International Residents' Perspectives on Education and Challenges in Microsurgery Training

Objective Microsurgery remains an integral component of the surgical skillset and is essential for a diversity of reconstructive procedures. The apprenticeship also requires overcoming a steep learning curve, among many challenges. The method of microsurgical training differs depending on the countries' regions and resources of their health care system. Methods The Journal of Hand and Microsurgery leadership held an international webinar on June 19, 2021, consisting of a panel of residents from 10 countries and moderated by eminent panelists. This inaugural event aimed to share different experiences of microsurgery training on a global scale, identifying challenges to accessing and delivering training. Results Residents shared various structures and modes of microsurgical education worldwide. Areas of discussion also included microsurgical laboratory training, simulation training, knowledge sharing, burnout among trainees, and challenges for female residents in microsurgical training. Conclusion Microsurgical proficiency is attained through deliberate and continued practice, and there is a strong emphasis globally on training and guidance. However, much remains to be done to improve microsurgical training and start acting on the various challenges raised by residents.Copyright © 2022. Society of Indian Hand & Microsurgeons. All rights reserved.

Restoration of Humoral Response to Covid-19 Vaccination in Rituximab-Treated Patients

Background: Previous studies had demonstrated that patients with hematologic malignancies had suboptimal antibody response after receiving COVID-19 vaccines, especially among those having previously treated with anti- CD20 monoclonal antibodies. Method(s): Adult patients with non-Hodgkin's lymphoma or chronic lymphocytic leukemia (CLL) were enrolled before receiving the second dose of SARS-CoV-2 vaccine. Determinations of anti-SARS-CoV-2 spike and nucleocapsid IgG titers were performed every 1-3 months, after they received the second and the third dose of SARS-CoV-2 vaccine, respectively. Patients were excluded from analysis if they were diagnosed with COVID-19. All serum samples were tested for anti-nucleocapsid antibody and those tested positive were excluded from subsequent analyses. Result(s): A total of 85 participants were enrolled, including 42 (49.4%) with diffused large B-cell lymphoma, and 13 (15.3) with follicular lymphoma and 9 with CLL. 72 (84.7%) participants had received anti-CD20 monoclonal antibodies, with a median interval of 24 months between last anti-CD20 treatment and the second dose of vaccine, and 21 (24.7%) had HIV infection. Factors associated with failure to achieve an anti-spike IgG titer >141 BAU/ mL within 12 weeks after the second dose of vaccine included HIV infection (adjusted odds ratio [aOR], 0.14;95% CI, 0.04-0.51), active hematologic disease (aOR, 5.50;95% CI 1.42-21.32), receipt of anti-CD20 monoclonal antibodies (aOR, 6.65;95% CI 1.52-29.07), and receipt of two doses of homologous mRNA vaccination (aOR, 0.17;95% CI 0.05-0.56). In the participants having previously treated with anti-CD20 regimen, only 8.6% achieved an antibody response ( >141 BAU/mL) in the first year, while 78.3% achieved anti-spike IgG titer > 141 BAU/mL after two years post B-cell depleting treatment. After the third dose of SARS-CoV-2 vaccine, 53.6% achieved an antispike IgG titer > 141 BAU/mL in the first year post anti-CD20 treatment. Conclusion(s): Our study demonstrated that previous treatment with anti-CD20 monoclonal antibodies was associated a lower antibody response among patients with lymphoproliferative disorders receiving two doses of SARS-CoV-2 vaccine. While two doses of SARS-CoV-2 vaccines might not be sufficient even one year apart from the last dose of rituximab, a third dose of vaccine may boost anti-spike IgG particularly in the subset of recent exposure to rituximab. Anti-spike IgG determined 1-3 months after the second (A) / third (B) dose of COVID-19 vaccine, stratified by the interval between last anti-CD20 regimen and the second / third dose of COVID-19 vaccine. (Figure Presented).

condLSTM-Q: A novel deep learning model for predicting COVID-19 mortality in fine geographical scale

Background: Modern machine learning-based models have not been harnessed to their total capacity for disease trend predictions prior to the COVID-19 pandemic. This work is the first use of the conditional RNN model in predicting disease trends that we know of during development that complemented classical epidemiological approaches. Methods: We developed the long short-term memory networks with quantile output (condLSTM-Q) model for making quantile predictions on COVID-19 death tolls. Results: We verified that the condLSTM-Q was accurately predicting fine-scale, county-level daily deaths with a two-week window. The model’s performance was robust and comparable to, if not slightly better than well-known, publicly available models. This provides unique opportunities for investigating trends within the states and interactions between counties along state borders. In addition, by analyzing the importance of the categorical data, one could learn which features are risk factors that affect the death trend and provide handles for officials to ameliorate the risks. Conclusion: The condLSTM-Q model performed robustly, provided fine-scale, county-level predictions of daily deaths with a two-week window. Given the scalability and generalizability of neural network models, this model could incorporate additional data sources with ease and could be further developed to generate other valuable predictions such as new cases or hospitalizations intuitively. © The Author (s) 2022. Published by Higher Education Press.

