bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical student education simulation competitions
Authors: Pajor Michael , Xie Nicholas , Podolej Gregory
Published: October 2022

Background

Sim Wars is a simulation‐based competition wherein teams of medical trainees are presented a clinical scenario and provide patient care in front of a live audience. This non‐traditional educational offering is a form of serious games in medical education and allows for experiential learning via direct observation. Although a well‐described educational modality within graduate medical education, there is a dearth of literature regarding Sim Wars as an educational tool within undergraduate medical education. In this paper, we aim to share student perspectives after participating in Sim Wars.

Approach

The Sim Wars competition was designed as a double‐elimination bracket tournament with arena‐style direct observation to maximise student engagement. Teams were provided formative feedback in areas of medical knowledge, clinical management and communication skills. A total of 64 students participated in a regional Sim Wars tournament over the course of 2 years.

Evaluation

A total of 36 students completed Likert‐based surveys immediately after the Sim Wars competition. Quantitative data and open‐ended responses were analysed. Fourteen students participated in focus groups held a few months after Sim Wars regarding their experiences during the competition. Thematic analysis was systematically performed on the qualitative data.

Implication

Participation in Sim Wars was viewed by students as a high‐yield learning experience that increased competence on subsequent clinical rotations. We conclude that this form of serious game can be a highly beneficial educational format for medical students especially if they spend time preparing for the competition and receive structured feedback on their performance.
ACERCA DE ALGUNOS ENCUENTROS ETNOGRÁFICOS: UNA “AMAPÔ” EN LAPA (RJ)
Authors:   Universidad Complutense Madrid, Vartabedian Julieta
Published: October 2022

Desde los años 1980s, la omnipresencia y la autoridad del etnógrafo/a fueron cuestionadas desde diferentes ángulos. Críticos postmodernistas desafiaron las clásicas descripciones etnográficas que pretendían ser ‘objetivas’ e invisibilizaban las relaciones que se establecían con los 'informantes' de la investigación. Las experiencias personales de los/as etnógrafos/as se volvieron centrales en los procesos de investigación (Marcus and Cushman, 1982; Clifford and Marcus, 1986). Las críticas feministas al positivismo también influyeron en la manera de problematizar cómo las relaciones investigador/a - participantes están atravesadas por relaciones de poder (Scheper-Hughes, 1993; Okely, 1996). Las ciencias sociales consideran que todo conocimiento se gesta en un determinado contexto social e histórico (Sherif, 2001) y que está situado (Haraway, 1991), es decir, los datos etnográficos no están ‘allí’ para ser revelados, sino que el conocimiento mismo es producto de las relaciones y negociaciones que surgen en cada encuentro etnográfico. En esta presentación analizaré la influencia que mi propia corporalidad tuvo en el proceso etnográfico. Durante la investigación que realicé junto a un grupo de travestis brasileñas trabajadoras del sexo, mi cuerpo - analizado y des-erotizado por parte de las participantes – sirvió como un medio de acercamiento a su universo y de herramienta para el conocimiento. En tanto mujer cis, heterosexual, de clase media, extranjera y leída como blanca, tuve que negociar mi posición en el entramado travesti para asegurarme un lugar desde donde llevar a cabo la investigación y entablar un diálogo junto a ellas guiado por la belleza y la interpelación de mi cuerpo “imperfecto”.
Flexible multifunctional hard coatings based on chromium oxynitride for pressure-sensing applications
Authors: Ferreira A. , Correa M. A. , Lanceros-Mendez S. , Vaz F.
Published: October 2022

The present work reports on the development of piezoresistive chromium oxynitride (CrN1−xOx) thin films deposited on flexible polymeric substrates. The relationship between the reactive gas supply (composed of 15% O2 and 85% N2) and the electromechanical response was analyzed in CrN1−xOx thin films, produced by glancing angle deposition (GLAD) in a sputtering DC-reactive environment. GLAD was used to modify the normal columnar growth microstructure into an inclined (zigzaglike) architecture, allowing us to the tune of the mechanical and electrical responses of the films. The piezoresistive response was quantified by the gauge factor (GF), reaching values from 2.3±0.1 up to 32.4±0.4 as the reactive gas was increased. The highest values of the GF of the CrN1−xOx films were found in the samples with hardness values in the order of 15.5 GPa and elastic modulus close to 173 GPa. This work shows that the change of characteristics, such as microstructure and the zigzag architecture of the films, can be powerful tools to improve the sensibility by the GF of the CrN1−xOx films and turn Cr-based thin films into an interesting multifunctional system with protective and sensing capabilities.
A spherical wave expansion for a steerable parametric array loudspeaker using Zernike polynomials
Authors: Zhong Jiaxin , Kirby Ray , Karimi Mahmoud , Zou Haishan
Published: October 2022

A steerable parametric array loudspeaker (PAL) can electronically steer highly directional audio beams in the desired direction. The challenge of modelling a steerable PAL is to obtain the audio sound pressure in both near and far fields with a low computational load. To address this issue, an extension of the spherical wave expansion is proposed in this paper. The steerable velocity profile on the radiation surface is expanded as Zernike polynomials which are an orthogonal and form a complete set over a unit circle. An expression for the radiated audio sound is then obtained using a superposition of Zernike modes. Compared to the existing methods, the proposed expansion is computationally efficient and provides a rigorous transformation of the quasilinear solution of the Westervelt equation without paraxial approximations. The proposed expansion is further extended to accommodate local effects by using an algebraic correction to the Westervelt equation. Numerical results for steering single and dual beams are presented and discussed. It is shown that the single beam can be steered in the desired direction in both near and far fields. However, dual beams cannot be well separated in the near field, which cannot be predicted by the existing far field models.
Semi-blind calibration for orbital angular momentum generating system using maximal likelihood estimation
Authors: Zhang Yi , Sun Xiaoyu , Luo Mingcheng , Li Shengquan
Published: October 2022

