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Objectives Our institution was the victim of a cyberattack that necessitated use of manual laboratory systems for more than 25 days. These manual processes had to be created not only to enable us to process our case volume without bottlenecks but also to maintain patient safety and allow for billing. Methods Our laboratory needed to create a safe reporting process to ensure ongoing patient safety and error reduction during the downtime. Additionally, we needed to ensure the ability to bill for performed tests in some areas of the lab and maintain compliance with regulatory policies. Results Amendment rates in our system were higher than before the attack, but no patient harm was observed. Intraoperative assessments declined, but high-acuity cases continued with a discrepancy rate comparable with the normal state. Many hours and resources (human and otherwise) were necessary to reconcile the work done to bill for services, but we were able to capture revenue through careful planning. Conclusions This article records the challenges we faced and the successes we achieved in maintaining compliance and a low error rate in the face of manual processes, the steps necessary to bring the cases into the newly restored electronic health record, and how we billed for the services we rendered.

This paper provides an analysis of interviews with seven faculty members who engaged in creating Open textbooks funded by government grants at a university in Canada in 2018. Using four values—access and equity, community and connection, agency and ownership, and risk and responsibility—identified by Sinkinson (2018), McAndrew (2018), and Keyek-Fransen (2018), we traced the ways in which university faculty members’ understanding of Open changed through the process of Open Educational Resource creation. As a teaching support-focused unit, we explore ways to provide our faculty and instructors with meaningful opportunities to develop their Open pedagogy. These findings reconceive the way that Open Educational Practice can be promoted at our University and others. Instead of focusing solely on OER creation, our faculty started engaging in thinking through the different conceptions of Open educational practice and identifying which concepts resonated with them. By reframing the ways in which faculty thought about Open Educational Practices, we have been better able to address the ways in which we support them.

Environmental remediation of polluted sites in developing communities often faces difficulties due to the misalignment of project objectives with the needs and interests of local communities, establishment of unrealistic expectations for the outcome of the project, and failure to account for the available resources in the community itself. Remediation decisions favor technical data and technical solutions as the main means of determining remediation options, requiring significant investment and local capacity that are often not found in developing communities. Often these systems fail to account for the social aspects in environmental management and remediation. In contrast, new approaches in local knowledge-based solutions focus on pre-existing environmental management initiatives to establish objectives that are meaningful to the community itself. “Positive deviance” – or the idea that there are solutions already in communities that are successful at addressing challenges despite the barriers that a community faces – are often overlooked during project design and implementation. Identifying examples of positive deviance and working with community members who are well versed in local challenges, available resources, and local capacity presents opportunities for community members to establish project objectives and provides the foundation for future environmental management projects in the area. We present a case study of artisanal and small-scale gold mining (ASGM) in the Andes municipality, Antioquia, Colombia and local initiatives to overcome community-identified environmental pollutants. Through a series of semi-structured interviews, surveys, and site visits, we identified community perception of environmental pollutants, management techniques for mining waste, and grassroots initiatives that were locally developed to address them. Through key communication and interaction between innovators with identified positive deviance projects, technical experts, and other miners facing similar challenges, innovative projects that account for the social, political, and economic realities of a developing community can become widespread, leading to improved environmental and social conditions.

Pollution remediation decisions in developing communities are often made with limited technical data and stakeholder engagement. Local knowledge of contamination is oftentimes neglected, resulting in efforts that fail to align with community objectives. In this work, we propose a new approach for incorporating local knowledge on contamination into remediation efforts, resulting in a community-informed conceptual site model framework for pollution remediation. This framework uses qualitative and quantitative social science methods to develop a holistic view of contamination as defined by the community, pairing social knowledge with existing technical information about a site. An example of the application of this framework is provided from a field study conducted in a mercury-contaminated artisanal and small-scale gold mining community in Andes, Colombia. We conducted qualitative unstructured and semi-structured interviews and surveys to elicit local knowledge on mercury contamination. We combined this stakeholder input with limited scientific published literature on mercury contamination in artisanal mining communities to develop different conceptual site models that vary based on the level and type of stakeholder input. Our findings demonstrate how local knowledge on contamination varies due to contextual factors within the community, revealed through the engagement. This work also demonstrates how the new framework can be utilized by environmental practitioners to define the needs, wants, and priorities of stakeholder groups throughout a remediation project, ensuring maximum participation in solution development.

