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Tony Zitek,1,2 Luke Weber,1 Dominique Pinzon,1 Nicole Warren1– 3 1Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA; 2Department of Emergency Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA; 3Department of Medical Education, University of Miami School of Medicine, Miami, FL, USACorrespondence: Tony ZitekMount Sinai Medical Center, Department of Emergency Medicine, 4300 Alton Road, Miami Beach, FL, 33140, USA, Tel +1 305-674-2121 x56632, Email Zitek10@gmail.comAbstract: Immune thrombocytopenia (ITP) is characterized by a platelet count less than 100 × 10^9/L without anemia or leukopenia. Patients with ITP may be asymptomatic, or they may have mild bleeding like petechiae, purpura, or epistaxis. In rare cases, they may present to the emergency department (ED) with life-threatening bleeding as a result of their thrombocytopenia. The emergency physician should thus be prepared to diagnose ITP and treat the bleeding that can result from it. The diagnosis of ITP requires excluding secondary causes of thrombocytopenia, and in the ED, the bare minimum workup for ITP includes a complete blood count and a peripheral blood smear. The peripheral blood smear should show a small number of large platelets with normal morphology, and there should not be an increased number of schistocytes. Many patients with ITP require no emergent treatment. However, if a patient with suspected ITP presents to the ED with critical hemorrhage, the emergency physician should initiate treatment with a platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG) as soon as possible. For less severe bleeding, platelet transfusions are not recommended, and the treatment consists of corticosteroids by themselves or in conjunction with IVIG.Keywords: ITP, symptoms, diagnosis, treatment

In this paper, we discuss active learning in College Algebra at Georgia Gwinnett College. This approach has been used in more than 20 sections of College Algebra taught by the authors in the past four semesters. Students work in small, structured groups on guided inquiry activities after watching 15-20 minutes of videos before class. We discuss a portion of an in-class activity and a writing project used in the course. The results after one semester are that the students in this model did marginally better than students in the traditional lecture sections on common final exam questions.

Organophosphorus pesticides are widely used in industrial agriculture and have been associated with water pollution and negative impacts on local ecosystems and communities. There is a need for testing technologies to detect the presence of pesticide residues in water sources, especially in developing countries where access to standard laboratory methods is cost prohibitive. Herein, we outline the development of a facile electrochemical sensor for amperometric determination of organophosphorus pesticides in environmental water samples. A three-electrode system was fabricated via UV laser-inscribing on a polyimide film. The working electrode was functionalized with copper nanoparticles with affinity toward organophosphate compounds. The sensor showed a limit of detection (LOD) of 3.42 ± 1.69 µM for glyphosate, 7.28 ± 1.20 µM for glufosinate, and 17.78 ± 7.68 µM for aminomethylphosphonic acid (AMPA). Sensitivity was highest for glyphosate (145.52 ± 36.73 nA⋅µM -1 ⋅cm -2 ) followed by glufosinate (56.98 ± 10.87 nA⋅µM -1 ⋅cm -2 ), and AMPA (30.92 ± 8.51 nA⋅µM -1 ⋅cm -2 ). The response of the sensor is not significantly affected by the presence of several ions and organic molecules commonly present in natural water samples. The developed sensor shows promising potential for facilitating environmental monitoring of organophosphorus pesticide residues, which is a current need in several parts of the world., (© 2022. The Author(s).)

Nucleic acid sensing is a 3 decades old but still challenging area of application for different biological sub-domains, from pathogen detection to single cell transcriptomics analysis. The many applications of nucleic acid detection and identification are mostly carried out by PCR techniques, sequencing, and their derivatives used at large scale. However, these methods' limitations on speed, cost, complexity and specificity have motivated the development of innovative detection methods among which nucleic acid biosensing technologies seem promising. Toehold switches are a particular class of RNA sensing devices relying on a conformational switch of secondary structure induced by the pairing of the detected trigger RNA with a de novo designed synthetic sensing mRNA molecule. Here we describe a streamlined methodology enabling the development of such a sensor for the RNA-mediated detection of an endangered plant species in a cell-free reaction system. We applied this methodology to help identify the rosewood Dalbergia maritima, a highly trafficked wood, whose protection is limited by the capacity of the authorities to distinguish protected logs from other unprotected but related species. The streamlined pipeline presented in this work is a versatile framework enabling cheap and rapid development of new sensors for custom RNA detection., Competing Interests: The authors declare no competing interests., (© 2022 The Authors.)

We present the case of a slightly obese 39-year-old patient with a severe course of COVID-19 pneumonia. The patient was referred from a hospital to regular care with suspected COVID-19 pneumonia. The initial clinical symptoms consisted of dysuria and fever. A bilateral infiltrate was seen in the chest x-ray. In the CT thorax, advanced COVID-19 typical changes were found on both sides. The COVID-19 infection was confirmed by a positive SARS-CoV-2 PCR from the nasopharynx smear. In the case of progressive ARDS with respiratory exhaustion, the patient was intubated and invasively ventilated. When a bacterial superinfection was suspected, we initiated empirical antibiotic therapy. In addition, a therapy with dexamethasone was applied. Therapy with ASA and weight-adapted semi-therapeutic low molecular weight heparin was also carried out. During the intensive care treatment the patient developed a fulminant septic shock with consecutive severe thrombocytopenia. A dilated tracheotomy was performed. The weaning progress was hampered by recurrent septic attacks. Necrosis in the area of ​​the right foot was identified as the cause of the septic relapses. As there was no alternative focus, surgical rehabilitation with partial amputation was carried out. The patient then remained infection-free and could be weaned from the respirator., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

