Office hysteroscopy: a review

With the invention of new techniques and modalities “see and treat” has become the norm of management now a days. Diagnostic hysteroscopy combined with histological examination of an endometrial biopsy is considered the ‘gold standard’ in the diagnosis of intrauterine abnormalities. The importance of office hysteroscopy lies in the fact that there is no need of any anesthesia and after the procedure the patient can return into his routine activity only with the minimal aid of NSAIDs. Two different types of hysteroscopes are used worldwide: flexible or rigid, which are made in different sizes. Optic miniaturization has been one of the greatest technological advancements in the field of hysteroscopy, both for rod-lens and fiberoptic scopes. The main concerns in office hysteroscopy are the need for necessary expertise, pain management and management of the complications in the office setting and the high cost of the equipment needed for the procedure. But office hysteroscopy has already demonstrated good correlation of findings compared with inpatient hysteroscopy, providing distinct advantages such as reduced anesthesia risks, enhanced time and cost-effectiveness, and faster recovery with less time away from work and home.

193 BALANCING EDUCATION AND PRACTICE: A REFLECTION FROM A SIMULATION EDUCATOR DURING THE COVID-19 PANDEMIC

What? I consider myself privileged to divide my work time between my roles as a clinical simulation educator and as an intensive care nurse in a large teaching hospital. I find that working alternate weeks in educational and clinical roles can be challenging because both demand complementary but different skills. However, I am thrilled to have the opportunity to continue caring for patients alongside supporting and learning with colleagues. Balancing these roles during a pandemic presented me with new challenges and rewards, and reflection on these experiences has given me some fascinating insights. As the COVID-19 pandemic progressed and the number of patients requiring admission to the Critical Care Unit increased, the units were expanded and staff were redeployed from other areas to provide support. These ‘surge’ staff required rapidly developed simulation-based training to allow them to work in this unfamiliar environment within a restricted scope of practice. Being involved with delivering this training as well as working with surge staff in Critical Care afforded me a deeper understanding of the surge role and the unique challenges it presented. Once surge training was completed and I returned to delivering our standard simulation-based education courses, my experiences of working clinically continued to enrich my teaching because I felt somewhat familiar with some of the challenges our learners were facing as the pandemic continued. So what? Over the last year, I have felt conflicted at times; when working clinically during the peak of the pandemic, there was very little time to facilitate learning at the bedside, and during my educator weeks I relished the opportunity to support and teach but felt guilty for spending time away from colleagues and patients in Critical Care Unit. However, continuing with both roles better equipped me to answer questions and to provide support during surge training, particularly for those staff who had not yet spent time on the units. When assisting with other courses as a faculty member, I was able to deeply empathize with participants who encountered situations that I had become familiar with in practice – for example, communicating with others when wearing full personal protective equipment – which helped me to validate and normalize some of the experiences shared during debrief discussions. Through continuing to reflect on my time spent working in these environments during the pandemic so far, I hope to present my learning and recommendations for optimizing practice under challenging circumstances.

Study on the Law of Harmful Gas Release from Limnoperna fortunei (Dunker 1857) during Maintenance Period of Water Tunnel Based on K-Means Outlier Treatment

It is of great significance for air pollution control and personnel safety guarantee to master the release characteristics of harmful gases in the process of Limnoperna fortunei corruption. In view of the lack of research on the environmental pollution caused by the corruption of Limnoperna fortunei, a model experiment was designed to study the three harmful gases of NH3, H2S, and CH4 in the putrid process of Limnoperna fortunei by considering the density of Limnoperna fortunei and the time of leaving water. The results show that: (1) The recognition and processing of outliers based on wavelet decomposition and K-means algorithm can effectively reduce the standard deviation and coefficient of variation of the data set and improve the accuracy of the data set. (2) The variation of NH3 and H2S gas concentrations with the time of water separation satisfies polynomial linear regression (R2 > 99%). (3) At a density of 0.5–7.0 × 104 mussels/m2, the highest concentration of NH3 reached 47.9777–307.9454 mg/m3 with the increase in the density of Limnoperna fortunei and the extension of the time away from water, far exceeding the occupational exposure limit of NH3 of 30 mg/m3, potentially threatening human health and safety. The highest detection value of H2S concentration is 0.1909–5.0946 mg/m3, and the highest detection concentration of CH4 is 0.02%, both of which can be ignored.

