bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress distribution by parafunctional loading on tooth–implant, implant–implant, and tooth–tooth-supported prosthesis: A comparative three-dimensional finite element analysis
Authors: Ravindran P Ambili , Raghavan Rohit , Christopher Kiran , Sramadathil Sethu , George Ann , Sasi Athira Kattachirakunnel
Published: October 2024

Aim:

The study’s objective was to evaluate the stress distribution in tooth-implant, implant-implant, and tooth-tooth supported prostheses under parafunctional loading in axial and oblique directions employing a 3D finite element analysis in the mandibular posterior region which had D3 bone (porous cortical bone and fine trabecular bone).

Setting and Design:

In vitro study, Finite element analysis.

Meterials and Methods:

Cone-beam computed tomography data was used by Mimics software (Materialize Mimics 19) to create a three-dimensional finite element simulation of the jaw. Solid Works 2018 (Dassault Systems) was used to produce a geometric 3D model of the three systems. Each model consisted of a bone, an implant, and teeth (Model I tooth-tooth supported, Model II tooth-implant supported and Model III implant-implant supported). The three models’ geometrical models were transferred to Ansys Workbench (19.2 software) for the analysis portion. A load that mimicked masticatory force was delivered in both axial and oblique directions.

Statistical Analysis Used:

In the present study, statistical analysis was not required because 3D finite element analysis uses deterministic numerical methods to simulate physical behavior and stress distribution patterns.

Result:

The results demonstrated that under the parafunctional combined loading process, the implant- implant supported prosthesis showed significantly higher stress concentrations in the bone. It was found that the cortical bone around the crestal region had the highest stresses.

Conclusion:

Within the constraints of this investigation, we could draw the following conclusion: Of the three models, the tooth-tooth supported prosthesis exhibited the least amount of stress distribution, which was also least when functional loading was applied in the axial direction.
Assessment of different shielding materials for radiation therapy of maxillofacial tumors – An in vitro study
Authors: Mohamed K Kasim , Srinivas K Satish , Seenivasan Madhankumar , Babu Annapoorani
Published: October 2024

Aim:

Since the advent of radiotherapy, the success rate of head and neck cancer treatment has increased significantly. However, when the tissue tolerance level is exceeded, unnecessary and uncontrolled exposure to radiation is considered detrimental. Such problems remain difficult to prevent and manage. The aim of the study to evaluate and compare the degree of attenuation of therapeutic radiation using four different radiation shielding materials of varying thickness.

Study Setting and Design:

In vitro experimental study.

Materials and Methods:

The samples were divided into four groups based on the different radiation shielding materials of thickness 3mm and 5mm. The materials are Lead (Pb), Silver-tin alloy (Ag-Sn) with Polyvinylsiloxane (PVS), Polymethylmethacrylate (PMMA) with Barium sulphate (BaSO4), and a combination of Ag-Sn with PVS and PMMA with BaSO4 which was exposed to radiation. The radiation dose measurements were recorded and the radiation attenuation properties of the shielding materials were evaluated. Among all of the shielding materials the most efficient material under consideration is determined.

Statistical Analysis Used:

One-way ANOVA followed by post hoc test was used to compare the means of all four groups.

Results:

A statistically significant difference between groups was found by a one-way ANOVA with a P = 0.001. In the post hoc test, statistically significant findings were obtained with a P = 0.05 when comparing the variation values of 3mm and 5mm thickness between each group and other groups.

Conclusion:

The shielding materials results in significant reductions in radiation dosage. It was concluded that the combinations of Ag-Sn alloy with PVS, and PMMA with BaSO4 of thickness 5 mm had a good shielding effect.
Digital prosthodontics in near future: Awareness among the dental students on intraoral scanners and its probability of replacement over conventional method in the near future of prosthodontics: A cross-sectional survey
Authors: Ketharinath N. , Kiruppashini T. , Kabilan P. , Nagappan C.
Published: October 2024

Aims:

The aim of the study is to analyse the awareness and knowledge about IOSs among the dental students of Tamil Nadu.

Settings and Design:

A cross sectional survey – questionnaire study.

Materials and Methods:

A descriptive, cross-sectional survey was carried out to assess the knowledge, awareness, and practice of IOSs among dental students through a questionnaire of five domains, with five questions in each domain. This is sent to various dental students of Tamil Nadu through mail and othersocial media platforms.

Statistical Analysis Used:

It was performed using a statistical package for the social sciences’ [SPSS] software version 22. Descriptive statistics were performed for demographic variables. Chi square test was performed for all the qualitative data.

Results:

Most of the answers were statistically significant with P < 0.05 and few results were not significant indicating less knowledge and awareness about digital prosthodontics among the dental students.

