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INTRODUCTION: With increasing engagement of commercial spaceflight participants in spaceflight activities, the evaluation of individuals with medical conditions not previously characterized in the spaceflight environment is of particular interest. Factors such as acceleration forces experienced during launch, reentry, and landing of spacecraft could pose an altered risk profile in some individuals due to known disease. Bleeding diatheses present a unique concern in the spaceflight environment given hypergravity exposure and, particularly, the potential for injury resulting from transient or impact acceleration.CASE REPORT: A 26-yr-old Caucasian man with severe hemophilia A and no detectable endogenous Factor VIII (FVIII) volunteered for participation in hypergravity exposures simulating spaceflight. His treatment regimen included 50 IU · kg−1 FVIII-Fc fusion protein intravenous administration every 96 h, with supplemental FVIII administration as needed for injury or bleeding. The subject experienced two profiles at the National Aerospace Training and Research Center (NASTAR), with maximum exposure +4.0 Gz, +4.5 Gx, 6.1 G resultant, and maximum onset rate z · s−1 and +1 Gx · s−1. The subject reported no abnormal events during the profiles other than brief mild vertigo. No petechial hemorrhage, ecchymosis, or other bleeding was noted during or after profiles. Supplemental FVIII was not required before, during, or after exposure.DISCUSSION: Inherited bleeding disorders present several potential concerns that must be evaluated prior to spaceflight participation. Cautious review and management of medical history, adherence and barriers to treatment, duration of spaceflight and longitudinal management concerns, and a thorough and detailed risk/benefit assessment may provide a future pathway for inclusion of individuals with hematological disorders in commercial spaceflight.Reeves IA, Blue RS, Auñon-Chancellor S, Harrison MF, Shah R, Powers WE. Tolerance of centrifuge-simulated commercial spaceflight in a subject with hemophilia A. Aerosp Med Hum Perform. 2023; 94(6):470–474.

Chemogenomics, also known as proteochemometrics, covers various computational methods for predicting interactions between related drugs and targets on large-scale data. Chemogenomics is used in the early stages of drug discovery to predict the off-target effects of proteins against therapeutic candidates. This study aims to predict unknown ligand–target interactions using one-dimensional SMILES as inputs for ligands and binding site residues for proteins in a computationally efficient manner. We first formulate a Deep learning CNN model using one-dimensional SMILES for drugs and motif-rich binding pocket subsequences of proteins as inputs. We evaluate and compare the proposed deep learning model trained on expert-based features against shallow feature-based machine learning methods. The proposed method achieved better or similar performance on the MSE and AUPR metrics than the shallow methods. Additionally, We show that our deep learning model, DeepPS is computationally more efficient than the deep learning model trained on full-length raw sequences of proteins. We conclude that a beneficial research approach would be to integrate structural information of proteins for modeling drug-target interaction prediction of large datasets for more interpretability, high throughput, and broad applicability. Graphical abstract

To evaluate the quality and reliability of medical information, the technical quality of the presentation of information, and the readability of informational websites that publish content on the definition, causes, symptoms, and treatment of glaucoma.A cross-sectional study was conducted to assess information published on websites with regard to glaucoma.The top 150 websites populated on a Google search using the keywords glaucoma, high intraocular pressure, and high eye pressure were chosen for evaluation.Two independent reviewers assessed quality and reliability of each website using the DISCERN, Health on the Net Code (HONcode), and Journal of the American Medical Association (JAMA) criteria. The reviewers also evaluated technical quality by determining each website's ability to satisfy 10 unique features. Readability was assessed using the Readability Studio software (Oleander Software).Quality of information was analyzed using the DISCERN, HONcode, and JAMA criteria. To assess readability, the Bormuth Cloze Mean, Bormuth Grade Placement, Flesch Kincaid Reading Ease, Coleman-Liau Index, Gunning Fog Score, Simple Measure of Gobbledygook Index, Readability Score, Fry Estimate, Raygor Estimate, and the Overall Mean Readability metrics were used. A separate subanalysis categorized websites into institutional and private categories.Readability was poor among all websites, with most websites requiring a reading level higher than the 11th grade. The overall mean DISCERN score ± standard deviation (SD) was 3.0 ± 0.4, the mean HONcode score ± SD was 9.6 ± 1.8, and the mean JAMA score ± SD was 2.1 ± 1.1. The reviewers had moderate to excellent interrater reliability. Institutional websites (n = 39) had a higher mean DISCERN score (3.18 ± 0.33 vs. 2.95 ± 0.39, P0.05) and mean HONcode score (10.18 ± 1.90 vs. 9.34 ± 1.71, P0.05) than those of private websites (n = 111). Technical quality was higher among institutional websites (P0.05).An overwhelming majority of websites presented information of low quality, reliability, and readability. Institutional websites generally received higher scores than those received by private websites; however, overall scores were still substandard, which necessitates improvement of online information on glaucoma.

