Pandemic Teaching: Exploration of Instructional Method Shifts

COVID-19 forced educators to unexpectedly move to distance teaching, requiring a shift in instructional methods. This study examined practices instructors integrated into their online and face-to-face facilitation over the long term

Mechanisms Predisposing Penile Fracture And Long-term Outcomes On Erectile And Voiding Functions

Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients' status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4%) were confirmed, mean age was 34.5 years (range: 18-60), mean follow-up 59.3 months (range 9-155). Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%), followed by penile manipulation (6 patients, 14.3%), and homosexual intercourse (4 patients, 9.5%). "Woman on top" was the most common heterosexual position (n = 14, 50%), followed by "doggy style" (n = 8, 28.6%). Four patients (9.5%) maintained the cause unclear. Six (14.3%) patients had urethral injury and two (4.8%) had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. "Woman on top" was the potentially riskiest sexual position (50%). Immediate surgical treatment warrants long-term very low morbidity. © 2014 Leonardo O. Reis et al.Kamdar, C., Mooppan, U.M.M., Kim, H., Gulmi, F.A., Penile fracture: Preoperative evaluation and surgical technique for optimal patient outcome (2008) BJU International, 102 (11), pp. 1640-1644. , 2-s2.0-56649083856 10.1111/j.1464-410X.2008.07902.xKramer, A.C., Penile fracture seems more likely during sex under stressful situations (2011) Journal of Sexual Medicine, 8 (12), pp. 3414-3417. , 2-s2.0-82955237445 10.1111/j.1743-6109.2011.02461.xSawh, S.L., O'Leary, M.P., Ferreira, M.D., Berry, A.M., Maharaj, D., Fractured penis: A review (2008) International Journal of Impotence Research, 20 (4), pp. 366-369. , 2-s2.0-48249147767 10.1038/ijir.2008.12Amit, A., Arun, K., Bharat, B., Navin, R., Sameer, T., Shankar, D.U., Penile fracture and associated urethral injury: Experience at a tertiary care hospital (2013) Canadian Urological Association Journal, 7, pp. E168-E170Moslemi, M.K., Evaluation of epidemiology, concomitant urethral disruption and seasonal variation of penile fracture: A report of 86 cases (2013) Canadian Urological Association Journal, 7, pp. E572-E575Hatzichristodoulou, G., Dorstewitz, A., Gschwend, J.E., Herkommer, K., Zantl, N., Surgical management of penile fracture and long-term outcome on erectile function and voiding (2013) The Journal of Sexual Medicine, 10, pp. 1424-1430Nomura, J.T., Sierzenski, P.R., Ultrasound diagnosis of penile fracture (2010) Journal of Emergency Medicine, 38 (3), pp. 362-365. , 2-s2.0-77949914168 10.1016/j.jemermed.2008.03.010Ash, A., Miller, J., Preston, D., Point-of-care ultrasound used to exclude penile fracture (2012) Critical Ultrasound Journal, 417Beysel, M., Tekin, A., Gürdal, M., Yücebaş, E., Dengör, F., Evaluation and treatment of penile fractures: Accuracy of clinical diagnosis and the value of corpus cavernosography (2002) Urology, 60 (3), pp. 492-496. , 2-s2.0-0036753673 10.1016/S0090-4295(02)01813-7Gamal, W.M., Osman, M.M., Hammady, A., Aldahshoury, M.Z., Hussein, M.M., Saleem, M., Penile fracture:;ong-term results of surgical and conservative management (2011) Journal of Trauma, 71 (2), pp. 491-493. , 2-s2.0-80051783736 10.1097/TA.0b013e318209311

Embodied GHG emissions of buildings – The hidden challenge for effective climate change mitigation

