bluuebunny/crossref_metadata_2025 huggingface dataset:
Malezas en cultivos de Colima: Un enfoque florístico y ecológico
Authors: Leopardi Verde Carlos Luis
Published: November 2022

Introducción. Las malezas constituyen un grupo ecológico y económicamente importante debido a que pueden provocar pérdidas monetarias. Sin embargo, este gremio también tiene aspectos positivos; por ejemplo, pueden ayudar a mantener poblaciones estables de insectos benéficos, con lo que pueden contribuir al control de plagas y enfermedades, así como a mantener saludables los servicios de polinización; además, también favorecen la movilización de nutrientes en el suelo (Clements et al., 1994; Gerowitt et al., 2017). Por ello es relevante conocer cuáles malezas se encuentran asociadas a los cultivos del estado de Colima. Objetivo. Elaborar un listado taxonómico de las malezas presentes en cultivos comerciales del estado de Colima; así como un análisis ecológico de algunos de los factores que podrían estar afectando su distribución. Métodos. Se muestrearon cuadratas de una hectárea en 25 campos agrícolas dedicados a cultivos comerciales (mora azul, zarzamoras, café, maíz, cebolla, chile jalapeño, papaya, limón mexicano y caña de azúcar) en el estado de Colima. Resultados y discusión. Se encontraron 222 especies de malezas, que representan 53 familias (43 eudicotiledóneas, seis monocotiledóneas, dos magnólidos, un helecho y una hepática). Las familias con más especies son Poaceae (29 especies) y Asteraceae (25). Un alto porcentaje de la flora de malezas es nativa (84.2%) y 15.8% exótica. Se encontró que 21 especies son endémicas y que Manihot chlorosticta se encuentra en la categoría de casi amenazada (NT) de la UICN (Leopardi et al., 2021). Conclusión. La evidencia disponible sugiere que cada cultivo tiende a tener una comunidad distintiva de malezas asociada, que en general parece estar determinada por factores bioclimáticos, principalmente la temperatura y la precipitación.
Efectividad biológica del herbicida pinoxaden sobre Avena sterillis L. en la zona norte del valle de Mexicali
Authors: González Ruiz Andrés , López Urquidez Guadalupe Alfonso , Ail Catzim Carlos Enrique , López Orona Carlos Alfonso , Medina López Raymundo , Estrada Acosta Mitzi Dayanira
Published: November 2022

Introducción. La avena silvestre es una de las malezas de importancia en el mundo por las pérdidas que ocasiona en cultivos cereales de invierno. El principal método de control es químico, mediante la aplicación de herbicidas postemergentes inhibidores de la Acetolactato Sintasa (ALS) y Acetil Coenzima A Carboxilasa (ACCasa). Objetivo. Evaluar la efectividad biológica del herbicida pinoxaden sobre A. sterillis en trigo. Métodos. El experimento consistió en evaluar el herbicida pinoxaden (1.2 L/ha) en comparación con un testigo (sin aplicación de herbicida) bajo un diseño de bloques completos al azar con cuatro repeticiones. Se evaluó el control del herbicida de forma visual, a los 14, 28, 42 y 56 días después de la aplicación (DDA), mediante la escala de la Sociedad Europea de la Ciencia de la Maleza, así como mediciones con cámara termográfica (°C), GreenSeeker (NDVI), SPAD, cámaras estándar (GA y GGA) y variables como altura (cm), plantas/m y rendimiento en t/ha. Los tratamientos se compararon mediante una prueba de t-Student al 5% de significancia. Resultados y discusión. La altura y plantas/m de A. sterillis disminuyeron significativamente por el efecto de pinoxaden con un 89.66% de control en comparación al testigo, con respecto al rendimiento del cultivo, pinoxaden registró 9.69, mientras que el testigo 1.46 t/ha. Se observó que el SPAD y GreenSeeker presentaron diferencias significativas entre las plantas tratadas con pinoxaden y el testigo (Da Cunha et al., 2015; Gutiérrez-Soto et al., 2011). Conclusión. El herbicida pinoxaden representa una alternativa para el manejo de A. sterillis.
Double-Bind, Baleful Hope:Peithô’s Constraint in theOresteia
Authors: Karas Allannah
Published: November 2022

At key moments of decision and action throughout Aeschylus's Oresteia, central characters actively or passively engage with the power of peithô (“inducement” or “agreeable compulsion”). The etymological and mythopoetic traditions of peithô, however, reveal deep roots in magical constraint and force. This paper demonstrates how, from Agamemnon through to the end of Eumenides, peithô enacts a magical double-bind upon nearly all of the characters: deluding them with power, producing mental weakness, shifting power dynamics, and occasioning potential (or actual) ruin. Only the Olympians wield peithô with impunity and, through it, maintain control within the new social structure.
Alcibiades's Epiphanic Experience in Plato'sSymposium
Authors: Petraki Zacharoula
Published: November 2022

In Plato's Symposium, Alcibiades resorts to the imagery of art and describes the Socratic virtues in terms of “divine statues.” In this paper, I argue that Plato makes Alcibiades use the poetics of divine salvific and erotic epiphany in order to describe his (quasi) epiphanic experience at the sight of Socrates at Potidaia, Delion, and Agathon's house. First, I offer a brief account of scholarly views on this imagery and of my own contribution. Then, I discuss Alcibiades's Bacchic experience with Socrates qua Silenus, and I examine those passages in which Plato turns traditional epiphanic language to his own ends.
Theater, Performance, and Illusion in OvidMetamorphoses11
Authors: Sacks Edward S.
Published: November 2022

Themes of theater, performance, and illusion course through Metamorphoses 11. The theme of “theater” and its disintegration is established in the opening Orpheus episode and culminates in Ceyx-Alcyone, where Morpheus's self-conscious acting in Alcyone's dream shatters the usual harmony between actor and role. The unveiling of theater is also connected with the unveiling of metamorphosis. This latter disruption, in the Peleus-Thetis episode, involves crucial disclosures about metamorphosis by one metamorphic deity Proteus to defeat the transformations of another (Thetis). These disintegrations are part of connected motifs, wherein art, artist, and metamorphosis are severed into component parts and exposed to view.
Celestial Realm, Vegetal Worlds, and the Marvelous in the First Book ofKyranides
Authors: Piperakis Spyros
Published: November 2022

The first book of the Hermetic Kyranides consists of 24 alphabetical chapters, one each listing a plant, a bird, a stone, and a fish, whose names all begin with the same letter of the Greek alphabet, and expounding their medical and magical properties. Even though the book deals entirely with the issue of natural sympathies and antipathies employed to attain various ends, it surprisingly lacks a great number of astrological references. My purpose in this paper is to analyze the rare and quite implicit at times relationships among stars and plants, including plant products, tracked down in the text.
LDBC
Extended Graph Schema (LEX)Work Charter
Authors: Green Alastair
Published: November 2022

This Work Charter describes the goals and scope of a graph data community effort to define a graph schema definition language that extends the proposed GQL feature of graph types.
Evaluation of Austrian nurses’ competence and factors related to it: An exploratory cross-sectional study
Authors: Kellerer Jan D. , Rohringer Matthias , Deufert Daniela
Published: November 2022

Background and objective: The continuous assessment of Registered Nurses' (RNs') competence is important at individual, organizational and systemic levels. Qualifications, the professional working environment as well as experience influence nursing competence. Nursing has significantly changed over the last 25 years in Austria, but RNs’ competence has not been evaluated so far. The aim of the study was to assess nursing competence of Austrian RNs, considering relevant influencing factors.Methods: An exploratory cross-sectional study was conducted. Between October 2021 and February 2022 a total of 841 RNs from 16 Austrian hospitals self-assessed their nursing competencies using the Austrian version of the Nurse Professional Competence Scale Short Form (NPC-SF-AUT). Multiple subgroup analyses with regard to theoretically reasonable influence factors on nursing competence were performed to explore differences in the extent of RNs’ competence.Results: Competencies in scale factors Multi-professional development and cooperation as well as in Health promotion and safeguarding were found as lowest. The overall work experience as well as further education and training had a significant influence on nursing competence, whereas the type of nursing education (vocational vs. higher education), the professional understanding of nursing care and the type of medical discipline did not.Conclusions: Appropriate structures must be implemented to ensure the development and application of Austrian RNs’ basically acquired competencies in practice.
Endoscopic submucosal dissection (esd) training sessions on ex-vivo porcine models
Authors: Thorpe Amelia , Howick Katherine
Published: November 2022

Endoscopic Submucosal Dissection (ESD) is a technique for removing lesions in the gastro-intestinal tract. It involves precise cutting into the submucosal layer, allowing for the lesion to be removed in one piece, and has been shown to have a high curative resection rate [1]. It is a technically challenging endoscopy technique that requires experience and practice. As one of the common complications from ESD is perforation [2], training on ex-vivo models is becoming popular with 84% of surveyed centres in the UK requiring Endoscopists to complete a number of ESDs on animal models before progressing to train on patients [3]. While training was accessible at other centres, this was infrequent and less accessible.

Sessions were created at the hospital training centre. This was done using decommissioned endoscopy stacks and endoscopes, so that these were always available and designated for ex-vivo use only. The animal model was a porcine oesophagus, stomach, and start of duodenum prepared in a box with a hole for endoscope insertion. The duodenum was clamped to ensure inflation would be possible. The days ran from 0830-1530 with a drop-in option. After 7 sessions were run over 5 months, a survey was sent out to the 8 people that had participated to assess the benefits of the service (including faculty doing the training and trainees).

8 responses (100%) were collected. 62% (n=5) of responders had used ex-vivo models before. 83.3% of trainees (n=5) said they had come to our hospital specifically to train in ESD technique. Responders attended between 1 and 10 sessions at our centre. All trainees and faculty said they found the training extremely beneficial and that they thought the ex-vivo model work well the way it was set up. All responders said they would recommend the sessions to a colleague. All trainees said that training with an experienced Endoscopist was more beneficial than training alone. Suggestions for improvement included a more consistent timetable of when they could access sessions, more accessibility and wider range of endoscopy kit, and involving the wider nursing team in the sessions.

