Taking Free Flap Surgery Abroad: A Collaborative Approach to a Complex Surgical Problem.

Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. Despite the obstacles in place, our experience shows that free flap surgery can be successfully and ethically performed in these areas of great need

Clonidine in the Treatment of Tardive Dyskinesia: A Case Review

Over the past several years, a number of cardiovascular preparations have become widely used in psychiatry. For example, propranolol, introduced for its anti-anginal properties, is now used for stage-fright, lithium tremor and neuroleptic induced akathisia (1,2). Calcium channel blockers are expected to prove useful in the treatment of bipolar affective disorders (3,4). Clonidine exemplifies the rapidity and variety with which a cardiovascular agent has been applied to psychiatric syndromes. Clonidine, a centrally acting anti-hypertensive drug with both alpha-l and alpha-2 adrenergic agonistic properties, has already been used in the treatment of narcotic with drawal, benzodiazepine withdrawal, Tourette\u27s syndrome, akathisia, depression, chronic schizophrenia and acute mania, as well as in tardive dyskinesia ( 1,5,6)

Virtual and Augmented Reality in Neurosurgery: The Evolution of its Application and Study Designs.

BACKGROUND: As the art of neurosurgery evolves in the 21st century, more emphasis is placed on minimally invasive techniques, which require technical precision. Simultaneously, the reduction on training hours continues, and teachers of neurosurgery faces double jeopardy -with harder skills to teach and less time to teach them. Mixed reality appears as the neurosurgical educators\u27 natural ally: Virtual reality facilitates the learning of spatial relationships and permits rehearsal of skills, while augmented reality can make procedures safer and more efficient. Little wonder then, that the body of literature on mixed reality in neurosurgery has grown exponentially. METHODS: Publications involving virtual and augmented reality in neurosurgery were examined. A total of 414 papers were included, and they were categorized according to study design and analyzed. RESULTS: Half of the papers were published within the last 3 years alone. Whereas in the earlier half, most of the publications involved experiments in virtual reality simulation and the efficacy of skills acquisition, many of the more recent publication are proof-of-concept studies. This attests to the evolution of mixed reality in neurosurgery. As the technology advances, neurosurgeons are finding more applications, both in training and clinical practice. CONCLUSIONS: With parallel advancement in Internet speed and artificial intelligence, the utilization of mixed reality will permeate neurosurgery. From solving staff problems in global neurosurgery, to mitigating the deleterious effect of duty-hour reductions, to improving individual operations, mixed reality will have a positive effect in many aspects of neurosurgery

A Competency-based Approach to Faculty Development

Background—Faculty development at the Virginia Commonwealth University School of Medicine (VCU SOM) has previously focused on enhancing teaching and learning in the medical and clinical education settings. While this work is important, this narrow focus does not address all facets a faculty member’s role. To broaden their programming, the VCU SOM faculty development team adopted a competency-based approach to the development and planning of faculty development activities. Summary of work—The Senior Associate Dean for Faculty Affairs completed a research project focused on successful medical faculty who promote through the tenure process and advance in their careers. She identified the following categories for success: teaching, service, scholarship, advancing, and leadership. Each of these categories contains action-focused competencies that align with career progression addressing early, mid, and late career stages. The faculty development team adopted the identified competencies to their curriculum development and planning processes. Summary of results—The results of this adoption have been clearer goals for learners, a mapped structure for faculty development activities, and a broader range of topics offered that align with career stages. Discussion—Faculty development activities are now categorized into five (5) categories: Teach, Lead, Serve, Discover, and Advance with each category color coded for easy recognition in event marketing materials. A new logo reflecting these competency categories is now included on all Office of Faculty Affairs communications. Faculty are beginning to recognize and register for activities they need for promotion, tenure, and advancement. Conclusions—The adoption of the competencies for success from the Senior Associate Dean’s study has enriched faculty development offerings providing a recognizable structure allowing faculty to easily identify competency areas for development

Hepatitis A Vaccination Program in Jefferson Emergency Departments

Aims for Improvement Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019

A Patient with Aids

Susan Ball , M.D.. Chief Resident: Mr. B, a thirty-five-year-old white male, was admitted to the medical service with chief complaints of fever, chills, and increasing shortness of breath. This was Mr. B\u27s second admission. His first was six month s ago for pneumonia, leukopenia, and lymphadenopathy of unknown etiology. At that time he was treated with antibiotics; he improved and was discharged. Since that time Mr. B reported continuing to feel weak and lethargic. Two weeks before this admission he noted the onset of fever, chills, sore throat, and a nonproductive cough. He initially saw a medical doctor for these complaints who diagnosed his problem as bronchitis and treated him with intramuscular injections that were probably antibiotic in nature. He continued to experience malaise and fever. Next he saw an otolaryngologist, who diagnosed Mr . B as having oral thrush. He was placed on Mycostatin Oral Suspensions , but continued to experience increasing fever, chills, shortness of breath , and sore throat, as well as a rthralgias, abdominal pain, and diar rhea. Shortly thereafter Mr. B was admitted to the hospital

Harnessing Synergistic Biostimulatory Processes: A Plausible Approach for Enhanced Crop Growth and Resilience in Organic Farming

