Hybrid architectures for terahertz molecular polaritonics.

Atoms and their different arrangements into molecules are nature's building blocks. In a regime of strong coupling, matter hybridizes with light to modify physical and chemical properties, hence creating new building blocks that can be used for avant-garde technologies. However, this regime relies on the strong confinement of the optical field, which is technically challenging to achieve, especially at terahertz frequencies in the far-infrared region. Here we demonstrate several schemes of electromagnetic field confinement aimed at facilitating the collective coupling of a localized terahertz photonic mode to molecular vibrations. We observe an enhanced vacuum Rabi splitting of 200 GHz from a hybrid cavity architecture consisting of a plasmonic metasurface, coupled to glucose, and interfaced with a planar mirror. This enhanced light-matter interaction is found to emerge from the modified intracavity field of the cavity, leading to an enhanced zero-point electric field amplitude. Our study provides key insight into the design of polaritonic platforms with organic molecules to harvest the unique properties of hybrid light-matter states.

Gradenigo Syndrome in a 6-Year-Old Boy with Acute Otitis Media: A Case Report.

Gradenigo Syndrome (GS) is not a common intracranial complication of acute otitis media infections that needs proper diagnosis and management. This case report presents a 6-year-old child diagnosed with unilateral headache, right eye diplopia, and right abducens nerve palsy. MRI and cranial nerve examination facilitate the confirmation of GS. The patient was treated with proper antibiotics and showed good outcomes. This case report highlights the importance of early detection and understanding of the clinical picture associated with GS, which have a crucial role in achieving desired outcomes and avoiding serious complications.

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care.

BACKGROUND: Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications. METHODS: All patients enrolled in the multicenter ClassIntra® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other's ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI®), a weighted sum of all postoperative complications according to the Clavien-Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra® on CCI® was assessed with a multivariable mixed-effects generalized linear regression analysis. RESULTS: Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI® was observed. CONCLUSION: Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.

Predicting long-term risk of reoperations following abdominal and pelvic surgery: a nationwide retrospective cohort study.

BACKGROUND: The risk of reoperations after abdominal and pelvic surgery is multifactorial and difficult to predict. The risk of reoperation is frequently underestimated by surgeons as most reoperations are not related to the initial procedure and diagnosis. During reoperation, adhesiolysis is often required, and patients have an increased risk of complications. Therefore, the aim of this study was to provide an evidence-based prediction model based on the risk of reoperation. MATERIALS AND METHODS: A nationwide cohort study was conducted including all patients undergoing an initial abdominal or pelvic operation between 1 June 2009 and 30 June 2011 in Scotland. Nomograms based on multivariable prediction models were constructed for the 2-year and 5-year overall risk of reoperation and risk of reoperation in the same surgical area. Internal cross-validation was applied to evaluate reliability. RESULTS: Of the 72 270 patients with an initial abdominal or pelvic surgery, 10 467 (14.5%) underwent reoperation within 5 years postoperatively. Mesh placement, colorectal surgery, diagnosis of inflammatory bowel disease, previous radiotherapy, younger age, open surgical approach, malignancy, and female sex increased the risk of reoperation in all the prediction models. Intra-abdominal infection was also a risk factor for the risk of reoperation overall. The accuracy of the prediction model of risk of reoperation overall and risk for the same area was good for both parameters ( c -statistic=0.72 and 0.72). CONCLUSIONS: Risk factors for abdominal reoperation were identified and prediction models displayed as nomograms were constructed to predict the risk of reoperation in the individual patient. The prediction models were robust in internal cross-validation.

The psychological impact of the ongoing COVID-19 pandemic on health-care workers in primary health-care centers in resource-poor settings.

Background: Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan. Materials and Methods: This is a health facility-based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff. Results: A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n = 44) of the participants. Women were significantly more likely to be affected than men (P = 0.0). Age (21-40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0). Conclusion: This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase.

The perception of shared governance and engagement in decision-making among nurses.

