The Unified Legal Skills Program: How One Law School Adapted to Meet the Needs of Students Online, and How Those Adaptations May Inform Post-Pandemic Teaching

When CWSL was forced to switch to online learning for the COVID-19 pandemic, we worked hard to follow best practices for online learning by attending online conferences and voraciously reading everything we could find to make the learning experience the best we could for our students. CWSL\u27s Legal Skills program earned high praise in student evaluations for adapting so quickly given the difficult circumstances. During the summer of 2020, we met as a Legal Skills team to discuss how to approach the regular school term. Specifically, we faced a larger-than-anticipated first-year class and contemplated how to remedy the sense of disconnection we expected would be felt by both students and us as teachers with online teaching and the ongoing pandemic. We asked ourselves, what if one of our colleagues become sick? How would we cover that professor\u27s classes? How can we create a sense of connection in a remote world? We also saw the challenges we faced as an opportunity to learn from one another and also mentor our new faculty members. To address these challenges and make the most of these opportunities, we decided to adopt what we came to call our Unified Program for Legal Skills. This paper describes our approach, experiences, and lessons

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The Unified Legal Skills Program: How One Law School Adapted to Meet the Needs of Students Online, and How Those Adaptations May Inform Post-Pandemic Teaching

When CWSL was forced to switch to online learning for the COVID-19 pandemic, we worked hard to follow best practices for online learning by attending online conferences and voraciously reading everything we could find to make the learning experience the best we could for our students. CWSL\u27s Legal Skills program earned high praise in student evaluations for adapting so quickly given the difficult circumstances. During the summer of 2020, we met as a Legal Skills team to discuss how to approach the regular school term. Specifically, we faced a larger-than-anticipated first-year class and contemplated how to remedy the sense of disconnection we expected would be felt by both students and us as teachers with online teaching and the ongoing pandemic. We asked ourselves, what if one of our colleagues become sick? How would we cover that professor\u27s classes? How can we create a sense of connection in a remote world? We also saw the challenges we faced as an opportunity to learn from one another and also mentor our new faculty members. To address these challenges and make the most of these opportunities, we decided to adopt what we came to call our Unified Program for Legal Skills. This paper describes our approach, experiences, and lessons

The association between simple renal cyst and aortic diseases: A systematic review and meta-analysis of observational studies.

OBJECTIVE The objective of this meta-analysis of observational studies was to evaluate the association between simple renal cysts (SRC) and presence of aortic pathology such as aortic aneurysms and dissection. METHODS We conducted searches in Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1960 to August 2019 to identify observational studies that examined the association between SRCs and any aortic diseases, including aortic aneurysms and dissection. Two reviewers independently extracted the data and assessed the risk of bias. The meta-analysis was performed by STATA 14.1. RESULTS In total, 11 observational studies with 19 719 participants were included in this meta-analysis. Compared to individuals without SRCs, patients with SRCs had higher odds of abdominal aortic aneurysm (AAA) (adjusted OR = 2.61, 95% CI 2.34-2.91, P < 0.001, I = 0%), ascending thoracic aortic aneurysm (TAA) (adjusted OR = 1.98, 95% CI 1.09-3.63, P = 0.03, I = 90.1%), descending TAA (adjusted OR = 3.44, 95% CI, 2.67-4.43, P < 0.001, I = 0%), type A aortic dissection (AD) (adjusted OR = 1.98, 95% CI 1.32-2.96, P = 0.001, I = 12.9%), and type B AD (adjusted OR = 2.55, 95% CI, 1.31-4.96, P = 0.006, I = 76.2%). There was a higher average in the sum of diameter of SRCs among AAA compared to patients without AAA (WMD = 19.80 mm, 95% CI 13.92-25.67, P < 0.001, I = 63.8%). CONCLUSION SRC is associated with higher odds of aortic diseases including AAA, ascending and descending TAA, type A and type B dissection even after adjusting for confounders

Platelet count: A predictor of sepsis and mortality in severe burns.

