During the COVID-19 Pandemic, Lung Specialists of the World Implore You: Inhale Only Clean Air

Recent social media and lay news report that nicotine may help protect from COVID-19. However, lung specialists of the American Thoracic Society and California Thoracic Society recommend that you inhale only clean air. Research shows that exposure to smoke, vapors, and air pollution all contribute to worse outcomes in COVID-19 infection. This fact sheet summarizes some of the common public questions addressed to lung healthcare professionals

COVID-19 Infection versus Influenza (Flu) and Other Respiratory Illnesses

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.SARS-CoV-2 is the virus that causes the COVID-19 infection. You can be ill with more than one virus at the same time. As the SARS-CoV-2 virus pandemic continues, influenza and other respiratory infections will also emerge in the community. Respiratory infections may present with similar symptoms and all can spread from person to person. It is hard to tell which virus or bacteria is causing a person’s illness based on symptoms alone. At times testing is needed to see which virus(es) or bacteria are present. These tests usually involve getting a nose and/or throat swab sample, as most of these viruses are present in large amounts in the back of the nose and throat. There is still a lot to learn about the COVID-19 infection and research is ongoing

Improving communication in intensive care unit to ward transitions: Protocol for multisite national implementation of the ICU-PAUSE handoff tool

BACKGROUND: The intensive care unit (ICU)-ward transfer poses a particularly high-risk period for patients. The period after transfer has been associated with adverse events and additional work for care teams related to miscommunication or omission of information. Standardized handoff processes have been found to reduce communication errors and adverse patient events in other clinical environments but are understudied at the ICU-ward interface. We previously developed an electronic ICU-ward transfer tool, ICU-PAUSE, which embeds the key elements and diagnostic reasoning to facilitate a safe transfer of care at ICU discharge. OBJECTIVE: The aim of this study is to evaluate the implementation process of the ICU-PAUSE handoff tool across 10 academic medical centers, including the rate of adoption and acceptability, as perceived by clinical care teams. METHODS: ICU-PAUSE will be implemented in the medical ICU across 10 academic hospitals, with each site customizing the tool to their institution\u27s needs. Our mixed methods study will include a combination of a chart review, quantitative surveys, and qualitative interviews. After a 90-day implementation period, we will conduct a retrospective chart review to evaluate the rate of uptake of ICU-PAUSE. We will also conduct postimplementation surveys of providers to assess perceptions of the tool and its impact on the frequency of communication errors and adverse events during ICU-ward transfers. Lastly, we will conduct semistructured interviews of faculty stakeholders with subsequent thematic analysis with the goal of identifying benefits and barriers in implementing and using ICU-PAUSE. RESULTS: ICU-PAUSE was piloted in the medical ICU at Barnes-Jewish Hospital, the teaching hospital of Washington University School of Medicine in St. Louis, in 2019. As of July 2022, implementation of ICU-PAUSE is ongoing at 6 of 10 participating sites. Our results will be published in 2023. CONCLUSIONS: Our process of ICU-PAUSE implementation embeds each step of template design, uptake, and customization in the needs of users and key stakeholders. Here, we introduce our approach to evaluate its acceptability, usability, and impact on communication errors according to the tenets of sociotechnical theory. We anticipate that ICU-PAUSE will offer an effective handoff tool for the ICU-ward transition that can be generalized to other institutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40918

Training Manual Training Programme on Brackishwater Farming

Training Manual prepared for a Training Programme on Brackishwater Farming at Mangalore Research Centre of CMFRI from 16 to 22 December 2015

Longitudinal Milestone Assessment Extending Through Subspecialty Training: The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones

Purpose Accreditation Council for Graduate Medical Education (ACGME) milestones were implemented across medical subspecialties in 2015. Although milestones were proposed as a longitudinal assessment tool potentially providing opportunities for early implementation of individualized fellowship learning plans, the association of subspecialty fellowship ratings with prior residency ratings remains unclear. This study aimed to assess the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones. Method A multicenter retrospective cohort analysis was conducted for all PCCM trainees in ACGME-accredited PCCM fellowship programs, 2017–2018, who had complete prior IM milestone ratings from 2014 to 2017. Only professionalism and interpersonal and communication skills (ICS) were included based on shared anchors between IM and PCCM milestones. Using a generalized estimating equations model, the association of PCCM milestones ≤ 2.5 during the first fellowship year with corresponding IM subcompetencies was assessed at each time point, nested by program. Statistical significance was determined using logistic regression. Results The study included 354 unique PCCM fellows. For ICS and professionalism subcompetencies, fellows with higher IM ratings were less likely to obtain PCCM ratings ≤ 2.5 during the first fellowship year. Each ICS subcompetency was significantly associated with future lapses in fellowship (ICS01: β = −0.67, P = .003; ICS02: β = −0.70, P = .001; ICS03: β = −0.60, P = .004) at various residency time points. Similar associations were noted for PROF03 (β = −0.57, P = .007). Conclusions Findings demonstrated an association between IM milestone ratings and low milestone ratings during PCCM fellowship. IM trainees with low ratings in several professionalism and ICS subcompetencies were more likely to be rated ≤ 2.5 during the first PCCM fellowship year. This highlights a potential use of longitudinal milestones to target educational gaps at the beginning of PCCM fellowship

