Prevention of syncope during IUD placement, a quality improvement project

Syncope is a common experience that patients within the medical community experience. The syncope and the sensation of syncope is secondary to a vagal response that causes excessive pooling in the peripheral vasculature leading to an overall decrease in blood flow to the cerebral tissue. This typically presents during medical procedures including cervical or uterine biopsies, pap smears, blood draws, injections, or seeing the site of blood. This presentation is usually diaphoresis, facial pallor, dilated pupils, and fatigue. The treatment should include having the patient recognizing these symptoms and to have them isometrically contract their extremities and other counter pressure maneuvers. The efficacy of these symptoms were studied which found that recurrent syncope was decreased (32 vs 51 percent), via patient education and early physician recognition

Chronic appendicular abscess presenting as a complex adnexal mass: A case report

Background: The authors present an unusual presentation of a chronic appendicular abscess. A 57-year-old presented to the emergency department with acute on chronic abdominal pain, worsening abdominal distention and decreased appetite. Abdominal imaging revealed the presence of a multi-septated cystic right adnexal mass concerning for metastatic ovarian carcinoma. Intra-operatively the diagnosis of a likely chronic ruptured appendix at the base of the colon was confirmed. In postmenopausal women the majority of adnexal masses are benign neoplasms, however, the risk of malignancy is much greater than in premenopausal women. Postmenopausal women with clinical symptoms and findings on diagnostic imaging suggestive of malignancy warrant expedited management. While imaging and biomarkers help to give insight into origin of masses and can aid in determining treatment, diagnostic operations may be ultimately required to achieve final diagnosis and direct further management.Methods: All data collected was de identified and kept within a secure location.Results: Adnexal masses can present in a variety of ways and yield pathology from simple cysts to infectious process or even metastatic carcinoma. On the contrary, the diagnosis of acute appendicitis is typically straight forward, classically manifesting with acute periumbilical pain localizing to the right lower quadrant, abdominal guarding, and leukocytosis. The atypical presentation of chronic appendicitis can often lead to misdiagnosis, particularly in sexually active females, or as in our case, patients presenting with symptoms consistent with an ovarian malignancy.Conclusions: Chronic appendicitis (CA) is a rare clinical entity with an incidence of 1.5% in all cases of chronic abdominal pain of unknown etiology. CA poses as a diagnostic and therapeutic dilemma for clinicians since a majority of patients present with atypical symptoms. It is very rarely thought to be the primary diagnosis due to the low frequency of occurrence. A postmenopausal patient with chronic worsening abdominal pain, distention, and decreased appetite presenting with a complex adnexal mass and ascites is highly suspicious for ovarian malignancy. It is imperative to thoroughly review all images and consider subsequent imaging modalities to ensure infectious etiologies are excluded, but ultimately, diagnostic operations may be inevitable

Prevention of lacerations at time of operative delivery: An evaluation of quality improvement interventions

Objective: To test the ability of a targeted intervention to decrease rates of vaginal or perineal lacerations occurring at the time of operative delivery. We used available evidence to implement an educational and clinical support program to promote operative delivery simulation and teaching. We hypothesized our quality improvement intervention supporting increased frequency of operative delivery simulation and training would show a decrease in the occurrence of lacerations following operative delivery.Methods: We are conducting a retrospective cohort study following the implementation of our quality improvement initiative promoting more frequent operative delivery simulations and training to assess the association with a decrease in vaginal or perineal lacerations at the time of operative delivery. This quality improvement initiative was instituted at our academic care center in 2018. The program included a needs assessment, simulation of operative delivery, online educational material as well as expanded core outcome documentation following operative deliveries. We analyzed rates and types of operative vaginal delivery birth in pregnancies at or beyond 35 weeks of gestation without a contraindication to operative delivery. We also analyzed rates of vaginal or perineal lacerations occurring after operative vaginal delivery using both vacuum and forceps instrumentation.Aim Statement: "To evaluate if increasing the frequency of operative delivery simulations of both forceps and vacuum delivery along with education to prevent perineal lacerations will show an associated decrease in vaginal or perineal lacerations during the time of operative delivery."Conclusions: We aim to prove an intervention that included systematic promotion and support of increased frequency of operative delivery simulation training/simulation is associated with an decrease in the rate of vaginal or perineal laceration at the time of operative delivery

The Effects of Arsenic Trioxide on DNA Synthesis and Genotoxicity in Human Colon Cancer Cells

