Medicine and Health Sciences Commons^™

Assessing Morbidity In Patients With Greater Trochanteric Pain Syndrome (Gtps), Sonia Wadekar, Joel Wells

Research Colloquium

Introduction: Greater trochanteric pain syndrome (GTPS) continues to be a challenge among orthopedics to rid discomfort for their patients, especially since there are few studies on characterization of GTPS morbidity.

Objective: The purpose of this study is to characterize the morbidity of GTPS in order to aid orthopedics in providing an early diagnosis and better treatment/care options for their patients.

Methods: A total of 156 patients were included from January of 2016 to July of 2020. Refer to Figure 1 for a visual of inclusion criteria. All patient information was taken from first appointment notes, operative notes, chart reviews, and …

Severe Hyponatremia Associated With Partial Empty Sella Syndrome, Lily Chen, Shyama Appareddy, Laura Garcia

Research Colloquium

Hyponatremia, serum sodium concentration < 135 mmol/L, is further classified by patient volume status. Symptoms are dependent on the acuity of sodium loss. Acute onset hyponatremia can present with confusion, disorientation, headache, agitation, vomiting, and lethargy. Patients with hyponatremia warrant a thorough workup and can be a leading manifestation of hypopituitarism in the geriatric population. A 77 year old patient, history of pituitary adenoma, presented with generalized symptoms of fatigue, gait instability, poor appetite and confusion associated with severe hyponatremia and hypoglycemia. The patient has a history of pituitary adenoma treated with cabergoline, hypothyroidism treated with levothyroxine and gonadal insufficiency treated with testosterone, with no reported history of diuretic use. On admission, the patient had a sodium level of 116 mmol/L. While the patient reported improvement in symptoms, patient’s confusion was noted to persist despite appropriate correction of sodium and glucose. Patient had an AM cortisol of 4 mcg/dL. Cosyntropin test was conducted and noted to be negative. MRI Brain with Gadolinium revealed empty sella turcica with a small amount of enhancing pituitary tissue, which may indicate a response to previous cabergoline therapy. Despite negative cosyntropin results, the patient was suspected to have relative adrenal insufficiency due to multiple acute stressors including illness, hospitalization, disruption of routine and abrupt smoking cessation. Patient was given a trial of hydrocortisone with improvements noted in his mental status, strength and appetite. Thus, careful consideration should be given towards adrenal insufficiency secondary to hypopituitarism as an etiology for severe hyponatremia.

A Covid-19-Inspired Comprehensive Approach To Resident Wellness And 360-Degree Approach To Pandemic Preparedness And Disinfection Practices, Preet Gudimella, Unnam Nasir, Heidi Pareja

Research Colloquium

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak that had led to the coronavirus disease 2019 (COVID-19) pandemic caused stress for medical residents on the frontline. This motivated our team to implement changes in our residency program’s inpatient service. We approached resident wellness in a comprehensive manner. The changes we implemented at our site had crucial benefits for our inpatient teams. Not only did we implement conventional best practices on infection prevention, we also executed additional safety measures, addressed mental and physical health, and had COVID-19-specific skills training. Consequently, our residents were less stressed, better prepared, and more focused …

Suicide Risk In Patients With Type Ii Diabetes, Ruthzaine Lopez Bolano, Michael Machiorlatti

Research Colloquium

Introduction: The comorbidity of mental and physical disorders represents a major challenge for health care worldwide. The comorbidity of depression and diabetes can be seen as a prototypical example of mental/physical comorbidity. The prevalence of both conditions is growing, with depression twice as frequent in people with diabetes compared with those without diabetes. [1] The prevalence of depressive disorders in diabetics is the general range of 10% to 15%, which is approximately twice as high as the prevalence of depression in non-diabetics. [1] For instance, diabetic patients, and during the course of the disease, are most likely to experience …

A Systematic Review And Meta-Analysis Of Empathy Changes In Medical Students During Medical Education, Sahar Panjwani, Jiyun Lim, Matthew Hidalgo, Michael Machiorlatti, Minerva Angelica Romero Arenas

Research Colloquium

Introduction: Reduction in empathy has been explored in medical students (MS). Questions remain on whether significant changes in empathy occur during MS education.

