Formal Report Research Articles

Entomopathogenic fungi (Ascomycota: Hypocreales) on a termite (Blattodea: Mastotermitidae) trapped in Miocene amber from Chiapas, Mexico

ABSTRACT Palaeomycological material has rarely been reported in Mexican localities, especially parasitic fungi. In this paper, we present the first formal report of an interaction between an entomopathogenic fungus and an insect trapped in the Miocene amber from Chiapas, Mexico. The described syninclusion corresponds to two well-developed fungal fruiting bodies and a third one in development, assigned to the order Hypocreales (Ascomycota: Sordariomycetes), emerging from the thorax and abdomen of a termite (Blattodea: Mastotermitidae). This syninclusion represents a remarkable example of biological interactions in ancient tropical environments reflected in the fossil record.

Orelabrutinib, Fludarabine, Cyclophosphamide, and Obinutuzumab (OFCG) for First-Line Treatment of Chronic Lymphocytic Leukemia: A Multicenter, Investigator-Initiated Study (cwCLL-001 Study)

Background: A phase II trial has shown, first-line treatment with iFCG (ibrutinib, fludarabine, cyclophosphamide, and obinutuzumab) led to a bone marrow (BM) undetectable minimal residual disease (uMRD) rate of 98% (44/45) as best response in treatment-naïve patients with chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL). But this study[1] does not include patients with unmutated immunoglobulin heavy⁃chain variable region gene ( IGHV) and/or del(17p)/ TP53 mutation, and ibrutinib was the first generation BTK (BTKi) which had relatively high off-target adverse effects (AEs). Our study has demonstrated the efficacy and safety of the second generation BTKi orelabrutinib in patients with relapsed/refractory CLL [2]. Therefore, we used orelabrutinib (O), and initiated the phase II OFCG trial in younger, fit patients with previously untreated CLL/SLL unrestricted by IGHV mutation status and del(17p)/ TP53 aberrations (cwCLL-001 study, NCT05322733). Methods：This is a multicenter, open-label, non-randomized phase II study for previously untreated patients with CLL/SLL without restriction by del(17p)/ TP53 aberrations and/or IGHV mutation status. A 7-day lead-in period with single-agent oral orelabrutinib（150 mg daily）was given in all patients, followed by OFCG regimen which consisted of orelabrutinib, intravenous Obinutuzumab, fludarabine and cyclophosphamide for up to three 28-day cycles. MRD was detected by 8 multi-color flow cytometry (FCM) at 10 -4 sensitivity and cloneSEQ using NGS (next generation sequencing) assay with a sensitivity of up to 10 −6. If the patients could achieve undetectable MRD in BM, they will discontinue FC and receive 3 cycles of OG (orelabrutinib and obinutuzumab). Otherwise, the patients will receive another 3 cycles of OFCG. Patients will discontinue obinutuzumab if they achieve BM uMRD after 6 cycles and continue six additional cycles of orelabrutinib; all other patients will receive six cycles of OG. Patients who achieved BM uMRD after 12 cycles discontinue all treatments, otherwise will continue orelabrutinib for up to additional 1 year (Fig. 1). The primary endpoint is the percentage of uMRD in BM after 6 cycles by FCM (at 10 -4 sensitivity). The secondary endpoint is the percentage of uMRD in BM and peripheral blood (PB) at other key time points by FCM, best overall response rate (ORR), complete response rate (CRR), progression-free survival (PFS), 2- and 3-year PFS rate, duration of response (DOR), overall survival (OS), 3-year OS rate as well as safety. The percentage of uMRD by NGS is an exploratory endpoint. Results：From 30 May 2022 to 30 Jun 2023, 25 patients were enrolled. Median age was 49 years old (range, 23-62). Unmutated IGHV, TP53 mutation/del(17p) and del(11q) were detected in 56.5% (13/23), 16.0% (4/25), and 24.0% (6/25) of patients, respectively. At data cut off (30 Jun 2023), 19 patients completed 3 cycles of OFCG and were evaluable. 75% (15/20, 1 patient who off study was assessed at the end of C2 cycle) of patients achieved PB uMRD and 57.9% (11/19) achieved BM uMRD by FCM, ORR and CR/CRi rate was 100% (18/18) and 38.9% (7/18) (Fig. 2). One patient died after cycle 3 due to COVID-19 infection. 16 patients completed 6 cycles, 14 of them were evaluable and achieved deeper response irrespective of different strategies during cycle 4 to 6, PB uMRD and BM uMRD was 100% (14/14) and 85.7% (12/14) by FCM, and the ORR and CRR was 100% (14/14) and 57.1% (8/14), respectively. In IGHV unmutated subgroup, ORR was 100% (10/10) with 50% (5/10) CRR, 87.5% (7/8) patients achieved BM uMRD by FCM after cycle 6. The results of MRD response by NGS assay will be presented in the formal report. 91.7% patients experienced at least one treatment emergent AE at the data cutoff. Most AEs were mild and tolerable. The most frequent AEs (≥10% of any grade) were neutropenia, leukopenia and thrombocytopenia. No bleeding or cardiovascular AEs greater than grade 3 occurred in these patients. Overall, OFCG demonstrated a favorable safety profile. Conclusion：This is the first clinical trial exploring the efficacy and safety of the second generation BTKi plus chemoimmunotherapy in patients with CLL. The OFCG regimen shows a rapid and deep molecular remission with a pleasant safety profile in the TN CLL patients including the ones with unfavorable factors.

