Using Serenity Rooms and Similar Tools to Improve the Workplace during COVID-19: A Rapid Review

This manuscript examines using serenity rooms and similar tools to improve the workplace during COVID-19 for nurses and other practitioners. A rapid review of the literature was conducted and completed from four different databases, including PubMed, CINAHL, Science Direct, and Academic Search Complete. The literature review was completed with the use of a single-string Boolean search to maximize the number of articles returned. The resulting 14 germane articles yielded six facilitator themes and four barrier themes. Facilitator themes included: benefits, assistive adjuncts, places of relaxation, leadership required, availability, and other effects. Barrier themes included: lacking leadership, concerns regarding lack of space, holistic concerns, and negative perceptions. There is a significant lack of research in the literature in this area. Most of the literature reviewed showed widely positive results for institutions that utilized serenity rooms or similar tools for decreasing nurse and practitioner stress and burnout. The use of these tools improved nurse and practitioner compassion, retention, and resiliency.

Comparative productive performance of cows born through embryo transfer, artificial insemination and natural mating in dairy and dual-purpose herds raised in tropical conditions

A populational, observational and longitudinal-retrospective study with records of 28 dairy specialized and dual-purpose farms, was carried out to compare the productive performance of cows born by embryo transfer (ET), artificial insemination (AI), and natural mating (NM), using the database of Centro Regional de Investigación para la Producción Animal Sostenible (CRIPAS) of cattle herds in Costa Rica. Herds (system × altitude), conception method (ET, AI and NM), genetic background (DSpB: specialized dairy breeds (Bos taurus) and crosses, GYR×HOL: Gyr × Holstein Crossbred and DSpB×BI: crosses between dairy breeds and Bos indicus), year of birth (or at calving), lactation number and days in milk were evaluated for the productive parameters age at first calving (AFC), calving to conception interval (CCI) and lactation milk yield (LMY) using a GLIMMIX procedure on SAS. The AFC, CCI, and LMY were affected (P<0.0001) by all factors considered in each parameter. ET has lower (P<0.0001) AFC in months (33.1) than AI (35.2) and NM (36.44). NM had lower (P=0.004) CCI (110 d) than AI or ET (121 d) values which were similar (P>0.05). The higher LMY (P<0.0001) was observed in ET (4140 kg), compared to AI (3706 kg) and NM (3595 kg). There was no difference between AI and NM. In conclusion, the method of conception in calves affected their future reproduction and production during puberty, postpartum, and lactation. The effects on management decisions will require a rigorous economical study to discern whether ET would be a cost-effective alternative to AI or NM.

Intimate partner violence and post-traumatic stress disorder

Introduction

Post-traumatic stress disorder (PTSD), is a Mental Health condition due to a traumatic experience. There are four types of Gender Violence in Latin America: physical, sexual, psychological or patrimonial violence, when it occurs between intimate partners it is called intimate partner violence (IPV). PTSD is highly associated with IPV.

Objectives

Determine the statistical index of IPV and PTSD in women and men in Guayaquil-Ecuador.

Methods

We carried out a descriptive cross-sectional study, the sample was collected at the Florida Prosecutor’s Office in Guayaquil-Ecuador by UCSG medical students in 2018. The sample was 239 individuals, 195 women, 44 men. Individuals were separated into groups by gender, marital status, children, age, habits and PTSD. We applied Beck test for Depression, Davidson and DSM-5 for PTSD.

Results

In this study we observe a male population suffering from IPV. Complaints of IPV 195 women (81.59%), 44 men (18.41%). PTSD positive 159 women (81.96%), men 35 (18.04%). More prevalent in age ranges 25-34. PTSD with children 147 (76%) and without children 47 (24%).

Conclusions

Factors such as being a woman, having children and younger ages are linked in this study as predisposing to suffer from IPV and PTSD. We highlight a male population that reports suffering from IPV despite the lack of support, especially in Latin America. It is worth mentioning that the final consequence in many cases is femicide and homicide. Although IPV is serious and frequent, Medical professionals still do not focus on IPV diagnosis, therefore affected individuals don t receive support.

