Search

In recent times, the usage of virtual teams has been accelerated, and virtual teams are being used exponentially in higher education and industry - driven by, and in response to, the Covid-19 pandemic - aided by developments in innovative technologies and globalisation. Teams have suddenly become an essential and necessary approach for collaborative learning as well as task completion. In examining the components of social interaction and its respective distinguished components, this paper positively points to virtual teams being an appropriate means for social interaction and team performance, albeit with some challenges. This qualitative study brings to the fore constructive and affirmative themes, along with various challenges that virtual teams present and also highlights areas for further research.

Inhaled epoprostenol is a selective pulmonary vasodilator that has shown a potentially broad number of applications in the management of critically ill patients. To date, the vast majority of the literature with regard to efficacy, indications for use, and adverse effects of inhaled epoprostenol is focused on use of this agent in critical care settings, with relatively little literature describing use of inhaled epoprostenol in the Emergency Department. This retrospective review sought to examine instances in which inhaled epoprostenol was administered in the Emergency Department of a tertiary-care, Level I trauma center following implementation of a clinical pathway for administration of this medication for cases of refractory hypoxemia, RV dysfunction, and refractory hypoxemia. Primary outcomes were monitoring for adverse effects (i.e. hypotension), trend in FiO2 requirement over time, and clinical indication for initiation of inhaled epoprostenol.An automated review was performed to query cases in which inhaled epoprostenol had been initiated in the Emergency Department following adoption of the inhaled epoprostenol clinical pathway. Cases were excluded if the medication was initiated in the prehospital setting, ordered but not administered, or administered for a period of1 h. Vital signs and co-administration of vasopressors were followed before and following epoprostenol administration to assess for change over time. Clinical indication of epoprostenol administration was assessed via manual chart review.Inhaled epoprostenol was administered in 20 instances, with 15 cases ultimately meeting inclusion criteria. There were no cases of clinically significant hypotension (MAP65) in any of the cases in which inhaled epoprostenol was administered in the Emergency Department, and mean vasopressor requirement did not increase over time. A majority of patients saw a reduction in FiO2 requirement following administration of inhaled epoprostenol. The most common indication for initiation of inhaled epoprostenol based on manual chart review was pulmonary embolism.In this review of cases in which inhaled epoprostenol was administered following adoption of a clinical pathway for medication administration, there were no cases of hypotension or other adverse effects that appear to be attributable to medication administration. Pulmonary embolism and refractory hypoxemia were the most common noted indications for administration of inhaled epoprostenol. Further research is warranted regarding development of clinical protocols for administration of inhaled pulmonary vasodilators in the Emergency Department setting.

Introduction Although endonasal endoscopic approaches (EEA) to the orbit have been previously reported, a didactic resource for educating neurosurgery and otolaryngology trainees regarding the pertinent anatomy, techniques, and decision-making pearls is lacking. Methods Six sides of three formalin-fixed, color latex–injected cadaveric specimens were dissected using 4-mm 0- and 30-degree rigid endoscopes, as well as standard endoscopic equipment, and a high-speed surgical drill. The anatomical dissection was documented in stepwise three-dimensional (3D) endoscopic images. Following dissection, representative case applications were reviewed. Results EEA to the orbit provides excellent access to the medial and inferior orbital regions. Key steps include positioning and preoperative considerations, middle turbinate medialization, uncinate process and ethmoid bulla removal, complete ethmoidectomy, sphenoidotomy, maxillary antrostomy, lamina papyracea resection, orbital apex and optic canal decompression, orbital floor resection, periorbita opening, dissection of the extraconal fat, and final exposure of the orbit contents via the medial-inferior recti corridor. Conclusion EEA to the orbit is challenging, in particular for trainees unfamiliar with nasal and paranasal sinus anatomy. Operatively oriented neuroanatomy dissections are crucial didactic resources in preparation for practical endonasal applications in the operating room (OR). This approach provides optimal exposure to the inferior and medial orbit to treat a wide variety of pathologies. We describe a comprehensive step-by-step curriculum directed to any audience willing to master this endoscopic skull base approach.

