Transitioning into the workforce during the COVID-19 pandemic: Understanding the experiences of student diagnostic radiographers

Introduction

The COVID-19 pandemic, with associated pressures on healthcare services and workforce, had implications for final year Diagnostic Radiography students completing their training and transitioning into employment. The aim of this study was to explore their experience as novice practitioners starting work and integrating into the workforce during a time of national crisis.

Methods

Five early career Diagnostic Radiographers, eligible to join the temporary HCPC register, were recruited. One to one interviews were completed online exploring their thoughts, feelings and experiences. Participants had the option of using photographs to aid communication.

Results

Interviews were transcribed, emerging themes identified and coded. Four main themes emerged specifically related to the COVID-19 pandemic, (i) perceived challenges associated with joining the workforce, (ii) managing expectations and unexpected outcomes during transition, (iii) adapting to changes in systems and structures, (iv) sense of uncertainty relating to professional identity. The impacts were experienced beyond the work environment into social and personal lives. Participants demonstrated resilience as they adapted to their shifting lives and drew on the support of clinical colleagues and University academics for help. They did report feelings of concern and anxiety. The participants all expressed a sense of feeling valued and supported in their new roles.

Conclusion

The Pandemic was unprecedented and created uncertainty in terms of workforce requirements. This study highlights the personal impact and professional responses of novice practitioners, who felt a sense of duty and care to help support the NHS and others.

Implications for practice

This will help in the understanding of the transition of student into employment and what wider support needs to be in place prior, during and after this phase.

483 Complete Sciatic Nerve Transection from A Closed Femoral Fracture: A Case Report

Introduction

Complete transection of the sciatic nerve following a closed femoral fracture is exceedingly uncommon. Delayed diagnosis may result due to this unrecognised injury pattern.

Case Description:

An 18-year-old male motorcyclist was referred following a significantly displaced closed, femoral fracture. The patient was sedated at the scene and transferred to theatre for definitive fixation, where an open reduction was performed via an anterior approach. Symptoms of paresthesia and weakness were reported immediately postoperatively, and formal neurological examination prompted an emergency MRI. On this basis, the patient was transferred to plastics and underwent surgical exploration, where complete transection of the sciatic nerve was identified just proximal to the bifurcation into the common peroneal and tibial nerve. A nerve gap of five centimetres was identified requiring reconstruction with grouped fascicular sural nerve grafts.

Discussion:

Complete transection of the sciatic nerve is a devastating injury that compromises the function of the posterior compartment of the thigh and all motor function below the knee. To our knowledge, reports of complete sciatic nerve transection secondary to a closed fracture of the femoral shaft are extremely rare in the pertinent literature, with only two other cases reported to date.

Insulin Resistance Moderates the Association Between BMI and Metabolic Syndrome Severity in Women 4–10 Years After Pregnancy, Independent of Gestational Diabetes Status

Objective: Obesity and gestational diabetes mellitus (GDM) increase the risk for metabolic syndrome (MetS). Insulin resistance (IR) is associated with obesity, contributes to risk for GDM, and persists after pregnancy even when glucose tolerance returns. Further, IR may enhance the risk of MetS associated with obesity and GDM. The purpose of this study was to test the hypothesis that IR moderates the relationship between BMI and MetS severity 4–10 years after pregnancy, independent of prior GDM, such that the positive association between BMI and MetS severity is stronger among women with greater IR. Methods: This hypothesis was tested in a secondary analysis of data collected from women enrolled in a study of the intergenerational transmission of obesity, 4–10 years after the index pregnancy. Recruitment in the parent study was stratified to include women with normal weight without GDM (NW), overweight or obesity without GDM (OwOB), and women with GDM during the index pregnancy. Standard clinical procedures were used to measure height, weight, waist circumference and blood pressure, and a fasting blood draw was obtained with which to measure glucose, insulin, triglycerides, and HDL-cholesterol. MetS was evaluated as a continuous outcome, reflecting severity, using the method of Gurka and DeBoer.1 IR was calculated with the homeostatic model assessment (HOMA-IR) and modeled as a continuous variable. An OLS regression model predicting MetS as a function of HOMA-IR, BMI, and their interaction, along with key covariates was used to test whether HOMA-IR moderates the relationship between BMI and MetS severity, independent of GDM. Results: The association between BMI and MetS severity was significantly modified by HOMA-IR (b=0.008, p<0.001), independent of GDM status during pregnancy, such that the positive association between BMI and MetS severity was stronger among individuals with higher HOMA-IR. For example, among women with HOMA-IR values 1-standard deviation below the mean, the estimated association between BMI and MetS severity was (b=0.0394, p<0.001); however, among women with a HOMA-IR value 1-standard deviation above the mean, the association between BMI and MetS severity was (b=0.0745, p<0.001). Conclusion: IR after pregnancy was a significant moderator of the association between BMI and MetS severity. Future studies should explore whether interventions to improve IR can reduce MetS severity independent of BMI and prior GDM.

