Emergency Plumbing Nightmares: Real Tales and Survival Guidelines When it comes to home emergencies, few issues can cause panic and stress that can compare with a plumbing catastrophe. From burst pipes to overflowing toilets, these unexpected mishaps can wreak havoc on our homes and keep us feeling helpless. In this article, we will explore some real-life domestic plumbing nightmares and share survival tips to help you navigate these crises with confidence. 1. The Great Flood: Picture this - you come house from a comforting weekend getaway only to discover your living room submerged in water. A burst tube has flipped your house into a scene from a devastation movie. What perform you do First and most important, locate the main drinking water shut-off valve. Knowing its whereabouts can save you valuable time and prevent additional damage. Keep a wrench close by in case you need to quickly shut off the water supply. 2. The Blocked Catastrophe: We've all been there - a stubborn clog that refuses to budge no matter how very much we plunge and pray. Instead of achieving for harmful chemical substances that can harm your pipes, consider using a drain snake or auger. These tools can efficiently dislodge the blockage and restore proper water stream. Remember to use gloves and follow the manufacturer's instructions for safe and sound and effective unclogging. 3. The Bathroom Nightmare: Ah, the feared overflowing bathroom. Nothing may ruin your day time quite like this unwelcome surprise. Work fast by turning off the water supply behind the toilet. If the clog persists, try using a plunger to create a seal and apply pressure. https://maps.app.goo.gl/QwU4LzEVgu8bFdHH9 For even more stubborn cases, a bathroom auger might be necessary. Remember to sanitize and disinfect the region completely to prevent any potential wellness dangers. 4. The Leaky Dilemma: A small drip may not really appear like a big deal, but over time, it may result in significant water waste materials and escalating tool bills. Don't let a leaky sink or showerhead dampen your spirits. Inspect the affected region for worn-out washers or seals that may want changing. If you're uncertain how to tackle the restoration yourself, don't wait to contact a professional plumber who may swiftly mend the leak and save you cash in the lengthy operate. 5. The Problem on Main Road: Think about hosting a dinner party and abruptly witnessing a sewage back-up in your drains. The horror! This type of plumbing nightmare requires immediate actions to prevent further contaminants and potential health risks. Call a professional plumber who is an expert in sewer range issues. They will have the knowledge, equipment, and experience to address the issue and restore normal working to your home's plumbing system. 6. The Aging Tube Blues: If your home was built many decades ago, probabilities are you have aged, corroded pipes lurking behind your walls. As these pipes age, they become more prone to leakages and bursts, causing headaches and costly fixes. Consider proactive actions such as tube inspections and regular maintenance. Changing maturing pipes may seem like a daunting task, but investing in your home's plumbing infrastructure can save you from future emergencies. 7. The DIY Catastrophe: In our age of instant knowledge at our fingertips, it's appealing to tackle domestic plumbing issues ourselves with the help of online lessons. While some small repairs may be within your capabilities, certain domestic plumbing nightmares require professional expertise. Knowing your limits and when to contact a plumber can save you from exacerbating the issue and incurring additional expenses. Keep in mind, it's better to be safe and sound than sorry. In conclusion, plumbing emergencies may be complicated and unforeseen, but with the right knowledge and preparedness, you may handle them like a pro. Whether it's a burst tube, clogged toilet, or leaky faucet, understanding how to respond quickly and successfully can help to make all the difference. And when in doubt, don't be reluctant to call a professional plumber who can navigate these nightmarish circumstances with ease. Stay proactive, stay positive, and keep your home's plumbing running smoothly.

They also expressed a greater appreciation for the ability to perform an in-person physical examination. Students performed similarly on the OSCE station in person compared to virtual visits (mean score 93% vs 93.75%).

Introducing telemedicine during a first-year medical school clinical skills course provides students with opportunities to refine their clinical skills while introducing a skill that will be commonplace in the postpandemic environment. This curriculum could be adopted not only during a time of necessary distance learning, but also continued as in-person education resumes.
Introducing telemedicine during a first-year medical school clinical skills course provides students with opportunities to refine their clinical skills while introducing a skill that will be commonplace in the postpandemic environment. This curriculum could be adopted not only during a time of necessary distance learning, but also continued as in-person education resumes.
Obesity has been declared a major risk factor for morbidity and mortality in COVID-19 patients. In this rapid review, we provide an overview of recently-published papers with clinical and epidemiological relevance on this topic.

As part of a weekly COVID-19 data mining meeting, we conducted a literature review regarding the role of obesity in COVID-19 outcomes, particularly in young patients with COVID-19. We utilized the PubMed, Upstate Medical University Health Sciences Library, Google Scholar, and LitCovid databases to identify the articles.

Our group identified seven relevant publications (four retrospective case series and three reviews).

