bluuebunny/crossref_metadata_2025 huggingface dataset:
Micropapillomatosis labialis – Report of three cases
Authors: Tayal Richa , Srihari Sahana , Goyal Vippan
Published: December 2024

Vestibular papillomatosis (VP) is an uncommon benign condition. This condition is very rare; hence, its incidence is difficult to estimate. It has been recorded in healthy young women in the range of 1%–33%. Owing to the papillomatous appearance of the lesion, it is often misdiagnosed as condyloma acuminatum, resulting in unnecessary investigations and multitude of treatments, which adds to the physical and economical burden on patients. We present three cases of VP.
Kaposi’s sarcoma immune reconstitution inflammatory syndrome: A forgotten entity nowadays
Authors: Cristina Fernández Romero , Lorena Vila Cobreros , Tamara Fenollosa Sanz , Juan Flores Cid , Marta Valero Núñez , Carlos Puglia Santos Víctor , Andrea Galeano Paniagua Laura , Rafael Carmena Ramón , Esther Quecedo Estébanez
Published: December 2024

The appearance of antiviral therapy has led to a change in the prognosis and clinical manifestations of patients with human immunodeficiency virus infections and Kaposi’s sarcoma. However, there are still countries in which access is inadequate and the disease progresses toward disseminated forms with an unfavorable outcome. We present two patients who presented with skin lesions that progressed for a month, compatible with disseminated Kaposi’s sarcoma in the context of HIV. One month after starting treatment, they were admitted for multi-organ failure associated with an Immune reconstitution inflammatory syndrome and eventually died.
Posterior uveitis of syphilitic etiology
Authors: Sankaranantham Murugan
Published: December 2024

Uveitis in syphilis was reported often though it is not common. It can occur both in early and late syphilis. Syphilis transmission through anal contact and heterosexual contact is common. Transmission through oral sex in the absence of extragenital lesions is extremely rare. If not diagnosed earlier, uveitis can damage the vision permanently. The eyes will not see what the mind does not know. Hence, this case was reported to alert the young physicians to recognize this condition earlier. A high index of suspicion is essential to arrive at the diagnosis of this condition. Ocular syphilis and late syphilitic manifestations are quite rare nowadays. Once again, a resurge in syphilis cases was observed widely all over the globe and also in India. At this juncture, it will not be a surprise to have once again a rising incidence of cerebral venous system and central nervous system syphilis. Young physicians would not have a chance to come across a case of a case of ophthalmic syphilis. The report of such cases will alert them and make them suspect and diagnose cases of ocular syphilis earlier so that we can overcome the chances of preventable blindness with effective treatment.
Mesothelial/monocytic incidental cardiac excrescences: An unusual cause for constrictive pericarditis
Authors: Shanmugasundaram Sakthisankari , Sreenivasan Vidyalakshmi , Sukumar Murugan M. , Sivanandam Shanthakumari
Published: December 2024

This case report explores an unusual cause of constrictive pericarditis discovered during histopathological examination. Mesothelial/monocytic incidental cardiac excrescences (MICE) have been reported in association with previous cardiac surgery and ruptures, and are typically found on heart valves or chambers. These excrescences are prone to being misdiagnosed as malignancies based on histopathological analysis. The present case provides a comprehensive examination of a rare instance of cardiac MICE, shedding light on this uncommon entity.
Conjunctival melanoma with conjunctival melanocytic intraepithelial neoplasia in a patient with neurofibromatosis type 1
Authors: Sreelakshmi S. , Divya V. , Goswami Moupia , Walvekar Priyanka V. , Kumar Rekha V.
Published: December 2024

Conjunctival melanomas are rare but aggressive ocular neoplasms, often arising from conjunctival melanocytic intraepithelial neoplasia (C-MIN) or primary acquired melanosis (PAM) with atypia. We report a case of conjunctival melanoma in a 42-year-old man with neurofibromatosis Type 1 (NF1), who developed a pigmented lesion on his left eyelid. Examination revealed diffuse pigmentation of the bulbar conjunctiva and nodular lesions in the lower palpebral conjunctiva and lateral canthus. A biopsy confirmed melanoma and a left orbital exenteration was performed. Histopathology showed melanoma with extensive melanosis, C-MIN and melanoma in situ. Conjunctival melanoma is rare and uncommon in NF1 patients. Hence, awareness of this entity and detailed evaluation and follow-up of a case of PAM are essential, especially in a setting of NF1 to exclude atypia and progression to melanoma.
The pheochromocytoma odyssey: Lives entwined
Authors: Vani D , Shashidhar H.B. , Shameel Mohammed Azm , Nataraju G
Published: December 2024

Background:

Pheochromocytoma is a rare catecholamine-secreting tumour of the adrenal medulla. We present two cases with contrasting outcomes.

Case Presentation:

Case 1: A 40-year-old female presented with acute abdominal pain. Imaging revealed a haemorrhagic cyst in the right suprarenal region. Laboratory tests showed normal plasma metanephrine and low cortisol levels. Histopathological diagnosis of pheochromocytoma was done. The patient made a full recovery following emergency surgery.

Case 2:

A 51-year-old male presented with acute abdomen and shock, elevated plasma metanephrine levels and normal cortisol. Contract computed tomography showed right suprarenal mass. Emergency adrenalectomy was done; the patient succumbed to complications. Histopathology identified the mass as pheochromocytoma.

