When Aways Went Away: How the Elimination of Away Rotations During Covid-19 was Perceived by Applicants Across Specialties

Introduction: COVID-19's emergence and subsequent social distancing guidelines resulted in severe restrictions on away rotations (ARs). This multi-institutional cross-sectional study investigated how these restrictions were perceived by residency applicants across specialties. Method(s): In fall, 2020, an online survey regarding COVID-19's impact on graduating medical students' education was distributed to ACGME Medical Schools. Demographics, specialty choice, and pre- COVID plans to participate in ARs verses one's participation post- COVID were collected. Respondents who provided e-mails received a post-Match follow-up survey in which retrospective thoughts on ARs were explored. Participants were grouped by specialty choice (medical, procedural, surgical) and answers were compared between groups using Kruskal-Wallis test. Result(s): 58 Institutions distributed the initial survey to 8200 graduating students. 1473 responded (18%). 81% were 25-29;65% were female. 49% were medical, 24% procedural and 26% surgical. Surgical and procedural applicants were more likely to have planned to participate in ARs (p<0.001) and be concerned that limitations on ARs would negatively impact their match (p<0.001). Of 1221 initial survey respondents who provided e-mails, 458 participated in the follow-up survey (37.5%). Demographics were similar to the index survey. Post-Match, surgical and procedural applicants were more likely to wish they could have participated in ARs and to propose that future ARs only be offered in-person (p<0.001). Conclusion(s): This multi-institutional survey across specialties highlights the perceived value of ARs for surgical and procedural candidates. Should opportunities for ARs continue to be limited, alternative opportunities for applicants to connect with programs and optimize successful matches should be investigated.

North American Orthopaedic Spine Fellowships: Evaluating Program Website Content During COVID-19 for Prospective Applicants

Introduction: Prospective applicants utilize the internet to obtain information on fellowship programs they wish to apply to. The COVID-19 pandemic presented challenges to orthopaedic spine fellowship programs, among them the transition to communicating with prospective applicants largely through web-based and virtual platforms. The purpose of this study was to assess the content of information accessible to applicants on orthopaedic spine fellowship program websites during September and October 2020 of the COVID-19 pandemic. Method(s): Seventy-nine accredited fellowship programs were identified from the North American Spine Society Fellowship Program Directory and assessed based upon 18 criteria categorized as composites of three domains: program overview, application information, and education. Information was compiled, tabulated to visualize numerical differences between each program, and analyzed via descriptive statistics. Result(s): No program website mentioned virtual tours or interviews. All websites listed an address for the program location, 99% listed a phone number, and 96% a contact email address. Seventy-seven percent mentioned research requirements, 77% mentioned research outputs, nine percent mentioned call responsibilities, and three percent mentioned international opportunities. Twenty-three percent of programs mentioned meetings or courses, 43% mentioned case log numbers, 37% mentioned didactics, 20% mentioned journal clubs, 20% mentioned clinic duties, and 16% mentioned rotations. Conclusion(s): Spine fellowship programs did not appreciably amend content on their websites during the COVID-19 pandemic. This is consistent with findings from pre-COVID-19, where fellowship programs were also underutilizing website platforms and did not showcase sufficient information online that prospective applicants could potentially benefit from knowing about their program.

Effect of Attentional Bias on the 3D Rotated Objects Recognition Ability of Dogs.

The ability to recognize rotated objects has been widely reported in the animal kingdom. Studies on animal and human spatial cognition highlighted the importance of visuo-spatial cognitive capability for surviving in a dynamic world. Although domestic animals are frequently involved in activities requiring a high level of visuo-spatial ability, currently, little is known about their visuo-spatial skills. To investigate this issue, we trained six dogs to discriminate between 3D objects (using a modified version of the Shepard-Metzler task) that were then reproduced digitally on a computer. We found that the dogs recognized three-dimensional objects and their rotated versions (45° and 180°) more easily when presented on the left side of the screen, suggesting right hemisphere superiority in the control of visuo-spatial functions. Moreover, we report inter-individual variability in their performance in the visuo-spatial task. Our preliminary results suggest that dogs could use a rotational invariance process for the discrimination of 3D rotated shapes that deserves further investigation.