Disclosure

No significant relationships.

Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer

BACKGROUND

Cancer-specific survival for patients with clinical stage I (CSI) germ cell testicular cancer (GCTC) is outstanding after inguinal orchidectomy regardless the treatment utilized. This study evaluated whether active surveillance (AS) of such patients yielded similar health outcomes to other therapeutic strategies such as adjuvant chemotherapy, radiotherapy or primary retroperitoneal lymphadenectomy as described in the literature.

PATIENTS AND METHODS

Patients with CSI GCTC were screened between January 2012 and December 2016. Patients had previously undergone inguinal orchidectomy as the primary treatment and chosen AS as their preferred management strategy after receiving information about all available strategies.

RESULTS

Out of 91 patients screened, 82 patients selected AS as their preferred management strategy. Relapse rate in the overall population was 20% (95% CI 12-30) and median time to relapse was 11.5 months (range 1.0-35.0). In patients with seminomatous tumors, relapse rate decreased to 13% and median time to relapse was 13 months; whereas in patients with non-seminomatous tumors, relapse rate was 33% (IA) or 29% (IB) and median time to relapse was 12 months in stage IA and 4.5 months in stage IB patients. All relapses were rescued with three or four cycles of chemotherapy and two also required a retroperitoneal lymphadenectomy. All patients are currently alive and free of disease.

CONCLUSIONS

The clinical outcomes of patients with CSI GCTC managed by AS in this series were excellent. This strategy limited the administration of active treatments specifically to the minority of patients who relapsed without compromising performance.

Classification of glucose records from patients at diabetes risk using a combined permutation entropy algorithm

BACKGROUND AND OBJECTIVES

The adoption in clinical practice of electronic portable blood or interstitial glucose monitors has enabled the collection, storage, and sharing of massive amounts of glucose level readings. This availability of data opened the door to the application of a multitude of mathematical methods to extract clinical information not discernible with conventional visual inspection. The objective of this study is to assess the capability of Permutation Entropy (PE) to find differences between glucose records of healthy and potentially diabetic subjects.

METHODS

PE is a mathematical method based on the relative frequency analysis of ordinal patterns in time series that has gained a lot of attention in the last years due to its simplicity, robustness, and performance. We study in this paper the applicability of this method to glucose records of subjects at risk of diabetes in order to assess the predictability value of this metric in this context.

RESULTS

PE, along with some of its derivatives, was able to find significant differences between diabetic and non-diabetic patients from records acquired up to 3 years before the diagnosis. The quantitative results for PE were 3.5878 ± 0.3916 for the nondiabetic class, and 3.1564 ± 0.4166 for the diabetic class. With a classification accuracy higher than 70%, and by means of a Cox regression model, PE demonstrated that it is a very promising candidate as a risk stratification tool for continuous glucose monitoring.

CONCLUSION

PE can be considered as a prospective tool for the early diagnosis of the glucoregulatory system.

Size-normalized Robustness of Dpp Gradient in Drosophila Wing Imaginal Disc

Exogenous environmental changes are known to affect the intrinsic characteristics of biological organizms. For instance, the synthesis rate of the morphogen decapentaplegic (Dpp) in a Drosophila wing imaginal disc has been found to double with an increase of 5.9°C in ambient temprerature. If not compensated, such a change would alter the signaling Dpp gradient significantly and thereby the development of thewing imaginal disc. To learn how flies continue to develop "normally" under such an exogenous change, we formulate in this paper a spatially two-dimensional reaction-diffusion system of partial differential equations (PDE) that accounts for the biological processes at work in the Drosophila wing disc essential for the formation of signaling Dpp gradient. By way of this PDE model, we investigate the effect of the apical-basal thickness and antero-posterior span of the wing on the shape of signaling gradients and the robustness of wing development in an altered environment (including an enhanced morphogen synthesis rate). Our principal result is a delineation of the role of wing disc size change in maintaining the magnitude and shape of the signaling Dpp gradient. The result provides a theoretical basis for the observed robustness of wing development, preserving relative but not absolute tissue pattern, when the morphogen synthesis rate is significantly altered. A similar robustness considerqation for simultaneous changes of multiple intrinsic system characteristics is also discussed briefly.