Conclusion:

These cases highlight the diverse presentations and outcomes of pheochromocytoma, emphasising the need for early diagnosis and appropriate management and intervention to improve patient outcome.
Anaphylaxis Induced Refractory Bronchospasm in “Anticipated Difficult Airway” Situation: Combined Approach of Fibre Optic Laryngoscope Guided Endotracheal Tube Placement via the Nasal Route and Sevoflurane during Rapid Sequence Induction
Authors: Kumar Sanjay , Bhattacharya Amrita , Khuba Sandeep , Gupta Nupur , Kant Rama
Published: December 2024

We wish to report here how we tackled anaphylaxis-induced bronchospasm in an ‘anticipated difficult airway’ situation using a novel combination of established practices. Our patient was morbidly obese and had both predicted difficult mask ventilation as well as predicted difficult intubation in the immediate pre-induction period. He developed bronchospasm, which we attempted to treat as per the established protocols. All of these failed, and we then proceeded to insert a 7-mm endotracheal tube nasally, its tip lying just above the epiglottis (via fibre-optic guidance). Sevoflurane vapours and oxygen were delivered through it, and this gradually relieved the bronchospasm and improved the patient’s oxygenation.
Heavy Slow Resistance Training for Proximal Hamstring Tendinopathy: A Case Report
Authors: Shah Dhairav A. , Lakhani Nirati P.
Published: December 2024

Abstract

Evidence suggests that not all tendinopathy patients respond solely to eccentric exercises. Systematic reviews on patellar and Achilles tendinopathies indicate positive outcomes with heavy slow resistance training (HSRT). This case report describes a 38-year-old active male with chronic left proximal hamstring tendinopathy (PHT), experiencing pain during squats, and prolonged sitting, running, and lifting objects. Familiar with loaded exercises, he followed an autoregulation progression method of training, using the rate of perceived exertion and repetitions-in-reserve to guide training. Within 3 weeks, his pain reduced from 8/10 to 0.5/10. Over 12 weeks, his performance surpassed pre-injury levels, achieving 100 kg back squats, 160 kg conventional deadlifts, 90 kg Romanian deadlifts, and 100 kg loaded barbell hip thrusts, and progressing from 60 kg back squats. At a 1-year follow-up, no recurrence was reported. Currently, no research exists on HSRT for PHT in India. Systematic reviews suggest that load intensity, rather than contraction type, maybe the key stimulus for muscle–tendon recruitment.
Hyperreal differentiation with an idempotent ultrafilter
Authors: Alexander Samuel Allen , Dawson Bryan
Published: December 2024

For every f:R-R, the sequence obtained by restricting f to the positive integers is a representative of a hyperreal number [f]. If f is differentiable, it is natural to consider the hyperreal [f'] represented by f'. Unfortunately, there exist differentiable functions f,g:R-R such that [f] equals [g] but [f'] is not equal to [g'], so the operation of taking derivatives does not induce the function on hyperreals that one might want it to. Using idempotent ultrafilters, we introduce a new derivative notion, assigning a hyperreal-valued function Df:R-*R to every f:R-R (even when f is not differentiable), such that [f] equals [g] implies [Df] equals [Dg] and thus inducing a mapping D([f]) equals [Df]. In a technical sense, our Df is infinitely close to f' provided f is differentiable and 2pi-periodic.
Unified Multi-Modal Multi-Agent Cooperative Perception Framework for
Intelligent Transportation Systems
Authors: Meng Zonglin , Xia Xin , Zheng Zhaoliang , Gao Letian , Liu Wei , Zhu Jiaqi , Ma Jiaqi
Published: December 2024

Cooperative perception has attracted wide attention given its capability to
leverage shared information across connected automated vehicles (CAVs) and smart
infrastructure to address the occlusion and sensing range limitation issues. To
date, existing research is mainly focused on prototyping cooperative perception
using only one type of sensor such as LiDAR and camera. In such cases, the
performance of cooperative perception is constrained by individual sensor
limitations. To exploit the multi-modality of sensors to further improve distant
object detection accuracy, in this paper, we propose a unified multi-modal
multi-agent cooperative perception framework that integrates camera and LiDAR
data to enhance perception performance in intelligent transportation systems. By
leveraging the complementary strengths of LiDAR and camera sensors, our
framework utilizes the geometry information from LiDAR and the semantic
information from cameras to achieve an accurate cooperative perception system.
In order to fuse the multi-agent and multi-modal features, we use a bird’s-eye
view (BEV) space as the consistent and unified feature representations and
employ a transformer-based network for effective multi-agent multi-modal BEV
feature fusion. We validate our method on the OPV2V and V2XSet benchmarks,
achieving state-of-the-art performance in 3D cooperative perception tasks. The
proposed framework significantly improves object detection accuracy and
robustness, especially in complex traffic scenarios with occlusions such as
dense intersections.
Driving Behavior Modeling Based on Inverse Reinforcement
Learning
Authors: Xu Xiaobin , Han Wei , Leng Bo , Xiong Lu
Published: December 2024

