Abstract: The article explores late-medieval vierges ouvrantes (hinged Virgins that reveal Christological or Trinitarian interiors) as thresholds between secrecy and revelation. They translate the porta clausa of Ezekiel 44:2 and the hortus conclusus of Song of Songs 4:12 into sculpture, illustrating the paradox of a body that is both inviolate and permeable. Their mechanisms turn the Incarnation into a visible event and also expose cultural fears about vision, curiosity and trespass. Patristic writers framed these fears in theological terms. Jean Gerson condemned the vierge ouvrante as ‘unwarranted exposure.’ Later comparanda, from illuminated manuscripts, obstetrical collections and the Mechelen Besloten Hofjes , repeat the same tension between revelation and restraint. The article argues that both the opening and the later sealing or destruction of these statues reveal a theology of thresholds that reshaped the act of seeing.

The study investigated social media users’ perspectives on content warnings by Big Tech. The study was guided by three specific purposes, three research questions and two hypotheses. The study adopted descriptive survey design. A population of the study was the Nnamdi Azikiwe University community involving staff and students, old and young. A sample of 500 respondents was selected used multi-method sampling techniques. A researcher-made questionnaire titled “Social Media Users’ Perspectives on Utility of Content Warning Survey” (SMUPUC) was used for the study. The SMUPUC was validated by two experienced lecturers in Mass Communication and one in Measurement and Evaluation from Nnamdi Azikiwe University, Awka. A pilot study was conducted to determine the reliability of the instrument. Results were analysed using Cronbach Alpha which yielded a correlation index of 0.82. SMUPUC was administered on respondents using two assistants from Nnamdi Azikiwe University, Awka who were briefed adequately on the exercise. At the end, a total of 467 copies of the questionnaire was returned leaving a mortality rate of 6.6 percent only. The research questions were analyzed with the mean (X) and standard deviation, while the hypotheses were tested with t-test statistic at 0.05 level of significance. The findings showed that social media users agreed with the utility of content warnings by Big Tech; sex and age of users were insignificant in their perspective on this utility. Based on the findings, it was recommended among others, that content warnings should continue to be included as requirement of the Big Tech to guard against unwarranted exposure of users to unwanted contents; and Big Tech should improve on apps to guard against underage exposure to adult contents in the social media.

Aerosolized drug therapy is a common approach in treating respiratory diseases in clinical practice. This study aimed to assess air quality in the pediatric intensive care unit (PICU) of the medical center and investigate variations in drug concentration relative to the patient’s position during aerosolized drug treatment. To monitor air quality and aerosolized drug concentrations in the PICU, we conducted bi-weekly 24-hour samplings over a month. Monitored air quality parameters included temperature, relative humidity (RH), carbon dioxide (CO2), particulate matter (PM), total volatile organic compounds (TVOCs), and aerosolized drug levels in the air. The study also used a small volume nebulizer (SVN) to analyze the relationship between aerosolized drug concentration and distance from a simulated patient. This study revealed that the average concentrations of CO2, PM10 (an aerodynamic diameter equal to or less than 10 µm), and PM2.5 (an aerodynamic diameter less than 2.5 µm) in the PICU met Taiwan’s Ministry of Environment (MOENV) indoor air quality standards. However, the hourly average concentration of TVOCs in the PICU was almost twice the MOENV standard. The concentration of acetylcysteine in the air showed a positive association with both RH and CO2 concentration. Additionally, drug concentrations measured at 1 m, 1.6 m, and 3 m from the SVN were significantly lower than those measured at 0.1 m from the SVN. Continuous monitoring of TVOCs and CO2 in the PICU is necessary. During aerosol therapy, it is crucial for medical staff and family members to maintain a safe distance or integrate a HEPA (high-efficiency particulate air) filter into the ventilator circuit system. This precautionary step aims to minimize unwarranted exposure and maintain hospital air quality.

Obstetrical Use of Intravenous Immunoglobulin at a Tertiary Care Canadian Center: A 14-Year Retrospective Study

The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site (“red ED”), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site (“green ED”). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.

The role of new technologies in monitoring the evolution ofpsychopathology and providing measurement-based care in youngpeople.

