Intraoperative Ultrasound for Removal of a Fishbone Foreign Body Embedded in the Tongue.

Background: Ultrasound (U/S) is a dynamic imaging modality with many applications in medicine. In Otolaryngology, U/S is used routinely in the clinic with several evolving applications intraoperatively. Case Report. A 53-year-old male presented to the emergency department with dysphagia, odynophagia, hoarseness, and sensation of foreign body after ingesting fish. A CT scan identified an approximately 2 cm horizontally-oriented foreign body consistent with a fishbone embedded in the left posterolateral tongue. Intraoperative U/S was used to localize and remove the fishbone without complications. Results: The patient recovered well after surgery and was discharged home on postoperative day 2. No residual foreign body was found on the repeat CT scan. Conclusion: Our case demonstrates the effectiveness of intraoperative U/S for removal of fishbone foreign bodies from the tongue and serves to inspire future applications of this modality in Otolaryngology.

Emergency medicine resident perceptions of simulation-based training and assessment in competence by design.

OBJECTIVES: With the launch of competence by design (CBD) in emergency medicine (EM) in Canada, there are growing recommendations on the use of simulation for the training and assessment of residents. Many of these recommendations have been suggested by educational leaders and often exclude the resident stakeholder. This study sought to explore their experiences and perceptions of simulation in CBD. METHODS: Qualitative data were collected from November 2020 to May 2021 at McMaster University and the University of Toronto after receiving ethics approval from both sites. Eligible participants included EM residents who were interviewed by a trained interviewer using a semi-structured interview guide. All interviews were recorded, transcribed, coded, and collapsed into themes. Data analysis was guided by constructivist grounded theory. RESULTS: A total of seventeen residents participated. Thematic analysis revealed three major themes: 1) impact of CBD on resident views of simulation; 2) simulation's role in obtaining entrustable professional activities (EPAs) and filling educational gaps; and 3) conflicting feelings on the use of high-stakes simulation-based assessment in CBD. CONCLUSIONS: EM residents strongly support using simulation in CBD and acknowledge its ability to bridge educational gaps and fulfill specific EPAs. However, this study suggests some unintended consequences of CBD and conflicting views around simulation-based assessment that challenge resident perceptions of simulation as a safe learning space. As CBD evolves, educational leaders should consider these impacts when making future curricular changes or recommendations.

RéSUMé: OBJECTIFS: Avec le lancement de la compétence par conception (CPC) en médecine d'urgence (MU) au Canada, il existe des recommandations croissantes sur l'utilisation de la simulation pour la formation et l'évaluation des résidents. Beaucoup de ces recommandations ont été suggérées par des leaders éducatifs et excluent souvent la partie prenante résidente. Cette étude visait à explorer leurs expériences et leurs perceptions de la simulation dans la CPC. MéTHODES: Des données qualitatives ont été collectées de novembre 2020 à mai 2021 à l'Université McMaster et à l'Université de Toronto après avoir reçu l'approbation éthique des deux sites. Les participants éligibles étaient des résidents en MU qui ont été interviewés par un interviewer formé à l'aide d'un guide d'entretien semi-structuré. Toutes les interviews ont été enregistrées, transcrites, codées et regroupées en thèmes. L'analyse des données a été guidée par la théorie ancrée constructiviste. RéSULTATS: Au total, dix-sept résidents ont participé. L'analyse thématique a révélé trois thèmes majeurs : (1) l'impact de la CPC sur les opinions des résidents sur la simulation ; (2) le rôle de la simulation dans l'obtention des activités professionnelles confiables (APC) et le comblement des lacunes éducatives ; et (3) des sentiments contradictoires sur l'utilisation de l'évaluation basée sur la simulation à hauts enjeux dans la CPC. CONCLUSIONS: Les résidents en MU soutiennent fortement l'utilisation de la simulation dans la CPC et reconnaissent sa capacité à combler les lacunes éducatives et à remplir des APC spécifiques. Cependant, cette étude suggère quelques conséquences imprévues de la CPC et des opinions divergentes sur l'évaluation basée sur la simulation qui remettent en question les perceptions des résidents de la simulation comme un espace d'apprentissage sécuritaire. À mesure que la CPC évolue, les leaders éducatifs devraient tenir compte de ces impacts lorsqu'ils apportent des changements ou des recommandations curriculaires futurs.