Our group's review of this topic illustrates that obesity is a common comorbidity in hospitalized COVID-19 patients. Obesity is associated with an increased likelihood of intermittent mandatory ventilation within the first 10 days of hospitalization and a higher risk of admission to acute or critical hospital care, including in patients aged less than 60 years, howing it to be a greater risk factor than cardiovascular or pulmonary conditions for critical COVID-19 illness. https://www.selleckchem.com/products/tas-120.html There are some indications that moderate-intensity exercise may be beneficial for promoting a healthy immune system in patients with and without obesity. Given these findings, hospitals should ensure their staff are prepared and their facilities are adequately equipped to provide high-quality care to patients with obesity (PWO) hospitalized with COVID-19. link2 Family medicine and primary care physicians are encouraged to counsel their PWO about their increased risk for morbidity and mortality during this pandemic.
Primary care is evolving to meet greater demands for the inclusion of collaborative health care quality improvement (QI) processes at the practice level. Yet, data on organizational preparedness for change are limited. We assessed the feasibility of incorporating an organizational-level readiness-to-change tool that identifies factors relevant to QI implementation at the practice level impacting new family medicine physicians.

We assessed organizational readiness to change at the practice level among residents participating in a team-based QI training curriculum from April 2016 to April 2019. Seventy-six current and former residents annually completed the modified Organizational Readiness to Change Assessment (ORCA) survey. We evaluated QI and leadership readiness among five subscales empowerment, management, QI, QI leadership (skills), and QI leadership (ability). We calculated mean survey scores and compared across all 3 years. Resident interviews captured unique perspectives and experiences with team-blevel readiness to change, as measured by the ORCA tool which was part of a multimethod assessment included within a team-based QI training curriculum. Training programs undergoing curricula transformations may feasibly incorporate ORCA as a tool to identify impediments to collaborative practice and inform resource allocation important for enhancing physician training in QI leadership.
Self-care has not been traditionally taught in medical education, but the epidemic of burnout among health professionals necessitates a change in culture, and consequently a change in curriculum. Burnout begins early in training and negatively impacts health professionals, patients, and institutions. Interventions that prevent and avert burnout are necessary at all stages of a doctor's career to assure well-being over a lifetime. Evidence-based strategies supporting both personal and system wellness have begun to emerge, but more research is needed.

We present a collaborative and comprehensive wellness program "A Culture of Wellness." We offered this pilot jointly for first-year medical students and faculty volunteers at the Geisel School of Medicine at Dartmouth. We gave participants the following (1) time-60 minutes per week for 8 weeks; (2) tools-weekly cases highlighting evidence-based wellness strategies; and (3) permission-opportunities to discuss and apply the strategies personally and within their community.

Pre- and postsurvey results show that dedicated time combined with student-faculty collaboration and application of strategies was associated with significantly lower levels of burnout and perceived stress and higher levels of mindfulness and quality of life in participants. link3 Components of the curriculum were reported by all to add value to personal well-being.

This pilot presents a feasible and promising model that can be reproduced at other medical schools and disseminated to enhance personal health and promote a culture of well-being among medical students and faculty.
This pilot presents a feasible and promising model that can be reproduced at other medical schools and disseminated to enhance personal health and promote a culture of well-being among medical students and faculty.
Women's health is only briefly explored in the preclerkship medical curriculum. Volunteering in student-run free clinics (SRFCs) increases clinical confidence; such service learning could bridge the gap between limited curricular offerings and student desire for exposure to women's health topics. This study aimed to identify weaknesses in the women's health preclerkship curriculum, build an educational intervention, and explore SRFCs as a teaching tool.

We performed chart review of SRFC female patients to evaluate care. We held student focus groups to elicit feedback about the established curriculum. Based on this information, we devised a workshop to review practical skills. Participants attended the workshop, volunteered at SRFC, and completed surveys preintervention and at 3 months postintervention. A control group completed baseline and follow-up surveys.

We invited all 151 second-year students to participate; six attended the workshop and 21 served as control. There were no baseline differences bet This initiative is student-led and reproducible, and could serve as an adjunct to established preclerkship curriculum.
Professional identity formation (PIF) is a sociocultural process through which medical students adopt the professional role of physician. This process is often unscripted and influenced by informal curricular elements. PIF is as important as the acquisition of knowledge and clinical skill in the continuum of medical education.

Using the ancient art of mask making, we created a process of reflective expression to explicitly examine and formally promote PIF. Students created individual masks to express elements of self in the context of their medical education experiences. Coupled with a narrative reflection describing the mask and the process of mask making, students were challenged to examine and give shape to their evolving sense of professional identity. Using a retrospective pre/post design, we used the mask-making process to examine identity across 4 years of medical school in a cohort of graduating students.

The masks and accompanying narratives showed themes of moving from anxiety and uncertainty at matriculation to a more calm and focused state at the time of graduation. Other themes included the ability to organize complex material and the accumulation of a broad fund of knowledge. Students found the mask-making experience to be introspective and enjoyable.

