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BACKGROUND: The time course and longitudinal impact of the COVID -19 pandemic on surgical education(SE) and learner well-being (LWB)is unknown. MATERIAL AND METHODS: Check-in surveys were distributed to Surgery Program Directors and Department Chairs, including general surgery and surgical specialties, in the summer and winter of 2020 and compared to a survey from spring 2020. Statistical associations for items with self-reported ACGME Stage and the survey period were assessed using categorical analysis. RESULTS: Stage 3 institutions were reported in spring (30%), summer (4%) [p 

The employment conditions in India were steadily deteriorating in the 2000s. Agriculture not just stopped accommodating new workers but was increasingly rendering many of the already employed workers—mostly less educated—redundant. Meanwhile, non-agriculture was generating employment at an increasingly slower pace and was also generating it basically for the educated. So, it was failing to absorb the labour moving out of agriculture. Under these conditions, progressive exclusion of the less educated from employment and decelerating employment growth of the educated emerged as the main trends, which showed up in declining employment rate, rising unemployment rate and, ironically enough, steady improvement in the average quality of employment. All this was happening in a period of rapid economic growth. The proximate explanation is that growth was less rapid than the skill-biased technological change that was associated with it. The deeper reason is that the benefits of growth accrued to a thin top layer of the population—the rich.

Author(s): Kene, Mamata; Arasu, Vignesh A; Mahapatra, Ajit K; Huang, Jie; Reed, Mary | Abstract: Introduction: Acute kidney injury (AKI) after intravenous contrast administration for computed tomography (CT) occurs infrequently, but certain patients may be susceptible. This study evaluated AKI incidence among emergency department (ED) patients with pre-existing chronic kidney disease (CKD) undergoing CT exams.Methods: This retrospective cohort study in an integrated healthcare system included ED patients previously diagnosed with CKD stages 3-5 (estimated glomerular filtration rate l60 milliliters per minute per 1.73 meters squared over at least three months), undergoing CT exams with or without intravenous contrast, from January 1, 2013–December 31, 2017. We excluded patients with CT prior to (30 days) or following (14 days) index CT and missing serum creatinine (sCr) measurements. We applied propensity score matching, and then multivariable regression adjustment for post-CT ED disposition and ED diagnosis, to calculate adjusted risk of AKI. Secondary patient-centered outcomes included 30-day mortality, end-stage renal disease (ESRD) diagnosis, and dialysis initiation.Results: Among 103,573 eligible ED patients undergoing CT, propensity score matching yielded 5,589 pairs. Adjusted risk ratio (ARR) for AKI was higher overall for contrast-enhanced CT (1.60; 95% confidence interval [CI], 1.43-1.79). However, secondary outcomes were infrequent: 19/5,589 non-contrast vs 40/5,589 contrast patients with new dialysis initiation at 30 days (adjusted risk 0.3% vs 0.7%; adjusted risk reduction 0.4%; 95% CI, 0.1%-0.7%).Conclusion: In ED patients with chronic kidney disease undergoing CT, intravenous contrast was associated with higher overall adjusted risk of AKI, but patient-centered secondary outcomes were rare. The clinical significance of transient kidney injury after CT is unclear, although patients with advanced chronic kidney disease appear to have elevated risk.

Background: Utility of N-terminal pro B-type natriuretic peptide (NT-proBNP) in the emergency department (ED) as a prognostic marker for acute breathlessness. Methods: An observational study was conducted on 241 patients presenting to ED with acute breathlessness. NT-proBNP levels were measured and patients were divided into two groups as per NT-proBNP measurement: Group-1(high) and Group-2(normal) as per agerelated pre-determined cut-offs. Primary outcomes including Length of stay (LOS), intervention and death were recorded and compared. th Secondary outcome in terms of readmission and death was done on the 30 day. Statistical analysis was done using univariate analysis and multivariate logistic regression. ROC curve analysis was performed for optimal cut-off for mortality within 30 days. Out of 241 patients, Results: 170 (71%) patients had high NT-proBNP levels. Group-1 had high LOS (7.0 day compared to 4.5 days, p=0.002), increased ICU admission (OR=77, 95 % CI : 8.2-162.4, p=0.0001), increased requirement of ventilator (OR=3, 95 % CI :1.3-7.1, p=0.002) noninvasive ventilator (OR=4.7, 95 % CI :2.2-9.2, p=0.0001) and dialysis (OR=8.1, 95 % CI : 1.1-160, p=0.016). Logistic regression also conrmed that NT-proBNP is a good predictor for increase death within 30 days (OR=2.80, 95 % CI : 1.2, 6.4, p=0.015) and increase LOS ≥7 days (OR=2.3, 95 % CI : 1.2-4.4, p=0.012) after adjustment for patient age, sex and underlying co-morbidities. For predicting mortality within 30 days, its cut-off values in Receiver operating characteristics (ROC) curve was 1655pg/ml (Sensitivity: 72%, Specicity:48.0%, AUCs: 62.5%, p=0.006). NT-proBNP levels are a Conclusion: rapid and good predictor of morbidity and mortality within 30 days. A single determination of the NT-proBNP level was sufcient to identify high risk patients with a poor prognosis at the time of admission in the ED.