BACKGROUND Platelet cells, or thrombocytes, have additional roles to haemostasis. After burn injury, platelet counts drop to a nadir at days 2-5 then rise to a peak between days 10-18. The nadir has previously been associated with mortality but there is currently no thorough investigation of its potential to predict sepsis in adults. The primary objective of this study is to assess whether platelet count can predict survival and sepsis in adults with severe burn injuries. METHODS AND FINDINGS A retrospective cohort analysis of platelet count and other blood parameters in 145 burn patients with a TBSA greater than 20%. AUROC analysis revealed that the platelet count and rBaux score together produce moderate discrimination for survival at less than 24h after injury (AUROC=0.848, 95%CI 0.765-0.930). Platelet count at day 3 combined with TBSA has a modest association with sepsis (AUROC=0.779, 95%CI 0.697-0.862). Multivariable Cox regression analysis revealed platelet peak was the strongest predictor of mortality. CONCLUSIONS A reduced peak platelet count is a strong predictor of 50-day mortality. Platelet count nadir may have some association with sepsis

Impact of Circadian Blood Pressure Pattern on Silent Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis.

Background Abnormal circadian blood pressure (BP) variations during sleep, specifically the non-dipping (<10% fall in nocturnal BP) and reverse-dipping patterns (rise in nocturnal BP), have been associated with an increased risk of cardiovascular events and target organ damage. However, the relationship between abnormal sleep BP variations and cerebral small vessel disease markers is poorly established. This study aims to assess the association between non-dipping and reverse-dipping BP patterns with markers of silent cerebral small vessel disease. Methods and Results MEDLINE, Embase, and Cochrane Databases were searched from inception through November 2019. Studies that reported the odds ratios (ORs) for cerebral small vessel disease markers in patients with non-dipping or reverse-dipping BP patterns were included. Effect estimates from the individual studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Twelve observational studies composed of 3497 patients were included in this analysis. The reverse-dipping compared with normal dipping BP pattern was associated with a higher prevalence of white matter hyperintensity with a pooled adjusted OR of 2.00 (95% CI, 1.13-2.37; I=36%). Non-dipping BP pattern compared with normal dipping BP pattern was associated with higher prevalence of white matter hyperintensity and asymptomatic lacunar infarction, with pooled ORs of 1.38 (95% CI, 0.95-2.02; I=52%) and 2.33 (95% CI, 1.30-4.18; I=73%), respectively. Limiting to only studies with confounder-adjusted analysis resulted in a pooled OR of 1.38 (95% CI, 0.95-2.02; I=52%) for white matter hyperintensity and 1.44 (95% CI, 0.97-2.13; I=0%) for asymptomatic lacunar infarction. Conclusions The non-dipping and reverse-dipping BP patterns are associated with neuroimaging cerebral small vessel disease markers

Inpatient burden and mortality of heatstroke in the United States.

BACKGROUND This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilisation of hospitalisation for heatstroke in the United States. Additionally, this study aimed to explore factors associated with in-hospital mortalities of heatstroke. METHODS The 2003-2014 National Inpatient Sample database was used to identify hospitalised patients with a principal diagnosis of heatstroke. The inpatient prevalence, clinical characteristics, in-hospital treatments, outcomes, length of hospital stay, and hospitalisation cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. RESULTS A total of 3372 patients were primarily admitted for heatstroke, accounting for an overall inpatient prevalence of heatstroke amongst hospitalised patients of 36.3 cases per 1 000 000 admissions in the United States with an increasing trend during the study period (P < .001). Age 40-59 was the most prevalent age group. During the hospital stay, 20% required mechanical ventilation, and 2% received renal replacement therapy. Rhabdomyolysis was the most common complication. Renal failure was the most common end-organ failure, followed by neurological, respiratory, metabolic, hematologic, circulatory, and liver systems. The in-hospital mortality rate of heatstroke hospitalisation was 5% with a decreasing trend during the study period (P < .001). The presence of end-organ failure was associated with increased in-hospital mortality, whereas more recent years of hospitalisation was associated with decreased in-hospital mortality. The median length of hospital stay was 2 days. The median hospitalisation cost was $17 372. CONCLUSION The inpatient prevalence of heatstroke in the United States increased, while the in-hospital mortality of heatstroke decreased