Fanconi anemia (FA) develops due to a mutation in one of the FANC genes that are involved in the repair of interstrand crosslinks (ICLs). FANCG, a member of the FA core complex, is essential for ICL repair. Previous FANCG-deficient mouse models were generated with drug-based selection cassettes in mixed mice backgrounds, leading to a disparity in the interpretation of genotype-related phenotype. We created a Fancg-KO (KO) mouse model using CRISPR/Cas9 to exclude these confounders. The entire Fancg locus was targeted and maintained on the immunological well-characterized C57BL/6J background. The intercrossing of heterozygous mice resulted in sub-Mendelian numbers of homozygous mice, suggesting the loss of FANCG can be embryonically lethal. KO mice displayed infertility and hypogonadism, but no other developmental problems. Bone marrow analysis revealed a defect in various hematopoietic stem and progenitor subsets with a bias towards myelopoiesis. Cell lines derived from Fancg-KO mice were hypersensitive to the crosslinking agents cisplatin and Mitomycin C, and Fancg-KO mouse embryonic fibroblasts (MEFs) displayed increased γ-H2AX upon cisplatin treatment. The reconstitution of these MEFs with Fancg cDNA corrected for the ICL hypersensitivity. This project provides a new, genetically, and immunologically well-defined Fancg-KO mouse model for further in vivo and in vitro studies on FANCG and ICL repair.

Crosslink repair depends on the Fanconi anemia pathway and translesion synthesis polymerases that replicate over unhooked crosslinks. Translesion synthesis is regulated via ubiquitination of PCNA, and independently via translesion synthesis polymerase REV1. The division of labor between PCNA-ubiquitination and REV1 in interstrand crosslink repair is unclear. Inhibition of either of these pathways has been proposed as a strategy to increase cytotoxicity of platinating agents in cancer treatment. Here, we defined the importance of PCNA-ubiquitination and REV1 for DNA in mammalian ICL repair. In mice, loss of PCNA-ubiquitination, but not REV1, resulted in germ cell defects and hypersensitivity to cisplatin. Loss of PCNA-ubiquitination, but not REV1 sensitized mammalian cancer cell lines to cisplatin. We identify polymerase Kappa as essential in tolerating DNA damage-induced lesions, in particular cisplatin lesions. Polk-deficient tumors were controlled by cisplatin treatment and it significantly delayed tumor outgrowth and increased overall survival of tumor bearing mice. Our results indicate that PCNA-ubiquitination and REV1 play distinct roles in DNA damage tolerance. Moreover, our results highlight POLK as a critical TLS polymerase in tolerating multiple genotoxic lesions, including cisplatin lesions. The relative frequent loss of Polk in cancers indicates an exploitable vulnerability for precision cancer medicine.