The promises and challenges of clinical AI in community paediatric medicine.

The widespread adoption of virtual care technologies has quickly reshaped healthcare operations and delivery, particularly in the context of community medicine. In this paper, we use the virtual care landscape as a point of departure to envision the promises and challenges of artificial intelligence (AI) in healthcare. Our analysis is directed towards community care practitioners interested in learning more about how AI can change their practice along with the critical considerations required to integrate AI into their practice. We highlight examples of how AI can enable access to new sources of clinical data while augmenting clinical workflows and healthcare delivery. AI can help optimize how and when care is delivered by community practitioners while also improving practice efficiency, accessibility, and the overall quality of care. Unlike virtual care, however, AI is still missing many of the key enablers required to facilitate adoption into the community care landscape and there are challenges we must consider and resolve for AI to successfully improve healthcare delivery. We discuss several critical considerations, including data governance in the clinic setting, healthcare practitioner education, regulation of AI in healthcare, clinician reimbursement, and access to both technology and the internet.

Congenital Adrenal Hyperplasia and Human Leukocyte Antigen B: A Meta-Analysis.

The link between specific human leukocyte antigen (HLA)-B genes and congenital adrenal hyperplasia (CAH) has been a subject of interest. This study investigates the association between specific HLA-B haplotypes and CAH through a meta-analysis. Google Scholar was used as a database. Articles were included if the research was conducted between 1970 and 2022, was not a meta-analysis, and had odds ratios or enough data points to calculate an odds ratio. The National Institutes of Health (NIH) quality assessment tool of case-control studies was used to evaluate the risk of bias in individual studies, and MetaXL was used to generate data and create a forest plot for analysis. Twelve studies met the selection criteria and were included in the study (641 patients and 3,614 controls). Two HLA-B haplotypes showed increased odds of CAH compared to controls: B14 (OR=3.81; 95%CI=2.88, 5.05; I2=3%) and B35 (OR=1.88; 95%CI=1.22, 2.90; I2=25%). All other HLAs either showed no significant effect or had high heterogeneity. The results suggest that specific HLA-B haplotypes have increased odds of developing CAH, specifically B14 and B35. These findings may prove helpful in the pre- and post-natal diagnosis of CAH as well as the identification of carriers and prediction of patient prognosis.

Video-based coaching for surgical residents: a systematic review and meta-analysis.

BACKGROUND: Video-based coaching (VBC) is used to supplement current teaching methods in surgical education and may be useful in competency-based frameworks. Whether VBC can effectively improve surgical skill in surgical residents has yet to be fully elucidated. The objective of this study is to compare surgical residents receiving and not receiving VBC in terms of technical surgical skill. METHODS: The following databases were searched from database inception to October 2021: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. Articles were included if they were randomized controlled trials (RCTs) comparing surgical residents receiving and not receiving VBC. The primary outcome, as defined prior to data collection, was change in objective measures of technical surgical skill following implementation of either VBC or control. A pairwise meta-analyses using inverse variance random effects was performed. Standardized mean differences (SMD) were used as the primary outcome measure to account for differences in objective surgical skill evaluation tools. RESULTS: From 2734 citations, 11 RCTs with 157 residents receiving VBC and 141 residents receiving standard surgical teaching without VBC were included. There was no significant difference in post-coaching scores on objective surgical skill evaluation tools between groups (SMD 0.53, 95% CI 0.00 to 1.01, p = 0.05, I2 = 74%). The improvement in scores pre- and post-intervention was significantly greater in residents receiving VBC compared to those not receiving VBC (SMD 1.62, 95% CI 0.62 to 2.63, p = 0.002, I2 = 85%). These results were unchanged with leave-one-out sensitivity analysis and subgroup analysis according to operative setting. CONCLUSION: VBC can improve objective surgical skills in surgical residents of various levels. The benefit may be most substantial for trainees with lower baseline levels of objective skill. Further studies are required to determine the impact of VBC on competency-based frameworks.