Multi-Hit TP53 Mutations in Myeloid Neoplasms: Prognostic Impact of Morphologic Subtype Designation and Variant Allele Frequency

Background: Biallelic TP53 alterations result from either sequence variations or deletions involving TP53 and are not necessarily synonymous with “multi-hit TP53”. According to the 2022 international consensus classification (ICC) for myeloid neoplasms (MN), multi-hit TP53 signifies i) the presence of two or more distinct TP53 mutations, each with variant allele frequency (VAF) ≥10%, ii) a single TP53 mutation with VAF ≥50%, or iii) a single TP53 mutation with VAF ≥10% accompanied by a cytogenetically-apparent del(17p13.1), copy-neutral loss of heterozygosity (LOH) at the 17p TP53 locus, or, in the absence of LOH information, complex karyotype ( Arber et al. Blood 2022;140: 1200). The current study is focused on MN with multi-hit TP53 and examines the additional prognostic impact of morphologic subtype designation, bone marrow (BM) or peripheral blood (PB) blast percentage, TP53 VAF, and MN with diagnostic qualifiers (i.e., therapy-related, or secondary progressing from myelodysplastic/myeloproliferative/overlap syndromes/neoplasms). Methods : The current study was conducted under an institutional review board approved minimum risk protocol that allowed retrospective collection and analysis of data from Mayo Clinic patient records. Multi-hit TP53 was defined as per ICC criteria as outlined above ( Arber et al. Blood 2022;140: 1200). Morphologic subtype designations of MN were according to ICC criteria and assigned at the time of TP53 detection. NGS and cytogenetic information was available in all study patients. Survival analyses were calculated from time of TP53 mutation detection. Conventional statistical methods were applied using JMP Pro 16.0.0 software (SAS Institute, Cary, NC, USA). Results : Initial screening flagged 143 patients with biallelic TP53 abnormalities derived from formal laboratory reports of NGS data and cytogenetic studies; of these, 130 met ICC criteria for multi-hit TP53: pure erythroid leukemia (PEL; N=24), acute myeloid leukemia (AML)-not PEL (N=54), myelodysplastic syndromes (MDS; N=36), MDS/AML (N=11), and other MN (N=5). Of these 130 informative cases, 128 (98%) harbored complex/monosomal karyotype (CK/MK). Further analysis excluded patients with “other” MN (N=5) and those without CK/MK (N=2), the latter to mitigate the confounding effect of CK/MK on survival and the former because of small sample size and disease heterogeneity. Clinical and laboratory characteristics of the 124 study patients are outlined in table 1. Survival analysis stratified by ICC-defined MN subtypes revealed the prognostic relevance of morphological distinction between PEL vs “AML-not PEL” (p<0.01; HR 2.4) and PEL vs “ TP53-muated MDS/AML” (p=0.02; HR 2.3) while survival was similar between “AML-not PEL” and “ TP53-mutated MDS/AML” (p=0.9; Figure 1a). Survival in “ TP53-mutated MDS” was significantly longer, compared to PEL (p<0.01; HR 0.2), “ TP53-mutated AML-not PEL” (p=0.01; HR 0.5), and “ TP53-mutated MDS/AML” (p=0.07; HR 0.5), the latter with borderline significance (Figure 1a). Multivariable analysis confirmed the independent prognostic relevance of ICC subtype designation (p<0.01) and also revealed additional negative prognostic contribution from advanced age (p=0.02), male gender (p=0.02), MN, secondary (p<0.01), MN, therapy-related (p=0.03), and DNMT3A mutation (p=0.02). Significance was retained in all instances, with the exception of MN, therapy-related (p=0.15), when analysis was repeated after excluding PEL cases (Figure 1b). Conclusions : The current study confirms the prognostic validity of the ICC morphologic subtype designation and TP53 VAF classification threshold, in the context of multi-hit TP53. The study also highlights the prognostic distinction between PEL and “ TP53-mutated AML-not PEL” and the prognostic alignment between the latter and “ TP53-muated MDS/AML”, both of which displayed inferior survival, compared to “ TP53-mutated MDS”. The study also suggests additional prognostic contribution from secondary and therapy-related qualification while the observation regarding DNMT3A mutation requires validation with higher number of informative cases.

