Medicine and surgery residents\u27 perspectives on the impact of COVID-19 on graduate medical education.

The COVID-19 crisis has had an unprecedented impact on resident education and well-being: social distancing guidelines have limited patient volumes and forced virtual learning, while personal protective equipment (PPE) shortages, school/daycare closures, and visa restrictions have served as additional stressors. Our study aimed to analyze the effects of COVID-19 crisis-related stressors on residents\u27 professional and personal lives. In April 2020, we administered a survey to residents at a large academic hospital system in order to assess the impact of the pandemic on residency training after \u3e6 weeks of a modified schedule. The primary outcome was to determine which factors or resident characteristics were related to stress during the pandemic. Our secondary goals were to examine which resident characteristics were related to survey responses. Data were analyzed with regression analyses. Ninety-six of 205 residents completed the survey (47% response rate). For our primary outcome, anxiety about PP

An Investigation of Anki Flashcards as a Study Tool Among First Year Medical Students Learning Anatomy

Purpose: Anatomy is a challenging course in medical school, in part because of the vast number of facts that must be memorized. Current literature suggests the value of spaced repetition in the learning of factual information, and online tools such as Anki flashcards have been developed to facilitate it. The purpose of this study is to investigate the role of curriculum-specific Anki flashcards as a study tool for first year medical students learning anatomy. Methods: A set of Anki flashcards was created for the anatomy thread of the first block (i.e. back, pectoral, shoulder, vertebral regions) of the JeffMD curriculum at Sidney Kimmel Medical College. Upon completion of an initial survey, study volunteers were provided with the curriculum-specific flashcards. Following the Block 1 anatomy exam, another survey was administered to gather data regarding participants’ usage and opinions of the flashcards. Results and Conclusions: 143 students completed the initial survey and were provided with the flashcards. Of the 78 students that used the curriculum-specific flashcards, 20.1% found them extremely helpful, 29.5% very helpful, 33.3% moderately helpful, 15.4% slightly helpful, and 1.3% not at all helpful. Moreover, 60.3% believed that the flashcards helped reduce anxiety related to the anatomy, 18.0% did not believe they reduced anxiety, and 12.8% either did not answer or selected “other”. These results suggest that spaced repetition of anatomy facts through curriculum-specific Anki flashcards may have a positive impact on affective learning outcomes among first year medical students

Opioid-Prescribing Practices for Post-Operative Patients in Otolaryngology: A Multiphasic Quality Improvement Project in a Single Large Institution

Objectives: In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution. Study Design: Prospective, survey study. Methods: Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis. Results: Of the 80 surveys that met criteria for inclusion for analysis, a total of 1,954.0 pills were prescribed, with 300.3 pills (15.4%) reported having been used by patients, leaving 1,653.7 pills (84.5%) unused. TORS (n=12) average pills used: 4.9 ± 5.9 (95% CI: 1.6-8.3); total % pills unused: 89.3%. Sialendoscopy (n=13) average pills used: 4.2 ± 5.1 (95% CI: 1.1-7.4); total % pills unused: 72.5%. Parathyroidectomy/thyroidectomy (n=22) average pills used: 3.1 ± 4.4 (95% CI: 1.7-5.5); total % pills unused: 79.2%. Parotidectomy (n=12) average pills used: 1.3 ± 2.5 (95% CI: 0.7-4.3); total % pills unused: 94.7%. Conclusions: At our institution, opioids for ((postoperative otolaryngology)) patients’ pain management in otolaryngologic procedures were prescribed in excess with 84.5% reported as unused. Procedure-specific opioid diversion pool ranged from 72.5%-94.7%. Our findings provide a foundation for procedure-specific evidence-based opioid prescription guidelines

Predictors of Literacy and Attitudes Toward Reading Among Syrian Refugee Children in Jordan

Refugee children often face disruptions to their education before and during displacement. However, little is known about either levels or predictors of refugee children’s literacy or about their attitudes toward reading in low- or middle-income countries. To address this, we conducted in-home literacy assessments using the Holistic Assessment of Learning and Development Outcomes with 322 Syrian refugee mother–child dyads who lived in Jordan (child age range 4–8 years, M = 6.32 years, 50% female). Overall, the children had quite low levels of literacy, although they indicated a strong enthusiasm for reading. Child age, maternal education, and maternal ability to read all predicted child literacy, although maternal literacy predicted it only among children enrolled in school. Among those enrolled in school (64.9% of the total sample, 88.7% of those aged ≥ 6), students attending hybrid classes had better literacy than those attending either solely in-person or solely online, although the frequency of school attendance did not predict literacy. A less consistent pattern emerged for predicting children’s attitudes toward reading. Our results suggest an urgent need to improve literacy skills among refugee children in Jordan, as well as a need for validated measures of attitudes toward reading for use with Arabic-speaking youth

Predictors of Literacy and Attitudes Toward Reading Among Syrian Refugee Children in Jordan