Perception of training and job perspectives among final-year residents in the specialty of Endocrinology and Nutrition

Introduction: The medical specialisation model in Spain is carried out in the context of specialised health training, through the residency programme. The aim of the study is to analyse, by an anonymous survey, the opinion on three aspects among final-year residents in Endocrinology and Nutrition (E&N): self-assessment of the knowledge acquired, working prospects, care and training consequences arising from the pandemic COVID-19. Material(s) and Method(s): Cross-sectional observational study using a voluntary and anonymous online survey, shared among final-year national interns in the last year of the E&N programme, carried out between June-July 2021. Result(s): 51 responses were obtained, 66% of the fourth-year residents. Overall perception of their knowledge was 7.8 out of 10. Most external rotations were in thyroid and nutrition areas. A total of 96.1% residents, carried out some activity associated with COVID-19, with a training deterioration of 6.9 out of 10. 88.2% cancelled their rotations and 74.5% extended their working schedule. The average negative emotional impact was 7.3 out of 10. 80.4% would like to continue in their training hospital, remaining 45.1%. 56.7% have an employment contract of less than 6 months, most of them practising Endocrinology. Conclusion(s): The perception of the knowledge acquired during the training period is a "B". Residents consider that the pandemic has led to a worsening of their training, generating a negative emotional impact. Employment outlook after completing the residency can be summarised as: temporality, practice of Endocrinology and interhospital mobility.Copyright © 2022 SEEN y SED

Shoulder Weakness Following Intramuscular COVID- 19 Vaccine

History: Transient and generalized adverse effects are common following COVID-19 vaccination;among other adverse effects, shoulder injuries related to vaccine administration (SIRVA) have been known to occur. In this case, a previously healthy right-hand dominant 62-year-old male presented with left shoulder pain and weakness 3 months after receiving a COVID-19 intramuscular vaccine in the left deltoid. Approximately 2 weeks after the injection, he started experiencing pain and numbness around the injection site along with ipsilateral shoulder weakness. Despite conservative management with Motrin, Medrol Dosepak, gabapentin and physical therapy (PT), the pain and weakness persisted. Physical Exam: Left Shoulder-No calor or erythema;significant atrophy of the anterior and middle deltoid muscle relative to right side;abduction 4/5;external rotation with shoulder adducted 4/5;range of motion for active forward flexion was 150 degrees and passive was 170 degrees;passive range of motion for external rotation was 70 degrees;internal rotation to the level of L5;sensation to light touch was intact. Right Shoulder-Range of motion, strength, and sensation were intact. Cervical Spine-Full ROM;no cervical paraspinal tenderness noted. Negative Spurling's and Lhermitte's tests. Differential Diagnosis: 161. Axillary Nerve Palsy 2/2 Chemical Neurotoxicity 162. Brachial Neuritis 163. Mechanical Axillary Nerve Palsy 2/2 Vaccination 164. Partial-Tear of Left Supraspinatus Tendon 165. Acromioclavicular Osteoarthritis Test Results: Left Shoulder-XR:Mild pseudo-subluxation;MRI w/o contrast: 8x9mmpartial-thickness articular surface tear of the distal supraspinatus tendon (<50%fiber thickness). Minimal subacromial bursitis. Mild acromioclavicular joint osteoarthritis. EMG/NCV: Left and Right Axillary Motor Nerves: prolonged distal onset latency;Left Deltoid: increased insertion activity, moderately increased spontaneous activity, reduced recruitment;Remaining LUE muscles without evidence of electrical instability Final Diagnosis: Axillary Nerve Palsy Secondary To Chemical Neurotoxicity from Intramuscular COVID-19 Vaccine. Discussion(s): We postulate that the neurologic deficits presented in our case may be attributed to chemical neurotoxicity to the axillary nerve following vaccination as the delayed onset of pain and weakness are most consistent with this differential. There are several cases of brachial neuritis following vaccination for the prevention of COVID- 19, however, EMG/NCV results in our patient were not consistent with brachial plexopathy. Additionally, while there have been a handful of reported cases of bursitis following COVID-19 vaccines falling under the SIRVA classification of injuries, this is the first case of reported axillary nerve neurapraxia. Outcome(s): The patient's left shoulder numbness and pain improved with PT and medical management. While mild improvement in strength was noted, weakness and atrophy persisted even on the third follow up visit 6 months after the initial appointment. He was counseled on his injury and was recommended to undergo repeat EMG testing to document recovery after his 6-month follow-up appointment. Follow-Up: The patient did not follow-up for a repeatEMG after his 6-month follow-up appointment. At that time, the patient was clinically stable, tolerating PT, and expecting recovery of his deltoid function.