Generating a high quality vortex beam carrying orbital angular momentum (OAM) is of importance in the application of the OAM to target detections or communications. This paper presents a semi-blind method to calibrate the uniform circle array (UCA) OAM generating system by using a virtual receiving sensor array without knowing the precise position of this auxiliary array. A low computational complexity algorithm is proposed to solve the maximum likelihood estimate (MLE) for the amplitude and phase errors of the transducers of the UCA based on the separation of parameters to be estimated. Moreover, this MLE is proved to be related to the beamforming of the virtual array. Simulations indicate that this method can estimate the mismatch parameters of the UCA effectively, and experiments in an anechoic tank show that the OAM generating system can generate a desirable vortex beam after we compensate each transducer of the UCA.
“Freshwater Components” in the Populations of Whitespotted Char Salvelinus leucomaenis (Salmonidae) in the North of the Species Range (Kamchatka)
Authors: Kuzishchin K. V. , Gruzdeva M. A. , Malyutina A. M. , Pavlov D. S.
Published: October 2022

The variety of types of life strategy and the structure of the populations of whitespotted char Salvelinus leucomaenis (Pallas, 1814) are considered at Kamchatka. At the north of the species range, the populations of whitespotted char are heterogeneous. The main role in reproduction belongs to anadromous whitespotted char, but there are also the groups in the populations that realize their life cycle exclusively in fresh waters. Dwarf males are common in the rivers of different types. In the geomorphologically complex river (Kol), there is also the river populations of rheodromous whitespotted char, represented by males and females. Favorite biotopes (blockages and creases of woody material on deep reaches, found only in foothill rivers) are key parameters predetermining the presence of a river population of rheodromous whitespotted char. At the north of the species range, the variety of individuals with different types of life strategy in whitespotted char is comparable to that observed in the southern parts, in particular, in the basin of the Sea of Japan, which is considered the zone of the ecological optimum of the species.
Species Composition, Abundance, Distribution Features and Size Characteristics of Fish of the Genus Liparis (Cottiformes: Liparidae) in the East-Siberian and Laptev Seas
Authors: Smirnova E. V. , Chernova N. V. , Karamushko O. V.
Published: October 2022

Abstract—

Information on the distribution and occurrence of three species of the genus Liparis, Liparis bathyarcticus Parr, 1931, L. cf. fabricii Krøyer, 1847 and L. tunicatus Reinhardt, 1836 on the shelf of the Laptev and East Siberian seas, depending on the temperature, salinity and sediment types is presented according to the data of trawl surveys in 2014 and 2017. L. cf. fabricii is the most common species in the surveyed water area with the frequency of occurrence of 22.4% in the Laptev Sea and 24.7% in the East Siberian Sea. The total relative abundance and biomass of all species of the genus Liparis in the East Siberian Sea (377.7 ind./km2 and 9.14 kg/km2) were slightly higher than in the Laptev Sea (326 ind./km2 and 8.32 kg/km2). The maximum length of L. tunicatus in the East Siberian Sea (172 mm) exceeds the previously known one (160 mm). The average length and weight of fish of all three species of Liparis in the East Siberian Sea are greater than in the Laptev Sea.
Orbital compartment syndrome secondary to subperiosteal abscess initiated by barotrauma
Authors: Toh Zhi Yon Charles , Cameron Angus
Published: October 2022

This case report demonstrates an unusual complication of bacterial rhinosinusitis, causing orbital compartment syndrome from a presumed barotrauma. We postulate that the patient developed unilateral optic neuropathy, as a result of orbital compartment syndrome, secondary to orbital subperiosteal abscess following direct communication with the ethmoid sinus initiated by barotrauma. It is supported by evidence of a bony dehiscence on the lamina papyracea of the medial orbital wall with sudden onset of pain, proptosis and visual symptoms during flight.
Primary bladder neck obstruction in female: ‘an enigmatic disorder’
Authors: Krishna Murali , Chaudhary Kapil , Sharma Aditya Prakash
Published: October 2022

A 36-year-old woman presented with problems of lower urinary tract symptoms for 2 years duration. Patient was being managed as a case of urethral stricture with routine calibration. Micturating cystourethrogram showed failure of bladder neck to open. On urodynamic study, she was found to have bladder outlet obstruction with high pressure, low flow pattern. Based on these findings, patient was diagnosed to have primary bladder neck obstruction (PBNO). She was also being evaluated for primary infertility and was to undergo in vitro fertilisation. She successfully underwent bladder neck incision after discussion about management options. Bladder neck incision is one of the accepted management options for PBNO. Post procedure patient was relieved of symptoms and also had an uneventful full-term pregnancy. Bladder neck incision in women is an effective treatment option when patient has been properly selected and procedure done with expert hands.
Homozygous V377I mutation causing mevalonate kinase
Authors: Brito Teresa , Banganho Denise , Pedrosa Cristina , Farela Neves João
Published: October 2022

Hyperimmunoglobulinaemia D syndrome (HIDS) is a rare autosomal recessive disorder caused by mutations in the mevalonate kinase (MVK) gene, located on chromosome 12. The most common mutation identified in MVK gene so far is V377I. Compound heterozygotes that include this variant may exhibit a more severe phenotype of the disease and homozygotes are rarely found in clinical practice probably they express a milder phenotype. HIDS is a chronic autoinflammatory disease characterised by recurrent febrile episodes, associated with lymphadenopathies, abdominal pain, rash and arthritis. These flares can be triggered by vaccination, minor trauma, surgery and stress.

