Barriers to Participation in Workplace Wellness Programs for People With Disabilities.

OBJECTIVE: As workplace wellness programs become increasingly popular, many concerns have been raised that these programs are inaccessible or infringe upon the legal rights of people with disabilities. In response to those concerns, we investigated the experiences of workers with disabilities with barriers to access for workplace wellness programs. METHODS: We disseminated an electronic survey and conducted a descriptive statistical analysis assessing the demographics, behavior, and attitudes of people with disabilities toward workplace wellness programs. RESULTS: We found that the largest barriers to workplace participation are lack of access to careers dominated by large employers who offer more employee benefits and issues regarding barriers to access within those employers. CONCLUSIONS: These findings indicate that there are significant barriers that prevent people with disabilities from fully participating in the workplace.

The Role of Microbiota in the Pathogenesis of Esophageal Adenocarcinoma.

Esophageal adenocarcinoma (EAC) is associated with poor overall five-year survival. The incidence of esophageal cancer is on the rise, especially in Western societies, and the pathophysiologic mechanisms by which EAC develops are of extreme interest. Several studies have proposed that the esophageal microbiome may play an important role in the pathophysiology of EAC, as well as its precursors-gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE). Gastrointestinal microbiomes altered by inflammatory states have been shown to mediate tumorigenesis directly and are now being considered as novel targets for both cancer treatment and prevention. Elucidating molecular mechanisms through which the esophageal microbiome potentiates the development of GERD, BE, and EAC will provide a foundation on which new therapeutic targets can be developed. This review summarizes current findings that elucidate the molecular mechanisms by which microbiota promote the pathogenesis of GERD, BE, and EAC, revealing potential directions for additional research on the microbiome-mediated pathophysiology of EAC.

Novel disease resistance gene paralogs created by CRISPR/Cas9 in soy.

KEY MESSAGE: Novel disease resistance gene paralogues are generated by targeted chromosome cleavage of tandem duplicated NBS-LRR gene complexes and subsequent DNA repair in soybean. This study demonstrates accelerated diversification of innate immunity of plants using CRISPR. Nucleotide-binding-site-leucine-rich-repeat (NBS-LRR) gene families are key components of effector-triggered immunity. They are often arranged in tandem duplicated arrays in the genome, a configuration that is conducive to recombinations that will lead to new, chimeric genes. These rearrangements have been recognized as major sources of novel disease resistance phenotypes. Targeted chromosome cleavage by CRISPR/Cas9 can conceivably induce rearrangements and thus emergence of new resistance gene paralogues. Two NBS-LRR families of soy have been selected to demonstrate this concept: a four-copy family in the Rpp1 region (Rpp1L) and a large, complex locus, Rps1 with 22 copies. Copy-number variations suggesting large-scale, CRISPR/Cas9-mediated chromosome rearrangements in the Rpp1L and Rps1 complexes were detected in up to 58.8% of progenies of primary transformants using droplet-digital PCR. Sequencing confirmed development of novel, chimeric paralogs with intact open reading frames. These novel paralogs may confer new disease resistance specificities. This method to diversify innate immunity of plants by genome editing is readily applicable to other disease resistance genes or other repetitive loci.

Escape the EM Boards: Interactive Virtual Escape Room for GI Board Review.

Audience: This interactive and entirely virtual escape room based on high yield gastrointestinal/abdominal board review material is a didactic activity for emergency medicine residents of all postgraduate years and third- or fourth-year medical students. This escape room can be completed in small teams or as individuals in a remote, in-person, or mixed location setting. Introduction: 2020 is a year that will forever change medical education. The novel coronavirus 2019 pandemic caused many national, state, local, or hospital specific recommendations for transition of meetings to be completely virtual or to only allow for limited in-person meetings. In order to abide by these recommendations, the majority of medical education transitioned to online platforms. Now more than ever, creative and engaging methods for expanding clinical knowledge and teaching teamwork as well as unique integrations of technology for medical education delivery are needed. Educational Objectives: By the end of this didactic activity, learners will be able to:Identify causes of upper gastrointestinal bleeding.Recall test-taking buzzwords for infectious causes of diarrhea.Acknowledge the correct hepatitis B titers that correspond with various clinical scenarios.Describe the management for alkali caustic ingestions.Determine the components of Maddrey Discriminant Function Score, Charcot's triad, Ranson's Criteria for Pancreatitis, and Glasgow-Blatchford Score.Diagnose specific gastrointestinal diseases from a clinical description.Choose the correct gastrointestinal diagnosis based on clinical image findings.Demonstrate teamwork in solving problems. Educational Methods: "Gamification" is the use of game elements in a nongame context.1 Gamification creates active, engaged learning opportunities and so it is a highly favored educational method for millennial learners.1 An Escape Room is a team-based game where a small group is locked in a room and they pick up objects at random in this room to solve a series of clues that will play a role in solving the final clue to "escape" the locked room. This didactic learning activity utilizes technology to deliver a fun and interactive distance learning activity that resembles a live escape room.The interactive virtual escape room provided is a no cost, unique alternative educational activity that can be done either entirely or partly remotely. In order to replicate this team-based didactic exercise, the instructor needs to simply divide residents and students into small groups and then share with each group the link provided. Research Methods: A five-point Likert scale survey was distributed to participating learners after completing this activity to assess relevance and satisfaction of the high yield gastrointestinal/abdominal board review escape room. Thirty-two of forty-two participating residents/medical students completed this seven-question survey. Results: All participating resident/medical students who completed the survey enjoyed this activity and that this was a unique learning experience, and the majority of participating residents/medical students thought this interactive virtual escape room was easy to use, learned something, thought this was a helpful way to review for emergency medicine boards or in-training exams, and preferred a game like this to a standard lecture. Additionally, over half of survey respondents said they are going to try to come up with a game for their assigned board review presentations. Discussion: Escape room gamification of high yield gastrointestinal/abdominal board review material was an engaging, fun, and effective distance learning activity for residents and medical students. This didactic activity not only promoted interactive learning but also encouraged virtual teamwork among small groups. Topics: Gastroenterology, GI, abdominal, board review, in-training exam review, escape room, virtual didactics, distance learning, high yield, upper GI bleeding, esophageal varices, diarrhea, alkali ingestion, volvulus, foreign body, intussusception.

