bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing hidden tensions and grey areas of general practice: a qualitative study of the experiences of newly qualified GPs attending a course on generalist medicine
Authors: Dell’Olio Myriam , Reeve Joanne 
Published: May 2024

BackgroundGeneralist approaches can help address several challenges facing today’s primary care. However, GPs report insufficient support to deliver advanced generalist medicine (AGM) in daily practice, struggling within a healthcare system that imposes strict adherence to single-disease focused guidelines.AimTo examine the professional and educational experiences of newly qualified GPs attending a course on AGM to understand how to redesign primary care systems to support their generalist work.Design and settingThis was a qualitative study focusing on AGM in UK general practice (England), conducted in the context of the research evaluation of an online career development programme on AGM.MethodWe conducted 36 interviews and six focus groups with newly qualified GPs attending an online career development programme on AGM, and analysed data using framework analysis.ResultsThree tensions experienced by the participants were identified: tension between realistic and idealistic practice; tension between different decision-making paradigms; and tension in the formation of the GPs’ professional identities. These were owing to grey areas of practice deeply rooted in primary care systems — namely areas of work not adequately addressed by current education and service design.ConclusionOur findings have implications for tackling the general practice workforce crisis, highlighting that solutions targeting individual problems will not suffice by themselves. By making visible the grey areas of everyday general practice, we describe the changes needed to target tensions as described by the GPs in this study to ultimately enable, enhance and make visible the complex work of generalist medicine.
DPD simulation to reproduce lipid membrane microdomains based on fragment molecular orbital calculations
Authors: Doi Hideo , Osada Yushi , Tachino Yusuke , Okuwaki Koji , Goh Melvin Wei Shern , Tero Ryugo , Mochizuki Yuji 
Published: May 2024

Abstract
Lipid domains play a critical role in signal transduction and transport across cell membranes. The formation of domains in “HLC” ternary lipid bilayers composed of high transition temperature (high-Tm) lipids, low-Tm lipids, and cholesterol (Chol) has been extensively studied as a raft-like system. Recently, experiments were performed to control the formation of submicron domains in LLC lipid bilayers containing low-Tm phosphatidylethanolamine (PE), low-Tm phosphatidylcholine (PC), and Chol by manipulating the presence or absence of Chol. The formation of microdomains in this LLC mixture was replicated by dissipative particle dynamics simulation. The results show that domain formation can be replicated.
Application of Contextual Teaching and Learning Models in Improving the Manasic Understanding of Haji for X-Class Students
Authors: Hamka Hamka , Saleh Muhammad , K. Abd. Halim 
Published: May 2024

This study discusses the application of the Contextual Teaching and Learning (CTL) learning model in improving the understanding of the Hajj rituals of class X students of SMK Amsir 1 Parepare . The research in this thesis aims to determine the increase in students' understanding of the X grade Islamic Religious Education subject at SMK Amsir 1 Parepare by applying the CTL learning model. This type of research is experimental research . The design used was Quasy Experimental Design , the research instrument was a written test. Data collection techniques are test techniques, and documentation; Data management and analysis techniques include Validity Test Statistics, Reliability Testing, and Hypothesis Testing. The results of this study are (1) The increased understanding of students' Hajj rituals in the experimental class after being treated, the post-test results increased was 85.60 while the pre-test results in the experimental class were 67.65 (2) the application of the CTL learning model proved effective in improving students' understanding of the Hajj rituals. This is evidenced by the results of the post-test test in the control class and experimental class, it is obtained t count (9.331) ≥ t table (1.725) (t count is greater than t table) then H 0 is rejected and H 1 is accepted.
A Multi-task Deep Learning Algorithm for Sleep Stage Scoring and Sleep Arousal Detection
Authors: Huo Jiayan , Li Huayu , Roveda Janet , Quan Stuart F , Li Ao 
Published: May 2024

