bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare Simulation: An effective way of learning in health care
Authors: Munazza Saleem  , Khan Zuhera
Published: May 2023

Background and Objective: Simulation-based learning has been a part of teaching in healthcare for a long time; however, in recent decades, simulation-based learning has been adopted by a significant number of healthcare institutes at different levels to improve practical skills, confidence, and preparedness to ensure patient safety and its application in real-life situations towards better patient care. The main objective of this paper was to use existing literature to explore aspects of simulation in healthcare teaching.

Methods: It is a narrative review on simulation in healthcare that was conducted by using various search engines for English-language articles published between 2010 and August 2020. The main search terms were simulation, healthcare teaching, and simulation in healthcare. All articles found relevant to the title and/or abstract were retrieved. Searches were conducted using the academic databases PubMed, Google Scholar, MEDLINE, CINAHL, and Athabasca University (AU) library site. The studies were reviewed if they were considered relevant to the search by the primary authors.

Results: Thirty-nine articles, which met the pre-set criteria, were analyzed and employed as a reference in this paper to support the idea that simulation is an effective way of learning in healthcare.

Conclusion: This paper reviewed various aspects of simulation, including its background, philosophies, and highlighted the advantages and disadvantages of incorporating simulation as a pedagogical approach into current educational curriculums for healthcare students. Furthermore, it presents a brief discussion on the current uses of simulation, followed by the educational strategies related to simulation and the importance of debriefing in simulation activities.

doi: https://doi.org/10.12669/pjms.39.4.7145

How to cite this: Saleem M, Khan Z. Healthcare Simulation: An effective way of learning in health care. Pak J Med Sci. 2023;39(4):---------.  doi: https://doi.org/10.12669/pjms.39.4.7145

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Significance of tumor markers combined with neutrophil to lymphocyte ratio, D-dimer and T-lymphocyte in the diagnosis of colon cancer
Authors: Li Qianying , Geng Shumei , Zhang Xiaowei , Jia Zilong
Published: May 2023

Objective: To analyze the value of combined detection of tumor markers, neutrophil to lymphocyte ratio (NLR), D-dimer and T lymphocyte in the diagnosis of colon cancer.

Methods: This is a retrospective study. A total of 80 patients with colon cancer and 80 patients with benign colon mass admitted to Baoding NO.1 Central Hospital from June 10, 2021 to December 10, 2022 were divided into the study group and the control group. Further comparison was performed on the tumor markers, NLR, D-dimer and T-lymphocyte levels between the two groups, associated with the comparison of corresponding levels of colon cancer at different stages. In addition, correlation analysis was carried out focusing on the above indicators with colon cancer.

Results: Carcinoembryonic antigen (CEA), CA199, NLR, D-dimer and CD8+ cell count levels in the study group were significantly higher than those in the control group, while CD4+ cell count and CD4+/CD8+ ratio were obviously lower (P<0.05). Among I-IV colon cancer, the highest levels of CEA, CA199, NLR, D-dimer, CD4+ and CD4+/CD8+ ratio were found in patients with Stage-IV colon cancer, while the level of CD8+ was the lowest (P<0.05). Correlation analysis indicated that CEA, CA199, NLR, D-dimer and CD8+ were positively correlated with whether the patient had colon cancer (r=0.841, 747,991,889,565, all P<0.05), but negative correlations with CD4+ and CD4+/CD8+ ratio (r=-0.999, -0.994, all P<0.05).

Conclusion: The detection of tumor markers combined with NLR, D-dimer and T-lymphocytes has reference value in the diagnosis of colon cancer.

doi: https://doi.org/10.12669/pjms.39.4.7157

How to cite this: Li Q, Geng S, Zhang X, Jia Z. Significance of tumor markers combined with neutrophil to lymphocyte ratio, D-dimer and T-lymphocyte in the diagnosis of colon cancer. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7157

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study
Authors: Mahmood Malik Lamees , Khalid Dr. Tanzeela , Ashar Abid
Published: May 2023

Background and Objective: Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS).

Methods: This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes.

Results: A total of 17 attributions noted were grouped into five categories namely ‘Inadequate exam preparation’, ‘Personal factors,’ ‘Exam related factors,’ ‘Training related factors and ‘Luck’. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner’s attitude (5/10).

Conclusions: Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.

doi: https://doi.org/10.12669/pjms.39.4.7693

How to cite this: Malik LM, Khalid T, Ashar A. Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7693

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Measurement of speech in individuals with selective mutism: A systematic review
Authors: Toma Yuria , Matsuda Soichiro
Published: May 2023

Background: The main characteristic of selective mutism (SM) is the failure to speak in specific social situations. Thus, assessing speech across social contexts is important for confirming a diagnosis of SM and for differentiating it from other disorders. The purpose of this review was to organize how the core symptom of SM, a lack of speech in specific social situations, has been assessed in previous studies.