Conclusions:

Thus, the addition of digital dentistry in the curriculum of dental students and giving them more knowledge helps in the flourishment of the future prosthodontic field with much accuracy of treatment and with less patient discomfort replacing the conventional methods.
Vascular Leiomyoma of oral cavity: A case report in young male patient
Authors: Agarwal Priyanka , Creanga Adriana D.
Published: October 2024

Vascular Leiomyoma of the oral cavity is an uncommon benign soft tissue neoplasia arising from the tunica media of the smooth muscle cells. We reported a rare case of Vascular Leiomyoma involving the retromolar trigone area of a young man. A 24-year-old male presented with a slowly growing mass in the retromolar area, which was associated with pain and difficulty in opening of mouth and eating and drinking. A punch biopsy was taken and sent for histopathological examination which revealed a benign angiomatous lesion. The mass was excised, and the adjoining area was curetted. Histopathological examination confirmed the diagnosis of Vascular Leiomyoma. The immunohistochemistry of cells shows: alpha-smooth muscle (+); vimentin (+), Desmin, actin (+), and S100 (−). Angioleiomyomas are benign lesions, but malignant transformation is a possibility so careful histologic inspection is necessary to distinguish these lesions from their malignant counterpart.
Cancer stem cells targeted therapy: A changing concept in head and neck squamous cell carcinoma
Authors: Manchanda Adesh S. , Rai Harmandeep K. , Kaur Manvir , Arora Paras
Published: October 2024

Identification of cancer stem cells (CSCs), their multilineage potential, and their ability of self-renewal have revolutionised the current concepts of cancer treatment. The suspected role of CSCs in cancer initiation, progression and relapse with the observed resistance to conventional cancer treatments has led to the development of more specific and targeted therapies. Identification of the properties of stem cells (SCs) and their potential for localisation in cancer has made targeted anti-cancer treatment possible by incorporating some modifications into these SCs. The same concept has been applied to the treatment strategy for head and neck squamous cell carcinoma (HNSCC) to control the relapse and improve the mortality rates in patients. This review aims to discuss the role of CSCs in the course and relapse of HNSCC, various surface markers for their identification and SC-targeted therapy options for the treatment of HNSCC, with a highlight on the advantages, shortcomings, opportunities and challenges to SC therapy in head and neck squamous cell carcinoma, treatment and scope for future research.
A brief insight regarding Nasopalatine duct cyst- Report of two cases with a review of literature
Authors: Sarangi Snehanjan , Ray Debarati , Bhattacharjee Tathagata , Ray Jay Gopal
Published: October 2024

Nasopalatine duct cysts (NPDCs) are among the most common nonodontogenic cysts, typically located in the midline of anterior maxillary hard palate. They usually arise from the embryonic epithelial vestiges of the nasopalatine duct. NPDCs predominantly affect adult males, generally during their fourth decade of life. Clinically, they present as asymptomatic or occasionally painful, fluctuant or discharging swellings involving the hard palate. Radiographically, NPDCs are characterized by a well-defined, fairly corticated, inverted pear-shaped or heart-shaped radiolucency situated between the roots of the maxillary incisors. Histopathologically, NPDCs exhibit a wide spectrum of findings. The lining may be comprised of stratified squamous, pseudostratified ciliated columnar, columnar, or cuboidal epithelium, or a combination and transition of these types. The cystic capsule is fibrocollagenous and can exhibit certain unique features, such as neurovascular bundles, mucous glands, and cartilaginous rests. NPDCs are typically managed through surgical enucleation, and recurrences are rare. Herein, we present two cases of NPDCs, along with a brief overview of their origin, relevant diagnostic features, and management.
Pathophysiology of oral lesions subsequent to SARS-CoV-2 vaccination: A systematic review
Authors: Sharma Preeti , Malik Sangeeta , Wadhwan Vijay , Sharma Rishabh
Published: October 2024

Amidst worldwide reports of adverse oral lesions subsequent to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, the current systematic review planned to determine the prevalence of adverse oral events in adult individuals (≥18 years) after SARS-CoV-2 vaccination, emphasizing upon the type and dose of vaccine, time of onset, and underlying pathophysiology. The registered protocol (PROSPERO CRD42023421307), conforming with PRISMA guidelines, included an all-inclusive literature search through online databases, consisting of Scopus, PubMed/MEDLINE, Web of Science, Lilacs, Livivo, and PROSPERO, completed on 2 May 2023, followed by assessment of risk of bias by Joana Briggs Institute Evaluation Checklist. Due to the paucity of literature, case reports and case series were included. Self-reported lesions were excluded. Qualitative synthesis employing Microsoft Excel software 2019 revealed low prevalence (43 subjects) from 26 case reports and two case series. There were multiple erosive oral ulcers on gingiva, palate, burning pain in the mouth, xerostomia, tongue fissuring and glossitis, palatal petechiae, diffuse erythematous lesions and loss of smell (16.2%), primary herpetic gingivostomatitis (21%), oral lichen planus (16.2%), Stevens-Johnson syndrome (6.9%), Bell’s palsy in four cases where two cases were Guillain-Barré syndrome (9.3%), erythema multiforme (11.6%), pemphigus (4.6%), idiopathic thrombocytopenic purpura (6.9%), unilateral hypoglossal nerve palsy (4.6%), and trigeminal neuralgia (2.3%). Maximum cases (22 subjects) presented oral lesions after Pfizer (BNT162b2) SARS-CoV-2 vaccine. No association was found between the vaccine type and dose with oral side effects. Dentists must be aware of the oral adverse effects after coronavirus disease 2019 vaccination to better understand the pathogenesis and the risk factors associated with such reactions.
Providing Cataract Surgeries at a Rural Primary Health Centre through Non-governmental Organisation Collaboration: An 8-year Experience
Authors: Sharma Shruti K , Sharma Vijay , Yadav Reena
Published: October 2024