Colon cancer is the third leading cause of cancer-related deaths worldwide. Recent studies in our laboratory have demonstrated that arsenic trioxide is cytotoxic in human colon cancer (HT-29), lung (A549) and breast (MCF-7) carcinoma cells. The purpose of the present study is to investigate the effects of arsenic trioxide on DNA synthesis and the possible genotoxic effects on human colon cancer cells. HT-29 cells were cultured according to standard protocol, followed by exposure to various doses (0, 2, 4, 6, 8, 10, and 12 μg/mL) of arsenic trioxide for 24 h. The proliferative response (DNA synthesis) to arsenic trioxide was assessed by [3H]thymidine incorporation. The genotoxic effects of arsenic-induced DNA damage in a human colon cancer cell line was evaluated by the alkaline single cell gel electrophoresis. Results indicated that arsenic trioxide affected DNA synthesis in HT-29 cells in a biphasic manner; showing a slight but not significant increase in cell proliferation at lower levels of exposure (2, 4 and 6 μg/mL) followed by a significant inhibition of cell proliferation at higher doses (i.e., 8 and 10 μg/mL). The study also confirmed that arsenic trioxide exposure caused genotoxicity as revealed by the significant increase in DNA damage, comet tail-lengths, and tail moment when compared to non-exposed cells. Results of the [3H]thymidine incorporation assay and comet assay revealed that exposure to arsenic trioxide affected DNA synthesis and exhibited genotoxic effects in human colon cancer cells

The roles of users in electric, shared and automated mobility transitions

This paper synthesizes insights from 19 peer-reviewed articles published in this Special Issue on the roles of users in shared, electric and automated mobility. While many researchers and stakeholders remain inspired by the potential low costs and societal benefits of these innovations, less is known about the real-world potential for uptake and usage. To better understand the likelihood and impacts of widespread uptake, we explore the perceptions of actual and potential users, including drivers, passengers, owners, and members, as well as other stakeholders such as pedestrians, planners, and policymakers. The Special Issue examines a range of cases, including plug-in electric vehicles, car-share and bike-share programs, ride-hailing and automated vehicles. For each innovation, we organize insights on user perceptions of benefits and drawbacks into four categories. Much of the research to date focuses on the first category, private-functional perceptions, mainly total cost of ownership (e.g., $/km), time use and comfort. Our synthesis however spans the other three categories for each innovation: private-symbolic perceptions include the potential for social signaling and communicating identity; societal-functional perceptions include GHG emissions, public safety and noise; and societal-symbolic perceptions include inspiring pro-societal behavior in others, and the potential to combat or reinforce the status quo system of “automobility”. Further, our synthesis demonstrates how different theories and methods can be more or less equipped to “see” different perception categories. We also summarize findings regarding the characteristics of early users, as well as practical insights for strategies and policies seeking societally-beneficial outcomes from mass deployment of these innovations

Supplement: "Localization and broadband follow-up of the gravitational-wave transient GW150914" (2016, ApJL, 826, L13)

This Supplement provides supporting material for Abbott et al. (2016a). We briefly summarize past electromagnetic (EM) follow-up efforts as well as the organization and policy of the current EM follow-up program. We compare the four probability sky maps produced for the gravitational-wave transient GW150914, and provide additional details of the EM follow-up observations that were performed in the different bands

Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Localization and broadband follow-up of the gravitational-wave transient GW150914

A gravitational-wave (GW) transient was identified in data recorded by the Advanced Laser Interferometer Gravitational-wave Observatory (LIGO) detectors on 2015 September 14. The event, initially designated G184098 and later given the name GW150914, is described in detail elsewhere. By prior arrangement, preliminary estimates of the time, significance, and sky location of the event were shared with 63 teams of observers covering radio, optical, near-infrared, X-ray, and gamma-ray wavelengths with ground- and space-based facilities. In this Letter we describe the low-latency analysis of the GW data and present the sky localization of the first observed compact binary merger. We summarize the follow-up observations reported by 25 teams via private Gamma-ray Coordinates Network circulars, giving an overview of the participating facilities, the GW sky localization coverage, the timeline, and depth of the observations. As this event turned out to be a binary black hole merger, there is little expectation of a detectable electromagnetic (EM) signature. Nevertheless, this first broadband campaign to search for a counterpart of an Advanced LIGO source represents a milestone and highlights the broad capabilities of the transient astronomy community and the observing strategies that have been developed to pursue neutron star binary merger events. Detailed investigations of the EM data and results of the EM follow-up campaign are being disseminated in papers by the individual teams

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease