Spontaneous spinal cord infarction: a systematic review.

Background and objectives: Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes. Methods: The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords 'spontaneous', 'spinal cord', 'infarction' and 'ischaemic'. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted and systematically analysed. Results: 440 patients from 33 studies were included in this systematic review. Analysis of vascular risk factors showed that hypertension was present in 40%, followed by smoking in 30%, dyslipidaemia in 29% and diabetes in 16%. The severity of symptoms at admission according to the American Spinal Injury Association (ASIA) Impairment Scale was score A 19%, score B14%, score C36% and score D32%. The mean follow-up period was 34.8 (±12.2) months. ASIA score at follow-up showed score A 11%, score B 3%, score C 16%, score D 67% and score E 2%. The overall mortality during the follow-up period was 5%. When used, MRI with diffusion-weighted imaging (DWI) supported the diagnosis in 81% of cases. At follow-up, 71% of the patients were able to walk with or without walking aids. Conclusion: The findings suggest a significant role for vascular risk factors in the pathophysiology of spontaneous SCInf. In the diagnostic workup, the use of DWI along with an MRI may help in confirming the diagnosis. The findings at follow-up suggest that neurological recovery is to be expected, with the majority of patients regaining ambulation. This systematic review highlights gaps in the literature and underscores the necessity for further research to establish diagnostic criteria and treatment guidelines.

Extended reality in cranial and spinal neurosurgery - a bibliometric analysis.

PURPOSE: This bibliometric analysis of the top 100 cited articles on extended reality (XR) in neurosurgery aimed to reveal trends in this research field. Gender differences in authorship and global distribution of the most-cited articles were also addressed. METHODS: A Web of Science electronic database search was conducted. The top 100 most-cited articles related to the scope of this review were retrieved and analyzed for trends in publications, journal characteristics, authorship, global distribution, study design, and focus areas. After a brief description of the top 100 publications, a comparative analysis between spinal and cranial publications was performed. RESULTS: From 2005, there was a significant increase in spinal neurosurgery publications with a focus on pedicle screw placement. Most articles were original research studies, with an emphasis on augmented reality (AR). In cranial neurosurgery, there was no notable increase in publications. There was an increase in studies assessing both AR and virtual reality (VR) research, with a notable emphasis on VR compared to AR. Education, surgical skills assessment, and surgical planning were more common themes in cranial studies compared to spinal studies. Female authorship was notably low in both groups, with no significant increase over time. The USA and Canada contributed most of the publications in the research field. CONCLUSIONS: Research regarding the use of XR in neurosurgery increased significantly from 2005. Cranial research focused on VR and resident education while spinal research focused on AR and neuronavigation. Female authorship was underrepresented. North America provides most of the high-impact research in this area.

Usage and attitude of medical students towards mobile medical applications during and after COVID-19 lockdown: repeated cross-sectional study.

BACKGROUND: COVID-19 pandemic has accelerated the shift toward e-learning, particularly in medical education. Mobile medical applications (apps) have become integral tools for e-learning due to the prevalence of smartphones among medical students. Therefore, we aim to assess the usage and attitude of undergraduate Egyptian medical students towards mobile medical apps during and after the COVID-19 lockdown. METHODS: This is a two-phase repeated cross-sectional study using an online, pilot-tested, and self-administered survey conducted at the Faculty of Medicine, Menoufia University, Egypt. Phase 1 was during the academic year 2019-2020 (during lockdown), and phase 2 was during the academic year 2021-2022 (after lockdown). Out of the 4800-target population for each phase, a sample size of 140 medical students was randomly selected from each study year, resulting in a total sample size of 840 students for all six academic and clinical years for each phase. RESULTS: A total of 566 students in phase 1 and 616 students in phase 2 responded to the survey, with response rates of 67.62% and 73.33%, respectively. In phase 1, 55.7% of students reported using medical apps, with no significant difference between males and females (60.1% vs. 53.8%; p = 0.17) or between academic and clinical years (56.3% vs. 54.7%; p = 0.7). In phase 2, the percentage increased to 70.9%, with a significant difference between males and females (80% vs. 62.9%; p < 0.001) and between academic and clinical years (79.8% vs. 63%; p < 0.001). Medical dictionaries were the most commonly used apps, whereas medical calculators were the least common in both phases. Regarding their attitude, most students (65.1% and 73.9% in phases 1 and 2, respectively) expressed confidence in using medical apps, while 81.3% in phase 1 and 88.1% in phase 2 agreed that using medical apps is a flexible method of learning. Lack of knowledge regarding which app to download was the most reported cause of limitation in medical app usage by 37.8% of the students in phase 1 and 40% in phase 2. CONCLUSION: Our study revealed that the COVID-19 lockdown led to a significant increase in the use of mobile medical apps among Egyptian medical students. Despite the positive attitude of students towards these apps, multiple challenges still need to be addressed to ensure their optimal utilization in medical education.