References: 1.Gurka MJ, Lilly CL, Oliver MN, DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. Metabolism. 2014;63(2):218–225.

HIDRADENITIS SUPPURATIVA IN POSTMENOPAUSE

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a profound impact on the quality of life of patients.

OBJECTIVES

To describe a rare case of HS with postmenopausal onset, to review the literature data regarding late onset HS and to discuss the current knowledge on the role of endocrine abnormalities in the development of HS.

CASE REPORT

We report the case of a 68-year-old patient in whom HS occurred 10 years after menopause. She was referred to our clinic for the presence of an open fistula on the left groin, fibrotic scars and visible alteration of the vulvar anatomy due to numerous surgical interventions. The patient shared features of the metabolic syndrome (obesity, arterial hypertension, dyslipidemia, aortic atherosclerosis), but showed no signs of virilism and no hormonal abnormality. HS was controlled using antiseptics, topical retinoids and antibiotics.

CONCLUSIONS

This case is of particular interest given the late onset of HS, long time after menopause. The development of HS requires a complex interaction between genetic predisposing factors, endocrine dysregulation, metabolic alterations, bacterial overgrowth and an aberrant inflammatory response. Evidence points to an important role of sex-hormones in the emergence and progression of the disease, but the underlying mechanisms are still unclear. A better understanding of HS pathogenesis is needed to elucidate the precise way in which endocrine factors influence the disease onset and course. This would guide the way to novel therapies and a better control of this challenging disease.

Just try it: A six months protocol for borderline personality disorder impulsivity and symptoms reduction

Introduction

Borderline Personality Disorder is defined from its impulsivity issues regarding relationships, abandonment and rejection issues and emotional regulation problems. This personality disorder issue are hard to treat and often related to poor treatment outcomes. Nonetheless, Dialectical Behavioral Therapy stands as a great therapeutical approach that can be adapted.

Objectives

We tested a 6-month CBT protocol (ECCCLORE)-3 modules respectively working on emotion regulation, distress tolerance and relationships- in a French context to compare its effectiveness to treatment as Usual (TAU).

Methods

We recruited 56 patients suffering from BPD, 34 receiving ECCCLORE treatment and 22 receiving TAU. We assessed BPD traits, impulsivity with UPPS, aggressiveness with AQ12, Suicidal risk with SBQr and Hopelessness with H.

Results

Our results revealed the effectiveness of this 6 months DBT adaptation for decreasing BPD traits and most of clinical dimensions. The dynamic analysis revealed the mediating effect of AQ12.

Conclusions

Shortened treatment protocol are effective for reducing symptoms. Further research is needed to replicate these results.

Experimental and theoretical study of photo-dissociation spectroscopy of pyrene dimer radical cations stored in a compact electrostatic ion storage ring

In this paper, we present an experimental and theoretical study of the photo-dissociation of free-flying dimer radical cations of pyrene (C16H10)2+. Experimentally, the dimers were produced in the plasma of an electron cyclotron resonance ion source and stored in an electrostatic ion storage ring, the Mini-Ring for times up to 10 ms and the photo-dissociation spectrum was recorded in the 400 to 2000 nm range. Two broad absorption bands were observed at 550 (2.25 eV) and 1560 nm (0.79 eV), respectively. Theoretical simulations of the absorption spectrum as a function of the temperature were performed using the Density Functional based Tight Binding approach within the Extended Configuration Interaction scheme (DFTB-EXCI) to determine the electronic structure. The simulation involved all excited electronic states correlated asymptotically with the five lowest excited states D1-D5 of the monomer cation and a Monte Carlo exploration of the electronic ground state potential energy surface. The simulations exhibit three major bands at 1.0, 2.1 and 2.8 eV respectively. They allow assigning the experimental band at 1560 nm to absorption by the charge resonance (CR) excited state correlated with the ground state of the monomer D0. The band at 550 nm is tentatively attributed to dimer states correlated with excited states D2-D4, in the monomer cation. Simulations also show that the CR band broadens and shifts towards longer wavelength with increasing temperature. It results from the dependence on the geometry of the energy gap between the ground state and the lowest excited state. The comparison of the experimental spectrum with theoretical spectra at various temperatures allows us to estimate the temperature of the stored (C16H10)2+ in the 300-400 K range, which is also in line with the expected temperatures of the ions deduced from the analysis of the natural decay curve.