Background: Sleep is crucial for overall health and well-being.
Analyzing sleep stages and sleep fragmentation can enhance our
understanding of sleep quality and help protect individuals’ sleep
health. The objective of this study is to explore the development and
application of a multitask deep learning model that can simultaneously
detect sleep arousal and score sleep stages.
Methods: We employed a task-incremental learning approach to develop the
multi-task deep learning model. For development and testing, 1069
polysomnography records were incorporated. Additionally, the model’s
fairness was assessed across various subgroups, including sex, age, and
ethnicity. Beyond performance evaluation, we investigated the
intermediate features extracted by the model from the raw ECG signal.
Results: The multi-task deep learning model achieved a Cohen’s 𝜅 of 0.68
for sleep stage prediction and an area under the receiver operating
characteristic (AUROC) of 0.94 for arousal detection. Additionally, the
model showed consistent performance across different subgroups. The
analysis of the interpretability of the intermediate features validated
their applicability and adaptability to related tasks in sleep analysis.
Conclusion: This study demonstrated the capacity of the multi-task deep
learning model to score sleep stages and arousal simultaneously with
substantial precision using a single-lead ECG. This research offers a
promising avenue for advancing incremental learning and multitask deep
learning models in sleep analysis.
Intraoperative Computed Tomography Scanner-Guided Junctional Zone Spinal Surgery in Fluoroscopic Limitation Zone-An Early Experience
Authors: Usman Ahmad Kamboh  , Adeel Rauf  , Muhammad Usama Saleem  , Mehreen Mehboob  , Mehwish Manzoor  , Sana Jamal  , Manzoor Ahmad  
Published: May 2024

Objective: Confirmation of the level for surgery at the junctional zones of the spine is associated with unique difficulties. C-Arm has its limitations in these areas. The use of intraoperative CT scan with navigation greatly helps in the surgery at junctional zones. These junctional zones include the craniocervical junction, cervico-dorsal junction, and sacroiliac junction. In 2019, we installed an Airo Brain Lab 32-slice MDCT in our facility and researched to evaluate its advantages in junctional zone fluoroscopy-restricted spine operations.
Material and Methods: We performed 20 complex surgeries in all these 3 junctional zones with the use of an intraoperative computed tomography scanner. 3 patients had craniovertebral junction fixation under intra-op CT while 6 had lateral mass fixation. 3 patients had cervicodorsal junction fixation and 4 patients had lumbosacral fixation.
Results: 2 out of 3patients with cervicodorsal fixation had correction of screws trajectory after usage of intra-op CT and 1 patient with lumbosacral fixation. All patients were discharged home with neurology better or the same as compared to pre-op. status while 13 patients had a favorable outcome.
Conclusion: Intraoperative computed tomography scanner is opening new horizons for complex spinal surgeries.
Keywords: , ,, .
A Spectrum of Spina Bifida: A Study of Neurosurgery Department of DHQ Teaching Hospital, Gomal Medical College, DI Khan
Authors: Shahid Nawaz  , Muhammad Usman  , Sarah Rehman  , Aneeta Ghazal  , Naseer Hassan  , Naeem-ul-Haq  
Published: May 2024

Objective: To pin down the spectrum of spina bifida in infants.
Materials & Methods: This prospective cohort study was conducted at the Neurosurgery Department, DHQ teaching hospital, Gomal Medical College, D.I Khan, Pakistan, from July 2021 to July 2022. A total of 100 diagnosed infants of spina bifida of either gender, who were undergoing surgery were included in the study. Demographics like; gender, name, age, cousin marriage, region, type of spina bifida (meningocele or meningomyelocele), associated with hydrocephalus, and width of the defect were noticed. Post-operatively the maximum follow-up was of 1 month for noticing the outcome and complications.
Results: Of a total number of 100 infants, 76 patients were male, while 24 were female. The mean age of the patients was 913.625 days. The majority of the children (n = 59) were having myelomeningocele. The lumbosacral spine was the most common location (n = 88) for myelomeningocele/meningocele. Post-operatively, there was the development of hydrocephalus in 12 patients.
Conclusion: The majority patients of with spina bifida were males. Meningomyelocele and lumbosacral location were the commonest findings. Furthermore, the lumbosacral location of the spina bifida and myelomeningocele were most commonly associated with the development of postoperative hydrocephalus.
Frequency of Misplacement of Percutaneously Placed Pedicle Screws in Thoracolumbar Fractures
Authors: Syed Ahmad Faizan  , Ajlan Ali  , Tariq Imran  , Zubair Mustafa  , Muhammad Aqeel Natt  , Asif Bashir  
Published: May 2024

