Early Wave Research Articles

Exploring the effect of cryopreservation in assisted reproductive technology and potential epigenetic risk.

Since the birth of the first baby by in vitro fertilization in 1978, more than 9 million children have been born worldwide using medically assisted reproductive treatments. Fertilization naturally takes place in the maternal oviduct where unique physiological conditions enable the early healthy development of the embryo. During this dynamic period of early development major waves of epigenetic reprogramming, crucial for the normal fate of the embryo, take place. Increasingly, over the past 20 years concerns relating to the increased incidence of epigenetic anomalies in general, and genomic-imprinting disorders in particular, have been raised following assisted reproduction technology (ART) treatments. Epigenetic reprogramming is particularly susceptible to environmental conditions during the periconceptional period and non-physiological conditions such as ovarian stimulation, in vitro fertilization and embryo culture, as well as cryopreservation procedure, might have the potential to independently or collectively contribute to epigenetic dysregulation. Therefore, this narrative review offers a critical reappraisal of the evidence relating to the association between embryo cryopreservation and potential epigenetic regulation and the consequences on gene expression together with long-term consequences for offspring health and wellbeing. Current literature suggests that epigenetic and transcriptomic profiles are sensitive to the stress induced by vitrification, in terms of osmotic shock, temperature and pH changes, and toxicity of cryoprotectants, it is therefore, critical to have a more comprehensive understanding and recognition of potential unanticipated iatrogenic-induced perturbations of epigenetic modifications that may or may not be a consequence of vitrification.

Primary care in Northern Ontario for transgender people in the context of the COVID-19 pandemic: A qualitative secondary analysis.

To examine changes to primary care practice for transgender clients resulting from government mandated public health measures in response to COVID-19 in Northern Ontario. Secondary analysis of qualitative data using interview transcripts from a dataset that included 15 interviews conducted between October 2020 and April 2021. The dataset came from a convergent mixed method study exploring the delivery of primary care services to transgender individuals in Northern Ontario. Qualitative interviews with primary care practitioners including nurse practitioners, nurses, physicians, social workers, psychotherapists, and pharmacists providing care for transgender people in Northern Ontario were included in the secondary analysis. Fifteen primary care practitioner providing care to transgender individuals in Northern Ontario participated in the parent study. Practitioners described their understanding of the effect of the early stages of the COVID-19 pandemic changes on their practice and the care experience for their transgender patients. Two themes were identified and described by participants: (1) a change in the delivery of care; and (2) barriers and facilitators to care. Practitioners' primary care experiences in the early waves of COVID suggest the integral use of telehealth in Northern Ontario transgender care. Nurses working in advance practice and nurse practitioners are essential in providing continuity of care for their transgender clients. Identification of initial practice changes for the primary care of trans people will illuminate avenues for further research. The urban, rural, and remote practice settings in Northern Ontario provide an opportunity for increasing access for gender diverse people in these areas and for developing increased understanding of uptake of telemedicine practice. Nurses are integral to primary care for transgender patients in Northern Ontario.

Exaggerated myocardial torsion may contribute to dynamic left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

Dynamic left ventricular (LV) outflow tract obstruction (LVOTO) is associated with symptoms and increased risk of developing heart failure in hypertrophic cardiomyopathy (HCM). The association of LVOTO and LV twist mechanics has not been well studied in HCM. The aim of the study was to compare the pattern of LV twist in patients with HCM associated with asymmetrical septal hypertrophy with and without LVOTO. Echocardiography (including speckle tracking) was performed in 212 patients with HCM, divided according to the absence (n = 130) or presence (n = 82) of LVOTO (defined as peak pressure gradient ≥30 mmHg either at rest and/or with Valsalva manoeuvre). Patients with LVOTO were older, had smaller LV dimensions, a higher LV ejection fraction (LVEF), a longer anterior mitral valve leaflet length, and a higher early transmitral pulsed wave to septal tissue Doppler velocity ratio (E/E'). A univariate analysis showed that peak twist was significantly higher in patients with LVOTO compared with patients without LVOTO (19.7 ± 7.3 vs. 15.7 ± 6.0, P = 0.00015). Peak twist was similarly enhanced in patients with LVOTO, manifesting only during Valsalva (19.2 ± 5.6, P = 0.007) and patients with resting LVOTO (19.9 ± 8.0, P = 0.00004) compared with patients without LVOTO (15.7 ± 6.0). A stepwise forward logistic regression analysis showed that LVEF, LV end-systolic dimension indexed to body surface area, anterior mitral valve leaflet length, E/E', and peak twist were all independently associated with LVOTO. This study demonstrates that increased peak LV twist is independently associated with LVOTO in patients with HCM. Peak twist was similarly exaggerated in patients with only latent LVOTO, suggesting that it may play a contributory role to LVOTO in HCM.

