Challenges with patient management of osteoarthritis during the COVID-19 pandemic: review.

Osteoarthritis is a growing public health concern, affecting millions of people worldwide. With progressively worsening joint function and pain, management of osteoarthritis is important to ensure high quality of life for patients. Treatment includes a combination of pharmacologic agents and non-pharmacologic methods such as exercise and physical therapy. However, if multiple treatments fail to improve symptoms, joint replacement surgery is the final course of action. When the new coronavirus, SARS-CoV-2 (COVID-19), was declared a pandemic, all aspects of osteoarthritis treatment become affected. Due to increased public health measures, non-pharmacologic modalities and elective surgeries became limited in accessibility. Additionally, there were concerns about the interaction of current medications for osteoarthritis with the virus. As a result of limited options for treatment and quality of life of patients was negatively impacted, especially in those with severe osteoarthritis. Furthermore, a backlog of joint replacement surgeries was created which could take up to several months or years to address. In this review, we describe the impact COVID-19 had on osteoarthritis management as well as tactics to deal with the large caseload of surgeries as operative rooms begin to re-open for elective surgeries.

Overview of ectopic pregnancy diagnosis, management, and innovation.

Ectopic pregnancies are the leading cause of maternal mortality in the first trimester, with an incidence of 5%-10% of all pregnancy-related deaths. Diagnosis of ectopic pregnancies is difficult due to clinical mimics and non-specific symptoms of abdominal pain and vaginal bleeding. The current standard for ectopic pregnancy diagnosis includes ultrasound imaging and ß-human chorionic gonadotropin (ß-hCG) monitoring. In addition to ß-hCG, serum markers are being explored as a potential for diagnosis, with activin-AB and pregnancy-associated plasma protein A specifically showing promise. Other diagnostic methods include endometrial sampling, with dilation and curettage showing the highest specificity; however, frozen section reduces the diagnostic timeline which may improve outcomes. Treatment options for confirmed ectopic pregnancies include medical, surgical, and expectant management. Chosen treatment methodology is based on ß-hCG levels, hematologic stability, and risk of ectopic pregnancy rupture. Current innovations in ectopic pregnancy management aim to preserve fertility and include laparoscopic partial tubal resection with end-to-end anastomosis and uterine artery embolization with intrauterine infusion of methotrexate. Psychological interventions to improve patient mental health surrounding ectopic pregnancy diagnosis and treatment are also valuable innovations. This literature review aims to bring light to current ectopic pregnancy diagnostics, treatments, and future directions.

Exploring the Intersection of Engineering and Medicine Through a Neuroscience Challenge Laboratory.

The medical curriculum is charged with training medical students who can possess both the technical and contextual abilities to adapt to the transformational world of medicine. This new objective would require incorporating engineering principles into the medical curriculum, which was formed by the University of Illinois as the Carle Illinois College of Medicine. As a fully integrated engineering based medical school, students partake in active learning modules that develop their quantitative, innovative, and entrepreneurship skills. An example of the active learning component of the curriculum is the "Neuroscience Engineering Challenge Lab." The purpose of this study was to explore students' perception of the lab and learn how the active-learning curriculum via the design thinking labs can be enhanced. Using a paired samples t test of pre- and post-survey results, we found that the students did not statistically gain a better understanding of the design thinking process (p = 0.052), which is expected due to the majority of students having an engineering background. Contrarily, the lab increased students' understanding of ideation tools (p = 0.003), user-centered design concepts (p = 0.004), preparing a business plan pitch (p = 0.027), and students felt better prepared for their IDEA and Capstone project (p = 0.010). Based on the results, students are becoming more confident with understanding, experience, and applying these specific tools and skills. Therefore, the medical curriculum should provide opportunities for students to develop and apply their innovation skills through active-learning activities such as a Neuroscience Engineering Challenge Lab.

Investigation of the Effects of Cardiovascular Therapeutic Ultrasound Applied in Female and Male Rats' Hearts of Different Ages.