of thoracolumbar fractures.
Material and Methods: A descriptive case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. The study comprised all individuals who had minimally invasive percutaneously implanted thoracic or lumbar pedicle screws placed. CT scans were conducted on the patient 24 hours after surgery as part of their usual post-operative care to capture axial pictures to find Pedicular cortical breaches in any direction.
Results: Mean age of the patients was 32 years. 82.7% were male whereas 17.3% were females. We found that the frequency of misplacement was 10.9% in the management of thoracolumbar fractures. 110 patients received 600 pedicle screws placed percutaneously. Of these, 534 screws (89.1%) were ideally placed inside the pedicle. 7% showed minor pedicle penetration, 3.6% showed moderate pedicle penetration and only 0.3% showed severe penetration. Out of misplaced screws (10.9%), 7.3% of patients were between 15 – 40 years, and 3.6% were between 41 – 50 years. Out of misplaced screws (10.9%), 9.7% were male patients and 1.3% were female patients. For thoracic injury, 4.5% of patients suffered from misplaced screws, and for lumbar injury, 6.5% of patients were observed for misplaced screws (p-value: 0.008).
Conclusion: The frequency of misplacement was 10.9% in the management of thoracolumbar fractures. The misplacement rate of the percutaneously placed screw is low. Therefore, we concluded that the percutaneously placed screw is safe to use.
Significance of Correlation Between Spinopelvic Parameters in Patients of Chronic Low Back Pain
Authors: Waqas Noor Chughtai  , Tahira Fatima  , Azhar Rashid  , Muhammad Adeel Razzaque  , Manqoosh-ur-Rehman  , Tahira Fatima  , Muhammad Asad Ullah  
Published: May 2024

Objective: To determine the significance of the correlation between spinopelvic parameters in patients with chronic low back pain.
Materials and Methods: 129 patients with chronic low back pain of a minimum of 03 months duration were included in our study from September 2020 to February 2023. Sagittal standing spinopelvic radiographs were done on all patients. Various spinopelvic measurements were done including PI, PT, LLA, SLA L1 – L3, SLA L3 – S1, LSA, SHA, and SIA. Pearson correlation was used to determine the correlation coefficient.
Results: The mean age was 36.45 ± 9.54 years. Males were 59 and females 70. Mean and SD of spine pelvic measures were LLA = 57.32 ± 12.45, SLA L1-L3 = 15.31 ± 3.75, SLA L3 – S1 = 42.46 ± 8.34, LSA = 8.94 ± 4.72, SHA = 38.10 ± 7.94, SIA = 52.42 ± 6.84, PT = 11.21 ± 5.83, PI = 48.72 ± 8.90. PI has a significant positive correlation with LLA ( r= 0.492 and p-value < 0.001).
Conclusion: PI and LLA are important spinopelvic parameters and have significant correlation with other spinopelvic parameters and derangement of one of them can affect the overall spine sagittal balance resulting in chronic low back pain.
Re-Operation Rates after Burr-Hole Aspiration of Brain Abscess
Authors: Sehrish Altaf  , Farrukh Javeed  , Iram Bokhari  , Anas Ahmed  , Raheel Gohar  , Mohammad Daniyal Mumtaz  
Published: May 2024

Objectives: To determine the re-operation rates after burr-hole aspiration of brain abscess.
Materials & Methods: The cross-sectional study was conducted from August 2022 to January 2023 at Jinnah Postgraduate Medical Centre (JPMC). A single burr-hole aspiration was used to treat a total of 64 cerebral abscess patients. Demographics, clinical presentation, predisposing variables, abscess location on imaging, and clinical outcomes were examined in medical records.
Results: The study included 64 patients with 60.9% males and 39.1% females. Patients most commonly presented with headache (90.6%) and fever (81.2%) with the majority of patients (92.1%) aged less than 30 years. The commonest source of infection was congenital heart disease (29.6%) in both aspiration and re-aspirations (46.6%). The parietal region was the most common location in both aspiration (32.8%) and re-aspiration (40%) of abscesses with the majority (40%) of re-aspirations done in the 3rd postoperative month.
Conclusion: Single burr-hole aspiration is a safe and effective method for the management of brain abscesses. It is a less invasive procedure and is associated with minimal complications. The learning curve is short and safely be performed by neurosurgeons in training.
Keywords: Brain abscess, Burr-hole aspiration, Re-aspiration, Infection, Meningitis.
Factors Predicting Outcome of Surgically Treated Acute Subdural Hematoma
Authors: Shah Khalid  , Amer Zaman  , Waseefullah  , Faiza  , Abdul Majid khan  
Published: May 2024