El Tiple is one of many marginalized Afrodescendant communities confined within a green desert located in the southwest region of Colombia. This green desert is most widely known as the second-largest sugarcane monoculture field in the Americas. Herein, we describe a transdisciplinary and participatory effort to understand agroindustrial expansion in the region through the lens of the El Tiple community. Using qualitative and quantitative methodologies, we characterized the socioenvironmental context of El Tiple in terms of ethnography, autoethnography, social cartography, and ethnobotany. We implemented a participatory approach to codevelop a technology-assisted strategy for strengthening the community's small-scale farming activities. Our contextual analysis results show systemic food dispossession, which arises from several factors, including dramatic land transformation, rapid depletion and contamination of natural assets, and biodiversity loss. All these factors are associated with the presence of bordering sugarcane plantations. In collaboration with community members, we designed, constructed, and analyzed a greenhouse hydroponic cultivation system as an actionable means to gradually restore local production of food and medicinal plants for the community. Our transdisciplinary and participatory approach demonstrates how academics can partner with vulnerable communities in the coproduction of knowledge and solutions to pressing social needs., Competing Interests: No competing financial interests exist., (© Irene Vélez-Torres et al. 2021; Published by Mary Ann Liebert, Inc.)

Non-technical skill training improves outcomes in surgery and quantifying the effects of this training may aid in designing surgical teaching models. In our study, 12 novices performed a wire-chaser laparoscopic task in 9 training sessions, working both as individuals and dyads. Task duration (p < 0.001), number of ring-wire contacts (p < 0.001), total duration of contact (p < 0.001), and number of pick up attempts (p = 0.044) all showed significant improvement in both groups with no significant difference in the learning curves between individuals and dyads. There was, however, an interaction effect for the number of ring-wire contacts (p = 0.027) whereby the number of contacts dropped more dramatically among dyads. Dyads also performed significantly more anticipatory movements than individuals (p = 0.005). Novices performed similarly when working individually and as dyads, suggesting that the need for collaboration neither hindered nor helped performance for our particular task.

In this manuscript, we discuss relevant socioeconomic factors for developing and implementing sensor analytic point solutions (SNAPS) as point-of-care tools to serve impoverished communities. The distinct economic, environmental, cultural, and ethical paradigms that affect economically disadvantaged users add complexity to the process of technology development and deployment beyond the science and engineering issues. We begin by contextualizing the environmental burden of disease in select low-income regions around the world, including environmental hazards at work, home, and the broader community environment, where SNAPS may be helpful in the prevention and mitigation of human exposure to harmful biological vectors and chemical agents. We offer examples of SNAPS designed for economically disadvantaged users, specifically for supporting decision-making in cases of tuberculosis (TB) infection and mercury exposure. We follow-up by discussing the economic challenges that are involved in the phased implementation of diagnostic tools in low-income markets and describe a micropayment-based systems-as-a-service approach (pay-a-penny-per-use-PAPPU), which may be catalytic for the adoption of low-end, low-margin, low-research, and the development SNAPS. Finally, we provide some insights into the social and ethical considerations for the assimilation of SNAPS to improve health outcomes in marginalized communities.

Many patients are treated in intensive care units daily, often over a long period of time. Sleep plays a role that should not be underestimated for these patients. Sleep disorders are a relevant problem for intensive care patients and lead to a higher prevalence of delirium in these patients and thus to a longer length of stay in the intensive care unit and to a higher mortality. This article tries to show the causes of sleep disorders in intensive care medicine and possible strategies for avoiding sleep disorders in intensive care patients., (© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020.)

Purpose: To examine the reaction time when human subjects process information presented in the visual channel under both a direct vision and a virtual rehabilitation environment when walking was performed., Method: Visual stimulus included eight math problems displayed on the peripheral vision to seven healthy human subjects in a virtual rehabilitation training (computer-assisted rehabilitation environment (CAREN)) and a direct vision environment. Subjects were required to verbally report the results of these math calculations in a short period of time. Reaction time measured by Tobii Eye tracker and calculation accuracy were recorded and compared between the direct vision and virtual rehabilitation environment., Results: Performance outcomes measured for both groups included reaction time, reading time, answering time and the verbal answer score. A significant difference between the groups was only found for the reaction time (p = .004). Participants had more difficulty recognizing the first equation of the virtual environment., Conclusions: Participants reaction time was faster in the direct vision environment. This reaction time delay should be kept in mind when designing skill training scenarios in virtual environments. This was a pilot project to a series of studies assessing cognition ability of stroke patients who are undertaking a rehabilitation program with a virtual training environment. Implications for rehabilitation Eye tracking is a reliable tool that can be employed in rehabilitation virtual environments. Reaction time changes between direct vision and virtual environment.

Background: It is important for a surgeon to perform surgical tasks under appropriate guidance from visual and kinesthetic feedback. However, our knowledge on kinesthetic (muscle) memory and its role in learning motor skills remains elementary., Objectives: To discover the effect of exclusive kinesthetic training on kinesthetic memory in both performance and learning., Methods: In Phase 1, a total of twenty participants duplicated five 2 dimensional movements of increasing complexity via passive kinesthetic guidance, without visual or auditory stimuli. Five participants were asked to repeat the task in the Phase 2 over a period of three weeks, for a total of nine sessions., Results: Subjects accurately recalled movement direction using kinesthetic memory, but recalling movement length was less precise. Over the nine training sessions, error occurrence dropped after the sixth session., Conclusions: Muscle memory constructs the foundation for kinesthetic training. Knowledge gained helps surgeons learn skills from kinesthetic information in the condition where visual feedback is limited., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency., (© The Author(s) 2016.)