Objective: Focusing on studies using the Jefferson Scale of Empathy medical student version (JSE-S), the authors aimed to quantify and assess reported changes across reviewed literature.

Methods: A systematic review and meta-analysis were performed using PRISMA guidelines. Criteria for inclusion were articles 1) written in English, 2) pertained to human subjects, and 3) written in the previous ten years (2009-2019). Exclusion criteria were those that 1) did not assess MS, 2) did not utilize the JSE-S, 3) …

Stem Cell Technology For Age Related Macular Degeneration Intervention, Laura Valdez

Research Colloquium

The main focus of this thesis is to study induced pluripotent stem cell derived Retinal Pigmented Epithelium (RPE) cells in various physiological conditions mimicking RPE transplantation rejection. Retinal pigmented epithelium (RPE) cells are located between the choroid and photoreceptors within the eye and are essential to provide nutrients from blood to rods and cones, as well retinoids of the visual cycle. Vision loss and various ocular diseases are attributable to the degeneration or dysfunction of the RPE cells, leading to blindness. One of the major ocular problem from RPE dysfunction is macular degeneration. Age-related macular degeneration (AMD) can be frequently …

Antifungal Prophylaxis And Risk For Invasive Mold Infections In Children With Hematologic Malignancies, Ashley Ikwuezunma, Ankhi Dutta, Maria I. Castellanos, Hana Paek, Debra L. Palazzi, Karen R. Rabin, Michael E. Scheurer, Maria M. Gramatges

Research Colloquium

Introduction: Invasive mold infections (IMI) are a leading cause of mortality in immunocompromised hosts. Children diagnosed with hematologic malignancies experience profound, prolonged neutropenia following intensive chemotherapy, and are at increased risk for infection-related outcomes. Depending on the anticipated therapeutic intensity, antimicrobial prophylaxis may be employed to mitigate risk for infection. We conducted a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or lymphoma between 2006-2015 and determined the incidence of IMI to be 4.8% (47/976), with an exceptionally high incidence observed in patients with AML (8.1%). This observation prompted a change in clinical practice …

Exploration Of Potential Risk Factors For Texas County Covid-19 Infection Rates, Keren Kahsai, Michael Machiorlatti

Research Colloquium

There have been over 2 million COVID-19 cases within the United States. When considering where infections take place, there appears to be variability between states and even between counties (Gardner 2020). To understand the reasons underlying this phenomenon, we used Texas county data on Covid-19 infection rates and utilized auxiliary data such as age, race, gender, diabetes and obesity rates, temperature, humidity, median household income, metropolitan or rural designation, and poverty rates to see what confers greater risk for higher total infection at a county level. Our study found a positive relationship between diabetes and obesity rates and COVID-19 infection …

It Takes A Big Heart To Shape Atrophic Hepatocytes: Hypoxic Hepatitis Secondary To Congestive Heart Failure, Lina Pedraza Sanchez, Jose Rivera, Cynthia Rivas, Grigoriy Rapoport, Michelle Lopez

Research Colloquium

Introduction: Hypoxic hepatitis (HH) also known as ischemic hepatitis is the result of a hypoperfusion state during diffuse hepatic injury¹. The incidence of HH is 2:1000 of patients within any hospital care level. 94% of HH are related to chronic heart failure (HF). In this setting, hepatic dysfunction occurs as a result of passive venous congestion². The most common predisposing factors are acute heart failure and shock states, however, more than half of the cases are not related to any hemodynamic change, thus, underrecognized.

Case description: A 77-year-old woman is admitted to the hospital for acute …

Case Report: Liver Failure In A 4-Month-Old Male With Sma Type 2 After Gene Therapy/Onasemnogene Abeparvovec (Zolgensma), Juliana Hager, Dustin J. Paul

Research Colloquium

Introduction: Spinal muscular atrophy (SMA) is characterized by muscle weakness and atrophy resulting from progressive degeneration of the anterior horn cells in the spinal cord and the brain stem nuclei. The onset of weakness ranges from before birth to adulthood. The weakness is symmetric, proximal > distal, and progressive.