Jordanian English language educators' perceived readiness for virtual learning environment.

Online engagement has assumed a pivotal role within educational pedagogy, particularly during the COVID-19 pandemic. This study delves into the perceptions of Jordanian English language educators regarding their preparedness for online teaching in the post-pandemic landscape. In this quantitative study, a group of 101 English language educators from Jordanian universities participated, and their responses were subjected to analysis through descriptive statistics. The findings of this analysis indicate that the respondents exhibited a moderate level of familiarity with technology and e-learning platforms, alongside a similarly moderate level of competence in managing their online courses. Furthermore, the study underscores a noteworthy gap in their exposure to online education, despite their considerable tenure in teaching English. Consequently, the study underscores the necessity for tailored training programs designed to comprehensively enhance the online teaching proficiency of English language educators, thereby facilitating a more effective virtual learning environment.

Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study.

BACKGROUND: Current guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation. METHODS: We conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening. RESULTS: A total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively). CONCLUSIONS: Despite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

Evaluation of a computational model for mycetoma-causative agents identification.

BACKGROUND: The therapeutic strategy for mycetoma relies heavily on the identification of the causative agents, which are either fungal or bacterial. While histopathological examination of surgical biopsies is currently the most used diagnostic tool, it requires well-trained pathologists, who are lacking in most rural areas where mycetoma is endemic. In this work we propose and evaluate a machine learning approach that semi-automatically analyses histopathological microscopic images of grains and provides a classification of the disease as eumycetoma or actinomycetoma. METHODS: The computational model is based on radiomics and partial least squares. It is assessed on a dataset that includes 890 individual grains collected from 168 patients originating from the Mycetoma Research Centre in Sudan. The dataset contained 94 eumycetoma cases and 74 actinomycetoma cases, with a distribution of the species among the two causative agents that is representative of the Sudanese distribution. RESULTS: The proposed model achieved identification of causative agents with an accuracy of 91.89%, which is comparable to the accuracy of experts from the domain. The method was found to be robust to a small error in the segmentation of the grain and to changes in the acquisition protocol. Among the radiomics features, the homogeneity of mycetoma grain textures was found to be the most discriminative feature for causative agent identification. CONCLUSION: The results presented in this study support that this computational approach could greatly benefit rural areas with limited access to specialized clinical centres and also provide a second opinion for expert pathologists to implement the appropriate therapeutic strategy.

Delay in prior authorization of biologic therapy: Another possible cause of healthcare disparity in IBD patients.