Refugee children often face disruptions to their education before and during displacement. However, little is known about either levels or predictors of refugee children’s literacy or about their attitudes toward reading in low- or middle-income countries. To address this, we conducted in-home literacy assessments using the Holistic Assessment of Learning and Development Outcomes with 322 Syrian refugee mother–child dyads who lived in Jordan (child age range 4–8 years, M = 6.32 years, 50% female). Overall, the children had quite low levels of literacy, although they indicated a strong enthusiasm for reading. Child age, maternal education, and maternal ability to read all predicted child literacy, although maternal literacy predicted it only among children enrolled in school. Among those enrolled in school (64.9% of the total sample, 88.7% of those aged ≥ 6), students attending hybrid classes had better literacy than those attending either solely in-person or solely online, although the frequency of school attendance did not predict literacy. A less consistent pattern emerged for predicting children’s attitudes toward reading. Our results suggest an urgent need to improve literacy skills among refugee children in Jordan, as well as a need for validated measures of attitudes toward reading for use with Arabic-speaking youth

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Not AvailablePicrorhiza kurrooa is an endangered medicinal herb which is distributed across the Himalayan region at an altitude between 3000–5000 m above mean sea level. The medicinal properties of P. kurrooa are attributed to monoterpenoid picrosides present in leaf, rhizome and root of the plant. However, no genomic information is currently available for P. kurrooa, which limits our understanding about its molecular systems and associated responses. The present study brings the first assembled draft genome of P. kurrooa by using 227 Gb of raw data generated by Illumina and PacBio RS II sequencing platforms. The assembled genome has a size of n = ~ 1.7 Gb with 12,924 scaffolds. Four pronged assembly quality validations studies, including experimentally reported ESTs mapping and directed sequencing of the assembled contigs, confirmed high reliability of the assembly. About 76% of the genome is covered by complex repeats alone. Annotation revealed 24,798 protein coding and 9789 non-coding genes. Using the assembled genome, a total of 710 miRNAs were discovered, many of which were found responsible for molecular response against temperature changes. The miRNAs and targets were validated experimentally. The availability of draft genome sequence will aid in genetic improvement and conservation of P. kurrooa. Also, this study provided an efficient approach for assembling complex genomes while dealing with repeats when regular assemblers failed to progress due to repeats.Not Availabl

Design, Synthesis, and Antisickling Investigation of a Nitric Oxide-Releasing Prodrug of 5HMF for the Treatment of Sickle Cell Disease

5-hydroxyfurfural (5HMF), an allosteric effector of hemoglobin (Hb) with an ability to increase Hb affinity for oxygen has been studied extensively for its antisickling effect in vitro and in vivo, and in humans for the treatment of sickle cell disease (SCD). One of the downstream pathophysiologies of SCD is nitric oxide (NO) deficiency, therefore increasing NO (bio)availability is known to mitigate the severity of SCD symptoms. We report the synthesis of an NO-releasing prodrug of 5HMF (5HMF-NO), which in vivo, is expected to be bio-transformed into 5HMF and NO, with concomitant therapeutic activities. In vitro studies showed that when incubated with whole blood, 5HMF-NO releases NO, as anticipated. When incubated with sickle blood, 5HMF-NO formed Schiff base adduct with Hb, increased Hb affinity for oxygen, and prevented hypoxia-induced erythrocyte sickling, which at 1 mM concentration were 16%, 10% and 27%, respectively, compared to 21%, 18% and 21% for 5HMF. Crystal structures of 5HMF-NO with Hb showed 5HMF-NO bound to unliganded (deoxygenated) Hb, while the hydrolyzed product, 5HMF bound to liganded (carbonmonoxy-ligated) Hb. Our findings from this proof-of-concept study suggest that the incorporation of NO donor group to 5HMF and analogous molecules could be a novel beneficial strategy to treat SCD and warrants further detailed in vivo studies

Design, Synthesis, and Investigation of Novel Nitric Oxide (NO)-Releasing Aromatic Aldehydes as Drug Candidates for the Treatment of Sickle Cell Disease

Sickle cell disease (SCD) is caused by a single-point mutation, and the ensuing deoxygenation-induced polymerization of sickle hemoglobin (HbS), and reduction in bioavailability of vascular nitric oxide (NO), contribute to the pathogenesis of the disease. In a proof-of-concept study, we successfully incorporated nitrate ester groups onto two previously studied potent antisickling aromatic aldehydes, TD7 and VZHE039, to form TD7-NO and VZHE039-NO hybrids, respectively. These compounds are stable in buffer but demonstrated the expected release of NO in whole blood in vitro and in mice. The more promising VZHE039-NO retained the functional and antisickling activities of the parent VZHE039 molecule. Moreover, VZHE039-NO, unlike VZHE039, significantly attenuated RBC adhesion to laminin, suggesting this compound has potential in vivo RBC anti-adhesion properties relevant to vaso-occlusive events. Crystallographic studies show that, as with VZHE039, VZHE039-NO also binds to liganded Hb to make similar protein interactions. The knowledge gained during these investigations provides a unique opportunity to generate a superior candidate drug in SCD with enhanced benefits