Onasemnogene abeparvovec (ZOLGENSMA) is a viral vector-based gene therapy designed to deliver a functional copy of the human survival motor neuron (SMN) gene to the motor neuron cells of patients with spinal muscular atrophy (SMA). It was approved in May 2019 in the USA for the treatment of pediatric patients aged < 2 years with SMA and bi-allelic mutations in the SMN1 gene. There has been significant motor function gain from the patients in and out of the clinical trials

However, …

Plasmid Midiprep: A Method To Purify Plasmids For Recombinant Dna Studies, Adithya Anilkumar, Kyle Doxtater, Samantha Lopez, Sudhir Kotnala, Justin Wendel, Manish Tripathi

Research Colloquium

A fundamental aspect of molecular biology involves exploring the properties and functions of specific genes. The rise of recombinant DNA technology has vastly improved and simplified functional studies by allowing scientists to isolate specific genes using restriction enzymes and plasmids providing greater precision. Plasmids take great significance in downstream studies, which is why quantity and quality of the plasmids purified is important. In this study, we isolated and purified recombinant plasmids in microgram quantities to confirm the yield, quantity, and quality using spectral and size fractionation methods. We also assessed the plasmids for application in downstream studies. We found the …

Public Communication Of Science: The Experience Of The Rio Grande Valley Alzheimer’S Disease Resource Center For Minority Aging Research, Amanda J. Guerrero, Rosa V. Pirela, Gladys E. Maestre

Research Colloquium

Introduction: There are multiple models of public communication of science. Some models focus on communication within the science community, while others involve public participation. At the Rio Grande Valley AD-RCMAR, we hope to implement a public outreach program to aid in the dissemination of accurate information regarding Alzheimer’s disease and related dementias.

Objective: The purpose of this project was to identify behavioral change models that will allow the RGV AD-RCMAR to increase awareness and engagement of brain aging, including Alzheimer’s disease, within the Rio Grande Valley.

Methods: A literature review was conducted to identify models of behavioral change that will …

A 3- And 6- Month Follow-Up To A Student-Led Approach To Patient Safety In Pre-Clinical Curriculum, Nelson D. Gonzalez, Sahar Panjwani, Daniel Nwosuocha, Lauren Bayliss, Ayleen Godreau

Research Colloquium

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer. In light of this, integration of formal patient safety education into undergraduate medical education has been encouraged by the World Health Organization. This study aimed to assess the change in patient safety knowledge, attitudes, and beliefs in students after early exposure to patient safety during pre-clinical years.

Methods: First and second-year medical students participated in the training and responses were assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assessed student knowledge on aspects …

Non-Paretic Forelimb Training Does Not Interfere With Recovery Of Paretic Forelimb Strength After Experimental Middle Cerebral Artery Occlusion, Krystal Schaar Valenzuela, Elizabeth Cook, Morgan Blaker, Naomi Cohen, Deepali Bhandari, Theresa A. Jones, Timothy Schallert

Research Colloquium

Humans often compensate with their unimpaired (non-paretic) forelimb after surviving a stroke. Research in rats suggests that this can be maladaptive after focal motor cortical strokes. Forelimb weakness is understudied in rodent models of stroke.

The purpose of the study is to determine whether behavioral experience with the non-paretic forelimb differentially affects paretic forelimb strength recovery after ischemic injury caused by middle cerebral artery occlusion (MCAo). Because behavioral manipulations can influence patterns of neural connectivity post-stroke, the present study also examined how training with non-paretic limb influenced corticostriatal projections.

After training to proficiency with the preferred forelimb on the Isometric …

The Unusual Opportunistic Pathogen With Superbug Potential: A Case Of Morganella Morganii Bacteremia, Rodolfo Singleterry, Khairiya Haj-Yahya

Research Colloquium

Morganella. morganii is considered a rare and unusual cause of infection despite its vast presence worldwide. Recently there has been increasing documentation of its opportunistic ability to infect immunocompromised patients, most notably in intensive care units.