Mask making is both a product (mask) and process (creation). As such, mask making is an innovative strategy to examine PIF within individuals and across time. Organization, focus, and self-understanding were common themes of professional growth.
Mask making is both a product (mask) and process (creation). As such, mask making is an innovative strategy to examine PIF within individuals and across time. Organization, focus, and self-understanding were common themes of professional growth.COVID-19 has complicated wildfire management and public safety for the 2020 fire season. It is unclear whether COVID-19 has impacted the ability of residents in the wildland-urban interface to prepare for and evacuate from wildfire, or the extent to which residents feel their household's safety has been affected. Several areas with high wildfire risk are also experiencing record numbers of COVID-19 cases, including the state of Arizona in the southwestern United States. We conducted a mixed-mode survey of households in close proximity to two recent wildfires in rural Arizona to better understand whether residents living in the wildland-urban interface perceive COVID-19 as a factor in wildfire safety. Preliminary data suggest that the current challenges around collective action to address wildfire risk may be further exacerbated due to COVID-19, and that the current pandemic has potentially widened existing disparities in household capacity to conduct wildfire risk mitigation activities in the wildland-urban interface. Proactive planning for wildfire has also increased perceived ability to practice safe distancing from others during evacuation, highlighting the benefits that household planning for wildfire can have on other concurrent hazards. Parallels in both the wildfire and pandemic literature highlight vast opportunities for future research that can expand upon and advance our findings.
Access to multidisciplinary pain treatment facilities (MPTF) is limited by extensive waiting time in many countries. However, there is a lack of knowledge about the impact of waiting time on clinical outcomes, particularly for patients with rheumatic conditions. This study examined the association between waiting time for MPTF and clinical outcomes in patients with rheumatic conditions.

Data were extracted from the Quebec Pain Registry, a large database of patients who received services in MPTF. The associations between waiting time (classified as < 2 months, 2-6 months and > 6 months) and change in pain interference, pain intensity and health-related quality of life, from the initial visit at the MPTF to the 6-month follow-up, were tested using generalized estimating equations.

A total of 3230 patients with rheumatic conditions (mean age 55.8 ± 14.0 years; 66% were women) were included in the analysis. Small significant differences in improvement between waiting time groups were revealed, with pant smaller improvements in pain interference, pain intensity and health-related quality of life; these differences were, however, not clinically significant. Based on these results, we advise that strategies are developed not only to reduce waiting times and mitigate their impacts on patients with rheumatic conditions, but also to improve treatment effectiveness in MPTF.

However, findings also indicated struggles with workload balance, inferior interactions with students and the need for additional support.

Findings from this study demonstrate that nursing faculty are generally accepting of technology and positive outcomes are possible if identified concerns are addressed and positive feelings are fostered and supported.
Findings from this study demonstrate that nursing faculty are generally accepting of technology and positive outcomes are possible if identified concerns are addressed and positive feelings are fostered and supported.
Nursing students must be prepared to care for diverse patient populations, including sexual and gender minorities.

The purpose of this study was to conduct a national survey of graduating prelicensure nursing students to assess their perceived preparedness for and comfort level with providing care for LGBTQ+ patients.

A multisite descriptive correlational design was utilized in conjunction with a modified version of the Lesbian, Gay, Bisexual, & Transgender Medical Education Assessment tool to survey graduating prelicensure nursing students' perceived levels of preparedness and comfort regarding their provision of care to LGBTQ+ individuals.

Students indicated that LGBTQ+ health topics had been covered in their programs, but some required further attention. The majority reported feeling prepared and sufficiently comfortable to provide care for LGBTQ+ patients but did not attribute this to their academic nursing education. Select demographic variables were significantly correlated to student levels of preparedness and comfort.

Nursing education programs must continue to evaluate curricular LGBTQ+ health content to ensure that graduates are equipped with the knowledge and confidence necessary to serve this unique patient population.
Nursing education programs must continue to evaluate curricular LGBTQ+ health content to ensure that graduates are equipped with the knowledge and confidence necessary to serve this unique patient population.Mentorship is important for doctoral education and development. Students in Doctor of Philosophy (PhD) in Nursing programs traditionally receive formal mentorship from more experienced faculty mentors, creating a top-down, mentor-mentee relationship. Peer mentorship, characterized by a mentor-mentee relationship between peers in similar career stages, provides unique opportunities for career development and socialization. The emergence of the COVID-19 pandemic limited in-person interactions and introduced new, complex challenges to peer mentorship. The authors, current and recently graduated PhD in Nursing students, were forced to create new ways of connecting with peers and sought to explore how other PhD in Nursing students experienced and maintained peer mentorship in their respective programs during the pandemic. In this article, the authors share their personal experiences with peer mentorship during the pandemic, their process of creating a formal peer mentor model, and findings from a national, cross-sectional survey on COVID-related, peer mentorship experiences among PhD in Nursing students from other academic institutions. Most respondents were able to maintain peer mentorship throughout the pandemic, however, less than half reported receiving faculty support to do so. Recommendations for PhD in Nursing program administrators are provided, based on the experiences of the authors and survey results from PhD in Nursing students across the United States.
In New Zealand, finding quality learning opportunities in the clinical setting is often challenging. In response, using simulation as an alternate learning environment has been proposed. Literature related to the substitution of clinical experience with simulation is relatively sparse and, in New Zealand, non-existent.