Aim: This study aims to study the frequency and severity of dry eye in diabetic patients and their correlation with duration of diabetes. Materials and Methods: This cross-sectional prospective study was conducted on all patients with diabetes mellitus presenting to ophthalmology department of a tertiary care hospital between November 1, 2019, and December 31, 2019. The study population included diabetic patients who were above the age of 40 years. Detailed ocular history including diabetic history was recorded and comprehensive ocular clinical examination to assess the dry eye status was done. Schirmer's I test and Tear film Break-Up Time (TBUT) tests were performed and results were recorded. Results: In this study, 100 eyes of 50 diabetic patients were subjected to dry eye tests. Varying degree of dryness was seen in 34 patients (68%). Schirmer's test was abnormal (

Introduction: Cataract surgery demands refractive accuracy. To achieve this, accurate biometry is required. So two biometry methods should be compared for accuracy. Aim: To compare accuracy of immersion USG and optical biometry with reference to AXL measurement and postphaco refraction. Materials and Methods: Prospective study was done involving 60 eyes of 60 patients undergoing phaco with foldable IOL implantation under LA. Biometry of Group A was done by immersion USG and that of group B was done by optical biometry (30 patients in each group). Detailed preop examination was done. Calculations of IOL power in all patients were done by using SRK/T formula. At 1 month f/up, spherical equivalent was noted. Using regression formula, emmetropic IOL powers and their differences with implanted IOL powers were calculated. Statistical analysis was done using unpaired t test. Results: Mean AXL in group B (23.2157 mm) was slightly longer than that in group A (23.2093 mm), {P=0.9754}. Mean spherical equivalent at 1 month f/up in group B (0.4583) was slightly lesser than that in group A (0.4625),{P=0.973}. Mean of differences between emmetropic IOL and actual IOL implanted was lesser in group B(0.6877), than that in group A(0.6932), {P=0.9762}. Conclusion: Difference in mean AXL and mean postop spherical equivalent between two methods of biometry were not statistically significant. Immersion USG biometry has accuracy comparable to optical biometry. Keywords: Cataract, Emmetropia, Intraocular lens, Visual acuity.

Objectives To define the top priorities in simulation-based surgical education where additional research would have the highest potential to advance the field and develop proposals that would address the identified research priorities. Summary and background data Simulation has become integral part of surgical training but there are a number of outstanding questions that have slowed advances in this field. Methods The Delphi methodology was used to define the top priorities in simulation-based surgical education. A research summit was held with multiple stakeholders under the auspices of the American College of Surgeons Division of Education to develop proposals to address these priorities. Results Consensus was achieved after the first round of voting on the following three most important topics: 1) impact of simulation training on patient safety and outcomes, 2) the value proposition of simulation, and 3) the use of simulation for physician certification and credentialing. Knowledge gaps, challenges and opportunities, and research questions to address these topics were defined by summit participants. Conclusions The top 3 priorities in surgical simulation research were defined and project outlines were developed for impactful projects on these topics. Successful completion of such projects is expected to advance the field of simulation-based surgical education.

The American College of Surgeons launched the Accredited Education Institutes (ACS-AEIs) in 2005 to create a network of simulation centers to offer the highest-quality surgical education and training and to pursue cutting-edge scholarship. Specific standards and criteria were developed to accredit simulation centers, and decisions made based on the application, site surveyor visit, and ACS-AEI Accreditation Committee review. In addition to granting accreditation and providing recommendations for improvement, site surveyors and the Accreditation Committee identified best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education. Best practices were compiled into a list starting in 2011 for dissemination to all members of the ACS-AEI Consortium through on-line videos, newsletters, and workshops at the Annual ACS Surgical Simulation Summit. Using thematic analysis, the authors classified common themes from the 337 best practices identified during 247 accreditation reviews between June 2011 and June 2019. As best practices were extracted, the authors compiled them into a single database. Eight overarching themes were identified, including approaches to faculty development, scholarly activity, development of curricula, use of resources, delivery of educational content, assessment of learners, and collaboration between centers. The authors discuss themes in the context of their practical relevance and highlight strategies used at different centers, with an emphasis on the importance of each theme in developing a successful simulation program.

Van der Waals heterostructures have attracted increasing interest, owing to the combined benefits of their constituents. These hybrid nanostructures can be realized via epitaxial growth, which offers a promising approach for the controlled synthesis of the desired crystal phase and the interface between van der Waals layers. Here, the epitaxial growth of a continuous molybdenum disulfide (MoS2) film on large-area graphene, which was directly grown on a sapphire substrate, is reported. Interestingly, the grain size of MoS2 grown on graphene increases, whereas that of MoS2 grown on SiO2 decreases with an increasing amount of hydrogen in the chemical vapor deposition reactor. In addition, to achieve the same quality, MoS2 grown on graphene requires a much lower growth temperature (400 °C) than that grown on SiO2 (580 °C). The MoS2/graphene heterostructure that was epitaxially grown on a transparent platform was investigated to explore its photosensing properties and was found to exhibit inverse photoresponse with highly uniform photoresponsivity in the photodetector pixels fabricated across a full wafer. The MoS2/graphene heterostructure exhibited ultrahigh photoresponsivity (4.3 × 104 A W–1) upon exposure to visible light of a wide range of wavelengths, confirming the growth of a high-quality MoS2/graphene heterostructure with a clean interface.

Introduction: Infective corneal ulcer is an important cause of visual impairment in developing countries. The present study was conducted to know demographic, clinical, and microbiological patterns of infective corneal ulcers in a tertiary hospital in western Maharashtra. Materials and Methods: This is a retrospective analytical study involving 68 eyes of 68 cases of infective corneal ulcer visited in the last two years. From medical records of all cases, details of history, clinical findings, and investigations were noted and data were analyzed. Results: Male to female ratio of study cases was 1.61:1 with age groups ranging between 18 to 90 years (mean 50.81 years). The main occupations of study cases were farming (28 i.e. 41.17%) and construction work (12 i.e.17.64%). Thirty-two (47.05%) cases had to present BCVA of

Expertise in surgery is essential to ensure the best outcomes across various phases of surgical care. Expertise is multidimensional and is both domain- and context-specific. It encompasses a broad range of knowledge, skills, and professional attributes. General expertise is characterized by pattern recognition, rapid and effective decision-making, fluency of actions, and efficiency in performance. Adaptive expertise involves complex decision-making and exceptional performance within the context of unexpected findings, unusual circumstances, complex systems, and the rapidly changing surgical environment. Traditionally, surgeons have acquired expertise through extensive experiences in a variety of difficult and demanding situations. Over the past few decades, considerable emphasis has been placed on a more planned and efficient approach to the development of surgical expertise through extended periods of deliberate practice coupled with specific feedback, and through establishment of progressively higher goals and benchmarks for the surgeon. Reflection and metacognition have been recognized as playing key roles in achieving expertise. More recently, an expert performance approach to training has been described that involves defining expert performance, focusing efforts on achieving expertise, and monitoring the outcomes of such efforts. The cycle of practice-based learning and improvement should serve as the essential framework for implementation of the expert performance approach. Simulation-based education and training, coaching, and communities of practice can be very helpful in achieving and maintaining expertise. Professional organizations, such as the American College of Surgeons, need to continue playing pivotal roles in supporting surgeons in their quest to achieve and maintain expertise.