BACKGROUND: Biologics, a mainstay in inflammatory bowel disease (IBD) treatment, typically require prior authorization from insurance companies. Multiple studies show that African Americans are less likely to be prescribed biologics. The prior authorization process may perpetuate disparities in healthcare. This study evaluated the approval time for biologics in IBD. METHODS: A chart review of IBD patients seen in a university gastroenterology clinic over 5 years was performed. Patient gender, race, IBD subtype, biologic use, and insurance type were recorded. Insurance type was classified as private or public (Medicaid or Medicare). Biologic agents evaluated included infliximab, adalimumab, vedolizumab and ustekinumab. Length of time to approval (TTA) and length of time to first infusion or administration (TFI) were recorded. Analysis was performed using t-testing, Fisher's exact testing, and ANOVA with significance set at p<0.05. The study was IRB approved. RESULTS: 458 charts were analyzed. 66 patients were being treated with a biologic. 42 had private insurance, 16 Medicaid and 8 Medicare. 37 patients had ulcerative colitis, 27 Crohn's disease, and 2 indeterminate colitis. There were 38 men and 28 women. 32 patients were white, 26 African American, 1 Asian, 5 other, and 2 declined identification. Average TTA was 30.5 days (range 1-145) and average TFI was 45.3 days (range 2-166). African Americans were more often on public insurance compared to whites (p=0.0001). Crohn's disease compared to ulcerative colitis patients were more often on public insurance (p=0.017). Significantly more private compared to public insurance patients were on infliximab (p=0.001). Medicaid and Medicare patients had significantly longer mean TTAs than private insurance patients (49.1 and 52.7 vs 19.4 days, p=0.007). African Americans had significantly longer mean TTA compared to whites (45.9 vs 24.8 days, p=0.044). Crohn's disease compared to ulcerative colitis patients had significantly longer mean TTA (39.7 vs 21.8 days, p=0.050). DISCUSSION: This study shows that prior authorization for biologic therapy was longer for African Americans. Patients on public insurance also tend to have a longer TTA, and more African Americans were on public insurance compared to White patients in this study which may explain the difference in biologic access for African Americans.

Comparison of chest radiographs against minimum intensity projection reconstruction computed tomography scans for detection of airway stenosis in children with lymphobronchial tuberculosis.

BACKGROUND: Ideally, suspected airway compression in symptomatic children with lymphobronchial tuberculosis (TB) would be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. However, in TB-endemic regions with limited resources, practitioners rely on conventional radiography for diagnosing TB and its complications. Furthermore, airway compression detected on conventional radiographs would upgrade a patient into the severe category according to the new World Health Organization guidelines, precluding the patient from shorter treatment protocols. The accuracy of conventional radiographs in the context of detecting airway compression in children with TB has not been specifically evaluated against an imaging gold standard. OBJECTIVE: We aimed to compare frontal chest radiographs against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine observer agreement between the modalities regarding the degree of stenosis. MATERIALS AND METHODS: This retrospective cross-sectional study compared chest radiographs with standardized angled coronal CT MinIP in children with symptomatic lymphobronchial TB at ten predetermined airway locations. Chest radiographs were evaluated by one pediatric radiologist and CT MinIP reconstructions were independently interpreted by three readers. Sensitivity and specificity were calculated using CT MinIP as the gold standard. Stenosis was graded as 1 for mild (1-50%), 2 for moderate (51-75%), 3a for severe (76-99%), and 3b for total occlusion (100%). Agreement between the two modalities regarding severity of stenosis was calculated using the kappa coefficient for each affected site. RESULTS: A total of 37 patients were included in the study. The median age of patients was 14.3 months (interquartile range 8.0-23.2). Three hundred and seventy individual bronchi (10 from each of the 37 patients) were evaluated for stenosis. Chest radiographs showed that 31 out of 37 (84%) patients had stenosis in at least one of ten evaluated sites, most commonly the left main bronchus and bronchus intermedius, and this was confirmed via CT MinIP. The gold standard (CT MinIP) demonstrated stenosis in at least one of ten sites in all 37 patients (100%). Left main bronchus stenosis was detected by chest radiography with a 92.9% sensitivity and 100% specificity. Sensitivity and specificity for bronchus intermedius stenosis were 80% and 75%, respectively. There was substantial agreement for grade of stenosis between chest radiographs and CT (kappa=0.67) for the left main bronchus and moderate agreement (kappa=0.58) for the bronchus intermedius. Severe stenosis was found in 78 bronchi on CT compared to 32 bronchi (Grade 3a: 9, Grade 3b: 23) on chest radiographs. CONCLUSION: The diagnosis of pulmonary TB in children continues to rely heavily on imaging, and we have shown that in young children, chest radiographs had a high sensitivity and specificity for detecting airway stenosis at certain anatomical sites, when adequately visualized, resulting from tuberculous lymph node compression at left main bronchus and bronchus intermedius. For most sites, the interobserver agreement was poor. Stenosis of the left main bronchus and bronchus intermedius should be the focus of chest radiograph interpretation and can assist both diagnosis and classification of patients for treatment.

Hospital waste incinerator ash: characteristics, treatment techniques, and applications (A review).