Background: Thrombosis of the left internal jugular vein in an astronaut aboard the International Space Station was recently described, incidentally discovered during a research study of blood flow in neck veins in microgravity. Given this event, and the high incidence of flow abnormalities, the National Aeronautics and Space Administration (NASA) instituted an occupational surveillance program to evaluate astronauts for venous thrombosis. Methods: Duplex ultrasound of the bilateral internal jugular veins was conducted on all NASA astronauts terrestrially, and at three points during spaceflight. Respiratory maneuvers were performed. Images were analyzed for thrombosis and certain hemodynamic characteristics, including peak velocity and degree of echogenicity. Results: Eleven astronauts were evaluated with matching terrestrial and in-flight ultrasounds. No thrombosis was detected. Compared to terrestrial ultrasound measurements, in-flight peak velocity was reduced and lowest in the left. Six of 11 astronauts had mild–moderate echogenicity in the left internal jugular vein during spaceflight, but none had more than mild echogenicity in the right internal jugular vein. Two astronauts developed retrograde blood flow in the left internal jugular vein. Conclusion: Abnormal flow characteristics in microgravity, most prominent in the left internal jugular vein, may signal an increased risk for thrombus formation in some individuals.

Introduction: For patients diagnosed with central retinal artery occlusion (CRAO), timely screening for underlying risk factors to prevent secondary stroke and other cardiovascular events is required. Given the profound impact on vision, there is also great interest in the potential to treat CRAO. Thrombolytic therapy is the current standard of care in acute ischemic cerebral stroke, but the window for administration is short. As part of a larger pilot to investigate the prospect of intravenous thrombolysis for patients presenting with acute CRAO in our institution, we set out to evaluate the specific presentation patterns of this population within our system. Methods: Retrospective study performed on 804 patients correctly diagnosed with CRAO from 2011-2020. From this cohort of patients, we identified 484 for whom we could accurately determine the time of first symptoms, the time of first contact with the healthcare system, and the time of evaluation by an ophthalmologist. Results: While 18.0% (87/484) of patients waited over 24 hours from time of vision loss to contact the health care system, 50.2% of patients did connect in under 4.5 hours (243/484). However, only 16.7% (81/484) of patients saw an ophthalmologist within that window, and 35.5% (172/484) did not have any ophthalmologic evaluation within 24 hours of vision loss. Conclusion: Half of CRAO patients within our institution connect with the health care system within a potential window for intravenous thrombolytic treatment, but the majority do not receive ophthalmic diagnosis within that time frame. In conclusion, public health education efforts to speed up presentation times and system-based strategies to decrease the time to ophthalmic diagnosis are needed if thrombolytic treatment either via compassionate use or within a clinical trial setting is to be more widely offered.

Ion channels play critical roles in the physiology and function of the nervous system and contractile tissue; however, their role in non-contractile tissue and embryonic development is less understood. Tracheobronchomalacia (TBM) and complete tracheal rings (CTR) are disorders affecting the muscle and cartilage of the trachea and bronchi, whose etiology remains poorly understood. We demonstrated that trachealis muscle organization and polarity are disrupted after the deletion ofWls, an essential component of the Wnt signaling pathway, in tracheal epithelium during embryonic development. The changes are similar to the anomalous trachealis muscle observed after deletion of ion channel encoding genes in developing mouse trachea. We hypothesize that Wnt signaling influences the expression of ion channels to promote trachealis muscle cell assembly and patterning. DeletingWlsin developing trachea causes differential regulation of genes mediating actin binding, cytoskeleton organization, and potassium ion channel activity. Wnt/β-catenin dependent signaling regulated expression ofKcnj13,Kcnd3,Kcnj8, and its related receptor,Abcc9, as demonstrated byin vitrostudies and in vivo analysis inWnt5aandβ-catenindeficient tracheas. Pharmacological inhibition of potassium ion channels and Wnt signaling impaired contractility of developing trachealis smooth muscle and formation of cartilaginous mesenchymal condensation. Thus, epithelial-induced Wnt/β-catenin signaling mediates trachealis muscle and cartilage development via modulation of ion channel expression to promote trachealis muscle architecture and contractility, and cartilaginous extracellular matrix in mice. Ion channel activity may influence tracheal morphogenesis underlying TBM and CTR.

Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is vital to addressing the regions rising burden of disease. Tissue from unselected Nigerian patients was analyzed with a multigene, next-generation sequencing assay. The rate of microsatellite instability is significantly higher among Nigerian CRC patients (28.1%) than patients from The Cancer Genome Atlas (TCGA, 14.2%) and Memorial Sloan Kettering Cancer Center (MSKCC, 8.5%, P, Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is important for early detection and treatment. Here, the authors use a multigene next-generation sequencing panel to identify genomic differences in Nigerian CRCs compared to those from TCGA and MSKCC cohorts.

Many countries' economic prosperity and strategic development are dependent on the aviation industry, and it plays an indispensable role in the global transportation system. The emergence of a pandemic, which is likely to shatter the sector and disrupt its operations fundamentally, is one of the most common and unprecedented challenges to this industry. Beginning in 2020, the terrible impact of coronavirus (COVID-19) disease, which has evolved into a worldwide pandemic and resulted in a radical reestablishment of society's daily existence, has been faced by aviation. The pandemic has caused a shift in the formerly usual method of air travel. This thesis investigates the ramifications of COVID-19 for the aviation business, as well as the measures employed by this industry in reaction to the crisis and the intention of passengers to travel by air during pandemics. This thesis' literature analysis covers the issues that the airline sector is facing as a result of the global pandemic, as well as the restructured onboard experience, including the new safety measures that have been implemented across the entire aviation network. The report also looks at the new passenger behaviour trends. In April-May 2021, an online empirical experiment using a video advertising as a stimulus in two separate experimental circumstances was done using a quantitative research approach. The impact of aircraft safety measures on travel intention, customer happiness, value for money, and perceived health risk on the general public was investigated. According to the findings, airline safety measures are likely to have a favourable impact on expected consumer satisfaction. At the same time, direct exposure to aircraft safety measures did not lessen their perceived health risk or raise their considered value for money. According to the findings, improving customer satisfaction and expected value for money might have a favourable impact on individual travel intentions. On the contrary, the greater the perception of a health danger, the less inclined people are to fly. This would be a negative scenario for the air traffic sector, whose future development is now difficult to foresee, and the amount of time required to recover is unknown. Keywords: Covid-19, Air traffic, Analysis, Python, Pre-processing

Background Coronaviruses are important emerging human and animal pathogens. SARS-CoV-2, the virus that causes COVID-19, is responsible for the current global pandemic. Early in the course of the pandemic, New York City became one of the world's "hot spots" with more than 250,000 cases and more than 15,000 deaths. Although medical providers in New York were fortunate to have the knowledge gained in China and Italy before it came under siege, the magnitude and severity of the disease were unprecedented and arguably under appreciated. The surge of patients with significant COVID-19 threatened to overwhelm health care systems, as New York City health systems realized that the number of specialized critical care providers would be inadequate. A large academic medical system recognized that rapid redeployment of noncritical providers into such roles would be needed. An educational gap was therefore identified: numerous providers with minimal critical care knowledge or experience would now be required to provide critical-level patient care under supervision of intensivists. Safe provision of such high level of patient care mandated the development of "educational crash courses." Methods The purpose of this special article is to summarize the approach adopted by the Institute for Critical Care Medicine and Department of Anesthesiology, Perioperative and Pain Medicine's Human Emulation, Education, and Evaluation Lab for Patient Safety and Professional Study Simulation Center in developing a training program for noncritical care providers in this novel disease. Results Using this joint approach, we were able to swiftly educate a wide range of nonintensive care unit providers (such as surgical, internal medicine, nursing, and advanced practice providers) by focusing on refreshing critical care knowledge and developing essential skillsets to assist in the care of these patients. Conclusions We believe that the practical methods reviewed here could be adopted by any health care system that is preparing for an unprecedented surge of critically ill patients.