Retrospectively assessing evaluation and management of artificial-intelligence detected nodules on uninterpreted chest radiographs in the era of radiologists shortage

PurposeHigh volumes of chest radiographs (CXR) remain uninterpreted due to severe shortage of radiologists. These CXRs may be informally reported by non-radiologist physicians, or not reviewed at all. Artificial intelligence (AI) software can aid lung nodule detection. Our aim was to assess evaluation and management by non-radiologists of uninterpreted CXRs with AI detected nodules, compared to retrospective radiology reports. Materials and methodsAI detected nodules on uninterpreted CXRs of adults, performed 30/6/2022–31/1/2023, were evaluated. Excluded were patients with known active malignancy and duplicate CXRs of the same patient. The electronic medical records (EMR) were reviewed, and the clinicians' notes on the CXR and AI detected nodule were documented. Dedicated thoracic radiologists retrospectively interpreted all CXRs, and similarly to the clinicians, they had access to the AI findings, prior imaging and EMR. The radiologists' interpretation served as the ground truth, and determined if the AI-detected nodule was a true lung nodule and if further workup was required. ResultsA total of 683 patients met the inclusion criteria. The clinicians commented on 386 (56.5%) CXRs, identified true nodules on 113 CXRs (16.5%), incorrectly mentioned 31 (4.5%) false nodules as real nodules, and did not mention the AI detected nodule on 242 (35%) CXRs, of which 68 (10%) patients were retrospectively referred for further workup by the radiologist. For 297 patients (43.5%) there were no comments regarding the CXR in the EMR. Of these, 77 nodules (11.3%) were retrospectively referred for further workup by the radiologist. ConclusionAI software for lung nodule detection may be insufficient without a formal radiology report, and may lead to over diagnosis or misdiagnosis of nodules.

Unveiling the landscape: Investigating education, skills, job description, and challenges in sonography professions and framework development

IntroductionThis paper discusses the current medical sonographer status in the United Arab Emirates (UAE). The paper explores the current education, skills, job description, and challenges towards developing sonography professions and a sonographer framework. MethodsThe study employed a quantitative descriptive research approach using a cross-sectional study design to collect and analyse data from sonographers in the UAE. Data was collected through a structured survey that included sections addressing demographic information, education, skills, current practices, and challenges. ResultsThe data showed a relatively even distribution across different age groups, with a higher proportion falling in the 31–40 age range. Females constitute a slightly higher percentage (55.9 %) than males (44.1 %). The study found that sonographers have the necessary skills and knowledge to interpret the scan results and provide a formal report. A significant percentage of participants taught ultrasound to others and participated in research activities. The survey responses indicate difficulty in reporting sonograms. ConclusionsThe study found that sonographers possess the necessary expertise and skills to pass on their knowledge to trainees and colleagues. The participants expressing a desire to increase their knowledge and skills indicate that sonographers recognised that continuous professional development is crucial for staying updated with advancements in the field. The participant's “Advanced Practitioners” title recommendation suggests a desire for professional recognition, career progression, and specialisations in sonography. Effective interdisciplinary collaboration is important for providing quality patient care. Implication for practiceThe paper emphasises the importance of recognising sonography as a vital healthcare profession. It aims to raise awareness about the crucial role of sonographers in patient care. The study also stresses the need for a well-defined career progression framework to guide professional growth and acknowledgement.

Sky-High Safety? A Qualitative Study of Physicians' Experiences of Patient Safety in Norwegian Helicopter Emergency Services.

Patients treated and transported by Helicopter Emergency Medical Services (HEMS) are prone to both flight and medical hazards, but incident reporting differs substantially between flight organizations and health care, and the extent of patient safety incidents is still unclear. A qualitative descriptive study based on in-depth interviews with 8 experienced Norwegian HEMS physicians from 4 different bases from February to July 2020 using inductive qualitative content analysis. The study objectives were to explore the physicians' experience with incident reporting and their perceived areas of risk in HEMS. The HEMS physicians stated that the limited number of formal incident reports was due to the "nature of the HEMS missions" and because reports were mainly relevant when deviating from procedures, which are sparse in HEMS. The physicians preferred informal rather than formal incident reporting systems and reporting to a colleague rather than a superior. The reasons were ease of use, better feedback, and less fear of consequences. Their perceived areas of risk were related to all the phases of a HEMS mission: the physician as the team leader, medication errors, the handover process, and the helicopter as a work platform. The sparse, informal, and fragmented incident reporting provides a poor overview of patient safety risks in HEMS. Focusing on organizational factors and system responsibility and research on environmental and contextual factors are needed to further improve patient safety in HEMS.