The National Programme for Control of Blindness and Visual Impairment aims to reduce blindness and visual impairment in India. Despite these efforts, rural areas still have high numbers of cataract patients due to inadequate healthcare services. Leveraging non-governmental organisation (NGO) networks to provide rural eye care camps has been proposed to address these challenges. This article shares an 8-year collaboration with an NGO in rural Haryana, delivering cataract surgeries. Initially, surgeries were conducted in temporary locations; however, due to complications, they were shifted to hospitals, increasing travel difficulties. In 2016, collaboration with ICARE Eye Hospital began, involving screening camps and transporting patients for surgery. This reduced patient expenses and referral burdens, performing 1690 surgeries with high satisfaction. Authors recommend similar collaborations to achieve the national blindness reduction goal.
Simultaneous occurrence of cerebral bleed and infarct
Authors: Aggarwal Amitesh , Bansal Luv , Jain Meenakshi
Published: October 2024

BACKGROUND:

Simultaneous occurrence of ischemic and hemorrhagic stroke is extremely rare although the pathology of both types of strokes is similar. However, this poses challenges in management of such cases.

CASE DETAIL:

An 80-year-old Indian housewife presented to the hospital in altered sensorium with no significant comorbidity in the past. On neurological imaging, she was found to have both intracerebral infarct and bleed. She was managed conservatively.

CONCLUSION:

There are challenges in management of these types of patients as treatment is different in both scenarios. This case raised the question regarding the routine management of such cases. In the absence of published guidelines, individual tailoring of treatment is needed.
Approach to anemia with caveats in focus
Authors: Aggarwal Amitesh , Thakur Sanat Kumar
Published: October 2024

Anemia being a very commonly encountered clinical condition can be a presentation of a wide range of underlying illness. This article tries to succinctly provide an approach to and give an overview of anemia without delving into any one particular type. To categorize anemia would help narrow down the list of differentials and enable diagnosing a large and varied number of conditions.
Reports of herpes simplex reactivation after COVID vaccination
Authors: Abidi Afroz , Fatima Ghizal , Srivastava Shruti , Chakravorty Saibal
Published: October 2024

Vaccination is a safe and effective way to control preventable infectious diseases. Since December 2019, the world has been facing a global pandemic of COVID-19. Physicians and scientists were totally baffled and unprepared for this sudden emergency, but the continued efforts of researchers help control the disease. Apart from the emergency use authorization of drugs, experts swiftly explored a number of candidate COVID-19 vaccines including live-attenuated, viral-vectored, nucleic acid–DNA and RNA, protein subunit, and inactivated vaccines. Post approval from regulatory authorities in India, the Ministry of Health and Family Welfare introduced a vaccine in the market after successful phase II/III clinical trials.
Thyroid profile in patients of liver cirrhosis and correlation with severity and etiology of liver disease
Authors: Singh Smriti , Maurya Sharad Kumar , Varma Anubha
Published: October 2024

INTRODUCTION:

Thyroid disease has been observed to be associated with liver injuries or deranged liver function. This study was conducted to study thyroid dysfunction in patients of liver cirrhosis and any association between severity of liver cirrhosis and thyroid profile.

MATERIALS AND METHODS:

In this case-control study, liver cirrhosis patients aged >18 years with evidence of hepatocellular dysfunction with portal hypertension compared with apparently healthy age-gender matched. Data were collected on a semistructural questionnaire with general physical and systemic examinations, including thyroid examination. The etiology of disease was ascertained on the basis of clinical examination and investigation.

RESULTS:

The study included 72 case (70.8% male and 29.2% female) and equal number of control participants. Controls as compared to cases had free triiodothyronine (fT3) (2.45 ± 0.40 vs. 1.60 ± 0.50 pg/ml) and free tetraiodothyronine (fT4) (1.26 ± 0.21 vs. 1.15 ± 0.48 ng/ml). Thyroid-stimulating hormone (TSH) value of cases were 3.61 ± 0.95 μIU/ml and controls were 3.01 ± 0.66 μIU/ml.

CONCLUSIONS:

Liver disease cases as compared to controls had significantly lower fT3 levels and significantly higher TSH levels. Mortality rate of liver disease cases with thyroid dysfunction was also found to be significantly higher.
The Effect of Quercetin on Oxidatıve Stress in IPNV-infected Cells of Rainbow Trout (Oncorhynchus mykiss)
Authors: Zorlu Kaya Dilek , Cenesiz Sena
Published: October 2024

In this study, the antioxidant effects and the free radical scavenging capacity of quercetin were investigated in IPNV-infected Rainbow Trout Gonad-2 (RTG-2) continuous cell culture. For this purpose, four different groups were formed (Control, IPNV, Quercetin, IPNV+Quercetin). Malondialdehyde (MDA), Total Antioxidant Status (TAS), Total Oxidant Status (TOS), Ceruloplasmin (Cp), and Glutathione Peroxidase (GPx) activities were measured at 0, 24, 48, 72, and 96 hours. According to the results of our study, there was a significant increase in TAS, TOS, and Cp results in the groups containing IPNV-infected cells. According to TAS and TOS measurements, there was a statistically significant increase both between groups and at different hours. When GPx results were analyzed, it was observed that there was no statistically significant change between the groups and between the measurement hours. When the MDA results were analyzed, it was observed that there was no change in the measurements made at different hours, while there were significant differences between the groups. It was observed that quercetin can minimize the damage caused by scavenging free radicals in the environment and thus provides an important development for fish farming and economy in cells infected with IPNV in the laboratory environment.
Human Schistosomiasis due to Schistosoma bovis in Nigeria
Authors: Enudi Antonia Omenebele , Nmorsi Onyebiguwa Patrick Goddey , Egwunyenga Andy Ogochukwu
Published: October 2024