The novel Mechanical Ventilator Milano for the COVID-19 pandemic

This paper presents the Mechanical Ventilator Milano (MVM), a novel intensive therapy mechanical ventilator designed for rapid, large-scale, low-cost production for the COVID-19 pandemic. Free of moving mechanical parts and requiring only a source of compressed oxygen and medical air to operate, the MVM is designed to support the long-term invasive ventilation often required for COVID-19 patients and operates in pressure-regulated ventilation modes, which minimize the risk of furthering lung trauma. The MVM was extensively tested against ISO standards in the laboratory using a breathing simulator, with good agreement between input and measured breathing parameters and performing correctly in response to fault conditions and stability tests. The MVM has obtained Emergency Use Authorization by U.S. Food and Drug Administration (FDA) for use in healthcare settings during the COVID-19 pandemic and Health Canada Medical Device Authorization for Importation or Sale, under Interim Order for Use in Relation to COVID-19. Following these certifications, mass production is ongoing and distribution is under way in several countries. The MVM was designed, tested, prepared for certification, and mass produced in the space of a few months by a unique collaboration of respiratory healthcare professionals and experimental physicists, working with industrial partners, and is an excellent ventilator candidate for this pandemic anywhere in the world.

No evidence of EMAST in whole genome sequencing data from 248 colorectal cancers

Microsatellite instability (MSI) is caused by defective DNA mismatch repair (MMR), and manifests as accumulation of small insertions and deletions (indels) in short tandem repeats of the genome. Another form of repeat instability, elevated microsatellite alterations at selected tetranucleotide repeats (EMAST), has been suggested to occur in 50% to 60% of colorectal cancer (CRC), of which approximately one quarter are accounted for by MSI. Unlike for MSI, the criteria for defining EMAST is not consensual. EMAST CRCs have been suggested to form a distinct subset of CRCs that has been linked to a higher tumor stage, chronic inflammation, and poor prognosis. EMAST CRCs not exhibiting MSI have been proposed to show instability of di- and trinucleotide repeats in addition to tetranucleotide repeats, but lack instability of mononucleotide repeats. However, previous studies on EMAST have been based on targeted analysis of small sets of marker repeats, often in relatively few samples. To gain insight into tetranucleotide instability on a genome-wide level, we utilized whole genome sequencing data from 227 microsatellite stable (MSS) CRCs, 18 MSI CRCs, 3 POLE-mutated CRCs, and their corresponding normal samples. As expected, we observed tetranucleotide instability in all MSI CRCs, accompanied by instability of mono-, di-, and trinucleotide repeats. Among MSS CRCs, some tumors displayed more microsatellite mutations than others as a continuum, and no distinct subset of tumors with the previously proposed molecular characters of EMAST could be observed. Our results suggest that tetranucleotide repeat mutations in non-MSI CRCs represent stochastic mutation events rather than define a distinct CRC subclass.

The Operative Incidence of Syndactyly in Northern Ireland. A 10-Year Review

BACKGROUND

Syndactyly is a common congenital condition that can present sporadically or in relation to an underlying genetic condition. Little contemporary published data exists detailing specific rates of presentation and surgical intervention, especially in Western European population. This is the first published review of operative intervention rates for the condition over time in Northern Ireland.

METHODS

A ten-year retrospective review of electronic operative records from January 2007 - October 2017 was carried out within Northern Ireland's regional tertiary centre Royal Belfast Hospital for Sick Children (RBHSC). All congenital hand surgery in the country was performed here during the period reviewed, by a single surgeon. Patient age at surgical intervention, their sex, digits involved and clinical grade of syndactyly was recorded.

RESULTS

One hundred and twenty four cases were returned following the review. On individual analysis 22 cases were excluded as they were not primary congenital syndactyly. The remaining 102 cases were all Caucasian. Six cases were toe syndactyly while 96 cases involved the upper limb digits. The group consisted of 70 males and 32 female infants. Age range at time of surgical intervention was 8 months to 14 years with a median age of 26 months. For clinical grade of upper limb syndactyly; 35 cases in the data set were classed as simple incomplete, 34 cases as simple complete, 17 as complex and 5 cases as complicated syndactyly. The remaining 5 cases lacked clear documentation. The most common site of syndactyly was between the ring and middle finger (40/102). Annual frequency of operative intervention has trended upwards in the period studied.

