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Background:. The novel coronavirus and associated Coronavirus Disease 2019 (COVID-19) is rapidly spreading throughout the world, with robust growth in the United States. Its drastic impact on the global population and international health care is swift, evolving, and unpredictable. The effects on orthopaedic surgery departments are predominantly indirect, with widespread cessation of all nonessential orthopaedic care. Although this is vital to the system-sustaining measures of isolation and resource reallocation, there is profound detriment to orthopaedic training programs. Methods:. In the face of new pressures on the finite timeline on an orthopaedic residency, the Emory University School of Medicine Department of Orthopaedics has devised a 5-pronged strategy based on the following: (1) patient and provider safety, (2) uninterrupted necessary care, (3) system sustainability, (4) adaptability, and (5) preservation of vital leadership structures. Results:. Our 5 tenants support a 2-team system, whereby the residents are divided into cycling “active-duty” and “working remotely” factions. In observation of the potential incubation period of viral symptoms, phase transitions occur every 2 weeks with strict adherence to team assignments. Intrateam redundancy can accommodate potential illness to ensure a stable unit of able residents. Active duty residents participate in in-person surgical encounters and virtual ambulatory encounters, whereas remotely working residents participate in daily video-conferenced faculty-lead, case-based didactics and pursue academic investigation, grant writing, and quality improvement projects. To sustain this, faculty and administrative 2-team systems are also in place to protect the leadership and decision-making components of the department. Conclusions:. The novel coronavirus has decimated the United States healthcare system, with an unpredictable duration, magnitude, and variability. As collateral damage, orthopaedic residencies are faced with new challenges to provide care and educate residents in the face of safety, resource redistribution, and erosion of classic learning opportunities. Our adaptive approach aims to be a generalizable tactic to optimize our current landscape.

Objective To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). Methods Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. Results 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD− patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. Conclusion Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.

Glycogen storage disease type 1a (GSD 1a) is a rare inborn error of metabolism. It causes severe fasting intolerance and lactic acidosis due to the deficiency of glucose-6-phosphatase enzyme. Blood glucose and lactate concentrations from 2 patients with GSD 1a were retrospectively compared to a control group of patients with familial amyloid polyneuropathy. Carbohydrate intake and infusions were compared to experimental data based on stable isotope studies. Perioperative lactate concentrations were significantly higher in our 2 patients with GSD 1a (median 15.0 mmol/L; range 9.9-22.0 mmol/L) versus 8 controls. In one patient, despite normal blood glucose concentrations, lactate acidosis was probably caused by a combination of the disease itself, insufficient (par)enteral carbohydrate intake, Ringer lactate infusions, and circulatory insufficiency. Patients with GSD 1a carry an increased risk of lactic acidosis during orthotopic liver transplantation compared to non-GSD patients. Multidisciplinary perioperative care is essential to prevent significant complications.

Background: Chest pain (CP) accounts for approximately 6 million emergency visits per year in the United States. There is growing interest in strategies to effectively risk stratify pts for coronary artery disease (CAD) related events in a cost-effective manner. The use of chest pain observation units followed by early stress testing is frequently employed in these pts. However the utility of stress testing in this population is not well defined, and the effect of stress test results on subsequent management decisions is a topic of controversy. In the present study we examined the relationship of stress myocardial perfusion imaging (MPI) results to physician decisions regarding ccath in a single community teaching hospital. Methods: Retrospective study of 426 pts undergoing a chest pain observation strategy over a 24 month period. Pt eligible for the program had CP deemed possibly related to CAD but no diagnostic ECG changes and negative TnI measurements x2. All pts underwent outpt. stress MPI within 72 hours of discharge. Pts saw a cardiologist the day of stress MPI who reviewed the CP history, MPI results, and made decisions regarding further risk stratification. Demographic and medical history was collected from the pts chest pain observation unit record. Multivariate regression analysis was used to determine significant independent variables related to physician decisions regarding further risk stratification. Results: Of 426 pts who underwent outpt stress MPI, 71(16.7%) were positive for ischemia, and 16 (22.5% of +MPI) underwent cath with reperfusion performed in 8 (5PCI, 3 CABG, 11.3% of +MPI). Of the 355 pts with negative stress MPI, 5(1.4% of -MPI) underwent cath with reperfusion performed in 2 (2PCI, 0 CABG, 0.5% of -MPI). A MLR model suggested only stress MPI results were independently predictive of the use of ccath for risk stratification. Conclusion: Stress MPI was an important factor in physician decision-making regarding the need for ccath in pts managed in a chest pain observation unit. The rate of +MPI and subsequent use of ccath in our institution supports MPI as an appropriate step in risk stratification of low to moderate risk CP pts triaged through a CP observation unit.