This study sought to answer the foundational issue of how students experience learning in the simulation and clinical environment. The research question was 'how do nursing students in New Zealand experience simulation and clinical practice as an environment for learning?'

This research used a descriptive qualitative design based on in-depth semi-structured interviews with twelve nursing students and written reflective stories from students' clinical practice.

Students' experiences in the two learning environments were different. https://www.selleckchem.com/products/AZD5438.html These differences were associated with relational care, predictability, responsibility and managing critical incidents.

Each environment offered nursing students valuable, yet unique learning opportunities. The key to educating nursing students is ensuring that both simulations and clinical practice are appropriately placed in the nursing curriculum while recognising their strengths and weaknesses.
Each environment offered nursing students valuable, yet unique learning opportunities. The key to educating nursing students is ensuring that both simulations and clinical practice are appropriately placed in the nursing curriculum while recognising their strengths and weaknesses.
To thoughtfully and strategically embed the updated Essentials into Doctor of Nursing Practice (DNP) curricula, it is important to understand the current landscape of the DNP project.

This discussion focuses on DNP project processes, providing a summary of the core challenges and solutions for project design, implementation and evaluation stages.

Main challenges include Difficulty defining a practice gap or absent training in protocol development for quality improvement (QI) projects (design stage); difficulty identifying and accessing project sites or practice mentors and limited academic faculty support (implementation stage); and a lack of common criteria for DNP project evaluation or unclear choices and use of QI measurement tools (evaluation stage). Scholarly Writing, Faculty Preparation, and Sustainability were overarching challenges hindering successful completion of DNP projects. Possible solutions included training and support for faculty, toolkits and practical strategies to support planning and organization.

The DNP, as an evolving degree, brings its own set of challenges for students, academic and clinical settings, faculty and administrators. Developing effective partnership of students, faculty, and healthcare systems is a key solution in helping students develop and demonstrate DNP competencies, and nursing institutions and leadership should explore further ways to fortify these partnerships.
The DNP, as an evolving degree, brings its own set of challenges for students, academic and clinical settings, faculty and administrators. Developing effective partnership of students, faculty, and healthcare systems is a key solution in helping students develop and demonstrate DNP competencies, and nursing institutions and leadership should explore further ways to fortify these partnerships.Healthcare workforce diversity is foundational for the reduction of health disparities, improvement of population health outcomes and the enhancement of patient satisfaction. To increase workforce diversity, health professional programs must be more inclusive during the admission process. Considering demographic trends and the changing landscape of healthcare, it is in the best interests of all institutions that develop students for healthcare roles to actively seek out qualified candidates from diverse backgrounds. Many colleges and universities have employed a holistic admission process to assemble a diverse class of students with the background, qualities, and skills needed for success in the profession. By engaging with students from diverse backgrounds, individuals learn how to think critically about the needs of all sectors of the community. This article discusses how one regional campus developed, implemented, and evaluated a holistic admissions process for their Bachelor of Science in Nursing (BSN) program in pursuit of a tool to work toward that aim.
Final-year baccalaureate nursing students can experience a significant amount of stress that negatively impacts their well-being, academic performance, and transition to professional practice.

This pilot study aimed to evaluate the impact of a Virtual Peer Mentoring (VPM) program using alumni mentors in addressing mental well-being, self-compassion, and professional development needs of final-year baccalaureate nursing students.

An explanatory sequential mixed-methods design was employed. The quantitative research used a quasi-experimental pretest-posttest design and quantitative data was collected using three validated instruments to assess mental well-being and self-compassion. The qualitative research used an individual and focus group interview design. Twenty-three mentees and eight mentors participated in the VPM program during the 2018-2019 academic year.

Quantitative results showed that while mental well-being and self-compassion scores improved post-intervention, the change was not statistically significant. Qualitative analysis uncovered new insights into the participants' experiences and revealed three categories (1) Continuation of the Mentoring Relationship; (2) Growth as a Recipient of Mentorship; and (3) Continual Development by Being a Mentor. The categories illustrate how mentees perceived benefits to their professional socialization, academic expectations, and well-being while mentors similarly expressed enrichment with their personal growth and professional development as a result of VPM.

VPM was well-received by participants and show promise in supporting nursing students to manage academic, practice, and socialization challenges. Both mentors and mentees described gaining mutual benefits and professional and personal growth.
VPM was well-received by participants and show promise in supporting nursing students to manage academic, practice, and socialization challenges. Both mentors and mentees described gaining mutual benefits and professional and personal growth.
Flipped classroom pedagogy is an innovative blended teaching-learning method. Prevailing evidence about flipped classroom pedagogy shows it is an effective and beneficial teaching method from the students' perspective. There is a dearth of evidence about teachers' perceptions of the flipped classroom and its implementation in low-resourced educational contexts.

To assess the university teachers' perceptions of readiness for adopting flipped classroom pedagogy in the Sri Lankan undergraduate nursing education context.