Surgeons' non-technical skills are important for patient safety. The Non-Technical Skills for Surgeons assessment tool was developed in the UK and recently adapted to the US surgical context (NOTSS-US). The aim of this study was to evaluate the reliability and distribution of non-technical skill ratings given by attending (consultant) surgeons who underwent brief online training.Attending surgeons across six specialties at a large US academic medical centre underwent a 10-min online training, then rated 60-s standardized videos of simulated operations. Intraclass correlation coefficient (ICC), and mean(s.d.) values for NOTSS-US ratings were determined for each non-technical skill category (score range 1-5, where 1 indicates poor, 3 average and 5 excellent) and for total NOTSS-US score (range 4-20; sum of 4 category scores). Outcomes were adjusted for rater characteristics including sex, specialty and clinical experience.A total of 8889 ratings were submitted by 81 surgeon raters on 30 simulated intraoperative videos. The mean(s.d.) total NOTSS-US score for all videos was 9·5(4·8) of 20. The within-video ICC for total NOTSS-US score was 0·64 (95 per cent c.i. 0·57 to 0·70). For individual non-technical skill categories, the ICC was highest for social skills (communication/teamwork: 0·63, 95 per cent c.i. 0·56 to 0·71; leadership: 0·64, 0·55 to 0·72) and lowest for cognitive skills (situation awareness: 0·54, 0·45 to 0·62; decision-making: 0·50, 0·41 to 0·59). Women gave higher total NOTSS-US scores than men (adjusted mean difference 0·93, 95 per cent c.i. 0·44 to 1·43; P = 0·001).After brief online training, the inter-rater reliability of the NOTSS-US assessment tool achieved moderate strength among trained surgeons rating simulated intraoperative videos.Las habilidades no técnicas de los cirujanos (Non-Technical Skills for Surgeons, NOTSS) son importantes para la seguridad del paciente. La herramienta de evaluación de habilidades no técnicas para cirujanos se desarrolló en el Reino Unido y se adaptó recientemente al contexto quirúrgico de los Estados Unidos (NOTSS-US.). El objetivo de este estudio fue evaluar la fiabilidad y distribución de las calificaciones de habilidades no técnicas obtenidas por cirujanos adjuntos de cirugía (consultores) que recibieron una breve formación online. MÉTODOS: Cirujanos adjuntos de 6 especialidades en un gran centro universitario de Estados Unidos recibieron una formación online de 10 minutos de duración y seguidamente puntuaron vídeos estandarizados de operaciones simuladas de 60 minutos de duración. Se calcularon el coeficiente de correlación intraclase (intraclass correlation coefficient, ICC), la media y la desviación estándar (standard deviation, SD) para la puntuación de cada categoría de habilidad no técnica del NOTSS-US (rango 1-5, siendo 1 = pobre, 3 = promedio, 5 = excelente) y para la puntuación global de NOTSS-US (rango 4-20, suma de las puntuaciones de las cuatro categorías). Los resultados se ajustaron de acuerdo con las características del evaluador, incluyendo sexo, especialidad, experiencia clínica.En 30 videos intraoperatorios simulados, 81 cirujanos evaluadores proporcionaron 8.889 puntaciones. La puntuación media global de NOTSS-US para todos los vídeos fue de 9,5 sobre 20 (SD 4,8). El ICC de los vídeos para la puntuación global de NOTSS-US fue 0,64 (i.c. del 95% 0,57-0,70). Para las categorías individuales de habilidades no técnicas, el ICC más alto fue para las habilidades sociales (comunicación / trabajo en equipo: 0,63, (i.c. del 95% 0,56-0,71); liderazgo, 0,64 (i.c. del 95% 0,55-0,72)) y el más bajo para las habilidades cognitivas (conciencia de la situación 0,54 (i.c. del 95% 0,45-0,62); toma de decisiones 0,50 (i.c. del 95% 0,41-0,59)). Las evaluadoras femeninas presentaron puntuaciones globales de NOTSS-US más altas que los evaluadores masculinos (diferencia 0,93, i.c. del 95% 0,44-1,43; P = 0,001)). CONCLUSIÓN: Después de una breve formación online, la fiabilidad de la herramienta de evaluación NOTSS-US mostró una correlación moderada entre los cirujanos que puntuaron vídeos de simulaciones de intervenciones quirúrgicas.