Effect of Local Antibiotic Prophylaxis on Postoperative Deep Infection in Fracture Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVES: Despite the use of systemic antibiotic prophylaxis, postoperative infection after fracture surgery remains an issue. The purpose of this systematic review and meta-analysis was to evaluate the effect of locally applied antibiotics on deep infection in fracture surgery in both the open and closed fractures. DATA SOURCES: A comprehensive search of MEDLINE, Embase, and PubMed was performed from the date of inception to April 15, 2021, and included studies in all languages. STUDY SELECTION: Cohort studies were eligible if they investigated the effect on the infection rate of local antibiotic prophylaxis on deep infection after fracture surgery. DATA EXTRACTION: This study was conducted according to the Cochrane Handbook for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials and the Methodological Index for Nonrandomized Studies tool where applicable. DATA SYNTHESIS: An inverse variance random-effects model was the primary analysis model because of the anticipated diversity in the evaluated populations. Univariate models were used when a single outcome was of interest. CONCLUSIONS: The risk of deep infection was significantly reduced when local antibiotics were applied compared with the control group receiving systemic prophylaxis only. This beneficial effect was observed in open fractures but failed to reach statistical significance in closed fractures. This meta-analysis suggests that there may be a significant risk reduction in deep infection rate after fracture surgery when local antibiotics are added to standard systemic prophylaxis, particularly in open fractures. Further high-powered Level I studies are needed to support these findings. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Senhance Surgical System in Colorectal Surgery: A Systematic Review.

The Senhance Surgical System allows for infrared eye tracking, haptic feedback, and an adjustable upright seat allowing for improved ergonomics. This systematic review was designed with the aim of reviewing the current literature pertaining to the use of the Senhance Surgical System in colorectal surgery. Medline, EMBASE, and CENTRAL were searched. Articles were eligible for inclusion if they evaluated adults undergoing colorectal surgery with the Senhance Surgical System. The primary outcome was intraoperative efficacy; as defined by operative time, estimated blood loss (EBL), and conversion. A DerSimonian and Laird inverse variance random-effects meta-analysis was used to generate overall effect size estimates and narrative review was provided for each outcome. Six observational studies with 223 patients (mean age: 63.7, 41.2% female, mean BMI: 24.4 kg/m2) were included. The most common indication for surgery was colorectal cancer (n = 180, 80.7%) and the most common operation was anterior resection (n = 72, 32.3%). Meta-analyses demonstrated a pooled total operative time of 229.8 min (95% CI 189.3-270.4, I2 = 0%), console time of 141.3 min (95% CI 106.5-176.1, I2 = 0%), and docking time of 10.8 min (95% CI 6.4-15.2, I2 = 0%). The pooled EBL was 37.0 mL (95% CI 24.7-49.2, I2 = 20%). Overall, there were nine (4.0%) conversions to laparoscopy/laparotomy. The Senhance Surgical System has an acceptable safety profile, reasonable docking and console times, low conversion rates, and an affordable case cost across a variety of colorectal surgeries. Further prospective, comparative trials with other robotic surgical platforms are warranted.

Delivering Point-of-Care ultrasound teaching using a video conferencing technique.

Point-of-care ultrasound (POCUS) has usually been taught using a hands-on, in-person approach. We present a novel approach to delivering POCUS virtually using a dual image videoconferencing technique. We outline an easily implementable approach and summarize medical students' experience and feedback. This form of delivery has potential to improve instructional delivery in resource restricted settings or during pandemic restrictions where a hands-on approach may not be possible.

L'échographie au chevet fait généralement l'objet d'un enseignement pratique, en personne. Nous présentons une nouvelle approche, virtuelle, pour son enseignement, par visioconférence à double flux vidéo. L'approche que nous décrivons est facile à mettre en œuvre. Nous résumons l'expérience et les commentaires des étudiants en médecine sur cette modalité qui est susceptible d'améliorer l'enseignement dans des contextes où les ressources sont limitées ou en cas de pandémie, lorsque l'approche pratique n'est pas possible.