Jornandes rileyi, new species Figures 3, 10A, 30 HOLOTYPE: ♀, MEXICO: Baja California Sur: 14.4 mi E on Ramal a Los Naranjo [23.25661 ° N 109.91648 ° W, 1101 m], IX-16- 88, E. G. Riley, black light (AMNH _ PBI 00184928). Department of Entomology, Texas A & M University, College Station, Texas. DIAGNOSIS: Recognized by body, including antennae and legs, shining reddish fuscous to black except for pale band extending across posterior margin of pronotum (fig. 3); frons rounded; vertex clearly wider than length of antennal segment I; labium reaching mesocoxa or slightly beyond; width of pronotum greater than length of antennal segment II; robust with costal margins of hemelytron curved; metepisternum dorsal to evaporative area of scent gland with microtrichia. DESCRIPTION: Male: COLORATION: Generally dark reddish fuscous to black with posterior margin of pronotum almost white. Corium appearing brown in translucent areas but dark fuscous or black as seen from side. Underside, antennae, labium, and legs reddish fuscous to black. VESTITURE: Head, pronotum, and corium shining with widely scattered, short, inconspicuous, darkcolored setae; setae on antennal segments II– IV semierect and not significantly longer than diameter of respective segments; decumbent setae on underside of abdomen denser and longer. GENITALIA (fig. 30): Genital segment with single small, pointed tergal process projecting from midline of dorsal margin of aperture; ventroposterior margin of capsule flangelike with medial cleft, distal width of subgenital plate narrow, projecting strongly dorsal to aperture of capsule. Left paramere C-shaped in dorsal view; without sensory lobe; diameter of paramere gradually expanded distally to mittenlike apex. Right paramere larger than left paramere; with long, narrow, strongly attenuate sensory lobe and paramere body, apices minutely serrate. Phallotheca elongate, cone shaped, equal to length of spiculum; aperture wide, open on right side, dorsal margin, and apex. Vesica with one long, medially thickened spiculum, situated on dorsal surface of ductus seminis; apical region of spiculum recurved, attenuate, strongly serrate, distal region almost 1/3 length of spiculum; base of spiculum with large process reaching to 1/2 length of main body of spiculum more distal to smaller flattened rectangular basal process. Females: Slightly larger than males; color and vestiture as for male. MEASUREMENTS: Male (n 5 2): Length, 2.40 and 2.70; width, 1.30 and 1.56. Head length, 0.24 and 0.26; width, 0.72 and 0.80; vertex width, 0.36 and 0.38. Length of antennal segment I, 0.24 (remaining segments missing). Pronotal length, 0.56 and 0.68; width across base, 1.10 and 1.30. Cuneal length, 0.48 and 0.52; width across base, 0.48 and 0.50. (AMNH_PBI 00118211); scale 5 0.20 mm. Female (n 5 4; those of holotype given first followed in parentheses by average and range): Length, 2.64 (2.74, 2.64–2.80); width, 1.80 (all). Head length, 0.24 (0.24, 0.20–0.25); width; 0.84 (0.83, 0.80–0.84); vertex width, 0.42 (0.42, 0.40–0.42). Length of antennal segment I, 0.28 (0.24, 0.22–0.28); II, 0.84 (single paratype, 0.80); III, 0.54 (holotype only); IV, missing. Pronotal length 0.80 (0.76, 0.64–0.80); width across base, 1.36 (1.34, 1.30–1.38). Cuneal length, 0.54, 0.54, 0.50– 0.58); width across base, 0.50 (0.50, 0.48– 0.50). DISCUSSION: The unique color pattern distinguishes this species from all others of the genus. The reddish fuscous to black pronotum has a whitish broad band along the posterior margin. Curiously, the same distinctive color pattern is exhibited by some specimens of Scalponotatus albibasis (Knight), which occurs in southwestern U. S. and northwestern Mexico. The typical Jornandes type of sculpturing is easily seen, whereas S. albibasis has a roughened dorsum. All specimens were collected into alcohol at light. No setae were present on the hemelytral membrane. This is the only known species of Jornandes occurring in Baja California Sur. A female was selected as holotype because it was better preserved than any of the three available males. HOST PLANT: Unknown. ETYMOLOGY: Named for E. G. Riley from Texas A&M University who collected all the specimens of this species. DISTRIBUTION: Known only from the type series from Baja California Sur (fig. 10A). PARATYPES: MEXICO: Baja California Sur: 14.4 mi E on Ramal a Los Naranjos, 23.25661 ° N 109.91648 ° W, 1101 m, 16 Sep 1988, E. G. Riley, black light, 1♀ (AMNH_ PBI 00119110), 13 (AMNH_PBI 00118211) (CNC). 13 (AMNH_PBI 00094301), 1♀ (AMNH_PBI 00094302), 13 (AMNH_PBI 00184787), 2♀ (AMNH_PBI 00184788, AMNH_ PBI 00184789) (TAMU)., Published as part of Schaffner, JC & Schwartz, MD, 2008, Revision Of The Mexican Genera Ficinus Distant And Jornandes Distant With The Description Of 21 New Species (Heteroptera: Miridae: Orthotylinae: Orthotylini), pp. 1-87 in Bulletin of the American Museum of Natural History 2008 (309) on pages 64-66