CONCLUSION

This case review adds epidemiological data on the operative incidence of syndactyly cases in Northern Ireland - a relatively isolated genetic population. Overall rates of incidence have increased over the past 10 years. It remains unclear if this is due to new environmental influences on the developing population or increased referral for surgical intervention over time.Levels of evidence - IV (Case Series).

Erratum: Fast Domain Wall Motion Governed by Topology and Œrsted Fields in Cylindrical Magnetic Nanowires [Phys. Rev. Lett. 123, 217201 (2019)]

This corrects the article DOI: 10.1103/PhysRevLett.123.217201.

Developing an interprofessional transition course to improve team-based HIV care for sub-Saharan Africa

BACKGROUND

With funding from the United States Health Resources Service Administration (HRSA), a consortium of health professional training institutions from Africa developed HIV-specific, interprofessional, team-based educational resources to better support trainees during the transition period between pre-service training and professional practice.

METHODS

Ten faculty members representing nine medical and nursing schools in sub-Saharan Africa (SSA) developed a training package of modules focused on core clinical, public health, interprofessional education (IPE), and quality improvement (QI) domains related to HIV service delivery. Curriculum development was informed by a rapid needs assessment of existing tools and future needs for HIV education across 27 SSA health professions training institutions. A total of 17 modules were developed, targeted at newly qualified health care professionals to be taught in a series of two-day workshops meant to complement existing institution specific HIV-curricula.

RESULTS

Between April and July 2019, a comprehensive case-based HIV training package was developed to support trainees in transition from pre-service training to independent professional practice. Each module, addressing different elements of interprofessional practice, was intended to be delivered in an interprofessional format. Thus far, 70 health professions training institutions in 14 countries have implemented the program; 547 educators facilitated STRIPE workshops, with a total of 5027 learners trained between September 2019 and September 2020.

CONCLUSIONS

To our knowledge this is the first IPE HIV-specific curriculum explicitly focused on enhancing the quality of training provided to graduating health care professionals working in SSA. The collaborative, cross-institutional, interprofessional approach to curriculum development provides a benchmark for how best-practice approaches to education can be disseminated in SSA.

Ensemble Random Forests as a tool for modeling rare occurrences

Relative to target species, priority conservation species occur rarely in fishery interactions, resulting in imbalanced, overdispersed data. We present Ensemble Random Forests (ERFs) as an intuitive extension of the Random Forest algorithm to handle rare event bias. Each Random Forest receives individual stratified randomly sampled training/test sets, then down-samples the majority class for each decision tree. Results are averaged across Random Forests to generate an ensemble prediction. Through simulation, we show that ERFs outperform Random Forest with and without down-sampling, as well as with the synthetic minority over-sampling technique, for highly class imbalanced to balanced datasets. Spatial covariance greatly impacts ERFs’ perceived performance, as shown through simulation and case studies. In case studies from the Hawaii deep-set longline fishery, giant manta ray Mobula birostris syn. Manta birostris and scalloped hammerhead Sphyrna lewini presence had high spatial covariance and high model test performance, while false killer whale Pseudorca crassidens had low spatial covariance and low model test performance. Overall, we find ERFs have 4 advantages: (1) reduced successive partitioning effects; (2) prediction uncertainty propagation; (3) better accounting for interacting covariates through balancing; and (4) minimization of false positives, as the majority of Random Forests within the ensemble vote correctly. As ERFs can readily mitigate rare event bias without requiring large presence sample sizes or imparting considerable balancing bias, they are likely to be a valuable tool in bycatch and species distribution modeling, as well as spatial conservation planning, especially for protected species where presence can be rare.

High conservation combined with high plasticity: genomics and evolution of Borrelia bavariensis

Background

Borrelia bavariensis is one of the agents of Lyme Borreliosis (or Lyme disease) in Eurasia. The genome of the Borrelia burgdorferi sensu lato species complex, that includes B. bavariensis, is known to be very complex and fragmented making the assembly of whole genomes with next-generation sequencing data a challenge.

Results

We present a genome reconstruction for 33 B. bavariensis isolates from Eurasia based on long-read (Pacific Bioscience, for three isolates) and short-read (Illumina) data. We show that the combination of both sequencing techniques allows proper genome reconstruction of all plasmids in most cases but use of a very close reference is necessary when only short-read sequencing data is available. B. bavariensis genomes combine a high degree of genetic conservation with high plasticity: all isolates share the main chromosome and five plasmids, but the repertoire of other plasmids is highly variable. In addition to plasmid losses and gains through horizontal transfer, we also observe several fusions between plasmids. Although European isolates of B. bavariensis have little diversity in genome content, there is some geographic structure to this variation. In contrast, each Asian isolate has a unique plasmid repertoire and we observe no geographically based differences between Japanese and Russian isolates. Comparing the genomes of Asian and European populations of B. bavariensis suggests that some genes which are markedly different between the two populations may be good candidates for adaptation to the tick vector, (Ixodes ricinus in Europe and I. persulcatus in Asia).