The patient is a 55-year-old female with a past medical history of diabetes mellitus(II), end-stage renal disease, hypertension, dyslipidemia, and a left above-knee amputation. She presented with shortness of breath, hypotension, and difficulties staying awake. Blood pressure on admission was 92/48 with an oxygen saturation of 82%. On physical exam, a 3cm linear non-purulent wound was found on the dorsum of her right foot. …

A System “Pump”Ed To Its Limits: A Case Of Proton Pump Inhibitor-Induced Acute Interstitial Nephritis, Jose Ramos, Heriberto Cantu, Rodolfo Singleterry, Laura Garcia

Research Colloquium

Proton pump inhibitors (PPIs) are some of the most commonly prescribed medications. Patients are given PPIs in the hospital as GI prophylaxis or sometimes as long-term therapies to reduce the symptoms of gastroesophageal reflux disease and gastrointestinal ulcers¹. There has been increasing data, including case reports implicating PPIs with acute interstitial nephritis and acute renal failure³.

A 26-year-old female with no past medical history presented to the emergency department (ED) complaining of the inability to voiding urine, facial swelling, and non-radiating, bilateral flank pain for three days. The patient was seen in the ED 10-days prior …

Multisystem Inflammatory Syndrome In Children (Mis-C): Is There A Relationship To Typhus?, Sravani Mannuru, Juliana Hager, Jacob Smith

Research Colloquium

The United Kingdom first reported in April 2020 a group of eight previously healthy children with a link to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that presented with systemic inflammation and multi-organ involvement, now named multisystem inflammatory syndrome in children (MIS-C). The Centers of Disease Control and Prevention (CDC) have reported over 1000 cases since the primary discovery as of October 2020 with 20 total deaths. [1] The clinical features of MIS-C have been previously compared to inflammatory syndromes including Kawasaki disease (KD) and toxic shock syndrome (TSS). We describe the clinical presentation and management for 3 pediatric cases with …

Functional Characterization Of The Ipsc Generated Hepatocytes Using Genome-Wide Transcriptomic Analysis, Ashley Ikwuezunma, Erica De Leon, Ana C. Leandro, Joanne E. Curran, John Blangero, Satish Kumar

Research Colloquium

Advances in iPSC technologies now allow us to consider non-invasive large-scale in-vitro disease modeling experiments on disease appropriate cell types in human subjects to better understand human disease pathophysiology, disease genetics and to develop better diagnostic and therapeutic technologies. We performed differential gene expression and functional annotation analysis using genome wide mRNA sequencing data to evaluate the functional and disease modeling potential of iPSC generated hepatocytes. Following the criteria moderated t statistics FDR corrected p-value ≤ 0.05 and fold change-absolute ≥ 2.0, 7,246 genes/transcripts were significantly differentially expressed iPSCs and hepatocytes. The 3,791 of these DE genes/transcripts were significantly …

Intranasal Delivery Of Human Umbilical Cord Stromal Cell Conditioned Media Improves Alveolar Growth And Vascular Remodeling In Experimental Bronchopulmonary Dysplasia, Jooby Joy, Dawn Mcdaniel, Caitlyn Winter, Michelle Noronha, Tyrelle Seno, Lauryn Winter, Rija Naqvi, Yasmeen Alayli, Maxwell Jones, Shamimunisa Mustafa, Sunil Ahuja, Alvaro Moreira

Research Colloquium

Introduction: Bronchopulmonary dysplasia (BPD) is a lung disease with high morbidity and mortality in premature neonates exposed to mechanical ventilation and oxygen support. Preclinical studies demonstrate mesenchymal stromal cell (MSC) conditioned media (CdM) improves histologic changes in BPD via the release of paracrine factors. Current modes of administration include intratracheal or intraperitoneal routes with CdM cultured in ambient air.

Objectives: The objective of this study was twofold: (i) assess the efficacy of intranasal delivery of CdM, and (ii) determine whether hypoxic preconditioning stimulates the therapeutic potential of CdM.

Methods: Newborn rat pups were randomly assigned to four groups: (1) room …

Cmv? An Uncommon Etiology For Significant Disease In The Immunocompetent Individual, Ashley Sareen, Cade Call, Sonya Saenz

Research Colloquium

A 51-year-old Hispanic male with Type 2 diabetes mellitus and dyslipidemia was admitted from the ED for evaluation of recurrent fevers, multiple joint pains, and tachycardia. Physical exam findings included cachectic appearance and right inguinal lymphadenopathy. Initial laboratory testing was significant for a WBC of 23,300 (80.2% neutrophils, 13.3% lymphocytes), Hb of 11.1, HCT of 33.1, and ESR of 120. Chest x-ray reported no acute findings and x-ray imaging of affected joints were unremarkable. Blood and urine cultures would eventually return negative. Despite acetaminophen and broad-spectrum antibiotic use, the patient continued with fevers and tachycardia, prompting further infectious and rheumatological …