Methods: A systematic search of articles was conducted in three databases, Web of Science, PsycINFO, and PubMed and reviews of surveys or experimental studies that reported empirical data on individuals with SM were performed. We excluded review, qualitative, epidemiological, and intervention studies. The study summarized the diagnostic criteria, methods of confirming SM diagnosis, distinction of SM from other disorders, and methods of speech assessment.

Results: A total of 447 articles were screened, where 60 articles were considered eligible. The results demonstrate that different interviews and questionnaires were used to establish the diagnosis of SM. However, the majority of interviews and questionnaires lacked validation. Only two (2/60) articles used validated methods of speech assessment to confirm SM diagnosis. Moreover, a consensus was lacking on the assessment method for differentiating SM from other disorders across studies. Specifically, 17 studies measured speech and are not intended for diagnosis. The majority of studies (16/17) used the questionnaire to assess the severity of the SM condition, and only one study conducted behavioral observation. Assessment methods based on the measurement of speech in real-life situations for individuals with SM were not established.

Conclusion: We have the limitation that we did not review intervention studies. However, this systematic review revealed the problem that speech assessment methods for surveys or experimental studies of SM were not established. Future studies should establish methods of speech assessment across social situations to assess SM symptoms.
Fatty acid composition on diet and carcasses, growth, body indices and profile serum of Asian redtail catfish (Hemibagrus nemurus) fed a diet containing different levels of EPA and DHA
Authors: Aryani Netti , Suharman Indra , Hasibuan Saberina , Asiah Nur , Syandri Hafrijal
Published: May 2023

Background: The Asian redtail catfish Hemibagrus nemurus is a promising commercial aquaculture freshwater big-sized Bagridae catfish across Asian countries such as the Mekong, Malay Peninsula, and Indonesia. This study analysed the effect of eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) supplementation in diets on changes in fatty acid compositions in feed and fish meat, lipid quality (atherogenic index and thrombogenic index), growth rate, body indicators, and serum metabolites of Hemibagrus nemurus juveniles.

Methods: A total of 180 Asian redtail catfish (initial weight 54.80 ± 2.72 g) were fed four levels (0, 3,150, 6,300, and 9,450 mg of EPA+DHA/kg feed) sourced from fish oil. Diets were fed in triplicate in freshwater tarpaulin ponds, with 15 fish per tarpaulin pond. During the experiment, fish were fed 3% per day of the biomass weight.

Results: Categorically, there were significant differences in the composition of fatty acids in the feed and fish meat. The atherogenic index was between 1.76 and 1.84, and the thrombogenic index was between 0.81 and 0.89 in all fish meat. Growth performance was significantly different between diets, while body indices did not make a significant difference between diets. The fish meat EPA and DHA showed positive linear relationships with diet EPA (p <0.001, r2 = 90%) and DHA diet (p<0.001, r2 = 85%). Serum metabolites among treatments D2 and D3 diet-fed feed for 60 days did not significantly differ. Glucose (GLU) levels had moderate relationships with triglycerides (TAG) (r2 = 65%), and GLU levels strongly correlated with low-density lipoprotein cholesterol (LDL-C) (r2 = 81%).

Conclusions: Based on diets and whole-body carcass compositions, growth performance, and serum metabolites, Asian redtail catfish fed a diet containing 6,300 mg of EPA+DHA/kg feed are best for food safety.
Comparative evaluation and co-relation in variation of curve of Spee and curve of Wilson in Class II div. 1, Class II div. 2, and Class III as against Class I malocclusion in central India population- an in vitro study
Authors: Pandey Ruchika , Kamble Ranjit
Published: May 2023

Introduction- Getting acceptable cosmetic results in the soft tissues of the face serves as the foundation for orthodontic treatment planning. Also, in order to achieve healthy static and dynamic occlusal interactions, the teeth must be positioned within the basal bone at the correct position, angle, and inclination. To avoid periodontal issues, provide stability, and achieve a functional occlusion, it is essential to ascertain the individual's dental arch form before starting of treatment and thus to utilise the mechanics that follow throughout the treatment.

Objectives- To evaluate and compare variation in Curve of Spee and Curve of Wilson in Class II Div.-1, Class II-Div-2 and Class-III as against Class I malocclusion in central India population.

Methodology- Irreversible hydrocolloid impression will be taken with perforated metal stock trays and stone cast will be poured. This will be scanned using CAD CAM machine and curve of Spee and Wilson will be measured using reverse engineering.

Expected Result- It will assist us in treatment planning for preventing periodontal issues, assuring stability, and achieving functional occlusion by evaluating and comparing the Spee and Wilson curves in Class II Divison-1, Class II Divison-2, and Class-III malocclusion with Class-I malocclusion.