Objectives: ATP-binding cassette transporter A1 (ABCA1) is a key player in the reverse cholesterol transport (RCT) and HDL biogenesis. Since RCT is compromised as a result of ABCA1 dysfunction in diabetic state, the objective of this study was to investigate the regulation of ABCA1 in a stably transfected 293 cells expressing ABCA1 under the control of cAMP response element. Methods: To delineate transcriptional and posttranscriptional regulation of ABCA1, 293 cells were stably transfected with the full length ABCA1 cDNA under the control of CMV promoter harboring cAMP response element. cAMP-mediated regulation of ABCA1 and cholesterol efflux were studied in the presence of 8-Br-cAMP and after withdrawal of 8-Br-cAMP. The mechanism of cAMP-mediated transcriptional induction of the ABCA1 gene was studied in protein kinase A (PKA) inhibitors-treated cells. Results: The transfected 293 cells expressed high levels of ABCA1, while non-transfected wild-type 293 cells showed very low levels of ABCA1. Treatments of transfected cells with 8-Br-cAMP increased ABCA1 protein by 10-fold and mRNA by 20-fold. Cholesterol efflux also increased in parallel. Withdrawal of 8-Br-cAMP caused time-dependent rapid diminution of ABCA1 protein and mRNA, suggesting ABCA1 regulation at the transcriptional level. Treatment with PKA inhibitors abolished the cAMP-mediated induction of the ABCA1 mRNA and protein, resulting dampening of ABCA1-dependent cholesterol efflux. Conclusions: These results demonstrate that transfected cell line mimics cAMP response similar to normal cells with natural ABCA1 promoter and suggest that ABCA1 is a short-lived protein primarily regulated at the transcriptional level to maintain cellular cholesterol homeostasis.

This study was conducted to determine if artificial neural networks (ANN) can be used to more accurately predict physiological stress responses in goats compared with statistical regression. Prediction models were developed for plasma cortisol and glucose concentrations, creatine kinase (CK) activity, neutrophil (N) and lymphocyte (L) counts, and N:L ratio as a function of time (0, 1, 2, 3, and 4 h; n = 16 goats per time) after a 2.5 h transportation (input 1) and stocking density (25 vs. 50 goats; input 2). However, input 2 was not included in the final models because density did not have a significant effect. The NeuralWorks Predict® software and SAS were used to develop ANN and regression models, respectively. Backpropagation (BP) and Kalman filter (KF) learning rules were used to develop nonparametric models. Correlations between predicted and observed values were better with ANN-BP (R values = 0.87, 0.67, 0.56, 0.27, 0.42, and 0.53) and ANN-KF (R values = 0.84, 0.67, 0.58, 0.27, 0.42, and 0.50) models for cortisol, glucose, CK, N, L, and N:L ratio, respectively, than with regression models (R values =0.85, 0.52, 0.27, 0.13, 0.31, and 0.12). The results showed that the ANN models can predict responses more robustly compared with statistical regression.

Nepal, a small landlocked country in South Asia, holds about 800 km of Himalayan Mountain range including the Earth’s highest mountain. Within such a mountain range in the north and plain lowlands in the south, Nepal provides a habitat for about 9% of global avian fauna. However, this diversity is underrated because of the lack of enough studies, especially using molecular tools to quantify and understand the distribution patterns of diversity. In this study, we reviewed the studies in the last two decades (2000‒2019) that used molecular methods to study the biodiversity in Nepal to examine the ongoing research trend and focus. Although Nepalese Himalaya has many opportunities for cutting-edge molecular research, our results indicated that the rate of genetic/genomic studies is much slower compared to the regional trends. We found that genetic research in Nepal heavily relies on resources from international institutes and that too is mostly limited to research on species monitoring, distribution, and taxonomic validations. Local infrastructures to carry out cutting-edge genomic research in Nepal are still in their infancy and there is a strong need for support from national/international scientists, universities, and governmental agencies to expand such genomic infrastructures in Nepal. We particularly highlight avian fauna as a potential future study system in this region that can be an excellent resource to explore key biological questions such as understanding eco-physiology and molecular basis of organismal persistence to changing environment, evolutionary processes underlying divergence and speciation, or mechanisms of endemism and restrictive distribution of species. Supplementary Information The online version contains supplementary material available at 10.1186/s40657-021-00290-5.

Chaos synchronization generally demands two coupled chaotic systems, with either one driving the other or mutually coupled. The objective of guiding a stable system to circumstance when the drive signal is chaotic. A data signal could be driving in a transmitter that turns out a chaotic signal. It is practicable to researchers who have no idea regarding the transmitter. Also, if the receiver is a model of the chaotic transmitter, it could be recovered. As in each practical execution of the communication system, transmitter and receiver circuits work under somewhat distinct situations; it is crucial to review the case of discrepancy between the transmitter and receiver framework. These ideas have been implemented to the Chua’s circuit and an electronic circuit that is especially appropriate for digital communications and its numerical model. The computation of stability measure shows approximate to the convergence of directed system to its stable situation. The numerical simulation results reveal the viability of the synchronization of chaotic systems and their implementation to the secure communication.

Even though neurosurgeons exercise these enormous and versatile skills, the COVID-19 pandemic has shaken the fabrics of the global neurosurgical family, jeopardizing human lives, and forcing the entire world to be locked down. We stand on the shoulders of the giants and will not forget their examples and their teachings. We will work to the best of our ability to honor their memory. Professor Harvey Cushing said: "When to take great risks; when to withdraw in the face of unexpected difficulties; whether to force an attempted enucleation of a pathologically favorable tumor to its completion with the prospect of an operative fatality, or to abandon the procedure short of completeness with the certainty that after months or years even greater risks may have to be faced at a subsequent session-all these require surgical judgment which is a matter of long experience." It is up to us, therefore, to keep on the noble path that we have decided to undertake, to accumulate the surgical experience that these icons have shown us, the fruit of sacrifice and obstinacy. Our tribute goes to them; we will always remember their excellent work and their brilliant careers that will continue to enlighten all of us.

Dermatophytic pseudomycetomas (DPM) is an important deep dermal infection caused by dermatophytes. It is mostly noticed in immune-deficient Persian cats. It is characterized by swelling, ulceration or draining sinuses and grains in tissue. An excisional biopsy sample from an abdominal mass from 2 year old male Persian cat was received at the Diagnostic section of Veterinary Clinical Complex, College of Veterinary and Animal Sciences, Meerut for diagnosis of the condition. History revealed that animal had a ventral abdominal nodular ulcerated swelling of about 6 cm diameter which was painless. Alopecia was noticed in the swelling. Physical examination of the mass was done and multiple impression smears were made from the cut section of the mass. The impression smears were stained with Field stain according to manufactures protocol. Grossly, the mass was firm and ulcerated and the cut surface contained multiple military light yellowish grain like substance. Cytological picture suggested pyo-granulomatous inflammation with presence of dermatophyte spores and septate hyphae. The case was diagnosed as derma- tophytic pseudomycetoma.