The ex-vivo ESD training sessions were well received by both faculty and trainees and were said to be very beneficial to their training. We will therefore be putting on more of these sessions, taking into account the suggestion for a regular accessible timetable.

1. Ahmed Y, Othman M. EMR/ESD: techniques, complications, and evidence. Current Gastroenterology Reports. 2020;22(8):1–2.

2. Kim SG, Hwang JH. How to decrease the risk of perforation in endoscopic submucosal dissection (ESD). Techniques in Gastrointestinal Endoscopy. 2019;21(2):99–103.

3. Küttner-Magalhães R, Pimentel-Nunes P, Araújo-Martins M, Libânio D, Borges-Canha M, Marcos-Pinto R, Koch AD, Dinis-Ribeiro M. Endoscopic submucosal dissection (ESD): how do Western endoscopists value animal models?. Scandinavian Journal of Gastroenterology. 2021;56(4):492–7.
Scenario template: a welsh perspective
Authors: Jones Bridie , Hawker Clare , Mitra Suman , Cook Sara-Catrin , Diaz-Navarro Cristina , Hoole Alice , Bartholomew Bethan
Published: November 2022

Simulation is an educational approach in health and care that is often used to address patient/service user safety issues, technical and non-technical skills, teamwork, problem solving, and decision-making. The goal of simulation is to create an authentic learning experience. To be effective it needs to be designed and planned appropriately [1]. Following feedback from a health and care simulation community at webinars and other engagement events, a designated simulation team has designed a scenario template to promote the development and sharing of high-quality standardised scenarios.

A scoping exercise was undertaken to review and identify relevant literature and published scenario templates. A database search was undertaken through CINAHL, Pubmed, and Medline using the search terms: simulation, simulation scenarios, scenario template, simulation guidance, using a time-frame of 2010 to 2022.

The lack of breadth of literature on scenario writing was a surprising finding. However, the available literature identifies that an effective robust scenario must consider the prospective learners and the intended learning objectives and outcomes. Additionally, knowledge of educational principles and best practices in both simulation and clinical practice are needed [2]. Scenario design must also consider the modality and fidelity of the simulation, faculty members, use of supplementary resources, moulage, other participants, simulators, and/or standardized patients [3]. An evidence-based scenario template was developed and peer reviewed. It was then presented to and tested by the health and care simulation community during a free, inclusive, and well attended scenario writing online workshop facilitated by a simulation team in collaboration with experts.

The scenario template provides step-by-step guidance on scenario writing best practice and includes a didactic element by signposting to further reading. It was revised based on constructive comments made by the health and care simulation community, which included more prescriptive facilitator guidance, and will be published via simulation web-pages as an open access resource for use by anyone across the health and care simulation education and training workforce (

1. Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare. 2007;2(3):183–93.

2. Bambini D. Writing a simulation scenario: a step-by-step guide. AACN advanced critical care. 2016;27(1):62–70.

3. Harrington D, Simon L. Designing a Simulation Scenario. Accessed via Designing a Simulation Scenario. 2021. StatPearls, NCBI Bookshelf (nih.gov).
The AWARE project (fAmiliarity with workplace and resuscitation equipment)
Authors: Bhargav Akshay , Harne Anuprita , Higham Helen , Pattanshetty Ravi
Published: November 2022

Doctors joining Emergency Departments (ED) have individual training needs based on their experience and background of working in different countries or hospitals, and a large proportion of junior doctors work for less than a year in a single ED. We designed the AWARE project to analyse the challenges associated with familiarity with the physical workplace and resuscitation equipment for doctors new to an ED environment. The goals of the project were to assess the diverse learning needs [1], impact of unfamiliarity with environment and equipment on physician confidence, ability to participate in resuscitation scenarios, and to develop a simulation-based intervention to support new doctors in ED.

We developed a questionnaire for multidisciplinary staff to explore problems with workplace unfamiliarity and its impact on different aspects of performance during resuscitation. We included questions (tailored to professional background) about the management of resuscitation and the location of vital equipment under the broad headings of: preparation, airway, breathing, circulation, and other critical interventions.

We collected 104 completed questionnaires (67 from doctors, 37 from nurses). Over 90% of staff felt that lack of workplace familiarity negatively affects performance and leads to delay in performing procedures. 92% of the nurses felt that it was easier and more efficient to work with doctors who were familiar with the workplace. Quantitative data revealed issues with locating equipment such as:

60% Doctors did not know where to find mechanical-CPR device (LUCAS). 81% of the Senior House Officers did not know where to find end-tidal CO

We have identified familiarity with workplace and resuscitation equipment as a key learning need. The data from Phase 1 of the project have informed the development of scenarios for new induction processes in phase 2. Simulation is an important tool for education but also for induction and analysis of systems and pathways [2]. Phase 2 will also use novel technologies including 360° videos to allow staff new to the department to access ED environments and equipment virtually and at their convenience. Future work will involve monitoring the success of the interventions in phase 2.