We report a case of a 2-year-old girl who had recurrent attacks of fever associated with cervical lymphadenopathy, macular erythematous skin rash, abdominal pain and aphthous ulcers in the mouth. The patient was found to excrete elevated amounts of urinary mevalonic acid and a homozygous V337I mutation in the MVK gene was identified.
Combined robotic and subinguinal microsurgical vasovasostomy for vasal obstruction after inguinal hernia repair
Authors: Wald Moshe , Steinberg Ryan
Published: October 2022

Obstruction of the vas deferens may occur after inguinal hernia repair with mesh and lead to infertility. In cases where natural conception is desired and after obtaining test results that suggest the presence of spermatogenesis, surgical reconstruction can be attempted but may be difficult. Several approaches have been reported, including the laparoscopic mobilisation of the pelvic vas deferens, as well as mobilisation and passage of the scrotal vas deferens intra-abdominally for robot-assisted vasovasostomy. We describe a novel approach that used the surgical robot and a no-touch technique to mobilise the pelvic vas deferens and deliver it to the subinguinal region for subinguinal microsurgical vasovasostomy. This approach appeared to be feasible and safe, allows for simultaneous bilateral repair if needed, and was associated with rapid postoperative convalescence.
Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application
Authors: Firoz Tabassum , Trigo Romero Carla Lionela , Leung Clarus , Souza João Paulo , Tunçalp Özge
Published: October 2022

Introduction

Maternal near miss (MNM) is a useful means to examine quality of obstetric care. Since the introduction of the WHO MNM criteria in 2011, it has been tested and validated, and is being used globally. We sought to systematically review all available studies using the WHO MNM criteria to develop global and regional estimates of MNM frequency and examine its application across settings.

Methods

We conducted a systematic review by implementing a comprehensive literature search from 2011 to 2018 in six databases with no language restrictions. The predefined data collection tool included sections on study characteristics, frequency of near-miss cases and study quality. Meta-analysis was performed by regional groupings. Reported adaptations, modifications and remarks about application were extracted.

Results

7292 articles were screened by title and abstract, and 264 articles were retrieved for full text review for the meta-analysis. An additional 230 articles were screened for experiences with application of the WHO MNM criteria. Sixty studies with near-miss data from 56 countries were included in the meta-analysis. The pooled global near-miss estimate was 1.4% (95% CI 0.4% to 2.5%) with regional variation in MNM frequency. Of the 20 studies that made adaptations to the criteria, 19 were from low-resource settings where lab-based criteria were adapted due to resource limitations.

Conclusions

The WHO MNM criteria have enabled the comparison of global and sub-national estimates of MNM frequency. There has been good uptake in low-resource countries but contextual adaptations are necessary.
Virtual reality device to improve the tolerability of lumbar puncture
Authors: Hill Katie , Brown Chris , Gibbs Austin , Mitchell Andrew Robert John
Published: October 2022

Background

Virtual reality is increasingly being used as an adjunct or replacement to pharmacological analgesia and sedation during medical procedures.

Methods and results

We report the successful use of a virtual reality device in a highly anxious patient undergoing lumbar puncture.

Conclusion

The case demonstrates how virtual reality technology may benefit patients undergoing invasive procedures such as lumbar puncture. Virtual reality may, therefore, offer an alternative or adjunct to sedation and analgesia and may reduce the amount of pharmacological therapy required.
Randomised controlled monocentric trial to compare the impact of using professional actors or peers for communication training in a competency-based inverted biochemistry classroom in preclinical medical education
Authors: Schneider Achim , Messerer David Alexander Christian , Kühn Veronika , Horneffer Astrid , Bugaj Till Johannes , Nikendei Christoph , Kühl Michael , Kühl Susanne Julia
Published: October 2022

Objective

In medical education, biochemistry topics are usually knowledge based, and students often are unaware of their clinical relevance. To improve students’ awareness of the relevance, we integrated communication skills training into biochemistry education. No studies before have examined the difference between peer and standardised patient (SP) role plays where students explain the biochemical background of a disease in patient-centred language. Therefore, we evaluated whether students’ self-perceived competency in Canadian Medical Education Directives for Specialists (CanMEDS) roles and their opinion of the quality of role play differ if the layperson is played by peers or SPs.

Methods

We randomly assigned medical students in a preclinical semester to one of the two groups. The groups used predefined scripts to role play a physician–parent consultation with either a peer (peer group) or an SP (SP group) in the parent role. Students then assessed the activity’s effects on their competency in CanMEDS roles and motivation and the relevance of the role play. To determine whether students achieved biochemistry learning goals, we evaluated results of a biochemistry exam.

