Search

Arterial desaturation following surgical repair of tetralogy of Fallot (TOF) is rare. In most instances, it results from residual right ventricular outflow tract obstruction, causing right-to-left shunt across residual interatrial or interventricular communication. In this report, we present an unusual scenario of arterial desaturation due to a recanalized left cardinal vein in a child with repaired TOF. We also discuss stepwise evaluation that led to successful identification and occlusion of the abnormal venous channel by percutaneous device closure.

Laboratory classes form an important aspect of bioscience education. However, this environment is challenging for students due to cognitive load and lack of confidence. Familiarising students with aspects of their laboratory classes prior to the session can improve this. This study compares the pre-laboratory scaffolding that bioscience and chemistry students experience across UK HE institutions. Typically, bioscience modules used fewer types of activities than chemistry although reading the protocol was the most common activity for both disciplines. Within bioscience, pre-laboratory activities differed by level: first year undergraduates were more likely to be asked to read the protocol, watch videos or do calculation practice in their modules whereas final year undergraduates were more likely to experience experimental design or contextualised activities. Alongside this, this paper discusses an institutional case study of the development and evaluation of technical laboratory videos as pre-laboratory scaffolding for first year students. These were found to benefit both student focus and enhance confidence: implying that using the videos impacted on cognitive load and hence learning. Exploring barriers to the uptake of these resources identified a lack of awareness of them as a major factor, suggesting that greater integration of such resources would enhance engagement and impact.

We perform an analysis on an M/G/1 system that has bulk arrival Poisson process as well as instantaneous service, Precipitous breakdown and random repair, Gqueue, and operation under an MBV (Modified Bernoulli vacation) policy. The positive outcome of a customer retrial is lost when an Anti-positive customer arrives during a positive (good) customer’s assistance period. If a new customer enters and notices that the server is currently undergoing repairs or on vacation, they may renege or balk from the system. To obtain a wide variety of additional outcomes, we use the details provided by the supplementary variable method regarding the rates at which different events occur and it is possible to determine the probability-generating functions of queue length distributions as well as the explicit formulations of important performance metrics. The numerical data confirm the analytical findings about the major performance metrics.

We are witnessing environmental degradation on a massive scale. Popular reactions to the devastation of our natural surroundings are a ubiquitous image in newscasts everywhere, and yet nations and institutions seem unable to cohere around programs to stop the looming disaster. American author John Grisham, an attorney by profession, elaborates on this issue in his novel The Appeal (2008). Grisham meticulously describes the human tragedy of a degrading bio-region and provides insights into the gradual process of contemporary environmental litigation. Grisham provides a panoramic view on the lives of people in Cary County, the place where a corporate toxic waste dump has caused massive groundwater pollution. The use of polluted drinking water destroys many lives and creates the worst cancer cluster in history. Plaintiff Jeannette Baker, along with her suffering neighbours, seeks justice through legal means against the corporate companies for the loss of life caused by corporate interests. The author makes us witnesses to the long judicial process that gathers a motley group of people with conflicting interests: victims, local authorities, and corporation representatives. They come together to analyse and acknowledge their role in the process of environmental devastation.

The ongoing wars in many regions—such as the conflict between Israel and Hamas—as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by individuals and communities affected by war and violence.

Objective The current study explored (1) changes in trust in federal and state governments and scientists across representative Australian national samples from 2003–2020; and (2) the extent to which trust in these sources predicted compliance with COVID-19 prevention measures at the onset of the pandemic. Method Using a nationally representative samples (N = 1000), we asked participants to rate their trust in federal and state government and in scientists, their extent of compliance with COVID-19 prevention measures, and to provide demographic information. Results We found that trust in federal and state governments had significantly increased, while trust in scientists was at a high level matched by only three other time-points. Higher levels of trust in state government and scientists uniquely predicted greater compliance with COVID-19 prevention measures. Women and older respondents also reported greater compliance. Conclusion The current findings reinforce those from Australia and other countries indicating that trust increased during the onset of the COVID-19 pandemic, and those identifying trust in government and in scientists as important predictors of compliance. Importantly, our findings highlight the role of trust in state government, which potentially reflects the role played by Australian state governments in enacting and enforcing COVID-19 prevention measures.