Development of process analytical tools for rapid monitoring of live virus vaccines in manufacturing.

In the development of end-to-end large-scale live virus vaccine (LVV) manufacturing, process analytical technology (PAT) tools enable timely monitoring of critical process parameters (CPP) and significantly guide process development and characterization. In a commercial setting, these very same tools can enable real time monitoring of CPPs on the shop floor and inform harvest decisions, predict peak potency, and serve as surrogates for release potency assays. Here we introduce the development of four advanced PAT tools for upstream and downstream process monitoring in LVV manufacturing. The first tool explores the application of capacitance probes for real time monitoring of viable cell density in bioreactors. The second tool utilizes high content imaging to determine optimum time of infection in a microcarrier process. The third tool uses flow virometry (or nanoscale flow cytometry) to monitor total virus particle counts across upstream and downstream process steps and establishes a robust correlation to virus potency. The fourth and final tool explores the use of nucleic acid dye staining to discriminate between "good" and "damaged" virus particles and uses this strategy to also monitor virus aggregates generated sometimes during downstream processing. Collectively, these tools provide a comprehensive monitoring toolbox and represent a significantly enhanced control strategy for the manufacturing of LVVs.

Legal concerns in health-related artificial intelligence: a scoping review protocol.

BACKGROUND: Medical innovations offer tremendous hope. Yet, similar innovations in governance (law, policy, ethics) are likely necessary if society is to realize medical innovations' fruits and avoid their pitfalls. As innovations in artificial intelligence (AI) advance at a rapid pace, scholars across multiple disciplines are articulating concerns in health-related AI that likely require legal responses to ensure the requisite balance. These scholarly perspectives may provide critical insights into the most pressing challenges that will help shape and advance future regulatory reforms. Yet, to the best of our knowledge, there is no comprehensive summary of the literature examining legal concerns in relation to health-related AI. We thus aim to summarize and map the literature examining legal concerns in health-related AI using a scoping review approach. METHODS: The scoping review framework developed by (J Soc Res Methodol 8:19-32, 2005) and extended by (Implement Sci 5:69, 2010) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) guided our protocol development. In close consultation with trained librarians, we will develop a highly sensitive search for MEDLINE® (OVID) and adapt it for multiple databases designed to comprehensively capture texts in law, medicine, nursing, pharmacy, other healthcare professions (e.g., dentistry, nutrition), public health, computer science, and engineering. English- and French-language records will be included if they examine health-related AI, describe or prioritize a legal concern in health-related AI or propose a solution thereto, and were published in 2012 or later. Eligibility assessment will be conducted independently and in duplicate at all review stages. Coded data will be analyzed along themes and stratified across discipline-specific literatures. DISCUSSION: This first-of-its-kind scoping review will summarize available literature examining, documenting, or prioritizing legal concerns in health-related AI to advance law and policy reform(s). The review may also reveal discipline-specific concerns, priorities, and proposed solutions to the concerns. It will thereby identify priority areas that should be the focus of future reforms and regulatory options available to stakeholders in reform processes. TRIAL REGISTRATION: This protocol was submitted to the Open Science Foundation registration database. See https://osf.io/zav7w .

Which Recommendations Are You Using? A Survey of Emergency Physician Management of Paroxysmal Atrial Fibrillation.

Background: Both the Canadian Cardiovascular Society (CCS) and the Canadian Association of Emergency Physicians (CAEP) have published documents to guide atrial fibrillation (AF) management. In 2021, the CAEP updated its AF checklist. Prior to this update, the recommendations of the 2 organizations differed in several key areas, including the suggested cardioversion timeframe, the factors determining cardioversion eligibility, and anticoagulant initiation after cardioversion. Whether emergency physicians (EPs) are aware of, or adhering to, one, both, or neither of these documents is unknown. Methods: We assessed document awareness, adherence, and EP practice using a piloted questionnaire administered to EPs at 5 emergency departments in 3 provinces. Results: Of 166 survey recipients, 123 (74.1%) responded. The majority (64.7%) worked at an academic site, 38.8% identified as female, and median years in practice was 10.0. Most (93.1%) were aware of at least one of the documents; 45.7% were aware of both. Reported awareness was higher for the CCS (77.6%) vs the CAEP (61.2%) guidelines. Respondents varied in their adherence, with 40.5% using parts of both documents. Considerable practice variability occurred when recommendations conflicted. Despite its use not being recommended by either organization, half of respondents (50.0%) reported using the CHA2DS2-VASc score as their stroke-risk assessment tool. Conclusions: Although most surveyed EPs were aware of at least one organization's AF documents, many reported using parts of both. When recommendations conflicted, EPs were divided in their decision-making. These findings emphasize the need to improve consensus between organizations and further improve knowledge translation.