Schistosomiasis is a global public health challenge, especially in sub-Saharan Africa, where Nigeria has the highest burden of disease. Schistosoma hybrids have been discovered in various countries, including Nigeria, where livestock and human beings share common water resources. This study, carried out in three communities, two of which are endemic for urinary schistosomiasis, aimed to identify the urinary schistosomiasis causative agent by using a species-specific molecular technique and their evolutionary relationship. Polymerase chain reaction using primers specific for a partial DNA sequence of the mitochondrial cox1 gene of Schistosoma haematobium was carried out on pooled urine sediments preserved in 70% ethanol. DNA from the high-intensity pooled samples from Onye-Uku camp amplified, and a BLAST search identified the pooled samples as Schistosoma bovis, whereas S. haematobium DNA did not amplify. The phylogenetic relationship of the sequence showed that it clustered with an S. bovis hybrid obtained from a human host in Côte d’Ivoire and had close ancestry with isolates from cattle in Cameroon. This finding revealed the prevalence of S. bovis among some inhabitants in a zone in Nigeria where schistosomiasis is endemic.
Prevalence and Genetic Diversity of Deer Tick Virus (Powassan Virus, Lineage II) in Ixodes scapularis Ticks in Five Habitats at a Nature Reserve in Southern Maine, United States
Authors: Robich Rebecca M. , Piantadosi Anne , Elias Susan P. , Cosenza Danielle S. , Schneider Elizabeth F. , Baxter Lindsay , LaFon Erin , Lubelczyk Charles B. , Meagher Molly , Vogels Chantal B. F. , Smith Robert P.
Published: October 2024

Deer tick virus (DTV), also known as Powassan virus lineage II, is a rising health concern due to increased recognition as a cause of human encephalitis. Since European tick-borne encephalitis virus persists in nature in enzootic foci (i.e., higher prevalence rates in small pockets in nature), we sought to determine whether DTV is also focally maintained in relation to habitat type, to better understand factors leading to human risk of exposure. From 2018 to 2021, questing Ixodes scapularis ticks were collected from five habitats at the Wells National Estuarine Research Reserve (WNERR) in Wells, ME: forest with invasive vegetation in the understory, edge, shrub, forest with native vegetation in the understory, and open field. Deer tick virus prevalence was greater in adult ticks (2.0%) than in nymphs (0.5%). Deer tick virus prevalence in adult ticks collected from forest with invasive vegetation was 3.2% compared to 0 to 1.7% in other habitat types. A hot spot analysis revealed a higher number of infected adults collected per hour on one of the transects located in forest with invasive vegetation. Phylogenetic analysis of 37 full-length DTV genomes sequenced in this study revealed four major clades from the WNERR, and there was high genetic diversity within each transect, suggesting frequent, short-range dispersal between habitats. Analysis of DTV sequences from other New England counties and states also indicated long-distance dispersal to and/or from the WNERR. This study provides preliminary evidence that DTV is focal and that the risk of encountering DTV-infected ticks in forest with invasive vegetation may be greater than in other habitat types.
Uptake, Acceptability, and Results of SARS–CoV-2 Antigen Rapid Diagnostic Testing in Community Settings in Cameroon
Authors: Djikeussi Tatiana K. , Tchounga Boris Kevin , Feuzeu Loic , Kana Rogacien , Tchakounte Youngui Boris , Viana Shannon , Hoffman Heather J. , Mambo Albert , Moussi Charlotte , Fokam Joseph , Epée Emilienne , Hoppe Anne , Dani Pallavi , Tchendjou Patrice , Guay Laura , Gill Michelle M.
Published: October 2024

Mass gathering event restrictions were part of mitigation measures during the COVID-19 pandemic that were lifted as prevalence decreased and after vaccination rollout. We explored SARS–CoV-2 antigen rapid diagnostic test acceptability and positivity in community settings in Cameroon. In August–October 2022, community workers sensitized and referred individuals for COVID-19 testing to nearby testing points in Douala and Yaoundé. Participants consented to SARS–CoV-2 antigen rapid diagnostic testing, a survey, or both components. We describe the positivity rate, COVID-19–related history, and Likert-scale testing perceptions. Factors associated with testing acceptance were analyzed using logistic regression. Overall, 20.5% (2,449/11,945) of sensitized individuals visited testing points, and 1,864 (76.1%) were enrolled; 50.6% accepted the survey and testing (46.0% accepted survey only). Seven (0.7%) of 1,006 individuals tested positive. Most (71.8%; 1,292/1,800) considered community testing more accessible than hospital-based testing. Individuals accepting versus refusing testing differed in perceived COVID-19 risk (67%, 49%; P <0.001), belief in accurate test results (79%, 47%; P <0.001), and ability to test easily (96%, 55%; P <0.001). Males (adjusted odds ratio [aOR]: 1.26 [1.04–1.53]) and those over 50 years (aOR: 1.9 [1.4–2.7]), with symptoms (aOR: 1.80 [1.30–2.50]), and at least partial vaccination (aOR: 0.76 [0.58–0.99]) were significantly associated with test acceptance. Refusal reasons included lack of perceived need for testing (33.8%) and testing discomfort (26.3%). Although community-based testing was generally perceived as important, actual testing uptake was low. In future pandemics, community testing should be optimized by addressing misinformation, offering alternative testing modalities for greater comfort, creating demand, and tailoring approaches to maximize testing uptake.
Case Report: Effects of Environmental Smoke Exposure on Respiratory Conditions—A Report of an Aboriginal Man Fire Hunting for Mud Turtles in the Top End, Northern Territory of Australia
Authors: Nockles Veronica , Hill Ethan , Howarth Timothy P. , Browning Samuel , Wurrawilya Shiraline , Ford Payi L. , Hickey Phil , Edwards Andrew , Heraganahally Subash S.
Published: October 2024

