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Tropopause-overshooting convection in the midlatitudes provides a rapid transport pathway of air from the lower troposphere to the upper troposphere and lower stratosphere (UTLS), and can result in the formation of above-anvil cirrus plumes (AACPs). Recent in situ observations from the Dynamics and Chemistry of the Summer Stratosphere (DCOTSS) field campaign are used to examine impacts from active overshooting convection on UTLS composition. There are little to no prior airborne observations of active overshooting convection, making observations from this flight valuable to interpreting and exploring processes seen in idealized modeling studies. DCOTSS research flight 13 on May 31st, 2022 sampled active overshooting convection over the state of Oklahoma for more than three hours with the NASA ER-2 high-altitude research aircraft. Additionally, an AACP was bisected during this flight, providing the first such extensive sampling of this phenomena. This study aims to provide a detailed understanding of changes in the UTLS composition from active overshooting convection and AACPs using the in-situ observations from this flight. The observations reveal multiple pronounced changes in air mass composition and stratospheric hydration. In agreement with prior modeling studies, maximum altitudes of water vapor enhancement were much higher than altitudes of mostly passive trace gas composition change. Stratospheric water vapor enhancements reached nearly a factor of four over background levels at a maximum altitude of 16.56 km and a potential temperature of 389.76 K. Carbon monoxide, a tracer of tropospheric origin, showed enhancements of a factor of two over background levels at a maximum altitude of 15.76 km and potential temperature of 363.6 K. There is a notable positive correlation between water vapor and ozone near the bisection of the AACP, which seems to be the result of horizontal mixing. It appears that the water vapor enhancement within the AACP was limited to the saturation mixing ratio of the low temperature environment.

Objective: This study examined the intra- and inter-rater reliability of the Recorded Interaction Task (RIT); a novel tool to assess mother-infant bonding via observational methods. Background: Mother-infant bonding describes the reciprocal early emotional connection between mother and infant. Whilst various tools exist to assess mother-infant bonding, many incorrectly confuse this construct with mother-infant attachment. Further, available tools are limited to those that employ self-report methods, thus may reflect perceived behaviour, rather than actual behaviour. The RIT is a novel tool for observational assessment of mother-infant bonding. A standard interaction between mother and infant is recorded, and later assessed against specified bonding-related behaviours. Before its use in research, reliability testing must be undertaken to ensure the RIT may be used consistently. Methods: The RIT was administered to 15 mother-infant dyads. Participant recordings were assessed by three trained raters at two time points, using the RIT observation scoring sheet. Intra-rater reliability was determined by comparing scores at each time point for each rater. Inter-rater reliability was determined by assessing reliability of scores at the first time point. Results: Strong intra-rater reliability (ICC >0.86) and fair inter-rater reliability (ICC = 0.55) were observed. Conclusion: The current findings support the RIT’s potential to reliably assess mother-infant bonding. Refereed/Peer-reviewed

IntroductionPoint-of-care ultrasound (POCUS) may detect the cardiopulmonary manifestations of COVID-19 and expediently predict patient outcomes.MethodsWe conducted a prospective cohort study at four medical centers from 3/2020-1/2021 to evaluate POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received cardiac or lung POCUS with a 12-zone protocol. Images were interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was ICU admission incidence. Secondary outcomes included intubation and supplemental oxygen usage.ResultsN=160 patients (N=201 scans) were included. Scans were collected a median 23 hours (IQR:7-80) from emergency department triage. Triage POCUS findings associated with ICU admission included B-lines (OR 4.41 [95% CI:1.71-14.30]; pConsolidations present on triage were associated with the need for oxygen at discharge (OR 2.16 [95% CI: 1.01-4.70]; p=0.047). A normal lung triage scan was protective for ICU admission (OR 0.28 [95% CI:0.09-0.75; pDiscussionLung POCUS findings detected early in the hospitalization may provide expedient risk stratification for important COVID-19 clinical outcomes, including ICU admission, intubation, or need for oxygen on discharge. A normal admission scan appears protective against adverse outcomes, which may aid in triage decisions of patients.

The present study describes the current relevance of designing a Disaster Recovery Plan (DRP) for modern businesses, even more for those which have a Data Center (DC) inside their infrastructures. The main purpose of any DRP is to achieve the continuity of the most important services for the enterprise, this being more important in times of COVID-19 pandemic due to the extreme technological dependence required. DRPs try to minimize the risks that may cause any affectation on a critical service. Based on field studies, a risk analysis is executed according to ISO27001 standard and a risk treatment matrix is done to reduce the emergence probability, having identified the power back-up failure as the main risk in the analyzed DC. A private cloud-based recovery design is also proposed in the event of a possible impact due to power and back-up procedure failures. According to the final analysis and execution of the DRP, it is concluded that the recovery of service is performed in an adequate time to preserve the critical business services running, despite electrical failures.

Background The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. Methodology In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. Results In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. Conclusions This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care.

Although many of the factors that contribute to anorexia nervosa are not within the physician's control, early detection and prompt initiation of treatment may improve patient outcome. A high level of suspicion and a willingness to address the issue can serve our patients well.

BACKGROUND: The blood based interferon-gamma release assays (IGRA) for the diagnosis of tuberculosis do not discriminate between active TB disease and latent TB infection (LTBI). The search for distinguishing biomarkers therefore continues, as the accurate diagnosis of tuberculosis is particularly challenging in children. IFN-gamma-inducible protein 10 (IP-10/CXCL10) has recently been evaluated as a marker for active TB in adults with promising results. AIM: To investigate this new biomarker for active TB and LTBI in paediatrics. METHOD: We measured IP-10 levels using ELISA in supernatants of whole blood samples stimulated with TB-specific-antigens and negative control antigen. RESULTS: IP-10 is produced in high levels following mycobacterial antigen stimulation in active TB (n = 17) and LTBI (n = 16) compared to controls (n = 16) and to IFN-gamma. The baseline levels of IP-10 are increased in active TB and in LTBI, but there is no significant difference of stimulated levels of IP-10 between active TB and LTBI. CONCLUSIONS: IP-10 is a biomarker for tuberculosis in children. However like IFNgamma, IP-10 also does not distinguish between active TB and LTBI.

Both red clover extracts and placebo equally reduce the frequency of hot flushes. Providers should encourage patients to avoid spending money on supplements and instead add soy to their diet. In general, however, if patients are already convinced that something works, don't discourage them.

(2001). Eating Disorders: 2. Bulimia Nervosa. Hospital Practice: Vol. 36, No. 3, pp. 71-72.