1. Grant J. Learning needs assessment: Assessing the need. Br Med J. 2002;324(7330):156–9.

2. Health Education England. Simulation immersive technologies.
Does adopting the role of the patient promote positive changes in student empathy, compassion, and communication skills?
Authors: Wallace Rebekah , Lennie Iona , Moulds Yvonne , Bell Linda
Published: November 2022

Simulation-based education is frequently used to develop empathic behaviours in medical and nursing students [1] however to our knowledge, there is no previous literature that develops such behaviours by allowing students to adopt the role of simulated patient as they are admitted acutely to hospital. The aim of our project was to explore changes in empathy, compassion, and communication styles by asking students to adopt the role of the simulated patient during the undergraduate multidisciplinary simulation.

Undergraduate final and penultimate year medical and nursing students who were undertaking their emergency medicine rotations were asked to participate. The simulation was delivered every 5 weeks, with one student adopting the role of the patient during the scenario. Two other students involved in the scenario adopted the role of the nurse and physician respectively. Data was collected via questionnaires and focus groups which were conducted immediately following the simulation. Questionnaires asked students to rank their agreement to several statements relating to improvements in empathy, compassion, and communication skills using a 1–5 ranking system, with 1 strongly disagreeing and 5 strongly agreeing. Focus groups were used to explore student opinions with the data transcribed and analysed into themes.

61 undergraduate students have participated thus far. 95% of participants agreed that adopting the role of patient provided them with a greater insight into the patient journey through the emergency department. 91% of participants agreed that they felt more empathy towards patients admitted acutely to hospital. Analysis of qualitative data shows improved empathy, compassion, teamwork, and communication with patients and colleagues within the multidisciplinary team. Students also developed a greater insight into how the unfamiliar hospital environment, lack of visitors, and COVID-19 precautions can negatively impact the patient’s journey. Finally, all students commented on how this simulation will positively influence their future practice.

Providing students with the opportunity to adopt the patient’s role has been shown to positively influence their empathy, compassion, teamwork, and communication skills. Future work will focus on whether these changes have been sustained and incorporated into clinical practice.

1. Karvelytė M, Rogers J, Gormley GJ. ‘Walking in the shoes of our patients’: a scoping review of healthcare professionals learning from the simulation of patient illness experiences. Advances in Simulation. 2021;6(1):1–11.
Patient and family involvement in designing and evaluating a simulation programme to combat childhood obesity
Authors: Berg Richard , Nightingale Helen , Mackenzie Megan , Anpananthar Amutha
Published: November 2022

14.4% enter school reception obese [1]. The Paediatric Emergency Department (PED) offers opportunities for professionals to identify obesity and provide support to children and young people (CYP). Our PED launched an Obesity Toolkit: a medical education project created to help Make Every Contact Count, and to increase opportunistic diagnosis and sensitive communication about obesity (2). This includes teaching resources including communication scenarios and videos. Staff focus groups identified the main barrier for professionals was fear around communicating about obesity in a sensitive way. We aimed to collaborate with CYP to develop our communication simulation programme within the Toolkit. In addition, we aimed to involve families in the evaluation of the project.

We developed written patient leaflets, written and filmed communication scenarios incorporating feedback given by focus groups with Youth Empowerment Squad (YES), our local Trust CYP forum. The feedback included preferred language, which was emphasised in the debriefings of simulated sessions. The educational role-play scenario videos, which can be debriefed in teaching sessions, were filmed with a CYP taking on the role of a patient. After the release of the toolkit and accompanying simulation programme, 10 patients diagnosed as overweight or obese were randomly selected 2 to 4 months after attendance, as part of a patient experience survey. This telephone call explored parent opinions about the obesity discussion.

Learning from CYP in YES helped us explore their preferred language, such as focussing on healthy living over the concept of obesity and explaining what is meant by body mass index (BMI). We included this in our debriefings. Our role-play videos are used in training to give examples of obesity discussions with CYP. These were semi-scripted to allow the CYP to incorporate their own voice and provide their insight into how they or their peers might react. In the patient experience survey, all parents were positive about the approach, rating the conversation on average 7.6/10 for being helpful (10 most helpful). Notable comments from parents included ‘the approach was sensitive, they spoke about positive change, not negative’.

Parents talked positively about conversations that they had about obesity with staff trained using our simulation programme designed following CYP collaboration. It is encouraging that these conversations have been useful for CYP and families. Based on this feedback, we will continue to engage CYP and parents. Feedback from CYP is planned. The Obesity Toolkit is made free and Open Access for any interested departments.

1. NHS Digital. National Child Measurement Programme, England 2020/21 School Year – NHS Digital. NHS Digital. 2022.

2. Health Education England. Making Every Contact Count (MECC). 2022.
Innovation in simulation: reducing the cost
Authors: Mcrae Daniel , Pullen Amy , Reed Juliette , van Santen Isabel , Wilson Anna , Cayuela Hector , Shawcross Noah
Published: November 2022

Simulation equipment is often prohibitively expensive. More so for smaller remote settings and developing countries. Reducing costs is essential to increase widespread uptake of high-fidelity simulation tools.

