: Day-case Transurethral Resection of Bladder Tumour (TURBT) is currently only performed in 18% cases across the United Kingdom. Concerns exist regarding the quality of TURBT, early recurrence rate and the high-risk patient cohort that makes this approach less popular in some centers. The Primary Outcome was to determine 30-day readmission rate and 30-day morbidity using the Clavien-Dindo classification. The Secondary Outcomes were to determine patient cohort selection, quality of TURBT and early recurrence rate and to report patient feedback following day-case TURBT. Materials & Methods: A retrospective audit of day-case TURBTs in a District General Hospital (DGH) over 3 years pre-COVID19 (January 2017 - March 2020) was performed. We only included patients who underwent a TURBT and excluded any cystoscopy, biopsy or fulguration. A day-case TURBT pathway is in place, for postoperative recovery, instillation of intravesical chemotherapy postoperatively if required and re-admission for trial without catheter when indicated in the hospital. Case notes were reviewed manually. Feedback was obtained from patients who had new tumour TURBT in the last year using hospital patient feedback forms. Results: We included 77 patients who underwent TURBT in the day-case theatre, of these 5 patients required in-patient stay after the surgery. Of the remaining 72 discharged on the same day, 8 were re-admitted (11%) for Clavien-Dindo I complications. The mean age of the patients was 71 years (34-94 years);77% (59/77) were male;reported ASA scores were 3/77 ASA 1 (4%), 43/77 ASA 2 (56%), 28/77 ASA 3 (36%);30% (23/77) patients were on anticoagulants or antiplatelets;the average tumour size was 2cm (1mm – 5cm), 69% (53/77) were papillary in nature and 36/77 were newly diagnosed tumours (47%) and the remainder were recurrences or re-resections. Of the new tumours, 32/36 (89%) received mitomycin C as indicated. On final histology, muscle was present in specimen in 50/77 (65%). The readmission/failed discharge group had a higher rate of older patients, with higher ASA scores and longer operative times, however resection quality and tumour characteristics were not different from the day-case TURBTs. The recurrence rate at first check cystoscopy for the newly diagnosed tumours was 3% (1/36) while 1 patient had residual disease in a bladder diverticulum. All patients reported an overall positive experience. Conclusions: In the first of its kind audit patients reported outcomes after day-case TURBT, though readmission rate was relatively higher than previous reports in the literature, the overall patient experience was favorable and the outcomes of TURBT quality and early recurrence were satisfactory. The data obtained can provide guidance to employ better patient selection to reduce readmission rates. Hence, day-case TURBT can be a feasible option in appropriately selected patients, with a suitable pathway in place.

Quality Assurance in Pre-Endoscopic Evaluation

Endoscopy is an essential component of gastroenterology, allowing for the diagnosis and management of a variety of gastrointestinal diseases. Although most endoscopies are considered to be low risk procedures, several factors including the sedation, patient, and procedure play a role in determining overall risk. Patient assessment prior to endoscopy is essential to risk-stratification and provides an opportunity to review comorbidities, adjust medications if necessary, and identify an optimal sedation plan. Several best practice recommendations and guidelines have been developed to ensure that safe, high-quality endoscopies are performed to minimize risks and optimize outcomes. The purpose of this review is to highlight best practices related to pre-endoscopic evaluation and, when available, review quality indicators.