[Abdominal manifestations in von Hippel Lindau disease in a group of 7 patients and literature review.]

OBJECTIVE

To evaluate the radiologic findings (ultrasound, computed tomography and magnetic resonance) of the abdominal manifestations in von Hippel-Lindau disease (VHL).

MATERIAL AND METHODS

We retrospectively reviewed the imaging studies performed to seven patients diagnosed of VHL in our hospital.

RESULTS

In all exmined patients, abdominal involvement was found. All of them showed renal affectation: cysts or renal cell carcinoma. Pancreatic involvement was found in the majority of patients: simple cysts, serous cystadenomas and one neuroendocrine tumor. One patient had a papillary cystadenoma of the broad ligament.

Correlation Between the Radiologic and Histologic Size of Hepatocellular Carcinoma in Patients Eligible for Liver Transplantation

Hepatocellular carcinoma is the most prevalent primary hepatic tumor. Early diagnosis and staging is of paramount importance to obtain favorable survivals. So far, there is no general agreement on the most appropriate imaging technique to detect the tumor for correlation between pretransplant radiologic and pathologic size of the tumor, which remains inadequate. With greater clinical experience and increasing accuracy of imaging methods, magnetic resonance (MR) appears to be the most accurate method, yielding a correlation in 67% of cases.

Effect of neosporosis on productive and reproductive performance of dairy cattle in Costa Rica

A cross-sectional study was conducted to assess the effect of neosporosis on productive and reproductive parameters in dairy cows. Cows (n=2743) from 94 farms located in the most important dairy areas in Costa Rica were used in the study. The size of the herds ranged from 32 to 379 females (mean=110, median=125). An indirect ELISA was used to determine the serostatus of the cows towards Neospora caninum. The effect of neosporosis on milk production was analysed by a mixed linear model. In addition, the effects on calving interval (days) and calving to conception interval (days) were analysed by survival analysis. The risk of abortion in relation to N. caninum serostatus was assessed by logistic regression, with herd as a random effect. Overall, 1185 of 2743 cows (43.3%) were seropositive for Neospora. Eighty-nine of 94 (94.7%) farms were classified as Neospora-seropositive. It was estimated that cows seronegative to Neospora produced an additional 84.7L of milk (P=0.6). Serostatus did not have a significant effect on the length of the calving interval in the Cox proportional hazard survival analysis (Hazard ratio=1.2, 95% CI: 0.9, 1.4). The logistic regression model had a weak positive association between serostatus and abortion (OR 1.7, 95% CI: 0.8, 3.9), but did not show a strong association between serostatus and the number of services per conception (OR=0.95, 95% CI: 0.7, 1.3). In conclusion, there were no significant effects of Neospora serostatus on production and reproductive performance in this study.

Aggregation of a Distributed Source in Morphogen Gradient Formation

In the development of a biological entity, ligands (such as Decapentaplegic (Dpp) along the anterior-posterior axis of the Drosophila wing imaginal disc) are synthesized at a localized source and transported away from the source for binding with cell surface receptors to form concentration gradients of ligand-receptor complexes for cell signaling. Generally speaking, activities such as diffusion and reversible binding with degradable receptors also take place in the region of ligand production. The effects of such morphogen activities in the region of localized distributed ligand source on the ligand-receptor concentration gradient in the entire biological entity have been modeled and analyzed as System F in [1]. In this paper, we deduce from System F, a related end source model (System A) in which the effects of the distributed ligand source is replaced by an idealized point stimulus at the border between the (posterior) chamber and the ligand production region that simulates the average effects of the ligand activities in the production zone. This aggregated end source model is shown to adequately reproduce the significant implications of System F and to contain the corresponding ad hoc point source model, System R of [2], as a special case. Because of its simpler mathematical structure and the absence of any limitation on the ligand synthesis rate for the existence of steady-state gradients, System A type models are expected to be used widely. An example of such application is the recent study of the inhibiting effects of the formation of nonsignaling ligand-nonreceptor complexes [3].