An exploratory qualitative study using focus group discussions was conducted in three public universities in Sri Lanka. The participants were 24 university teachers who were involved in undergraduate nursing education programmes in Sri Lanka. Four focus group interviews were conducted. Data were transcribed and analysed using inductive thematic analysis.

Four themes emerged. Three themes explained the teachers' perceptions of readiness for implementing flipped classrooms educational technology, acceptability of the flipped classroom pedagogy, and the educational environment. A further theme refers to future requirements for implementing the flipped classroom.

The study revealed teachers' readiness to use flipped classroom pedagogy. Nevertheless, limited resources and existing teacher-centric practice were identified as challenges to implement the flipped classroom.
The study revealed teachers' readiness to use flipped classroom pedagogy. Nevertheless, limited resources and existing teacher-centric practice were identified as challenges to implement the flipped classroom.

Leber hereditary optic neuropathy (LHON) is a maternally inherited bilaterally blinding optic neuropathy, predominantly affecting otherwise healthy young individuals, mostly men. The visual prognosis is generally poor, with most patients worsening to at least 20/200 visual acuity. The m.11778G>A (MTND4) mitochondrial DNA mutation is the most common cause of LHON and is associated with poor outcomes and limited potential for meaningful visual recovery. Treatments for LHON are limited, and clinical trials are hampered by inadequate data regarding the natural history of visual loss and recovery. In this article, we review the current literature specifically related to visual function of LHON patients with the m.11778G>A mutation.

Literature review was performed using MEDLINE through PubMed, Cochrane Reviews Library, and Orpha.net with search terms of "Leber hereditary optic neuropathy," "LHON," "ND4," "G11778A," "visual acuity," "nadir," "natural history," and "registry." All English-language, peer-revstudies with sufficient sample sizes of genotypically homogeneous untreated LHON patients stratified by age, immediately enrolled when symptomatic, followed regularly for adequate periods of time with consistent measures of visual function, and analyzed with a standard definition of visual improvement are unfortunately lacking. Future clinical trials for LHON will require more standardized reporting of the natural history of this disorder.
During a pandemic, it is paramount to understand volume changes in Level I trauma so that with appropriate planning and reallocation of resources, these facilities can maintain and even improve life-saving capabilities. Evaluating nonaccidental and accidental trauma can highlight potential areas of improvement in societal behavior and hospital preparedness. These critical questions were proposed to better understand how healthcare leaders might adjust surgeon and team coverage of trauma services as well as prepare from a system standpoint what resources will be needed during a pandemic or similar crisis to maintain services.

(1) How did the total observed number of trauma activations, defined as patients who meet mechanism of injury requirements which trigger the notification and aggregation of the trauma team upon entering the emergency department, change during a pandemic and stay-at-home order? (2) How did the proportion of major mechanisms of traumatic injury change during this time period? (3) How di which suggest community awareness, crisis de-escalation strategies, and programs need to be created to address violence in the community. Understanding these changes allows for adjustments in staffing schedules. Surgeons and trauma teams could allow for longer shifts between changeover, decreasing viral exposure because the volume of work would be lower. Understanding the shift in injury could also lead to a change in specialists covering call. With the often limited availability of orthopaedic trauma-trained surgeons who can perform life-saving pelvis and acetabular surgery, this data may be used to mitigate exposure of these surgeons during pandemic situations.

Level III, therapeutic study.
Level III, therapeutic study.
The aim of this study was to develop and validate a mobile application patient decision aid (mPDA) for providing treatment options to women with overactive bladder (OAB).

We performed a mixed methods study. We conducted cognitive interviews to gain insight about treatment decisions for OAB. We then developed an evidence-based mPDA and conducted a prospective cohort study to validate it. Women completed the validated Decisional Conflict Scale. Construct validity was determined by comparing Decisional Conflict Scale scores before and after use of the decision aid. Concurrent validity was assessed by determining the relationship between change in Decision Conflict Scale score and a validated Patient Satisfaction Questionnaire. Discriminant validity was assessed by comparing the change in Decision Conflict Scale score in women who had failed 2 or less versus 3 or more prior treatments.

Fifteen women participated in cognitive interviews. Thematic analysis revealed that women want information about adverse events, personalization of treatment options, and supplemental interactive sources. Sixty-five women participated in the validation study. Decision Conflict Scale scores improved significantly after use of the decision aid (60.2 ± 22.3 vs 18.7 ± 19.5, P < 0.001). Change in Decision Conflict Scale score correlated moderately with Patient Satisfaction Questionnaire score (r = 0.437, P = 0.003). Women with 3 or more prior treatment failures had greater improvement in Decision Conflict Scale score than women with 2 or less prior treatment failures (P < 0.001).

The mPDA is a valuable adjunct to physician counseling for treatment options in women with OAB.
The mPDA is a valuable adjunct to physician counseling for treatment options in women with OAB.
A major challenge for stroke rehabilitation and recovery research is the recruitment and retention of participants. https://www.selleckchem.com/products/azd3514.html Our prior challenges and successes have influenced our team to rethink our approach and the potential for large-scale stroke recruitment.