Results

Students’ self-perceived competency improved in both groups. The SP group rated their competency in the roles ‘Scholar’ and ‘Professional’ significantly higher than the peer group did. The peer group rated their competency in the role of ‘Medical Expert’ significantly higher if they played the role of the parent rather than physician or observer. The SP group agreed more that they were motivated by the role play and wanted to receive more role play-based teaching. The SP group perceived the role play as being realistic and rated the feedback discussion as more beneficial. The examination results were the same in both groups.

Conclusion

We showed that role plays in a biochemistry seminar improve students’ self-perceived competency. The use of SPs has some advantages, such as being more realistic.
Association of the Intermountain Risk Score with major adverse health events in patients positive for COVID-19: an observational evaluation of a US cohort
Authors: Horne Benjamin D , Bledsoe Joseph R , Muhlestein Joseph B , May Heidi T , Peltan Ithan D , Webb Brandon J , Carlquist John F , Bennett Sterling T , Rea Susan , Bair Tami L , Grissom Colin K , Knight Stacey , Ronnow Brianna S , Le Viet T , Stenehjem Edward , Woller Scott C , Knowlton Kirk U , Anderson Jeffrey L
Published: October 2022

Objectives

The Intermountain Risk Score (IMRS), composed using published sex-specific weightings of parameters in the complete blood count (CBC) and basic metabolic profile (BMP), is a validated predictor of mortality. We hypothesised that IMRS calculated from prepandemic CBC and BMP predicts COVID-19 outcomes and that IMRS using laboratory results tested at COVID-19 diagnosis is also predictive.

Design

Prospective observational cohort study.

Setting

Primary, secondary, urgent and emergent care, and drive-through testing locations across Utah and in sections of adjacent US states. Viral RNA testing for SARS-CoV-2 was conducted from 3 March to 2 November 2020.

Participants

Patients aged ≥18 years were evaluated if they had CBC and BMP measured in 2019 and tested positive for COVID-19 in 2020.

Primary and secondary outcome measures

The primary outcome was a composite of hospitalisation or mortality, with secondary outcomes being hospitalisation and mortality separately.

Results

Among 3883 patients, 8.2% were hospitalised and 1.6% died. Subjects with low, mild, moderate and high-risk IMRS had the composite endpoint in 3.5% (52/1502), 8.6% (108/1256), 15.5% (152/979) and 28.1% (41/146) of patients, respectively. Compared with low-risk, subjects in mild-risk, moderate-risk and high-risk groups had HR=2.33 (95% CI 1.67 to 3.24), HR=4.01 (95% CI 2.93 to 5.50) and HR=8.34 (95% CI 5.54 to 12.57), respectively. Subjects aged <60 years had HR=3.06 (95% CI 2.01 to 4.65) and HR=7.38 (95% CI 3.14 to 17.34) for moderate and high risks versus low risk, respectively; those ≥60 years had HR=1.95 (95% CI 0.99 to 3.86) and HR=3.40 (95% CI 1.63 to 7.07). In multivariable analyses, IMRS was independently predictive and was shown to capture substantial risk variation of comorbidities.

Conclusions

IMRS, a simple risk score using very basic laboratory results, predicted COVID-19 hospitalisation and mortality. This included important abilities to identify risk in younger adults with few diagnosed comorbidities and to predict risk prior to SARS-CoV-2 infection.
Health and coping strategies of nursing home residents and their relatives during the COVID-19 pandemic: a mixed-methods study protocol
Authors: Ortoleva Bucher Claudia , Abt Maryline , Berthoud Laurent , Cohen Christine
Published: October 2022

Introduction

The COVID-19 pandemic hit older adults particularly hard, especially those living in nursing homes. The present study’s primary aim is to quantify the states of physical and mental health of nursing home residents and their relatives following the implementation of the exceptional confinement measures. The secondary aim is to explore the lived experiences of the stressors perceived by older adults and their relatives, as well as the support strategies implemented by health professionals and their results.

Methods and analysis

We chose a mixed-methods (quantitative/qualitative) study to best deliver a profound understanding of this phenomenon.

Quantitative phase: participants are asked to complete several questionnaires. The study population includes all the nursing home residents in four French-speaking cantons of Switzerland (and their relatives) who are living through the COVID-19 pandemic. Descriptive statistics will be calculated for the scores of the General Health Questionnaire-12, Impact of Event Scale-6, Perceived Stress Scale, Brief Cope, Post-traumatic Growth Inventory, World Health Organization Quality of Life-BREF(WHOQOL-BREF) and WHOQOL-OLD scales. Correlational analyses will be considered.

Qualitative phase: data are collected from several sources (individual semi-structured interviews, focus groups, field notes). Interviews are planned with about 12 representatives of each group of participants (residents and relatives). Two focus groups made up of healthcare professionals will be constituted to explore the lived experiences of the stressors perceived by residents and relatives, the coping strategies those two groups implemented to deal with them. The interviews and focus groups will be subjected to a thematic contents analysis.

Integrating the quantitative and qualitative data will take place jointly with data interpretation.

Ethics and dissemination

This project was approved by the Human Research Ethics Committee of the Canton of Vaud on 14 December 2020 (project ID: 2020-02397). The prior written informed consent of the study subjects is collected by a member of the research team before data collection. Study results will be disseminated via professional and peer-reviewed publications.