Simple Summary Demand for organically grown crops has risen globally due to its healthier and safer food products. From a sustainability perspective, organic farming offers an eco-friendly cultivation system that minimizes agrochemicals and producing food with little or no environmental footprint. However, organic agriculture's biggest drawback is the generally lower and variable yield in contrast to conventional farming. Compatible with organic farming, the selective use of biostimulants can close the apparent yield gap between organic and conventional cultivation systems. A biostimulant is defined as natural microorganisms (bacteria, fungi) or biologically active substances that are able to improve plant growth and yield through several processes. Biostimulants are derived from a range of natural resources including organic materials (composts, seaweeds), manures (earthworms, fish, insects) and extracts derived from microbes, plant, insect or animal origin. The current trend is indicative that a mixture of biostimulants is generally delivering better growth, yield and quality rather than applying biostimulant individually. When used correctly, biostimulants are known to help plants cope with stressful situations like drought, salinity, extreme temperatures and even certain diseases. More research is needed to understand the different biostimulants, key components, and also to adjust the formulations to improve their reliability in the field. Demand for organically grown food crops is rising substantially annually owing to their contributions to human health. However, organic farm production is still generally lower compared to conventional farming. Nutrient availability, content consistency, uptake, assimilation, and crop responses to various stresses were reported as critical yield-limiting factors in many organic farming systems. In recent years, plant biostimulants (BSs) have gained much interest from researchers and growers, and with the objective of integrating these products to enhance nutrient use efficiency (NUE), crop performance, and delivering better stress resilience in organic-related farming. This review gave an overview of direct and indirect mechanisms of microbial and non-microbial BSs in enhancing plant nutrient uptake, physiological status, productivity, resilience to various stressors, and soil-microbe-plant interactions. BSs offer a promising, innovative and sustainable strategy to supplement and replace agrochemicals in the near future. With greater mechanistic clarity, designing purposeful combinations of microbial and non-microbial BSs that would interact synergistically and deliver desired outcomes in terms of acceptable yield and high-quality products sustainably will be pivotal. Understanding these mechanisms will improve the next generation of novel and well-characterized BSs, combining microbial and non-microbial BSs strategically with specific desired synergistic bio-stimulatory action, to deliver enhanced plant growth, yield, quality, and resilience consistently in organic-related cultivation

Influence of Overweight on ICU Mortality* A Prospective Study

Study objective: Overweight patients seem to have a poorer outcome and a higher risk of complications during their stay in the ICU. We conducted a prospective study in order to examine the relationship between body mass index (BMI) and mortality among these patients. Design: Prospective clinical study. Setting: A 24-bed medical ICU in a university-affiliated hospital. Methods: All patients hospitalized in the ICU over a 1-year period were included except those dying or being discharged from the hospital within 24 h of admission. Overweight patients were defined as those having a BMI > 75th percentile of this selected ICU population. Other data collected were demographic and ICU-related data. The Mann-Whitney test was used to compare numeric data between groups (ie, obese and nonobese populations). Variables that were significantly associated with ICU mortality by univariate analysis were entered into a multiple logistic regression model, allowing the determination of independent predictors. Results: Eight hundred thirteen patients were included in the study. The limit of the upper quartile of the BMI was 27. This value was used to separate obese (n ‫؍‬ 215) and nonobese (n ‫؍‬ 598) groups. Significant differences between obese and nonobese patients were observed in age, length of stay in the ICU, simplified acute physiology score (SAPS) II, and ICU mortality. The observed mortality of obese patients was significantly higher than that predicted by SAPS II (32% vs 18%, respectively; p ‫؍‬ 0.001). No difference was observed in frequency of nosocomial infection or duration of mechanical ventilation for mortality in ICU patients. Using a multivariate analysis, the predictive factors of mortality were SAPS II (p < 0.0001) and BMI > 27 (p < 0.01). Conclusion: This is the first prospective study showing high BMI value as an independent prognostic factor of mortality for ICU patients. The prognostic scoring systems currently in use, which were designed to predict the mortality of ICU patients, do not include BMI or do not consider obesity. These may underestimate, therefore, the risk for the specific population of obese patients. (CHEST 2004; 125:1441-1445) Key words: body mass index; critical illness; mortality; obesity; overweight; prognostic index Abbreviations: APACHE ϭ acute physiology and chronic health evaluation; BMI ϭ body mass index; LOS ϭ length of stay; SAPS ϭ simplified acute physiology scor

The Effect of High-Impact Exercise on Stress Urinary Incontinence in Physically Active Women

Stress urinary incontinence (SUI) is a condition in which increased abdominal pressure with coughing, laughing, sneezing, or exercise can cause unintentional leakage of urine in the female population. CrossFit and other high impact aerobic exercises, are popular forms of exercise amongst women all age groups. The purpose of this study was to examine specific high impact exercises that can affect SUI in women

COVID-19 Pandemic Severity, Lockdown Regimes, and People Mobility: Early Evidence from 88 Countries

This study empirically investigates the complex interplay between the severity of the coronavirus pandemic, mobility changes in retail and recreation, transit stations, workplaces, and residential areas, and lockdown measures in 88 countries of the word. To conduct the study, data on mobility patterns, socioeconomic and demographic characteristics of people, lockdown measures, and coronavirus pandemic were collected from multiple sources (e.g., Google, UNDP, UN, BBC, Oxford University, Worldometer). A Structural Equation Modeling (SEM) technique is used to investigate the direct and indirect effects of independent variables on dependent variables considering the intervening effects of mediators. Results show that lockdown measures have significant effects to encourage people to maintain social distancing. However, pandemic severity and socioeconomic and institutional factors have limited effects to sustain social distancing practice. The results also explain that socioeconomic and institutional factors of urbanity and modernity have significant effects on pandemic severity. Countries with a higher number of elderly people, employment in the service sector, and higher globalization trend are the worst victims of the coronavirus pandemic (e.g., USA, UK, Italy, and Spain). Social distancing measures are reasonably effective at tempering the severity of the pandemic.Comment: 17 pages, 3 figures, 6 table