In this special interest article, we highlight how the adoption and implementation of recruitment strategies such as physician engagement and a streamlined "customer service" approach helped us improve our enrollment and maximize efficiency. Another positive outcome of enrollment was increased representation of those who identify as underrepresented minority or live in rural areas.

Rethinking our recruitment processes and infrastructure allowed for greater interprofessional interactions, minimal burden for our stroke physician team members, and maximized enrollment into our stroke studies.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at http//links.lww.com/JNPT/A324).
Rethinking our recruitment processes and infrastructure allowed for greater interprofessional interactions, minimal burden for our stroke physician team members, and maximized enrollment into our stroke studies.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at http//links.lww.com/JNPT/A324).Professional burnout has reached epidemic levels among U.S. medical providers. One key driver is the burden of clinical documentation in the electronic health record, which has given rise to medical scribes. Despite the demonstrated benefits of scribes, many providers-especially those in academic health systems-have been unable to make an economic case for them. With the aim of creating a cost-effective scribe program in which premedical students gain skills that better position them for professional schooling, while providers at risk of burnout obtain documentation support, the authors launched the Clinical Observation and Medical Transcription (COMET) Program in June 2015 at Stanford University School of Medicine. COMET is a new type of postbaccalaureate premedical program that combines an apprenticeship-like scribing experience and a package of teaching, advising, application support, and mentored scholarship that is supported by student tuition. Driven by strong demand from both participants and faculty, the program grew rapidly during its first 5 years (2015-2020). Program evaluations indicated high levels of satisfaction among participants and faculty with their mentors and mentees, respectively; that participants felt the experience better positioned them for professional schooling; and that faculty reported improved joy of practice. In summary, tuition-supported medical scribe programs, like COMET, appear to be feasible and cost-effective. The COMET model may have the potential to help shape future health professions students, while simultaneously combating provider burnout. While scalability and generalizability remain uncertain, this model may be worth exploring at other institutions.
To explore what influences clinicians in selecting continuing medical education (CME) activities in the United States.

In August 2018, the authors conducted an Internet-based national survey, sampling 100 respondents from each of 5 groups family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants. In total, 1,895 clinicians were invited and 500 (26%) responded. Questions addressed the selection and anticipated use of CME delivery modalities and perceived characteristics of specific CME providers. Response formats used best-worst scaling or 5-point ordinal response options.

The factors identified as most important in selecting CME activities were topic (best-worst scaling net positivity 0.54), quality of content (0.51), availability of CME credit (0.43), and clinical practice focus (0.41), while referral frequency (-0.57) ranked lowest. The activities that the respondents anticipated using most in the future wereioners, and physician assistants are interested in using a variety of CME delivery modalities. Appealing features of online and live CME were different.Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening clinical conditions predominantly arising from uncontrolled inflammatory reactions. It has been found that the administration of astaxanthin (AST) can exert protective effects against lipopolysaccharide (LPS)-induced ALI; however, the robust genetic signatures underlying LPS induction and AST treatment remain obscure. Here we performed a statistical meta-analysis of five publicly available gene expression datasets from LPS-induced ALI mouse models, conducted RNA-sequencing (RNA-seq) to screen differentially expressed genes (DEGs) in response to LPS administration and AST treatment, and integrative analysis to determine robust genetic signatures associated with LPS-induced ALI onset and AST administration. Both the meta-analyses and our experimental data identified a total of 198 DEGs in response to LPS administration, and 11 core DEGs (Timp1, Ly6i, Cxcl13, Irf7, Cxcl5, Ccl7, Isg15, Saa3, Saa1, Tgtp1, and Gbp11) were identified to be associated with AST therapeutic effects. Further, the 11 core DEGs were verified by quantitative real-time PCR (qRT-PCR) and immunohistochemistry (IHC), and functional enrichment analysis revealed that these genes are primarily associated with neutrophils and chemokines. Collectively, these findings unearthed the robust genetic signatures underlying LPS administration and the molecular targets of AST for ameliorating ALI/ARDS which provide directions for further research.The tumor microenvironment is closely related to the progression and immune escape of tumor cells. Tumor-infiltrating immune cells (TIICs) and immune-related genes (IRGs) are indispensable components of the tumor microenvironment and have been demonstrated to be highly valuable in determining the prognosis of multiple cancers. To elucidate the prognostic value of TIICs and IRGs in gastric cancer, we conducted a comprehensive analysis focusing on the abundances of 22 types of TIICs and differentially expressed IRGs based on a dataset from The Cancer Genome Atlas (TCGA). The results showed that great composition differences in TIICs and immune cell subfractions were associated with survival outcomes in different stages. Additionally, 29 hub genes were characterized from 345 differentially expressed IRGs and found to be significantly associated with survival outcomes. Then, an independent prognostic indicator based on ten IRGs was successfully constructed after multivariate adjustment for some clinical parameters.