Trial registration number

ISRCTN12345167.
Issues related to pregnancy, pregnancy prevention and abortion in the context of the COVID-19 pandemic: a WHO qualitative study protocol
Authors: Cecatti Jose Guilherme , Bahamondes Luis , Ali Moazzam , Alangea Deda Ogum , Brizuela Vanessa , Nahyuha Chomi Eunice , Kouanda Seni , Karmaliani Rozina , Ladak Laila , Lumbiganon Pisake , Emefa Modey , Jen Sothornwit , Kuganantham Hamsadvani , Kim Caron
Published: October 2022

Introduction

WHO has generated standardised clinical and epidemiological research protocols to address key public health questions for SARS-CoV-2 (COVID-19) pandemic. We present a standardised protocol with the aim to fill a gap in understanding the needs, attitudes and practices related to sexual and reproductive health in the context of COVID-19 pandemic, focusing on pregnancy, pregnancy prevention and abortion.

Methods and analysis plan

This protocol is a prospective qualitative research, using semi-structured interviews with at least 15 pregnant women at different gestational ages and after delivery, 6 months apart from the first interview. At least 10 partners, 10 non-pregnant women and 5 healthcare professionals will be interviewed once during the course of the research. Higher number of subjects may be needed if a saturation is not achieved with these numbers. Data collection will be performed in a standardised way by skilled trained interviewers using written notes or audio-record of the interview. The data will be explored using the thematic content analysis and the researchers will look for broad patterns, generalisations or theories from these categories.

Ethics and dissemination

The current protocol was first technically assessed and approved by the WHO scientific committee and then approved by its ethics review committee as a guidance document. It is expected that each country/setting implementing such a generic protocol adapted to their conditions also obtain local ethical approval. Comments for the user’s consideration are provided the document, as the user may need to modify methods slightly because of the local context in which this study will be carried out.
Assessing the role of depressive symptoms in the association between social engagement and cognitive functioning among older adults: analysis of cross-sectional data from the Longitudinal Aging Study in India (LASI)
Authors: Kumar Manish , Muhammad T , Dwivedi Laxmi Kant
Published: October 2022

Objective

The present study aimed to examine the confounding effects of depressive symptoms and the role of gender in the association between social engagement and cognitive functioning among older Indian adults.

Design

Large-scale cross-sectional survey data were analysed.

Setting and participants

Data from the Longitudinal Aging Study in India (2017–2019) were used in the analysis. The sample included 23 584 individuals aged 60 years and above (11 403 men and 12 181 women).

Outcome measures

The outcome variable was cognitive functioning, which was based on various measures including immediate and delayed word recall, orientation, executive functioning, arithmetic ability and object naming. Social engagement measure consists of marital status, living arrangement, availability of confidant, and participation in indoor games, and social and cultural functions. The Center for Epidemiological Studies-Depression Scale was used to assess depressive symptoms.

Results

Significant gender differences in mean cognition scores (men: 25.8, women: 21.1; on a scale of 0–43) were observed. Two-way stratification between social engagement and depressive symptoms was significantly associated with cognitive functioning after controlling for selected explanatory factors. Older men with a low level of social engagements had significantly poor cognitive functioning (β=−1.12; 95% CI: −1.53 to –0.72) compared with men with a high level of social engagements. On the other hand, women with a higher level of social engagement performed poorly on cognitive tests (β=−1.54; 95% CI: −2.11 to –0.98) compared with men with higher social engagements. Three-way stratification between social engagement, gender and depressive symptoms suggests that social engagement’s buffering effects are lower in women than in men. The Karlson-Holm-Breen method identified a significant confounding effect of depressive symptoms on the relationship between social engagement and cognitive functioning.

Conclusion

The positive association of social engagement with cognitive functioning was significantly confounded by depressive symptoms, suggesting the need for maintaining social relations that help improve mental health and cognitive functioning among older adults.
Histopathological profile of orbito-ocular cancers at a tertiary hospital in Northern Malawi: a retrospective cross-sectional study
Authors: Sinyiza Frank Watson , Chisale Master R O , Kayira Alfred B , Chimbatata Chikondi Sharon , Kaseka Paul Uchizi , Kamudumuli Pocha , Wu Tsung-Shu Joseph , Mbakaya Balwani Chingatichifwe
Published: October 2022

Objective

Orbito-ocular cancers are a common cause of morbidity and mortality in our population, yet these cancers have not been adequately described in Malawi. This study sought to describe the burden and histopathological profile of orbito-ocular cancers in Northern Malawi.

Methods and Analysis

A retrospective review of pathology reports was done. Descriptive analyses were performed to summarise patients’ demographic and clinical characteristics, and histopathological results. A binary logistic regression was used to explore the association between demographic variables, site of lesion and cancer.

Results

210 pathology reports of orbito-ocular biopsies were reviewed. 60.0% of patients were female. The majority (39.5%) of patients were in the 31 to 40 age group but overall mean age (±SD) was 34.81±15.9 years. Cancer was diagnosed in 84 (40.0%) patients. Squamous cell carcinoma constituted the majority (82.1%) of cancers followed by retinoblastoma at 7.1%. Orbito-ocular cancers were associated with HIV infection (OR5.9, 95% CI 2.0 to 17.2) and intraocular tumours were 8.3 times (OR 8.3, 95% CI 2.0 to 33.8) more likely to be malignant. However, squamous cell carcinoma was the only type of cancer found in patients with HIV infection and mostly affected the conjunctiva, constituting 94.4% of cancers affecting this site. Retinoblastoma on the other hand only affected children less than 10 years of age.