Prevalence of metabolic syndrome and metabolic dysfunction-associated fatty liver disease in Malaysia 2023: study protocol for a community-based nationwide cross-sectional survey

IntroductionMetabolic syndrome (MetS) is a cluster of cardio-metabolic dysfunctions characterised by increased fasting plasma glucose, waist circumference, blood pressure, triglycerides and reduction in high-density lipoprotein cholesterol. Meanwhile, metabolic dysfunction-associated fatty...

To assess the knowledge and attitudes about depression in the general population in the Wardha District, India.

Background: Physical symptoms of depression, especially tiredness, pain, or disturbed sleep, are common. Some people may experience depression as a chronic condition, with more episodes increasing the risk of recurrence. Others may experience a single episode of depression in their lifetime. Given its great incidence and crippling consequences on development, early-onset depression is regarded as one of the most common mental illnesses in children and adolescents which can last into adulthood. The following categories can be used to classify the factors that affect depression susceptibility: genetics, familial environment, individual characteristics, and extreme stress. Gender, history of depression in the family, subclinical symptoms, poor cognitive style, and negative life events are also main risk factors. Methods: This protocol is for an observational study, which will take place over a four month period in the Wardha district. Participants will be recruited via the Acharya Vinoba Bhave Rural Hospital (AVBRH) as a medical center from the general population. A piloted questionnaire with a Likert scale will be completed by the participants enrolled in the study with assistance from interviewers. Frequency percentage, mean, and SD will be calculated to understand the relationship between various demographic variables and knowledge. Chi-square tests will also be used. Distribution: The data collection of this study is supposed to be completed August 2023 and the results will be communicated to the external funding body through formal report. In addition, the trial results will be communicated to the public through publishing as dataset and original research published in the relevant scientific journals.

First report of Robbsia andropogonis causing bacterial leaf spot of bougainvilleas in Taiwan.

Bougainvilleas (Bougainvillea spp.) are popular ornamentals commonly grown as bushes, vines, or trees worldwide (Kobayashi et al. 2007). Leaf spot symptoms were observed on a bougainvillea hedge located in North District, Taichung, Taiwan during August of 2022. The lesions were brown, necrotic and had yellow halos (Fig. S1). All the plants at the location showed similar symptoms. Leaf samples were collected from five plants and symptomatic tissues were minced in 10 mM MgCl2. The samples were streaked onto nutrient agar (NA) and after culturing at 28°C for 2 days, small, round, creamy white colonies were consistently isolated from all the samples. A total of five strains (BA1 to BA5) were obtained; each of them was isolated from a different plant. All five strains induced hypersensitive response in tobacco leaves. Amplification and sequencing of the isolated strains' 16S rDNA using primers 27F and 1492R (Lane 1991) revealed that all five strains shared identical sequences (GenBank accession no. OQ053015) with Robbsia andropogonis LMG 2129T (formerly Burkholderia andropogonis and Pseudomonas andropogonis; GenBank accession no. NR104960; 1,393/1,393 bp). Further testing of BA1 to BA5's DNA samples using the pathogen's species-specific primers Pf (5'-AAGTCGAACGGTAACAGGGA-3') and Pr (5'-AAAGGATATTAGCCCTCGCC-3'; Bagsic et al. 1995) successfully amplified the expected 410-bp amplicon in all five samples; the sequences of the PCR products completely matched to those of BA1 to BA5's 16S rDNA. Strains BA1 to BA5 also tested negative for arginine dihydrolase and oxidase activity, and failed to grow at 40°C, all of which are consistent with descriptions of R. andropogonis (Schaad et al. 2001). Pathogenicity of the isolated bacteria was confirmed by spray inoculation. Three representative strains, BA1 to BA3, were used for the assay. Bacterial colonies were scraped from NA plates and suspended in 10 mM MgCl2 added with 0.02% Silwet L-77. The concentrations of the suspensions were adjusted to 4.4-5.8 x 108 cfu/ml. The suspensions were sprayed onto three-month-old, cutting-propagated bougainvillea plants (to runoff). Controls were treated with bacteria-free solutions. Three plants were used for each treatment group (and the controls). The plants were placed in a growth chamber (27/25°C, day/night; 14-hour photoperiod) and bagged for three days. Within 20 days post inoculation, brown, necrotic lesions resembling those observed in the sampling site were observed on all inoculated plants, but not on the controls. One strain was re-isolated for each treatment group and the re-isolated strains all shared the same colony morphology and 16S rDNA sequence with BA1 to BA5. Additional PCR testing of these re-isolated strains using Pf and Pr also produced the expected amplicon. This is the first formal report of R. andropogonis affecting bougainvilleas in Taiwan. The pathogen has been reported causing diseases of betel palm (Areca catechu), corn and sorghum in Taiwan (Hseu et al. 2007; Hsu et al. 1991), some of which are economically important (Lisowicz 2000; Navi et al. 2002). As such, infected bougainvilleas could potentially serve as an inoculum source for these diseases.