TFIIB is implicated in multiple aspects of eukaryotic transcription. To investigate the broader role of TFIIB in transcription, we performed quantitative proteomic analysis of yeast TFIIB. We purified TFIIB from soluble cell lysate and the chromatin fraction. TFIIB purified from the chromatin exhibits a number of interactions that explain its non-canonical roles in transcription. Apart from preinitiation components RNAPII, TFIIF and TFIIH, all three 3’ end processing-termination complexes; CF1, CPF and Rat1, are significantly enriched in chromatin-TFIIB preparation. These results explain the presence of TFIIB at the 3’ end of genes, its role in gene looping, and its newly identified role in termination of transcription. Presence of the Lsm complex as well as TREX complex subunit Sub2 in chromatin-TFIIB opens up the possibility of novel roles of TFIIB in synthesis-decay coupling and nucleocytoplasmic transport of mRNA. This multiplicity of functions may contribute to the preferential targeting of TFIIB during viral pathogenesis.

In a cohort of 483 high-risk patients treated with nirmatrelvir/ritonavir for COVID-19, 2 patients (0.4%) required hospitalization by day 30. Four patients (0.8%) experienced rebound of symptoms, which were generally mild, at a median of 9 days after treatment, and all resolved without additional COVID-19–directed therapy.

Facilitation is a global phenomenon that occurs when one species promotes the growth, survival, or reproduction of another species, mostly in stressful environments. However, the importance of facilitation by shrubs in maintaining plant community diversity is not well evaluated in the Himalayas, especially for the richness and conservation of medicinal and human-valued species. Therefore, we aimed to explore the facilitative role of a dwarf shrub species, Berberis angulosa, in maintaining plant composition and richness of human-valued species in the Langtang valley of Nepal's Himalayas. We censused plant species in open patches and beneath Berberis during monsoon and post-monsoon (dry) seasons at three elevations. Total species richness and richness of human-valued species were significantly higher inside the Berberis canopy than in gaps; the former being 39% and the latter 46% greater under shrubs than in open sites. Facilitation by Berberis shrubs promoted plant community diversity irrespective of season and elevation; however, higher differences in mean species richness for both total plant species and human-valued species during the dry season and at high elevation indicated increased facilitation intensity under more stressful conditions. The facilitative effect of Berberis shrubs increased, combining both seasons, overall plant diversity by 19% (total=105), and human-valued species by 16% (total=56). Our results show the importance of facilitation by nurse shrubs in structuring plant communities and protecting medicinal and socio-ecologically important plants, thus enriching ecosystem services in the Himalayas. These results suggest nurse plant species should be incorporated into conservation policies and management strategies for effective biodiversity conservation and sustainability, especially in the face of climate change.

The use of temporary mechanical circulatory support (MCS) for patients with refractory cardiogenic shock has increased over the past decade. Impella devices (intravascular microaxial ventricular assist devices [VADs]) have become common MCS options but reportedly cause thrombocytopenia. Limited published data regarding the incidence or severity of microaxial VAD-associated thrombocytopenia exists.The goal of this study was to determine the incidence, timing, and severity of thrombocytopenia in a microaxial VAD population.A retrospective multicenter review of electronic medical records identified all patients implanted with microaxial VAD at three US academic teaching hospitals between June 2015 and August 2017. Patients were excluded for short-term procedural microaxial VAD use during percutaneous coronary intervention.Sixty-four patients underwent microaxial VAD insertion (95% for left-sided support) during the observed time period. Support was in place for a median duration of 5.2 (interquartile range [IQR]: 2.4-10.0) days. Within 7 days postinsertion, 98.5% of patients developed thrombocytopenia (platelet count150,000/μl) and 81.3% of patients experienced a 50% platelet decrease. Average platelet count nadir was 68,200/μl or 63.9% from baseline occurring on median day 3.8 (IQR: 2.4-5.4). Twenty-four patients (38.1%) were tested for heparin-induced thrombocytopenia by the heparin-dependent antibody (HDA) test. All HDAs were either negative or had serotonin release assay negative confirmation. Postdevice removal, platelet counts returned to baseline or150,000/μl in 63% of patients by Day 5.Microaxial VAD-associated thrombocytopenia is common. Practitioners should consider this when evaluating supported patients for other causes of thrombocytopenia. Platelet counts return to preimplantation levels within days of device removal.

In the health spending debate, what policy makers need most is an honest, realistic, and evidence-based discussion. Unfortunately, many studies in the public arena fall far short.

Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and benefits of PAO in patients with hip dysplasia in studies reporting both adverse events and patient-reported hip pain and function.A systematic search combing PAO and patient-reported outcomes was performed in the databases MEDLINE, CINAHL, EMBASE, Sports Discuss and PsychINFO. Studies including both harms and benefits defined as adverse events and patient-reported hip pain and function were included. Risk of bias was assessed using The Cochrane Risk of Bias In Non-Randomized Studies - of Interventions.Twenty-nine cohort studies were included, of which six studies included a comparison group. The majority of studies had serious risk of bias and the certainty of evidence was very low. The proportion of adverse events was 4.3 (95% CI 3.7; 4.9) for major adverse events and 14.0 (95% CI 13.0; 15.1) for minor adverse events. Peroneal nerve dysfunction was the most frequent adverse event among the major adverse events, followed by acetabular necrosis and delayed union or non-union. All patient-reported hip pain and function scores improved and exceeded the minimal clinically important differences after PAO. After 5 years, scores were still higher than the preoperative scores.PAO surgery has a 4% risk of major, and 14% risk of minor adverse events and a positive effect on patient-reported hip pain and function among patients with hip dysplasia.

Post-traumatic headache (PTH) is a challenging clinical condition to identify and treat as it integrates multiple subjectively defined symptoms with underlying physiological processes. The precise mechanisms underlying PTH are unclear, and it remains to be understood how to integrate the patient experience with underlying biology when attempting to classify persons with PTH, particularly in the pediatric setting where patient self-report may be highly variable. The objective of this investigation was to evaluate the use of different machine learning (ML) classifiers to differentiate pediatric and young adult subjects with PTH from healthy controls using behavioral data from self-report questionnaires that reflect concussion symptoms, mental health, pain experience of the participants, and structural brain imaging from cortical and sub-cortical locations. Behavioral data, alongside brain imaging, survived data reduction methods and both contributed toward final models. Behavioral data that contributed towards the final model included both the child and parent perspective of the pain-experience. Brain imaging features produced two unique clusters that reflect regions that were previously found in mild traumatic brain injury (mTBI) and PTH. Affinity-based propagation analysis demonstrated that behavioral data remained independent relative to neuroimaging data that suggest there is a role for both behavioral and brain imaging data when attempting to classify children with PTH.

In a cohort of 483 high-risk patients treated with nirmatrelvir/ritonavir for coronavirus disease-2019, two patients (0.4%) required hospitalization by day 30. Four patients (0.8%) experienced rebound of symptoms, which were generally mild, at median of 9 days after treatment, and all resolved without additional COVID-19-directed therapy.

Fungal pathogens are implicated in driving tropical plant diversity by facilitating strong, negative density‐dependent mortality of conspecific seedlings (C‐NDD). Assessment of the role of fungal pathogens in mediating coexistence derives from relatively few tree species and predominantly the Neotropics, limiting our understanding of their role in maintaining hyper‐diversity in many tropical forests. A key question is whether fungal pathogen‐mediated C‐NDD seedling mortality is ubiquitous across diverse plant communities. Using a manipulative shadehouse experiment, we tested the role of fungal pathogens in mediating C‐NDD seedling mortality of eight mast fruiting Bornean trees, typical of the species‐rich forests of South East Asia. We demonstrate species‐specific responses of seedlings to fungicide and density treatments, generating weak negative density‐dependent mortality. Overall seedling mortality was low and likely insufficient to promote overall community diversity. Although conducted in the same way as previous studies, we find little evidence that fungal pathogens play a substantial role in determining patterns of seedling mortality in a SE Asian mast fruiting forest, questioning our understanding of how Janzen‐Connell mechanisms structure the plant communities of this globally important forest type., Assessment of the role of fungal pathogens in mediating coexistence derives from relatively few tree species and predominantly the Neotropics, limiting our understanding of their role in maintaining hyper‐diversity in many tropical forests. Using a manipulative shadehouse experiment, we find little evidence that fungal pathogens play a substantial role in determining patterns of seedling mortality of eight mast fruiting Bornean trees. Our results starkly contrast those of similar neotropical studies, questioning our understanding of how Janzen–Connell mechanisms structure the plant communities of this globally important forest type.