The COVID-19 pandemic has adversely impacted the training of residents in all specialties of medicine.[12] Most institutes have discontinued offline didactic lectures, clinical grand rounds, and clinical rotations. They have also modified the working hours of their trainees/residents to reduce unwarranted exposure to coronavirus in hospitals. Surgical training in ophthalmology is severely affected as most of the surgeries are elective in our specialty. With the implementation of standard COVID precautions in hospitals, travel restrictions and fear among patients to contract COVID, the surgical volume will take some time to restore back to normal.[3] A large number of residents are also deployed in the care of COVID positive patients, hampering their training in ophthalmology. These reasons have given rise to stress and anxiety among residents and other stakeholders. These findings are aptly highlighted in the present study.[4] The need of the hour is to restructure residency programs, trying to address the gaps in the existing ones. This will require the use of technology, innovative ideas and coordinated efforts among stakeholders.[5] It should focus on achieving excellence in 3 important domains – patient care, academic teaching, and research. Trainee health and safety should be always kept on priority. Most institutes have devised a rotation strategy for residents where some residents are posted in active clinical duty and others are kept in reserve. Residents who are not on active duty can also be involved in patient care, decision making, and surgical planning. This can be easily done by conducting daily briefings about various clinical cases on digital platforms like Zoom, Cisco Webex, Microsoft Teams, etc.[6] Virtual grand rounds can also be undertaken by faculties discussing clinical cases. This will ensure uninterrupted learning of all residents. Didactic lectures/interactive sessions/symposiums/conferences can easily be held on these digital platforms on a routine basis. Technology has now removed barriers of time, space and boundaries. Collaborative sessions can also be held comprising eminent speakers from different regions, sharing their experiences. The present study has also found these online teaching methods useful. Group discussions can also be held among residents on platforms like WhatsApp where they can discuss and clear their doubts.[7] Getting proficiency in surgical training will be difficult in present times due to limited number of surgeries. Residents can use virtual surgical simulators for basic cataract and vitreoretinal surgery training.[5] Institutes can formulate roster-based posting of residents in skills lab where they can perform basic surgical techniques on goat's eye and wax models. Some specialties have roped in various 3D printed models to improve basic surgical training, accuracy and muscle memory of residents.[8] They can also learn online from a vast database of surgical videos of different case scenarios. Teachers can discuss important surgical tips through online video-assisted surgical training sessions. Residents must be increasingly involved in the development of their non-technical skills like crisis management, teamwork, financial literacy, patient communication, etc.[2] Special peer groups can be formed to take care of the mental and emotional health of residents. These can also help in mentoring students in crisis times. Residents must also be encouraged to engage in research activities which will improve their analytical skills. Institutions can formulate revised guidelines for all patient-based clinical studies to make their sample size feasible. These will help residents to complete their research thesis/projects. Some of the countries are thinking to postpone the recruitment of new batch of fellows temporarily till the conditions revert back to normal.[9] There will be a grace period for existing fellows to make up for their surgical training and become proficient in their field. Virtual exams/interviews can be conducted, limiting large gatherings. Surgical qualifying and certification exams have been postponed globally. Some adjustments and exemptions can be made in these examinations, compensating for hardships related to COVID-19. Hence, there is an urgent need to formulate policies regarding residency training at a national level. Crises are opportunities in disguise. Efforts must be made to address the existing gaps productively and innovatively.