INCIDENTAL FINDINGS AND CLINICAL SIGNIFICANCE OF PREOPERATIVE CT IMAGING FOR THE PLANNING OF ROBOTIC ARTHROPLASTY

AbstractIntroductionTotal joint arthroplasty (TJA) is one of the commonest and most successful orthopaedic procedures, used for the management of end-stage arthritis. With the recent introduction of robotic assisted joint replacement, Computed Tomography (CT) has become part of required pre-operative planning.The aim of this study is to quantify and characterise incidental CT findings, their clinical significance, and their effect on planned joint arthroplasty.MethodologyAll consecutive patients undergoing an elective TJR (hip or knee arthroplasty) were retrospectively identified, over a 3-year period (December 2019 and December 2022). Data documented and analysed included patient demographics, type of joint arthroplasty, CT findings, their clinical significance, as well as potential delays to the planned arthroplasty because of these findings and subsequent further investigation.ResultsA total of 624 patients (637 studies, 323 (51.8%) female, 301 (48.2%) male) were identified of which 163 (25.6%) showed incidental findings within the long bones or pelvis. Of these 52 (8.2%) were significant, potentially requiring further management, 32 (5.0%) represented potential malignancy and 4 (0.6%) resulted in a new cancer diagnosis.ConclusionIt is not currently national standard practice to report planning CT imaging as it is deemed an unnecessary expense and burden on radiology services. Within the study cohort 52 (8.2%) of patients had a significant incidental finding that required further investigation or management and 4 (0.6%) had a previously undiagnosed malignancy. In order to avoid the inevitability of a missed malignancy on a planning CT, we must advocate for formal reports in all cases.

Supporting Activism in Latin America: The Role of Science Communication, Science Journalism, and NGOs in Socio-environmental Conflicts

ABSTRACT This exploratory paper addresses the relationship of science journalism, science communication, environmental activism, and social movements. It draws on data from Latin America, exploring how journalists and activists use science communication as a tool for telling stories about environmental conflicts that frequently turn violent (more than 1600 land and environmental activists lost their lives between 2002 and 2020 in Latin America, more than three times that of all other regions of the world combined). The main goal of the paper is to understand how scientific storytelling by NGOs helps them present their points of view for journalists and to influence public opinion. Our data is drawn from the formal reports of four NGOs and from semi-structured interviews with representatives from each NGO’s staff about their use of science communication. Our analysis suggests that Latin American NGOs use science communication tools such as scientific storytelling and scientific explanation to support journalists and to communicate with broad publics about complex phenomena such as socio-environmental conflicts, contributing to efforts to reduce the alarming amount of violence in the region.

Deep convolutional neural network for rib fracture recognition on chest radiographs.

Rib fractures are a prevalent injury among trauma patients, and accurate and timely diagnosis is crucial to mitigate associated risks. Unfortunately, missed rib fractures are common, leading to heightened morbidity and mortality rates. While more sensitive imaging modalities exist, their practicality is limited due to cost and radiation exposure. Point of care ultrasound offers an alternative but has drawbacks in terms of procedural time and operator expertise. Therefore, this study aims to explore the potential of deep convolutional neural networks (DCNNs) in identifying rib fractures on chest radiographs. We assembled a comprehensive retrospective dataset of chest radiographs with formal image reports documenting rib fractures from a single medical center over the last five years. The DCNN models were trained using 2000 region-of-interest (ROI) slices for each category, which included fractured ribs, non-fractured ribs, and background regions. To optimize training of the deep learning models (DLMs), the images were segmented into pixel dimensions of 128 × 128. The trained DCNN models demonstrated remarkable validation accuracies. Specifically, AlexNet achieved 92.6%, GoogLeNet achieved 92.2%, EfficientNetb3 achieved 92.3%, DenseNet201 achieved 92.4%, and MobileNetV2 achieved 91.2%. By integrating DCNN models capable of rib fracture recognition into clinical decision support systems, the incidence of missed rib fracture diagnoses can be significantly reduced, resulting in tangible decreases in morbidity and mortality rates among trauma patients. This innovative approach holds the potential to revolutionize the diagnosis and treatment of chest trauma, ultimately leading to improved clinical outcomes for individuals affected by these injuries. The utilization of DCNNs in rib fracture detection on chest radiographs addresses the limitations of other imaging modalities, offering a promising and practical solution to improve patient care and management.