An increasing concern of families caring for children living with disabilities is related to planning for their future care. This qualitative study explores how the country contexts shape the plans for future care provision of Korean parents in New Zealand and Korea. Data were collected using semi-structured interviews with parents ( n = 18) and professionals ( n = 18). The study revealed that there are differences and similarities regarding the social reality of future care planning among Koreans in different national contexts. Recommendations are made In support of future care planning process taking its place as a conventional phase of care provision for people living with disabilities.

ObjectivesThe Emergency Medicine (EM) Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) specifies that resuscitation entrustable professional activities (EPAs) can be assessed in the workplace and simulated environments. However, limited validity evidence for these assessments in either setting exists. We sought to determine if EPA ratings improve over time and whether an association exists between ratings in the workplace v. simulation environment.MethodsAll Foundations EPA1 (F1) assessments were collected for first-year residents (n = 9) in our program during the 2018–2019 academic year. This EPA focuses on initiating and assisting in the resuscitation of critically ill patients. EPA ratings obtained in the workplace and simulation environments were compared using Lin's concordance correlation coefficient (CCC). To determine whether ratings in the two environments differed as residents progressed through training, a within-subjects analysis of variance was conducted with training environment and month as independent variables.ResultsWe collected 104 workplace and 36 simulation assessments. No correlation was observed between mean EPA ratings in the two environments (CCC(8) = -0.01; p = 0.93). Ratings in both settings improved significantly over time (F(2,16) = 18.8; p < 0.001; η2= 0.70), from 2.9 ± 1.2 in months 1–4 to 3.5 ± 0.2 in months 9–12. Workplace ratings (3.4 ± 0.1) were consistently higher than simulation ratings (2.9 ± 0.2) (F(2,16) = 7.2; p = 0.028; η2= 0.47).ConclusionsNo correlation was observed between EPA F1 ratings in the workplace v. simulation environments. Further studies are needed to clarify the conflicting results of our study with others and build an evidence base for the validity of EPA assessments in simulated and workplace environments.

Aims Non-structural carbohydrates (NSCs) are plant storage compounds used for metabolism, transport, osmoregulation and regrowth following the loss of plant tissue. Even in conditions suitable for optimal growth, plants continue to store NSCs. This storage may be due to passive accumulation from sink-inhibited growth or active reserves that come at the expense of growth. The former pathway implies that NSCs may be a by-product of sink limitation, while the latter suggests a functional role of NSCs for use during poor conditions. Methods Using 13C pulse labelling, we traced the source of soluble sugars in stem and root organs during drought and everwet conditions for seedlings of two tropical tree species that differ in drought tolerance to estimate the relative allocation of NSCs stored prior to drought versus NSCs assimilated during drought. We monitored growth, stomatal conductance, stem water potential and NSC storage to assess a broad carbon response to drought. Important Findings We found that the drought-sensitive species had reduced growth, conserved NSC concentrations in leaf, stem and root organs and had a larger proportion of soluble sugars in stem and root organs that originated from pre-drought storage relative to seedlings in control conditions. In contrast, the drought-tolerant species maintained growth and stem and root NSC concentrations but had reduced leaf NSCs concentrations with a larger proportion of stem and root soluble sugars originated from freshly assimilated photosynthates relative to control seedlings. These results suggest the drought-sensitive species passively accumulated NSCs during water deficit due to growth inhibition, while the drought-tolerant species actively responded to water deficit by allocating NSCs to stem and root organs. These strategies seem correlated with baseline maximum growth rates, which supports previous research suggesting a trade-off between growth and drought tolerance while providing new evidence for the importance of plasticity in NSC allocation during drought.

It would be hard to assert that one can understand an entire building by looking at a part so small as a piece of ornament, but after constructing through drawing, a number of these pieces of ornament, and doing the same for Sullivan’s late commissions, I believe that it can now be asserted that Sullivan was designing buildings that were architectural ornament at a large scale. Sullivan’s belief in his own creative will, fueled by the power of nature, learned from the lectures of Asa Grey, the poetry of Whitman, the drama of Richard Wagner’s music Nietzsche’s “Übermensch,” Goethe’s “Urpflanze” and his utopian ideal of Chicago seems to have been the key to the visceral power of his architectural ornamental that can only be described as fantastic and a career achievement. But Sullivan went farther than the design of ornament according to the formal methods documented his last publication, “A System of Architectural Ornament according to Man’s Powers.” Most of his last series of architectural commissions show evidence that he was attempting to construct whole buildings according to the same formal methods used in making the ornament. This paper will present an overview of Sullivan’s principles of ornament and the primary ornament types he employed across his fifty-year career, and will focus on the medallion type of ornament and its role in the development of Sullivan’s commissions following his break from Dankmar Adler in 1895 and its pivotal role during his last period of practice, 1907- 1919 in transforming inert buildings into vibrant containers of human energy