We describe the evolution of a cooperative simulation model development team incorporating the local Emergency Medicine Department clinical staff and local Secondary school pupils. This was a symbiotic relationship that utilised the clinical expertise of the doctors while giving the students project management experience while using the significant resources of the schools for physical product development. Roughly 15,000 tracheostomies are performed each year in the UK. After looking further in depth at emergency tracheostomies, we recognised a gap in this area of healthcare training [1]. Consequently, developing a surgical airway trainer was selected as the model to produce over the course of an academic year. The partnership project required infrequent visit from the clinical team to inform on clinical particulars and review model progression. Ultimately 2 models were selected from various prototypes to take to completion. These represented 3 core areas we wished to develop. The first model was a high-fidelity model completed using latest technology available in the school’s workshops. The second was built with minimal technology and aimed to be reproducible following simple instructions with widely available materials and be completely biodegradable.

This project resulted in successful development of two surgical airway models – both clinically and anatomically accurate, reusable, which deliver high quality simulation to a group of doctors and students at the local hospital. Both models are easily reproducible with minimal skills, but varied in both the detail and tools required to produce and degree of sustainability. Maximum cost of materials was £15.

Partnership with local schools gives hospitals access to resources not otherwise available that can lead to the development of innovative simulation models that can significantly reduce the cost of simulation. Both parties gain significantly from this partnership. Going forwards we aim to continue the partnership with aims to develop a central line training model over the next academic year.

1. Taylor C. Training for tracheostomy. BJA: British Journal of Anaesthesia. 2013;111(5):842–843.
Using simulation to support a new theatre setup
Authors: Midwinter Elizabeth , Wilson James
Published: November 2022

Following the redevelopment of the day case theatre complex at Chorley District General Hospital it was identified that new ways of working were required, and changes to patient processes would need to be made. Some of these were normal, expected, adaptations to be made when moving to a new working environment, such as the location and storage of equipment.

The Resuscitation and Simulation Team, led by the associate Clinical Lead for Simulation, modelled the theatre list for the first day using simulated patients and in line with the ASPiH standards [1]. This gave the theatre staff the opportunity to run through cases in real time and gauge when patients needed to be sent for, how long was needed for setting up, and at what time they could safely call for the next patient without causing unnecessary delays or having patients waiting in corridors. Each step in the process was followed by a debriefing so that the actions could be discussed and any changes made.

The feedback was positive and team members found it extremely useful to simulate their upcoming lists. As expected, there were several patient flow related issues raised, mainly around timings and logistics (

Issues identified following simulation of a theatre list

Simulation of normal business can be successfully used to improve patient safety and the confidence of clinical staff when developing new clinical areas.

1. Association for Simulated Practice in Healthcare. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education.
Does simulation help medical support workers transition into working in the NHS?
Authors: Thomas Hope , Clarke Ygraine , Karamura Paul , Whittaker-Jain Revathi , Waring Kitt , Nye Abigail
Published: November 2022

A simulation-based programme was developed for the Medical Support Workers (MSW) within the Trust. The MSW role was created in response to the COVID-19 pandemic, providing an opportunity for doctors seeking GMC registration to gain clinical experience within a supervised NHS placement [1]. This project explored the MSWs’ perceptions and previous experience of simulation and their overall confidence working within the NHS before and after the teaching programme. The aim was to assess if simulation is a useful tool to help international medical graduates transition into working in the NHS.

29 MSWs (28 of whom were from Myanmar) worked in acute and medical specialties across the Trust, performing roles including: writing in medical notes, taking collateral histories, examining patients under supervision, procedures such as venepuncture and writing discharge summaries. Each MSW was invited to attend three training days between January and March 2022. We provided a programme incorporating medical and surgical simulation, communication workshops, and procedural skills, supported by human factors teaching. We delivered the sessions in our learning and research building, including our simulation suite. We collated data by sending out pre- and post-training surveys. There were 22 and 18 responses to the two initial surveys and 20 responses to the post-training survey.

44% had prior experience of clinical simulation and only 9% had previous experience working as a doctor in the NHS. On further analysis, 50% felt either quite unconfident, or neither confident or unconfident working in the NHS. A minority felt confident dealing with medical emergencies (18%) and surgical emergencies (13%) and with their communication (32%) and leadership skills (23%). In the post-simulation feedback, 100% reported that simulation was a useful method to help doctors transition into working in the NHS and felt it improved their confidence in the workplace. Furthermore, 100% stated that the simulation sessions had changed their clinical practice and addressed their learning needs. The participants reported that the sessions had improved their stepwise approach to emergencies (100%), communication (95%), teamwork (100%), leadership (70%), and decision-making skills (95%).

This project demonstrated that simulation is a popular and useful educational resource in helping improve international doctors’ confidence when transitioning into working in the NHS. Given that 100% of our participants wanted further simulation sessions, our Trust plans to employ a dedicated MSW simulation fellow to support further cohorts.