Financial Statement Analysis of Infosys and Wipro through DUPONT Analysis

Abstract: Uniformity, Timeliness, Understandability, Relevance, Reliability and Comparability are some of the qualitative characteristics of financial statements. Every company aims at providing the financial information to its users about the operations of a company through formal reports in the form of financial statements. It summarizes the operations of a business and transactions conducted in a particular accounting period. Financial statements are the trueindicators of the financial health of the company at a particular point of time. The study deployed secondary data published in the form of annual reports of the selected companies. In this context, the present paper aims at analyzing the financial statements of the year 2020- 21 and 2021- 22 prepared as per new accounting standards i.e., Indian Accounting Standards (IND-AS) of two different companies that is Infosys and Wipro through DUPONT analysis. The study highlights there is an increase in Return on Equity (ROE) of both the companies which is the one of the important measures used to find out the direction of the company.

Current practice of placental cord insertion documentation in Australia - A sonographer survey.

During pregnancy, the umbilical cord attaches to the placenta in a central, eccentric, marginal or velamentous location. Maternal and fetal complications are associated with marginal and velamentous cord insertions, the most clinically significant being perinatal mortality due to undiagnosed vasa praevia. Current literature describes a wide variation regarding regulation of placental cord insertion (PCI) documentation during antenatal ultrasound examinations. This prospective cross-sectional study aimed to assess the current practice of antenatal PCI documentation in Australia. Members of the Australian Sonographer Accreditation Registry were invited to participate in an online survey which was distributed between February and March 2022. Four hundred ninety sonographers met the inclusion criteria for the study of which 330 (67.3%) have more than 10 years' experience as a sonographer and 375 (76.5%) are employed primarily in a public or private setting offering general ultrasound. Most respondents (89.6%) indicated documentation of the PCI site is departmental protocol at the second trimester anatomy scan (17-22 weeks gestation), but PCI documentation is protocol in less than 50% of other obstetric ultrasound examinations listed in the survey. The PCI site is included in the formal ultrasound report at a rate significantly less than inclusion in the departmental protocol and the sonographer's worksheet. Considering the potential maternal and fetal complications associated with abnormal PCI and the ease at which the PCI site is identified in the first and second trimesters, we believe that standard inclusion of the PCI site in departmental protocol and in the formal ultrasound report from 11 weeks gestation, regardless of whether it is normal or abnormal, would prove invaluable.

Bystander Responses to Bullying and Harassment in Medical Education.

Bullying and harassment in medical education are common. The aims of this study were (a) to describe how medical trainees respond to harassment or bullying in medical settings, and (b) to determine whether trainees respond differently based on the type of harassment. Participants were medical students, residents, and fellows (N=80) recruited from a rural teaching hospital in Pennsylvania. We invited them to complete an electronic survey and react to four standardized situations that included common harassment types in graduate medical education. On average, 31.6% reported that they would consult with peer colleagues, 50.6% would provide direct support to the victim, 16.3% would approach the perpetrator or intervene directly, and 19.3% would file a formal report with a supervisor or human resources. Findings indicated that respondents as bystanders would intervene significantly more often when harassment was related to inappropriate racial or ethnic comments. Given that a sizable portion of trainees would speak directly with a victim, training bystanders in strategies to address or mentor others on how to address harassment more effectively could be useful in graduate medical education. Future research might explore trainees' differential reactions to harassment types toward developing more comprehensive intervention programs in graduate and undergraduate medical education.

Gender Roles, Sexual Cognitions, and History of Victimization: A Preliminary Model of Reporting Behavior among College Students