Environmental smoke has been shown to have significant associations with both causation and exacerbation of respiratory conditions. Aboriginal Australians in the Northern Territory (NT) of Australia are disproportionately affected by respiratory illness in comparison with non-Aboriginal Australians. Traditionally, Aboriginal communities have utilized fire for multiple purposes, such as land management practices, cultural ceremonies, hunting, and cooking. In this report, we describe an Aboriginal man who presented with acute exacerbation of airway disease after environmental smoke exposure while being in the close vicinity of “fire hunting” for “mud turtles” from a Top End remote Aboriginal community in the NT of Australia. This report highlights the potential impact of nontobacco environmental smoke exposure contributing to the causation and exacerbation of chronic respiratory conditions among Aboriginal Australians. Hence, further research is warranted to address mitigating strategies in this population.
The 2024 Public Health Emergency of International Concern: A Global Failure to Control Mpox
Authors: Zumla Alimuddin , Rosenthal Philip J. , Sam-Agudu Nada A. , Ogoina Dimie , Mbala-Kingebeni Placide , Ntoumi Francine , Nakouné Emmanuel , Njouom Richard , Ndembi Nicaise , Mills Edward J. , Muyembe-Tamfum Jean-Jacques , Nachega Jean B.
Published: October 2024

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.
The Effect of Implicit Bias on the OB/GYN Residency Application Process
Authors: Vorawandthanachai Thammatat , Lambert Calvin , Tavella Nicola , Gonzalez Cristina M. , Hughes Francine
Published: October 2024

Background Medical students from racially minoritized backgrounds receive negative evaluations more frequently, possibly from implicit bias.

Objective To determine if a preference for White applicants over Asian and Black applicants exists among resident and attending reviewers of obstetrics and gynecology (OB/GYN) residency applications.

Methods In 2021, we sampled academic OB/GYN physicians from 6 academic institutions to randomly receive questionnaire form A or B, each containing 4 contrived Electronic Residency Application Service profiles stratified by United States Medical Licensing Examination scores; institutions attended; and strength of recommendation letters into top-, mid-, and low-tiers. Form A applicants were White top-tier, White mid-tier without resilience, Asian mid-tier with resilience, and White low-tier. Form B applicants were Black top-tier, Asian mid-tier without resilience, White mid-tier with resilience, and White low-tier applicants. Both questionnaires’ profiles were identical except for applicants’ names and races. The primary outcome was participants’ rankings of applicants from most to least desirable. Baseline characteristics of participants were compared with chi-square tests. Rankings were compared using generalized estimating equations to calculate the odds ratio (significance P<.05).

Results One hundred and ninety-one were invited to participate; 109 participants started the questionnaire, and 103 ranked applicants (response rate 54%). Fifty-three participants completed form A, and 56 completed form B. No significant differences were found in participants’ demographics. Participants frequently ranked White applicants significantly more highly than Black applicants (-3.3, 95% CI -3.5, -3.1) and Asian applicants (-3.3, 95% CI -3.5, -3.1).

Conclusions Despite identical qualifications, a stronger preference for White applicants over Black or Asian applicants was found.
Gender Differences in Operative Autonomy Using the Surgical Autonomy Program: A Multicenter Study
Authors: Kirsch Elayna P. , Venkatraman Vishal , Deng Di , McDaniel Katherine E. , Suarez Alexander D. , Lew Sean M. , Orina Josiah , Silberstein Howard , Goldstein Ira , Gould Grahame , Gandhi Chirag D. , Patil Chirag , Dengler Bradley A. , Dharmapurikar Rajeev , Lad Shivanand P. , Haglund Michael M.
Published: October 2024

Background The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men.

Objective We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents.

Methods The SAP tracks resident progression and guides teaching in neurosurgery. Surgeries are divided into zones of proximal development (opening, exposure, critical portion, and closure). Postoperatively, resident autonomy is rated on a 4-point scale by the resident and the attending for each part of the case, or zone. We utilized data from July 2017 to February 2024 from 8 institutions. Ordinal regression was used to evaluate the odds of self- and attending-evaluated autonomy, accounting for gender, training year, case difficulty, and institution. Differences between attending assessment and self-assessment were calculated across time. Chi-square analyses were used to measure any differences in feedback given to men and women.