Scalable Strategies to Increase Efficiency and Augment Public Health Activities During Epidemic Peaks.

Scalable strategies to reduce the time burden and increase contact tracing efficiency are crucial during early waves and peaks of infectious transmission. We enrolled a cohort of SARS-CoV-2-positive seed cases into a peer recruitment study testing social network methodology and a novel electronic platform to increase contact tracing efficiency. Index cases were recruited from an academic medical center and requested to recruit their local social contacts for enrollment and SARS-CoV-2 testing. A total of 509 adult participants enrolled over 19 months (384 seed cases and 125 social peers). Participants completed a survey and were then eligible to recruit their social contacts with unique "coupons" for enrollment. Peer participants were eligible for SARS-CoV-2 and respiratory pathogen screening. The main outcome measures were the percentage of tests administered through the study that identified new SARS-CoV-2 cases, the feasibility of deploying the platform and the peer recruitment strategy, the perceived acceptability of the platform and the peer recruitment strategy, and the scalability of both during pandemic peaks. After development and deployment, few human resources were needed to maintain the platform and enroll participants, regardless of peaks. Platform acceptability was high. Percent positivity tracked with other testing programs in the area. An electronic platform may be a suitable tool to augment public health contact tracing activities by allowing participants to select an online platform for contact tracing rather than sitting for an interview.

Clinico-Demographic Profiles of Herpes Zoster Cases in Patients With and Without COVID-19 Infection During the Pandemic: A Retrospective Analysis of 32 Cases.

Coronavirus disease 2019 (COVID-19) has multiple impacts on the human body. The immunological effect is one of the prominent ones, which is thought to be fundamental in many physical manifestations and disease severity. Herpes zoster (HZ) reactivation has been well-linked to immunity; immunocompromised states predispose a person to HZ. Studies have raised concerns about HZ incidences in COVID-19 patients; however, the clinical characteristics of the HZ cases among patients with and without COVID-19 are another area to be explored. In this retrospective analysis, we compared the clinical and demographic characteristics of HZ cases presented to our outpatient department immediately before and during the early second wave of the COVID-19 pandemic (September 2020 to April 2021) in India. The cases were divided into two groups based on the history of COVID-19 infections. The clinico-demographic characteristics were then compared using an unpaired t-test, Fisher's exact test, and analysis of variance as applicable using InStat software; a two-sided p-value <0.05 was considered significant. During the period, 32 cases (17 HZ cases with a history of COVID-19; 15 HZ cases without) were detected. The age and gender distribution were indifferent statistically. Our analysis showed that multi-dermatomal and disseminated involvements were significantly higher in HZ cases having a history of COVID-19. The present retrospective analysis of 32 cases indicates that persons who suffered from COVID-19 and presented with HZ were likely to have a higher chance of multi-dermatomal and disseminated involvement. While our analysis cannot establish a true association between COVID-19 infection and HZ reactivation, which will require a large-scale study, clinicians might get a clue of the possible progression of the extent of HZ manifestations from our findings.

Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%,P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%,P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%,P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%,P = 0.019). The hospital stay was significantly shorter (1day vs. 2days,P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB;P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.