Conclusion- Every single patient receiving orthodontic treatment has the COS, which is crucial to achieving a stable occlusion. Almost every patient who receives orthodontic treatment eventually experiences the Spee Curve. Since there aren't many studies examining the relationship between the Curves of Spee and Wilson, their impact on dentoskeletal morphology, and their role in occlusal stability.
Strategic Visual Merchandising of New and Open-Box Products: Evidence from Experiment and Retail Data
Authors: Ertekin Necati , Ding Yuanyuan , Donohue Karen
Published: May 2023

Retailers are increasingly selling returned products as open-box along with their new product offerings. Whereas some retailers position open-box products side-by-side with their new counterparts in the assortment (i.e., side-by-side strategy), other retailers position them separately in a different part of the retail space/website (i.e., separate strategy). We conduct multimethodology research to investigate the effectiveness of these two visual merchandising strategies. First, using a choice-based conjoint design in a controlled behavioral experiment, we identify how the two strategies affect the perceived value of new products. Next, using proprietary data from a retailer that has implemented both strategies across different stores, we empirically test the impact of each strategy on new product sales and returns under real market conditions. Finally, we extend our empirical analysis to prescribe how retailers can identify the right visual merchandising strategy for a given product profile. Overall, our results reveal a novel trade-off between the two visual merchandising strategies. With respect to retail revenue, the separate strategy outperforms the side-by-side strategy as we find that new product sales are higher with the separate strategy. However, with respect to retail cost, the side-by-side strategy outperforms the separate strategy as we find that new product returns are lower with the side-by-side strategy. Our extended analysis reveals that this tradeoff varies by product profile. Using counterfactual analysis, we further demonstrate that customizing the visual merchandising strategy by product mix could increase profit by 3.2% at the focal retailer.

This paper was accepted by Jeannette Song, operations management.

Supplemental Material: The data files and online appendices are available at https://doi.org/10.1287/mnsc.2023.4786 .
Perforated spontaneous intestinal intramural haematoma
Authors: Chan DYS , Ooi GS
Published: May 2023

Spontaneous intestinal intramural haematomas are uncommon in the absence of trauma and may occur in those on anticoagulation. A young girl presented with generalised abdominal pain and was found to have pneumoperitoneum. She underwent an exploratory laparotomy and was found to have multiple ileal intramural haematomata with an area of possible perforation with a collection of pus. We believe that this is the first reported case of a rupture of spontaneous intestinal intramural haematoma in a young girl with no history of anticoagulation use or coagulation disorders.
Aberrant right posterior sectoral duct injury necessitating liver resection
Authors: Bowen G , Hannan E , Harding T , Maguire D , Stafford AT
Published: May 2023

Aberrant insertion of the right posterior sectoral duct is a particularly hazardous variation of biliary anatomy which makes it prone to injury during laparoscopic cholecystectomy. Such injuries are challenging to manage, as multiple therapeutic options are available with no clear consensus in the literature for an optimal approach. Options include conservative management, intraoperative ligation of the injured duct, Roux-en-Y reconstruction and segmental liver resection. Most cases in the literature advocate for nonoperative management or hepaticojejunostomy. We present an unusual case of aberrant right posterior sectoral duct injury in which neither of these approaches was viable, necessitating a bi-segmental liver resection.
Open new simplified totally extraperitoneal (ONSTEP) versus Lichtenstein repair for primary inguinal hernias
Authors: Berri T , Brahmi K , Seddiki MMSE
Published: May 2023

Introduction

Chronic postsurgical pain (CPP) remains the main complication after Lichtenstein hernioplasty. The open new simplified totally extraperitoneal (ONSTEP) technique is a more recent transinguinal procedure that seems to be associated with less CPP. The aim of this study was to compare outcomes of the ONSTEP versus the Lichtenstein procedure for primary inguinal hernia.

Methods

In this prospective, double-blinded and single-centre clinical trial, CPP at the six-month follow up assessed by a visual analogue scale was the primary endpoint. Secondary endpoints were operative time, perioperative complications, length of hospital stay, early pain, time to return to daily activities and to work, pain-related sexual dysfunction, aesthetic satisfaction and recurrence.

Results

A total of 100 men were allocated to undergo either the Lichtenstein (n=50) or the ONSTEP (n=50) hernioplasty. The incidence of CPP was nonsignificantly lower in the ONSTEP group compared with the Lichtenstein group (28% vs 42%; p=0.142). However, the ONSTEP procedure required less operative time (42 vs 62min; p<0.001). Patients from the ONSTEP group resumed their daily activities earlier (5.94±3.9 days vs 8.56±5.14 days; p=0.009), had fewer postsurgical complications (5 vs 19; p=0.001) and expressed better satisfaction with the cosmetic result (p=0.041). No recurrence was observed after six months of follow up.