Objectives: Patients with ST elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs; dyslipidaemia, hypertension, diabetes mellitus and smoking) are reported to have a worse clinical outcome compared to those with SMuRFs. However, robust prospective data and low-and middle-income country perspective are lacking. We aimed to study the patients with first STEMI and assess the influence of SMuRFs on clinical outcomes by comparing the patients with and without SMuRFs. Methods: We included all consecutive STEMI patients without prior coronary artery disease enrolled in the Madras Medical College STEMI Registry from September 2018 to October 2019. We collected baseline clinical characteristics, revascularisation strategies and clinical outcome. We analysed suboptimal self-reported sleep duration as a 5th extended SMuRF (eSMuRF). Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications and one-year all-cause mortality. Results: Among 2,379 patients, 605 patients (25.4%) were SMuRF-less. More women were SMuRF-less than men (27.1% vs 22.1%; P = 0.012). SMuRF-less patients were older (57.44 ± 13.95 vs 55.68 ± 11.74; P < 0.001), more often former tobacco users (10.4% vs 5.0%; P < 0.001), with more anterior wall MI (62.6% vs 52.1%; P = 0.032). The primary outcome [in-hospital mortality (10.7% vs 11.3%; P = 0.72)] and secondary outcomes [in-hospital complications (29.1% vs 31.7%; P = 0.23) and one-year all-cause mortality (22.3% vs 22.7%; P = 0.85)] were similar in both groups. Addition of suboptimal self-reported sleep duration as a 5th eSMuRF yielded similar results. Conclusions: 25% of first STEMI patients were SMuRF-less. Clinical outcomes of patients without SMuRFs were similar to those with SMuRFs. Suboptimal sleep duration did not account for the risk associated with the SMuRF-less status.

IntroductionThe COVID-19 pandemic has become the greatest challenge of the new millennium. Most healthcare workers (HCWs) experienced unprecedented levels of workload since the pandemic. This study aims to identify the prevalence and factors of depression, anxiety and stress among HCWs in Malaysian healthcare facilities in the midst of the pandemic due to the SARs-CoV-2.MethodsAn emergency response programme on mental health was conducted from June to September 2020. A standardized data collection form was distributed among the HCWs in the government hospital in Klang Valley. The form contained basic demographic information and the self-reported Malay version of the Depression, Anxiety and Stress scale (BM DASS-21).ResultsOf the1,300 staff who attended the Mental Health and Psychosocial Support in Covid-19 (MHPSS COVID-19) programme, 996 staff (21.6% male, 78.4% female) completed the online survey (response rate: 76.6%). Result showed that staff aged above 40 years old were almost two times more likely to have anxiety (AOR = 1.632; 95% CI = 1.141-2.334, p:0.007) and depression (AOR = 1.637; 95% CI = 1.1.06-2.423, p:0.014) as compared to staff who were less than 40 years old. Those who had direct involvement with COVID-19 patients were likely to suffer stress (AOR = 0.596; 95% CI = 0.418-0.849, p:0.004), anxiety (AOR = 0.706; 95% Ci = 0.503-0.990, p:0.044) and depression (AOR = 0.630; 95% Ci = 0.427-0.928, p:0.019). HCWs with stress (AOR = 0.638; 95% CI of 0.476-0.856, p = 0.003), anxiety (AOR = 0.720; 95% CI 0.542-0.958, p = 0.024) and depression (AOR = 0.657; 95% CI 0.480-0.901, p = 0.009) showed less confidence to treat critically ill patients and need psychological help during outbreak.ConclusionThis study showed the importance of psychosocial support to reduce psychological distress among HCWs when working or coping during the COVID-19 pandemic or outbreak.

Interstitial lung disease is characterised by a combination of cellular proliferation, inflammation of the interstitium and fibrosis within the alveolar wall. A 58-year-old man was referred for lung transplantation after developing worsening dyspnoea and progressive hypoxaemic respiratory failure from idiopathic pulmonary fibrosis. Three years later, he developed desquamative interstitial pneumonia in his transplanted lungs, and despite augmentation of immune suppression, he had a progressive decline in his lung function and exercise capacity. Interestingly, in our case, the histopathology obtained post transplant strongly goes against the recurrence of usual interstitial pneumonia/idiopathic pulmonary fibrosis; rather, two separate interstitial disease processes have been identified.