Introduction: La Société canadienne de cardiologie (SCC) et l'Association canadienne des médecins d'urgence (ACMU) ont publié des documents pour orienter la prise en charge de la fibrillation auriculaire (FA). En 2021, l'ACMU a actualisé sa liste de vérification sur la FA. Avant cette actualisation, les recommandations des deux organismes différaient sur plusieurs points importants, notamment le laps de temps suggéré avant la cardioversion, les facteurs qui déterminent l'admissibilité à la cardioversion, et l'amorce du traitement anticoagulant après la cardioversion. On ignore si les médecins d'urgence (MU) connaissent ou adhère à un, à deux ou à aucun de ces documents. Méthodes: Nous avons évalué la connaissance qu'ont les MU de ces documents, leur adhésion et leur pratique grâce à un questionnaire pilote soumis aux MU de cinq services des urgences de trois provinces. Résultats: Parmi les 166 participants à l'enquête, 123 (74,1 %) y ont répondu. La majorité (64,7 %) travaillait dans un établissement universitaire, 38,8 % étaient des femmes, et le nombre médian d'années de pratique était de 10,0. La plupart (93,1 %) connaissaient au moins un des documents; 45,7 % connaissaient les deux. La connaissance rapportée était plus élevée pour les lignes directrices de la SCC (77,6 %) que pour les lignes directrices de l'ACMU (61,2 %). L'adhésion des répondants variait, mais 40,5 % utilisaient des parties des deux documents. La variabilité considérable de la pratique était observée lorsque les recommandations étaient contradictoires. Bien que son utilisation ne soit pas recommandée par l'un ou l'autre de ces organismes, la moitié des répondants (50,0 %) signalaient utiliser le score CHA2DS2-VASc comme outil d'évaluation du risque d'accident vasculaire cérébral. Conclusions: Bien que la plupart des MU interrogés connaissaient au moins un document sur la FA des organismes, plusieurs signalaient utiliser des parties des deux documents. Lorsque les recommandations étaient contradictoires, les MU étaient divisés sur la prise de décision. Ces résultats confirment la nécessité d'améliorer le consensus entre les organismes et d'améliorer davantage l'application des connaissances.

Water Dynamics in a Peptide-appended Pillar[5]arene Artificial Channel in Lipid and Biomimetic Membranes.

Peptide-appended Pillar[5]arene (PAP) is an artificial water channel that can be incorporated into lipid and polymeric membranes to achieve high permeability and enhanced selectivity for angstrom-scale separations [Shen et al. Nat. Commun. 9:2294 (2018)]. In comparison to commonly studied rigid carbon nanotubes, PAP channels are conformationally flexible, yet these channels allow a high water permeability [Y. Liu and H. Vashisth Phys. Chem. Chem. Phys. 21:22711 (2019)]. Using molecular dynamics (MD) simulations, we study water dynamics in PAP channels embedded in biological (lipid) and biomimetic (block-copolymer) membranes to probe the effect of the membrane environment on water transport characteristics of PAP channels. We have resolved the free energy surface and local minima for water diffusion within the channel in each type of membrane. We find that water follows single file transport with low free-energy barriers in regions surroundings the central ring of the PAP channel and the single file diffusivity of water correlates with the number of hydrogen bonding sites within the channel, as is known for other sub-nm pore-size synthetic and biological water channels [Horner et al. Sci. Adv. 1:e1400083 (2015)].