Conclusion

CPP was similar, but the ONSTEP technique was associated with shorter operating time, earlier return to normal daily activities, fewer postsurgical complications and better cosmetic results.
‘There’s a frog in my throat’: bilateral prolapsing lung apices presenting as a neck lump
Authors: Ahmed RA , Yang D , Nedham M , Osborne MS , Ahsan SF
Published: May 2023

This case report discusses an unusual presentation of a voluntarily produced neck mass, caused by the rare case of lung herniation. Lung herniation is associated with increased intrathoracic pressure that can be caused by chronic chough, straining and continuous positive airway pressure ventilation. An association with Ehlers-Danlos syndrome 1 also exists. We present a case of lung herniation that was multifactorial in nature and was identified at a head and neck clinic. The female patient presented with a voluntarily expandable anterior neck mass on Valsalva manoeuvre. Computed tomography imaging with and without Valsalva manoeuvre demonstrated bilateral anterior lung herniation and findings of spinal spondylosis.
Spilled gallstone mimicking right middle lobe pulmonary nodule
Authors: Osman M , Doukas G , Namjoshi G , Khalil R , Ali J , Bhusari S
Published: May 2023

Laparoscopic cholecystectomy is the standard of care for the surgical management of symptomatic gallstone disease. Gallstone spillage at laparoscopic cholecystectomy is common, with a reported incidence of 0.2–20%. In the majority of cases there are no complications associated with this spillage, but a series of studies report patients with complications of free peritoneal gallstones. We present a case of migration of gallstone to the lung resulting in an inflammatory mass in the right middle lobe as a complication of spillage at laparoscopic cholecystectomy.
Thyroid lobectomy for low-risk thyroid cancers
Authors: Puttergill B , Khan S , Christakis I , Dumbill R , Mclaren A , Sadler G , Mihai R
Published: May 2023

Background

The 2016 American Thyroid Association (ATA) guidelines proposed thyroid lobectomy for low-risk differentiated thyroid cancer (DTC); however, this approach is yet to be widely adopted. The aim of the study was to review our practice over three years following the publication of these guidelines identifying patients who underwent lobectomy-only for low-risk DTC in two regional units in the same multidisciplinary team (MDT).

Method

A retrospective review of patients who were operated between January 2016 and December 2018 was carried out.

Results

In total, 288 patients undergoing thyroid surgery were included. The preoperative distribution of cytology was: Thy 1 or 2 in 46, THY3a in 57, THY3f in 154, THY4 in 18 and THY5 in 13 patients. Median size of nodules was 26mm (range 1–70mm). DTC was diagnosed in 95 patients (33%). Overall, 39% (n = 37) of patients underwent completion thyroidectomy according to ATA recommendations on size or adverse histological features. The only variable associated with likelihood of completion was tumour size (p < 0.05, OR 1.14). Ten patients were discharged following surgery with no further follow-up as they had T1a/b well-differentiated DTC with no high-risk histological features.

Conclusion

Lobectomy-only appears to be the current surgical practice in two-thirds of patients presenting to our regional units with differentiated thyroid carcinoma. In the context of the current drive to reduce the extent of treatment for low-risk thyroid cancer, there is a need for a more homogeneous approach to these patients and for protocols for long-term follow-up after lobectomy-only.
Senior triaging of ENT emergency clinic referrals alleviates pressures on the outpatient department
Authors: Mughal Z , Seigel J , Basu S
Published: May 2023

Introduction

The ear, nose and throat (ENT) emergency clinic is managed by foundation year (FY) doctors from taking referrals to discharging patients, under the supervision of a registrar. FYs learn essential skills and knowledge on how to manage common ENT problems. The clinic is often overloaded because of a high patient demand, and this limits the opportunities for teaching. We hypothesised that the clinic bookings would be better managed if referrals from general practitioners (GPs) were triaged by registrars.

Methods

Telephone referrals from GPs for the ENT emergency clinic were directed to the on-call ENT registrar, between 8am and 1pm from Monday to Friday, and to the FY outside of this period. Consecutive referrals to the emergency clinic were analysed in a baseline audit and a post-intervention cycle.

Results

A total of 646 and 611 patients were given clinic appointments in the first and second cycles, respectively. Clinic session overbookings decreased from 85% to 46.3%. Appointments for referrals that were deemed inappropriate had reduced from 22% to 12.1%.

Discussion and Conclusion

Involvement of a registrar in taking referrals for the ENT emergency clinic was associated with a reduction in clinic overbookings. It is feasible and productive to involve a senior decision maker in the operational management of the emergency clinic, while preserving the delivery of this service by FYs for its training value.
A case of disintegrated Strattice™ 4 years after immediate breast reconstruction
Authors: Demant M , Lauritzen E , Lang CL , Bredgaard R , Gramkow C
Published: May 2023

Acellular dermal matrices (ADMs) are used frequently in immediate breast reconstruction (IBR). In general, the porcine-derived ADM Strattice™ has been reported with good outcomes and low complication rates. Nonetheless, we report here a case of a 42-year-old, otherwise healthy woman with a history of uncomplicated bilateral prophylactic nipple-sparing mastectomies and subpectoral IBRs performed using Strattice™ and Mentor® CPG™, who was referred to the Department of Plastic Surgery 4 years after this surgery due to changed appearance of her breast implants. Both CPG implants were found intact and there were no signs of infection but, surprisingly, the Strattice™ had completely disintegrated on both sides. Examinations did not show any malignancies, and at 1-year clinical follow-up, the patient had no signs of relapse. Thus, we suggest that the Strattice™ had disintegrated as a late aseptic foreign body reaction and emphasise the importance of surgeons being aware of this late and rare complication.
Robotic total pelvic exenteration for rectal cancer: case report and review of literature
Authors: Stefan S , Gangi A , Wilby D , Khan J
Published: May 2023