1. Temporary Medical Support Worker (MSW) Secondary Care – Job description and person specification. NHS England and NHS Improvement.
Using simulation to improve confidence in the escalation of patients with learning disabilities by nurses in the acute care setting
Authors: Van Den Tooren Harriet , Kasfiki Eirini , Blackmore Andrew , Wright David
Published: November 2022

The National Early Warning Score (NEWS) is used to collate measurements of patients’ vital functions, identifying patients who require management to prevent deterioration [1]. Not following NEWS escalation protocols is linked to adverse events and may occur due to prioritising clinical judgement over scores and communication failures [2]. Patients with learning disabilities are even more at risk of avoidable adverse events in hospital, but education to improve the understanding of the needs of these patients may be a protection against this [3]. This research assessed the improved confidence of nurses in escalation following a simulation-based course focused on escalating an unwell patient with learning difficulties.

The course started with an interactive talk on how to measure NEWS by a nurse educator. A simulation-based video we created of a mismanaged scenario involving a patient with learning disabilities was shown, followed by a discussion about handover using the SBAR structure. The simulation required the attendee accurately calculating a NEWS score of an actor connected to a monitor we could control and escalate to a doctor over the phone. This simulation was shown in real time to the other attendees, and the debriefing was facilitated by a doctor trained in debriefing. Pre- and post-course questionnaires were completed by attendees to assess their nursing experience, confidence in assessing NEWS, and escalation rated on a scale of 0 (very unconfident) to 5 (very confident).

The course was run 6 times for a total of 26 nurses. The median length of nursing experience was 17 months (range 1–249months). More attendees were confident (defined as 4 or 5 out of 5 in the confidence scale) in assessing NEWS, escalating to the medical team, and using SBAR post-course (96%, 96%, and 93% respectively) compared to pre-course (68%, 57%, and 54% respectively), which can be seen in

Confidence of the participating nurses before and after the course.

This simulation-based course focusing on care of a patient with learning disabilities has improved confidence in assessing NEWS and escalation with a structured handover to the medical team. Further research should be focused on multidisciplinary simulation on escalation in the acute care setting, and how including cases involving learning disabilities improves outcomes in this at-risk group.

1. Royal College of Physicians. National Early Warning Score (NEWS) 2 Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: 2017.

2. Ede J, Jeffs E, Vollam S, Watkinson P. A qualitative exploration of escalation of care in the acute ward setting. Nursing in Critical Care. 2020;25:171–178.

3. Louch G, Albutt A, Harlow-Trigg J, Moore S, Smyth K, Ramsey L, O’Hara JK. Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review. BMJ Open 2021;11:47102.
Creating an easy to construct, low-cost aspiration simulator for airway training
Authors: Warburton Sean , Hartopp Andrew
Published: November 2022

Aspiration of gastric contents remains the commonest cause of death during anaesthesia, accounting for 50% of deaths and occurring more frequently than cannot intubate, cannot oxygenate (CICO) events [1]. Despite this, training for CICO is ubiquitous while rehearsal of aspiration management is rare. Soiled airway simulation has been shown to reduce the time to intubation with less volume entering the lungs, a factor known to correlate with the severity of aspiration [2]. Initially developed by Dr DuCanto, high-fidelity vomit simulators have existed since 2014 however cost (£1,595) precludes their widespread use. Low-cost models have since been described, however, the materials are sourced from hardware stores, relatively expensive, require skills to construct, utilise noisy pumps, and some even require electrical safety considerations [3]. We aimed to improve access to aspiration training by designing an aspiration simulator that is easy to construct and low-cost.

Employing an iterative design process we created an aspiration simulator using materials readily available in the operating theatre. The final model requires an intubatable manikin with an oesophagus, such as the Laerdal Airway Management Trainer

The setup silently produces a titratable flow of up to 250 ml per minute, sufficient to flood the oropharynx within 30 seconds. The simulation itself can be set up in under 10 minutes, used several times before requiring refilling, and is easily transported between theatres as a part-task trainer or concealed for a multi-disciplinary simulation (Figure 1, bottom left). All parts are reusable and the total cost equals £9.90 (excluding the manikin, which is undamaged). Our simulator was tested on a cohort of 16 middle-grade anaesthetic trainees and its performance was evaluated using pre and post-course questionnaires (scale 0–10). All successfully intubated the simulator. Average user-rating scores for realism were 8.4/10 while confidence in managing soiled airways improved from 6.2/10 to 8.9/10 after exposure to the simulation.

Soiled airway simulation can be simple and affordable, creating a realistic environment to practise the unique skills necessary to manage this important yet under-rehearsed cause of death during anaesthesia.

1. Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia †. British Journal of Anaesthesia. 2011;106(5):617–631

2. Jensen M, Louka A, Barmaan B. Effect of Suction Assisted Laryngoscopy Airway Decontamination (SALAD) Training on Intubation Quality Metrics. Air Medical Journal. 2019;38(5):325.

