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Management Strategies for Traumatic Injuries in Pregnant Women: A Comprehensive Literature Review
Get PDFIntroduction: Traumatic injuries in pregnant women are the leading cause of non-obstetric death and affect 6% to 8% of all pregnancies. Therefore, it is imperative to maintain updated guidelines to construct a framework for the optimal management strategies for traumatic injuries in pregnant women, considering the perspectives of obstetrics/gynecology, emergency medicine, and orthopedics.
Methods: To conduct this study, research was done via a database search through the Rowan-Virtua School of Osteopathic Medicine’s research library. PubMed was the sole database used to review 8 peer-reviewed sources. Articles that were published within the last 10 years were chosen.
Results: Every woman with significant traumatic injuries must have pregnancy ruled out given its unique physiologic characteristics. First responders gather history surrounding fetal movement, contractions, and vaginal bleeding. Stabilization includes fetal monitoring, fluid resuscitation, blood transfusions, and maternal repositioning. Laboratory studies and diagnostic imaging (ultrasound) do not harm the mother or baby and reflect fetal status. Sometimes, emergency cesarean delivery (≤ 5 minutes of arrest) is indicated. There are some reports of fetal survival and maternal benefit beyond 15 minutes of arrest. Domestic violence is the most common trauma mechanism for pregnant women and triggers several obstetric complications (fetal loss, pre-term delivery, and placental abruption).
Conclusion: Adverse outcomes of pregnancy happen more frequently following trauma. Non-emergent trauma may be managed conservatively, delaying treatment until after delivery. Surgical positioning, medication administration, and diagnostic imaging determine the best outcomes for the mother and child
Potential Mechanisms for New Onset Atrial Fibrillation in COVID-19 Patients
Get PDFIntroduction: This study shows the prevalence of New-Onset Atrial Fibrillation in COVID-19 patients and highlights the most prevalent explanatory pathologic theories for the correlation.
Methods: The authors carried out a literature review over PubMed using the keywords “atrial fibrillation” and “long-term COVID.” 48 articles were reviewed. Articles relating to new onset of atrial fibrillation in COVID-19 patients were included while articles posted before 2020, not related to COVID and atrial fibrillation were excluded.
Results: The prevalence of atrial fibrillation in COVID patients is often reported to be around 17%, however 44% of patients within Intensive Care units (ICU) have atrial fibrillation with COVID. COVID-19 is proposed to lead to development of atrial fibrillation through dysregulation of the ACE2 receptor, increase in T-cell activation, and increasing the thrombocytes within the heart. Leading to increased edema and blockage of the electrophysiology of the heart.
Discussions: Atrial fibrillation constitutes a significant risk factor for patients hospitalized for COVID-19, especially in severe cases like in the ICU. This finding resembles similar arrhythmias found in other viruses like Middle East respiratory syndrome (MERS). The prevalence of arrhythmias with viral infections shows the need to monitor the cardiac rhythms of patients with viral infections.
Conclusions: COVID-19 poses a significant risk of leading to atrial fibrillation in severe cases. However, the pathophysiology has not been confirmed. Future work needs to confirm the pathophysiology of COVID-19 and atrial fibrillation to establish better treatments for patients and show the need to monitor patients’ hospitalized for viral infection cardiac rhythm
An Online Nanoinformatics Platform Empowering Computational Modeling of Nanomaterials by Nanostructure Annotations and Machine Learning Toolkits.