Evaluate the safety and efficacy of the Janus kinase (JAK)1/JAK2 inhibitor ruxolitinib in COVID-19-associated acute respiratory distress syndrome requiring mechanical ventilation.Phase 3 randomized, double-blind, placebo-controlled trial Ruxolitinib in Participants With COVID-19-Associated Acute Respiratory Distress Syndrome Who Require Mechanical Ventilation (RUXCOVID-DEVENT; NCT04377620).Hospitals and community-based private or group practices in the United States (29 sites) and Russia (4 sites).Eligible patients were greater than or equal to 12 years old, hospitalized with severe acute respiratory syndrome coronavirus 2 infection, and mechanically ventilated with a Pa o2 /F io2 of less than or equal to 300 mm Hg within 6 hours of randomization.Patients were randomized 2:2:1 to receive twice-daily ruxolitinib 15 mg, ruxolitinib 5 mg, or placebo, each plus standard therapy.The primary endpoint, 28-day mortality, was tested for each ruxolitinib group versus placebo using a mixed-effects logistic regression model and one-tailed significance test (significance threshold: plt; 0.025); no type 1 error was allocated to secondary endpoints. Between May 24, 2020 and December 15, 2020, 211 patients (age range, 24-87 yr) were randomized (ruxolitinib 15/5 mg, n = 77/87; placebo, n = 47). Acute respiratory distress syndrome was categorized as severe in 27% of patients (58/211) at randomization; 90% (190/211) received concomitant steroids. Day-28 mortality was 51% (39/77; 95% CI, 39-62%) for ruxolitinib 15 mg, 53% (45/85; 95% CI, 42-64%) for ruxolitinib 5 mg, and 70% (33/47; 95% CI, 55-83%) for placebo. Neither ruxolitinib 15 mg (odds ratio, 0.46 [95% CI, 0.201-1.028]; one-sided p = 0.029) nor 5 mg (odds ratio, 0.42 [95% CI, 0.171-1.023]; one-sided p = 0.028) significantly reduced 28-day mortality versus placebo. Numerical improvements with ruxolitinib 15 mg versus placebo were observed in secondary outcomes including ventilator-, ICU-, and vasopressor-free days. Rates of overall and serious treatment-emergent adverse events were similar across treatments.The observed reduction in 28-day mortality rate between ruxolitinib and placebo in mechanically ventilated patients with COVID-19-associated acute respiratory distress syndrome was not statistically significant; however, the trial was underpowered owing to early termination.

Background: The aerosol box was rapidly developed and disseminated to minimize viral exposure during aerosolizing procedures during the COVID-19 pandemic, yet users may not understand how to use and clean the device. This could potentially lead to increased viral exposure to subsequent patients and practitioners. We evaluated intraoperative contamination and aerosol box decontamination and the impact of a preoperative educational visual aid. Methods: Using a double-blinded randomized design, forty-four anesthesiology trainees and faculty completed a simulated anesthetic case using an aerosol box contaminated with a fluorescent marker; half of the subjects received a visual aid prior to the simulation. Intraoperative contamination was evaluated at 10 standardized locations using an ultraviolet (UV) light. Next, subjects were instructed to clean the aerosol box for use on the next patient. Following cleaning, the box was evaluated for decontamination using an UV light. Results: Median total contamination score was significantly reduced in the experimental group (5.0 vs. 10.0, P < 0.001). The aerosol box was completely cleaned by 36.4% of subjects in the experimental group compared to 4.5% in the control group (P = 0.009). Conclusions: The use of a visual aid significantly decreased intraoperative contamination and improved box cleaning. Despite these findings, a potentially clinically significant amount of viral exposure may exist. Thorough evaluation of the risks and benefits of the aerosol box should be completed prior to use. If an aerosol box is used, a visual aid should be considered to remind practitioners how to best use and clean the box.