The amount of medical waste generated has increased enormously since the COVID-19 outbreak. An incineration process is the main method that is usually used to treat this waste, causing an increase in both medical waste bottom ash (MWBA) and medical waste fly ash (MWFA). In this work, the physical and chemical characteristics of MWFA and MWBA were reviewed. This ash contains high levels of polychlorinated dibenzo-p-dioxin (PCDD), dibenzofurans (PCDFs), and heavy metals. Furthermore, medical waste ash appears to have high leachability in the toxicity characteristics leaching procedure (TCLP) test and the European standard test (EN 12457). Owing to its toxicity, medical ash can be treated using various methods prior to disposal based on the covered review. These techniques include chemical, supercritical fluid, cement-based, melting, microwave, and mechanochemical techniques. The shortcomings of some of these treatment methods have been identified, such as the emission of high levels of chlorine from the melting technique, limited applications of the flotation method on the industrial scale, long-term stability of leachate treated by cement-based methods that have not been confirmed yet, and high energy consumption in the supercritical technique. This review also covers possible applications of medical waste ash in cement production, agriculture, and road construction.

Perception, attitude, and practice toward research among medical students in Hadhramout University, Yemen.

BACKGROUND: Research is an important element in the improvement of the quality of health services provided to the public. It is documented that globally; medical students apply research in their school life. In Hadhramaut University, medical students work on research in groups, and it is an important part of the curriculum. There is a formal assessment of the student's research, but there is still a gap regarding individual viewpoints and challenges faced. This study aimed to assess perception, attitude, and practice toward research among medical students at Hadhramout University. METHODS: This is a cross-sectional descriptive study which was conducted among medical students. This study was undertaken in Hadhramout University in Al-Mukalla district, Yemen, during the academic year 2016-2017. A self-administered pilot-tested questionnaire was used for data collection to assess perception, attitude, and practice toward the research during the educational year 2016-2017. RESULTS: A total of 265 completed responses were received. The majority had a low Knowledge score (72%). However, the majority had a positive attitude toward research (90.9%). Eighty-three students reported participation in research work. However, (44.4%) expressed research interest. Many barriers were highlighted by students including a lack of time (78.4%) and a lack of training in statistics (75.9%). CONCLUSION: The study identified several barriers for undergraduate medical students to undertake research. It is important that these barriers should be addressed in curriculum development, so that students can retain their motivation to engage effectively in research.

Lidar attenuation coefficient in the global oceans: insights from ICESat-2 mission.

The attenuation coefficient of natural waters plays a significant role in our understanding of hydrology from both the oceanographic and biological point of view. The advent of near-continuous observations by sophisticated space-based lidars now offers an unprecedented opportunity to characterize attenuation coefficients over open oceans on global and regional scales. At present, however, literature reports of lidar-derived attenuation coefficient estimates (klidar, m-1) in oceanic waters are very limited. In this study, we present a global survey of klidar derived from ATLAS/ICESat-2 nighttime measurements. Our results augment the existing passive sensor ocean color data set with a new diurnal component and extend the record to now include previously unavailable polar nighttime observations. The values of ATLAS measured klidar at 532 nm are between 0.045 and 0.39 m-1 with the higher values (>0.15 m-1) correlated with coastal waters and sea ice covered oceans. The average klidar in clearest oligotrophic ocean gyres is ∼0.058 ± 0.012 m-1 at 532 nm. The results reported here demonstrate the feasibility of using ATLAS/ICESat-2 lidar measurements for global klidar studies, which will in turn provide critical insights that enable climate models to correctly describe the amount of light present under sea ice, and for heat deposition studies in the upper ocean.

Spontaneous spinal cord infarctions: a systematic review and pooled analysis protocol.