We describe a case report of a robotic total pelvic exenteration (TPE) performed for a locally advanced rectal cancer at our institution in August 2018. Technical details and comparison with published literature are discussed. A 62-year-old patient with a locally advanced low rectal cancer T4N1cM0 with extramural vascular invasion (EMVI) underwent an elective robotic pelvic clearance performed by the urology and colorectal teams. He received neoadjuvant long-course chemo-radiotherapy to downstage the rectal cancer. The primary tumour was T4N1c with involvement of the bladder (trigone area) and prostate. After neoadjuvant therapy, MRI scan showed tumour regression grade 4 (TRG4). The patient underwent single docking totally robotic pelvic clearance. Patient’s body mass index (BMI) was 32. The operative time was 400 minutes with the docking time of 15 minutes. There were no intraoperative complications, and the blood loss was 100ml. Histology was ypT4b, ypN1b, ypMx with 2/9 positive lymph nodes, and there was a complete resection by >1mm at all margins. The postoperative complications were ileus and urinary tract infection. Length of stay was 11 days complicated by prolonged ileus requiring total parenteral nutrition (TPN). The 30-day follow-up had no postoperative complications or readmission. The robotic approach is safe and feasible for multiorgan resections for locally advanced pelvic cancers, with curative intent. The literature supports it by highlighting the advantages of robotic pelvic surgery: better access, stable platform, quick inter-specialty change of operator by use of dual console and superior visualisation.
Glomus tumour of the nipple in a male patient
Authors: Al-Ishaq Z , Asif U , Roy M , Sikdar O , Bhatnagar A , Sircar T
Published: May 2023

A glomus tumour is a benign mesenchymal tumour. It is extremely rare in the breast. We report a case of glomus tumour of the nipple in a 54-year-old man. To the best of the authors' knowledge, this is the first case report of a glomus tumour of the nipple. We describe the different presenting symptoms, method of diagnosis and treatment.
Can virtual reality headsets be used safely as a distraction method for paediatric orthopaedic patients? A feasibility study
Authors: Shepherd K , Shanmugharaj Y , Kattan O , Kokkinakis M
Published: May 2023

Introduction

Virtual reality (VR) has been shown to decrease pain and anxiety in clinical areas. The purpose of this study was to assess the feasibility of ‘Rescape DR.VR Junior’ headset as a distraction method for paediatric orthopaedic patients.

Methods

An internal risk assessment by medical engineers to determine its safety deemed the device safe to be used only in the venepuncture and plaster rooms, while further investigation is needed to establish its safety in the operating theatre/anaesthetic room. A total of 32 children (age range: 2–15 years) took the option to use the device while they underwent venepuncture or a cast procedure. Anxiety scores, measured on a Likert scale, were collected pre and postprocedure. Participants were asked if they would use the device again. Subjective feedback was also collated from the supervising clinical staff.

Results

A total of 66% (21) showed a reduction in anxiety scores, 28% (9) had no change in score; all scores being mild, 1–3 on the Likert scale; 6% (2) showed an increase in postprocedure score. All participants stated they would use the device again. One patient declined the device. Health professionals also gave positive subjective feedback and they would all use it again with their paediatric patients. No adverse events were recorded.

Conclusion

The ‘Rescape DR.VR Junior’ headset has been found to be a safe and feasible distraction method for use in children in the venepuncture and plaster room. Further research is required to assess its safety and effectiveness in other clinical areas, including the paediatric orthopaedic operating theatre.
What’s up with WhatsApp in supplementing surgical education: an objective assessment
Authors: Mukherjee R , Roy P , Parik M
Published: May 2023

Introduction

This is the first study aimed at objectively quantifying the benefit of virtual education using WhatsApp-based discussion groups.

Methods

A prospective, non-randomised interventional study was undertaken in the Department of General Surgery, at a tertiary care centre in Kolkata, India, with 200 undergraduate students over a period of 5 days each for 2 weeks, with the first week acting as a control arm. A WhatsApp group was created consisting of 197 eligible undergraduates, faculty members and the authors of this study. Each day, three questions were posted on this group. The second week involved an hour-long WhatsApp-based discussion between the participants and the faculty. Responses were recorded and compared for improvements between the two weeks. Participant feedback was collected and analysed.

Results

Statistically significant improvements were observed in the study group compared with the control group in rates of one in three, two in three and three in three correct responses (p=0.01649, 0.01146 and 0.00946, respectively). A total of 68 (51.92%) feedback respondents were satisfied with the programme. Convenience of use was the principal reason behind satisfaction in 79 respondents (60.31%), whereas 62 participants (47.33%) reported lack of hands-on training as a major drawback.