Jornandes rileyi, new species Figures 3, 10A, 30 HOLOTYPE: ♀, MEXICO: Baja California Sur: 14.4 mi E on Ramal a Los Naranjo [23.25661 ° N 109.91648 ° W, 1101 m], IX-16- 88, E. G. Riley, black light (AMNH _ PBI 00184928). Department of Entomology, Texas A & M University, College Station, Texas. DIAGNOSIS: Recognized by body, including antennae and legs, shining reddish fuscous to black except for pale band extending across posterior margin of pronotum (fig. 3); frons rounded; vertex clearly wider than length of antennal segment I; labium reaching mesocoxa or slightly beyond; width of pronotum greater than length of antennal segment II; robust with costal margins of hemelytron curved; metepisternum dorsal to evaporative area of scent gland with microtrichia. DESCRIPTION: Male: COLORATION: Generally dark reddish fuscous to black with posterior margin of pronotum almost white. Corium appearing brown in translucent areas but dark fuscous or black as seen from side. Underside, antennae, labium, and legs reddish fuscous to black. VESTITURE: Head, pronotum, and corium shining with widely scattered, short, inconspicuous, darkcolored setae; setae on antennal segments II– IV semierect and not significantly longer than diameter of respective segments; decumbent setae on underside of abdomen denser and longer. GENITALIA (fig. 30): Genital segment with single small, pointed tergal process projecting from midline of dorsal margin of aperture; ventroposterior margin of capsule flangelike with medial cleft, distal width of subgenital plate narrow, projecting strongly dorsal to aperture of capsule. Left paramere C-shaped in dorsal view; without sensory lobe; diameter of paramere gradually expanded distally to mittenlike apex. Right paramere larger than left paramere; with long, narrow, strongly attenuate sensory lobe and paramere body, apices minutely serrate. Phallotheca elongate, cone shaped, equal to length of spiculum; aperture wide, open on right side, dorsal margin, and apex. Vesica with one long, medially thickened spiculum, situated on dorsal surface of ductus seminis; apical region of spiculum recurved, attenuate, strongly serrate, distal region almost 1/3 length of spiculum; base of spiculum with large process reaching to 1/2 length of main body of spiculum more distal to smaller flattened rectangular basal process. Females: Slightly larger than males; color and vestiture as for male. MEASUREMENTS: Male (n 5 2): Length, 2.40 and 2.70; width, 1.30 and 1.56. Head length, 0.24 and 0.26; width, 0.72 and 0.80; vertex width, 0.36 and 0.38. Length of antennal segment I, 0.24 (remaining segments missing). Pronotal length, 0.56 and 0.68; width across base, 1.10 and 1.30. Cuneal length, 0.48 and 0.52; width across base, 0.48 and 0.50. (AMNH_PBI 00118211); scale 5 0.20 mm. Female (n 5 4; those of holotype given first followed in parentheses by average and range): Length, 2.64 (2.74, 2.64–2.80); width, 1.80 (all). Head length, 0.24 (0.24, 0.20–0.25); width; 0.84 (0.83, 0.80–0.84); vertex width, 0.42 (0.42, 0.40–0.42). Length of antennal segment I, 0.28 (0.24, 0.22–0.28); II, 0.84 (single paratype, 0.80); III, 0.54 (holotype only); IV, missing. Pronotal length 0.80 (0.76, 0.64–0.80); width across base, 1.36 (1.34, 1.30–1.38). Cuneal length, 0.54, 0.54, 0.50– 0.58); width across base, 0.50 (0.50, 0.48– 0.50). DISCUSSION: The unique color pattern distinguishes this species from all others of the genus. The reddish fuscous to black pronotum has a whitish broad band along the posterior margin. Curiously, the same distinctive color pattern is exhibited by some specimens of Scalponotatus albibasis (Knight), which occurs in southwestern U. S. and northwestern Mexico. The typical Jornandes type of sculpturing is easily seen, whereas S. albibasis has a roughened dorsum. All specimens were collected into alcohol at light. No setae were present on the hemelytral membrane. This is the only known species of Jornandes occurring in Baja California Sur. A female was selected as holotype because it was better preserved than any of the three available males. HOST PLANT: Unknown. ETYMOLOGY: Named for E. G. Riley from Texas A&M University who collected all the specimens of this species. DISTRIBUTION: Known only from the type series from Baja California Sur (fig. 10A). PARATYPES: MEXICO: Baja California Sur: 14.4 mi E on Ramal a Los Naranjos, 23.25661 ° N 109.91648 ° W, 1101 m, 16 Sep 1988, E. G. Riley, black light, 1♀ (AMNH_ PBI 00119110), 13 (AMNH_PBI 00118211) (CNC). 13 (AMNH_PBI 00094301), 1♀ (AMNH_PBI 00094302), 13 (AMNH_PBI 00184787), 2♀ (AMNH_PBI 00184788, AMNH_ PBI 00184789) (TAMU).