INTRODUCTION: Spinal cord infarction (SCInf) is a rare ischaemic event that manifests with acute neurological deficits. It is typically classified as either spontaneous, defined as SCInf without any inciting event, or periprocedural, which typically occur in conjunction with vascular surgery with aortic manipulations. While periprocedural SCInf has recently been the subject of intensified research, especially focusing on the primary prevention of this complication, spontaneous SCInf remains less studied. METHODS AND ANALYSIS: Electronic databases, including PubMed, Web of Science and Embase, will be searched using the keywords "spinal cord", "infarction", "ischemia" and "spontaneous". The search will be set to provide only English studies published from database inception. Editorials, letters and reviews will also be excluded. Reference lists of relevant records will also be searched. Identified studies will be screened for inclusion, by one reviewer in the first step and then three in the next step to decrease the risk of bias. The synthesis will address several topics of interest including epidemiology, presentation, diagnostics, treatment strategies, outcomes and predictors. The review aims to gather the body of evidence to summarise the current knowledge on SCInf. This will lead to a better understanding of the condition, its risk factors, diagnosis and management. Moreover, the review will also provide an understanding of the prognosis of patients with SCInf with respect to neurological function, quality of life and mortality. Finally, this overview of the literature will allow the identification of knowledge gaps to help guide future research efforts. ETHICS AND DISSEMINATION: Ethics approval was not required for our review as it is based on existing publications. The final manuscript will be submitted to a peer-reviewed journal.

A Novel IoT-Enabled Healthcare Monitoring Framework and Improved Grey Wolf Optimization Algorithm-Based Deep Convolution Neural Network Model for Early Diagnosis of Lung Cancer.

Lung cancer is a high-risk disease that causes mortality worldwide; nevertheless, lung nodules are the main manifestation that can help to diagnose lung cancer at an early stage, lowering the workload of radiologists and boosting the rate of diagnosis. Artificial intelligence-based neural networks are promising technologies for automatically detecting lung nodules employing patient monitoring data acquired from sensor technology through an Internet-of-Things (IoT)-based patient monitoring system. However, the standard neural networks rely on manually acquired features, which reduces the effectiveness of detection. In this paper, we provide a novel IoT-enabled healthcare monitoring platform and an improved grey-wolf optimization (IGWO)-based deep convulution neural network (DCNN) model for lung cancer detection. The Tasmanian Devil Optimization (TDO) algorithm is utilized to select the most pertinent features for diagnosing lung nodules, and the convergence rate of the standard grey wolf optimization (GWO) algorithm is modified, resulting in an improved GWO algorithm. Consequently, an IGWO-based DCNN is trained on the optimal features obtained from the IoT platform, and the findings are saved in the cloud for the doctor's judgment. The model is built on an Android platform with DCNN-enabled Python libraries, and the findings are evaluated against cutting-edge lung cancer detection models.

An Optimization-Linked Intelligent Security Algorithm for Smart Healthcare Organizations.

IoT-enabled healthcare apps are providing significant value to society by offering cost-effective patient monitoring solutions in IoT-enabled buildings. However, with a large number of users and sensitive personal information readily available in today's fast-paced, internet, and cloud-based environment, the security of these healthcare systems must be a top priority. The idea of safely storing a patient's health data in an electronic format raises issues regarding patient data privacy and security. Furthermore, with traditional classifiers, processing large amounts of data is a difficult challenge. Several computational intelligence approaches are useful for effectively categorizing massive quantities of data for this goal. For many of these reasons, a novel healthcare monitoring system that tracks disease processes and forecasts diseases based on the available data obtained from patients in distant communities is proposed in this study. The proposed framework consists of three major stages, namely data collection, secured storage, and disease detection. The data are collected using IoT sensor devices. After that, the homomorphic encryption (HE) model is used for secured data storage. Finally, the disease detection framework is designed with the help of Centered Convolutional Restricted Boltzmann Machines-based whale optimization (CCRBM-WO) algorithm. The experiment is conducted on a Python-based cloud tool. The proposed system outperforms current e-healthcare solutions, according to the findings of the experiments. The accuracy, precision, F1-measure, and recall of our suggested technique are 96.87%, 97.45%, 97.78%, and 98.57%, respectively, according to the proposed method.

Geotechnical and environmental radioactivity investigations at Al Sadis Min Uktober city, Cairo municipality (Egypt), for the high-speed railway construction.