BackgroundIn India, control of asthma with persistent symptoms remains a clinical enigma with likely incriminating factors including non- and pseudoadherence to the inhaled corticosteroids and long-acting beta2-agonists. The United States Food and Drug Administration guidance recommends the use of dose counter pressurized metered-dose inhalers (pMDIs) with further mechanisms to track adherence and pseudoadherence in real-world settings.ObjectiveDigital dose counter pMDIs (dpMDIs) offer simplified, reliable tracking of individual “actuated” dosages with “END” display at completion of the labelled therapeutic aerosol spray. The translational impact on symptom persistence with likely unwarranted exposure to the “Step up” strategy is often prevented if not treated, as in the cases of “pseudo” severe asthma. To further assess the real-world acceptance and clinical impact of dpMDIs in bronchial asthma including poorly controlled or uncontrolled bronchial asthma cases, a noninterventional observational study was performed.MethodsThis cross-sectional, retrospective, case cohort, observational study—the Drug Utilization Surveillance—of dpMDIs in bronchial asthma was conducted in September 2016 in an outpatient setting in India. The retrospective analysis was initiated and conducted as per the International Conference on Harmonization Good Clinical Practice principles and Declaration of Helsinki, following approval from the local ethics committee and registration in the Clinical Trial Registry of India.ResultsConsecutive cases of moderate-to-severe asthma with poor control (n=4575), diagnosed as per the Global Initiative for Asthma symptom scale at baseline and follow-up, were included. Patients under treatment using dpMDIs were enrolled from 500 centers across India and assessed by respiratory care specialists. Baseline asthma control was assessed as partly controlled (n=4575) or poorly controlled (n=2942). Per protocol analyses showed that asthma was well controlled with dpMDIs at 8 weeks in 92.7% of the cases (2727/2942, P<.001). Adverse events (n=106, 2%) of mild-to-moderate intensity were reported. Nebulization was required in two patients with episodic breathlessness who were discharged with no consequent sequelae. Post hoc analyses for patients with baseline poorly controlled asthma who “switched” exclusively to dpMDI monotherapy or a combination with xanthines or long-acting beta2-agonists showed a “well controlled” asthma status in 85.9% (500/582, P=.04), 95.4% (395/414, P=.048), and 80.3% (106/132, P=.28) of the cases, respectively. The patient acceptability criteria for an “empty” canister was well correlated with the clinical strategy to identify and avoid pseudoadherence in poorly controlled or difficult-to-treat asthma cases, especially in patients who “switched” exclusively to dpMDIs (n=582) and demonstrated responses of “Use till twenty dose display” (65/156, 41.6%), “Use till END display” (83/156, 53.2%), and “Use till LAST spray” (8/156, 5.1%).ConclusionsdpMDIs offer simple, accurate, and reliable tracking of non- and pseudoadherence while highlighting incremental asthma-control rates in severe and pseudosevere asthma cases before risk assessment for further “add-on” therapyTrial RegistrationClinical Trials Registry - India CTRI/2018/06/014595; http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php? trialid=24583

Lack of pathogen specificity in antimicrobial therapy causes non-discriminant microbial cell killing that disrupts the microflora present. As a result, potentially helpful microbial cells are killed along with the pathogen, altering the biodiversity and dynamic interactions within the population. Moreover, the unwarranted exposure of antibiotics to microbes increases the likelihood of developing resistance and perpetuates the emergence of multidrug resistance. Synthetic biology offers an alternative solution where specificity can be conferred to reduce the non-specific, non-targeted activity of currently available antibiotics, and instead provides targeted therapy against specific pathogens and minimising collateral damage to the host's inherent microbiota. With a greater understanding of the microbiome and the available genetic engineering tools for microbial cells, it is possible to devise antimicrobial strategies for novel antimicrobial therapy that are able to precisely and selectively remove infectious pathogens. Herein, we review the strategies developed by unlocking some of the natural mechanisms used by the microbes and how these may be utilised in targeted antimicrobial therapy, with the promise of reducing the current global bane of multidrug antimicrobial resistance.

Delaware and Financial Risk

Unwarranted exposure due to liberal use of metals for maintaining the lavish life and to achieve the food demand for escalating population along with an incredible boost in the average human life span owing to orchestrated progress in rejuvenation therapy have gradually increased the occurrence of Parkinson's disease (PD). Etiology is albeit elusive; association of PD with metal accumulation has never been overlooked due to noteworthy similitude between metal-exposure symptoms and a few cardinal features of disease. Even though metals are entailed in the vital functions, a hysterical shift, primarily augmentation, escorts the stern nigrostriatal dopaminergic neurodegeneration. An increase in the passage of metals through the blood brain barrier and impaired metabolic activity and elimination system could lead to metal accumulation in the brain, which eventually makes dopaminergic neurons quite susceptible. In the present article, an update on implication of metal accumulation in PD/Parkinsonism has been provided. Moreover, encouraging and paradoxical facts and fictions associated with metal accumulation in PD/Parkinsonism have also been compiled. Systematic literature survey of PD is performed to describe updated information if metal accumulation is an epicenter or merely an outcome. Finally, a perspective on the association of metal accumulation with pesticide-induced Parkinsonism has been explained to unveil the likely impact of the former in the latter.

Cloud-integrated Internet of Things (IoT) is emerging as the next-generation service platform that enables smart functionality worldwide. IoT applications such as smart grid and power systems, e-health, and body monitoring applications along with large-scale environmental and industrial monitoring are increasingly generating large amounts of data that can conveniently be analyzed through cloud service provisioning. However, the nature of these applications mandates the use of secure and privacy-preserving implementation of services that ensures the integrity of data without any unwarranted exposure. This article explores the unique challenges and issues within this context of enabling secure cloud-based data analytics for the IoT. Three main applications are discussed in detail, with solutions outlined based on the use of fully homomorphic encryption systems to achieve data security and privacy over cloud-based analytical phases. The limitations of existing technologies are discussed and models proposed with regard to achieving high efficiency and accuracy in the provisioning of analytic services for encrypted data over a cloud platform.