Conclusions

We present the characterization of genomes of a large sample of B. bavariensis isolates and show that their plasmid content is highly variable. This study opens the way for genomic studies seeking to understand host and vector adaptation as well as human pathogenicity in Eurasian Lyme Borreliosis agents.

The Prevalence of Children and Adolescents at Risk for Avoidant Restrictive Food Intake Disorder in a Pediatric and Adolescent Gynecology Clinic

STUDY OBJECTIVE

The purpose of this study was to determine the prevalence of child and adolescent females at risk for Avoidant Restrictive Food Intake Disorder (ARFID) in a tertiary care pediatric and adolescent gynecology (PAG) clinic.

DESIGN

Cross-sectional study design.

SETTING

Tertiary care PAG clinic at the Hospital for Sick Children in Toronto, Ontario, Canada.

PARTICIPANTS

Females between 8 and 18 years of age presenting to the tertiary care PAG clinic.

INTERVENTION

Between October 2017 and April 2019, eligible patients completed a 3-part, self-administered questionnaire that included demographic and anthropometric information, reason(s) for referral, medical history, menstrual history and function, and the Eating Disorders in Youth-Questionnaire (EDY-Q).

MAIN OUTCOME MEASURES

The main outcome measure was the prevalence of child and adolescent females who were identified to be at risk for ARFID in a tertiary care PAG clinic.

RESULTS

Seven (3.7%) of 190 patients were identified to be at risk for ARFID based on the EDY-Q. All patients at risk for ARFID had a significantly lower body mass index (17.4 ± 1.6 vs 24.4 ± 6.7, P < .001) than patients not at risk for ARFID.

CONCLUSIONS

This study demonstrated that 3.7% of patients seeking treatment in a tertiary care PAG clinic were identified to be at risk for ARFID. Clinicians in tertiary care PAG clinics can play a pivotal role in the identification and referral of children and adolescents at risk for ARFID. Referral to the patients' primary care physician or to an eating disorder program is important so as not to delay the diagnosis and treatment.

GDM Acts as a Moderator Between Pregnancy BMI and Metabolic Syndrome Severity Score

Objectives

Overweight or obesity is a risk factor for Metabolic Syndrome (MetS), as is a history of gestational diabetes (GDM). Many women with GDM are overweight in pregnancy, and so it is difficult to disentangle the effects of pregnancy BMI (pregBMI) from GDM. The purpose of this study was to examine whether GDM moderates the association between pregBMI and MetS severity Z-scores 4–10 years following pregnancy. We hypothesized that the positive association between pregBMI and MetS Z-scores would be stronger in women with GDM compared to women without GDM.

Methods

Data for this analysis were drawn from N = 179 women enrolled in a cross-sectional study examining obesity and cardiometabolic disease risk in mother-child dyads. Women with GDM were oversampled relative to the prevalence in the general population. Women were eligible for inclusion if they delivered a healthy term infant 4–10 years prior to enrolling in this study, and were aged 20–36 years at delivery. PregBMI was calculated using measured body weight recorded in the medical record from their first prenatal visit. GDM status was retrieved from medical records. Waist circumference and blood pressure were measured using standard clinical procedures, and a fasting blood draw was obtained to measure glucose, triglycerides, and HDL-cholesterol. MetS Z-scores were measured using the method of Gurka and DeBoer (Metabolism, 63(2), 218–225; Clinical and Translational Science – Informatics and Technology group).

Results

The association between pregBMI and MetS was significantly modified by GDM status (P &lt; 0.001) such that pregBMI was more strongly associated with MetS in women with GDM. Among women with a pregBMI of 30.9 (the sample mean), the mean difference in MetS Z-scores between conditions (those with or without GDM) is 0.65 SD units, a difference that grows larger at higher levels of pregBMI.

Conclusions

These results suggest greater MetS severity in women with GDM and a high pregBMI compared to women with a high pregBMI but without GDM. Future research should prospectively examine whether MetS is present in early pregnancy for women who develop GDM, and whether there are other modifiable factors that could reduce the risk for MetS among women with overweight or obesity in pregnancy.

Funding Sources

American Heart Association, NHLBI T32 training grant.