Streptococcus dysgalactiae: A Pathogen of Feral Populations of Silver Carp from a Fish Kill Event.

In August 2018, a series of large fish kills involving only Silver Carp Hypophthalmichthys molitrix occurred on the Mississippi River in northern Louisiana. Clinical signs observed in moribund animals included erratic swimming behavior, such as spiraling and spinning at the surface. A moribund specimen was captured by dip net near the surface at Lake Providence Landing in East Carroll Parish, northern Louisiana, and was submitted for analysis. An aseptic necropsy was performed, and diagnostic procedures, including bacteriology, parasitology, histopathology, virology, and electron microscopy, revealed that a gram-positive coccus was the primary pathogen. Pure cultures of the organism were obtained from the brain, and it was the predominant colony type isolated from the spleen, kidney, and liver. Bacterial sepsis caused by the gram-positive coccus and involving multiple organ systems was diagnosed histologically. Bacterial colonization and necrotic lesions were seen in the spleen, liver, kidney, heart, eye, and brain. Numerous cocci were observed dividing intracellularly in phagocytic cells of the kidney and brain by transmission electron microscopy. The organism was identified as Streptococcus dysgalactiae ssp. dysgalactiae by conventional biochemical methods and subsequently by the API 20 Strep system. The identity of the pathogen was later confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and sequencing of the 16S ribosomal RNA gene. Multilocus sequence analysis clustered this isolate along with two other S. dysgalactiae isolates from fish in a divergent phyletic group that was separate from other S. dysgalactiae ssp. dysgalactiae isolates from terrestrial animals, implying a possible novel clade that is pathogenic for fish.

End-to-end versus end-to-side anastomosis for low anterior resection: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Numerous randomized controlled trials comparing end-to-end and end-to-side anastomoses after low anterior resection have been performed. Rates of anastomotic leakage and overall postoperative morbidity, as well as reported quality of postoperative bowel function, vary across individual studies. As such, this study meta-analyzes pooled data comparing end-to-end and end-to-side anastomosis after low anterior resection in terms of anastomotic leak rate and postoperative bowel function. METHODS: A search of Medline, EMBASE, and Cochrane Central Register of Controlled Trials was performed. Articles were included if they were randomized controlled trials that compared end-to-end and end-to-side anastomosis after low anterior resection for benign or malignant disease. The primary outcome was anastomotic leak rate. A pairwise meta-analysis was performed using inverse variance random effects. RESULTS: From 1,452 citations, 6 randomized controlled trials with 270 patients undergoing end-to-end anastomosis (45.9% female, mean age: 63.5 years) and 268 patients undergoing end-to-side anastomosis (52.4% female, mean age: 64.0 years) met inclusion criteria. Patients undergoing end-to-side anastomosis had a significantly lower rate of anastomotic leak (RR 0.37, 95% CI 0.15-0.93, P = .04, I2=0%). There were no differences in rate of anastomotic stenosis (RR 1.03, 95% CI 0.21-5.19, P = .97) or overall postoperative morbidity (RR 0.60, 95% CI 0.33-1.07, P = .08). Narrative review of postoperative bowel function demonstrated evidence of improved Wexner scores for 6 months postoperatively in patients undergoing end-to-side anastomosis. CONCLUSION: End-to-side anastomosis significantly reduces the risk of anastomotic leak after low anterior resection. Additional prospective trials are warranted to confirm the findings of this review and to contribute to the growing evidence-base aimed at optimization of bowel function after low anterior resection.

Symptoms of COVID-19 infection and magnitude of antibody response in a large community-based study