Enhanced ocean wave modeling by including effect of breaking under both deep- and shallow-water conditions

Abstract. Accurate description of the wind energy input into ocean waves is crucial to ocean wave modeling and a physics-based consideration on the effect of wave breaking is absolutely necessary to obtain such an accurate description. This study evaluates the performance of an improved formula recently proposed by Xu and Yu (2020), who took into account not only the effect of breaking but also the effect of airflow separation on the leeside of steep wave crests in a reasonably consistent way. Numerical results are obtained through coupling an enhanced atmospheric wave boundary layer model with the ocean wave model WAVEWATCH III (v5.16). The coupled model has been extended to be valid in both deep and shallow waters. Duration-limited waves under controlled normal conditions and storm waves under practical hurricane conditions are studied in detail to verify the improved model. Both the representative wave parameters and the parameters characterizing the wave spectrum are discussed. It is shown that the improved source-term package for the wind energy input and the wave energy dissipation leads to more accurate results under all conditions. It performs evidently better than other standard source-term options of ST2, ST4 and ST6 embedded in WAVEWATCH III. It is also demonstrated that the improvement is particularly important for waves at their early development stage and waves in shallow waters.

External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study

BackgroundTools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification...

Somatosensory-Evoked Early Sharp Waves in the Neonatal Rat Hippocampus.

The developing entorhinal-hippocampal system is embedded within a large-scale bottom-up network, where spontaneous myoclonic movements, presumably via somatosensory feedback, trigger hippocampal early sharp waves (eSPWs). The hypothesis, that somatosensory feedback links myoclonic movements with eSPWs, implies that direct somatosensory stimulation should also be capable of evoking eSPWs. In this study, we examined hippocampal responses to electrical stimulation of the somatosensory periphery in urethane-anesthetized, immobilized neonatal rat pups using silicone probe recordings. We found that somatosensory stimulation in ~33% of the trials evoked local field potential (LFP) and multiple unit activity (MUA) responses identical to spontaneous eSPWs. The somatosensory-evoked eSPWs were delayed from the stimulus, on average, by 188 ms. Both spontaneous and somatosensory-evoked eSPWs (i) had similar amplitude of ~0.5 mV and half-duration of ~40 ms, (ii) had similar current-source density (CSD) profiles, with current sinks in CA1 strata radiatum, lacunosum-moleculare and DG molecular layer and (iii) were associated with MUA increase in CA1 and DG. Our results indicate that eSPWs can be triggered by direct somatosensory stimulations and support the hypothesis that sensory feedback from movements is involved in the association of eSPWs with myoclonic movements in neonatal rats.

Enhancing technical vocabulary acquisition: a multimedia strategic approach for English for specific purposes during COVID-19

ABSTRACT This study focuses on developing specific vocabulary learning strategies to assist the receptive knowledge of English for Specific Purposes (ESP). It aims to provide a practical framework for teaching technical vocabulary. The study introduced the Multimedia Strategic Vocabulary Learning (MSVL) model and investigated its effects on teaching technical vocabulary to pre-engineering students in online courses during the early wave of COVID-19. A total of 88 Saudi undergraduate students randomly assigned to control and experimental groups were treated with an intact pre-engineering ESP course for ten weeks. Vocabulary learning strategies from Schmitt's (1997) vocabulary taxonomy were adopted and incorporated into two stages of the vocabulary acquisition process. The experimental group was treated with the MSVL model through multimedia and explicit vocabulary learning instructions in online classes using Blackboard Learning Management System (LMS) to assist them with specialized vocabulary acquisition. The dependent measure in this study was the participants’ receptive knowledge of technical vocabulary, which was assessed using the pre-test, post-test, and delayed post-test. The findings indicated that using the MSVL model significantly improved the experimental group's receptive knowledge of technical vocabulary. This study's guidelines help educators create multimedia resources for ESP learners, preparing them for their professions.