Results From 128 residents (32 women, 25%), 11894 cases were included. Women were granted less autonomy (OR 0.81; 95% CI 0.74-0.89; P<.001) and self-evaluated as having less autonomy (OR 0.73; 95% CI 0.67-0.80; P<.001). The odds of women operating at higher autonomy were similar to the odds of operating on a hard case compared to average difficulty (OR 0.77; 95% CI 0.71-0.84; P<.001). Men’s and women’s self-assessment became closer to attending assessment over time, with women improving more quickly for the critical portions of surgeries. Women residents received meaningful postoperative feedback on fewer cases (women: 74.2%, men: 80.5%; X2=31.929; P<.001).

Conclusions Women operated with lower autonomy by both attending and self-assessment, but the assessment gap between genders decreased over time. Women also received less feedback from their attendings.
Interventions to Support Resident and Fellow Well-Being During the COVID-19 Pandemic: A Scoping Review
Authors: Ibrahim Halah , Abdel-Razig Sawsan , Konopasek Lyuba , Silverberg Jillian , Philibert Ingrid
Published: October 2024

Background The COVID-19 pandemic led to rapid and wide-scale changes in graduate medical education and impacted the well-being of frontline physicians, including residents and fellows. While institutions and programs implemented initiatives to support the unique needs of trainees during the pandemic, there remains a gap in the literature in examining the approaches used, the domains of well-being addressed, and the effectiveness of these efforts.

Objective To review the literature on interventions designed to promote resident and fellow well-being during the COVID-19 pandemic.

Methods The authors conducted a scoping review of the literature published between January 1, 2020, and November 30, 2023, in PubMed, Scopus, Embase, PsycINFO, CINAHL, and ERIC to identify interventions to promote the well-being of trainees during the COVID-19 pandemic.

Results Eighteen articles met inclusion criteria, mainly studies conducted in the United States (14 of 18, 77.8%). Most interventions targeted psychological well-being (16 of 18, 88.9%), with only a few studies that included interventions in the physical or social domains. Interventions entailed redeployment, schedule modifications, communication strategies, and expanded mental health support. Most interventions were limited to a few weeks’ duration in the first surge phase of the pandemic. Only 11 studies (61%) reported outcome measures, and only 2 (11%) used instruments with validity evidence. Most studies did not report sufficient data to evaluate study quality.

Conclusions While longer-term outcome data were often lacking, studies described a range of interventions to support resident well-being. Future research should focus on the effectiveness of well-being interventions and include cohorts from more diverse clinical settings.
Formal Parental Leave Policies and Trainee Well-Being in US Graduate Medical Education: A Systematic Review
Authors: Corbisiero Michaele Francesco , Stellern Jordan J. , Kyllo Hannah M. , Burnet George , DeSanto Kristen , Christian Nicole , Acker Shannon N.
Published: October 2024

Background Variability in parental leave policies across graduate medical education (GME) programs in the United States complicates efforts to support resident wellness and identify best practices for resident well-being.

Objective This review aims to assess how formal parental leave policies affect trainees’ well-being, professional satisfaction, and performance during training.

Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2020 guidelines was conducted and registered on PROSPERO in May 2023. Databases searched included MEDLINE, Embase, and Cochrane Central. Studies that evaluated parental leave policies of US-based GME programs and their direct impact on residents and/or fellows were included. Studies were screened for inclusion by 2 independent reviewers, and any conflicts were resolved by a third author.

Results Of 1068 articles screened, 43 articles met inclusion criteria. These studies highlighted that leave durations of less than 6 weeks were associated with higher rates of burnout and postpartum depression among trainees. There was no evidence that taking parental leave increased program attrition rate; however, 3 studies reported more than one-third of trainees extended training as a result of taking leave. Trainees who had more than 8 weeks of parental leave reported more successful breastfeeding 6 months out from delivery than those with less than 8 weeks of leave.

Conclusions Extended parental leave, notably beyond 6 weeks, improved trainee well-being and professional satisfaction. Based on trainees’ perspectives, ideal parental leave policies offer a minimum of 6 to 8 weeks of leave, with a formal and clearly written policy available.
Providing Delayed, In-Person Collected Feedback From Residents to Teaching Faculty: Lessons Learned
Authors: Finn Kathleen M. , Healy Michael G. , Petrusa Emil R. , Borowsky Leila H. , Begin Arabella S.
Published: October 2024

Background Teaching faculty request timely feedback from residents to improve their skills. Yet even with anonymous processes, this upward feedback can be difficult to obtain as residents raise concerns about identification and repercussions.

Objective To examine faculty perception of the quality and content of feedback from residents after increasing anonymity and sacrificing timeliness.

Methods Between 2011 and 2017, an associate program director at a large internal medicine residency program met briefly with each resident individually to obtain feedback about their teaching faculty shortly after their rotation. To improve anonymity, residents were promised their feedback would not be released until they graduated. In 2019, all feedback was collated and released at one time to faculty. We administered 3 timed, voluntary, anonymous, 36-item closed-ended surveys to faculty asking about the content and value, and to self-identify whether the feedback was praise, constructive, or criticism.