Development of an Online Learning Module on Gastroenterology Issues in Global Health

Introduction: Global health (GH) education is expanding and 23.1% of US medical students acquire international health experience prior to postgraduate training. Digestive diseases carry a high global burden. However, few GH programs and professional societies consider the inclusion of gastroenterology into their standard curriculum. In addition, travel restrictions during the COVID-19 pandemic have brought traditional GH rotations to a halt and spurred new educational approaches. Our goal is to develop a comprehensive online learning module on gastroenterology issues in GH for medical students undertaking GH electives. Method(s): A team of faculty and residents was convened between the Center for Community and Global Health and the Division of Gastroenterology. GH curricula across institutions and core competencies across 2 professional societies were examined via literature review. A survey was conducted among 2nd (MS2) and 3rd year medical students (MS3) interested in GH to assess attitudes toward GI-related issues in GH curriculum. An online learning module was developed consisting of 10, video-based lessons each addressing specific GH competencies (Figure 1). Result(s): In total, 41% (28/69) of MS2 and MS3 interested in GH responded to the survey, with a similar distribution of MS2 (13/28) and MS3 (15/28). Nearly all (92.8%) reported that learning GI conditions in a GH curriculum is moderately or very important (Table 1). A majority (78.5%) also reported feeling at least somewhat anxious or more about managing GI conditions during GH electives. Few medical students reported feeling moderately or extremely prepared to identify risk factors for GI conditions in different settings (21.5%) and to define approaches to therapy in resource-limited settings (14.3%). Interestingly, a majority (71.4%) reported feeling not at all prepared or slightly prepared to deliver cost-effective care to challenging populations. Conclusion(s): Our survey responses demonstrated an unmet need for GI-related training and cost-conscious care in the GH curriculum. Developing an online learning module on GI conditions to supplement GH curriculum may be useful and feasible. A randomized controlled trial is underway to examine the effect of this online learning module on medical student knowledge and preparedness to address GI conditions in GH electives.

Does Smartphone Use Really Impact Cervical Rotation and Cervical Proprioception in Asymptomatic Individuals?

Background and objective Smartphone use has increased exponentially over the last two years worldwide. The outbreak of the coronavirus disease 2019 (COVID-19) pandemic led to significantly higher dependence on the smartphone for information exchange and communication among the general public. Currently, India has hundreds of millions of smartphone users, and their numbers are on the rise. This has raised concerns regarding the adverse effects of smartphone use on mental and musculoskeletal health. In light of this, this study aimed to determine and evaluate the musculoskeletal consequences of smartphone use. Method A total of 102 participants (50 adolescents and 52 adults) who were smartphone users and are asymptomatic for cervical spine-related disorders were included based on convenience sampling. The components assessed were cervical rotation using tape measurement and cervical proprioception using the head repositioning accuracy test. Frequency distribution tables and text were used to report the results. Results The results of this research indicated reduced cervical rotation range and cervical proprioception deficits in both adolescent and adult smartphone users. Furthermore, no correlation was found between cervical rotation (right and left) and cervical proprioception (right and left rotation). Conclusion Though the results showed that both the individual components - cervical rotation and cervical proprioception - were significantly affected, there was no correlation between the components, which indicates that these asymptomatic individuals who are marginally excessive smartphone users are at increased risk for reduced cervical mobility and deficits in cervical proprioception.

The Impact of COVID-19 on Emergency Medicine Rotations.