Ka“Posing” A Problem In An Already Problematic Situation: A Case Of Kaposi’S Sarcoma In Hiv, Khairiya Haj-Yahya, Rodolfo Singleterry

Research Colloquium

The progression of HIV to Acquired Immunodeficiency Syndrome (AIDS) is characterized by a CD4 cell-count below 200, and/or the development of an AIDS-defining illness. Kaposi’s sarcoma is a malignant tumor that manifests as violaceous skin lesions, occurring predominately in immunosuppressed patients.

Patient is a 37-year-old male with no past medical history who presented with a 4-month history of rapid, unintentional 60lbs weight loss and worsening dysphagia. He further noted multiple dark purple, raised skin lesions on his back and extremities appearing 9 months ago. Patient was uninsured and without a primary care physician. Labs revealed elevated monocytes and a dangerously …

How To Get Ripped Muscles In 7 Days: A Case Of Daptomycin-Induced Rhabdomyolysis, Khairiya Haj-Yahya, Rodolfo Singleterry

Research Colloquium

In phase III clinical trials, the use of Daptomycin was associated with an increase in creatinine phosphokinase (CPK) levels in 2.8% of patients treated. Elevation of CPK levels greater than 5 times the upper limit of normal (10-120 mcg/L), indicates a probable diagnosis of rhabdomyolysis. Rhabdomyolysis is the breakdown of skeletal muscle and subsequent leakage of contents into the blood, causing extreme weakness and pain.

A 50-year-old male with a past medical history of chronic osteomyelitis, presented to the ED with right foot pain with swelling. He was subsequently started on Daptomycin. During this time his CPK level was within …

Medical School Watercooler Newsletter - October 11, 2023, Lindsey Lyle

Watercooler Newsletter

This is the October 11, 2023 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• Meet a Med Student: Corinne Gautreaux
• Menger wins national young Neurosurgeon Award for second consecutive year
• Grants development series begins Oct. 19

Insights Into The Molecular Roles Of Foxr2 In The Pathology Of Primary Pediatric Brain Tumors, Rajendra Gharbaran

Publications and Research

Forkhead box gene R2 (FOXR2) belongs to the family of FOX genes which codes for highly conserved transcription factors (TFs) with critical roles in biological processes ranging from development to organogenesis to metabolic and immune regulation to cellular homeostasis. A number of FOX genes are associated with cancer development and progression and poor prognosis. A growing body of evidence suggests that FOXR2 is an oncogene. Studies suggested important roles for FOXR2 in cancer cell growth, metastasis, and drug resistance. Recent studies showed that FOXR2 is overexpressed by a subset of newly identified entities of embryonal tumors. This review discusses the …

A Proof-Of-Concept Pilot Test Of A Behavioral Intervention To Improve Adherence To Dietary Recommendations For Cancer Prevention, Meghan Butryn, Charlotte Hagerman, Nicole Crane, Marny Ehmann, Evan Forman, Brandy-Joe Milliron, Nicole L. Simone

Department of Radiation Oncology Faculty Papers

OBJECTIVES: Prevention programs that can help adults improve the quality of their diets to reduce cancer risk are needed. This Phase IIa study prospectively tested a mHealth intervention designed to improve adherence to dietary quality guidelines for cancer prevention.

METHODS: All participants (N = 62) received nutrition education and a self-regulation skills curriculum, with a primary target of changing grocery shopping behavior. Using a randomized, factorial design, the study varied whether each of the following 4 components were added to the 20-week intervention: (1) location-triggered app messaging, delivered when individuals arrived at grocery stores, (2) reflections on benefits of change, …