Environmental risk mitigation strategies employed in developing communities to address mercury pollution from artisanal and small-scale gold mining (ASGM) have largely failed to meet community needs, resulting in their abandonment. In contrast, the water and wastewater treatment sector has gained more traction, introducing sustainable and community supported water treatment strategies. This paper discusses why initiatives in water and wastewater treatment in developing communities are succeeding while initiatives in ASGM environmental risk mitigation are falling short. Selected case studies illustrate that water and wastewater treatment project success is contingent on the inclusion of a fully comprehensive approach that considers the socio-economic and ecological context of communities and individuals along with behavior change interventions. These elements of successful WASH projects were then applied to past ASGM environmental projects to determine their applicability to the sector. By adopting the core traits of successful water and wastewater treatment projects in developing communities, a framework can be developed for ASGM projects that, when applied correctly, could lead to measurable impact and long-term sustainability.

Objective: The objective of this study was to assess the ability of optical coherence tomography to detect clinical and subclinical actinic keratoses confirmed by histopathology. The efficacy of ingenol mebutate treatment of actinic keratosis was also evaluated using optical coherence tomography, and correlation of treatment efficacy with severity of local skin reactions was determined. Design: Single-arm, open-label, split-face study. Setting: Hospital outpatient clinic. Participants: Male subjects (N=30) with seven actinic keratoses. Measurements: A suspected actinic keratosis and the normal-appearing, perilesional skin were imaged, biopsied for histopathologic analysis, and the results compared with the clinical and a blinded optical coherence tomography diagnosis. Treatment with ingenol mebutate gel 0.015% was randomly administered to three clinically suspected actinic keratoses and the perilesional skin; three additional, suspected actinic keratoses lesions and perilesional areas were left untreated. Clinical and optical coherence tomography images were obtained for all lesions. Severity of local skin reactions was recorded to evaluate the relationship between local skin reaction and treatment effect. Results: Optical coherence tomography analysis had a 100-percent (28/28) correlation with the clinical diagnosis of actinic keratosis and detected 16 of 22 (73%) histopathologically confirmed subclinical lesions from perilesional skin sites. By optical coherence tomography assessment, the clearance rate for clinically observed lesions was 76 percent for ingenol mebutate-treated areas versus 11 percent for untreated areas; the clearance rate for treated subclinical lesions was 88 percent versus 43 percent for untreated areas. Clearance rates did not vary with the severity of the local response. Conclusion: Optical coherence tomography is effective at detecting clinical and subclinical actinic keratoses and monitoring their response to treatment.