Age of Early Specialization, Competitive Volume, Injury, and Sleep Habits in Youth Sport: A Preliminary Study of US Youth Basketball

Background: Concerns for youth sports in the United States often focus on early sport specialization, overemphasis on competition, injuries, and burnout. Little research has addressed relationships among the preceding and other concerns, including time away from organized sport, sleep, and perceptions of physical and psychological well-being. Hypothesis: There is an association between reported competitive gameplay volume and specialization, injury, and fatigue among elite youth basketball players. Study Design: Cross-sectional study; convenience sample. Level of Evidence: Level 4. Methods: An anonymous questionnaire was administered to a convenience sample of youth basketball players between 13 and 18 years of age from across the United States. Participants were queried about multiple factors, including the extent of their participation in organized basketball and other sports, time away from organized basketball, injury, sleep, and feelings of exhaustion related to basketball participation. Results: A total of 772 participants (145 girls, 627 boys) completed a survey. All participants played for a select or elite club basketball team and/or a high school basketball team. Overall, 49% played more than 50 games within the past year. A total of 73% were specialized in basketball, 58% prior to age 14 years, and 35% prior to age 11 years. In all, 70% reported less than 1 month away from organized basketball within the past year, and 28% reported no time away. A total of 54% reported sleeping less than the recommended 8 hours each night during the school year. Within the prior year, 55% reported feeling physically exhausted and 45% reported feeling mentally exhausted from basketball. Regression analysis did not find any significant relationships between early specialization prior to age 14 years and basketball-related injury or feelings of mental or physical exhaustion. Conclusion: In this select group of youth basketball players, the majority specialized in basketball prior to age 14 years and reported a large number of competitive events with little time away from organized basketball. Clinical Relevance: The results from a sample of highly competitive youth basketball players indicate issues that warrant further attention and research regarding the potential impact of specialization, frequent competitions, lack of time away from organized sport, and perceptions of well-being in young athletes.

INNV-38. COVID-19 INDUCED TELEMEDICINE LESSONS FOR CLINICIANS CARING FOR PATIENTS WITH PRIMARY BRAIN TUMORS

BACKGROUND The COVID-19 pandemic triggered a rapid conversion from in-person to video-visits for new patient consultations and follow-up visits. Now with available vaccines and declining case rates efforts are underway to return to in-person visits as they provide more revenue and are viewed as best for patients and clinicians. This abstract reviews these assumptions. METHODS Electronic medical records from seven full-time faculty neuro-oncologists at Johns Hopkins Hospitals were retrospectively reviewed from 4/1/20 to 3/31/21 to examine the use of video visits over time and their patient demographics. RESULTS From 4/1/20 to 3/31/21, 279 new patients were seen (57% video-visits) with a median age of 52 years for both video and in-person visits. Patients came from 15 states for video and 17 states for in-person visits. There were also 2247 follow-up visits (85% video-visits) with a median age of 47 yrs for video and 50 yrs for in-person visits. Patients came from 28 states for video and 14 for in-person visits. No show visits were more frequent for in-person visits. During early months of the pandemic, few patients were seen in the clinics. Thereafter, video-visits rose sharply comprising 93% of follow-up visits in June 2020 and 62% of new patient consultations in September 2020. These rates have remained high (in March 2021, 72% of all follow-up visits and 59% of new patient consultations). CONCLUSIONS Despite reductions in COVID-19 infection rates, our neuro-oncologists continue to favor video-visits for new patient consultations and follow-up visits. Video-visits save patients and caregivers travel time, parking costs, and time away from work. They also allow an acceptable history and neurological exam, participation by many family members, easy sharing of MRI scans and laboratory data, and discussions unencumbered by face masks and shields. These advantages to video-visits remain significant even as the pandemic recedes.