With the advancement of intelligent driving technology, today’s smart vehicles
must not only make accurate and safe driving decisions but also exhibit high
human-likeness to ensure better acceptance from people. Developing vehicle
behavior models with increased human-likeness has become a significant industry
focus. However, existing vehicle behavior models often struggle to balance
human-likeness and interpretability. While some researchers use inverse
reinforcement learning (IRL) to model vehicle behavior, ensuring both
human-likeness and a degree of interpretability, challenges such as reward
function design difficulties and low human-likeness in background vehicle
modeling persist. This study addresses these issues by focusing on highway
scenarios without on-ramps, specifically following and lane-changing behaviors,
using the CitySim dataset. IRL is employed to create a vehicle behavior model
with improved human-likeness, utilizing a linear reward function to capture
driver decision-making motives. Building on prior research, this study further
explores various feature combinations for the reward function and introduces new
features. The final feature combination resulted in a 12.6% and 14.4% reduction
in planning errors on the training and test sets, respectively, compared to the
baseline method. Additionally, the study enhances background vehicle modeling
methods based on the Intelligent Driver Model (IDM) and the Minimizing Overall
Braking Induced by Lane-change (MOBIL) model by adding traffic flow and patience
correction terms. The results show that the improved background vehicle modeling
method reduced test set errors by 4.3%, demonstrating greater human-likeness and
making it more suitable for simulation environments.
Interaction-Aware Deep Reinforcement Learning Approach Based on
Hybrid Parameterized Action Space for Autonomous Driving
Authors: Li Zhuoren , Jin Guizhe , Yu Ran , Leng Bo , Xiong Lu
Published: December 2024

Learning-based motion planning methods such as reinforcement learning (RL) have
shown great potential of improving the performance of autonomous driving.
However, comprehensively ensuring safety and efficiency remain a challenge for
motion planning technology. Most current RL methods output discrete behavioral
action or continuous control action, which lack an intuitive representation of
the future motion and then face the problems with unstable or reckless driving
behavior. To address these issues, this work proposes an interaction-aware
reinforcement learning approach based on hybrid parameterized action space for
autonomous driving in lane change scenario. The proposed method can output
high-level feasible trajectory and low-level actuator control command to control
the vehicle’s motion together. Meanwhile, the reward functions for the local
traffic environment are designed to evaluate the effect of the interaction
between ego vehicle and surrounding vehicles. The contributions of the proposed
method are: 1) propose a hybrid parameterized action based interaction-aware DRL
framework (HPA-IDRL); 2) the proposed HPA-IDRL
can learn from the reward not only considering self-benefits but also
considering the benefits of the local traffic environment; 3) A multi-head
attention layer is embedded before actor network and critic network respectively
to exploit the interactive information in the traffic environment. Thus, the
HPA-IDRL agent can generate more flexible and smooth
driving behavior, which improves the safety and the efficiency of autonomous
driving. The proposed method is implemented and validated with other four
advanced DRL model in various simulation environments. The results demonstrate
that the proposed HPA-IDRL can effectively balance the
flexibility and smoothness of driving behavior, leading to the improving
performance that is both safe and efficient.
Redundant Brake Boost Control Strategy of Integrated
Electro-hydraulic Braking System
Authors: Dexing Lao , Luping Yan , Qinghai Sui , Long Cao , Shang Gao , Zhigang Chen , Mingxing Ren , Zhicheng Chen
Published: December 2024

The traditional braking system has been unable to meet the redundant safety
requirements of the intelligent vehicle for the braking system. At the same
time, under the change of electrification and intelligence, the braking system
needs to have the functions of braking boost, braking energy recovery, braking
redundancy and so on. Therefore, it is necessary to study the redundant braking
boost control of the integrated electro-hydraulic braking system. Based on the
brake boost failure problem of the integrated electro-hydraulic brake system,
this paper proposes a redundant brake boost control strategy based on the
Integrated Brake Control system plus the Redundant Brake Unit configuration,
which mainly includes fault diagnosis of Integrated Brake Control brake boost
failure, recognition of driver braking intention based on pedal force, pressure
control strategy of Integrated Brake Control brake boost and pressure control
strategy of Redundant Brake Unit brake boost. The designed control strategy of
redundant brake boost is tested and verified on the real vehicle platform. The
results show that the designed control strategy can effectively judge the brake
boost fault of Integrated Brake Control and accurately identify the driver’s
braking intention after the Integrated Brake Control is in brake boost failure.
After receiving the expected braking pressure of the driver, the braking
pressure is built by Redundant Brake Unit, which can accurately respond to the
driver’s braking request and improve the redundant safety of the braking
system.
Dynamic SLAM with Real-Time Semantic Segmentation and Inter-Frame and
Multi-Frame Motion Feature Detection
Authors: Qin Xiaohui , Gao Chengyu , Huang Shengjie , Zeng Conglei , Zhou Yunshui
Published: December 2024

Traditional Simultaneous Localization and Mapping (SLAM) methods often assume
static environments. This limitation can lead to inaccurate localization or even
the loss of tracking in dynamic scenes. To address this issue, we propose a
novel SLAM approach specifically designed for dynamic environments. Our method
integrates the real-time image semantic segmentation network BisenetV2 with
inter-frame and continuous multi-frame motion feature detection. Firstly,
semantic segmentation is applied to render the semantic mask, which is then used
by the inter-frame motion detection module to identify potential motion
features. Subsequently, these suspected motion features are evaluated by a
likelihood probability model across consecutive frames. Finally, points with a
high probability of motion are monitored in real-time by the Luenberger
observer, which filters out motion features and re-adds static ones. Our
experiments demonstrate that semantic segmentation can meet real-time
requirements in various scenarios. Evaluations of the TUM-RGBD dataset and
simulation experiment show that our proposed method significantly improves SLAM
accuracy and robustness in dynamic scenes.
A Fuzz Testing Method Based on DDPM for Intelligent Connected
Vehicles CAN Communication
Authors: Shen Lin , Xiu Jiapeng , Zhang Zhuopeng , Yang Zhengqiu
Published: December 2024