Sexual cognitions that flow from gender roles and previous history of victimization are strong predictors of sexual assault victimization. Because these cognitions reside within the individual themselves, we hypothesized that these same cognitions will also be predictors of subsequent reporting behavior to formal campus supports. An online self-report survey for assessing student awareness and perception of sexual safety was administered in a random stratified sample of college students (<em>N </em>= 98; 78% female). Participants were shown a hypothetical vignette involving a quid pro quo sexual harassment incident involving a student and were asked to rate their likelihood of making a formal report if this happened to them. Controlling for Type 1 error rates, a backward-chunk-wise elimination procedure was used to build a regression model involving nine predictors grouped into five categories: (1) conformity to traditional gender roles; (2) rape myth acceptance beliefs; (3) token resistance; (4) sexual assertiveness; and (5) prior history of victimization. Three of the five categories remained in the model after a sequential process of eliminating non-significant predictors. Specifically, lower agreement with token resistance beliefs, stronger sexual assertiveness, and not being a victim in the past increased the likelihood of respondents stating they would initiate a formal report. When predicting reporting behavior among the general college student sample, sexual cognitions related to token resistance beliefs and sexual assertiveness appear to be more robust predictors compared to conformity to traditional gender roles alone. Programming activities could consider targeting these attitudes as opposed to broad aspects of traditional gender roles. Future studies should test this model in a confirmatory manner to determine its reliability in subsequent samples, in addition to the potential role of toxic masculinity attitudes.

(030) A Preliminary Analysis of the Effects of Title IX Mandatory Reporting Policies on Undergraduate Students’ Likelihood of Disclosing Sexual Violence

Abstract Introduction In the United States, Title IX requires employees of federally funded universities to report any knowledge of university-related nonconsensual sexual experiences (NSEs), whether or not the students involved desire to file a report. Research assessing students’ likelihood of disclosing sexual violence to someone at their university under these policies remains sparse; however, the extant literature found that people with NSE histories feel they would be less likely to disclose sexual violence with mandatory reporting (MR) policies present. Even without MR policies, one factor that has consistently shown to impact an individual’s likelihood of disclosing an NSE is whether or not they label their NSE with a sexual violence term (e.g., rape). Individuals who do not identify their NSEs with these terms (“non-identifiers”) are less likely to report than individuals who do identify with these terms (“identifiers”). None of the previous studies on MR have used an experimental design to evaluate the effects of MR on students’ likelihood of reporting sexual violence to universities, nor have they taken the students’ identification of their NSEs into account when evaluating this likelihood. Objectives The current study aimed to fill these gaps by (1) using an experimental design to assess students’ likelihood of reporting sexual violence to the university under MR policy and (2), evaluating how NSE identification, rather than NSE history alone, impacts likelihood of reporting under such policies. Methods 120 undergraduate students were recruited for the current study. Participants were randomized into two groups: one group was instructed to imagine that their university had MR policies in place while the other was instructed to imagine that university employees were all confidential reporting sources-- meaning that students could disclose their NSE without creating a formal report. Next, participants were presented with four gender-neutral vignettes that differed in the perpetrator (professor vs. student) and type of assault (penetrative vs. non-penetrative). After each vignette, participants responded to questions adapted from Newins and White (2018) asking how likely they would be to report the offense if they were the student in the vignette. Students also completed the Non-Consensual Sexual Experiences Inventory to assess NSE history and identification (NSEI; Kilimnik et al., 2018). Results Preliminary analyses using a mixed factor repeated-measures ANOVA indicated a significant difference in student likelihood of disclosure (p < 0.001). Post-hoc analyses revealed that students were significantly more likely to report with a professor perpetrator than a student. Additionally, when the perpetrator was a student, participants were more likely to disclose in cases of penetrative rather than non-penetrative assault. No significant differences were detected by condition or NSE identification in the preliminary analyses. Conclusions These preliminary results suggest that MR policy may not significantly affect a student’s likelihood of disclosing sexual violence to the university as some previous literature has suggested. Further analysis will be conducted to increase our understanding of any potential impact of mandatory reporting policies on students’ overall likelihood to seek university resources and receive support for nonconsensual sexual experiences. Disclosure No.

Diagnostic yield and concordance of image-guided biopsy in musculoskeletal lesions.

Image-guided biopsy is well-established in the diagnosis of musculoskeletal lesions. While several studies have demonstrated a high diagnostic yield in image-guided biopsy, there are no current guidelines around procedural factors such as number of cores. Furthermore, there have been mixed results regarding which lesions are more favourable to a diagnostic biopsy. We wanted to evaluate diagnostic yield and concordance for image-guided biopsies for musculoskeletal lesions. The null hypothesis was that there are no controllable factors that contribute to positive yield. Retrospective review of consecutive patients who underwent image-guided biopsy at a large teaching hospital for musculoskeletal lesions discussed at the sarcoma multi-disciplinary meeting. The formal biopsy histology report was evaluated, and biopsies were considered diagnostic or non-diagnostic. In those that had subsequent surgery (by wide excision or open biopsy), final and initial histology was compared and biopsies were considered concordant or not. Overall diagnostic yield and concordance were calculated. Statistical analysis was performed with Stata 13.0 (StataCorp). Over the 14-year period, 429 biopsies were included. Diagnostic yield was 85% and concordance was 100%. No cases of malignant lesions were initially called benign on biopsy. One biopsy had a complication (0.2%). Factors associated with higher diagnostic yield included soft tissue versus bone lesions, three or more cores and longer total specimen length. Factors that were not associated included core size, use of FNA cytology, gender, age, benign versus malignant, anatomic location and lesion appearance. The null hypothesis is rejected. The main predictor of diagnostic biopsy was total specimen length, independent of number of cores taken. Three or more cores and longer cores are optimal, though these factors are influenced by lesion biology and not always able to be controlled.