Objective: The study aimed to evaluate operative mortality and prognosis factors in posttraumatic acute subdural hematoma patients.
Material & Methods: A prospective cross-sectional study was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad. 82 patients operated for Acute Subdural Hematoma were included in the study. Variables that influence the outcome were recorded. The outcome was measured in terms of mortality.
Results: Of 82 patients operated on, 61 were male, and 21 were female. 51 were <40 old years, 21 were aged 41-60, and 7 were over 60. The most common cause is fall from height (47.6%). Cerebral contusion is often associated (28%). Overall mortality: 39.2%. Male mortality: 29.2%, female: 9.7%. Surgery >4 hours post-injury had higher mortality (18.2%) vs. <4 hours (8.5%). 14/43 GCS <8 patients survived, with no deaths when GCS >12. Pupillary abnormalities had higher mortality (31.9%) vs. normal pupils (7.3%). No deaths with hematoma thickness <10mm and only 1 survived with a thickness >16mm. 25/29 died with midline shift >11mm.
Conclusion: Prognostic factors for surgically treated traumatic acute subdural hematoma include GCS at presentation, pupils, hematoma thickness, midline shift, and time to surgery. Better outcomes associated with GCS>9, normal pupils, hematoma width <1.5cm, midline shift <1cm, and surgery within 4 hours.
Association of Hydrocephalus in Children with an Encephalocele
Authors: Habib Sagheer , Bokhari Iram , Ahmed Tanveer , Akbar Rabail , Gohar Raheel , Ahmed Anas 
Published: May 2024

Objectives: To describe the association between the occipital encephaloceles with hydrocephalus and how to improve the outcome of patient.
Methodology: Our Prospective study collected records of fifty patients diagnosed with posterior encephaloceles. Data were collected on the gender, location of the encephalocele, presence of neural tissue , dandy walker, microcephaly and hydrocephalus.
Results: Twenty-nine females and twenty-one males were present. Over half of the lesions were supratorcular, while the remaining eight (16%) were torcular and the remaining seventeen (34%) were infratorcular. Primary encephalocele repair were done at an average of 9 days (range 2.5–120 days). In twenty-five of the instances, a diagnosis of hydrocephalus was made. Twenty-four patients had a ventriculo-peritoneal shunt implanted. The average age of implantation of VP shunt was only 1.2 months (range 0.3–9 months). One patient underwent an endoscopic third ventriculostomy with good results. Hydrocephalus was related with Dandy-Walker and ventriculomegaly before encephalocele surgery was performed (p values 0.01 and 0.05, respectively). For hydrocephalus therapy,
Conclusions: Patients born with encephaloceles frequently suffer from hydrocephalus (50%). This is especially true in cases where the patient also has Dandy-Walker syndrome, CMIII malformation, or pre-existing ventriculomegaly. The severity of large encephaloceles is a limiting factor for the development of hydrocephalus when connected with torcular types and microcephaly.
Assessment of Neuropsychological Impairment among Individuals with a History of Head Trauma – A Case-Control Analysis
Authors: Khan Javeria , Shamim Zainab , Tehreem Khudija , Abbas Kiran , Ahmed Moiz , Javeed Farrukh 
Published: May 2024

Objective: To determine the frequency of different neuropsychological impairments in traumatic head injury survivors compared to those without a history of head trauma.
Materials and Methods: A case-control study was done in Karachi, Pakistan, during February 2023 and March 2023, with participants aged 18 and above, of both genders, with or without a history of head trauma forming the case and control groups, respectively. Individuals with a history of head trauma or congenital neurological impairment were not included. Screening tools included the ESS, UNS, GAD-7 scale, and PHQ-9.
Results: A total of 303 participants were enrolled, out of these 128 (42.2%) were in the case group and 175 (57.8%) were in the control group. The most common source of head injury was Road Traffic Accidents (53.9%, n = 69). 143 (63.8%) out of 224 males had a positive history of head trauma in their lifetime, making the male gender more susceptible. The majority who had a history of head trauma lie in the age group < 21 years (52.6%, n = 110). No significant association was found between the interpretations of screening scales and history of head trauma.
Conclusion: Traumatic head injuries and their long-term consequences can predispose a person to experience any cognitive impairment in their life. However, in this study, we could not find significant neuropsychiatric deficits in patients with a history of head trauma. Therefore, it is crucial to conduct further large-scale, multi-center, and controlled studies to explore the cognitive and psychological impairment associated with head trauma.
Head Injury Due to Fall from Heights in Pediatric Population of a Middle Resource Country
Authors: Iqbal ahamad  , Muhammad Hassan Raza  , Adnan Qasim  , Eram Abbas  , Sheraz Ahmad  , Muhammad Kashif Chishti  
Published: May 2024