BACKGROUND There are about 2.4 hundred thousand new cases and 1.5 hundred thousand deaths of ovarian cancer (OC) annually in the world. Chronic inflammation is a risk factor for OC. C-X-C motif chemokine ligand 1 (CXCL1) defects may facilitate inflammation and transactivate EGFR in ovarian cancer, but the precise haplotypes associated with the potential diseases remained largely unknown. In this work, we characterized CXCL1 gene variations to elucidate their possible associations with OC. METHODS We analyzed the CXCL1 gene for 300 OC patients with 400 healthy participants as controls. The statistical analyses and Hardy-Weinberg equilibrium tests of the patients and control populations were conducted using the SPSS software (version 19.0) and Plink (version 1.9). RESULTS The variants rs11547681, rs201090116, rs199791199, rs181868085, rs4074 and rs1814092 within or near the CXCL1 gene were characterized. https://www.selleckchem.com/products/mitopq.html The genetic heterozygosity of rs11547681 and rs4074 was very high. Statistical analysis showed that the variant rs11547681 in the gene was closely associated with the risk of OC in the Chinese Han population, although this variant was not associated with FIGO stages or pathological grades of the patients. CONCLUSIONS Rs11547681 in CXCL1 gene was associated with the risk of OC in the Chinese Han population.INTRODUCTION The current epidemic of chronic kidney disease (CKD) in Sri Lanka is ascribed to the exponential increase in the number of CKD patients, which cannot be attributed to any known etiology (CKDu). The aim of this study is to describe the health related quality of life (HRQOL) and the associated factors among CKD/CKDu patients in a rural district in Sri Lanka. METHODS A community based cross-sectional study included 1174 CKD/CKDu patients. Kidney Disease Quality of Life-Short Form was used to assess the HRQOL, while Centre for Epidemiologic Studies Depression Scale, General Health Questionnaire (GHQ) 12 and CKD Symptom Index - Sri Lanka were used to assess presence of depression, psychological distress and symptom burden respectively. Three summary scores; kidney disease (KDSC), physical (PCS) and mental (MCS) are derived from Kidney Disease Quality of Life-Short Form (KDQOL-SF™). RESULTS Mean age of the study population was 58.3 years (standard deviation (SD) 10.7). Median KDSC (58.4; inter-quartile range (IQR) 54.2-63.4), was higher than the median scores of PCS (35.0; IQR 26.2-41.9) and MCS (58.4; IQR 54.2-63.4). Multiple linear regression revealed low income, advanced stages of CKD, symptom burden, being positive for depression and psychological distress were significantly associated with low HRQOL. CONCLUSION The HRQOL of the CKD patients in this rural Sri Lankan population was found to be poor. Superior socio-economic status, less physical and psychological symptom burden were found to be independently associated with better HRQOL. Periodical screening of the CKD patients for depression and psychological distress and measures to alleviate symptom burden seem to be important to improve the HRQOL of these patients.BACKGROUND There is an increasing incidence rate of ground-glass opacity (GGO), especially for multiple GGOs (≥2). Whether it is safe and feasible to have bilateral simultaneous surgical resection remains unknown. The purpose of this study is to summarize the experience of surgical resection of patients with multiple GGOs in our Hospital in recent years, and to discuss the above questions. METHODS Clinical datas of patients who underwent one-stage bilateral uni-portal VATS resections of multiple pulmonary ground glass opacities and had routine pathological examination were collected from May 2016 to May 2019 in our hospital. RESULTS A total of 34 patients underwent simultaneous bilateral surgical resection of multiple GGO lesions, 28 were women,6 were men, the average age of total patients was 57.9 ± 6.7 years. All patients underwent bilateral uni-portal video-assisted thoracoscopic surgery (Uni-portal VATS), the average intraoperative blood loss was 100.9 ± 67.7 ml, the average operation time was 140 ± 74.8 y, either sub-lobar resection or lobectomy was acceptable. The risk of postoperative complications and the prognosis were optimal.The novel coronavirus disease (COVID-19) outbreak was first declared in China in December 2019, and WHO declared the pandemic on 11 March 2020. A fast-rising number of confirmed cases has been observed in all continents, with Europe at the epicentre of the outbreak at this moment.Sexual and reproductive health (SRH) and rights is a significant public health issue during the epidemics. The novel coronavirus (SARS-CoV-2) is new to humans, and only limited scientific evidence is available to identify the impact of the disease COVID-19 on SRH, including clinical presentation and outcomes of the infection during pregnancy, or for persons with STI/HIV-related immunosuppression. Beyond the clinical scope of SRH, we should not neglect the impacts at the health system level and disruptions or interruptions in regular provision of SRH services, such as pre- and postnatal checks, safe abortion, contraception, HIV/AIDS and sexually transmitted infections. Furthermore, other aspects merit attention such as the potential increase of gender-based violence and domestic abuse, and effects of stigma and discrimination associated with COVID-19 and their effects on SRH clients and health care providers. Therefore, there is an urgent need for the scientific community to generate sound clinical, epidemiological, and psycho-social behavioral links between COVID-19 and SRH and rights outcomes.BACKGROUND The spices based dietary interventions are in lime light among the scientific community owing to their promising therapeutic perspective. The