Get PDFModern nanotechnology has generated numerous datasets from in vitro and in vivo studies on nanomaterials, with some available on nanoinformatics portals. However, these existing databases lack the digital data and tools suitable for machine learning studies. Here, we report a nanoinformatics platform that accurately annotates nanostructures into machine-readable data files and provides modeling toolkits. This platform, accessible to the public at https://vinas-toolbox.com/, has annotated nanostructures of 14 material types. The associated nanodescriptor data and assay test results are appropriate for modeling purposes. The modeling toolkits enable data standardization, data visualization, and machine learning model development to predict properties and bioactivities of new nanomaterials. Moreover, a library of virtual nanostructures with their predicted properties and bioactivities is available, directing the synthesis of new nanomaterials. This platform provides a data-driven computational modeling platform for the nanoscience community, significantly aiding in the development of safe and effective nanomaterials
Academic Instruction Librarians’ Conceptions of Teacher Agency and Affective Orientations toward the Concept
Get PDFThis article reports on findings of an online survey on academic instruction librarians’ conceptions and experiences of teacher agency in the context of their instruction work and, more specifically, on their affective orientations (positive, ambivalent, or negative emotions and feelings) toward teacher agency. Two key dimensions of participants’ conceptions of teacher agency are evident throughout this analysis: 1) views of teacher agency as an individual experience of autonomy (individual agency) and/or views of it as more relational and interactive (and thus potentially collective), and 2) beliefs about the feasibility of librarians’ teacher agency, given librarians’ roles and positions as educators. Participants generally expressed positive affect when they felt they were independently in control of their teaching (individual agency), or when they described reciprocal and collaborative relationships with faculty (potentially collective agency). Participants expressed negative affect about experiences of lacking teacher agency. Almost all participants expressed 1) a desire to experience meaning and purpose in teaching and 2) a sensitivity to the highly relational nature of librarians’ instructional work. Finally, the author discusses potential implications for academic instruction librarians’ teaching practices, professional development, and work environments
INTEGRATED COMPUTER-AIDED DESIGN, EXPERIMENTATION, AND OPTIMIZATION APPROACH FOR PEROVSKITES AND PETROLEUM PACKAGING PROCESSES
Get PDFAccording to the World Economic Forum report, the U.S. currently has an energy efficiency of just 30%, thus illustrating the potential scope and need for efficiency enhancement and waste minimization. In the U.S. energy sector, petroleum and solar energy are the two key pillars that have the potential to create research opportunities for transition to a cleaner, greener, and sustainable future. In this research endeavor, the focus is on two pivotal areas: (i) Computer-aided perovskite solar cell synthesis; and (ii) Optimization of flow processes through multiproduct petroleum pipelines. In the area of perovskite synthesis, the emphasis is on the enhancement of structural stability, lower costs, and sustainability. Utilizing modeling and optimization methods for computer-aided molecular design (CAMD), efficient, sustainable, less toxic, and economically viable alternatives to conventional lead-based perovskites are obtained. In the second area of optimization of flow processes through multiproduct petroleum pipelines, an actual industrial-scale operation for packaging multiple lube-oil blends is studied. Through an integrated approach of experimental characterization, process design, procedural improvements, testing protocols, control mechanisms, mathematical modeling, and optimization, the limitations of traditional packaging operations are identified, and innovative operational paradigms and strategies are developed by incorporating methods from process systems engineering and data-driven approaches
Understanding the LGBTQ+ Divide: A review on the impact of geographic location and political climate on LGBTQ+ patient care in the United States.
Get PDFBackground:
In the United States, laws and policies are proposed and passed daily that either protect or restrict transgender patients’ access to care. The objective of this study is to review the existing body of literature on the effect of state-level policy on transgender patients’ overall health.
Methods:
Primary literature was identified through PubMed and the National Institutes of Health. Search terms included keywords related to the following concepts: LGBTQ terms, differentiating terms, regional terms, and health outcome terms. Inclusion criteria: Quantifiable studies conducted on the American LGBTQ and Transgender population from January 2015 to April 2023. Exclusion criteria: Studies not conducted in English, on the American population, and not relevant to the research question. Results were individually discussed and then synthesized using a narrative approach.