Conclusions

WhatsApp was found to be a satisfactory supplement to traditional medical teaching. It can be implemented to fill lapses in medical education, especially in light of the COVID-19 pandemic, which has caused great disruption to traditional teaching methods. Research is needed to assess the feasibility of incorporating it into the curriculum.
Total neoadjuvant chemotherapy: a silver lining during the COVID pandemic for a patient with locally advanced diffuse distal gastric adenocarcinoma
Authors: Patil P , Clements HA , Ramkumar PG , Walsh S , Petty R
Published: May 2023

Perioperative oncological therapies resulting in pathological complete response (pCR) in diffuse-type distal gastric adenocarcinoma are extremely rare. We report a case of locally advanced (cT3 N2 M0) diffuse-type distal gastric adenocarcinoma treated with ‘total neoadjuvant’ FLOT (eight cycles), due to the COVID-19 pandemic, and laparoscopic radical subtotal gastrectomy with D2 lymphadenectomy. The patient demonstrated a progressive radiological response on positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography (18F-FDG PET-CT) and pCR in the resected specimen (ypT0 N0). As far as we are aware, this is the first case of pCR in locally advanced T3 N2 diffuse distal gastric cancer to be reported in the literature. It introduces a novel approach of total neoadjuvant chemotherapy with 18F-FDG PET-CT to assess response, combined with radical minimally invasive surgical management to provide optimal care for patients with gastric cancer.
Celebrating the lives and legacies of our colleagues
Authors: Mortensen Neil
Published: May 2023

Our President reflects on the lives of our recently passed colleagues, and how our encounters with those around us can have a profound and lasting effect.
Spatial Autoregressive Modeling on Linear Mixed Models for Dependency Between Regions
Authors: Sirait Timbang
Published: May 2023

This study develops a linear mixed model (LMM) that includes spatial effects between regions with a spatial autoregressive model (SAR model). Between observations (regions) on that LMM are usually assumed to be independent. However, these assumptions are not always fulfilled due to dependency between regions. There are two important parts in spatial modeling: spatial dependence and spatial heterogeneity. In this study, we are concerned with the spatial lag or SAR models because dependency between variables of interest is easier to predict. On the other hand, all observations are real and can be directly seen from the data patterns. In addition, as a challenge for researchers to find all estimators while the values of the spatial dependence, sampling variance, and component variance are all unknown. This study aims to find all parameter estimators using a numerical approach and exact solutions. All exact estimators obtained are consistent estimators.
Mapping of Flood Inundation and Eco-hydraulic Analyses to Minimize Food Discharge in Tributaries
Authors: Ziana Ziana , Azmeri Azmeri , Yulianur Alfiansyah , Meilianda Ella , Mubarak Mubarak
Published: May 2023

Eco-hydraulic analyses begin with the arrangement of tributaries. This research aimed to minimize the discharge of flood run-off downstream and map the flood inundation by spatial analysis uses DEMNAS data and mapping of flood inundation areas using ArcGIS. Analysis of return period flood points using HEC-RAS version 5.0.7. The data needed is the cross section of the river, the distance between the sections, the Manning's roughness number, the return period flood discharge and the slope of the river. The integration between topographic maps, watersheds and flood water levels can display areas that are potentially affected by inundation floods, so that the flood inundation limits and flood inundation areas can be calculated. This research examined proper eco-hydraulics design so that it could reduce discharge, identify locations prone to flooding, and describe the magnitude of the flood impact quantitatively. The results eco-hydraulic method obtained the design border width of 100 m, the condition before the existing river border arrangement was carried out, the inundation height was 0.30 – 1.13 m and after the river border arrangement the discharge could be reduced to 113.09 – 209 m3/s and the inundation height is 0 – 0.31 m. Based on the research results, it is known that border arrangement can provide benefits for flood control measures.
Double-slit interference experimental platform based on a Sagnac interferometer
Authors: Liu Pan , Song Xin-Bing , Aili Mairikena , Chen Xiao-Xiao , Zhang An-Ning
Published: May 2023

In this paper, we build a Young’s double-slit experimental platform with adjustable multiparameters by inserting a single slit in a Sagnac interferometer. Our experiment proves that this platform can easily control the parameters related to double slits. In addition, a new, to the best of our knowledge, type of double-slit experiment is performed on the platform. Our approach provides a detailed conceptual and experimental analysis for wave–particle duality and will be useful for research on quantum optics.
Purcell enhancement of single-photon emitters in silicon
Authors: Gritsch Andreas , Ulanowski Alexander , Reiserer Andreas
Published: May 2023

Individual spins that are coupled to telecommunication photons offer
unique promise for distributed quantum information processing once a
coherent and efficient spin–photon interface can be fabricated at
scale. We implement such an interface by integrating erbium dopants
into a nanophotonic silicon resonator. We achieve spin-resolved
excitation of individual emitters with
<0.1GHz spectral diffusion
linewidth. Upon resonant driving, we observe optical Rabi oscillations
and single-photon emission with a 78-fold Purcell enhancement. Our
results establish a promising platform for quantum networks.
The bZIP transcription factor AREB3 mediates FT signalling and floral transition at the Arabidopsis shoot apical meristem
Authors: Martignago Damiano , da Silveira Falavigna Vítor , Lombardi Alessandra , Gao He , Korwin Kurkowski Paolo , Galbiati Massimo , Tonelli Chiara , Coupland George , Conti Lucio
Published: May 2023