P87: Fracture Of A Dual Lumen Protekduo Cannula With Ventricular Perforation And Tamponade In A Recovery COVID-19 Patient

Background: In the absence of formal registry data anecdotal reports of cannula complications provide the only mechanism of risk assessment in the extended use of short term mechanical circulatory support devices. We report an unrecognized cannula fracture with perforation of the right ventricular apex and subsequent tamponade at the time of de-cannulation. Methods and Results: Patient is a 38 yo AAF with a history of asthma diagnosed with COVID 19 (nasal PCR) and admitted to an OSH with hypoxia (O2 sat 70%) and progressive dyspnea on exertion requiring HFNC and subsequent deployment of a right internal jugular 29 Fr Protek-DUO double lumen cannula with in-line oxygenator for venovenous ECMO respiratory support. After 36 days of VV ECMO support and mechanical ventilation, the patient was transferred with a diagnosis of COVID ARDS for transplant evaluation. Fourteen days post-transfer the patient was ambulatory and no longer required mechanical ventilation. No flow related issues were noted during the entire period of ECMO support (flow 2.8 to 3.4 L/min, delta P 20 mmHg or less, single oxygenator exchange on ECMO day 38). On ECMO day 67 the patients CxR was clear (Figure 1) and the RIJ cannula was removed without complication. Approximately two minutes after cannula removal the patient became unresponsive with tachycardia and hypotension (SBP 60 mmHg) which initially responded to volume resuscitation. With progressive loss of systolic blood pressure chest compressions were started with complete hemodynamic collapse. A transthoracic ECHO suggested tamponade and the chest was opened at the bedside demonstrating a chronic appearing hematoma with blood extravasation at the apex of the right ventricle (Figure 2). Bleeding was controlled with a single prolene stitch. Subsequent examination of the cannula demonstrated a fracture in the wire reinforced cannula at the point where the catheter transitioned from the apical RV into the RVOT (Figure 3). Conclusion: Given the progressive pulmonary hypertension frequently seen with prolonged COVID ECMO support, the RA to PA dual-lumen cannula has proven an effective MCS strategy (1) with survival advantage when compared to standard VV ECMO support (2). The Protek-DUO cannula was not designed for prolonged ambulatory MCS (> 60 days). Given the recent report of a seemingly identical cannula fracture event (3), clinicians should be aware of the potential for cannula fracture over time. Literature Cited (1) Mustafa AK, et al. (2020) ECMO for patients with COVID-19 in severe respiratory failure. JAMA Surg 155(10):990-992. (2) Saeed O, et al (2022) Outcomes by cannulation method for venovenous ECMO during COVID-19: a multicenter retrospective study. 46(8):1659-1668. doi: 10.1111/aor.14213. (3) Odish MF, et al (2022) Fracture right atrial-pulmonary artery cannula (Protek-DUO) in a 164-day extracorporeal membrane oxygenation bridge to lung transplant. doi: 10.1097/MAT.0000000000001879. Online ahead of print.

Analysis Of The Application Of Financial Accounting Standards Of Entities Without Accountability Public At The Cooperative Of Employees Of The Republic Of Indonesia

Financial reports are formal reports of the financial activities of an entity including cooperatives and are prepared as a management responsibility to internal and external parties. Generally Accepted Accounting Standards are still difficult for cooperatives to apply because existing standards are more specific to large entities and have public accountability. IAI has issued Standard Financial Accounting for an entity without Public Accountability or known as SAK ETAP. SAK ETAP is intended to accommodate the needs of an entity that has significantly no accountability to operate on a Small and Medium Enterprises (UKM) and cooperative basis. This study aims to evaluate the implementation of SAK ETAP in the Financial Report of KPRI Padangsidimpuan City. KPRI Padangsidimpuan City is a cooperative engaged in the savings and loan sector. The research method is descriptive comparative by comparing primary and secondary data. It was found that the cooperative's financial reports in 2021 did not comply with the SAK ETAP principles and several reports had not been presented such as the Cash Flow report and Report of changes in equity. This is due to the limited accounting skills acquired by its human resources.