Genetic comparison of breeding schemes based on semen importation and local breeding schemes: framework and application to Costa Rica

Local breeding schemes for Holstein cattle of Costa Rica were compared with the current practice based on continuous semen importation (SI) by deterministic simulation. Comparison was made on the basis of genetic response and correlation between breeding goals. A local breeding goal was defined on the basis of prevailing production circumstances and compared against a typical breeding goal for an exporting country. Differences in genetic response were <3%, and the correlation between breeding goals was 0.99. Therefore, difference between breeding objectives proved negligible. For the evaluation of genetic response, the current scheme based on SI was evaluated against a progeny testing (PT) scheme and a closed nucleus (CN) breeding scheme, both local. Selection intensities and accuracy of selection were defined according to current population size and reproduction efficiency parameters. When genotype x environment interaction (G x E) was ignored, SI was the strategy with the highest genetic response: 5.0% above the CN breeding scheme and 33.2% above PT. A correlation between breeding values in both countries lower than one was assumed to assess the effect of G x E. This resulted in permanent effects on the relative efficiencies of breeding strategies because of the reduction in the rate of genetic response when SI was used. When the genetic correlation was assumed equal to 0.75, the genetic response achieved with SI was reduced at the same level as local PT. When an initial difference in average genetic merit of the populations was assumed, this only had a temporal effect on the relative ranking of strategies, which is reverted after some years of selection because the rate of change in genetic responses remains unchanged. Given that the actual levels of genetic correlation between countries may be around 0.60, it was concluded that a local breeding scheme based on a nucleus herd could provide better results than the current strategy based on SI.

Modeling extended lactations of dairy cows

Nine mathematical models were compared for their ability to predict daily milk yields (n = 294,986) in standard 305-d and extended lactations of dairy cows of Costa Rica. Lactations were classified by parity (first and later), lactation length (9 to 10, 11 to 12, 13 to 14, 15 to 16, and 16 to 17 mo), and calving to conception interval (1 to 2, 3 to 4, 5 to 6, 7 to 8, and 9 to 10 mo). Of the nine models, the diphasic model and lactation persistency model resulted in the best goodness of fit as measured by adjusted coefficient of determination, residual standard deviation, and Durbin-Watson coefficient. All other models showed less accuracy and positively correlated residuals. In extended lactations, models were also fitted using only test-day records before 305 d, which resulted in a different ranking. The diphasic model showed the best prediction of milk yield in standard and extended lactations. We concluded that the diphasic model provided accurate estimates of milk yield for standard and extended lactations. Interpretation of parameters deserves further attention because of the large variation observed. As expected, the calving to conception interval was found to have a negative effect on milk yield for cows with a standard lactation length. In extended lactations, these negative effects of pregnancy on milk yield were not observed.

Event-time analysis of reproductive traits of dairy heifers

Data on the reproductive traits of dairy heifers were analyzed using event-time techniques. Traits analyzed were age at first calving (n = 4631), days to first breeding, and days open (n = 1992) during the first lactation. A proportional hazard model was used that included fixed effects of herd-year, year-season, breed type, herd weight, and heifer weight. Body weights were recorded at 390 d of age, on average. The model for days open and days to first breeding included two additional fixed effects of herd and heifer milk yield at 100 d. A significant effect of heifer weight category on age at first calving was found. The chance of calving was consistently higher for herds and heifers with higher body weight at 390 d and decreased linearly from the top to the lowest quartiles. The effects of herd weight category on days to first breeding and days open were significant. Heifers in herds with a higher average body weight were less likely to be bred, and heifers in herds with lower average body weight were less likely to get pregnant. The effect of heifer weight category on days to first breeding or days open was not significant. The effect of herd milk yield on days to first breeding was significant. Heifers in herds with lower yield were more likely to be bred. The effect of heifer milk yield category on days to first breeding and days open was significant, but no linear trend was found for the estimates of the hazard ratios. The chance of a heifer being bred and becoming pregnant was similar among the first three quartiles and was lower for heifers in the lowest quartile. The probability of a heifer reaching a first calving can be improved by increasing the body weight at 390 d. Body weight at 390 d did not appear to have a large effect on reproductive performance after first calving. High milk yield appears not to have a large negative effect on days open, at least for the milk yield levels analyzed in this study.