Evaluation of wave-induced instability of nearly saturated sandy slopes under partially undrained condition: A case study of landslide in Fraser River delta front

A significant amount of Methane gas in soil deposits at Fraser River Delta (FRD), Canada, was identified as it adversely impacted the stability of the sloping seabed in the area under waves and tides. In this study, an integrated FEM model is utilized to investigate the instability of FRD front due to 1985 storm waves. Despite earlier studies that focused only on the role of residual pore pressure reached at late wave cycles in inducing the slide of FRD front (using empirical correlations), the transient response of sediments at early wave cycles is considered herein. The effect of coupled-flow-and-deformation processes within the sediments on the extent of the sliding plane is considered. For wave-seabed interaction modeling, Biot’s poroelasticity and linear wave theory are employed to represent the fluid and seabed domains, respectively. The slide evaluation of the sloping seabed is conducted using Strength Reduction Technique with Mohr-Coulomb failure criterion. The results indicate that the storm waves cause a shallow slide within the slope, and the proximity of the unsaturated layer to mudline exacerbated the instability condition. Moreover, instantaneous liquefaction zones are found to emerge away from the slope; thus, they may not lead to an exacerbated sliding of the slope.

Dynamics of spatially confined ns laser induced atmospheric air plasma and shock waves: visualization vis-à-vis validation

A clear visualization of the physical processes of spatially confined ns laser induced atmospheric air plasma within a rectangular glass cavity using optical imaging is presented. The occurrence of various processes starting from the early plasma and shock wave expansion dynamics to shock reflection at the cavity boundaries and compression of the plasma due to reflected shockwaves is studied using defocused shadowgraphy and self-emission imaging techniques. Experimentally, we evidenced that the counter propagating reflected primary shockwaves interact with the expanding plasma generating a secondary shockwave which compresses the plasma core, modifying the plasma morphology resulting in enhanced plasma parameters. The numerical simulations performed via the two-dimensional hydrodynamic (2D-HD) FLASH codes, revealed that the number density increases up to a maximum of 3.6 times compared to the unconfined plasma. The input laser pulse energy and the aspect ratio of the cavity is observed to play a dominant role in the confinement and compression of the plasma.

Biological sex influences aortic hemodynamic responses to maximal exercise in healthy older adults

Aging is associated with stiffening of large elastic arteries resulting in early wave reflection, which increases aortic systolic blood pressure (BP) and left ventricular afterload. These age-related alterations predispose older adults to cardiovascular disease (CVD). Exercise is recommended for reducing CVD risk in older adults, but the acute aortic hemodynamic responses to exercise have not been fully described. We have previously shown that exercise intensity influences acute aortic hemodynamic responses to submaximal exercise in older adults, however, the responses to maximal exercise have not been investigated. In young adults, the influence of maximal exercise on aortic wave characteristics is impacted by sex. Therefore, the objective of this study was to investigate the acute effects of maximal exercise on aortic wave characteristics in healthy older adults and to test the hypothesis that the acute aortic hemodynamic responses to maximal exercise will be influenced by sex. Twenty-two older men and postmenopausal women (66.4±1.0 yrs, mean±SE, 11M/11W) completed the study. Research participants were free of major clinical disease, were not using hormone replacement therapy or participating in endurance exercise training. Aortic wave characteristics were assessed using wave separation analysis (SphygmoCor XCEL) before and immediately after maximal exercise, based on a modified Balke treadmill test. We found that wave reflection, assessed as augmentation index (AIx) at heart rate of 75 bpm (AIx@75), was not different between older men and women prior to maximal exercise ( P=0.2). Following maximal exercise, AIx@75 increased in older men (21.1±2.6 vs. 28.2±2.4 %, pre- vs. post-exercise, P=0.02) and women (27.4±3.3 vs. 33.9±3.2 %, P=0.03), but the response was not influenced by sex ( P=0.9 for sex × time interaction). Aortic systolic and diastolic BP (AoSBP and AoDBP) were not different in older men compared with women prior to maximal exercise ( P≥0.4). In response to maximal exercise, AoSBP and AoDBP significantly increased in older men (AoSBP: 113±3 vs. 118±2 mmHg, P=0.01 and AoDBP: 75±2 vs. 80±2 mmHg, P&lt;0.01), but not in women (AoSBP: 113±4 vs. 113±4 mmHg, P=0.9; P=0.04 for sex × time interaction and AoDBP: 73±2 vs. 74±2 mmHg, P=0.054; P=0.02 for sex × time interaction). In conclusion, sex influences the aortic BP response to maximal exercise, but not the wave reflection response in older adults. This finding suggests that left ventricular afterload remains elevated during recovery from maximal exercise in older men which may differentially expose them to a transient risk of experiencing a cardiac complication. This work was supported by National Institute of Aging grant AG063143. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Deciphering influencing processes in a tropical delta system (middle-late Eocene? to Early Miocene, Colombian Caribbean): Signals from a well-core integrative sedimentological, ichnological, and micropaleontological analysis