Aim: To study the visual outcome and morbidity of patients who will be treated by Nd: YAG laser capsulotomy following PCO. Keywords: Cataract, Elsching pearl, Intra-ocular pressure, Retinal detachment.

Heterostructure formation is an effective method used for designing photocatalysts that solve problems caused by photoexcited charge recombination phenomena associated with the photocatalytic water...

Aim: To study visual and surgical outcome in aphakic patients after implantation of retropupillary fixated iris claw lens. Materials and Methods: Medical records of the patients operated in Bharati Hospital, Sangli for the treatment of aphakia by secondary retropupillary fixated iris claw lens from September 2017 to August 2018 were included in the study. The data collected included the preoperative best corrected visual acuity (BCVA), auto-refractokeratometry, anterior segment evaluation on the slit lamp and posterior segment evaluation done by indirect ophthalmoscopy after pupillary dilatation with tropicamide eyedrops. The patients were also assessed for lacrimal sac patency and Goldmann applantion tonometry for intraocular pressure (IOP). Intraocular lens (IOL) power was calculated by SRK-T formula in aphakic mode by immersion based biometry. At follow up i.e. day 7 and 1 month, findings of patients include in study were BCVA, slit lamp examination and auto-refractokeratometry. Results: 86.66% patients operated by retropupillary fixated iris claw lens had postoperative improvement in visual acuity as compared to preoperative visual acuity. Conclusions: Retropupillary fixated Iris claw lens is an effective method of aphakia management with good visual outcomes and easy learning curve. Keywords: Aphakia, Iris claw lens, Visual acuity.

The transition from surgical training to surgical practice is a critical juncture in the career progression of surgeons. This period is associated with myriad challenges that need to be addressed through specific educational interventions to ensure delivery of safe care to patients and to support the career aspirations of junior surgeons entering the practice environment. These interventions should be based on principles of contemporary surgical education and training, and focus on the needs of surgery residents and junior surgeons entering practice. The specific systems of patient care in which the junior surgeons will work should also be considered while planning and implementing such educational interventions. Senior surgeon colleagues within these systems should play key roles in supporting the junior surgeons entering practice, and may require special training to serve as effective mentors, preceptors, and coaches. Professional societies should play a key role in establishing national standards regarding the educational programs aimed at this transition and develop programs to complement local efforts to address various needs. The American College of Surgeons Division of Education has developed a spectrum of innovative programs that are aimed at this important transition.

Contemporary models of surgical education that are founded on sound educational theories and constructs need to be used across the continuum of professional development of surgeons starting with the first day of medical school, through surgery residency and fellowship training, to the last day of surgical practice. The highly learner-centered and individually-focused special interventions of preceptoring, proctoring, mentoring, and coaching should be linked to innovative competency-based education models to address the educational needs of learners at all levels, and especially of surgeons in practice to continually improve their knowledge, skills, and performance, with the aspirational goal of achieving expertise and mastery. Each of these interventions is distinct with its own unique characteristics, applications, and anticipated impact, which must be clearly recognized for the interventions to be used most effectively. Broad acceptance and adoption of the aforementioned special interventions require recognition of the value each brings to the learner and the educational program. Professional organizations should play a key role in designing innovative educational programs that include these interventions, supporting their integration into surgical education and surgical practice, and influencing changes in the cultures in surgery to facilitate broad adoption of these interventions.

Introduction: Posterior Capsular Opacification (PCO) is a condition which develops months or years after cataract surgery. The Neodymium Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy is the procedure of choice for PCO and its adverse effects include intraocular pressure elevation, cystoid macular oedema, corneal endothelial cell damage, retinal detachment and Intraocular Lens (IOL) pitting. Aim: To assess the corneal endothelial structure and function before and after Nd:YAG laser capsulotomy in patients with PCO using specular microscopy. Materials and Methods: This was a prospective observational study carried out in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India on 50 eyes of 50 patients having PCO. This study was conducted in the time period between October 2020 to February 2021 for four months. Patients were subjected to Nd:YAG laser capsulotomy in the affected eye and were followed-up at one week and one month postprocedure. Specular Microscopy was used to evaluate the Endothelial Cell Density (ECD), Coefficient of Variation (CV) and Hexagonality of endothelial cells before and after laser capsulotomy. Statistical Package for Social Sciences (SPSS) version 26.0 was used for the statistical analysis. Chi-square test and ANOVA test are the tests of significance applied in this study. Results: Forty-five patients (90%) gained Best Corrected Visual Acuity (BCVA) of >6/18 after one week and 47 patients (94%) gained BCVA of ≥6/18 after one month postprocedure. Mean ECD prelaser was 2356.76 cells/mm2, which decreased to 2231.8 cells/mm2 at one week and 2199.2 cells/mm2 at one month follow-up. The difference between prelaser ECD and at one week and one month was 124.96 cells/mm2 and 157.56 cells/mm2, respectively, which was statistically significant at one month (p

Cardiac involvement in tuberculosis mainly affects the pericardium, with the myocardium being rarely involved. Coronary stent infection in patients with tuberculosis is rarely described. Myocardial involvement in tuberculosis can lead to complications such as ventricular granuloma, or dysrhythmias. Here, we present the case of a 60-year-old gentleman who had a history of multiple percutaneous coronary angioplasty, and pericardiectomy for constrictive tubercular pericardial effusion. Nine months after surgery, he presented with a left ventricular pseudoaneurysm and multiple stent fractures in the right coronary artery. Myocardial involvement in tuberculosis can cause ventricular pseudoaneurysms due to contiguous involvement from the pericardium. Stent fractures are commonly associated with pyogenic infections but can occur in cardiac tuberculosis. The occurrence of a stent fracture and ventricular pseudoaneurysm in the background of cardiac tuberculosis is, however, very rare. Patients with a history of cardiac tuberculosis should always be followed for late sequelae and complications, which may be bizarre.