Analysis of test day yield data of Costa Rican dairy cattle

Estimates of variance components for test day records in an animal model that considered multiple traits over multiple lactations were calculated using REML methodology. Test day records were classified into 11 periods within first and later lactations. Missing ancestors in the relationship matrix were classified in genetic groups. Data were collected from Costa Rican dairy farms. Estimates of components for total and additive genetic variance were clearly heterogeneous during the lactation. Heritabilities for traits in later parities were slightly higher than those for traits in first parity. Heritabilities were highest for records of midlactation. Phenotypic and genetic correlations for adjacent test days were close to 1. Phenotypic correlations were lower than genetic correlations. Heterogeneity of variances during the lactation suggests the adequacy of the multiple-trait test day model to describe milk yield during the lactation. When missing ancestors were allocated to a single base population instead of genetic groups, the estimates of residual variance were lower, and the estimates of genetic variance and genetic correlations were higher. When standardized records were used instead of actual test day records, the estimates of residual and total variance were lower, and the estimates of genetic variance were higher. Consequently, estimates of heritability and genetic correlations were also higher. Use of standardized data obtained by interpolation procedures is not advised for estimation of genetic variance components in a test day model.

[Malformations of Wolffian duct derived male genital organs (epididymis, vas deferens, seminal vesicules, ejaculatory ducts)]

OBJECTIVES

To analyse embryological phenomena, in order to define a practical approach to management.

METHODS

The authors reviewed the files of eight boys with an abnormality of Wolffian duct derived genital organs, consisting of three cases of vas deferens agenesis, two of which were accompanied by homolateral renal agenesis, one case of ectopic vas deferens with contralateral renal agenesis, three cases of duplicated vas deferens and one congenital seminal vesicle cyst with renal agenesis.

DISCUSSION

Congenital malformations of the epididymis consist of cysts and agenesis or partial atresia. Cysts essentially raise a problem of differential diagnosis. Treatment is only required in the case of severe discomfort. Vas deferens agenesis is the commonest lesion, an incidental finding in children. An experimental treatment is proposed in adults. Duplications, interdeferential communications and deferentomegaly are much rarer lesions. Seminal vesicle cysts are well visualized by transrectal ultrasonography and should be treated surgically. Lastly, ejaculatory ducts may present urethroseminal reflux or may be ectopic.

CONCLUSION

The possibility of absent or ectopic vas deferens should be considered in the case of unilateral renal agenesis. Vas deferens agenesis justifies examination of the contralateral side and investigation to exclude renal agenesis. Congenital cysts of the epididymis only require surgery when they are symptomatic. The presence of ipsilateral renal agenesis should be investigated in the case of cystic dilatation of the seminal vesicle.

Stones in the urinary bladder in children and young adults

Bladder stones were diagnosed in 22 children and young adults at The Children's Hospital, Boston, from 1969 to 1985. One half of the patients were less than 12 years old (mean, 11.9 years). One or more lithogenic factors were implicated in all but two. The most common causes were the presence of an intravesical foreign body, infection with Proteus (a urea-splitting organism), exstrophy of the bladder, and the presence of intestinal mucosa in the urinary tract. The radiologic features of the stones were not specific, and no special techniques were needed to identify them. Heightened awareness of patients at risk will lead to prompt diagnosis and treatment.

The coexistence of congenital megacalyces and primary megaureter

Congenital megacalyces is a rare developmental condition of the kidney consisting of hypoplasia of the medullary pyramids and dilatation of the calyces. There is no obstruction. Primary megaureter is a form of obstructive uropathy in which there is an obstructing juxtavesical segment of ureter that is normal in caliber but that is aperistaltic. These conditions were found to occur simultaneously in the same patient six times during the past 10 years. Recognition of this rare coexistence is important so that unnecessary surgery can be avoided.