Modern vehicles are increasingly integrating electronic control units (ECUs),
enhancing their intelligence but also amplifying potential security threats.
Vehicle network security testing is crucial for ensuring the safety of
passengers and vehicles. ECUs communicate via the in-vehicle network, adhering
to the Controller Area Network (CAN) bus protocol. Due to its exposed
interfaces, lack of data encryption, and absence of identity authentication, the
CAN network is susceptible to exploitation by attackers. Fuzz testing is a
critical technique for uncovering vulnerabilities in CAN network. However,
existing fuzz testing methods primarily generate message randomly, lacking
learning from the data, which results in numerous ineffective test cases,
affecting the efficiency of fuzz testing. To improve the effectiveness and
specificity of testing, understanding of the CAN message format is essential.
However, the communication matrix of CAN messages is proprietary to the Original
Equipment Manufacturer (OEM) and varie s among different models of the same
vehicle brand, requiring manual reverse analysis of the CAN protocol, which
significantly increases the cost and complexity of an attack. To enhance the
efficiency of fuzz testing data generation, a fuzz testing data generation
algorithm based on Denoising Diffusion Probabilistic Models (DDPMs) is proposed.
This method learns the distribution of existing CAN bus message data, enabling
the generation of data messages similar to the original data distribution for
testing purposes. Furthermore, the LoRA fine-tuning method is introduced to
accommodate the differences between communication matrices of various vehicles.
Comparative analysis indicates that this method can generate fuzz test messages
that more closely resemble real message data than existing methods.
Research on the Pull Drift Compensation Control Algorithm based on
Steer-By-Wire Systems
Authors: Xiangfei Xu , Qu Yuan
Published: December 2024

SBW(Steer-by-wire) is a steering system that transmits the driver’s request and
gives feedback to the driver through electrical signals. This system eliminates
the mechanical connection of the traditional steering system, and can realize
the decoupling of the steering wheel and the road wheel. In addition, this
system has a perfect torque feedback system, which can accurately and delicately
feedback the road surface information to the driver.

However, vehicle driving deviation is one of the most common failure modes
affecting vehicle performance in the automotive aftermarket, this failure mode
can exacerbates tire wear, reducing their life cycle, at the same time, the
driver must apply a counter torque to the steering wheel for a long time to
maintain straight-line travel during driving. This increases the driver’s
operational burden and poses safety hazards to the vehicle’s operation. Based on
the steer-by-wire system and vehicle driving deviation characteristics, this
paper proposes Pull Drift Compensation (PDC) function. This function is based on
the identification of vehicle driving deviation conditions. Based on Hardware In
Loop Test (HIL) platform for tuning and simulation verification.
Is the Future Green? Assessing Environmental Health Confidence in Internal Medicine Residents
Authors: Chambers Jessica Y. , Rippon Jillian , Ahle Daniel , Le Xavier , Miller Beth , Moreno Alejandro
Published: December 2024

Background Despite global awareness of the impacts of climate change on human health, assessment of resident physicians’ confidence in environmental health is limited. Lack of confidence in explaining environmental health topics can affect both patient education and advocacy efforts.

Objective To determine how confident resident physicians are in their environmental health training and their ability to explain climate health topics.

Methods An online survey was distributed to internal medicine residents at a large university-affiliated program in 2023. Self-perceived confidence levels in explaining various environmental health topics to a peer were measured using a Likert scale (from 1=not confident at all, to 5=completely confident) and a subsequent rank-order analysis of the response means.

Results The response rate was 56% (62 out of 110 residents). A mean confidence score of 2.22 was reported on all topics, with hazardous waste (m=1.73), endocrine disruptors (m=1.76), water quality (m=1.9), toxicology (m=2.02), and environmental justice (m=2.04) representing lowest scores. Highest mean scores were reported in food security (m=2.71) and emerging infectious disease (m=2.92). Twenty-seven of 62 (44%) residents reported no confidence at all in their ability to discuss environmental justice concepts, with 17 of 62 (27%) reporting slight confidence in doing so.

Conclusions Physician trainees report low confidence levels regarding their ability to explain multiple environmental topics to their peers. Forty-four of 62 (71%) residents report either no or slight confidence in their ability to explain environmental justice to a colleague.
A Graduate Medical Education Fellowship in Climate Change and Human Health: Experience and Outcomes From the First 5 Years
Authors: Dresser Caleb , Wiskel Tess , Giudice Catharina , Humphrey Kimberly , Storr Latoya , Balsari Satchit
Published: December 2024

Background Climate change is affecting health and health care, but most physicians lack formal training on climate change. There is a need for graduate medical education (GME) programs that prepare physician leaders to address its health impacts.

Objective To describe the development and iterative piloting of a GME fellowship in climate change and health and to assess fellows’ academic output and public engagement before and after fellowship matriculation.

