MacEmerg Podcast: A Novel Initiative to Connect a Distributed Community of Practice.

BACKGROUND: Regional knowledge dissemination and information sharing is a challenge among physically divided groups of physicians. Many staff and resident physicians do not have easy access to share clinical and medical education and research information with each other in an academic setting. Our divisions of emergency medicine could benefit from a novel approach aimed at improving overall connection and collaborative engagement. INNOVATION: By harnessing the sociomateriality properties of podcasting, we could achieve the dual goals of better connecting our faculty as well as educating the audience on aspects of clinical practice and education that are especially relevant to our region. We sought to primarily draw on local expertise for content. We developed a standardized structure for our monthly releases, with each episode composed of a main faculty segment, a resident-focused segment, and a medical education segment. Accessibility to the podcast was maximized through its publication across multiple platforms and detailed individual show notes were made available. OUTCOMES: We applied logic model methodology with the intended goal of having much of our content consumed by local faculty and trainees. Using Web-based analytic data, we were able to ascertain the proportion and number of listens that occurred from within our local university-affiliated and/or catchment region. Episodes averaged 227.7 ± 67.2 listens with an overall 44.1% of those originating from within our defined region. REFLECTION: Given the number of regional listeners we are consistently reaching, we have been effective in serving to connect a widely distributed group of academic physicians. As we continue to grow the podcast, we plan on collecting quantitative data to better ascertain its effect on our stated goals.

Endotracheal intubation with barrier protection.

Given the high risk of healthcare worker (HCW) infection with COVID-19 during aerosol-generating medical procedures, the use of a box barrier during intubation for protection of HCWs has been examined. Previous simulation work has demonstrated its efficacy in protecting HCWs from cough-expelled droplets. Our objective was to assess its ability to protect HCWs against aerosols generated during aerosol-generating medical procedures. We used a battery-powered vapouriser to assess movement of vapour with: (1) no barrier; (2) a box barrier; and (3) a box barrier and a plastic sheet covering the box and patient's body. We visualised the trajectory of vapour and saw that the vapour remained within the barrier space when the box barrier and plastic sheet were used. This is in contrast to the box barrier alone, where vapour diffused towards the feet of the patient and throughout the room, and to no barrier where the vapour immediately diffused to the laryngoscopist. This demonstrates that the box with the plastic sheet has the potential to limit the spread of aerosols towards the laryngoscopist, and thus may play a role in protecting HCWs during aerosol-generating medical procedures. This is of particular importance in the care of patients with suspected COVID-19.

Studying with the cloud: the use of online Web-based resources to augment a traditional study group format.

Cloud-based applications such as Google Docs, Skype, Dropbox, and SugarSync are revolutionizing the way that we interact with the world. Members of the millennial generation (those born after 1980) are now becoming senior residents and junior attending physicians. We describe a novel technique combining Internet- and cloud-based methods to digitally augment the classic study group used by final-year residents studying for the Royal College of Physicians and Surgeons of Canada examination. This material was developed by residents and improved over the course of 18 months. This is an innovation report about a process for enhanced communication and collaboration as there has been little research to date regarding the augmentation of learner-driven initiatives with virtual resources.

Methadone dosing strategies in HIV-infected injection drug users enrolled in a directly observed therapy program.

OBJECTIVES: We have measured methadone dose adjustments and treatment responses after nevirapine (NVP)-, efavirenz (EFV)-, ritonavir-boosted lopinavir (LPV/r), or atazanavir (ATV; with or without ritonavir)-based highly active antiretroviral therapy (HAART) was initiated in injection drug users (IDUs). METHODS: We identified 120 IDUs receiving HAART and methadone within a directly observed therapy (DOT) program. Follow-up was according to clinical standards, with changes in methadone dose being made as required to achieve clinical stabilization within the first 3 months of HAART. RESULTS: The observed median methadone dose changes from baseline were 20 mg/d (P<0.001) in patients on NVP, with 32 (86%) of 37 patients requiring daily dose increases, and 7.5 mg/d (P=0.004) in patients on EFV, with 11 (61%) of 18 patients requiring daily dose increases. Conversely, median changes were 0 mg/d for patients on LPV/r (P=0.56) or ATV (P=0.95). Virologic suppression (HIV RNA<400 copies/mL) was achieved in 26 (70%) of 37, 12 (67%) of 18, 25 (76%) of 33, and 24 (75%) of 32 patients receiving NVP-, EFV-, LPV/r-, and ATV-based regimens, respectively (P=0.89). CONCLUSIONS: Although methadone-based DOT can be a successful tool for the coadministration of HAART, careful monitoring is required to ensure that methadone withdrawal does not adversely affect the goals of treatment, particularly when nonnucleoside reverse transcriptase inhibitors are used.

RIVETS: the recombinant immunoglobulin and viral epitope tag system.

The human monoclonal antibody 8F9 binds to a linear 10 amino acid epitope that is present within the N-terminal region of the gB envelope glycoprotein of HCMV. Here we show that this short sequence (ETIYNTTLKY) can function as a tag for the detection of recombinant proteins using antibody 8F9. The AD-2S1 tag was recognized by 8F9 whether present at the N- or C-terminus of recombinant proteins and tagged recombinant proteins could be quantified with multiple analytical techniques such as ELISA, western blotting, immunofluorescence and flow cytometry. Production of 8F9 using different constant regions or constant regions from different species enhances the convenience and range of use of this system which we term the Recombinant Immunoglobulin and Viral Epitope Tag System or RIVETS.

A point mutation in the Ch3 domain of human IgG3 inhibits antibody secretion without affecting antigen specificity.

Immunoglobulins (Ig) require correct folding and assembly of both heavy (H) and light (L) chains to form a functional H2L2 dimer that is secreted from plasma cells. This process is dependent upon the endoplasmic reticulum (ER) chaperone BiP, which targets improperly, folded or assembled Ig molecules for degradation. While investigating the mechanism of low IgG3 secretion, we identified a missense mutation L368P in the Ch3 region of the human gamma3 H-chain that was associated with impaired secretion of intact and functional Ig. The non-secreted H-chains displayed slower electrophoretic migration than secreted H-chains, consistent with them being glycosylated in the ER but not fully processed in the golgi apparatus and secretory pathway. Reversion of the mutated codon to wild type restored secretion of the IgG3, which displayed the same fine specificity for antigen as non-secreted IgG3. However, the non-secreted IgG3 was not opsonic in an in vitro phagocytosis assay. The results indicate that correct IgG3 Ch3 domain folding is essential for secretion and effective function but does not affect specificity for antigen.