Patients presenting with pain in lower back and paresthesia in lower limbs may have tethered cord causing the symptomology. Tethered cord may be associated with intradural tumors causing symptoms due to progressive increase in size. Association of tethered cord with single intradural tumor is a common occurrence but, to date, only one case has been reported of tethered cord associated with intradural lipoma and epidermoid cyst. The authors would like to present a similar case in a middle-aged patient.

Objective As the COVID-19 pandemic dynamically changes our society, it is important to consider how the pandemic has affected the training and wellness of surgical residents. It is our hypothesis that through a qualitative study via national focus groups with general surgery residents, common themes emerge surrounding their personal, clinical, and educational experiences that could be used to inform practice and policy for future pandemics and disasters. Design Six 90-minute focus groups were conducted by a trained qualitative researcher who elicited responses on six predetermined topics. De-identified transcripts and audio recordings were later analyzed by two independent researchers who organized responses to each topic into themes. Setting Focus groups were conducted virtually and anonymously. Participants General surgery residents were recruited from across the country. Demographic information of potential participants was coded, and subjects were randomly selected to ensure a diverse group of participants. Results The impact of the COVID-19 pandemic on residents’ clinical, educational, and personal experiences varied depending on the institutional response of the program and the burden of COVID-19 cases geographically. Many successes were identified: the use of telehealth and virtual didactics, an increased sense of camaraderie amongst residents, and flexibility in scheduling. Many challenges were also identified: uncertainty at work regarding personal protective equipment and scheduling, decreased case volume and educational opportunities, and emotional trauma and burnout associated with the pandemic. Conclusions These data gathered from our qualitative study highlight a clear, urgent need for thoughtful institutional planning and policies for the remainder of this and future pandemics. Residency programs must ensure a balanced training program for surgical residents as they attempt to master the skills of their craft while also serving as employed health care providers in a pandemic. Furthermore, a focus on wellness, in addition to clinical competency and education, is vital to resident resilience and success in a pandemic setting. Competencies Systems-Based Practice, Medical Knowledge, Interpersonal and Communication Skills, Professionalism

OBJECTIVE The objectives of this study were to review the coaching literature to 1) characterize the criteria integral to the coaching process, specifically in surgery, and 2) describe how these criteria have been variably implemented in published studies. BACKGROUND Coaching is a distinct educational intervention, but within surgery the term is frequently used interchangeably with other more established terms such as teaching and mentoring. METHODS A systematic search was performed of the MEDLINE and Cochrane databases to identify studies that used coach/coaching as an intervention for surgeons for either technical or nontechnical skills. Study quality was evaluated using the Medical Education Research Quality Instrument (MERQI). RESULTS A total of 2280 articles were identified and after screening by title, abstract and full text, 35 remained. Thirteen coaching criteria (a-m)were identified in 4 general categories: 1. overarching goal (a. refine performance of an existing skill set), 2. the coach (b. trusting partnership, c. avoids assessment, d. two way communication), the coachee (e. voluntary participation, f. self-reflection, g. goal setting, h. action plan, i. outcome evaluation), and the coach-coachee rapport (j. coaching training, k. structured coaching model, l. non-directive, m. open ended questions). Adherence to these criteria ranged from as high of 73% of studies (voluntary participation of coach and coachee) to as low as 7% (use of open-ended questions). CONCLUSION Coaching is being used inconsistently within the surgical education literature. Our hope is that with establishing criteria for coaching, future studies will implement this intervention more consistently and allow for better comparison and generalization of results.

Low Mass X-ray binaries (LMXBs) are binary systems where one of the components is either a black hole or a neutron star and the other is a less massive star. It is challenging to unambiguously determine whether a LMXB hosts a black hole or a neutron star. In the last few decades, multiple observational works have tried, with different levels of success, to address this problem. In this paper, we explore the use of machine learning to tackle this observational challenge. We train a random forest classifier to identify the type of compact object using the energy spectrum in the energy range 5-25 keV obtained from the Rossi X-ray Timing Explorer archive. We report an average accuracy of 87+/-13 in classifying the spectra of LMXB sources. We further use the trained model for predicting the classes for LMXB systems with unknown or ambiguous classification. With the ever-increasing volume of astronomical data in the X-ray domain from present and upcoming missions (e.g., SWIFT, XMM-Newton, XARM, ATHENA, NICER), such methods can be extremely useful for faster and robust classification of X-ray sources and can also be deployed as part of the data reduction pipeline., 16 pages, 10 figures, 7 tables, Accepted for publication in MNRAS main journal

Optical imaging with nanometer resolution offers fundamental insights into light-matter interactions. Traditional optical techniques are diffraction limited with a spatial resolution100 nm. Optical super-resolution and cathodoluminescence techniques have higher spatial resolutions, but these approaches require the sample to fluoresce, which many materials lack. Here, we introduce photoabsorption microscopy using electron analysis, which involves spectrally specific photoabsorption that is locally probed using a scanning electron microscope, whereby a photoabsorption-induced surface photovoltage modulates the secondary electron emission. We demonstrate spectrally specific photoabsorption imaging with sub-20 nm spatial resolution using silicon, germanium, and gold nanoparticles. Theoretical analysis and Monte Carlo simulations are used to explain the basic trends of the photoabsorption-induced secondary electron signal. Based on our current experiments and this analysis, we expect that the spatial resolution can be further improved to a few nanometers, thereby offering a general approach for nanometer-scale optical spectroscopic imaging and material characterization.