bioactive components in spices can be used to exert various health promoting functions in human body such as prompting weight loss, inhibit diet-induced obesity, hypercholesterolemia, hyperglycemia, allergies and various other maladies. In current study extraction and in vitro characterization of coriander seed (CS), black cumin seed (BCS) and fenugreek seed (FS) polyphenols was conducted for further development of dietary intervention against lipid and glycemia related abnormalities in experimental Sprague Dowley rats fed with control and different spice powder supplemented diets. METHODS Purposely, extraction of Coriander (CS), Black cumin (BCS) and Fenugreek seeds (FS) were carried out by using water and aqueous methanol (7030 v/v). Afterwards, the resultant extracts were thoroughly investigated for their antioxidant potential through different indices likom T0 (58.58 ± 2.51) to 61.71 ± 1.62 (T4) in hypercholesterolemia rats whereas in hyperglycaemia rats the HDL was varied from 38.77 ± 1.2 to 40.02 ± 0.99 in T0 and T4, respectively. Similarly, T2 significantly lowered the low density lipoprotein from 62.53 ± 1.22 (T1) & 46.53 ± 0.99 to 54.88 ± 0.52 & 40.94 ± 1.99 (T2) in hypercholesteraemic and diabetic rats. Moreover, T4 treatment showed maximum reduction as 10.01 & 11.53% in respective studies. CONCLUSIONS The diet prepared from the different combination of spices has been proven effective against Oxidative stress related physiological malfunctioning.BACKGROUND The etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand. Since 2010, the Thailand Ministry of Public Health (MOPH) and US CDC have conducted surveillance to detect known and new etiologies of severe pneumonia. METHODS Surveillance for severe community-acquired pneumonia was initiated in December 2010 among 30 hospitals in 17 provinces covering all regions of Thailand. Interlinked clinical, laboratory, pathological and epidemiological components of the network were created with specialized guidelines for each to aid case investigation and notification. Severe pneumonia was defined as chest-radiograph confirmed pneumonia of unknown etiology in a patient hospitalized ≤48 h and requiring intubation with ventilator support or who died within 48 h after hospitalization; patients with underlying chronic pulmonary or neurological disease were excluded. Respiratory and pathological specimens were tested by reverse transcription polymerase chain reaction for ereby enhanced global health security. Guidelines for investigation of severe pneumonia from this project were incorporated into surveillance and research activities within Thailand and shared for adaption by other countries.More than 75% of emerging infectious diseases are zoonotic in origin and a transdisciplinary, multi-sectoral One Health approach is a key strategy for their effective prevention and control. In 2004, US Centers for Disease Control and Prevention office in Kenya (CDC Kenya) established the Global Disease Detection Division of which one core component was to support, with other partners, the One Health approach to public health science. After catalytic events such as the global expansion of highly pathogenic H5N1 and the 2006 East African multi-country outbreaks of Rift Valley Fever, CDC Kenya supported key Kenya government institutions including the Ministry of Health and the Ministry of Agriculture, Livestock, and Fisheries to establish a framework for multi-sectoral collaboration at national and county level and a coordination office referred to as the Zoonotic Disease Unit (ZDU). The ZDU has provided Kenya with an institutional framework to highlight the public health importance of endemic and epidemic zoonoses including RVF, rabies, brucellosis, Middle East Respiratory Syndrome Coronavirus, anthrax and other emerging issues such as anti-microbial resistance through capacity building programs, surveillance, workforce development, research, coordinated investigation and outbreak response. This has led to improved outbreak response, and generated data (including discovery of new pathogens) that has informed disease control programs to reduce burden of and enhance preparedness for endemic and epidemic zoonotic diseases, thereby enhancing global health security. Since 2014, the Global Health Security Agenda implemented through CDC Kenya and other partners in the country has provided additional impetus to maintain this effort and Kenya's achievement now serves as a model for other countries in the region.Significant gaps remain in implementation of the One Health approach at subnational administrative levels; there are sustainability concerns, competing priorities and funding deficiencies.BACKGROUND Strong laboratory capacity is essential for detecting and responding to emerging and re-emerging global health threats. We conducted a quantitative laboratory assessment during 2014-2015 in two resource-limited provinces in southern China, Guangxi and Guizhou in order to guide strategies for strengthening core capacities as required by the International Health Regulations (IHR 2005). METHODS We selected 28 public health and clinical laboratories from the provincial, prefecture and county levels through a quasi-random sampling approach. The 11-module World Health Organization (WHO) laboratory assessment tool was adapted to the local context in China. At each laboratory, modules were scored 0-100% through a combination of paper surveys, in-person interviews, and visual inspections. We defined module scores as strong (> = 85%), good (70-84%), weak (50-69%), and very weak ( less then  50%). We estimated overall capacity and compared module scores across the provincial, prefecture, and county levels. RESULTS Overall, laboratories in both provinces received strong or good scores for 10 of the 11 modules.