Objective: One of the serious concerns for public health is unintentional injuries. Falls rank as the second most common cause of unintentional injury deaths globally, after injuries sustained in transportation accidents. The study's goals were to check the mechanisms and severity of the head injury from falls among children.
Materials and Methods: A non-randomized retrospective study was conducted and children aged 0 – 12 years (n = 228) undergoing cranial CT guidance for head injury were enrolled. All patients were treated under the supervision of the neurosurgery department. Detailed radiological evaluation was done and recorded on specialized proforma.
Results: Among the enrolled patients, mild head injury was noted in 49.1% of children while moderate head injury was noted among 40.4% of children. A total of 72 (31.6%) patients had skull fractures, of which 12 (5.3%) had a thin underlying subdural hemorrhage. Four cases of extradural hemorrhage complicated a skull fracture, and eight cases of isolated Subdural hemorrhage (SDH) were observed without a skull fracture. Of those 48 (21%), radiologically evident diffuse axonal injuries were present, and each of them included high-force injury mechanisms.
Conclusion: When children sustain minor trauma, skull fractures, and focal SDH are rather common, although most of the time there are no long-term neurological effects. On the other hand, patients with an equally severe cause of injury were the only ones who experienced diffuse brain injury with significant neurological disability that followed.
Efficacy Of Short-Segment Transpedicular Fixation for Thoracolumbar Fractures in Terms of Improvement in Neurological Status
Authors: Ahmad Sajjad , Mian Iftikhar ul haq  
Published: May 2024

Objective: To determine the efficacy of short-segment transpedicular fixation for thoracolumbar fractures in terms of improvement in neurological status.
Materials and Methods: A prospective observational research was conducted at Bacha Khan Medical Complex, Swabi, Section of Neurosurgery. Patients having traumatic thoracolumbar fractures with neurological deficits were subjected to short-segment transpedicular fixation and evaluated for post-operative improvement in neurological status at a 6-month follow-up.
Results: 48 patients participated in the study. Mean age was 35.69±8.22 years and 60.4% were males. History of falls was the most common mechanism responsible for spinal injury i.e. 56.3%. D12 vertebra was fractured in 43.8% of patients. The leading type of fracture was, AO type B in 37.5% of patients. 23 (47.9%) of the patients showed one or more grade improvements in their neurological status on the ASIA scale at 6-month follow-up. Surgical site infection was the common postoperative complication (8.3%).
Conclusion: Short-segment transpedicular fixation is an effective procedure for traumatic thoracolumbar fractures in terms of improvement in neurological status.
Anterior Lateral Approach for Anterior Decompression, Corpectomy, and Fixation with Webb Morley Procedure for Dorsolumbar Spinal Fracture
Authors: Aurangzeb Kalhoro  , Vashdev Khimani  , Muhammad Hamid Ali  , Mubarak Hussain  , Mahesh Kumar Luhano  
Published: May 2024

Objective: Efficacy of anterolateral approach Webb Morley procedure in a low-income country.
Materials & Methods: A descriptive study was conducted at the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro. Patients of any gender presented to us with dorsal or lumber injury, plus a presentation on X-ray / MRI as spinal fractures having bone fragments pressing the cord, especially from the anterior side were included in the study. The assessed tool was based on clinical findings of Frankel's grading.
Results: We had 64 patients, who had dorsal and lumber fractures and went through the procedure of Webb Morley 43 were male and 31 were female patients The male-to-female ratio was 2:1 and the mean age was 39±3 yrs. with a median age was 42.5yrs. Fall (n = 34, 53.12%) was the common cause, road traffic accidents were (n = 16, 25%), fall of heavy objects (n = 11, 17.18%), and assault (n = 03, 4.68%).
Conclusion: Based on the current study of our Centre the anterior lateral approach for lower dorsal and upper lumber level with decompression and fixation with Webb-Morley procedure is a safe and effective method.