Results:
A total of 6 studies were identified for review. The difference in rates of suicidality, suicide attempt, depression, and anxiety between Democratic and Republican states was statistically significant (p
Conclusion:
Republican-run states, on average, had policies in place restricting access and treatment for transgender patients which is correlated with worse health outcomes. Advocacy is greatly needed to help protect this at-risk population and further research is needed to better understand how state-level barriers impact transgender patients across the US
New vertebrate microfossils expand the diversity of the chondrichthyan and actinopterygian fauna of the Maastrichtian–Danian Hornerstown Formation in New Jersey
Get PDFThe abundance of shark and actinopterygian fossils in the Cretaceous and Paleogene strata of the Atlantic Coastal Plain is well documented; but much remains unknown about the survivorship patterns of these major components of shallow marine faunas in the western Atlantic through the K/Pg mass extinction. To shed light on this subject, we describe an assemblage of new actinopterygian, chondrichthyan, and reptilian microfossils recently recovered from the Maastrichtian Navesink and Maastrichtian–Danian Hornerstown formations at the Jean and Ric Edelman Fossil Park at Rowan University in Mantua Township, New Jersey. The new microfossils clarify extinction patterns across the K/Pg, create temporal and geographic range extensions for several taxa, and expand the known fauna of this regionally-rare and important K/Pg-boundary locality. We report 11 new additions to the vertebrate fauna of Edelman Fossil Park, the first Paleocene record of Saurocephalus lanciformis, the first Cretaceous records of Paralbula marylandica and Palaeogaleus vincenti, and the first recovery of gar and dercetid fish remains from the Paleocene in New Jersey (the last indicating that these fish survived the K/Pg extinction in the western Atlantic). Geographic range extensions include: Notidanodon brotzeni into the Western Hemisphere, Saurocephalus into northeastern North America and Phyllodus paulkatoi to the eastern coast of North America. A dentary of a juvenile alligatorid, Bottosaurus harlani, indicate that the mandible exhibited isometric growth through ontogeny. Our findings generally agree with other studies that these groups were significantly impacted by the extinction event, that extinctions were selective, and recovery was slow. This wealth of novel insights garnered from microfossils in this study highlights their critical importance for elaborating past faunas and illuminating the character of ancient ecosystems. We therefore recommend microsieving as a fruitful method for future faunal studies of shallow-marine strata and predict that such efforts will frequently yield similar important insights
Improved Network Integrity and Patient Follow-up After In-Office Needle Arthroscopy Compared to Outpatient Advanced Diagnostic Imaging for Intra-articular Pathology
Get PDFPurpose To evaluate network integrity for diagnostic testing and patient follow-up comparing in-office needle arthroscopy and outpatient advanced diagnostic imaging for intra-articular pathology. Methods A retrospective chart review was performed to identify patients who were indicated for either in-office needle arthroscopy (IONA) or outpatient advanced diagnostic imaging (OADI). Current Procedural Terminology (CPT) codes 29870 and 29805 with place of service modifier 11 were used to identify patients who underwent IONA of the knee and shoulder, respectively, between January 2020 and March 2023. CPT codes 73721-3 and 73221-3 were utilized to identify patients indicated for outpatient advanced magnetic resonance imaging of the knee or shoulder. All patients who were indicated for the procedure and denied by the insurance were identified and recorded. Inclusion criteria consisted of patients older than 18 years with suspected intra-articular pathology who had failed conservative treatment. Exclusion criteria included patients younger than 18 years, non-English speaking, or those who failed to follow up due to death. The location of where the imaging was performed was recorded (within the health system vs an unaffiliated center). Additionally, patient follow-up with the provider after the diagnostic testing was indicated was recorded. Results Two separate groups of 100 consecutive patients who were indicated for IONA or OADI were identified and retrospectively chart reviewed. Ninety-four percent of the IONA patients underwent the procedure after it was indicated within the physician office. Sixty-eight percent underwent the procedure the day they were indicated for the procedure. All 94 patients were deemed to have a follow-up with a definitive plan of care after the procedure. Eighty-seven percent of the OADI patients completed their ordered testing. Sixty-two percent (54/87) of the patients had the study performed at one of the primary hospital-affiliated imaging centers. Thirty-eight percent of the studies (33/87) were deemed to have leaked from the system. Of the 87 