The floral transition occurs at the shoot apical meristem (SAM) in response to favourable external and internal signals. Among these signals, variations in daylength (photoperiod) act as robust seasonal cues to activate flowering. In Arabidopsis, long-day photoperiods stimulate production in the leaf vasculature of a systemic florigenic signal that is translocated to the SAM. According to the current model, FLOWERING LOCUS T (FT), the main Arabidopsis florigen, causes transcriptional reprogramming at the SAM, so that lateral primordia eventually acquire floral identity. FT functions as a transcriptional coregulator with the bZIP transcription factor FD, which binds DNA at specific promoters. FD can also interact with TERMINAL FLOWER 1 (TFL1), a protein related to FT that acts as a floral repressor. Thus, the balance between FT-TFL1 at the SAM influences the expression levels of floral genes targeted by FD. Here, we show that the FD-related bZIP transcription factor AREB3, which was previously studied in the context of phytohormone abscisic acid signalling, is expressed at the SAM in a spatio-temporal pattern that strongly overlaps with FD and contributes to FT signalling. Mutant analyses demonstrate that AREB3 relays FT signals redundantly with FD, and the presence of a conserved carboxy-terminal SAP motif is required for downstream signalling. AREB3 shows unique and common patterns of expression with FD, and AREB3 expression levels are negatively regulated by FD thus forming a compensatory feedback loop. Mutations in another bZIP, FDP, further aggravate the late flowering phenotypes of fd areb3 mutants. Therefore, multiple florigen-interacting bZIP transcription factors have redundant functions in flowering at the SAM.
Characterization of the anti-pathogenic, genomic and phenotypic properties of a Lacticaseibacillus rhamnosus VHProbi M14 isolate
Authors: Zhang Jingyan , Li Kailing , Bu Xinping , Cheng Shumin , Duan Zhi
Published: May 2023

A strain of lactic acid bacteria from cheese was isolated, that showed strong growth inhibitory effects on Streptococcus mutans. The API 50CH system and 16S rDNA sequencing verified that this was a novel strain, and was named Lacticaseibacillus rhamnosus VHProbi M14. The strain inhibited the growth of S. mutans and Fusobacterium nucleatum under mixed culture conditions, coaggregated with S. mutans and F. nucleatum, and reduced the adhesion of S. mutans and F. nucleatum on cultured human primary gingival epithelial (HPGE) cells. The pH, peroxidase and protease sensitivity testing found antibacterial substances of protein- and peptide-like structures in addition to organic acids. The antimicrobial substances were sensitive to hydrolysis with trypsin, papain and pineapple protease and were inactived at temperatures above 100°C. Ammonium sulphate-precipitated proteins from the M14 strain retained the ability to inhibit the growth of S. mutans and F. nucleatum. The M14 strain contained 23 bacteriocin-related genes encoding for metabolites, belonging to class II bacteriocins. The M14 strain also showed inhibitory effects on 8 other pathogenic strains (A. actinomycetemcomitans, C. albicans, E. coli, G. vaginalis, P. acnes, P. gingivalis, S. aureus, S. enteritids), and thus has a broad spectrum of bacterial inhibition. This new isolate has been identified as having potential to be used as a probiotic bacterium in clinical applications.
Improving biology faculty diversity through a co-hiring policy and faculty agents of change
Authors: Harris Marissa , Rosser Sue , Goldman Michael , Márquez-Magaña Leticia , Rohlfs Rori V.
Published: May 2023

Persons Excluded due to Ethnicity and Race (PEERs) remain underrepresented in university faculties, particularly in science, technology, engineering, math and medicine (STEMM) fields, despite increasing representation among students, and mounting evidence supporting the importance of PEER faculty in positively impacting both scientific and educational outcomes. In fact, the ratio of PEER faculty to students has been steadily dropping since 2000. In our case study, we examine the factors that explain creation of an unusually diverse faculty within a biology department. We analyzed nearly 40 years of hiring data in the study department and show that this department (the study department), historically and currently, maintains a significantly higher proportion of PEERs on faculty as compared to two national datasets. Additionally, we identify factors that contributed to hiring of PEERs into tenure and tenure-track positions. We observed a significant increase in the hiring of PEERs concurrent with the implementation of a co-hiring policy (p = 0.04) which allowed a single search to make two hires when at least one candidate was a PEER. In contrast, three key informants at sister departments reported that co-hiring policies did not result in PEER hires, but instead different practices were effective. In line with one of these practices, we observe a possible association between search committees with at least one PEER member and PEER hiring (p = 0.055). Further, the presence of particular faculty members (Agents of Change) on search committees is associated with PEER hiring. In this case study the combination of a co-hire policy based on the principle of interest-convergence to redress hiring inequities, along with the presence of agents of change, increased faculty PEER representation in STEMM departments.
Understanding the early career self-initiated expatriation
Authors: Li Xueyan , Primecz Henriett , Paget Anna Laura
Published: May 2023