Cytoskeletal Tensegrity in Microgravity

In order for Man to venture further into Space he will have to adapt to its conditions, including microgravity. Life as we know it has evolved on Earth with a substantial gravitational field. If they spend considerable time away from Earth, astronauts experience physiological, mental, and anatomical changes. It is not clear if these are pathological or adaptations. However, it is true that they experience difficulties on their return to stronger gravity. The cytoskeleton is a key site for the detection of gravitational force within the body, due to its tensegrity architecture. In order to understand what happens to living beings in space, we will need to unravel the role cytoskeletal tensegrity architecture plays in the building and function of cells, organs, the body, and mind.

Do Walking Distance and Time Away from the Paddock Influence Daily Behaviour Patterns and Milk Yield of Grazing Dairy Cows?

In pasture-based systems, cows may spend several hours away from the paddock and may also walk several kilometres to meet daily milking requirements; this could lead cows to experience time constraints for grazing, ruminating and lying time in the paddock. This study investigated how walking distance and time spent away from the paddock affected daily behavioural patterns (i.e., grazing, ruminating and lying time) and milk yield. Dairy cows were managed in three rotationally grazed groups (n = 29 cows each) on the same farm and milked twice daily. A triaxial ear tag accelerometer on each cow recorded daily duration of grazing and ruminating, and a leg-based accelerometer recorded the daily lying time, for 13 days. GPS collars on four cows per group recorded the daily walking distance and total time away from the paddock for the group. A mixed repeated measures model tested how time off-paddock and walking distance affected the daily behavioural patterns; age, breed, milk yield and maximum ambient temperature were used as covariates with group as the observational unit. A second similar model tested how these factors affected milk yield. Walking distance and time spent away from the paddock were not correlated. When daily walking distance increased (to a maximum of 4 km/d), cows spent more time grazing and less time ruminating, but lying time was not affected. This result may, in part, be related to the greater energy expenditure demands for walking longer distances and milk production. When time away from the paddock increased (to a maximum of 4 h/d), cows spent less time lying, but grazing and ruminating times were not affected. Milk yield was not affected by walking distance, but one of the groups experienced a lower milk yield when time away from the paddock was increased. This result suggests that, for some cows, lying times may be shorter when experiencing a longer time away from the paddock, which may also affect milk yield. Overall, this study indicates that paddock behaviours are associated with walking distance to the milking parlour and time spent away from the paddock. Efforts to reduce walking distance and time spent away from the paddock are likely to provide cows with greater opportunity to engage in daily behaviours in the paddock that meet their needs and maintain their milk yield.

The cost of correcting for error during sensorimotor adaptation

Learning from error is often a slow process. In machine learning, the learning rate depends on a loss function that specifies a cost for error. Here, we hypothesized that during motor learning, error carries an implicit cost for the brain because the act of correcting for error consumes time and energy. Thus, if this implicit cost could be increased, it may robustly alter how the brain learns from error. To vary the implicit cost of error, we designed a task that combined saccade adaptation with motion discrimination: movement errors resulted in corrective saccades, but those corrections took time away from acquiring information in the discrimination task. We then modulated error cost using coherence of the discrimination task and found that when error cost was large, pupil diameter increased and the brain learned more from error. However, when error cost was small, the pupil constricted and the brain learned less from the same error. Thus, during sensorimotor adaptation, the act of correcting for error carries an implicit cost for the brain. Modulating this cost affects how much the brain learns from error.

A Sports Practitioner’s Perspective on the Return to Play During the Early Months of the COVID-19 Pandemic: Lessons Learned and Next Steps

With high profile events such as sporting and mass gathering events, recent history has revealed the importance of developing incident command structures to streamline communication, maximize coordination and establish contingencies. With the advent of COVID-19, a virus with significant human-to-human transmission and the potential for super-spreader events, there has been a brief universal cessation of sports, and the main question now is how to return to play in a way that keeps our athletes and general population healthy. This review aims to describe the core principles regarding return to play using a focus on incident command centers and disaster management. These principles include appropriate hygiene and social distancing, use of masks, rigorous monitoring and screening of symptoms, widespread testing, comprehensive contact tracing and considerations for travel and facilities. In addition, organizations need to have established scalable protocols for athletes who do contract the virus with symptom-based algorithms for length of time away from play and with screening for cardiac and pulmonary complications from COVID-19. Also, encouraging our athletes to become immunized against the virus and educating our athletes about nutrition and the relation to immune health is important as we return to play.