Summary: Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

Integration of technology is widespread in laboratory teaching, whose purpose includes building theoretical understanding and practical skills. How second-year bioscience undergraduate students at a UK university use technology to construct their understanding of laboratory-based topics was investigated using a concurrent think-aloud protocol in the laboratory, followed by semi-structured interviews. Analysis of think-aloud data used socially shared metacognitive coding since students may co-construct their understanding in these collaborative spaces. This analysis demonstrated that participants used technology within the laboratory either as a tool to conduct their experiment or, as a source of information to help them understand, apply or perform their experimental task. Semi-structured interviews demonstrated that students integrated technology into all aspects of their laboratory learning. Eight out of the ten participants described using technology to help them make connections between theory and practice as part of post-laboratory activities such as analysing or conducting further research on the topic. A survey of UK bioscience undergraduate modules found that 22% of modules did not use post-laboratory activities, suggesting that more scaffolding of post-laboratory activities could provide bioscience students with greater integration of practical and theoretical understanding and consequently meaningful laboratory learning.

Background: In an attempt to provide quantitative, reproducible, and standardized analyses in cases of eosinophilic esophagitis (EoE), we have developed an artificial intelligence (AI) digital pathology model for the evaluation of histologic features in the EoE/esophageal eosinophilia spectrum. Here, we describe the development and technical validation of this novel AI tool. Methods: A total of 10 726 objects and 56.2 mm2 of semantic segmentation areas were annotated on whole-slide images, utilizing a cloud-based, deep learning artificial intelligence platform (Aiforia Technologies, Helsinki, Finland). Our training set consisted of 40 carefully selected digitized esophageal biopsy slides which contained the full spectrum of changes typically seen in the setting of esophageal eosinophilia, ranging from normal mucosa to severe abnormalities with regard to each specific features included in our model. A subset of cases was reserved as independent “test sets” in order to assess the validity of the AI model outside the training set. Five specialized experienced gastrointestinal pathologists scored each feature blindly and independently of each other and of AI model results. Results: The performance of the AI model for all cell type features was similar/non-inferior to that of our group of GI pathologists (F1-scores: 94.5–94.8 for AI vs human and 92.6–96.0 for human vs human). Segmentation area features were rated for accuracy using the following scale: 1. “perfect or nearly perfect” (95%–100%, no significant errors), 2. “very good” (80%–95%, only minor errors), 3. “good” (70%–80%, significant errors but still captures the feature well), 4. “insufficient” (less than 70%, significant errors compromising feature recognition). Rating scores for tissue (1.01), spongiosis (1.15), basal layer (1.05), surface layer (1.04), lamina propria (1.15), and collagen (1.11) were in the “very good” to “perfect or nearly perfect” range, while degranulation (2.23) was rated between “good” and “very good”. Conclusion: Our newly developed AI-based tool showed an excellent performance (non-inferior to a group of experienced GI pathologists) for the recognition of various histologic features in the EoE/esophageal mucosal eosinophilia spectrum. This tool represents an important step in creating an accurate and reproducible method for semi-automated quantitative analysis to be used in the evaluation of esophageal biopsies in this clinical context.

Global vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. The study aims to determine the seroprevalence of SARS-CoV-2 IgG antibodies among vaccine-naïve healthcare workers and to describe the impact of vaccination roll-out on COVID-19 antibody prevalence among the health care centers in tertiary care centers in South India. Serum samples collected from vaccinated and unvaccinated health care workers between January 2021 and April 2021were subjected to COVID-19 IgG ELISA, and adverse effects after the first and second dose of receiving the Covishield vaccine were recorded. The vaccinated group was followed for a COVID-19 breakthrough infection for a period of 6 months. Among the recruited HCW, 156 and 157 participants were from the vaccinated and unvaccinated group, respectively. The seroprevalence (COVID-19 IgG ELISA) among the vaccinated and unvaccinated Health Care Workers (HCW) was 91.7% and 38.2%, respectively, which is statistically significant. Systemic and local side-effects after Covishield vaccination occur at lower frequencies than reported in phase 3 trials. Since the COVID-19 vaccine rollout has commenced in our tertiary care hospital, seropositivity for COVID-19 IgG has risen dramatically and clearly shows trends in vaccine-induced antibodies among the health care workers.