Cage farming as a livelihood option for the socio economics upliftment of Tribal communities in India

The technologies developed by Central Marine Fisheries Research Institute (CMFRI) through Farmer's Participatory Research (FPR) on marine and brackish water cage fish farming and allied activities are unanimously adopted as their livelihood option by many farmers in India. The vision of Tribal Sub Plan Project (TSP) is also to improve the level of knowledge and skills to elevate the social and economic status of tribal communities by utilizing coastal resources and infrastructural support. It is therefore these technologies were also given to Indian tribal communities for their socio economic upliftment and develop their skills enough to contribute to the fish production in India. In order to implement this project in India, survey work was conducted in Pathanamthitta, Kallam and Thiruvananthapuram, Nettoor, Thathappally, Ezhikkaraand Vaikom in Kerala;Oyyalikuppam village, Rajarethinam Nagar, Senjiamman Nagar and Kallukadamedu at Kottayakuppam village in Chennai;Byndoor and Mulky areas in Karnataka;Chuabahal, Kanthibhaunri, Jugadiha, Balughat, Laing colony, Jugadiha, Jhaga, Baniguni, Parikhi, Jambu, Bhateni, Hari Bank and Parikhi in Orissa; Madhupur and Raipur areas in Gujarat with the help of ST Promoters from the Tribal Welfare Department of respective states to identify the tribal areas in India. Benchmark assessment on the social, historical and livelihood of each village carried out through the initial interaction programmes. Preliminary meetings were held to make an assessment of the community status, their occupation and interest in improving their skills in marine fisheries and aquaculture. An assessment was also carried out to know their present level of involvement into marine fishery related activities, interest to do fish culture, employment status, intensity, investment capacity, resources, options, competitions, space, amenability and viability of the CMFRI technologies and adoption programmes. Later they were invited to CMFRI for interaction and further analysis on their strengths and weakness. Detailed programmes were chalked out to provide training and hands on support and skill development programmes for the identified families of tribal communities in India.The isolated settlement of an important ethnic tribal group of Ulladar in Kerala, lrular in Chennai, Marathy Naik in Karnataka, Khaira, Bhumija, Mahali, Bhuyan, Bhumij, Santai, Bhuyan, Mahali, Kolha, Santai and Kolhain Orissa and sidi tribes in Gujarat were identified for the effective implementation of this project in India

Importance sampling method of correction for multiple testing in affected sib-pair linkage analysis

Using the Genetic Analysis Workshop 13 simulated data set, we compared the technique of importance sampling to several other methods designed to adjust p-values for multiple testing: the Bonferroni correction, the method proposed by Feingold et al., and naïve Monte Carlo simulation. We performed affected sib-pair linkage analysis for each of the 100 replicates for each of five binary traits and adjusted the derived p-values using each of the correction methods. The type I error rates for each correction method and the ability of each of the methods to detect loci known to influence trait values were compared. All of the methods considered were conservative with respect to type I error, especially the Bonferroni method. The ability of these methods to detect trait loci was also low. However, this may be partially due to a limitation inherent in our binary trait definitions

Hospitalist and Intensivist Experiences of the "Open" Intensive Care Unit Environment: a Qualitative Exploration.

BackgroundMost U.S. academic medical centers employ "closed" intensive care units (ICUs), where critically ill patients are admitted under the supervision of intensivists managing dedicated ICU teams. Some centers utilize a unique "open" ICU structure, where primary services longitudinally follow patients who become critically ill into the ICU with intensivist comanagement. The impact of open ICUs on patient care and education of trainees has not been well-characterized.ObjectiveThe objective of this study is to characterize affordances and barriers to education and patient care, from the perspectives of hospitalists and intensivists teaching in the ICU.DesignWe conducted semi-structured interviews with hospitalist and intensivist faculty at a large academic medical center with an open ICU structure. We coded deidentified interview transcripts to inductively analyze the data for themes and subthemes.ParticipantsWe recruited hospitalist and intensivist faculty members who attend on teaching services in the open ICU system.ApproachGiven the complexity of multiple teachers and learners in the ICU environment, we selected shared mental models as our primary theoretical lens through which we analyzed and interpreted our data.Key resultsWe identified three main themes regarding education in the open ICU system: (1) communication challenges, (2) educational barriers and affordances, and (3) structural barriers and affordances. Hospitalists and intensivists agreed on some barriers and facilitators to education, such as continuity of care, yet they disagreed on others. Specifically, hospitalists and intensivists had a shared mental model regarding barriers to patient care and education in the open ICU structure, but had divergent opinions regarding the affordances of the structure, such as continuity and availability of ICU expertise.ConclusionsThe open ICU environment presents facilitators and barriers to trainee education and patient care. Our findings can be leveraged to improve communication, education, and patient care on both hospitalist and ICU teams