Nader Rabie,1 Ronak Shah,2 Shona Ray-Griffith,3 Jessica L Coker,3 Everett F Magann,4 Zachary N Stowe5 1Tripler Army Medical Center, Department of Obstetrics and Gynecology, Honolulu, HI, USA; 2Our Lady of Angels, Department of Obstetrics and Gynecology, Bogalusa, LA, USA; 3University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, USA; 4University of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Little Rock, AR, USA; 5University of Wisconsin School of Medicine and Public Health, Psychiatric Institute and Clinic, Madison, WI, USACorrespondence: Everett F MagannUniversity of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Little Rock, AR, USAEmail efmagann@uams.eduObjective: The use of electroconvulsive therapy in pregnancy has been limited by concerns about its effects on fetal well-being, despite limited evidence that suggests it is safe and effective. No studies have utilized continuous fetal heart rate monitoring during electroconvulsive therapy sessions. We aimed to describe the fetal heart rate patterns of patients undergoing electroconvulsive therapy.Design: This study is a prospective case series of pregnant patients undergoing electroconvulsive therapy with continuous fetal heart rate monitoring.Setting: University-based hospital.Population: Pregnant patients with a psychiatric indication for electroconvulsive therapy.Methods: Patients underwent fetal heart rate monitoring immediately prior, during and immediately after ECT therapy.Main Outcome Measures: Characterization of the fetal heart rate tracing.Results: Five subjects underwent 44 electroconvulsive therapy sessions. Continuous fetal monitoring was performed on 34 of the sessions. Transient fetal heart rate decelerations occurred in 4 sessions, all self-resolved and none required intervention.Conclusion: This case series is the first to report the results of continuous FHR monitoring during electroconvulsive therapy. The most common finding was a transient, self-resolving bradycardia that was not associated with adverse perinatal outcomes. This supports the opinion that electroconvulsive therapy is a safe treatment option in pregnancy in women with severe mental disease.Keywords: pregnancy, electroconvulsive therapy, fetal monitoring, mental illness and pregnancy

HER2 mutations are infrequent genomic events in biliary tract cancers (BTCs). Neratinib, an irreversible, pan-HER, oral tyrosine kinase inhibitor, interferes with constitutive receptor kinase activation and has activity in HER2-mutant tumours. SUMMIT is an open-label, single-arm, multi-cohort, phase 2, ‘basket’ trial of neratinib in patients with solid tumours harbouring oncogenic HER2 somatic mutations (NCT01953926). The primary objective of the BTC cohort was objective response rate (ORR). Among 25 treatment-refractory patients (11 cholangiocarcinoma, 10 gallbladder, 4 ampullary cancers), the ORR was 16%. The most common HER2 mutations were S310F (n = 11; 48%) and V777L (n = 4; 17%). Outcomes appeared worse for ampullary tumours or those with co-occurring oncogenic TP53 and CDKN2A alterations. Loss of amplified HER2 S310F and acquisition of multiple previously undetected oncogenic co-mutations were identified at progression in one responder. Neratinib demonstrated anti-tumour activity in patients with refractory BTC harbouring HER2 mutations. Future studies of rational combinations are warranted.

Biomass-burning improved cookstoves (ICS) are often seen as a promising intermediate technology solution along the path of household transition to cleaner cooking. This study reports on the results of an experimental evaluation of a carbon finance-enabled program conducted in rural villages in Rajasthan, India. Half (or 20) of 40 purposively-selected treatment villages were randomly assigned to an ‘early’ intervention group that was offered a package of two biomass fuel ICS one year prior to the other half (the ‘late’ group). Analysis of data collected prior to the second phase of the intervention shows that adoption of ICS reached nearly 46% in the group exposed to the intervention, and that households largely held positive short-term views of the effects of these technologies. Moreover, we found evidence of both time savings and reductions in fuel use among intervention households. Consistent with the wider literature on the limitations of biomass-burning ICS, however, we failed to detect consistent effects on self-reported respiratory health. Findings were generally consistent across simple and difference-in-difference estimates of impacts, and suggest that biomass-burning ICS can deliver benefits even when they offer few improvements in health.