The present study aims to evaluate the possibility of constructing a new high-speed railway (HSR) at Al Sadis Min Uktober city, Cairo (Egypt): geotechnical and environmental radiological hazards are estimated from several collected soil and water samples. A variety of laboratory geotechnical tests such as grain size, free swelling test, liquid and plastic limits, chemical analysis and uniaxial compression strength are applied to sixty-one drill holes. A geotechnical examination of the coarse-grained soil at the foundation level classified it as poorly graded soil. The results of the investigation of fine-grained soil at the foundation level shown that the liquid limit ranges from 22% to 55%, the plastic limit ranges from 12% to 28%, the plasticity index varies from 11% to 33%, free swelling varies from 51% to 71%. Mechanically, the uniaxial compressive strength values on rock samples range from 6.96 MPa to 142.39 MPa. The radioactive study is performed to detect the 226Ra, 232Th, and 40 K activity concentrations of the soil samples: their mean values are 34 ± 10 Bq·kg-1, 14 ± 5 Bq·kg-1 and 552 ± 20 Bq·kg-1, respectively. The values of radiological hazard indexes are not exceeded the permissible limits: e.g. the mean value of absorbed dose rate is 47 ± 6 nGy h-1; the annual gonadal dose equivalent is 0.3 ± 0.04 mSv·y-1; the lifetime cancer risk is 02 ± 0.2·10-3. Thus, the soil in the studied railway area is safe to use in building materials and infrastructure applications: the radiological hazards and the geotechnical studies confirmed the studied area is suitable to construct a new community having a HSR. According to the SWOT-PEST and environmental impact analyses, the construction of the HSR meets the criteria of the Kyoto Protocol, the EU Climate and Energy policy, and other international treaties.

Nearshore bathymetry and seafloor property studies from Space lidars: CALIPSO and ICESat-2.

In shallow nearshore waters, seafloor heights and properties can be accurately measured by the current generation of space-based elastic backscatter lidars: CALIOP, flying aboard the CALIPSO satellite and ATLAS aboard ICESat-2. CALIOP's 532 nm volume depolarization ratios, together with the ratios of the attenuated backscatter coefficients measured at 532 nm and 1064 nm, can efficiently distinguish optically shallow waters from nearby land surfaces and deep oceans. ATLAS's high vertical resolution photon measurements can accurately determine seafloor depths in shallow water bodies, characterize seafloor reflectance, and provide assessments of ocean biomass concentrations in the intervening water column. By adding bathymetry, seafloor optical properties (e.g., reflectance, depolarization ratio and attenuated backscatter), and nighttime observations, space lidar measurements obtained in nearshore waters can provide a wealth of unique information to complement existing satellite-based ocean color remote sensing capabilities. The results reported here demonstrate the feasibility of using satellite lidars for nearshore seafloor ecosystem analyses, which in turn provide critical insights for studies of coastal navigation and seabed topography changes due to disasters, as well as the temporal and spatial morphological evolution of coastal systems.

Meta-Analysis Comparing Fractional Flow Reserve and Angiography-Guided Complete Revascularization of Nonculprit Artery for ST-Elevation Myocardial Infarction.

This study aimed to compare complete revascularization (CR) guided by angiography with a fractional flow reserve (FFR)-guided strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). CR is preferred to culprit-only revascularization for patients with STEMI and MVD. However, whether FFR-guided CR is superior to angiography-guided CR is unclear in patients presenting with STEMI who have MVD. Randomized controlled trials comparing CR with an FFR- or angiography-guided strategy to culprit-only revascularization in patients with STEMI and MVD were systematically identified. A random-effects network meta-analysis was performed comparing clinical outcomes in the 3 arms. A total of 13 studies with a total of 8,927 patients were included in our analysis. Compared with culprit-only revascularization, angiography-guided CR was associated with a significantly decreased risk of myocardial infarction (MI) (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.37 to 0.82), all-cause death (HR 0.69, 95% CI 0.49 to 0.97), and cardiovascular death (HR 0.54, 95% CI 0.34 to 0.85) but FFR-guided CR was not (MI: HR 0.77, 95% CI 0.53 to 1.12; cardiovascular death: HR 0.89, 95% CI 0.64 to 1.24; all-cause death: HR 0.93, 95% CI 0.72 to 1.18). The network meta-analysis comparison of angiography- versus FFR-guided CR showed an HR of 0.75 (95% CI 0.50 to 1.11) for all-cause death and an HR of 0.71 (95% CI 0.54 to 1.17) for MI. In conclusion, for patients with MVD presenting with STEMI, angiography-guided CR may provide additional benefits compared with FFR-guided CR.