Conclusion

Cancer constituted a substantial proportion of orbito-ocular lesions in our study population, with conjunctiva being the common site. This calls for improved capacity to prevent, diagnose and manage orbito-oracular cancers in Northern Malawi and similar settings.
Associations with visual acuity outcomes after 12 months of treatment in 9401 eyes with neovascular AMD
Authors: Relton SD , Chi GC , Lotery Andrew , West RM ,   Real world AMD treatment outcomes EMR User Group, McKibbin Martin
Published: October 2022

Objective

To record visual acuity outcomes after 12 months of treatment for neovascular age-related macular degeneration (NvAMD), investigate variation between sites and explore associations with baseline characteristics and care processes.

Methods and analysis

Anonymised demographic and clinical data were extracted from electronic medical records at treating National Health Service (NHS) Trusts. Associations with acuity outcomes were investigated using multivariate linear and logistic regression.

Results

Analysis included 9401 eyes (7686 patients) treated at 13 NHS Trusts. From baseline to month 12, median acuity improved from LogMAR 0.50 (IQR 0.30–0.80) to 0.40 (0.22–0.74) and the proportion of eyes with LogMAR ≥0.3 increased from 34.5% to 39.8%. Baseline visual acuity was the strongest predictor of visual acuity outcomes. For each LogMAR 0.1 worsening of baseline acuity, the acuity at 12 months was improved by LogMAR 0.074 (95% CI 0.073 to 0.074) and the odds of a ‘poor’ acuity outcome was multiplied by 1.66 (95% CI 1.61 to 1.70). Younger age, independent living status, lower socioeconomic deprivation, timely loading phase completion and higher number of injections were associated with better acuity outcomes. Despite case-mix adjustments, there was evidence of significant variation in acuity outcomes between sites.

Conclusions

Even after adjustment for other variables, variation in acuity outcomes after NvAMD treatment within the NHS remains. Meaningful comparison of outcomes between different providers requires adjustment for a range of baseline characteristics, not visual acuity alone. Identifying best practice at sites with better outcomes and adapting local care processes are required to tackle this health inequality.
A case of antipsychotic-induced psychomotor seizure
Authors: Zheng Yanqun , Liu Xiaohua , Ju Mingliang
Published: October 2022

A seizure is one of the most uncommon severe adverse side effects of antipsychotics. Clinical recognition rates for it are low, especially for psychomotor seizures. The authors present a case of psychomotor seizure caused by amisulpride to treat schizophrenia. A 60-year-old male patient in our hospital experienced a recent onset of repetitive, stereotyped involuntary and unconscious movements that began with amisulpride use. All of the symptoms disappeared following amisulpride withdrawal. His Naranjo Adverse Drug Reactions Probability Scale Score was 5 points. The case sheds light on the clinical risk of seizures related to antipsychotics.
Hypertriglyceridaemia: an update
Authors: Wierzbicki Anthony S , Kim Eun Ji , Esan Oluwayemisi , Ramachandran Radha
Published: October 2022

Triglycerides (TGs) form part of the standard lipid profile. Elevations in TGs are associated with increased cardiovascular disease risk through triglyceride-rich lipoprotein particles found as part of non-HDL cholesterol. Many elevations of TGs are secondary to other causes, but primary hypertriglyceridaemia syndromes need to be identified. The genetic causes of hypertriglyceridaemia range from familial combined hyperlipidaemia through the autosomal recessive remnant hyperlipidaemia (related to apolipoprotein E variants) and familial chylomicronaemia syndromes. Patients with primary hypertriglyceridaemia >10 mmol/L require characterisation and specific intervention. Simple lipid profiles do not provide adequate information for detailed diagnosis and additional assays such as apolipoprotein (apo)B100, apoE genotype and next-generation sequencing may be useful. Management of raised TGs includes optimising diet, reducing exacerbating factors as well as lipid-lowering medications such as statins, fibrates, niacin and omega-3 fatty acids. Novel medications for orphan disease indications such as familial chylomicronaemia syndrome include volanesorsen, evinacumab and other antisense therapeutics. Extreme hypertriglyceridaemia syndromes, especially chylomicronaemia syndromes, which can be exposed by pregnancy or other factors are a medical emergency and require admission and specialist management sometimes including plasma exchange.
Longer-term rates of survival and reintervention after thoracic endovascular aortic repair (TEVAR) for blunt aortic injury: a retrospective population-based cohort study from Ontario, Canada
Authors: Evans Christopher C D , Li Wenbin , Yacob Michael , Brogly Susan
Published: October 2022

Objectives

Blunt aortic injury (BAI) is associated with a high rate of mortality. Thoracic endovascular aortic repair (TEVAR) has emerged as the preferred treatment option for patients with BAI. In this study, we compare the longer-term outcomes of patients receiving TEVAR with other treatment options for BAI.

Methods

We conducted a retrospective cohort study using administrative health data on patients with BAI in Ontario, Canada between 2009 and 2020. Patients with BAI and who survived at least 24 hours after hospital admission were identified using diagnostic codes. We classified patients as having received TEVAR, open surgical, hybrid repair, or medical management as their initial treatment approach based on procedure codes. The primary outcome was survival to maximum follow-up. Secondary outcomes included aorta-related mortality or aortic reintervention. Cox’s proportional hazards models were used to estimate the effect of TEVAR on survival.