Introduction The impact of modifications in curriculum and clinical rotations made secondary to the COVID-19 pandemic on medical education has yet to be fully investigated. We observed differences in the types of patients seen by medical students that may have resulted from clinical disruptions due to the COVID-19 pandemic. We then evaluated what impact these disruptions had on the students' clinical competency. Methods We obtained patient logbooks of third-year medical students (M3) and fourth-year sub-interns (M4) from the first three emergency medicine (EM) rotation blocks of the 2019-2020 (Y19) and 2020-2021 (Y20) academic years. We then reviewed and categorized the chief complaints seen and procedures in which they participated. A robust t-test was used to detect differences in chief complaints and procedures. Finally, we looked for objective differences using the chi-square test in clinical performance between the class of 2021 (Class21) and the class of 2022 (Class22), as assessed by performance on our institution's clinical competency examination. Results Overall, students saw a 25.3% decrease in average number of patient encounters. Statistically significant decreased average numbers of infectious (-28.3%, p=0.013); musculoskeletal (-22.2%, p=0.018); gastrointestinal (GI) (-24.6%, p<0.01); genitourinary (GU) (-33.2%, p<0.01); head, eyes, ears, nose, throat (HEENT) (-31.1%, p<0.01); trauma (-33.0%, p<0.01); and respiratory (-45.4%, p<0.001) complaints were observed. Both M3s and M4s encountered significantly less GU (-25.6%, p=0.048; -41.7%, p=0.016) and trauma (-29.1%, p=0.023; -33.2%, p=0.032) complaints in Y20. M4s saw significantly less GI complaints (-42.6%, p<0.001) in Y20, whereas M3s encountered significantly less psychiatric and HEENT complaints (-30.3%, p=0.046; -34.6%, p=0.013). Both classes saw significantly less respiratory complaints in Y20 but more so for M4s (-65.3%, p<0.001) than for M3s (-27.9%, p=0.033). There were no significant differences in average number of procedures between years. We did not observe any differences in overall clinical performance between the two selected classes. While class of 2021 scored a significantly higher average on a case of fatigue (p=0.0004) and class of 2022 on a case of abdominal pain (p<0.0001), there were no significant differences in the primary chief complaints that would be attributed to COVID-19, such as dyspnea. Conclusion Modifications made to curricula and clinical rotations due to the COVID-19 pandemic led to students encountering less patients overall, with significant decreases in multiple chief complaint types compared to Y19 but no significant change in procedure numbers. Notably, there was no major impact seen on clinical competency providing a positive argument for considering innovative teaching and learning methods.

Impact of COVID-19 pandemic on anesthesia resident's training program in Cairo University Hospital

Background: The purpose of this study was to evaluate the impact of COVID-19 pandemic on the training process of anesthesia residents in Cairo University Hospital regarding technical skills, operative, and critical care experience. Method(s): This cross-sectional survey study included two groups of anesthesia residents according to the time of their residency in relation to the pandemic (before-pandemic group [N = 44] and during-pandemic group [N = 42]). The participants were asked to fill out a questionnaire regarding their training. The questionnaire included technical skills experience (regional anesthesia, vascular access, and advanced airway techniques, soft tissue ultrasound), operative and critical care experience, and duration of intensive care unit (ICU) rotation. The quality of training was graded as adequate, moderate, or deficient training according to the number of performed procedure/managed cases. Comparisons of continuous data were done using the Mann-Whitney test, and qualitative categorical was analyzed using the chi-square test. Result(s): All the participants completed the questionnaire. The training in the during-pandemic group was lesser than that in the before-pandemic group for most of the technical skills except for soft tissue ultrasound which was more in the during-pandemic group. The operative experience was less in the during-pandemic group than that in the before-pandemic group. On the other hand, the ICU experience was more in the during-pandemic group than that in the before-pandemic group. Conclusion(s): The COVID-19 pandemic disrupted the training program of anesthesiology residents with regard to elective procedures and produced over-training in critical care subspeciality.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Enhancement of Molecular Transport into Film Stacked Structures for Micro-Immunoassay by Unsteady Rotation.