Background Critical care airway management (CCAM) is a key skill for critical care physicians. Simulation-based training (SBT) may be an effective modality in training intensivists in CCAM. Research Question Is SBT of critical care fellows an effective means of providing training in CCAM, in particular in urgent endotracheal intubation? Study Design and Methods Thirteen first-year pulmonary critical care medicine (PCCM) fellows at an academic training program underwent SBT with a computerized patient simulator (CPS) in their first month of fellowship training. At the end of the training period, the fellows underwent video-based scoring using a 46-item checklist (of which 40 points could be scored) while performing a complete CCAM sequence on the CPS. They were then tested, using video-based scoring on their first real-life CCAM. Maintenance of skill at CCAM was assessed during the fellows' second and third year of training, using the same scoring method. Results For the first-year fellows, the score on the CPS was 38.3 ± 0.75 SD out of a maximum score of 40. The score on their first real-life patient CCAM was 39.0 ± 0.81 SD (P = .003 for equivalence; 95% CI for difference between real-life patient CCAM and CPS scores, 0.011-1.373). Sixteen second- and third-year fellows were tested at a real-life CCAM event later in their fellowship to examine for maintenance of skill. The mean maintenance of skill score of this group was 38.7 ± 1.14 SD. Interpretation Skill acquired through SBT of critical care fellows for CCAM transfers effectively to the real-life patient care arena. Second- and third-year fellows who had initially received SBT maintained skill at CCAM.

The ITER electron cyclotron (EC) system will have gyrotron sources used for plasma heating and current drive applications. During gyrotron operation, different faults may be encountered and in the case of critical faults, the High Voltage Power Supplies (HVPS) should be switched off in $ time scale, which otherwise could damage the internal components of a gyrotron tube. Also during the operation, the main operating parameters need to be acquired on fast time scales (~5 Msps) to know the gyrotron output characteristics. A solution is required catering to both the requirements, which should be cost-effective, and also comply with recommended hardware and software framework. In this context, a custom prototype module compatible with NI-CompactRIO (NI-cRIO) system is under development for ITER-India Gyrotron Test Facility (IIGTF). The module has protection and monitoring functions both in parallel in a single unit. It has a transmitter (TX) and receiver (RX) card connected optically to complete the link. The TX has fast sampling analog-to-digital converter (ADC), fast comparator, field-programmable gate array (FPGA), and an optical transmitter. The TX sends monitoring and trip information optically to the RX. The RX card has an optical receiver, FPGA, and digital-to-analog converter (DAC), which generates back the original signals. The heart of the module is FPGA logic, which performs encoding and decoding (as per 8b10b standard) of ADC serial data, thereby eliminating the use of any serial converter ICs. The module can be plugged into the cRIO chassis and also can be used as a standalone module. This article discusses the concept, design, development, and test results of fast protection and fast signal monitoring module

Contamination of intravenous (IV) ports and stopcocks has been associated with postoperative infections. We tested the usability and efficacy of a novel passive shielding device to prevent such contamination even in the absence of hand hygiene or port disinfection. In a desktop setting with deliberately contaminated hands, qualitative port contamination was detected after 5/60 (8.3%; 95% confidence interval [CI], 2.8-18.4) control port injections versus 0/60 (0%; 95% CI, 0-6.0) shielded injections (P = .025). In clinical simulations with a quantitative bioburden assay (measured in relative light units [RLUs]), median (interquartile range [IQR]) postsimulation bioburden was 46 (32-53) vs 27 (21-42) RLU for the control versus intervention groups (P = .036), yielding a median shift of -13 RLU (95% CI, -2 to -26) in favor of the shielding. Usability of the device was acceptable to practitioners.

Simulation-based education (SBE) has become pervasive in health care training and medical education, and is even more important in subspecialty training whereby providers such as otolaryngologists and anesthesiologists share overlapping patient concerns because of the proximity of the surgical airway. Both these subspecialties work in a fast-paced environment involving high-stakes situations and life-changing events that necessitate critical thinking and timely action, and have an exceedingly small bandwidth for error. Team training in the form of interprofessional education and learning involving surgeons, anesthesiologists, and nursing is critical for patient safety in the operating room in general, but more so in otolaryngology surgery.