Tailoring 3D-Printed Electrodes for Enhanced Water Splitting.

Alkaline water electrolysis, a promising technology for clean energy storage, is constrained by extrinsic factors in addition to intrinsic electrocatalytic activity. To begin to compare between catalytic materials for electrolysis applications, these extrinsic factors must first be understood and controlled. Here, we modify extrinsic electrode properties and study the effects of bubble release to examine how the electrode and surface design impact the performance of water electrolysis. We fabricate robust and cost-effective electrodes through a sequential three-dimensional (3D) printing and metal deposition procedure. Through a systematic assessment of the deposition procedure, we confirm the close relationship between extrinsic electrode properties (i.e., wettability, surface roughness, and electrochemically active surface area) and electrochemical performance. Modifying the electrode geometry, size, and electrolyte flow rate results in an overpotential decrease and different bubble diameters and lifetimes for the hydrogen (HER) and oxygen evolution reactions (OER). Hence, we demonstrate the essential role of the electrode architecture and forced electrolyte convection on bubble release. Additionally, we confirm the suitability of ordered, Ni-coated 3D porous structures by evaluating the HER/OER performance, bubble dissipation, and long-term stability. Finally, we utilize the 3D porous electrode as a support for studying a benchmark NiFe electrocatalyst, confirming the robustness and effectiveness of 3D-printed electrodes for testing electrocatalytic materials while extrinsic properties are precisely controlled. Overall, we demonstrate that tailoring electrode architectures and surface properties result in precise tuning of extrinsic electrode properties, providing more reproducible and comparable conditions for testing the efficiency of electrode materials for water electrolysis.

Online Teaching Practicum in Malaysia in the Time of COVID-19 Pandemic.

When the teachers' training practicum was paralyzed during the COVID-19 pandemic, preservice teachers in Malaysia were required to adapt to the online practicum. This qualitative case study was conducted with 20 preservice teachers to investigate their online teaching practicum experiences. The study drew on the Engagement Theory and Disaster Management Cycle framework to further suggest teaching approaches that might be effective during a tragic situation. Data were collected from interviews and video observations, and analyzed thematically. The findings contribute to the understanding of how preservice teachers learn to modify their teaching practices during the challenging context. A number of themes related to positive experience were identified: (i) higher confidence level, (ii) improved interaction, (iii) engagement in active learning, and (iv) adapting to online syllabus. On the other hand, the negative experience revolves around the problem with Internet connection. It is hoped that the findings of this study will encourage preservice teachers to consider hybrid approaches and online teaching in the future.

Study on the Impact and Water Absorption Performance of Prosopis juliflora & Glass Fibre Reinforced Epoxy Composite Laminates.

Current global trends demand the replacement of synthetic fibres with natural fibres in polymeric composites. The present work makes use of Prosopis juliflora, a plant that is a threat to the environment as a partial replacement in a hybrid composite. Individual Prosopis juliflora fibres are added to matrices at ratios of 12, 6, 9 and 8 wt % and glass fibres are added discretely at ratios of 28, 24, 21 and 32 wt % into matrices as well. The composites are prepared with four different combinations and tested in terms of the mechanical benefits and water absorption performance. This work exploits the mechanical advantage of impact energy in addition to producing Prosopis juliflora particles, fibre glass mats, and resin appropriate for structural uses. Water absorption tests are conducted for four different compositions. Among the four samples, sample 3 (9 wt % Prosopis juliflora fibres and 21 wt % glass fibres) has a higher rate of water absorption than the others, although sample 2 (6 wt % Prosopis juliflora fibres and 24 wt % glass fibres) has a lower rate. The difference in the quantity of water absorption between the hybrid composites can be attributed to the weight percentage of fibres. On the other hand, sample 1 (12 wt % Prosopis juliflora fibres and 28 wt % glass fibres) is reported to have absorbed 2.6 J of energy in the impact strength test. The increase in impact strength is attributed to the increase in the weight percentage of glass fibres. A scanning electron microscope is employed to study the fractured surfaces of the composites. This study shows that the developed hybrid composite could be employed in structural and automotive applications because of its improved impact strength and water resistance.