A film-stacked structure consisting of polyethylene terephthalate (PET) films stacked in a gap of 20 µm that can be combined with 96-well microplates used in biochemical analysis has been developed by the authors. When this structure is inserted into a well and rotated, convection flow is generated in the narrow gaps between the films to enhance the chemical/bio reaction between the molecules. However, since the main component of the flow is a swirling flow, only a part of the solution circulates into the gaps, and reaction efficiency is not achieved as designed. In this study, an unsteady rotation is applied to promote the analyte transport into the gaps using the secondary flow generated on the surface of the rotating disk. Finite element analysis is used to evaluate the changes in flow and concentration distribution for each rotation operation and to optimize the rotation conditions. In addition, the molecular binding ratio for each rotation condition is evaluated. It is shown that the unsteady rotation accelerates the binding reaction of proteins in an ELISA (Enzyme Linked Immunosorbent Assay), a type of immunoassay.

Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury-An RCT study.

Objective: Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol-GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery. Methods: The study's design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre-treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences - International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study. Results: Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study's findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic. Conclusion: The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.

Scoliosis Management through Apps and Software Tools.

Background: Scoliosis is curvature of the spine, often found in adolescents, which can impact on quality of life. Generally, scoliosis is diagnosed by measuring the Cobb angle, which represents the gold standard for scoliosis grade quantification. Commonly, scoliosis evaluation is conducted in person by medical professionals using traditional methods (i.e., involving a scoliometer and/or X-ray radiographs). In recent years, as has happened in various medicine disciplines, it is possible also in orthopedics to observe the spread of Information and Communications Technology (ICT) solutions (i.e., software-based approaches). As an example, smartphone applications (apps) and web-based applications may help the doctors in screening and monitoring scoliosis, thereby reducing the number of in-person visits. Objectives: This paper aims to provide an overview of the main features of the most popular scoliosis ICT tools, i.e., apps and web-based applications for scoliosis diagnosis, screening, and monitoring. Several apps are assessed and compared with the aim of providing a valid starting point for doctors and patients in their choice of software-based tools. Benefits for the patients may be: reducing the number of visits to the doctor, self-monitoring of scoliosis. Benefits for the doctors may be: monitoring the scoliosis progression over time, managing several patients in a remote way, mining the data of several patients for evaluating different therapeutic or exercise prescriptions. Materials and Methods: We first propose a methodology for the evaluation of scoliosis apps in which five macro-categories are considered: (i) technological aspects (e.g., available sensors, how angles are measured); (ii) the type of measurements (e.g., Cobb angle, angle of trunk rotation, axial vertebral rotation); (iii) availability (e.g., app store and eventual fee to pay); (iv) the functions offered to the user (e.g., posture monitoring, exercise prescription); (v) overall evaluation (e.g., pros and cons, usability). Then, six apps and one web-based application are described and evaluated using this methodology. Results: The results for assessment of scoliosis apps are shown in a tabular format for ease of understanding and intuitive comparison, which can help the doctors, specialists, and families in their choice of scoliosis apps. Conclusions: The use of ICT solutions for spinal curvature assessment and monitoring brings several advantages to both patients and orthopedics specialists. Six scoliosis apps and one web-based application are evaluated, and a guideline for their selection is provided.

Do Not Attempt Conversations Pre-Rehearsal: Teaching Medical Students to Have Dnacpr Conversations

Introduction The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel learning experience designed to aid these discussions. Students were timetabled to a 1.5 hour workshop, facilitated by a clinical teaching fellow. They were invited to complete ReSPECT form for a celebrity to familiarise themselves with the layout. They then considered a patient admission scenario in 3 different groups from the perspective of the patient, family and medical team, and used this to contemplate potential, future, emergency treatments. Subsequently a discussion surrounding CPR effectiveness, ways of communicating this, and legal advanced decision documents occurred. The session concludes with scrutinising example ReSPECT forms provided by the Resuscitation Council UK. Method Students' confidence levels were measured pre and post session using a Likhert scale questionnaire. Results 90 students attended workshops across 6 rotations. 80% students completed post - session questionnaires, of which 100% reported an increase in confidence with having a DNACPR/advanced care planning discussion compared to before the session. Conclusion DNACPR conversations can incite anxiety in any seniority of health care professionals. Medical educators need to adequately prepare medical students during their training in advanced care planning and DNACPR discussions. This can be done with simulated workshop experiences, reinforced with opportunistic or organised observational experience. Adequate preparation will lead to increased confidence in discussions, ultimately leading to better experiences for patients and their families.

