Understanding the relationships between genetic and microenvironmental factors that drive normal and malformed embryonic development is fundamental for discovering new therapeutic strategies. Advancements in imaging technology have enabled quantitative investigation of the organization and maturing of the body plan, but later stage embryonic morphogenesis is less clear. Chicken embryos are an attractive vertebrate animal model system for this application because of its ease of culture and surgical manipulation. Early embryos can be cultured for a short time on filter paper rings, which enables complete optical access for cell patterning and fate studies 1,2 . Studying advanced developmental processes such as cardiac morphogenesis are traditionally performed through a window of the eggshell 3-5 , but this technique limits optical access due to window size. We previously developed a simple method to culture whole embryos ex-ovo on hexagonal weigh boats for up to 10 days, which enabled high resolution imaging via ultrasonography 6,7 . These cultures were difficult to transport, limiting the types of imaging tools available for live experiments. We here present an improved shell-less culture system with a cost-effective, portable environmental chamber. Eggs were cracked onto a hammock created by a polyurethane membrane (cling wrap) affixed circumferentially to a plastic cup partially filled with sterile water. The dimensions of the circumference and depth of the hammock were both critical to maintain surface tension, while the mechanics of the hammock and water beneath helped dampen vibrations induced by transportation. A small footprint circulating water bath was also developed to enable continuous temperature control during experimentation. We demonstrate the ability to culture embryos in this way for at least 14 days without morphogenic defect or delay and employ this system in several microsurgical and imaging applications. (Figure 1a) i. Fill ¾ of 9 oz plastic cups with warm sterile water. A regular 9 oz cup has a top diameter of 8 cm. We found that this size was most suitable for long time culture application presented here. ii. Cut about 20 cm cling wrap. Affix circumferentially on top of the cup by placing a rubber band around. Plastic should be spread on top of the water. Cut the excess plastic around the band. We found cling wrap to be most appropriate for this application since it prevents adhesion of the yolk, resulting in the yolk splitting during transportation. iii. Wipe the plastic with kimwipes (Kimberly-Clark, Inc.) wetted with 70% ethanol. Prepare hammocks

Purpose: Our purpose was to test the null hypothesis that no patient or clinic visit characteristics affect satisfaction of hand surgery outpatients, as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS).Methods: Adult patients (≥ 18 years) evaluated by five fellowship-trained hand surgeons between January 2014 and December 2016 for a new patient clinic visit at a single tertiary academic medical center, were included. Prospectively-collected PGOMPS data were reviewed retrospectively for each visit. Chart review was performed to collect demographic and visit characteristics data. Satisfaction was defined a priori as achieving a PGOMPS score above the 33rd percentile. Both the PGOMPS Total Score (primary outcome) and Provider Sub-Score (secondary outcome) were analyzed using univariate and multivariable logistic regression.Results: Of 748 included patients, mean age was 51.7 ± 15.5 years, and 64% were female. Leading diagnoses included tendonitis (19%), neuropathy (19%), arthritis (16%), and fracture/ dislocation (13%). Multivariable modelling of the PGOMPS Total Score revealed that older age, shorter wait times, and scheduling surgery were significantly associated with greater satisfaction. PGOMPS Provider Sub-Score multivariable modelling revealed that older age, shorter wait times, scheduling surgery, and administering injections were significantly associated with greater satisfaction. Diagnostic category and insurance status did not affect satisfaction. Conclusions:Increasing patient age, decreased wait time, and receiving an intervention (scheduling of surgery or injection) are associated with increased satisfaction among newlypresenting hand surgery clinic patients as measured by the Press Ganey Outpatient Medical Practice Survey. Diagnosis and access to healthcare (insurance status and distance to clinic) did not influence patient satisfaction.

One-third of patients referred for assessment of PFO experience oxygen desaturation during stair exercise. Closure of PFO seems to ameliorate this phenomenon and improve functional status.

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