Az expatrióta irodalmon belül a nem vállalati kiküldötteknek (önerejéből külföldön elhelyezkedő; self-initated expatriates; SIE) bejáratott irodalma van a menedzsmentben, azonban a pályakezdő expatrióták sajátosságaival eddig még senki sem foglalkozott. Jelen összefoglaló cikk célja, hogy azonosítsa és elemezze azokat a publikációkat, amelyek kifejezetten erre a csoportra fókuszálnak, azaz, akik úgy döntenek, hogy külföldön kezdik meg a pályafutásukat, beleértve a munkatapasztalat nélküli vagy csekély szakmai tapasztalattal rendelkezőket. Külön hangsúlyt helyezünk a karriermotivációjuk, viselkedésük, és globális karrierhez való hozzájárulásuk megértésére. A cikk két tekintetben járul hozzá a szakirodalomhoz, egyrészt összefoglalja a témában az elmúlt évtizedekben készített kutatások lényeges következtetéseit, másrészt információval szolgál a pályakezdő önerejéből külföldön elhelyezkedő munkavállalók menedzseléséről. Ezen felül jövőbeli kutatási irányokat is kínál, rámutatva az észlelt hiányosságokra és elősegítve a levont következtetések gyakorlati alkalmazását.
Endocrine disorders after combined chemoradiotherapy in Hodgkin Lymphoma survivors
Authors: Voytko M. S. , Klimontov V. V. , Pospelova T. I. , Shebunyaeva Y. Y. , Fazullina O. N.
Published: May 2023

BACKGROUND: Hodgkin’s lymphoma (HL) is one of the most common malignant lymphoproliferative diseases. Chemotherapy and radiotherapy used in the treatment of LH induce a number of toxic effects leading to dysfunction of endocrine system. Hormonal disorders in HL and their relationships with the therapy used remain to be clarified.

AIM: To assess disorders of the endocrine function of thyroid, parathyroid glands and gonads in HL survivors.

MATERIALS AND METHODS: Screening of endocrine dysfunction of the thyroid, parathyroid glands and gonads was performed in 160 adult patients with HL, 55 men and 105 women, at remission stage induced by chemotherapy or chemoradiotherapy. Forty healthy subjects, matched by age, were acted as control. The levels of TSH, T3, free T4, PTH, FSH, LH, free testosterone, dehydroepiandrosterone sulfate (DHEA-S), and sex-hormone binding globulin (SHBG) were measured in blood serum by ELISA. Bone mineral density (BMD) was assessed by DEXA.

RESULTS: Hypothyroidism (25%), hyperparathyroidism (15.6%) and hypogonadism (29% of men and 25.3% of women) were the most prevalent endocrine disorders in LH survivors. Hypothyroidism was significantly more common in patients after chemoradiotherapy than in those who received only chemotherapy (χ2=9.4, р=0.002). In patients with hyperparathyroidism, there were negative correlations between PTH levels and BMD in the lumbar spine (r=-0.74, p=0.00002) and in the femoral neck (r=-0.66, p=0.0003). Men with HL demonstrated lower free testosterone concentrations when compared to control (p=0.04); LH and FSH levels were elevated (p=0.0004 and p=0.04, respectively). In men with HL the levels of DHEA-S were reduced (p=0.0009). The increased SHBG concentrations were revealed in 13 (23.6%) men. Women of reproductive age with HL had higher levels of LH in the luteal phase (p=0.05) and FSH in the follicular phase (p=0.02) than controls.

CONCLUSION: The data indicate a high prevalence of the dysfunctions of thyroid, parathyroid glands, and gonads in HL survivors. Screening for endocrine disorders in these patients is highly recommended.
Rare forms of hereditary endocrine neoplasia: co-existence of pituitary adenoma and pheochromocytoma/paraganglioma
Authors: Mamedova E. O. , Lisina D. V. , Belaya Zh. E.
Published: May 2023

Functioning pituitary adenomas and pheochromocytomas/paragangliomas are rare in the general population. Pituitary adenomas occur in the familial setting in approximately 5% of cases, whereas pheochromocytomas/paragangliomas can be hereditary in 30–40% of cases. Hereditary syndromes associated with pituitary adenomas include multiple endocrine neoplasia types 1 and 4, familial isolated pituitary adenomas, and Carney complex. Hereditary syndromes associated with pheochromocytomas/paragangliomas and genes, mutations in which predispose to their development, are more numerous. The first clinical descriptions of the co-occurrence of pituitary adenoma and pheochromocytoma/paraganglioma in one patient date back to the mid 20th century, however delineating such a co-occurrence into a particular syndrome («3PAs» (pituitary adenoma, pheochromocytoma, paraganglioma)) was suggested only in 2015. To date, approximately 100 cases of such a co-occurrence have been described in the literature. Mutations in genes encoding subunits of succinate dehydrogenase complex II (SDHx) are revealed in the majority of cases, much less common are mutations in MAX, MEN1 and some other genes. This review summarizes the current information on the «3PAs» syndrome.