Buildings are major sources of greenhouse gas (GHG) emissions and contributors to the climate crisis. To meet climate-change mitigation needs, one must go beyond operational energy consumption and related GHG emissions of buildings and address their full life cycle. This study investigates the global trends of GHG emissions arising across the life cycle of buildings by systematically compiling and analysing more than 650 life cycle assessment (LCA) case studies. The results, presented for different energy performance classes based on a final sample of 238 cases, show a clear reduction trend in life cycle GHG emissions due to improved operational energy performance. However, the analysis reveals an increase in relative and absolute contributions of so‐called ‘embodied’ GHG emissions, i.e., emissions arising from manufacturing and processing of building materials. While the average share of embodied GHG emissions from buildings following current energy performance regulations is approximately 20–25% of life cycle GHG emissions, this figure escalates to 45–50% for highly energy-efficient buildings and surpasses 90% in extreme cases. Furthermore, this study analyses GHG emissions at time of occurrence, highlighting the ‘carbon spike’ from building production. Relating the results to existing benchmarks for buildings’ GHG emissions in the Swiss SIA energy efficiency path shows that most cases exceed the target of 11.0 kgCO$^{2}$eq/m$^{2}$a. Considering global GHG reduction targets, these results emphasize the urgent need to reduce GHG emissions of buildings by optimizing both operational and embodied impacts. The analysis further confirmed a need for improving transparency and comparability of LCA studies

Onset of human preterm and term birth is related to unique inflammatory transcriptome profiles at the maternal fetal interface.

BackgroundPreterm birth is a main determinant of neonatal mortality and morbidity and a major contributor to the overall mortality and burden of disease. However, research of the preterm birth is hindered by the imprecise definition of the clinical phenotype and complexity of the molecular phenotype due to multiple pregnancy tissue types and molecular processes that may contribute to the preterm birth. Here we comprehensively evaluate the mRNA transcriptome that characterizes preterm and term labor in tissues comprising the pregnancy using precisely phenotyped samples. The four complementary phenotypes together provide comprehensive insight into preterm and term parturition.MethodsSamples of maternal blood, chorion, amnion, placenta, decidua, fetal blood, and myometrium from the uterine fundus and lower segment (n = 183) were obtained during cesarean delivery from women with four complementary phenotypes: delivering preterm with (PL) and without labor (PNL), term with (TL) and without labor (TNL). Enrolled were 35 pregnant women with four precisely and prospectively defined phenotypes: PL (n = 8), PNL (n = 10), TL (n = 7) and TNL (n = 10). Gene expression data were analyzed using shrunken centroid analysis to identify a minimal set of genes that uniquely characterizes each of the four phenotypes. Expression profiles of 73 genes and non-coding RNA sequences uniquely identified each of the four phenotypes. The shrunken centroid analysis and 10 times 10-fold cross-validation was also used to minimize false positive finings and overfitting. Identified were the pathways and molecular processes associated with and the cis-regulatory elements in gene's 5' promoter or 3'-UTR regions of the set of genes which expression uniquely characterized the four phenotypes.ResultsThe largest differences in gene expression among the four groups occurred at maternal fetal interface in decidua, chorion and amnion. The gene expression profiles showed suppression of chemokines expression in TNL, withdrawal of this suppression in TL, activation of multiple pathways of inflammation in PL, and an immune rejection profile in PNL. The genes constituting expression signatures showed over-representation of three putative regulatory elements in their 5'and 3' UTR regions.ConclusionsThe results suggest that pregnancy is maintained by downregulation of chemokines at the maternal-fetal interface. Withdrawal of this downregulation results in the term birth and its overriding by the activation of multiple pathways of the immune system in the preterm birth. Complications of the pregnancy associated with impairment of placental function, which necessitated premature delivery of the fetus in the absence of labor, show gene expression patterns associated with immune rejection

Embodied GHG emissions of buildings - Critical reflection of benchmark comparison and in-depth analysis of drivers