Results

427 patients with BAI were followed for a median of 3 years (IQR: 1–6 years), with 348 patients (81.5%) surviving. Survival to maximum follow-up did not differ between treatment groups: TEVAR: 79%, surgical repair: 63.6%, hybrid repair: 85.7%, medical management: 83.3% (p=0.10). In adjusted analyses, TEVAR was not associated with improved survival compared with surgical repair (HR: 0.6, 95% CI: 0.3 to 1.6), hybrid repair (HR: 1.4, 95% CI: 0.5 to 3.6), or medical management (HR: 1.5, 95% CI: 0.8 to 2.6). Aortic reinterventions were required in only 2.6% of surviving patients but were significantly more common in the TEVAR group (p<0.01).

Conclusions

The longer-term survival from BAI appears highly favorable with low rates of reintervention and death in the years after injury, regardless of the initial treatment approach.

Level of evidence

IV, Therapeutic study.
Decay property for a novel partially dissipative viscoelastic beam system on the real line
Authors: Mori N. , Jorge Silva M. A.
Published: October 2022

We address here a viscoelastic Timoshenko model on the (one-dimensional) real line with memory damping coupled on a shear force. Our main results concern a complete decay structure of the system under the so-called equal wave speeds assumption, as well as without this condition. This is the first result of this type for partially dissipative beam systems with memory-type damping on the shear force. Our method is based on expanded structural conditions such as the so-called SK condition. In addition, we give a characterization of the dissipative structure of the system by using a spectral analysis method, which confirms that our decay structure is optimal.
To the Nature of Surfactant Adsorption onto Metallic Surfaces: Interaction with Metal or Hydrophobic Effect? Adsorption of Hexylamine on Platinum
Authors: Ostapenko Gennady I. , Kalashnikova Nina A.
Published: October 2022

We investigated the adsorption of hexylamine (in its hydrated form, hexylammonium ion) on the solution-platinum interface in 1 M HClO4 in the presence of 0.1 M Fe2+ and 0.1 Fe3+ by potentiodynamic and impedance methods, and also at the solution-air interface by the maximum bubble pressure technique. We show that the physical adsorption of hexylamine at both interfaces is described by the Dhar-Flory-Huggins isotherm equation. The values of adsorption constant and free adsorption energy are close for both interfaces. For the solution-air interface, the hydrophobic effect is the main reason for the surfactant adsorption at this interface. Based on the closeness of the main adsorption characteristics for both interfaces, we suggest that the adsorption of hexylamine on platinum occurs mainly due to the hydrophobic interaction of hexylamine polar molecules with water polar molecules as well. It has been shown that for the solution–platinum interface, the share of the hydrophobic effect is about 60%, and that of the van der Waals interaction is about 40%.
Use of Ethylene Carbonate Free Ester Solvent Systems with Alternative Lithium Salts for Improved Low-Temperature Performance in NCM622∣∣ Graphite Li-ion Batteries
Authors: Rodrigo Nuwanthi D. , Jayawardana Chamithri , Rynearson Leah , Hu Enyuan , Yang Xiao-Qing , Lucht Brett L.
Published: October 2022

An investigation of alternative lithium salts, lithium tetrafluoroborate (LiBF4), lithium difluoro(oxalato)borate (LiDFOB) and lithium hexafluorophosphate (LiPF6), in novel ester-based (methyl acetate/fluoroethylene carbonate- MA/FEC or methyl propionate/fluoroethylene carbonate- MP/FEC) electrolyte formulations has been conducted in LiNi0.6Co0.2Mn0.2O2 (NCM622)/graphite cells to improve low temperature cycling performance of lithium ion batteries at −20 °C. Improved low temperature performance was observed with all the lithium salts in MA/FEC electrolyte while comparable room temperature (25 °C) capacities were observed with LiPF6 salt only. Detailed ex-situ analysis of surface films generated with LiBF4, LiDFOB and LiPF6 in ester-based electrolytes reveals that the solid electrolyte interphase (SEI) is predominately composed of lithium salt decompaction products and addition of 10% FEC (by volume%) may not be sufficient at forming a protective SEI.
Modeling Reversible Expansion of Porous Electrodes in Si/NMC Cells within the Framework of Multi-Species, Multi-Reaction Theory
Authors: Arisetty Srikanth , Jimenez Niccolo , K. Raghunathan
Published: October 2022

We formulated a model that describes the diffusion, volume change and mechanical compression, coupled with multi-site-multi-reaction theory of the porous electrodes, and we apply the treatment to battery cells with silicon as anode active material. Irreversible thermodynamics and conservation laws have been used to tie all the equations together. For cell lithiation (charge), changes in the porosity, cell thickness and cell electrochemical resistance due to increase in active material volume and mechanical compression are calculated. Experimental data on cell expansion is collected on pouch cells with silicon anode and NMC622 the cathode; the model compares favorably with the data. Model simulations show that during the C/5 charge cycle, particle expands by 10% and porosity of the electrode decreases by approximately 8%. The model can be exercised to evaluate the cell operating regime for meeting targets and design considerations. Simulation studies revealed the importance of compression pressure and the spring constant on cell expansion.
Neuromotor deficits and altered physiological responses to repeated exertional heat stroke exposures in mice
Authors: Alzahrani Jamal M. , Murray Kevin O. , Gambino Bryce J. , Garcia Christian K. , Sheikh Laila H. , Cusack Kevin J. , Laitano Orlando , Clanton Thomas L.
Published: October 2022