Methods A GME training program was developed and implemented at an emergency medicine department in a US teaching hospital in collaboration with affiliated academic centers. Participants consisted of emergency physicians from the United States and abroad. Program duration and format were adjusted to meet individual career goals. Outcomes assessed include program completion, postgraduation professional roles, and academic outputs and public engagement before and after fellowship matriculation (2019-2023), compared via paired t tests.

Results Five fellows have matriculated; 2 have graduated, while 3 remain in training. Costs and in-kind support include salaries, faculty time, research support, travel to conferences, and tuition for a public health degree. Fellows averaged 0.26 outputs per month before matriculation (95% CI 0.01-0.51) and 2.13 outputs per month following matriculation (95% CI 0.77-3.50); this difference was significant via 2-tailed t test (alpha=.05, P=.01). Subanalyses of academic output and public engagement reveal similar increases. Following matriculation, 186 of 191 (97.4%) of outputs were related to climate change.

Conclusions For the 5 fellows that have enrolled in this GME climate change fellowship, academic and public engagement output rates increased following fellowship matriculation.
Teaching Climate and Health in Preventive Medicine Residency Programs: A Survey of Program Directors
Authors: Passannante Marian R. , Shahani Shaun , Gochfeld Michael , Purcell Wendy M. , Savul Sajjad A. , Thomas Pauline
Published: December 2024

Background Climate change and related pollution and environmental damage are an urgent focus for public health physicians. Curricular content is increasing in medical schools, but to date, only pediatrics has published guidance for residency education.

Objective To survey program directors of Accreditation Council for Graduate Medical Education preventive medicine specialties (public health and preventive medicine [PHPM], occupational and environmental medicine [OEM], and aerospace medicine [AM]) for current teaching on climate and health issues.

Methods Links to an online 9-question confidential survey were sent to all program directors through Listservs January through March 2024. Questions were developed with guidance from a climate health expert. Responses were analyzed via summary statistics for continuous data, as well as Fisher’s Exact, Kruskal-Wallis, and Wilcoxon pairwise comparison tests for nominal data.

Results Thirty-five of 71 programs responded (49.3%), including 21 of 42 PHPM, 12 of 23 OEM, and 2 of 6 AM programs. Two (5.9%) reported having a formal curriculum for climate and health issues, and 2 (5.9%) reported not covering any included topics. Programs differed by topic emphasis with OEM and AM more likely to address fire, smoke, wind, and flooding effects. Lectures and local or state health department rotations were the most frequent teaching strategies. Of complete responders, 23 of 34 (67.6%) expressed interest in joining a workgroup to develop shared curricula.

Conclusions This survey of preventive medicine residency programs found that most include climate and health topics, but only 2 have a formal curriculum, and 2 reported no topics included in the survey.
“It’s Kind of a Rite of Passage”: An Exploration Into Residents’ Experience of Learning in a Critical Care Setting
Authors: Kopstick Avi J. , Sanders Benjamin W. , Felmet Kathryn , Yarris Lalena M. , Phromsivarak Kelly Serena
Published: December 2024

Background Many trainees complete rotations in intensive care units (ICUs), but little is known about how ICU rotations impact learners. Understanding residents’ experiences in ICU rotations is a crucial step toward improving resident education and understanding the consequences, intended and unintended, of critical care learning.

Objective We performed a qualitative study to understand how pediatric and emergency medicine residents experience a pediatric ICU (PICU) rotation.

Methods For this phenomenological study, we explored residents’ experiences with critical care learning by focusing on the high-stakes, emotionally charged PICU environment. Semistructured interviews were conducted with 12 residents after their first PICU rotation from July 2019 through March 2020. Data were analyzed through line-by-line coding, serial discussions, and consensus meetings. Finally, emergent themes and convergent narratives were constructed around the resident PICU experience.

Results Residents perceived the PICU as a challenging environment for independent, self-driven, and active learning. They suffered adverse psychological effects, leading some to “give up” and many to experience feelings consistent with acute traumatic stress. Despite these challenges, residents described their PICU rotation as a “rite of passage” and reported increased comfort with caring for “sick kids.”

Conclusions Residents describe their PICU rotations as intense experiences that result in increased physician comfort. However, they also endure psychologically traumatic experiences that may hinder them, and the independent practitioners they become, from caring for certain types of patients in the future.
Characteristics of ADHD in Struggling Residents and Fellows
Authors: Warburton Karen M. , Yost Joanna S. , Bajo Stephanie D. , Martindale James R. , Parsons Andrew S. , Ryan Michael S.
Published: December 2024

Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that often results in poor academic performance. Little is known about how ADHD manifests in residents and fellows.

Objective To describe the prevalence and phenotype of ADHD among residents and fellows referred to a centralized remediation program.

Methods We conducted a retrospective review of data obtained from referrals to a single-center centralized graduate medical education remediation program from 2017 to 2023. Data included demographic variables, ADHD and mental health history, and training performance characteristics. ADHD was determined by self-report, clinical diagnosis by mental health provider, or neuropsychological testing.