No study to date has thoroughly examined US Huntington disease (HD) care delivery in a variety of clinic settings by HD specialists and non-specialists.To obtain a clearer understanding of current care structure and delivery of care through a survey of representative US physicians treating HD patients.We designed and fielded a survey of 40 closed-ended evaluative items and one open-ended item to a sample of 339 US practices. Unique to this survey was the inclusion of non-specialists.Responses were received from 156 practices (overall response rate 46.02 %), with 52.6 % from academic sites, 35.3 % from private practices, and 12.2 % from the VA. More than half (63.5 %) of the practice leads were movement disorder trained or Directors of HDSA Centers of Excellence and 58.3 % had an HD or multidisciplinary care clinic. However, 48.7 % of the practices saw 1-25 HD patients, 28.2 % saw 26-100 HD patients, and 23.1 % served over 100 HD patients annually. Most practices (69 %) reported having difficulty providing social work, genetic counseling, care coordination and psychologists/psychiatrists. Increased HD practice size was associated with higher rates of pre-visit screenings, care navigator/care coordinators, routine monitoring of weight, and provision of genetic counseling by genetic counselors.Not surprisingly, we found that HD care was inconsistently applied across the US. Practices led by neurologists trained in movement disorders, and higher HD volume practices, tended to be better equipped to provide multi-disciplinary staffing and procedures as compared to those with fewer numbers of HD patients.

Emergency medicine (EM) training programs incorporate simulation for teaching as well as formative and summative assessment. The development of a simulation curriculum for Canadian postgraduate EM programs is underway and would be facilitated by a standardized, user-friendly, nationally endorsed simulation template. We convened a nationally representative group of simulation educators to participate in a three-phase process to develop and refine a simulation case template for Canadian EM educators. Participants provided feedback by means of free text comments and focus groups which were analyzed to inform modification of the template. We anticipate that this template will facilitate the sharing of cases across sites and the development of standardized cases for simulation-based assessment.

Introduction the ageing global population and concomitant increase in the use of opioid analgesia have highlighted the need to evaluate the effectiveness of opioids for chronic pain in older people. Methods a systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling people aged 65 years or more was conducted using PRISMA guidelines. The databases MEDLINE, EMBASE, Pubmed and PsychINFO were searched. The quality of studies was assessed. Secondary aims were to assess correlates of opioid use and the decision-making processes of prescribers. Results seven studies were identified of low to high quality. The majority of older people experienced ongoing pain despite continuing opioid therapy. There were mixed results regarding benefits of opioids in terms of activities of daily living and social engagement. In nursing home residents, opioid use at baseline was associated with severe pain, severe impairment in activities of daily living and a diagnosis of depression. Fear of causing harm to older people was common amongst opioid prescribers, limiting prescription. Facilitators of opioid prescription included educational interventions and access to an evidence base for opioid use. Conclusion there is limited evidence supporting the use of long-term opioid use in older people for chronic non-cancer pain and a lack of trials in this age group. Age-specific guidelines are required addressing initial assessment, indications, monitoring and de-prescribing.

ObjectiveSimulation plays an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High-quality, simulation-based research will ensure its effective use. This study sought to summarize simulation-based research activity and its facilitators and barriers, as well as establish priorities for simulation-based research in Canadian emergency medicine (EM).MethodsSimulation-leads from Canadian departments or divisions of EM associated with a general FRCP-EM training program surveyed and documented active EM simulation-based research at their institutions and identified the perceived facilitators and barriers. Priorities for simulation-based research were generated by simulation-leads via a second survey; these were grouped into themes and finally endorsed by consensus during an in-person meeting of simulation leads. Priority themes were also reviewed by senior simulation educators.ResultsTwenty simulation-leads representing all 14 invited institutions participated in the study between February and May, 2018. Sixty-two active, simulation-based research projects were identified (median per institution = 4.5, IQR 4), as well as six common facilitators and five barriers. Forty-nine priorities for simulation-based research were reported and summarized into eight themes: simulation in competency-based medical education, simulation for inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology.ConclusionThis study summarized simulation-based research activity in EM in Canada, identified its perceived facilitators and barriers, and built national consensus on priority research themes. This represents the first step in the development of a simulation-based research agenda specific to Canadian EM.