The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patient-centered, multi-modal treatment plans.

We wish to communicate the case of a young patient with schistosomiasis mansoni and pseudothrombocytopenia. Failure to recognize pseudothrombocytopenia (PTCP) leads to unnecessary diagnostic tests, unnecessary therapies such as steroid administration and splenectomy, delay in treatment and unwarranted exposure to transfusion-related complications. Also, the presence of PTCP can mask true thrombocytopenia.

The asymmetric distribution of the amino-containing phospholipids, phosphatidyl-serine (PS) and phosphatidyl-ethanolamine (PE), across the two leaflets of red blood cell (RBC) membrane is essential to the function and survival of the cell. PS and PE are sequestered in the inner leaflet by an ATP-dependent transport activity of a membrane protein known as the RBC flippase that specifically moves amino-phospholipids from the outer to the inner leaflet. The enucleated RBC lacks the means to replace damaged enzymes and inactivation of the flippase can lead to the unwarranted exposure of PS on the cell surface. Loss in the ability to maintain phospholipid asymmetry is exacerbated in RBC disorders and PS-exposing RBCs present in the circulation play a significant role in the pathology of hemoglobinopathies. We identified the Atp8a1 protein, a member of the family of the P(4)-type ATPases, as a RBC flippase candidate. Atp8a1 is expressed in RBC precursors and is present in the membrane of mature red cells. The flippase activity of the protein was established in purified secretory vesicles of Saccharomyces cerevisiae. ATPase activity was stimulated by PS and PE. In addition, Atp8a1 can move PS molecules across the leaflets of the vesicle membrane in presence of ATP.

The use of silver foils in various food preparations is a common practice in Middle Eastern and South East Asian countries. The FAO/WHO Joint Expert Committee on Food Additives (JECFA) has included silver in the list of food additives, but specifications were not prepared. Indian food legislation has included food-grade silver foil and laid down a purity requirement of 99.9%. This leaves an unspecified margin of 0.1% or 1000 µg g−1 for contaminants. Therefore, a study to investigate the levels of metallic contaminants in food-grade silver foil was undertaken. Of 178 foils analysed, 161 (90%) contained silver, whilst 10% were fraudulently made up of aluminium. In the case of silver foils, 46% of the samples adhered to the desired purity requirement of 99.9%, while 54% had a lower silver content. Copper was present in 86.3% of the silver foils, while chromium, nickel and lead contamination was found in over 54% of samples. Cadmium levels were detected in 28% of the silver foils and manganese was present in 6.8% of samples. In silver foils showing metal contaminants, average levels were found for nickel (487 µg g−1), lead (301 µg g−1), copper (324 µg g−1), chromium (83 µg g−1), cadmium (97 µg g−1) and manganese (43 µg g−1), which being appreciable justify the need to prescribe limits for some metals in food-grade silver foil as well as for silver powder used in confectioneries and medicinal preparations. The work reported here should encourage manufacturers to use high-purity raw materials and take suitable precautions to reduce unwarranted exposure of consumers to toxic metal contaminants.

Ethylenediaminetetraacetic Acid-Dependent Pseudothrombocytopenia in a Cardiac Surgical Patient

In a reactor accident with release of radioactivity, the major potential public health risks are likely to result from radioiodines, particularly iodine 131, which can be readily volatilized and dispersed. They are rapidly absorbed and concentrated by the thyroid, which could result in substantial thyroidal radiation. Although some forms of radiation can cause thyroid cancer in humans, 131I has not been shown to do so, and 40 years of safe experience with this radionuclide in routine clinical thyroid testing and treatment has been reassuring. Nevertheless, since 131I has been shown to cause thyroid neoplasms in animals, efforts to minimize unwarranted exposure seem advisable. Potassium iodide, administered at an appropriate time, will effectively block thyroid uptake, but it has potential toxicity and may be difficult to distribute effectively and safely on a large scale in an emergency. Evaluation of the risks and benefits of potassium iodide use is essential to establishing sound public health policy but awaits additional scientific information.

(3) Patients with sarcoidosis do not require sanatorium treatment with its unwarranted exposure to tuberculosis and the associated psychological trauma. The patient should be speedily rehabilitated to his normal occupation even when receiving steroid hormones.