3. Sampson C, Pauly J, Horner J. Low-cost Portable Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) Simulator for Dynamic Emesis. Journal of Education and Teaching in Emergency Medicine. 2019;4(2).
Relationship between the Presence of Anisakis Parasite in Some Local Marine Water Fish Flesh and Some Quality Parameters in Alexandria Governorate
Authors: Hussein Diaa , Bessat Mohamed , Elsenduony Mohamed
Published: November 2022

Background: Fish meat represents an essential source of animal protein worldwide and possesses a significant nutritive value, especially in Egypt. Anisakid nematodes are the most abundant parasites among various species of marine fishes. These worms could alter the chemical properties of fish tissue reducing their quality. Objective: The current study aimed to analyze the presence of larvae in marine fish frequently consumed in Egyptian supermarkets, and to measure the chemical traits of fish, inferring the risk of
infection and its impact on the fish quality. Materials and methods: In total 435 specimens of three of the most consumed marine fish species in Alexandria, Egypt; chub mackerel (Scomber japonicus), Spanish mackerel (Scomber commerson), and Atlantic herring (Clupea harengus) were examined for Anisakid nematodes. The degree of infestation was categorized into a control group (completely free from Anisakis), a mild infection group (up to 15 larvae/100 g), a medium infection group (>15-30 larvae/100 g), and the high or heavy infection group (>30-50 larvae/100 g). The larvae were isolated, counted then fish tissues were subjected to chemical and molecular analysis. Results: Analysis showed that the overall Anisakis infestation among the examined fish species was 27.1% (118/435). The Atlantic herring represented the highest parasitic infection with Anisakis larvae (37.3%), then came the chub mackerel (23.8%), and lastly the Spanish mackerel (23.5%). Regarding the chemical quality parameters of fish samples, Trimethylamine values of the heavy Anisakis-infested samples of all chub, Spanish and herring samples were higher (mean
values 11.38, 10.61, and 11.52 mg/100g, respectively) than the control and other groups with different degrees of Anisakis infestation. Also, histamine values followed the same manner in the highest infection group (mean values 4.38, 3.78, and 5.73 mg/100g, respectively). Conclusion: The degree of Anisakis infestation in marine water fish should be considered by marketers and consumers, as it has a crucial impact on the quality parameters of fish flesh.
Regression of lumbar disc herniation with a self-managed comprehensive exercise program: A case report
Authors: Kovac Dimitrije , Krkeljas Zarko
Published: November 2022

Background: Conservative therapeutic interventions may improve the regression of lumbar disc herniations, reducing the demand for surgical intervention. However, the vast number of conservative methods, variability in treatment combinations, including patient treatment preferences, delay the time-to-recovery and impact the recovery rates of patients. Current study presents the methods and outcomes of 15-week self-managed functional rehabilitation training.
Case presentation: Patient is a 40-year-old recreational female runner with L4-L5 disc herniation, which occurred after lifting a heavy object three weeks prior. After initial three weeks of rehabilitation program, patient’s pain reduced from 8/10 to 5/10 to VAS scale, and after 12 weeks of stabilization and functional program, patient has regained full functionality with pain score of 0/10 on VAS scale.
Conclusion: The presented case demonstrates that a self-managed functional rehabilitation exercise program may lead to regression of lumbar disc herniation and full reduction of symptoms after 15 weeks.
The COVID-19 Vaccine Opinions of Women Planning a Pregnancy: International Web Blogs Scanning
Authors: Sopjani Idriz , Arbag Esra , Tokat Merlinda , Ozozturk Sevcan
Published: November 2022

Background: The unprecedented COVID-19 has infected millions of people and killed hundreds of thousands of people. A strategy to contain the spread of the disease was the development of the COVID-19 vaccine. Objective: In our study, it was determined the opinions of women who are planning to become pregnant about the COVID-19 vaccine. Methods: Blogs were used as the data source in the research, which was designed as a descriptive qualitative study. For this purpose, the expressions of 34 women identified between February and March 2021 were evaluated with directed qualitative content analysis. Results: Psychological changes, cognitive changes, and coping methods were determined as the themes of our results. This study demonstrates the value of using qualitative methods to determine the thoughts of women planning to become pregnant regarding the COVID-19 vaccine. Conclusion: For women planning pregnancy, continued research into vaccine safety and efficacy is vital, and results should be carefully investigated and handed in the right channels.
Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients
Authors: Algargaz Wisam , Mohamad Issa , Eid Suhaib , Khanfa Asim , Abushukair Hassan
Published: November 2022