Future care provision is a pervasive concern of parents with children living with disabilities. This article aims to provide an overview of the impact of familism on future care planning fo...

Arbuscular mycorrhizal (AM) and ectomycorrhizal (EcM) associations are critical for host-tree performance. However, how mycorrhizal associations correlate with the latitudinal tree beta-diversity remains untested. Using a global dataset of 45 forest plots representing 2,804,270 trees across 3840 species, we test how AM and EcM trees contribute to total beta-diversity and its components (turnover and nestedness) of all trees. We find AM rather than EcM trees predominantly contribute to decreasing total beta-diversity and turnover and increasing nestedness with increasing latitude, probably because wide distributions of EcM trees do not generate strong compositional differences among localities. Environmental variables, especially temperature and precipitation, are strongly correlated with beta-diversity patterns for both AM trees and all trees rather than EcM trees. Results support our hypotheses that latitudinal beta-diversity patterns and environmental effects on these patterns are highly dependent on mycorrhizal types. Our findings highlight the importance of AM-dominated forests for conserving global forest biodiversity., The relationship of mycorrhizal associations with latitudinal gradients in tree beta-diversity is unexplored. Using a global dataset approach, this study examines how trees with arbuscular mycorrhizal and ectomycorrhizal associations contribute to latitudinal beta-diversity patterns and the environmental controls of these patterns.

The decline in species richness at higher latitudes is among the most fundamental patterns in ecology. Whether changes in species composition across space (beta-diversity) contribute to this gradient of overall species richness (gamma-diversity) remains hotly debated. Previous studies that failed to resolve the issue suffered from a well-known tendency for small samples in areas with high gamma-diversity to have inflated measures of beta-diversity. Here, we provide a novel analytical test, using beta-diversity metrics that correct the gamma-diversity and sampling biases, to compare beta-diversity and species packing across a latitudinal gradient in tree species richness of 21 large forest plots along a large environmental gradient in East Asia. We demonstrate that after accounting for topography and correcting the gamma-diversity bias, tropical forests still have higher beta-diversity than temperate analogues. This suggests that beta-diversity contributes to the latitudinal species richness gradient as a component of gamma-diversity. Moreover, both niche specialization and niche marginality (a measure of niche spacing along an environmental gradient) also increase towards the equator, after controlling for the effect of topographical heterogeneity. This supports the joint importance of tighter species packing and larger niche space in tropical forests while also demonstrating the importance of local processes in controlling beta-diversity.

BACKGROUND The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. METHODS Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999-2019). Short- and long-term outcomes and complications following augmentation cystoplasty were defined. RESULTS Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy-epispadias complex (30%) and posterior urethral valves (23%). The most common tissue-type utilized was ileal (58%) and ureteric (30%). Peri-operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end-of-study detrusor pressure improved significantly following bladder augmentation (38-17 cmH2 O, P