Results A total of 173 trainees were referred in the study period. The prevalence of ADHD was 20% (35 of 173). ADHD was most commonly diagnosed in childhood (57%, 20 of 35); however, 26% (9 of 35) were diagnosed during or after medical school. Only 37% (13 of 35) were on medication, and 69% (24 of 35) disclosed at least one concomitant mental health diagnosis. Performance deficits were common in professionalism (69%, 24 of 35), organization/efficiency (O/E; 63%, 22 of 35), and medical knowledge (46%, 16 of 35). Repeated errors in patient care were made by 34% (12 of 35); 29% (10 of 35) failed at least one board examination, and 20% (7 of 35) required extension of residency or fellowship training. When compared to referrals without ADHD, residents and fellows with ADHD were more likely to struggle with O/E, failure to engage, and repeated errors.

Conclusions One in 5 trainees referred to a GME remediation program had ADHD, and most were not being treated for ADHD when referred. The deficits identified suggest an ADHD phenotype in GME which may be considered for struggling residents and fellows.
Epidemiological Profile, Predominant Morbidity Among Veterans and Military Retirees: retrospective analysis of case series from 1969 to 2022
Authors: Muajima Jean Baptiste , Kapour Germain , Mukengeshay Twende Patrick , Ghoma Linguiss Laure Stella , Nkoko Bompangue Didier
Published: December 2024

Context and objective. Increasing morbidity among veterans is a major public health concern in low-income countries. This specific group often receives less attention. This study aimed to describe the distribution of the most common diseases among veterans and military retirees in Kinshasa and identify factors associated with the predominant pathology in this group. Methods. A cross-sectional analytical study was conducted on veterans and military retirees in Kinshasa. Data were collected through a documentary review and analyzed using RStudio software. Results. Five pathologies were predominant among veterans and military retirees: hypertension, heart disease, diabetes mellitus, stroke, and malaria. Related diseases were also identified, including hypertension associated with diabetes mellitus, stroke associated with diabetes mellitus, sepsis associated with Buruli ulcer, and heart disease associated with hypertension. The sole factor significantly associated with hypertension in these individuals was the military rank: Subaltern officer (aOR = 0.290, 95% CI [0.117-0.720], p = 0.008); Non-commissioned officers (aOR = 0.186, 95% CI [0.098-0.356], p < 0.001); Senior officers (aOR = 0.246, 95% CI [0.079-0.758], p = 0.015). Conclusion. The present study provides valuable information on the health status of veterans and military retirees, contributing to a better understanding of their healthcare needs. 
Received: December 13th, 2023
Accepted: July 16th, 2024
https://dx.doi.org/10.4314/aamed.v17i4.10
Implementation trial of color coding for emergency caesarean section management in resource-limited settings
Authors: Mumbere Matumo Philémon , Kyakimwa Mutsuva Marie-Claire , Magala Batakuya Patrick , Sihalikyolo Juakali Jean-Jeannot
Published: December 2024

Context and objective. An emergency caesarean section carries a greater risk of complications for the mother and her baby than a normal delivery. Worldwide, the proportion of births by emergency caesarean section has risen sharply in recent decades. The aim of this study was to evaluate the impact of implementing color coding on decision-extraction time and maternal-fetal prognosis in the management of emergency caesarean sections in resource-limited settings. Methods. This was a cross-sectional analytical study that took place in the Matanda Hospital Maternity Unit in the Province of North-Kivu in the Democratic Republic of Congo. Data were collected prospectively over a 6-month period from 1 June to 30 November 2021. The study population consisted of parturient who had undergone an emergency caesarean section. Data processing was performed using Epi Info software version 7.2.4.0. Results. The frequency of emergency caesarean section in this study was 27.99%. The mean age of parturient was 29.07 years, with extremes of 16 and 43 years. Acute fetal distress was the most frequent indication (19.3%). For red code indications, the decision-extraction time was more than 15 minutes in 70.37% of cases. However, for Orange and Green codes, the extraction time was exceeded in 32% and 25% of cases respectively. The lengthening of the decision-to-birth delay was attributed to three types of delay: delay in installation (44.6%), delay in anesthesia (19.3%) and technical difficulties in extraction (12.6%). There was no statistically significant correlation between delay in decision to deliver and fetal outcome, but rather between the mode of admission and neonatal mortality, with an OR of 63.00 [15.33-258.86] (p<0.0001). Conclusion. The use of color coding in resource-limited settings does not appear to improve the maternal-foetal prognosis of emergency caesarean sections. Working conditions should be improved for its feasibility.
Received: June 8th, 2023
Accepted: June 1st, 2024
https://dx.doi.org/10.4314/aamed.v17i4.7
Comparative assessment of well and borehole water quality index in Sokoto Metropolis
Authors: Mahmud Amina Y. , Birnin-Yauri Umar A. , Muhammad Chika , Magami Ibrahim M.
Published: December 2024

The study focuses on the comparative assessment on the levels of some physiochemical parameters of well and borehole water collected from five locations in Sokoto metropolis to ascertain their quality index. Samples were collected randomly and analyzed using standard method of analysis. The physiochemical parameters analyzed include; pH, Turbidity, Total Dissolved Solids (TDS), Calcium (Ca2+), Magnesium (Mg2+), Chlorides (Cl-), Fluorides (F-) Sulphates (SO42+) and Nitrate (NO3-). The result of the study was subjected to Descriptive statistics and water quality index. The descriptive statistics results revealed that physicochemical parameters like pH, TDS, SO42-, and turbidity are within the WHO limit of drinking water while parameters like Ca2+, Mg2+ and Cl- were within and not within the WHO limit in some sampling locations whereas parameters like F- and NO3- were found not within the WHO limit in all the sampling locations. The result shows that both water sources were found within excellent and very good water quality index respectively which indicates that both water sources (well and borehole water) consumed within Sokoto metropolis are safe and suitable for drinking as it meets the minimum requirements of WHO standard of drinking water quality.
Effect of age on the structural strength of timbers commonly used in Nigeria
Authors: Olaniyi O.S. , Ogunbode E.B , Makun C.S , Ekekezie C.U. , Abdul A.
Published: December 2024