Intracranial Air Embolism after Inferior Alveolar Nerve Block: A Case Report.

INTRODUCTION: The number of nontraumatic dental pain emergency department (ED) visits continues to substantially rise in frequency every year. While there are several methods for treating dental pain, an inferior alveolar nerve block (IANB) is a non-narcotic alternative that provides instantaneous relief of severe pain. CASE REPORT: A 59-year-old male presented to the ED from a dentist's office for evaluation of a right-sided headache with an associated episode of palpitations and near syncope that developed while receiving an inferior alveolar nerve block. Computed tomography of the patient's head revealed multiple small foci of air in the right temporalis muscle and in the intracranial venous drainage system. Given the patient's history of dental procedure, the intravascular introduction of air and local anesthetic was suspected. CONCLUSION: Inferior alveolar nerve block procedures can have complications, including hematoma formation, trismus, facial palsy, needle breakage, and in this case, intravascular injection and cerebral air embolism. To perform a successful IANB, it is critical for providers to be familiar with anatomical landmarks and to consistently perform aspiration to confirm that needle placement is not intravascular.

Crazy-Paving: A Computed Tomographic Finding of Coronavirus Disease 2019.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. COVID-19 first occurred in Wuhan, China, in December 2019, and by March 2020 COVID-19 was declared a global pandemic. CASE PRESENTATION: We describe a case of a 52-year-old female with past medical history of asthma, type 2 diabetes, and previous tobacco use who presented to the emergency department with dyspnea and was found to be positive for COVID-19. We discuss the computed tomographic finding of "crazy-paving" pattern in the patient's lungs and the significance of this finding in COVID-19 patients. DISCUSSION: Emergency providers need to be aware of the different imaging characteristics of various stages of COVID-19 to appropriately treat, isolate, and determine disposition of COVID-19 infected patients. Ground-glass opacities are the earliest and most common imaging finding for COVID-19. Crazy-paving pattern is defined as thickened interlobular septa and intralobular lines superimposed on diffuse ground-glass opacities and should be recognized by emergency providers as a radiographic finding of progressive COVID-19.

Coronavirus disease 2019 (COVID-19) complicated by Spontaneous Pneumomediastinum and Pneumothorax.

The first reports of severe acute respiratory symptoms from a novel coronavirus called coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China in December 2019.1 The World Health Organization declared COVID-19 a global pandemic by March 2020.1 The COVID-19 outbreak has resulted in a current global health emergency. Clinical information about the findings of COVID-19 and its associated complications are constantly evolving and becoming more widely available. Providers should be familiar with both typical symptoms and image study results for COVID-19 as well as less commonly reported complications of progressive COVID-19, such as spontaneous pneumomediastinum and spontaneous pneumothorax as highlighted in this case.

Electrochemical properties and temperature dependence of a recombinant laccase from Thermus thermophilus.

The electrochemical properties of a laccase from Thermus thermophilus HB27 (Tth-laccase) were characterized. The gene encoding the laccase was cloned and overexpressed in Escherichia coli. One-step purification of the corresponding apo-enzyme was achieved by nickel-affinity chromatography. Copper was incorporated into the apo-laccase as the cofactor to yield the holo-enzyme. The temperature-dependent catalytic activity of the laccase was investigated by spectrophotometric as well as electrochemical methods. Specifically, the catalytic properties of the enzyme were characterized by employing a photometric assay based on the oxidation of the substrate 2,2-azino-bis-(3-ethylbenzthiazoline-6-sulfonate) (ABTS). The electroactive substrate ABTS can be also monitored by cyclic voltammetry, thus allowing for determination of the enzymatic activity electrochemically. It was found that the recombinant laccase exhibited higher activity as the temperature increased up to 65 °C. Spectroscopic studies of Tth-laccase based on circular dichroism and fluorescence measurements are consistent with a thermally stable secondary structure of the protein.