Exertional heat stroke (EHS) is a life-threatening illness that can lead to negative health outcomes. Using a “severe” preclinical mouse model of EHS, we tested the hypotheses that one EHS exposure results in altered susceptibility to a subsequent EHS and reduced neuromotor performance. Female C57BL/6 mice underwent two protocols, 2 wk apart, either an EHS trial (EHS) or a sham exercise control trial (EXC). For EHS, mice ran in a forced running wheel at 37.5°C/40% relative humidity until loss of consciousness, followed by a slow cooling protocol (2 h recovery at 37.5°C). EXC mice exercised equally but in ∼22°C. Mice were randomized into three groups: 1) EXC-EXC (two consecutive EXC, n = 6, 2) EHS-EXC (EHS followed by EXC, n = 5), and 3) EHS-EHS (repeated EHS, n = 9). Mice underwent noninvasive neuromotor and behavioral tests during recovery and isolated soleus force measurements at the end of recovery. At the first EHS, mice reached average peak core temperatures (Tc,max) of 42.4°C, (46% mortality). On the second EHS, average Tc,max was reduced by ∼0.7°C ( P < 0.05; mortality 18%). After the first EHS, both EHS-EX and EHS-EHS showed significant reductions in maximum strength (24 h and 1 wk post). After the second EHS, strength, horizontal rotation, hindlimb tone, suspended hindlimb splay, trunk curl, and provoked biting continued to decline in the EHS-EHS group. In conclusion, exposure to a second EHS after 2 wk leads to increased exercise times in the heat, symptom limitation at a lower Tc,max, and greater deficits in neuromotor and behavioral function during recovery.
White Matter Hyperintensities and Poststroke Apathy: A Fully Automated MRI Segmentation Study
Authors: Martins-Filho Rui Kleber , Rodrigues Guilherme , da Costa Raul Ferreira , Castro Rodrigo de Souza , Zanon Zotin Maria Clara , Camilo Millene R. , Pontes-Neto Octavio M.
Published: October 2022

Introduction: Poststroke apathy (PSA) is a common neuropsychiatric disorder that may affect up to 30% of stroke patients. Despite the difficulties of investigating this condition (overlapping with depression, heterogeneity of diagnostic criteria, a small number of studies), some recent diffusion tensor imaging studies have suggested that widespread microstructural white matter (WM) disruption plays a key role in the development of PSA. Therefore, we intended to investigate this hypothesis by evaluating the relationship between WM hyperintensities (WMH) and apathy in patients with cerebrovascular disease. Methods: We studied patients with apathy (n = 7), depression (n = 13), comorbid apathy and depression (n = 13), and controls (n = 20), and we investigated the variables associated with the volume of WMH measured by an automated brain MRI segmentation software. Results: The overall prevalence of PSA was 37.7% (pure and comorbid). Patients with apathy presented a higher volume of WMH in comparison to controls. Mini-Mental State Examination (MMSE), NPI-A, and the number of cerebral microbleeds were the only variables associated with WMH. Conversely, NPI-D did not correlate to WMH. Discussion/Conclusion: This is an exploratory study that supports the view of PSA as a distinct syndrome from PSD mediated mainly by diffuse white matter hyperintensities, which suggests that WM disruption is an important pathway to the development of apathy in stroke patients.
Burosumab Therapy in a Paediatric Patient with McCune-Albright Syndrome: A Case Report
Authors: Apperley Louise J. , Senniappan Senthil
Published: October 2022

Introduction: McCune-Albright syndrome is characterized by the triad of fibrous dysplasia, café au lait skin pigmentation, and hyperfunctioning endocrinopathies. It is a sporadic condition caused by a missense mutation in the GNAS locus, located on chromosome 20q13.3, resulting in mosaic activation of the G protein alpha subunit. Case Presentation: We pre‑sent a paediatric patient diagnosed with McCune-Albright syndrome at the age of 5 years. During the course of his condition, he was medically managed for a number of complications, such as peripheral precocious puberty and growth hormone excess, and monitored for hyperprolactinaemia. Due to fibroblast growth factor 23-mediated phosphate wasting, the patient was commenced on oral phosphate supplements and alfacalcidol. After 2 years of treatment, this therapy did not optimize his bone biochemistry (phosphate 0.96 mmol/L, alkaline phosphatase 1,172 IU/L, and parathyroid hormone 9.1 pmol/L), and the patient was started on two-weekly burosumab therapy via subcutaneous injection. His bone biochemistry soon normalized (phosphate 1.52 mmol/L, alkaline phosphatase 358 IU/L, and parathyroid hormone 6.9 pmol/L) following this, and he remains on burosumab without any adverse effects. Discussion: This case shows the positive effect that a short-term course of burosumab has on bone health in a paediatric patient with McCune-Albright syndrome. Further research is required to assess long-term effects. Our patient also presented with precocious puberty and growth hormone excess, a coexistence that can be challenging to diagnose and is less common in males. He received medical management for both conditions, but due to the similar presentations, this case highlights the importance to investigate and diagnose associated complications as early as possible, so they can be managed in a timely manner.