Timber is a material used for structural purposes in construction. Hence, the knowledge of properties of timber especially strength and factor affecting the strength of timber is very important. Age of timber is one major factor affecting timber strength and timber was usually fetched without knowledge of whether the timber is matured to meet the structural strength required. Therefore, this research tends to evaluate the effect of age on the strength of some selected timber species so that forester and users likewise could be guided on when to deforest. In this study, timbers studied were Universitas Orientalis Kentuckiensis (Eku), Entandrophragma cylindricum (Sapele) and Gmelina Arborea (Melina). The age of timber was determined by counting the number of annual growth rings, which is the combination of early wood and late wood and samples of different ages of timber, were obtained by personal visit to forest where they were fetched freshly. The samples obtained were machined and trimmed to standard sizes according to BS 5268 pt2 2003. The compressive strength was done using a timber size of 20mm X 20mm X 60mm, 20mm X 20mm X 300mm for determination of the bending strength and shear was performed using 20mm X 20mm X 20mm timbers (all in three replicate). The maximum compressive strength values were 49.31kN/m2 (at 45years), 45.89kN/m2 (at 60years) and 11.30kN/m2 (at 25years) for Eku, Sapele and Melina while the maximum bending strength were 187.55kN/m2 (at 35years), 278.79kN/m2 (at 70years) and 176.36kN/m2 (at 20years) and shear strength were 10.05kN/m2 (at 50years), 9.22kN/m2 (at 70years) and 10.91kN/m2 (at 25years) for the for the three samples. It was concluded that age of timber affects the strength of timber.
Prediction of milk yield using visual images of cows through deep learning
Authors: Jembere L. , Chimonyo M.
Published: December 2024

The objective of the study was to determine, through deep learning, the predictability of milk yield from a cow's side-view, rear-view image, or a combination of the two. The data size of 1 238 image pairs (the side-view and rear-view images) from 743 Holstein cows in their first or second parity, and their corresponding first-lactation, 305-day milk yield values were used to train and test Deep Learning models. The data were first split into the training and testing data at a ratio of 80:20, respectively. The training data were augmented four times, then again divided into training and validation data at the ratio of 4:1, respectively. Three principal analyses were done, the prediction of milk yield using rear-view images, using side-view images, and using a merge of the side-view and rear-view images. In all three analyses, poor predictions were observed, i.e., R2 values ranging from 0.30 to 0.38, the mean absolute error ranging from 1112.9 kgs to 1148.3 kgs, the root mean square error values ranging from 1401.2 kg to 1480.5 kg, and the mean absolute error percentages ranging from 17.0 to 17.6%. Hypothesis tests were done to check whether there was any difference between these three prediction models. There was no significant difference in performance between the prediction models. It was concluded that predicting the 305-day milk yield of Holstein cows using either view had the same level of accuracy, and no additional benefits were derived from using both the rear and side views.
Early lactational response to rumen-protected methionıne supplementation in dairy buffalo fed forage-based diets
Authors: Muruz H. , Çelik S. , Selçuk Z. , Bölükbaş B. , Ertan S.
Published: December 2024

This study determined the effects of rumen-protected methionine (RPMet) supplementation on milk yield and milk composition in early lactation dairy buffalo fed a forage-based diet. A total of 20 lactating, multiparous Anatolia water buffalo were used, with a mean initial milk yield of 4.63 ± 0.52 kg/d, 42.75 ± 6.21 days in milk, and a body weight of 452.8 ± 28.92 kg. The buffalo were separated into two groups, each containing 10 animals of similar body weight, parity, days in milk, and milk yield. The first group (CON) received a ration without feed additives as a control, whereas the second group (RPMet) was fed the control diet supplemented with 10 g/head/day of RPMet. The buffalo were housed in two separate free-stall barns. The experiment lasted for nine weeks, including one week for adaptation and eight weeks for the trial period. Experimental animals were fed a total mixed ration with a forage to concentrate ratio (R:C ratio) of 70:30 containing 15% crude protein and 1.72 Mcal/kg NEL. Daily milk yield was recorded for individual animals and milk samples were collected at 2-w intervals. The supplementation with 10 g/d of RPMet considerably increased milk yield (+ 0.16 kg/d), FCM (+ 0.66 kg/d), energy-corrected milk (+ 0.74 kg/d), milk protein yield (+ 0.02 kg/d), and milk fat yield (+ 0.05 kg/d), but did not affect milk lactose and SNF yield. A higher milk protein percentage was obtained with RPMet compared to the CON (0.23% vs.0.21); fat, lactose, and solid non-fat were similar. Early lactation RPMet supplementation beneficially affects milk yield, milk protein content and yield, and milk fat yield. Further studies are needed to assess the efficiency of RPMet under different dietary conditions in lactating buffalo.
Citric acid in the diet of male Venda chickens: Effects on carcass characteristics and physico-chemical attributes
Authors: Mamabolo M.V. , Ng’ambi J.W. , Gunya B.
Published: December 2024