Results Exactly 189 faculty participated with 140 completing all 3 surveys (74.1% response rate). Faculty reported this feedback content to be of higher quality (81.0%, 81 of 100) and quantity (82.4%, 84 of 102) in contrast to prior feedback. More than 85.4% (88 of 103) of faculty agreed this feedback was more specific. Faculty identified less praise (median 35.0% vs median 50.0%, P<.001) and more negative constructive feedback (median 20.0% vs median 5.0%, P<.001) compared to prior feedback. More than 82% (116 of 140) of faculty reported it would change their behavior, but 3 months after receiving the feedback, only 63.6% (89 or 140) felt the same way (P<.001). Faculty were divided on the necessity of a time delay, with 41.4% (58 of 140) believing it reduced the feedback’s value. Despite the delay, 32.1% (45 of 140) felt they could identify residents.

Conclusions Offering a substantial delay in feedback delivery increased anonymity and enabled residents to furnish more nuanced and constructive comments; however, faculty opinions diverged on whether this postponement was valuable.
A Resident-Led Quality Improvement Initiative to Increase End-of-Life Planning in Primary Care
Authors: Wagen Brooke , Kuye Simisola , Patel Rajvi , Vasudevan Jaya , Wang Lisi , Reister Robin , Pignone Michael , Moriates Christopher
Published: October 2024

Background Despite many benefits of end-of-life (EOL) planning, only 1 in 3 adults has EOL documentation, with low rates in resident primary care clinics as well.

Objective To increase clinic completion of life-sustaining treatment (LST) notes and advance directives (AD) for veterans at highest risk for death.

Methods The setting was a Veterans Affairs (VA) internal medicine primary care clinic. All clinic residents in the 2021-2022 academic year and all clinic patients identified through a VA risk-stratification tool as highest risk for death were included. Baseline AD and LST completion rates were determined through manual chart review. Our interventions included 2 hours of teaching to increase resident knowledge of EOL planning and a systematic process improvement to complete EOL planning appointments. Outcomes assessed included anonymous resident pre- and post-surveys of self-assessed knowledge and comfort with EOL conversations, as well as rates of LST and AD completion determined through serial chart review.

Results In the 2021-2022 academic year, 22 residents (100%) and 54 patients were included. Post-intervention surveys (n=22, 100%) showed improved self-assessed knowledge of EOL concepts and comfort with patient discussions (median Likert increase 3 to 4). The number of residents who completed an EOL planning visit increased from 9 of 22 (41%) to 15 (68%). LST completion increased from 9 of 54 (17%) to 29 (54%), and AD completion increased from 18 of 54 (33%) to 33 (61%).

Conclusions A brief teaching intervention to prepare residents for comprehensive EOL visits combined with process improvement to offer EOL planning visits improved self-reported knowledge and comfort and completion of EOL visits.
Analysis of suicide cases in post-mortem examination files of the Department of Forensic Medicine at the Medical University of Białystok in the years 2016-2021 = Analiza samobójstw w materiale sekcyjnym Zakładu Medycyny Sądowej Uniwersytetu Medycznego w Białymstoku w latach 2016-2021
Authors: Francuziak Anna , Kulasza Paulina , Kozłowska Kinga , Janica Julia , Cwalina Urszula , Niemcunowicz-Janica Anna , Szeremeta Michał
Published: October 2024

Cel pracy. Celem pracy jest analiza samobójstw na podstawie sądowo-lekarskich sekcji zwłok i akt spraw Zakładu Medycyny Sądowej Uniwersytetu Medycznego w Białymstoku.

Materiał i metody. liczba sądowo-lekarskich sekcji zwłok przeprowadzonych w Zakładzie Medycyny Sądowej w Białymstoku w latach 2016-2021 wynosiła 2365. Na podstawie wyników badań pośmiertnych i okoliczności zgonów zawartych w aktach spraw, 391 przypadków zakwalifikowano jako samobójstwa. W analizie uwzględniono płeć, wiek, czas, dynamikę zmian liczby samobójstw w poszczególnych latach, miejsce popełnienia samobójstwa, sposób dokonania samobójstwa oraz stan trzeźwości. Dane poddano analizie statystycznej przy użyciu testów: X2 niezależności, Shapiro-Wilka, U Manna-Whitneya, nieparametrycznego testu ANOVA rang Kruskala-Wallisa z testem post hock wielokrotnych porównań średnich rang dla wszystkich prób. Poziom p<0,05 uznano za wyniki istotne statystycznie. Do obliczeń użyto pakietu Statistica 13.3 firmy StatSoft.

Wynik. W badanych latach samobójstwa stanowiły 16,54% wszystkich sekcji. W 82,09% przypadków samobójstwa popełnili mężczyźni a 17,91% kobiety. Stwierdzono, że osoby wybierające samobójstwo przez zatrucie są istotnie statystycznie młodsze od osób wybierających samobójstwo przez skok z wysokości (p=0,0035). Stwierdzono istotny statystycznie związek między płcią a preferowanym terenem popełnienia samobójstwa (p=0,033). Stwierdzono istotny statystycznie związek pomiędzy płcią a trzeźwością i stanem po użyciu alkoholu (p=0,00008).