Joanna Emilio,1 Michelle Schwartz,2–4 Eleanor Feldman,2–4 Amy Kalowitz Bieber,2–4 Amanda Bienenfeld,2–4 Min-Kyung Jung,1 Daniel M Siegel,2,3 Orit Markowitz2–4 1Department of Dermatology, NYIT College of Osteopathic Medicine, Old Westbury, 2Department of Dermatology, SUNY Downstate Medical Center, 3Department of Dermatology, NY Harbor Healthcare System, Brooklyn, 4Department of Dermatology, Mount Sinai Medical Center, New York, NY, USA Abstract: Actinic keratoses (AKs), especially on areas of the face, have a negative impact on a patient's quality of life (QoL). These lesions manifest on sun-damaged skin and have the potential to progress to squamous cell carcinoma. Field-directed therapy alone and in combination with lesion-directed treatment is effective in clearing both visible and nonvisible AK lesions. Topical treatments of AKs thus have the potential to improve a patient's well-being. However, evidence demonstrating improvements in patient QoL is limited, and is mostly based on observational or retrospective studies. Some prospective studies have reported unchanged or even worsening QoL despite excellent treatment outcomes. Our prospective, pilot study demonstrated a significant increase in QoL in 28 subjects with AKs of the face treated with ingenol mebutate gel 0.015%. QoL was assessed at days 0 and 60 using the Skindex-16 survey. Mean overall scores improved from 24.5% at baseline to 15.5% at day 60 (P=0.031). Improvements in QoL were consistent with an 80% reduction in AK lesion number at day 60. These improved QoL findings are in line with those from a recent retrospective study using ingenol mebutate 0.015% gel. This study therefore further demonstrates the potential for field therapy to improve both treatment outcomes and patient satisfaction. Keywords: actinic keratosis, squamous cell carcinoma, ingenol mebutate gel, local skin reaction, quality of life, Skindex-16

There is increased emphasis on self-determination as an important outcome for youth with disabilities if they are to achieve positive adult outcomes after they leave school. However, the causal link between self-determination and positive adult outcomes has remained untested. The Arc conducted a follow-up study of students with mental retardation or learning disabilities for whom data regarding self-determination had been collected prior to their high school exit. Data regarding adult outcomes for these students nearly 1 year after graduation were collected. The resulting analysis determined that self-determined students were more likely to have achieved more positive adult outcomes, including being employed at a higher rate and earning more per hr than peers who were not self-determined. A framework for promoting self-determination as an educational outcome is presented.

A consumer study was administered in order to test the effects of utilizing augmented reality in online shopping for an apparel item. A theoretical model was developed as a framework for the analysis and included telepresence, attitude, and product knowledge as independent variables, and purchase intent as the dependent variable. The results of the analysis suggested that only attitude predicted purchase intent. Attitude was affected directly by the stimulus, telepresence, and product knowledge. This implied that augmented reality has the potential to positively impact purchase intent, if and only if it can positively impact attitude.

Non-invasive imaging devices are currently being utilized in research and clinical settings to help visualize, characterize, anddiagnose cancers of the skin. Speckle-variance optical coherence tomography (svOCT) is one such technology that offers considerable promise for non-invasive, real time detection of skin cancers given its added ability to show changes in microvasculature. We present four early lesions of the face namely sebaceous hyperplasia, basal cell skin cancer, pigmented actinic keratosis, and malignant melanoma in situ that each display different important identification markers on svOCT. Up until now, svOCT has mainly been evaluated for lesion diagnosis using transversal (vertical) sections. Our preliminary svOCT findings use dynamic en face (horizontal) visualization to differentiate lesions based on their specific vascular organizations. These observed patterns further elucidate the potential of this imaging device to become a powerful tool in patient disease assessment.

We used a murine monoclonal antibody to herpes simplex virus (HSV) type 2 (HSV-2) glycoprotein G (gG) to develop an enzyme immunoassay that detected HSV-2 type-specific antibodies in human sera. Antibodies to HSV-2 gG were detected in 98 (96%) of 102 sera from pregnant women with culture-proved HSV-2 infection. Sixty-five percent of the women had serological evidence of past HSV-2 infection by the Rawls index, based on titers of neutralizing antibody to HSV type 1 and HSV-2. Thirty (88%) of 34 infants exposed to maternal HSV infection at delivery had antibodies to HSV-2 gG and remained well. One infant exposed to primary maternal HSV-2 infection lacked antibodies to HSV-2 gG and developed neonatal HSV-2 infection. The mean +/- SD optical density by HSV-2 gG enzyme-linked immunosorbent assay for sera obtained from 17 infants within one week after onset of neonatal HSV-2 infection was 0.25 +/- 0.12, compared with 1.15 +/- 0.34 in cord blood sera from exposed infants who did not develop symptoms (P less than .0001 by t test).