BackgroundThe majority of COVID-19 cases are asymptomatic, or minimally symptomatic with management in the home. Little is known about the frequency of specific symptoms in the general population, and how symptoms predict the magnitude of antibody response to SARS-CoV-2 infection. MethodsWe quantified IgG antibodies against the SARS-CoV-2 receptor binding domain (RBD) in home-collected dried blood spot samples from 3,365 adults participating in a community-based seroprevalence study in the city of Chicago, USA, collected between June 24 and November 11, 2020. Results17.8% of the sample was seropositive for SARS-CoV-2. A cluster of symptoms (loss of sense of smell or taste, fever, shortness of breath, muscle or body aches, cough, fatigue, diarrhea, headache) was associated with stronger anti-RBD IgG responses among the seropositives. 39.2% of infections were asymptomatic, and 2 or fewer symptoms were reported for 66.7% of infections. Total number of symptoms was positively but weakly associated with IgG response: Median anti-RBD IgG was 0.95 ug/mL for individuals with 3 or more symptoms, in comparison with 0.61 ug/mL for asymptomatic infections. ConclusionWe document high rates of asymptomatic and mild infection in a large community-based cohort, and relatively low levels of anti-SARS-CoV-2 IgG antibody in the general population of previously exposed individuals.

Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis.

PURPOSE: Patients with stage I anal squamous cell carcinoma (SCC) have been underrepresented in landmark trials showing superiority of chemoradiotherapy over radiotherapy for definitive treatment. This review aims to elucidate whether definitive treatment with radiotherapy versus chemoradiotherapy is associated with differences in survival and treatment-related toxicity outcomes in patients with stage I anal SCC. METHODS: Medline, EMBASE, and CENTRAL were searched as of November 2020 to identify studies comparing outcomes of radiotherapy versus chemoradiotherapy for non-operative treatment of patients with stage I anal SCC. The primary outcomes were 5-year overall survival and 5-year disease-free survival. The secondary outcome was treatment-related toxicities. A pairwise meta-analysis was performed using an inverse-variance random-effects model. RESULTS: From 2174 citations, 5 retrospective studies with 415 patients treated with radiotherapy and 3784 patients treated with chemoradiotherapy were included. Patients treated with chemoradiotherapy had an increased 5-year overall survival (RR 1.18, 95% CI 1.10-1.26, p < 0.00001, I2 = 0%) but no significant difference in 5-year disease-free survival (RR 1.01, 95% CI 0.92-1.11, p = 0.87, I2 = 0%). Treatment-related toxicities could not be meta-analyzed due to heterogeneity. Limited data from individual studies suggested an increased frequency of select toxicities with chemoradiotherapy. CONCLUSION: Radiotherapy may be an appropriate alternative to chemoradiotherapy for patients with stage I anal SCC who may be unable to tolerate chemotherapy-related toxicity; however, chemoradiotherapy remains the gold standard. Larger prospective studies comparing strategies for this select patient population are needed to clarify whether treatment can be de-escalated.

Cross-sectional study of readmissions to the psychiatric ward of Hospital Estadual Mário Covas in Santo André, state of São Paulo, between 2008 and 2015 / Estudo transversal das reinternações na enfermaria psiquiátrica do Hospital Estadual Mário Covas em Santo André, Estado de São Paulo, entre 2008 e 2015

Abstract Objectives To assess the sociodemographic and diagnostic profile of data related to psychiatric readmissions to the psychiatric ward at Hospital Estadual Mário Covas between January 2008 and September 2015, in order to investigate the possible correlation between the rate of admission and readmission and the presence or absence of a discharged patient unit or other outpatient treatment unit. Methods This was a cross-sectional, descriptive study. Data on patients readmitted during the study period were sourced from a statistical analysis of the Hospital Estadual Mário Covas database using STATA 11.0. Results During the study period, hospitalization rates decreased, while the readmission rates increased over the years, at a total of 662 readmissions. This rise in readmissions had no correlation with the presence of a discharged patient unit or other outpatient unit. Women comprised the majority of the sample, with a mean age of 42; the most prevalent disorder among women was bipolar affective disorder, while among men it was schizophrenia. The length of hospitalization increased over time, with a maximum mean time of 23 days in 2015. Most of the patients were referred from Santo André as well as from hospitals in São Paulo. Conclusion The increase in the rate of readmissions over the years suggests that the mental healthcare model may have shortcomings along the chain. It is important to understand the epidemiological profile and chain of events that led to repeated hospitalizations in order to design new strategies and approaches to care so as to keep the patients stabilized.