Background High-quality workplace-based assessments are essential for competency-based surgical education. We explored education leaders’ perceptions regarding faculty competence in assessment. Methods Surgical education leaders were surveyed regarding which areas faculty needed improvement, and knowledge of assessment tools. Respondents were queried on specific skills regarding (a)importance in resident/medical student education (b)competence of faculty in assessment and feedback. Results Surveys (n = 636) were emailed, 103 responded most faculty needed improvement in: verbal (86%) and written (83%) feedback, assessing operative skill (49%) and preparation for procedures (50%). Cholecystectomy, trauma laparotomy, inguinal herniorrhaphy were “very-extremely important” in resident education (99%), but 21–24% thought faculty “moderately to not-at-all” competent in assessment. This gap was larger for non-technical skills. Regarding assessment tools, 56% used OSATS, 49% Zwisch; most were unfamiliar with all non-technical tools. Summary These data demonstrate a significant perceived gap in competence of faculty in assessment and feedback, and unfamiliarity with assessment tools. This can inform faculty development to support competency-based surgical education.

Background The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication is to report the impact of the pandemic on surgical training and learner wellbeing and to document adaptations made by surgery departments. Study Design A 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic as defined by the Accreditation Council for Graduate Medical Education (ACGME). Statistical associations for items with Stage were assessed using categorical analysis. Results The response rate was 21% (472/2,196). U.S. Stage distribution (n=447) was Stage 1 22%, Stage 2 48%, Stage 3 30%. Impact on clinical education significantly increased by Stage with severe reductions in non-emergency operations (73%and 86% vs.98%) and emergency operations (8% and 16% vs. 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7%and 13%vs.37%). Severity of impact on didactic education increased with stage (14%and 30% vs.46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner wellbeing increased by Stage: physical safety (6%and 9%vs.31%), physical health (0% and 7%vs.17%), emotional health (11% and 24%vs.42%). Regardless of stage most, but not all, made adaptations to support trainees’ wellbeing. Conclusion The pandemic adversely impacted surgical training and wellbeing of learners across all surgical specialties proportional to increasing ACGME Stage. There is a need to develop education disaster plans, to support technical competency, and learner wellbeing. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have significant impact on the future of surgical education., Graphical abstract

Our aim was assess whether an integrated Advanced Modular Manikin (AMM) provides improved participant experience compared with use of peripheral simulators alone during a standardized trauma team scenario. Simulation-based team training has been shown to improve team performance. To address limitations of existing manikin simulators, the AMM platform was created that enables interconnectedness, interoperability, and integration of multiple simulators ("peripherals") into an adaptable, comprehensive training system.A randomized single-blinded, crossover study with 2 conditions was used to assess learner experience differences when using the integrated AMM platform vs peripheral simulators. First responders, anesthesiologists, and surgeons rated their experience and workload with the conditions in a 3-scene standardized trauma scenario. Participant ratings were compared and focus groups conducted to obtain insight into participant experience.Fourteen teams (n = 42) participated. Team experience ratings were higher for the integrated AMM condition compared with peripherals (Cohen's d = .25, p = 0.016). Participant experience varied by background with surgeons and first responders rating their experience significantly higher compared with anesthesiologists (p0.001). Higher workload ratings were observed with the integrated AMM condition (Cohen's d = .35, p = 0.014) driven primarily by anesthesiologist ratings. Focus groups revealed that participants preferred the integrated AMM condition based on its increased realism, physiologic responsiveness, and feedback provided on their interventions.This first comprehensive evaluation suggests that integration with the AMM platform provides benefits over individual peripheral simulators and has the potential to expand simulation-based learning opportunities and enhance learner experience, especially for surgeons.

Site-specific forage management (SSFM), comprising growth observation, impact assessment, and timely strategic response to small variations in sericea lespedeza (SL, Lespedeza cuneata (Dum-Cours.) G. Don) production, has been envisioned as a life-changing approach for resource-poor (R-P) farmers in developing countries, assisting in the effective rearing of their small ruminants. The application of geospatial technologies, including geographic information systems (GIS), remote sensing, global navigation satellite system, and information technology, can support SSFM but has not been widely used for site-specific forage management. From our previous studies, it appears that the entire range of condensed tannins of lespedeza, namely extractable condensed tannin (ECT), fiber-bound condensed tannin (FBCT), and protein-bound condensed tannin (PBCT), as well as crude protein (CP), are excellent for promoting small ruminant digestion and overall health. The goal of this study was to develop an SSFM strategy for SL to enhance animal production in areas of drought-prone, low pH, marginally infertile soils. To achieve this goal, study objectives were to: (i) develop statistical and artificial neural networks-based (ANN) models to identify if a sound correlation exists among forage growth environmental features and SL-ECT content, (ii) determine suitability criteria, including climate, soil, and land use/land cover (LULC), for mass scale production of SL and collect supporting environmental geospatial data, and (iii) develop an automated geospatial model for SL growth suitability analysis in relation to optimal areas for its production in a case-study location. Telemetric data and individual climatologic parameters (including minimum, maximum, and average temperature, humidity, dewpoint, soil temperatures at three depths, soil moisture, evapotranspiration, total solar radiation, and precipitation) were found to correlate well (&gt, 75%) with the forage production parameters, including values of SL-ECT from the Fort Valley State University (FVSU) research station in Georgia in the southern United States. A backpropagation neural network (BPNN) model was developed using similar climatic input parameters, along with elevation (topography) and a normalized difference vegetation index (NDVI) to estimate the forage&rsquo, s ECT with a testing root mean square error (RMSE) of 1.18%. With good correlation obtained between the climatic, soil, slope, and land cover input parameters, and SL-ECT as the output parameter, an SSFM model was developed with potential application to R-P farmers in areas suitable for SL establishment and growth. Eswatini (previously Swaziland), a landlocked country in southern Africa, in which numerous R-P small ruminant (sheep and goat) farmers reside, was used as the case study location to develop the SL production suitability model. Geospatial data were used for automated model development in an ArcGIS Pro ModelBuilder platform to provide information on where to grow SL efficiently to economically feed small ruminants. Land use/land cover, soil, topography, and climate based geospatial data of the region helped in the development of the automated SSFM geospatial model for spatial growth suitability location determination to assist farmers of Eswatini with their SL production decision making. This automated model can easily be replicated for farmers in other countries in Africa, as well as in other parts of the world having similar climatic conditions.