Teleconsultation after outpatient total mastectomy

Background: In response to regulations related to the COVID 19 pandemic and to patient demand, an outpatient total mastectomy pathway has been implemented at the Léon Bérard Center (CLB). This study evaluates the implementation of this pathway in terms of postoperative complications and patient satisfaction. Materials and Methods: Observational, retrospective, uni-centric study comparing two care pathways: traditional hospitalization versus outpatient care, for a total mastectomy associated or not with an axillary lymph node procedure. In the outpatient care, a teleconsultation by the coordinating nurses (IDEC) was performed the day after the surgery (D1 postoperative). Patient satisfaction in the outpatient care protocol was assessed by means of a satisfaction questionnaire sent by e-mail, in person or by telephone. Results: Between January 2020 and March 2021, 314 total mastectomies, without immediate breast reconstruction, associated or not with an axillary lymph node procedure, were performed at CLB. Thirty-six patients (11.46%) benefited from the outpatient program. We matched them in age and ASA score with 36 patients who underwent total mastectomy in traditional hospitalization during the same period. The complication rate in our cohort was 54.2%, 30.6% of which were lymphoceles. The postoperative complication rate and the revision surgery rate were not significantly different between the 2 groups (p=0.509, p=0.614). Five patients (13.9%) in the outpatient protocol were converted to traditional hospitalization. No patient in the outpatient program was rehospitalized for a surgical complication. In 66.7% of cases, the teleconsultation on D1 post-operation was carried out between the patient, the IDEC and the nurse in the patient's home who was responsible for the rest of the management. The patients in the outpatient protocol responded to the satisfaction questionnaire in 83.3% of cases. The overall satisfaction rate was rated at 4 or 5 out of 5 in 72.2% of cases. Patients would recommend the outpatient program to a relative in 90% of cases. Conclusions: Our study highlights the feasibility of outpatient total mastectomy, with good patient satisfaction. Teleconsultation at D1 post-op facilitates the link between the surgical management center and the city, favoring continuity of care.

Echocardiographic predictors of mortality and morbidity in COVID-19 disease using focused cardiovascular ultrasound.

BACKGROUND: Focused transthoracic echocardiography (fTTE) has emerged as a critical diagnostic tool during the COVID-19 pandemic, allowing for efficient cardiac imaging while minimizing staff exposure. The utility of fTTE in predicting clinical outcomes in COVID-19 remains under investigation. METHODS: We conducted a retrospective study of 2,266 hospitalized patients at Rush University Medical Center with COVID-19 infection between March and November 2020 who received a fTTE. fTTE data were analyzed for association with primary adverse outcomes (60-day mortality) and with secondary adverse outcomes (need for renal replacement therapy, need for invasive ventilation, shock, and venous thromboembolism). RESULTS: Of the 427 hospitalized patients who had a fTTE performed (mean 62 years, 43% female), 109 (26%) had died by 60 days. Among patients with an available fTTE measurement, right ventricular (RV) dilation was noted in 34% (106/309), 43% (166/386) had RV dysfunction, and 17% (72/421) had left ventricular (LV) dysfunction. In multivariable models accounting for fTTE data, RV dilation was significantly associated with 60-day mortality (OR 1.93 [CI 1.13-3.3], p = 0.016). LV dysfunction was not significantly associated with 60-day mortality (OR 0.95 [CI: 0.51-1.78], p = 0.87). CONCLUSIONS: Abnormalities in RV echocardiographic parameters are adverse prognosticators in COVID-19 disease. Patients with RV dilation experienced double the risk for 60-day mortality due to COVID-19. To our knowledge, this is the largest study to date that highlights the adverse prognostic implications of RV dilation as determined through fTTE in hospitalized COVID-19 patients.

Student Internships during Times of Pandemic: A Historical View of Pandemics, Recession and Their Effect on Education

With the current pandemic, a potential recession is also occurring. Considering the “Great Recession” of 2007-2010, student enrollments went up while taxpayer support to public universities fell. Also associated with these changes was the increase in unemployment which correlates with the increase in enrollment. Non-traditional students (not typical recent high school graduates) return to college as jobs become more difficult to find. In a thorough review of the American Society of Engineering Education archives, there is little about any correlation between job placement and the Great Recession. Internships are a part of many construction, engineering, and architecture degree programs. These might be mandatory for course credit or strongly encouraged, yet voluntary, during college. Internships could also be mandatory for professional credentials after graduation. Little research is available to identify any correlation between internship placement and recessions. Anecdotal relationships between recessions and internships have been reported. With the current economic situation associated with the Covid pandemic, there is an opportunity to identify changes that occur in the construction industry. A thorough review of existing literature is performed. To determine the change in internship employment, a survey instrument was created. Respondents shared their perspective about gaining a summer internship this summer as compared to previous years. A comparison of recent salary data and career fair data was used to identify any economic changes which have occurred. This research seeks to define the relationship between the university, industry, and student and how it was affected by Covid. © American Society for Engineering Education, 2021