Resumo Objetivos Obter o perfil sociodemográfico e diagnóstico dos pacientes reinternados no Hospital Estadual Mário Covas entre janeiro de 2008 e setembro de 2015, com o intuito de investigar a possível relação entre as taxas de admissão e readmissão e a existência ou ausência do serviço para pacientes de alta clinica do hospital ou de outros serviços. Métodos Este foi um estudo descritivo transversal. Os dados foram obtidos do Hospital Estadual Mário Covas e analisados pelo programa STATA 11.0 Resultados Durante o período do estudo, as taxas de hospitalização diminuíram, enquanto as taxas de readmissão aumentaram progressivamente, com um total de 662 reinternações. O aumento dessas reinternações não teve relação com a presença da unidade pós-alta hospitalar do próprio hospital ou de outros serviços. A maioria dos pacientes era composta de mulheres, com idade média de 42 anos; o principal diagnóstico entre mulheres foi o transtorno afetivo bipolar, enquanto que para homens foi a esquizofrenia. O tempo de hospitalização aumentou com os anos, com uma média máxima em 2015 de 23 dias. A maior parte dos pacientes era referenciado de Santo André e outros hospitais de São Paulo. Conclusão O aumento das taxas de reinternação ao longo dos anos sugere que o sistema de cuidado mental tem deficiências em sua prática. É importante entender o perfil epidemiológico e a cascata de eventos que levam a rehospitalizações e, assim, traçar novas estratégias e abordagens de cuidado, mantendo os pacientes estabilizados.

Cross-sectional study of readmissions to the psychiatric ward of Hospital Estadual Mário Covas in Santo André, state of São Paulo, between 2008 and 2015.

OBJECTIVES: To assess the sociodemographic and diagnostic profile of data related to psychiatric readmissions to the psychiatric ward at Hospital Estadual Mário Covas between January 2008 and September 2015, in order to investigate the possible correlation between the rate of admission and readmission and the presence or absence of a discharged patient unit or other outpatient treatment unit. METHODS: This was a cross-sectional, descriptive study. Data on patients readmitted during the study period were sourced from a statistical analysis of the Hospital Estadual Mário Covas database using STATA 11.0. RESULTS: During the study period, hospitalization rates decreased, while the readmission rates increased over the years, at a total of 662 readmissions. This rise in readmissions had no correlation with the presence of a discharged patient unit or other outpatient unit. Women comprised the majority of the sample, with a mean age of 42; the most prevalent disorder among women was bipolar affective disorder, while among men it was schizophrenia. The length of hospitalization increased over time, with a maximum mean time of 23 days in 2015. Most of the patients were referred from Santo André as well as from hospitals in São Paulo. CONCLUSION: The increase in the rate of readmissions over the years suggests that the mental healthcare model may have shortcomings along the chain. It is important to understand the epidemiological profile and chain of events that led to repeated hospitalizations in order to design new strategies and approaches to care so as to keep the patients stabilized.

Parameterization and atomistic simulations of biomimetic membranes.

Biomimetic membranes, designed by combining proteins or protein-mimics with self-assembled block copolymers, are emerging as novel hybrid materials with applications in the next generation of sensing and separation devices. However, designing such membranes requires a fundamental understanding of the atomic-scale interactions between biological channel proteins and their non-native polymeric membrane environment as it affects their stability and function. In principle, all-atom molecular dynamics (MD) simulations are well-suited to probe the atomistic details of channel/membrane interactions, but the absence of interatomic potentials is a major limiting factor in conducting such simulations. To alleviate this, we have developed CHARMM force-field compatible parameters and conducted all-atom explicit-solvent MD simulations of biomimetic membranes composed of block copolymers of poly(butadiene), poly(isoprene), and poly(ethylene oxide). Consistent with scaling laws and literature data, we report measurements on several structural properties that inform on molecular-scale features of chain conformations. Finally, we report simulations of a synthetic transport channel in selected membranes and characterize its functional behavior by measuring the single-channel water permeability. We suggest that the interatomic potentials and membrane models reported here could be useful in studies of other proteins as well as for deriving potentials for coarse-grained models to permit future simulations of large-scale protein/polymer membranes.