Facilitated virtual learning for advanced geriatric education among nursing students during the COVID pandemic in Taiwan

Purpose: This study explored the students' perception of their adoption and acceptance of virtual learning (VL), the factors affecting the adoption of educational technologies and the correlation between their intention, perceived behavioral control and care competence in caring for older adults. Design/methodology/approach: A cross-sectional survey was conducted. Surveys were administered to evaluate the participants who were involved in VL on geriatric care during coronavirus disease 2019 (COVID-19) pandemic. A total of 315 nursing students participated in the survey, and 287 valid questionnaires were collected (response rate: 91.11%). Findings: A total of 287 participants (mean age 21.09, SD 1.44 years;242/287, 84.3% female) were included in the study. The variables of intention to use technologies were positively correlated with care competence (r = 0.59, p < 0.001). The results revealed that the major predictors were perceived ease-of-use (PEOU) (β = 0.28, 95% confidence interval (CI) 0.16–0.40) and perceived usefulness (PU) (β = 0.22, CI 0.09–0.35) which were significantly positive predictors of competence in geriatric care. Research limitations/implications: Nursing students lack in clinical knowledge and situational experience in geriatric care;therefore, their perceptiveness, expressions and reflection on the process of providing care to hospitalized older patients should be increased. These results indicated that students improved in geriatric healthcare after/during the VL program during COVID-19 pandemic. Originality/value: It is hoped that the present study would make an invaluable contribution to existing research on education in general and on the quality of care in geriatric nursing as limited studies have been published so far. © 2022, Pei-Lun Hsieh, Shang-Yu Yang, Wen-Yen Lin and Tien-Chi Huang.

Using focus group interviews to investigate the willingness of medical personnel to voluntarily participate in COVID-19 group tasks in a one government quarantine facility in north Taiwan

Objectives: The Taiwan Centers for Disease Control have established government quarantine facilities (GQF) to prevent the community spread of COVID-19. Medical personnel are frontline workers who must have contact with individuals in quarantine and are thus at higher risk of infection. As a reference for future recruitment, this study investigated why some medical personnel volunteer to care for individuals in GQF. Methods: The researchers used purposive sampling to recruit participants from a GQF in northern Taiwan. Focus group interviews were administered. The consistency of the interview outline content was 91%. After the interviews, content analysis was performed to examine and summarize the data. The data were coded before comparison, categorization and summarization, producing various core categories. Results: A total of 12 participants voluntarily attended our interviews, compromising 4 men and 8 women, with an average age of 48.1 ±6.4 years and an average length of service in GQF of 82.1 ± 77.1 days. Our study results revealed four aspects and six reasons that affect the voluntary participation of medical personnel in epidemic prevention tasks. The first aspect was meeting safety needs, and the reasons included sufficient personal protective equipment, complete standard operating procedures, and orientation training and in-service education and training. The second aspect was meeting the needs of love and belonging, and the reason included a good working atmosphere. The third aspect was meeting the need for self-esteem, and the reason included Taiwan's previous SARS epidemic prevention experience. Finally, the fourth aspect was meeting the need for selfrealization, and the reason was based on the humanistic concern. Conclusions: At the time of the coronavirus outbreak, various countries reported insufficient medical personnel or personnel unwilling to participate in epidemic prevention work. Our results revealed that if the environment met the Maslow's hierarchy of needs, it can attract medical personnel to volunteer in GQF tasks. In formulating policies, the needs must be met at all levels, so that medical staff would be willing to participate in epidemic prevention work. © 2021 Chinese Public Health Association of Taiwan. All rights reserved.

Sequence-function correlation of the transmembrane domains in NS4B of HCV using a computational approach

An algorithm is applied to propose a sequence-function correlation of the transmembrane domains (TMDs) of the non-structural protein 4B (NS4B) of hepatitis C virus (HCV). The putative sequence of the TMDs is obtained using 20 available secondary structure prediction programs (SSPPs) with different lengths of the overall amino acid sequence of the protein as input. The results support the notion of four helical TMDs. Whilst the region of the first TMDs leaves room for speculation about an additional TMD, the other three TMDs are consistently predicted. Structural features and the role of each of the TMDs is proposed by applying pairwise sequence alignment using BLAST on the level (i) protein sequence alignment and consequent (ii) function-related alignment. Sequence identity with those TMDs of proteins involved in Ca-homeostasis and generation of replication vesicles, such as Nsp3 of corona viruses, murine coronavirus especially mouse hepatitis virus (MEW), middle east respiratory syndrome coronavirus (MERS), severe acute respiratory syndrome coronavirus (SARS-CoV) and SARS-CoV-2, are suggested. Focusing the search on those proteins in particular and their TMDs playing an active role in their mechanism of function, such as transporters, pumps, viral channel forming protein Vpu of human immunodeficiency virus type 1 (HIV-1) and mediators, suggests TMDs 2 and 4 to have functional roles in NS4B, as well as additionally TMD1 and 3 in case of vesicle formation.