Prevalence of Musculoskeletal Disorders among Nursing Personnel

Background: Health sectors can be listed under the high-risk work areas. As we all know, in this COVID 19 pandemic, doctors, nurses, health workers are the front line warriors. If we consider only the nursing personnel here, their tasks alone are prone to occupational hazards. Musculoskeletal disorders (MSDs) are most common among the self-reported occupational diseases. In previous studies, a significantly large number of participants reported musculoskeletal symptoms faced at least once. Insufficiency of ergonomic expertise is one of the most important recognizable risk factors as well as the shortage of staff in hospitals. MSDs are caused due to stressful physical work, static work postures, frequent bending, and twisting, lifting, pushing, and pulling of heavy objects, vibrations, localized mechanical pressure, etc. Various studies have shown that the daily chores of nursing personnel put them at high risk of MSDs. Methods : The study areas were different hospitals and nursing homes in West Bengal. Only the female, registered nurses working in different wards are chosen for this study. The study's inclusion criteria were only the female, registered nurses and the absence of any chronic disease in them. The exclusion criteria were the nursing students, nurses having histories of recent or previous major accidents/injuries or chronic diseases. The study population was interviewed on a one-to-one basis by means of a questionnaire based on Modified Nordic Musculoskeletal Questionnaire. Result(s): Among the total study population, 67.5% of subjects reported low back pain (LBP). 22.5% reported upper back, knee, and ankle discomfort. 27.5%, 15%, and 12.5% reported neck, shoulder, and wrist/hand discomfort, respectively. Conclusion(s): The results of this study have revealed that MSDs are a common phenomenon among nursing personnel. LBP is the most familiar among them, 67.5% of subjects have reported the presence of discomfort. Not only LBP, subjects reported neck, shoulder, knee, and upper back discomfort along with ankle and wrist symptoms. In this COVID-19 scenario, their jobs have become more strenuous than usual. It is found that tasks requiring continuous long hours to perform are causing symptoms to appear. Shift rotations, splitting of shifts, using more ergonomically designed tools, knowledge of ergonomic skills are required in this situation to avoid the aggravation of symptoms.

Medical Interns' Perceptions and Attitudes During the COVID-19 Pandemic: A Qualitative Study

Objective: This study was designed to explore the potential association between the severity of the impact of the coronavirus disease-2019 (COVID-19) pandemic on perceptions and attitudes among medical interns. Material(s) and Method(s): The study was carried out as qualitative key informant semi-structured interviews, and were enrolled from September-October 2020 using a convenience sampling was used to recruit nine medical interns at King Faisal University College of Medicine, Saudi Arabia. Data were analyzed qualitatively using framework analysis. Semi-structured interviews were performed in Mi-crosoft Teams (online) for an average of 21 minutes, and the English language was utilized. A thematic analysis was done to identify the main concerns of the interns about education loss. Result(s): Nine participants (4 male medical interns and 5 female interns) were interviewed. The interview time averaged 18.4 minutes (range 17-21 minutes) and the mean age of the sample was 24 (standard deviation 0.707) years. Interns were more likely to be anxious, panic-ridden, horrified, depressed, stressful and disorganised due to the influence of the COVID-19 pandemic. In addition, the COVID-19 pandemic has had an impact on interns' organization of hospital rotation schedules. Furthermore, there is disagree-ment on the impact of the COVID-19 epidemic on preparation for the Medical Licensing Exams. Conclusion(s): It should be ensured that the pandemic does not affect any more interns on medical rotations, by rais-ing awareness through a bundle of educational courses.Copyright © 2023 by Turkiye Klinikleri.