Background: The use of staplers in surgical repair of the pharynx after laryngectomy has gained traction in recent years, with differing results. Objective: In this study, we compare the use of stapler suturing (SS) after laryngectomy in comparison with the manual suturing (MS) technique in laryngeal cancer patients regarding pharyngocutaneous fistula (PCF) formation, operative time, blood loss, margin status, and length of hospital stay. Methods: We conducted a retrospective cohort study of laryngeal cancer patients undergoing pharyngeal repair after total laryngectomy by either a stapler or manual suturing. Demographic data, stage of disease, postoperative complications, duration of hospital stay, and operative time were collected. Results: A total of 59 laryngeal cancer patients were included, of which 22 underwent SS and 37 had MS. Our cohort was predominantly males (98%), and similar mean ages were observed across both suturing groups (60.5 vs 59.9, P = 0.83). Negative margins were more frequent with SS (100% vs 86.5%, P = 0.13) yet this difference was not statistically significant, whereas preoperative tracheostomy procedure was present more in MS patients (43.2% vs 0, P = 0.003). Lymph node involvement was higher in the manual suturing cohort, yet this difference was statistically insignificant (41.2% vs 25%, P = 0.49). The muscle flap procedure was significantly higher in the MS cohort (70.3% vs 20%, P = 0.001). In both groups, comparable PCF rates were noted (13.3% vs 10.8%) and there was no association between salvage laryngectomy and PCF occurrence in the entire cohort. For surgery details, there was no statistical difference between both groups in blood loss, hospitalization length, or oral feeding start. Only surgical time was significantly lower in the stapler cohort (277 vs 372.6 minutes, P = 0.000). Conclusion: Both suturing techniques did not show any statistically significant difference in PCF rates. However, was markedly reduced with stapler use in comparison to manual suturing. Further randomized studies with larger sample size are needed to validate the role of stapler suturing for pharyngeal repair.
Case Report of Fibrolamellar Hepatocellular Carcinoma in A 15-Year-old Male
Authors: Alsadery Humood , Almaiman Hisham , Alibrah Rawan , Mnayan Marooh , Alblowi Abdulrahman , Alzayyat Remah , Alshahrani Abdulwahab
Published: November 2022

Background: A rare form of hepatocellular cancer is called fibrolamellar hepatocellular carcinoma (FL-HCC) which occurs mostly in young adults who are medically free, regardless of their gender. It usually presents with abdominal pain with right upper quadrant palpable mass, nausea, and weight loss associated with higher Alpha-Fetoprotein (AFP) in some cases. Objective: We report a case of a 15-year-old male patient who was diagnosed with (FL-HCC), successfully treated with surgical resection and is currently free of relapses. Case presentation: A 15-year-old male patient with no previous medical or surgical history, presented with recurrent vomiting for two months, weight loss, and loss of appetite. Patient presented with normal systemic examination except for abdominal examination which revealed a generalized distended abdomen with mild tenderness in the right upper quadrant with the presence of hepatomegaly. Laboratory and radiological investigation showed high level of (AFP). CT and liver MRI showed large right hepatic lobe lesion then TRU-CUT needle biopsy was performed which showed Fibrolamellar hepatocellular carcinoma and patient underwent surgical resection with no postoperative complication followed by multiple cycle of chemotherapy and no signs of relapse with 3 year follow up. Conclusion: Fibrolamellar hepatocellular carcinoma is rear type hepatocellular carcinoma which occurs mostly in young adults who are medically free with vague symptom and to diagnose it need high index of suspicion and variers Laboratory and radiological investigation including biopsy. However, it can be treated successfully by surgical resection followed by chemotherapy in selected cases if diagnosis in timely manner.
A study of the different learning styles of the present first professional MBBS students at United Institute of Medical Sciences, United Medicity, Prayagraj, India
Authors: Chakravarty Soumitra , Khan Mohd , Singh Shafali , Bhushan Bhawesh , Jaiswal Geeta , Dwivedi Shweta , Pandey Abha
Published: November 2022

Background: The study is designed to evaluate the different learning styles of the present first professional MBBS students. Students were requested to complete the visual-aural-read/write-kinesthetic (VARK) questionnaire at VARK-LEARN.COM. Results of the questionnaire were collected by email and analyzed using Microsoft Excel. We found that 68.2% had multimodal learning preferences and 31.7% had single learning preference.

Aims and Objectives: The objective of this study is to analyze the different learning styles of MBBS 1st year students of United Institute of Medical Sciences, Prayagraj, using the VARK questionnaire.

Materials and Methods: This study includes the informed consent taken from each student before participating. The Institutional Ethics Committee approved the study. Copyright permission was taken from the website vark-learn.com, from VARK Learn Limited, New Zealand. One hundred and two students had consented, and out of them, 85 students participated in the study. The students were asked to complete the questionnaire on the website. The data on their learning styles were collected and analyzed using Microsoft Excel.

Results: Out of 85 Students, 58 (68.2%) had multimodal learning preferences. Of these, 28.2% of students had four-part VARK or quadrimodal preferences, 28.2% of students had bimodal, and 11.7% had trimodal learning preferences. Twenty-seven (31.7%) had single learning preferences, and, out of these 27 students, 17 (20%) had kinesthetic, 6 (7.05%) had visual learning preferences, and 4 (4.7%) students had aural learning preferences.

Conclusion: With the help of this study, we concluded that most of the students who participated in our study are multimodal learners, and out of the students who had a single learning preference, most had kinesthetic learning preferences.