In the face of the unfolding climate crisis, the role and importance of reducing Greenhouse gas (GHG) emissions from the building sector is increasing. This study investigates the global trends of GHG emissions occurring across the life cycle of buildings by systematically compiling life cycle assessment (LCA) studies and analysing more than 650 building cases. Based on the data extracted from these LCA studies, the influence of features related to LCA methodology and building design is analysed. Results show that embodied GHG emissions, which mainly arise from manufacturing and processing of building materials, are dominating life cycle emissions of new, advanced buildings. Analysis of GHG emissions at the time of occurrence, shows the upfront \u27carbon spike\u27 and emphasises the need to address and reduce the GHG \u27investment\u27 for new buildings. Comparing the results with existing life cycle-related benchmarks, we find only a small number of cases meeting the benchmark. Critically reflecting on the benchmark comparison, an in-depth analysis reveals different reasons for cases achieving the benchmark. While one would expect that different building design strategies and material choices lead to high or low embodied GHG emissions, the results mainly correlate with decisions related to LCA methodology, i.e. the scope of the assessments. The results emphasize the strong need for transparency in the reporting of LCA studies as well as need for consistency when applying environmental benchmarks. Furthermore, the paper opens up the discussion on the potential of utilizing big data and machine learning for analysis and prediction of environmental performance of buildings

Prescription and Other Medication Use in Pregnancy

OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined. RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication). CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common

Sleep During Pregnancy: The nuMoM2b Pregnancy and Sleep Duration and Continuity Study

Study Objectives: To characterize sleep duration, timing and continuity measures in pregnancy and their association with key demographic variables. Methods: Multisite prospective cohort study. Women enrolled in the nuMoM2b study (nulliparous women with a singleton gestation) were recruited at the second study visit (16-21 weeks of gestation) to participate in the Sleep Duration and Continuity substudy. Women <18 years of age or with pregestational diabetes or chronic hypertension were excluded from participation. Women wore a wrist activity monitor and completed a sleep log for 7 consecutive days. Time in bed, sleep duration, fragmentation index, sleep efficiency, wake after sleep onset, and sleep midpoint were averaged across valid primary sleep periods for each participant. Results: Valid data were available from 782 women with mean age of 27.3 (5.5) years. Median sleep duration was 7.4 hours. Approximately 27.9% of women had a sleep duration of 9 hours. In multivariable models including age, race/ethnicity, body mass index, insurance status, and recent smoking history, sleep duration was significantly associated with race/ethnicity and insurance status, while time in bed was only associated with insurance status. Sleep continuity measures and sleep midpoint were significantly associated with all covariates in the model, with the exception of age for fragmentation index and smoking for wake after sleep onset. Conclusions: Our results demonstrate the relationship between sleep and important demographic characteristics during pregnancy

Buildings LCA and digitalization: Designers\u27 toolbox based on a survey

In a context of digitalization and increasing quality requirements, the building sector is facing an increasing level of complexity regarding its design process. This results in a growing number of involved actors from different domains, a multitude of tasks to be completed and a higher degree of needed expertise. New buildings are also required to reach higher performances in terms of environmental quality. To that regard, the exploitation of the full potential of digital tools can facilitate the integration of environmental aspects in the planning process, limit productivity shortcomings and reduce environmental impacts, which can result from an unaware decision making. Building environmental assessment can be performed through several Life Cycle Assessment (LCA)-based tools. “Pure calculation” tools quantify final buildings\u27 environmental potential, while “complex tools” additionally support decision making during the planning process. It is often difficult to choose the best suitable tool, which strongly depends on the user\u27s needs. Within the IEA EBC Annex 72, a survey was realized with the main objective of creating a comprehensive overview of the existing tools dedicated to buildings LCA. The questionnaire included the usability, functionality, compliance, data reliability and interoperability of the analysed tools. Lastly, based on the survey outcomes and their critical assessment, a procedure for the identification and selection of a tool has been proposed based on user\u27s needs. As a result, this work outlines main features of currently available building LCA tools, for which there is a harmonized status in terms of usability and overall applied LCA methodology. Despite the need for more automatized workflows, tools\u27 embedding is mostly not yet applicable in system chains or limited to a restricted number of tools

The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components

Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health\u27s Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment and education (SEE), and individualized medication treatment. NAVIGATE embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews. The NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis. A cluster-randomized controlled trial comparing NAVIGATE with usual community care has recently been completed

Pregnancy-Associated Hypertension in Glucose-Intolerant Pregnancy and Subsequent Metabolic Syndrome

To evaluate whether pregnancy-associated hypertension (preeclampsia or gestational hypertension), among women with varying degrees of glucose intolerance during pregnancy is associated with maternal metabolic syndrome 5-10 years later