Wnioski. Z przeprowadzonych badań wynika, że główną grupę samobójców wciąż stanowią mężczyźni (82,09%). Wiek kobiet i mężczyzn odbierających sobie życie nie różnił się istotnie statystycznie. Istnieje większa szansa na popełnienie samobójstwa w terenie miejskim przez kobiety, niż przez mężczyzn. Kobiety istotnie statystycznie częściej były trzeźwe lub w stanie po użyciu alkoholu podczas popełnienia samobójstwa. Najczęściej wybieranym sposobem popełnienia samobójstwa jest śmierć przez powieszenie.
The role of computed tomography in post-mortem examinations = Rola tomografii komputerowej w badaniu pośmiertnym
Authors: Modzelewski Wojciech , Janica Jacek
Published: October 2024

In the study, data from the literature regarding the use of computed tomography in post-mortem examinations (post-mortem computed tomography - PMCT) were analyzed. Literature data indicate that PMCT should be used as a complementary tool rather than an alternative to autopsy, detecting additional changes that may have been unnoticed due to anatomical location or the need to extend traditional autopsy techniques. The ability to save, create and reconstruct images is very helpful in creating documentation and final opinions. There is a need to develop standards for the evaluation of post-mortem computed tomography images, which will enable further development of virtual autopsy techniques in the field of forensic medicine, supported by artificial intelligence.
Processo simplificado de calibração por meio de faturas de energia para um supermercado de médio porte
Authors: Rodrigues Thiago toledo viana , Carlo Joyce correna
Published: October 2024

As pesquisas em eficiência energética, geralmente, concentram-se em abordar edifícios residenciais e de escritórios, outras tipologias como supermercados ainda são pouco abordadas, apesar do elevado consumo energético que apresentam. Conhecer o consumo típico da tipologia ajuda na tomada de decisão. Entretanto, durante o processo de simulação a necessidade de calibração pode apresentar algumas dificuldades, principalmente, quando envolve medições em edificações antigas, com quadros de energia de difícil acesso ou um sistema elétrico que já passou por diversas interferências e não é organizado por usos finais.  Assim, o objetivo deste artigo é identificar o potencial de um método simplificado de calibração. Este inclui um estudo prévio (com medições horárias) de outro edifício da mesma tipologia e de mesmo porte, análises de faturas de energia elétrica e dados gerados por simulação computacional, por meio do software EnergyPlus. Como resultados foram identificados os usos finais de energia para o edifício analisado: sistema de refrigeração (82%), equipamentos (11%), sistema de iluminação (6%) e AVAC (1%).
Instrumento auxiliar para verificação do desempenho de paredes de alvenaria estrutural de blocos de concreto, em atendimento à ABNT NBR 15575:2021
Authors: Vicente Mitidieri Filho Cláudio , Curi Salle Patricia
Published: October 2024

Este artigo apresenta um instrumento auxiliar para a verificação e geração de evidências do atendimento à NBR 15575: 2021 Edificações habitacionais – desempenho e normas correlatas ao sistema de alvenaria estrutural de blocos de concreto. O instrumento foi desenvolvido para ser utilizado em empresa construtora que adota o sistema construtivo na construção de suas edificações habitacionais. O instrumento de verificação dispõe dos requisitos e critérios da ABNT NBR 15575 e de normas pertinentes ao tema. Este instrumento é objeto de dissertação de mestrado e foi elaborado após uma revisão bibliográfica e uma sistematização dos requisitos e critérios aplicáveis ao sistema construtivo, considerando o conhecimento e a vivência dos autores. A metodologia utilizada para realização da pesquisa enquadra-se na pesquisa-ação. Foi feita uma aplicação piloto com o instrumento preliminar elaborado a fim de aprimorá-lo, gerando modificações para melhor entendimento e praticidade durante o uso. O instrumento reúne em único documento as normas a serem atendidas, os responsáveis pela verificação dos requisitos, os métodos de avaliação e verificação a serem adotados, bem como os documentos necessários para evidenciar o atendimento à norma. Ao final de cada análise, em cada etapa do processo de produção, é possível verificar se o empreendimento atende os diversos requisitos e critérios de desempenho e, caso contrário, permite identificar as ações corretivas ou as melhorias a serem adotadas.
A A ventilação natural em edifícios com elementos côncavos (h e c)
Authors: Andrioli Medinilha de Carvalho Talita , Labaki Lucila Chebel
Published: October 2024

Elementos côncavos em planta são comuns na arquitetura; devido a seu perímetro recortado, possibilitam mais aberturas para o exterior. Edifícios com forma de “C” e “H” são exemplos de projetos deste tipo, o segundo sendo o mais recorrente no Brasil e muito usado para a habitação social multifamiliar. Porém, em muitos casos tais edifícios não apresentam boa ventilação natural, estratégia altamente recomendada para melhorar o conforto térmico em climas quentes, bem como a qualidade do ar. Neste sentido, foi realizada uma revisão sistemática da literatura sobre a ventilação natural de edifícios com reentrâncias côncavas (“H” e “C”) com objetivo de compreender o comportamento dos ventos ao redor destes edifícios e o impacto da sua forma na ventilação. Em sínteses, resultados indicam que o formato em “C” foi menos eficiente que um retângulo na remoção de poluentes. Visando um bom fluxo de ar foi sugerido construir prédios com elementos côncavos mais baixos; além disso as reentrâncias devem ser largas, rasas e a barlavento. Por fim, foi identificado que conjuntos numerosos de prédios em “H” apresentam maior resistência ao vento e prejudicam a ventilação dos edifícios a sotavento.