Nrg/Rtog 0837: Randomized, Phase Ii, Double-Blind, Placebo-Controlled Trial Of Chemoradiation With Or Without Cediranib In Newly Diagnosed Glioblastoma, Tracy T. Batchelor, Minhee Won, Arnab Chakravarti, Costas G. Hadjipanayis, Wenyin Shi, Lynn S. Ashby, Volker W. Stieber, H. Ian Robins, Heidi J. Gray, Alfredo Voloschin, John B. Fiveash, Clifford G. Robinson, Ushasree Chamarthy, Young Kwok, Terrence P. Cescon, Anand K. Sharma, Rekha Chaudhary, Mei-Yin Polley, Minesh P. Mehta

Department of Radiation Oncology Faculty Papers

BACKGROUND: A randomized, phase II, placebo-controlled, and blinded clinical trial (NCT01062425) was conducted to determine the efficacy of cediranib, an oral pan-vascular endothelial growth factor receptor tyrosine kinase inhibitor, versus placebo in combination with radiation and temozolomide in newly diagnosed glioblastoma.

METHODS: Patients with newly diagnosed glioblastoma were randomly assigned 2:1 to receive (1) cediranib (20 mg) in combination with radiation and temozolomide; (2) placebo in combination with radiation and temozolomide. The primary endpoint was 6-month progression-free survival (PFS) based on blinded, independent radiographic assessment of postcontrast T1-weighted and noncontrast T2-weighted MRI brain scans and was tested using a 1-sided …

The Inherited Kras-Variant As A Biomarker Of Cetuximab Response In Nsclc, Joanne Weidhaas, Chen Hu, Ritsuko Komaki, Gregory Masters, George Blumenschein, Joe Chang, Bo Lu, Adam Dicker, Jeffrey Bogart, Yolanda Garces, Samir Narayan, Clifford Robinson, Vivek Kavadi, Joel S Greenberger, Christopher Koprowski, James Welsh, Elizabeth Gore, Robert Macrae, Rebecca Paulus, Jeffrey Bradley

Department of Radiation Oncology Faculty Papers

PURPOSE: RTOG 0617 was a phase III randomized trial for patients with unresectable stage IIIA/IIIB non-small cell lung cancer comparing standard-dose (60 Gy) versus high-dose (74 Gy) radiotherapy and chemotherapy, plus or minus cetuximab. Although the study was negative, based on prior evidence that patients with the KRAS-variant, an inherited germline mutation, benefit from cetuximab, we evaluated KRAS-variant patients in RTOG 0617.

EXPERIMENTAL DESIGN: From RTOG 0617, 328 of 496 (66%) of patients were included in this analysis. For time-to-event outcomes, stratified log-rank tests and multivariable Cox regression models were used. For binary outcomes, Cochran-Mantel-Haenzel tests and multivariable logistic regression …

Engaging Nurses With In-Person Multidisciplinary Education, Caitlin Silva

Articles, Abstracts, and Reports

"Title: Engaging Nurses with In-Person Multidisciplinary Education

By Caitlin Silva MSN, RN, CCRN, SCRN

Purpose:

This project was to evaluate the impact of “Brain Day,” a targeted multidisciplinary continuing education (CE) class that utilized in-person teaching to promote engagement and satisfaction among nurses in a progressive care unit (PCU).

Relevance/Significance/Background:

Staffing shortages have reached critical levels and educators are tasked to find new ways to increase engagement and satisfaction. Perceived organizational support and workplace relationships have a significant impact on retention. Required contact hours can be used to address staff identified learning needs to keep CE relevant and promote satisfaction. …

Editorial For "Automated Breast Density Assessment In Mri Using Deep Learning And Radiomics: Strategies For Reducing Inter-Observer Variability"., Pegah Khosravi

Publications and Research

No abstract provided.

Pacing Strategies Differ By Sex And Rank In 2020 Crossfit® Open Tests, Gerald Mangine, Elisabeth K. Zeitz, Joshua D. Dexheimer, Ashley Hines, Brandon Lively, Brian Kliszczewicz

Faculty Articles

This retrospective study collected video recordings of a random selection of eighty men and women (n = 160) completing all five tests of the 2020 CrossFit® Open. All competitors were ranked within the top 10,000 overall but were sub-divided based on whether they ranked within the top 10% of their respective divisions. To examine the effect of sex and rank on pacing strategy, video analysis quantified the overall repetition completion rate on each test, as well as per minute (or round) repetition completion rates for each test’s individual exercises, quantity of failed repetitions, break times, and transition times. All …