Objectives: Shoulder pain in the young overhead athlete is commonly thought to result from instability and SLAP pathology, but not from a primary subacromial space pathology. We encountered a series of young overhead athletes with shoulder pain not due to instability or SLAP pathology. All had pain at the anterolateral (AL) corner of the acromion. We report the clinical characteristics, pathology, and results of treatment of this previously unreported association. Methods: 92 young (mean age 19 [13-26]) overhand athletes presented with shoulder pain unresponsive to conservative treatment. There were 54 (59%) males and 38 (41%) females. 76% had pain at the AL acromial corner. 71% had pain with an overhand arc of motion from Abd/ER to Abd/IR position. 53% had SLAP-type physical exam findings, but none had instability symptoms. Patients most commonly participated in the following sports: Baseball 38.5%, Swimming 16%, Softball 15%, and Volleyball 11%. Pre-op mean scores were: ASES= 60, SST= 7.5, and VAS pain= 4.3. All underwent EUA and arthroscopy. There was no evidence of instability or SLAP pathology. All had varying degrees of subacromial bursitis. But, the primary pathology was a thickened anterior CA ligament (CAL). The hypertrophic CAL inserted on the acromion, but also extended far laterally under the deltoid muscle. This formed an “awning” at the AL acromial corner which resulted in significant subacromial space compromise. The hypertrophic CAL anterior edge and lateral extension was excised and bursectomy performed in all and in 90% an osseous acromioplasty was performed as well. There were associated pathologic findings: 15 (16%) had posterior capsular contracture with GIRD, 10 (11%) had a posterior labral split tear at the equator of the glenoid. Results: At average follow-up of 2.2 years (1-5), all had returned to the former level of overhead sport activity. Rapid rehabilitation was possible and average time to return to sport was 19 weeks (8-52, SD 10.2). Seventy-five (81.5%) returned to the same level of sport. At final follow-up, mean VAS decreased from a preoperative level of 3.7 (SD 2.5, range 0-8) to a postoperative level of 0.6 (SD 1.1, range 0-4) (pConclusions: Younger age (avg 19 yrs, high school and collegiate athletes) participating in overhand sports, typically year-round were defining, consistent factors in this patient population. Female athletes made up a substantial 41% of the series. We feel that symptomatic, hypertrophic anterior CAL is a variant of impingement, most likely due to use and overuse in a repetitive overhead sport. Overuse is recognized as an etiology for shoulder pathology including instability, SLAP lesion, and labral injury, but subacromial pathology is more thought of as a condition of an older age group. This clinical entity in this series, we feel, is another form of overuse pathology and is a primary subacromial space pathology. It was not secondary to occult instability or posterior capsule tightness or SLAP pathology. Thus, not all shoulder problems in young, overhead athletes should be attributed to occult instability or SLAP pathology. We have developed a mnemonic for this clinical entity: CALYPSO. C: Coracoacromial ligament A: Anterior band hypertrophy and L: Lateral extension under the deltoid. Y: Youth (high school and college age) P: Posterior capsular contracture and labral pathology. S: Subacromial bursitis; O: Overuse and Overhead sport Clinicians should maintain a high index of suspicion for this clinical entity when evaluating young overhead athletes. In all cases, arthroscopy was successful in identifying and treating the pathology and all athletes were able to return to their previous level of sport.

Paediatric urological surgery is often required for managing congenital and acquired disorders of the genitourinary system.

Background: There is rising interest in remote clinical trial assessments, particularly in the setting of the COVID-19 pandemic. Objective: To demonstrate the feasibility, reliability, and value of remote visits in a phase III clinical trial of individuals with Parkinson’s disease. Methods: We invited individuals with Parkinson’s disease enrolled in a phase III clinical trial (STEADY-PD III) to enroll in a sub-study of remote video-based visits. Participants completed three remote visits over one year within four weeks of an in-person visit and completed assessments performed during the remote visit. We evaluated the ability to complete scheduled assessments remotely; agreement between remote and in-person outcome measures; and opinions of remote visits. Results: We enrolled 40 participants (mean (SD) age 64.3 (10.4), 29% women), and 38 (95%) completed all remote visits. There was excellent correlation (ICC 0.81–0.87) between remote and in-person patient-reported outcomes, and moderate correlation (ICC 0.43–0.51) between remote and in-person motor assessments. On average, remote visits took around one quarter of the time of in-person visits (54 vs 190 minutes). Nearly all participants liked remote visits, and three-quarters said they would be more likely to participate in future trials if some visits could be conducted remotely. Conclusion: Remote visits are feasible and reliable in a phase III clinical trial of individuals with early, untreated Parkinson’s disease. These visits are shorter, reduce participant burden, and enable safe conduct of research visits, which is especially important in the COVID-19 pandemic.

In the summer of 2018, our effects department took advantage of some downtime. We decided to use this opportunity to create a short film with no characters, animators, or our full pipeline. The team wanted to test how far we could push our effects pipeline to create an end-to-end short film using Houdini as much as possible. We leveraged several new technologies and concepts in order to collaborate among 20 artists and include lighting and rendering when normally they would use other tools. The result was Automaton.