Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

Background: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as health care seeks to define treatment outcomes. The Visual Analogue Scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in nonoperative patients. We hypothesize that patients’ VAS scores reported to the surgeon and a nurse will be the same Methods: This study is a retrospective cohort of 201 consecutive nonoperative patients treated by a single surgeon. Patients were asked to rate pain intensity by a nurse followed by the surgeon using a horizontal VAS, 0 “no pain” to 10 worst pain”. Differences in reported pain levels were compared with data from the previous cohort of 201 consecutive operative patients. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the surgeon was 4.2 (p\u3c.001). The mean difference in VAS scores reported for operative patients was 2.9, whereas the mean difference for nonoperative patients was 1.0 (p \u3c .001). Conclusion: This study found statistically significant differences between VAS scores reported to the surgeon versus the nurse in nonoperative patients which support the trend found in our previous study, where operative patients reported significantly higher scores to the surgeon. The mean difference between reported pain scores is significantly higher for operative patients compared to nonoperative patients

Association Between Buprenorphine Use and Weight Gain in Pregnancy

Many pregnant women in the Appalachian Highlands region utilize buprenorphine as medication-assisted treatment (MAT) for opioid use disorder. This treatment is a tool used by medical teams to minimize patients’ drug cravings and optimize chances for a healthy pregnancy. Providers in our region have posited a relationship between MAT use and poor pregnancy weight gain based on clinical experience and observation. Appropriate weight gain in pregnancy is a critical determinant of pregnancy health; without it, pregnant mothers will possibly need nutritional supplementation. Therefore, understanding the association between buprenorphine use and weight gain may contribute to healthier pregnancies. In order to evaluate the association between buprenorphine use and weight gain in pregnant women using MAT, we conducted a retrospective chart review. A list of potential participants was generated by ETSU Population Health using ICD-10 codes. We enrolled patients who were cared for by ETSU Health and delivered babies between July 1, 2019 and June 30, 2021: a total of 504 patients. Of these, 96 were participants in the ETSU low-dose MAT clinic (Group 1), 109 were receiving MAT from other community clinics (Group 2), 97 were non-smoking women in the regular OB clinic (Group 3), and 202 were smoking women in the regular OB clinic (Group 4). Participants’ medical records were screened for inclusion and exclusion criteria. All patients were over age 18 with singleton pregnancies, had pregnancy care initiated in the first trimester, and delivered at or after 37 weeks’ gestation. Patients with confounding medical conditions including (but not limited to) Crohn’s disease, diabetes, heart disease, hypertension, fetal anomalies, or IUFD were excluded. In addition, patients were also excluded with BMI \u3e30 or undocumented BMI, prenatal care initiated after the first trimester, transfer to another practice or lost to follow up, or other documented drug abuse other than opiate use disorder. After consideration of the above criteria, 262 patients were excluded and 242 patients remained in the study. Of these, 53 were in Group 1, 53 in Group 2, 45 in Group 3, and 90 in Group 4. All protected health information was stored in the ETSU HIPAA-compliant REDCap server. At this time, the project is in the data analysis stage, with results expected by the end of March 2023. If an association between buprenorphine use and lower weight gain in pregnancy is discovered, these results can be used to recommend additional measures such as nutritional supplementation to optimize maternal and fetal health during pregnancy. Final conclusions will be drawn after data analysis is complete and associations, or lack thereof, can be fully evaluated. Based on observations of obstetric providers in the region, some association between lower weight gain and buprenorphine use is anticipated

Innovative learning at The University of Edinburgh

The activities available to civil engineering students during the University of Edinburgh's innovative learning week in 2012 were examined. The academic staff proposed a wide range of possible activities and student participation was optional. Popular activities were those with a ‘hands-on’ element: making or doing something. The practical activities offered included designing and building trebuchets, relaying railway permanent way on a heritage railway, practical workshops on engineering in international development and learning to juggle. These activities suggested that heuristic learning by trial and error was likely to enhance the visualisation skills that contribute to good engineering design. Further, the linking of achievement to purposeful practice rather than innate talent could inform teaching methods in the future. They also showed that in some cases safety culture messages were still not fully assimilated by students

In Vitro Effect of Ascorbic Acid in HIV-1 Infected CD4+ T-cells

Human immunodeficiency virus-1 (HIV-1) attacks the immune system by infecting and depleting CD4+ T-cells. HIV infection induces cellular oxidative stress potentially leading to DNA damage. Although no cure has been found for HIV-1, antiretroviral treatment (ART) can control its viral load. Since impoverished countries have limited access to ART, complementary, inexpensive treatments need to be further studied. Studies have shown that micronutrients have a positive effect in limiting HIV-1 pathogenesis. Ascorbic acid (vitamin C) is a known antioxidant micronutrient found in fruits, vegetables and as a dietary supplement. This study aims to assess the effect of ascorbic acid in HIV-1 infected CD4+ T-cells in terms of viral load reduction and protection from oxidative stress-induced DNA damage. We hypothesize that, upon exposure to ascorbic acid, there will be a reduction in viral load and oxidative stress-induced DNA damage in infected CD4+ T-cells. The devised method consists of exposing HIV-1 infected and non-infected CD4+ T-cells to ascorbic acid at concentrations ranging from 2 to 140 µg/ml. At 24, 48 and 72 hours of incubation viral load was measured through qRT-PCR; cell number and viability were assessed with trypan blue dying using an AutoT4 Cellometer and DNA damage was measured at 72 hours through the Comet assay. Comparing the oxidative stress levels and viral counts of HIV-1 infected CD4+ T-cells upon exposure to ascorbic acid can provide a significant insight into the use of this antioxidant in HIV-1 infected CD4+ T-cells in limiting its viral replication

Remarks on the method of comparison equations (generalized WKB method) and the generalized Ermakov-Pinney equation

The connection between the method of comparison equations (generalized WKB method) and the Ermakov-Pinney equation is established. A perturbative scheme of solution of the generalized Ermakov-Pinney equation is developed and is applied to the construction of perturbative series for second-order differential equations with and without turning points.Comment: The collective of the authors is enlarged and the calculations in Sec. 3 are correcte