This study investigates the role of age and sex on the cardiovascular effects of 3.5-MHz pulsed ultrasound (US) in a rat model. Ultrasonic bursts of 2.0-MPa peak rarefactional pressure amplitude (equivalent to an in vitro spatial-peak temporal-peak intensity of ~270 W/cm2 and a mechanical index of 1.1) were delivered in five consecutive 10-s intervals, one interval for each pulse repetition frequency (PRF) (6, 5, 4, 5, and 6 Hz; always the same order) for a total exposure duration of 50 consecutive seconds. Sixty F344 rats were split into 12 groups in a 3×2×2 factorial design (three ages, male versus female, and US application versus control). This study is the first study on US-induced cardiac effects that contains data across three age groups of rats (premenopause, fertile, and postmenopause) to mimic the fertile and nonfertile human window. US was applied transthoracically, while heart rate, stroke volume, ejection fraction, temperature, and other physiologic parameters were recorded at baseline and after exposure. Significant decreases in cardiac output compared to respective control groups were observed in multiple experimental groups, spanning both females and males. A negative chronotropic effect was observed in young male (~7%) and female (~16%) rats, in five-month-old male (~9%) and female (~15%) rats, and in old rats where the effect was not statistically significant. Younger groups and, to a lesser extent, lower weight groups generally had more significant effects. The pathophysiology of US-induced cardiovascular effects appears to be multifactorial and not strictly related to hormones, menopause, weight, sex, or age, individually.

Experimental Technologies in the Diagnosis and Treatment of COVID-19 in Patients with Comorbidities.

The COVID-19 pandemic has impacted the whole world and raised concerns about its effects on different human organ systems. Early detection of COVID-19 may significantly increase the rate of survival; thus, it is critical that the disease is detected early. Emerging technologies have been used to prevent, diagnose, and manage COVID-19 among the populace in the USA and globally. Numerous studies have revealed the growing implementation of novel engineered systems during the intervention at various points of the disease's pathogenesis, especially as it relates to comorbidities and complications related to cardiovascular and respiratory organ systems. In this review, we provide a succinct, but extensive, review of the pathogenesis of COVID-19, particularly as it relates to angiotensin-converting enzyme 2 (ACE2) as a viral entry point. This is followed by a comprehensive analysis of cardiovascular and respiratory comorbidities of COVID-19 and novel technologies that are used to diagnose and manage hospitalized patients. Continuous cardiorespiratory monitoring systems, novel machine learning algorithms for rapidly triaging patients, various imaging modalities, wearable immunosensors, hotspot tracking systems, and other emerging technologies are reviewed. COVID-19 effects on the immune system, associated inflammatory biomarkers, and innovative therapies are also assessed. Finally, with emphasis on the impact of wearable and non-wearable systems, this review highlights future technologies that could help diagnose, monitor, and mitigate disease progression. Technologies that account for an individual's health conditions, comorbidities, and even socioeconomic factors can drastically reduce the high mortality seen among many COVID-19 patients, primarily via disease prevention, early detection, and pertinent management.

COVID-19 vaccine and booster hesitation around the world: A literature review.

The development of COVID-19 vaccines has helped limit the extent of the pandemic, which over the past 2 years has claimed the lived of millions of people. The Moderna and Pfizer COVID-19 vaccines were the first to be manufactured using mRNA technology. Since then, other manufacturers have built their own vaccines which utilize adenovirus vector, whole inactivated coronavirus, and protein subunit methods. Given the continued mutation of the SARS-CoV-2 virus, a booster of the COVID-19 vaccine offers additional protection for citizens, especially those with comorbid conditions. However, uptake of the vaccine and booster has faced hurdles. This literature review aims to analyze the acceptance of the COVID-19 booster among different populations throughout the world. Keywords searched include "COVID-19 vaccine rates OR COVID-19 booster rates," "COVID-19 vaccine hesitancy," "COVID-19 booster hesitancy," "reasons against COVID-19 vaccine," "reasons for COVID-19 vaccine," and "COVID-19 vaccine acceptance" (for each country). Research articles indexed in PubMed, University of Illinois Urbana-Champaign Library, and Google Scholar were included. Despite the proven effectiveness of the COVID-19 booster, vaccine hesitancy is still causing suboptimal compliance to the primary vaccine and booster, thus slowing down control of the pandemic. Reasons for vaccine hesitancy differ by country and acceptance is affected by misinformation, political circumstances, and cultural values. Among the most common reasons found are distrust in the government, a lack of safety information, and fear of side effects. Uptake of the COVID-19 vaccine has also been delayed in low and middle income countries due to resource allocation and as a result, these countries have fallen behind vaccination benchmarks. The future of COVID-19 vaccination is unknown, but vaccine mandates and additional booster doses are a possibility. Determining the ethical impact that these policies could have will allow for the best implementation.

Positive chronotropic effect caused by transthoracic ultrasound in heart of rats.

Pulsed ultrasound can produce chronotropic and inotropic effects on the heart with potential therapeutic applications. Fourteen 3-month-old female rats were exposed transthoracically to 3.5-MHz 2.0-MPa peak rarefactional pressure amplitude ultrasonic pulses of increasing 5-s duration pulse repetition frequency (PRF) sequences. An increase in the heart rate was observed following each PRF sequence: an ∼50% increase after the 4-5-6 Hz sequence, an ∼57% increase after the 5-6-7 Hz sequence, and an ∼48% increase after the 6-7-8 Hz sequence. Other cardiac parameters showed a normal or indicated a compensatory decrease at 3 and 15 min post-ultrasound compared to control.

The future of COVID-19: A vaccine review.

The COVID-19 pandemic has impacted individuals, families, and communities for well over a year, and has brought light to how a broad range of social, economic, and historically relevant factors take massive tolls on the health and well-being of underserved communities around the world. This literature review aims to bring light to the current landscape of vaccines, disparities that exist in COVID-19 response, the historical relevance of the ongoing pandemic, and what needs to be accomplished for a more prepared response to potential future pandemics. It will be shown that as the world continues become more interconnected, amplification of international cooperation and well-funded response organizations are imperative to provide more equitable care in future health crises. The synthesis of current research will be helpful to researchers analyzing historical trends in the COVID-19 pandemic and individuals interested in better understanding and advocating for underserved communities across the globe.

How COVID-19 Transformed Problem-Based Learning at Carle Illinois College of Medicine.

The Carle Illinois College of Medicine is creating an innovative model for medical education that integrates engineering principles into an active learning curriculum. At the Carle Illinois due to the state order of social distancing during the COVID-19 pandemic, students were mandated to terminate in-person instruction. The goal of this work is to show the pros and cons of online versus in person Problem Based Learning (PBL) sessions. In the online environment, the sessions tend to run slower since we need to pause to allow time for people to speak and others to understand. There is more risk for students to become distracted by increased screen-time and access. Thus, the facilitator has a greater role in keeping the students engaged and focused while managing time. Despite these differences, we found that overall student performance with respect to generating and researching learning issues was similar between online and in-person PBL sessions.

Therapeutic Ultrasound in Cardiovascular Medicine.

An advantage of therapeutic ultrasound (US) is the ability to cause controlled biological effects noninvasively. Depending on the magnitude and frequency of exposure parameters, US can interact in different ways with a variety of biological tissues. The development and clinical utility of therapeutic US techniques are now rapidly growing, especially with regard to the application of US pulses for cardiac pacing and the potential treatment of cardiovascular diseases. This review outlines the basic principles of US-based therapy in cardiology, including the acoustic properties of the cardiovascular tissue, and the use of US in therapeutic cardiovascular medicine.

Introducing First-Year Medical Students to Product Innovation and Entrepreneurship.

Medical education is changing and evolving, and it is evident there is a need for emerging technologies that will improve patient outcomes and healthcare (Brazile et al. Med Teach. 40(12):1264-74, 2018). The Carle Illinois College of Medicine is creating an innovative model for medical education that integrates engineering principles into an active learning curriculum.

Medical Engineering Education: Designing a Product Innovation and Technology Session for First-Year Medical Students.

The Carle Illinois College of Medicine created an innovative model for medical education that integrates engineering principles into an active learning curriculum. First-year students were introduced to a medical device in an engaging product innovation and technology session. The goals were to discuss the physiology of oxygen saturation and demonstrate the ability to use observation and research to develop a new product idea. Students hypothetically competed with others to raise money from investors to pursue an efficient medical device and attend the users' needs. Student's feedback reflected a positive impact on their understanding of oximetry measurements and product innovation.

The Negative Chronotropic Effect in Rat Heart Stimulated by Ultrasonic Pulses: Role of Sex and Age.

OBJECTIVES: The goal of this study is to investigate the role of sex and age of the negative chronotropic effect after exposure of 3.5-MHz pulsed ultrasound (US) to the rat heart. METHODS: Forty F344 rats were exposed transthoracically to ultrasonic pulses at a duty factor of approximately 1.0% at 2.0-MPa peak rarefactional pressure amplitude. The transthoracic ultrasonic bursts were delivered consecutively in five 10-s intervals, that is, 10 s of 6-Hz pulse repetition frequency (PRF), 10 s of 5-Hz PRF, 10 s of 4-Hz PRF, 10 s of 5-Hz PRF, and 10 s of 6-Hz, for a 50-s total exposure duration. The rats were divided into 8 groups (n = 5 each): US young male, control young male, US young female, control young female, US old male, control old male, US old female, and control old female. RESULTS: Two-way ANOVA for repeated measures was used to compare heart rate, cardiac output, arterial pressure, and other hemodynamic values (baseline) before and after US stimulation. Sex versus age versus US interaction was detected for heart rate. Cardiac output showed an age effect, and ejection fraction showed age and US effects. The arterial pressure showed a sex effect. A negative chronotropic effect (∼30% decrease in heart rate) was observed for young female rats. An hypothesis is that the US effect is weight (menopause) dependent, because the young (premenopausal) female rats weighed approximately 40 to 60% less than other groups of rats. CONCLUSIONS: It is likely that the ovarian hormones are responsible for different US-induced cardiac bioeffects in different ages and sexes.

Ultrasound-induced heart rate decrease: role of the vagus nerve.

The goal of this study is to investigate the role of the vagus nerve (VN) in the ultrasound (US)-induced negative chronotropic effect (deceased heart rate). One of the functions of the VN is to mediate lowering of the heart rate. A previous study showed a decrease of ~20% in the heart rate but the mechanism of the effect was not investigated. Sprague Dawley rats (n = 20) were exposed transthoracically to ultrasonic pulses at an approximate duty factor of 1% with sequentially 2.0, 2.5, and 3.0 MPa peak rarefactional pressure amplitudes (PRPAs). The ultrasonic exposure parameters herein were chosen to match those of the previous study to have confidence that an ultrasound-induced negative chronotropic effect would occur. For each of the three PRPA sequences, the pulse repetition frequency (PRF) started slightly greater than the rat's heart rate and then was decreased sequentially in 1-Hz steps every 10 s (i.e., 6, 5, and 4 Hz for a total duration of 30 s). The experiments were organized in a standard (2 × 2) factorial design with VN (cut versus intact) as one factor and US (on versus off) as another factor. VN (intact/cut) and US (on/off) groups were divided into four groups each consisting of 5 animals: 1) VN intact-US off, 2) VN intact-US on, 3) VN cut-US off, and 4) VN cut-US on. Two-way analysis of variance for repeated measures was used to compare heart rate, cardiac output, systolic volume, ejection fraction, end-diastolic volume, end-systolic volume, respiratory rate, and arterial pressure before and after ultrasound stimulation. In this study, the heart rate decreased ~4% for the non-vagotomy and vagotomy groups. The ultrasound effect was significant for heart rate (p = 0.02) and cardiac output (p = 0.005) at 3 min post US exposure; the vagotomy effect was not significant. For heart rate, the Bonferroni test showed no differences between the four groups. The vagotomy group showed similar ultrasound-induced cardiac effects compared with the non-vagotomy group, suggesting that the vagus nerve is not influenced by the ultrasound exposure procedures. The US application caused a negative chronotropic effect of the rat heart without affecting the hemodynamic conditions. The results at this point are suggestive for an alternative cardiac pacing capability.

The role of the duty factor in ultrasound-mediated cardiac stimulation.

The role of the duty factor (DF) in ultrasound-mediated cardiac stimulation is studied. Five 3-month-old female rats were exposed transthoracically to 3.5-MHz ultrasonic pulses of 2.0-MPa peak rarefactional pressure amplitude, variable DF, and variable pulse repetition frequency. A change in the heart rate was not observed following the 0.25%-DF sequence. A decrease of ∼4% in the heart rate was observed following the 0.50%-DF and 1.00%-DF sequences. Outcomes suggest a possible DF threshold for cardiac pacing.