Deltaic depositional systems are characterized by a complex interaction of physical, chemical, and biological factors. Although fluvial-, wave- and tidal-dominated deltaic environments have been extensively studied, evaluation of the processes in tropical mixed sedimentary systems has not been fully documented. Tropical regions with active margins are tectonic environments where these multiple factors act on the development of coastal systems. An onshore well-core from this tropical setting (Sinú-San Jacinto Basin, Colombian Caribbean) revealed that a middle-upper Eocene?-lower Oligocene coarse-grained deltaic setting is replaced by a thick coal-bearing mixed-energy fine-grained deltaic succession from the Oligocene to Early Miocene. The integrated analysis of facies associations, ichnological data, and terrestrial/marine micropaleontological assemblages (palynomorphs, foraminifera, and calcareous nannofossils) of this well-core allowed us to identify changes in dominance and influence of coastal processes (fluvial-, wave- and tide) and shoreline evolution. Using this information, as well as the sediment supply and accommodation space ratio, we were able to distinguish three intervals from the bottom to the top of the siliciclastic succession: (i) middle-late Eocene?–early Oligocene, prograding, fluvial-dominated, wave- and tide-influenced coarse-grained deltas with amalgamation of hyperpycnal-dominated mouth bars with hyperconcentrated flow input, (ii) Oligocene, retrograding to prograding, hyperpycnal-dominated heterolithic delta deposits punctuated by transgressive pulses, and (iii) late Oligocene to Early Miocene, aggradational, coal-bearing fine-grained delta plain with a higher proportion of transgressive phases over the continental environment. The complete succession represents long-term (∼14 Myr) mixed-energy nearshore siliciclastic systems, showing different lithological arrangements and sedimentation styles. A long-term evolution is observed from a middle-late Eocene? steep, short and coarse-grained sedimentary system with tropical humid lowland forest and punctual development of macrobenthic tracemaker communities (Interval I) to an Early Miocene gently (poorly drained), well-developed delta plain with mangroves and wave- and storm-influence record through trace fossils assemblages (Interval III). A combination of factors, including subsidence, relief uplifting, and possible relative sea level changes, are interpreted as the main controls on the stratigraphic evolution of sedimentary styles throughout the entire succession. Minor-order sedimentary successions into each interval (e.g., prograding distributary mouth-bar channel) revealed short-term cycles presumably controlled by an internal delta dynamic. Multidisciplinary analysis is essential for recognizing the influence of fluvial, wave, and tidal processes on tropical deltas, where high spatial and temporal variability makes it difficult to determine dominant processes for long periods of time.