Introduction: Human placenta is often considered a controlled-tumour because of shared properties such as invasion and angiogenesis. We assessed the status of a few selected tumour-associated factors (TAFs) in late onset pre-eclamptic (PE) and normotensive (NT) placentae, to understand their involvement in trophoblast invasion. These molecules include aldehyde dehydrogenase (ALDH3A1), aurora kinases (AURK-A/C), platelet derived growth factor receptor-α (PDGFRα), jagged-1 (JAG1) and twist related protein-1 (TWIST1).Methods: The expression of TAF was compared in 13 NT and 11 PE (late onset) placentae using immunoblotting/immunohistochemistry. We then used a novel spheroidal cell model developed from transformed human first trimester trophoblast cell lines HTR8/SVneo and TEV-1 to determine the expression and localization of these six factors during invasion. We also compared the expression of these TAFs during migration and invasion.Results: Our results suggest that expressions of ALDH3A1, AURK-A, PDGFRα, and TWIST1 are significantly upregulated in PE placentae (p < 0.05) when compared to NT placentae, whereas AURK-C and JAG1 are down-regulated (p < 0.05). The protein expression pattern of all the six factors were found to be similar in spheroids in comparison to their parental counterparts. The invasive potential of the spheroids was also enhanced when compared with the parental cells.Discussion: Collectively, data from our present study suggests that these TAFs are involved in placental invasion and their altered expressions may be regarded as a compensatory mechanism against reduced invasion. [ABSTRACT FROM AUTHOR]

Missile Guidance system needs accurate estimates from Inertial Navigation System (INS) for guiding the vehicle towards the target. In this paper a target point, specified before launch, in a battlefield scenario is considered for a landmark using missile Strap Down Inertial Navigation System (SDINS) aided by Master INS (MINS) placed on a moving platform. Azimuth information of the missile is one of the most critical navigation states for estimation on the moving platform before launching the missile for precise impact. An Adaptive Kalman Filter (AKF) based on the error state model is formulated. The 7-state AKF with 4-measurement forms the core, where the filter gain of the innovation sequence (measurements) is evaluated. This approach of adaptively computing the gain is tested in a laboratory, on a van and in a ship trial, culminating in a successful guided missile launch. Mean and the covariance of the measurement residuals were used in a unique way to compute adaptive gain after the accumulation of initial samples. A Master INS (with advanced Gyros) whose accuracy is much higher than the accuracy of the missile's SDINS is used for velocity matching algorithm before the launch with execution of an S-maneuver for generation of accelerations towards observing the states more appropriately. Estimated error states were used in a feedback mode to get near the true orientation of the Missile's slave INS. Error quaternions are used for this purpose in the feedback and the gains were selected using offline matrix Riccati equation solution in a discrete domain as used in the modern control system. The results were very encouraging with less than 5 arc minutes of error in azimuth. [ABSTRACT FROM AUTHOR]

Davenport's q method & the Singular Value Decomposition (SVD) method are the two vigorous estimators that reduces Wahba's loss function. In these, the q method is slightly quicker due to its computation of optimum quaternion as an eigenvector of a symmetric 4x4 matrix through the prevalent eigenvalue. The ESOQ and ESOQ2 (EStimators of the Optimal Quaternion) and the QUEST (QUaternion ESTimator) algorithms are less determined as the extreme eigenvalue's distinguishing polynomial equation is solved by them. These estimators are apt to track the undulations of the sea with equivalent precision and accurateness. The SVD method is chosen and shown to be the most robust of all the hostile methods for the orientation of SDINS (Strap-Down Inertial Navigation Systems) using rate matching observations at sea in this paper. SVD is known most robust decomposition of all the decompositions of a matrix. SVD based attitude estimation being a batch technique would suffer from much less computational issues. [ABSTRACT FROM AUTHOR]