In 12 patients stimulated for in vitro fertilization and embryo transfer (IVF-ET), a single leading follicle developed, whereas the other follicles were 6 mm smaller. In 7 patients chosen at random (group A), the leading follicle was aspirated, whereas in the other 5 the leading follicle was allowed to continue growing (group B). Comparison of the hormonal pattern of both groups showed that a premature luteinizing hormone (LH) surge was avoided only in group A, and only in this group a second follicle aspiration for IVF-ET was done, and two pregnancies were achieved. In group B, aspiration for IVF-ET was canceled because of premature LH surge. It is suggested that aspiration of a single leading follicle during ovulation induction may be an efficient method to avoid premature LH surge enabling other follicles to develop up to the preovulatory stage.

Sexual experience and attitudes and the use of contraception were studied in 482 unmarried students at Tel-Aviv University. A third of the female students were virgin while the majority (51%) were sexually active at the time of study as were 61% of male students. The use of contraceptives was found to be directly related to engagement in sexual activity on a regular basis. A similar relationship was found between the use of contraception and attitudes towards unwanted pregnancy. Although 75% of all students supported termination of unwanted pregnancy, about half of the inexperienced females would opt for marriage and childbearing. The greater the extent of past sexual experience the more sexual activity was considered as contributory to interpersonal relationships. The extent of sexual activity of female students differed significantly between the various faculties. Female students in the Arts were the most active, although their use of contraceptives was not proportionally greater. Among medical...