The absorption range of Si is extended to essential wavelength range of lidar sensor for self-driving car via strain engineering., Silicon has been widely used in the microelectronics industry. However, its photonic applications are restricted to visible and partial near-infrared spectral range owing to its fundamental optical bandgap (1.12 eV). With recent advances in strain engineering, material properties, including optical bandgap, can be tailored considerably. This paper reports the strain-induced shrinkage in the Si bandgap, providing photosensing well beyond its fundamental absorption limit in Si nanomembrane (NM) photodetectors (PDs). The Si-NM PD pixels were mechanically stretched (biaxially) by a maximum strain of ~3.5% through pneumatic pressure–induced bulging, enhancing photoresponsivity and extending the Si absorption limit up to 1550 nm, which is the essential wavelength range of the lidar sensors for obstacle detection in self-driving vehicles. The development of deformable three-dimensional optoelectronics via gas pressure–induced bulging also facilitated the realization of unique device designs with concave and convex hemispherical architectures, which mimics the electronic prototypes of biological eyes.

The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in water and wastewater has recently been reported. According to the updated literature, the stools and masks of the patients diagnosed with coronavirus disease (COVID-19) were considered as the primary route of coronavirus transmission into water and wastewater. Most coronavirus types which attack human (possible for SARS-CoV-2) are often inactivated rapidly in water (i.e., the survival of human coronavirus 229E in water being 7 day at 23 °C). However, the survival period of coronavirus in water environments strongly depends on temperature, property of water, concentration of suspended solids and organic matter, solution pH, and dose of disinfectant used. The World Health Organization has stated that the current disinfection process of drinking water could effectively inactivate most of the bacterial and viral communities present in water, especially SARS-CoV-2 (more sensitive to disinfectant like free chlorine). A recent study confirmed that SARS-CoV-2 RNA was detected in inflow wastewater (but not detected in outflow one). Although the existence of SARS-CoV-2 in water influents has been confirmed, an important question is whether it can survive or infect after the disinfection process of drinking water. To date, only one study confirmed that the infectivity of SARS-CoV-2 in water for people was null based on the absence of cytopathic effect (CPE) in infectivity tests. Therefore, further studies should focus on the survival of SARS-CoV-2 in water and wastewater under different operational conditions (i.e., temperature and water matrix) and whether the transmission from COVID-19-contaminated water to human is an emerging concern. Although paper-based devices have been suggested for detecting the traces of SARS-CoV-2 in water, the protocols and appropriate devices should be developed soon. Wastewater and sewage workers should follow the procedures for safety precaution against SARS-CoV-2 exposure.

Introduction: Collection of fluid in the macula is called macular oedema. It is a manifestation of various pathologies, main being diabetic retinopathy. Since the burden of the disease is immense and can cause blindness, its early detection and treatment are of utmost necessity. Optical Coherence Tomography (OCT) is a fast, efficacious and easy diagnostic tool for detecting macular oedema at the earliest and hence is used widely now. Intravitreal Injection Bevacizumab (IVB) is an anti Vascular Endothelial Growth Factor (anti-VEGF) agent effective in the treatment of macular oedema and is cost effective compared to its contemporaries. Aim: To study the clinical effectiveness of IVB as measured by Spectral Domain-Optical Coherence Tomography (SD-OCT) changes in macular thickness in patients with macular oedema. Materials and Methods: This was a retrospective analysis of 32 eyes of 30 patients with macular oedema due to various retinal pathologies that underwent IVB and followed-up for a period of minimum 6 months. The outcomes were measured on SD-OCT at baseline then at one month, three months and six months. Morphological changes were also analysed through the OCT pictures. Paired t-test and chi-square test were used for statistical analysis. Results: The Central Foveal Thickness (CFT) reduced from 445.28±155.87 μm at baseline to 334.44±100.42 μm at one month which was statistically significant (p

Androgen receptor (AR) signaling remains crucial in castration-resistant prostate cancer (CRPC). Since it is also essential in immune cells, we studied whether the expression of AR full-length (ARFL) and its splicing variant ARV7 in peripheral blood mononuclear cells (PBMC) predicts systemic treatment response in mCRPC in comparison with circulating-tumor cells (CTC). We measured ARFL and ARV7 mRNA in PBMC and CTC from patients prior to receiving abiraterone (AA), enzalutamide (E), or taxanes by a pre-amplification plus quantitative reverse-transcription PCR. They were also tested in LNCaP-ARV7-transfected and in 22RV1 docetaxel-resistant (22RV1DR) cells. We studied 171 PBMC from 136 patients and from 24 non-cancer controls, and 47 CTC from 22 patients. High PBMC ARV7 levels correlated with worse AA/E and better taxane response. In taxane-treated patients high PBMC ARFL also correlated with longer progression-free survival (PFS). High ARV7 and ARFL expression were independently associated with better biochemical-PFS. Conversely, high CTC ARV7 and ARFL correlated with shorter radiological-PFS and overall survival, respectively. High ARV7 in 22RV1DR and LNCaP-ARV7 cells correlated with taxane resistance. In conclusion, ARFL and ARV7 at PBMC or CTC have a different predictive role in the taxane response, suggesting a potential influence of the AR pathway from PBMC in such response modulation.