This experiment was conducted to determine the effects of citric acid (CA) on carcass characteristics and physico-chemical attributes of male Venda chickens. A total of 200 male, one-day-old Venda chicks were distributed in a completely randomized design with four treatments and five replicates of 10 chickens each. The treatments were as follows: four diets with citric acid supplementation of 0, 12.5, 25, and 50g CA/kg. In this study, the live weight, carcass weight, thigh weight, drumstick weight, and carcass yield were higher in CA25 than in other treatments. The wing weight was higher in CA12.5 than in CA0. The highest value was determined in CA0, followed by CA12.5, and CA25, respectively, according to pH24 h, pH48 h, pH72 h, cooking loss, as well as shear force. The lowest value was recorded in CA50 as expected. The pH24 h, pH48 h, pH72 h, cooking loss, and shear force were found to be similar. The current study indicates that 12.5 and 50 g CA/kg can be used easily in the diet of male Venda chickens without any negative effects.
PCV2: The unexpected threat - How fish infection can transform industries and society: A pilot study
Authors: Silva V.H. , Silva D.F. , Baldisseri F. , Borges J.C.S. , Borba L.J. , Silva R.R. , Castro A.M.M.G.
Published: December 2024

Integrated fish and livestock farming is an ancient practice and is used to increase production per unit area and reduce the environmental impact caused by untreated animal excreta. Although integrated aquaculture has been used in some countries, including Brazil, this practice has declined. However, many pig farmers maintain their ponds and/or have rivers near their pig farms, allowing raw manure to drain to them. The objective of this work was to verify the possibility of infection of fish by porcine circovirus 2 (PCV2) and, thus, serving as a reservoir species. Eleven specimens of Nile tilapia (Oreochromis niloticus), negative for PCV2, were inoculated with PCV2 intramuscularly and observed for 61 d post-inoculation (dpi), when they were euthanized and had their intestines, livers and gills removed to evaluate for presence of PCV2. The faeces were collected directly from the fish aquarium every four days up to 12 dpi and then once a week up to 61 dpi. The organs and faeces were tested by qualitative polymerase chain reaction (qPCR) for PCV2. This preliminary study showed that PCV2 inoculation was successful in infecting fish. In addition, PCV2 was eliminated in the faeces intermittently during the 61 d of experimentation.
The effect of dietary non-protein nitrogen content on the meat quality of finishing lambs
Authors: Einkamerer O.B. , Ferreira A.V. , Fair M.D. , Hugo A.
Published: December 2024

The effect of increasing the non-protein nitrogen content of low-fibre finishing diets on the meat quality of South African Mutton Merino wether lambs was investigated. Four similar dietary treatments were formulated with different non-protein nitrogen contents (16.6 g/kg, 28.3 g/kg, 40 g/kg, and 51.7 g/kg) on a dry matter basis. The study was conducted over 71 days. Muscle lipid content was higher on the 40 g/kg compared to 16.6 g/kg and 28.3 g/kg non-protein nitrogen diets. Myristic acid and total saturated fatty acid content of lamb muscle tissue was higher, whereas the total unsaturated fatty acid content of the same tissue was lower following a high dietary non-protein nitrogen content. A high nonprotein nitrogen diet (51.7 g/kg) reduced conjugated linoleic acid content of adipose tissue, compared to 28.3 and 40 g/kg non-protein nitrogen treatments. Malonaldehyde content of fresh lamb meat was higher on the 28.3 g/kg compared to the 16.6 g/kg non-protein nitrogen diet. The malonaldehyde content of the treatment containing 40 g/kg non-protein nitrogen was higher than the 51.7 g/kg when stored for 90 days. Therefore, the non-protein nitrogen content of low-fibre lamb finishing diets does not affect mutton fatty acid composition and quality parameters. Protein quality and its effect on ruminant meat quality requires more attention.
Using Nigella sativa seed meal as a substitute for soybean meal in broiler diets
Authors: Elgandy M.F.
Published: December 2024

The proximate chemical composition, mineral, fatty acid, and amino acid profiles of Nigella seed meal (NSM) was determined. In addition, apparent (AAAU) and true (TAAU) amino acid utilization, and apparent (AMET) and true (TMET) metabolisability were determined using a force-feeding bioassay with two groups of eight cockerels each at 20 weeks old. Furthermore, a protein efficiency bioassay was conducted with 160 Ross-308 unsexed broilers aged between 22 and 42 days. These broilers were randomly assigned to two treatments, each with eight replicates of 10 broilers. The broilers were fed two diets in which soybean meal 44% CP (SBM) and NSM were the main protein sources. NSM contains approximately 35% crude protein, 10% ether extract, and significant amounts of minerals, fatty acids, and amino acids. AAAU and TAAU were 82.33% and 89.17%, whereas AMET and TMET were 2998 and 3780 kcal/kg, respectively. The protein efficiency bioassay clarified the possibility of using NSM instead of SBM in broilers diets aged 22–42 days of age. NSM is a rich source of nutrients that can be tested in further studies to estimate its capability as a source of protein in broilers diets during the whole period of growth (1–42 d of age). Moreover, testing higher levels of NSM in broilers diets is of the utmost importance in future studies.