The British Society for Dermatological Surgery virtual surgery learning project

Dermatological surgery training across the UK has been severely affected by the COVID-19 pandemic, with reduced face-to-face clinical activity, trainee redeployment and suspension of specialist rotations. Simultaneously, the new dermatology curriculum implemented in August 2021 has set the bar for surgical competency even higher than previously, while surgical courses and meetings that trainees have relied upon to augment their skills and knowledge have had to be suspended. Achieving curriculum learning outcomes has therefore been very challenging, and has been highlighted at National Dermatology Trainee Meetings, as well as reflected in General Medical Council surveys. In response to these difficulties, the British Society for Dermatological Surgery (BSDS) and the British Association of Dermatologists have sought new ways of delivering aspects of surgical training and established the 'Virtual Surgery Learning Project' (VSLP). A pilot group of senior dermatological surgeons and a dermatology specialist trainee with interests in education and digital technology was set up to map the project in early summer 2021, to explore possible modules and secure technical support from an e-learning company with expertise in producing innovative virtual learning. Five key aspects of surgical training were identified: surgical anatomy of the head and neck, informed consent and medicolegal matters, local anaesthesia, preoperative assessment and biopsy techniques. Over 30 volunteers, comprising dermatology specialist trainees, Mohs fellows and consultants from across the country were then recruited to the project in September 2021 and divided into working groups to design the modules, each led by a consultant with an interest in medical education and/or skin surgery. The five virtual modules are each based on clinical cases encountered in daily practice. They have been developed with a key emphasis on interactive learning and innovative self-assessment features to consolidate teaching outcomes, encourage trainee engagement and facilitate deeper learning. Users can access the 45-60-min modules at their choosing on multiple platforms. The presentation will show the features of the modules, the interactivity and innovations they contain, as well as explore how the modules were developed. While not intended as a replacement for hands-on surgical experience, the VSLP goes a significant way in addressing the shortfall in surgical education and will remain a valuable learning resource, even once working patterns normalize. Furthermore, it is an important step in expanding and improving the BSDS digital education resources available to its membership and establishing a national collaborative surgical education project.

Can Online Teaching of Radiographic Anatomy Replace Conventional On-Site Teaching? A Randomized Controlled Study.

Different modalities such as lectures, dissections, 3D models, and online learning are used for teaching anatomy. To date, online learning has been considered a useful additional didactic tool. This study aimed to compare veterinary students' performance in radiographic anatomy (radio-anatomy) after online or classroom-based teaching to assess the extent to which the two methods were interchangeable. Three strategies were compared in a cohort of 83 learners. Students were committed to online learning only, online learning with the use of specimen equine bones, or learning on conventional radiographs with specimen equine bones. At baseline (pre-test), scores from a mental rotation test and radio-anatomy knowledge test were similar between groups. After training (post-test), scores in mental rotation and radio-anatomy significantly increased by 6.7/40 units (95% CI: 5.2-8.2; p < .001) and 5.1/20 units (95% CI: 4.3-5.9; p < .001), respectively. There was no difference in scores for mental rotation and radio-anatomy knowledge between groups at post-test. Gender influenced the mental rotation, with men scoring significantly higher than women at pre-test (M = 23.0, SD = 8.8 vs. M = 16.5, SD = 6.9; p = .001) and post-test (M = 32.1, SD = 5.5 vs. M = 22.7, SD = 8.6; p < .001). However, radio-anatomy knowledge was not influenced by gender. These results suggest radio-anatomy teaching can be safely achieved with either conventional radiographs or online resources. This is of interest since, due to the COVID-19 outbreak, rapidly changing from on-site to online methods for teaching veterinary medical education proved necessary.