patients who had the imaging performed, 79% (69/87) had a definitive treatment plan rendered with the lead author (S.M.) based on the imaging results. Twenty-one percent (18/87) of the patients who underwent imaging did not follow up with the treating provider or show for a scheduled follow-up appointment. Nineteen percent (13/69) of the patients who had a definite treatment plan rendered did not come into the office for their results but requested and received them over the phone from the provider. The IONA cohort demonstrated statistically significant (P \u3c .001) network integrity in terms of location of service remaining within the system compared to the OADI group. Furthermore, patient follow-up for definitive treatment plans after IONA was also higher (P \u3c .001) than in the OADI group. Conclusions IONA results in greater network integrity and patient follow-up compared to conventional imaging. Clinical Relevance In-office needle arthroscopy performed for the diagnosis of intra-articular pathology may offer a valuable clinical diagnostic tool while providing a meaningful avenue for network integrity and patient retention
Back to the Future: A Case for the Resurgence of Approximation Theory for Enabling Data Driven “Intelligence”
Get PDFArtificial Intelligence (AI) has exploded into mainstream consciousness with commercial investments exceeding $90 billion in the last year alone. Inasmuch as consumer-facing applications such ChatGPT offer astounding access to algorithms that were hitherto restricted to academic research labs, public focus of attention on AI has created an avalanche of misinformation. The nexus of investor-driven hype, “surprising” inaccuracies in the answers provided by AI models – now anthropomorphically labeled as “hallucinations”, and impending legislation by well-meaning and concerned governments has resulted in a crisis of confidence in the science of AI. The primary driver for AI’s recent growth is the convergence of ubiquitous cloud computing technology and pivotal developments in artificial neural network (ANN) architectures and machine learning topologies, leading to the emergence and dominance of large language models. These models have cast aside the need for extensive data pre-processing and incorporate feature extraction into network training. In some cases, such as in the use of generative AI models for natural language processing, the results are astonishing, but also, in many ways, concerning. An overreliance on the network to perform multiple tasks, well beyond data interpolation, leads to output anomalies and errors. Also, increasing the size of datasets and number of network layers to ensure better performance is soon to hit a brick wall of incurred time and expense to train the network. But of greatest concern, despite the race to advance the technology, is that we are unable to adequately describe the operation of AI models mathematically, and, therefore, we do not completely understand how such systems develop the relationships within the training data to produce results. It is in this context that the research work presented in this dissertation comprehensively investigates the origins of ANNs based on approximation theory, in order to refocus efforts on data pre-processing, and away from the exclusive attention on the development of more and more complex architectures. In a sense, the science and mathematics of AI algorithms must provide a path for the robust, reliable, and rapid deployment of intelligent algorithms without an over-reliance of technological prowess – inexpensive bandwidth and computing power. An algorithm for shape recognition in image data is developed based on geometric transformations, which forms the input to data to any neural network architecture of choice. Results demonstrate that such intelligent pre-processing provides significantly more control to the network designer than brute-force methods of exponentially increasing network layers
An Unexpected Finding During a Breast Excisional Biopsy: A Case Report
Get PDFBackground: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.
Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. Since the two leads were found to be transecting the left breast mass, the mass was removed in pieces. Postoperative pathology revealed a 2.2 cm invasive papillary carcinoma. Due to concern for unclear margin status, the patient elected for a left modified radical mastectomy and sentinel lymph node biopsy following the implantation of a new pacemaker lateralized to the right side of the chest. Following this operation, final pathology was negative for residual cancer. Sentinel lymph node biopsy was negative.
Conclusion: This case describes an interdisciplinary approach to the relocation of a permanent pacemaker and clinical treatment of a patient’s breast cancer. If encountered, the presence of a pacemaker lead within the breast of a patient with breast cancer will likely require an individualized management strategy. Therefore, collaboration between cardiologists and surgeons is vital to successful clinical management of this phenomenon