Clinical courses of 24,563 hospitalized COVID-19 patients during the first 12 months of the pandemic in the Central City of Iran

This study was designed and implemented to analyze and establish documents related to the above cases in the first to third COVID-19 epidemic waves for the use of researchers and doctors during and after the epidemic. The current case series study was conducted on 24,563 thousand hospitalized COVID-19 patients by examining their clinical characteristics within a one-year period from the beginning of the pandemic on 02.22.2020 to 02.14.2021, which included the first to the third waves, based on gender and severity of COVID-19. The mean age of the participants was 56 ± 20.71, and 51.8% were male. Out of a total of 24,563 thousand hospitalized COVID-19 patients until February 2021, there were 2185 mortalities (9.8%) and 2559 cases of severe COVID-19 (13.1%). The median length of hospitalization from the time of admission to discharge or death in the hospital (IQR: 13–41) was estimated to be 21 days. The rate of hospital mortality was higher in severe (37.8%) than in non-severe (4.8%) cases of COVID-19, While the risk of severe cases increased significantly in the third (HR = 1.65, 95% CI: 1.46–1.87, P < 0.001) and early fourth waves (HR = 2.145, 95% CI: 1.7–2.71, P < 0.001). Also, the risk of contracting severe COVID-19 increased significantly in patients aged ≥ 65 years old (HR = 2.1, 95% CI 1.1.93–2.72, P < 0.001). As shown by the results, the rates of hospital mortality (9.3% vs. 8.5%) and severe cases of COVID-19 (13.6% vs. 12.5%) were higher among men than women (P < 0.01). In our study, the mortality rate and severity of COVID-19 were within the scope of global studies. Men experienced higher severity and mortality than women. The was a significantly higher prevalence of old age and underlying diseases in individuals with severe COVID-19. Our data also showed that patients with a previous history of COVID-19 had a more severe experience of COVID-19, while most of these patients were also significantly older and had an underlying disease.

Gametogenesis in two-year-old Siberian sturgeon hybrids in industrial fish farming

The paper presents a comparison of gonad development of two-yearold Siberian sturgeon × Amur sturgeon interspecific hybrid and Siberian sturgeon × Kaluga fish interspecific hybrid bred using a combination technology with a twoyear cycle in a recirculating aquaculture system of the Experimental Selection and Breeding Farm “Yakot” and in flow-through tanks at the Konakovo Division of the Branch for Freshwater Fisheries of the Federal State Budget Scientific Institution “Russian Federal Research Institute of Fisheries and Oceanography” (VNIIPRKH). To determine the synchronism of gonad development, a histological analysis of cranial, medial, and caudal portions of the testes and ovaries was performed at the end of breeding, with a thermal constant of 12,217 degree days. The study of gametogenesis in SS×KF and SS×AS hybrids showed that gonad maturity in the two-yearold hybrids corresponded to early maturity stage II. An examination of germ cell development in the left and right gonads during the early stages of gametogenesis revealed a similar pattern. The hybrids showed normal gonad development early in maturity. In females, the main parameter is cytological sex determination: the presence of zygotene oocytes and single-layer follicle basophilic oocytes. In males, secondary sperm cell multiplication occurs in the forming cysts. Early spermatogenic wave is observed in some cases, which suggests normal germ cell development in the studied hybrids. The studies show normal reproductive system development in females and males of the studied SS×KF and SS×AS hybrids at the age of two years.

A machine learning approach to predict self-protecting behaviors during the early wave of the COVID-19 pandemic

Using a unique harmonized real‐time data set from the COME-HERE longitudinal survey that covers five European countries (France, Germany, Italy, Spain, and Sweden) and applying a non-parametric machine learning model, this paper identifies the main individual and macro-level predictors of self-protecting behaviors against the coronavirus disease 2019 (COVID-19) during the first wave of the pandemic. Exploiting the interpretability of a Random Forest algorithm via Shapely values, we find that a higher regional incidence of COVID-19 triggers higher levels of self-protective behavior, as does a stricter government policy response. The level of individual knowledge about the pandemic, confidence in institutions, and population density also ranks high among the factors that predict self-protecting behaviors. We also identify a steep socioeconomic gradient with lower levels of self-protecting behaviors being associated with lower income and poor housing conditions. Among socio-demographic factors, gender, marital status, age, and region of residence are the main determinants of self-protective measures.