Effect of ceiling fan in mitigating exposure to airborne pathogens and COVID-19

Ceiling fans are the ubiquitously used electrical appliance in indoor spaces that affect the local airflow pattern and, consequently, transmission of airborne pathogens and respiratory droplets. This study numerically investigated the effect of airflow induced by the ceiling fan and ventilation rate on aerosol distribution to mitigate exposure to airborne pathogens and COVID-19. A full-scale room with a ceiling fan, natural ventilation and an occupant was modelled through transient computational fluid-particle dynamics (CFPD). To analyze the relationship between the ceiling fan rotation speed and the aerosol distribution, a ceiling fan was operated with 160, 265 and 365 revolutions per minute (RPM). The effect of the ceiling fan on particles was analyzed for particles of different sizes. The increasing ceiling fan rotation speed, the percentage deposition of the aerosol particles with diameters >40 μm was increased. The effect of different ventilation rates on aerosol distribution was evaluated. The increased ventilation rate, the percentage of the total aerosol particles flushed out was increased. The effectiveness of the mask in mitigating the exposure risk of airborne pathogens was also investigated. In combination with the natural ventilation and mask, the ceiling fan was demonstrated to have the potential to reduce airborne pathogen transmission in indoor spaces.

Pivot to SPARCC diversity in the clinical cancer research workforce, implementation and evaluation of an academic enrichment pathway before, during, and after the COVID-19 global pandemic

Academic pipeline programs are designed to mitigate systemic barriers that have historically excluded individuals due to deep-rooted, structural inequities. The Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) was developed in 2018 to diversify the clinical research health professions workforce and has graduated three cohorts of scholars from 20192021. Due to COVID-19 and safety concerns, SPARCC evolved, pivoting to establish effective learning environments virtually and in-person to ensure the original curriculum of academic, research, and professional identity development were upheld. The program aims to a.) immerse students in the clinical cancer research environment, supporting immediate employment as a clinical research professional (CRP) and b.) to provide structured support and guidance for individuals intending to pursue advanced professional degrees. SPARCC programmatic evaluations included a multifactorial strategy utilizing the same three evaluative instruments each year. These included a 17-item knowledge, attitudes, and practices (KAP) survey specific to clinical cancer research, daily workshop evaluations, and clinical practicum rotation evaluations. The SPARCC KAP was distributed immediately prior to the start of the program, upon graduation from the program, and six months later. After exploratory factor analysis, items were grouped into three factors: knowledge of clinical research practice, knowledge of research practice, and knowledge of culturally responsive cancer care. Mixed ANOVAS were used to assess changes in factors based on time (pre-, post-, and 6-month follow up;within) and cohort (year of participation;between). Over three years 156 students applied, 65% of whom identified belonging to an underrepresented ace or ethnicity. Thirty-six scholars matriculated through the program: 14(39%) White;13(36%) Black;3(8%) Asian;3(8%) Native American;1 3%) Native American/Black;1(3%) Black/Asian;1(3%) Pacific Islander. Forty-four percent (16 scholars) identified as Hispanic/Latino/a. Six scholars (17%) entered the clinical research workforce within six months of graduating from the SPARCC program, all who identified as belonging to underrepresented groups. The KAP evaluations revealed that scholars' knowledge increased significantly after participation in the program in each of the three factors: knowledge of clinical research practice (p < .007);knowledge of research practice (p < .007);and knowledge of culturally responsive cancer care (p < .007). Within six months of graduation from SPARCC, 17% of scholars entered the clinical research workforce, and nearly 60% were enrolled in graduate-research degree programs or medical school. SPARCC demonstrated curricular flexibility and ingenuity when pivoting from entirely in-person to entirely virtual, and finally to a hybrid program over the first three years of the program. Through didactic, clinical, research, and career professional identity exploration, robust learning experiences engaged scholars despite limitations on in-person contact.

Firm behavior during an epidemic.

We derive a model in which firms operate in an epidemic environment and internalize infections among their employees in the workplace. The model is calibrated to fit the moments of the Covid-19 epidemic. We show that firms have incentives to fight against infections and can do so very effectively by increasing teleworking and rotating employees between on-site work, teleworking, and leave. The fight against infections in firms flattens the aggregate infections curve. Subsidies to teleworking reduce infections and save lives. Subsidies to sick leave reduce the cost of sick workers and raise workplace infections. Firms delay and weaken the fight against infections during economic downturns. We also consider the problem of a government that values output and lives. We show that the government prefers to severely restrict the epidemic by tolerating short-term output losses when it has a high valuation of life.