Impact of early waves of the COVID-19 pandemic on family medicine residency training: Analysis of survey data.

To identify how graduating and incoming family medicine residents (FMR) experienced changes to their education during the early waves of the COVID-19 pandemic. The Family Medicine Longitudinal Survey was modified with questions related to the impact of COVID-19 on FMR and their training. Short-answer responses underwent thematic analysis. Responses to Likert scale and multiple-choice questions were reported as summary statistics. Department of Family and Community Medicine at the University of Toronto in Ontario. Graduating FMR in spring 2020 and incoming FMR in fall 2020. Residents' perceptions of the impact of COVID-19 on clinical skills acquisition and preparedness for practice. Surveys response rates were 124 of 167 (74%) and 142 of 162 (88%) for graduating and incoming residents, respectively. Important themes for both cohorts included reduced access to clinical environments, reduced patient volumes, and lack of exposure to procedural skills. While the graduating cohort indicated they felt confident to begin practising family medicine, they described being impacted by the loss of a tailored learning environment, including canceled or altered electives. In contrast, incoming residents reported the loss of core skills, such as physical examination competency, as well as the loss of face-to-face communication, rapport, and relationship-building opportunities. However, both cohorts endorsed gaining new skills during the pandemic, including conducting telemedicine appointments, pandemic planning, and interfacing with public health. Based on these results, residency programs can specifically tailor solutions and modifications to address common themes across cohorts to facilitate optimal learning environments in pandemic times.

COVID-19 Crisis Management Left Tacit Knowledge Behind

As the COVID-19 pandemic raged throughout New York City and its surrounding suburbs, more than 500,000 positive cases and 30,000 deaths were recorded between early March and early May 2020. In response, built environment firms were forced to confront uncertainty, shift mindsets, and embrace new workflows to remain viable in the face of city and state mandatory stay-at-home orders and curfews. This required the creation of new internal processes for document dissemination. Firms focused on alleviating clients’ concerns and boosting productivity by providing information, a hierarchy of business processes, and new codes of conduct. Utilizing case study methodology, this evolution at one architecture firm was tracked. Semi-structured interviews before and after the early wave of the pandemic clarified and verified findings. Participants were asked probing follow-up questions to better understand the impacts, especially regarding tacit knowledge. The firm’s efforts were optimized, but tacit knowledge sharing disappeared. Once this form of knowledge sharing was highlighted, participants acknowledged the loss and speculated about how to address this critical activity moving forward.

QBO/Solar Influences on the Tropical Madden‐Julian Oscillation: A Mechanism Based on Extratropical Wave Forcing in Late Fall and Early Winter

AbstractPossible sources of the observed modulation of the tropical Madden‐Julian oscillation (MJO) by the stratospheric quasi‐biennial oscillation (QBO) and the 11‐year solar cycle are investigated using 41 years of reanalysis data and archived climate model data. Larger upward fluxes of extratropical planetary‐scale waves, leading in some cases to sudden stratospheric warmings (SSWs), are observed in late fall and early winter during the easterly phase of the QBO than during the westerly phase (the “Holton‐Tan effect”). A similar but smaller increase occurs, on average, during solar minima relative to solar maxima. In addition to the warming at high latitudes, extratropical wave forcing events produce cooling and reduced static stability in the tropical lower stratosphere. Here, it is found that if SSWs occur in early winter (before ∼mid‐January), the reduced static stability produces, on average, a statistically significant, lagged strengthening of the MJO. This therefore represents a possible mechanism for producing, or at least enhancing, the observed QBO and solar modulations of the MJO in boreal winter. An initial analysis of archived climate model data shows that at least one model version with realistic QBO and solar forcing and with 4 CO2 forcings partly simulates both of these characteristics (QBO/solar modulation of early winter wave forcing and lagged strengthening of the MJO following early winter SSWs). However, the modeled MJO is insufficiently sensitive to QBO‐induced static stability reductions, precluding simulation of the QBO‐MJO connection.