BACKGROUND: Shared governance is a structural framework for operationalizing nursing ownership and accountability for nursing practice. Healthcare institutions are striving to promote healthy and satisfactory work conditions to retain their qualified personnel and achieve organizational stability and high care quality. However, little is known about nurses' participation in governance in developing countries. AIM: This study aims to evaluate the levels of shared governance, also known as professional governance, among nurses in Jordan. The demographics of the study participants will also be assessed. METHODS: The current study used a cross-sectional design implementing an anonymous online survey technique to collect data from 111 nurses on the Index of Professional Nursing Governance (IPNG). Descriptive statistics were performed to evaluate the nurses' perception of the concept of shared governance in the domains of personnel, information, resources, participation goals and conflict resolution, and practice. RESULTS: Among the 111 nurses, 55% of the participants were females, 45.5% were affiliated with governmental hospitals, and about half of them worked in critical care units. The analysis showed that the mean score for the total IPNG was 113 (SD = 26.28). The analyses of the mean scores of IPNG domains ranged from 11.5 (SD = 4.6) for goals and conflict resolution to 23.8 (SD = 5.7) for access to information. DISCUSSION: The results revealed that nurses' average perception of professional governance demonstrated shared governance, and more specifically, in the lower level of shared governance where decisions are made primarily by management with some staff input. Analysis of the domains of governance revealed that participants' scores corresponded with shared governance in the areas of information, resources, goals and conflict, and practice, while traditional governance was prevalent in the governance of nursing personnel and participation. CONCLUSION: There is an agreement on the need of moving the position of frontline nurses to the center of their organizations where equity, accountability, and ownership are the pillars of participative governance. Frontline nurses need further empowerment to be more actively engaged especially in the management of nursing staff and related structures and in the participation in structures connected to governance activities at different organizational levels such as in committees.

Association between Alexithymia and Depression among King Khalid University Medical Students: An Analytical Cross-Sectional Study.

Alexithymia is a condition in which a person is unable to explain his/her emotions, bodily sensations, or discuss sentiments. This study aims to determine the prevalence of alexithymia and its relationships with socio-demographics and depression among medical students. A cross-sectional survey was conducted among medical students at King Khalid University (KKU), Saudi Arabia. A stratified random sampling technique was utilized for data collection using the Toronto Alexithymia Scale (TAS-20) and the Patient Health Questionnaire-9 (PHQ-9). A multiple logistic regression model was used to identify the factors associated with alexithymia. A total of 333 students participated in this study, almost two-thirds (64.6%) were from clinical years, and 51.4% were females. The prevalence of alexithymia and depression was 47.4% and 88.9%, respectively. Regression analysis showed females had a doubled risk (OR = 2.09), and students with high-income status showed less probability of having alexithymia (OR = 0.39), whereas people with chronic health problems showed a doubled risk for alexithymia (OR = 2.04). Moreover, depression was significantly associated with alexithymia (OR = 1.91). Our study revealed that the prevalence of alexithymia was high along with depression among studied samples. This raises attention towards finding measures to reduce it for the better performance of students and to avoid psychological problems in the future.

Adipogenic Stimulation and Pyrrolidine Dithiocarbamate Induced Osteogenic Inhibition of Dental Pulp Stem Cells Is Countered by Cordycepin.

BACKGROUND: dental pulp-derived stem cells are easy to access and collect and are an excellent source of stem cells for regenerative therapy. These cells can interact with many biomolecules and scaffolds and can pass on the instructive signals to the sites of regeneration where they are used. In this regard cordycepin, a potential biomolecule derived from medicinal mushrooms with a spectrum of bioactive properties such as antioxidant, anti-inflammatory, and anticancer has not yet been tested for its effect on human dental pulp stem cells. OBJECTIVE: the objective of the present study was to assess the in vitro adipogenic and osteogenic differentiation potential of human dental pulp stem cells with or without induction after administration of cordycepin. MATERIALS AND METHODS: human dental pulp stem cells DPSCs were isolated from a healthy permanent tooth extracted for orthodontic purposes after obtaining informed consent. Flow cytometry technique was used to assess the surface markers of these cells such as CD73, CD90, and CD105, CD34, CD45, and HLA-DR. Further, an MTT assay was performed on the cells after subjecting them to various concentrations of cordycepin. Following this, the adipogenic and osteogenic potential of the dental pulp stem cells was assessed with or without induction under the influence/absence of 5 µM of cordycepin. The results obtained were statistically analyzed and documented. RESULTS: it was found that the dental pulp stem cells showed strong positive expression for CD73, CD90, and CD105 and faint expression of CD34, CD45, and HLA-DR. MTT assay revealed that 5 µM was the optimum concentration of cordycepin for all the assays. Concerning adipogenesis experiments, there was a statistically significant lowering of all the 4 adipogenesis-related genes PPARγ, FABP4, LPL, and C/EBPα following cordycepin treatment in the presence of induction compared to the only induction group and untreated control cells (p < 0.05). In connection with osteogenesis, was found that there was a statistically significant increase in the expression of RUNX2, COL1A1, OSX and OCN genes along with the increase in alkaline phosphatase and alizarin red staining in the DPSC treated with cordycepin along with the presence of induction and simultaneous addition of PDTC compared to the control untreated cells and cells treated with induction and simultaneous addition of PDTC (p < 0.05). CONCLUSION: cordycepin can be exploited for its osteopromotive properties and can be used as a bioactive molecule alongside the administration of dental pulp stem cells in the area of regenerative biology and medicine.

Quantifying the annual incidence and underestimation of seasonal influenza: A modelling approach.

BACKGROUND: Seasonal influenza poses a significant public health and economic burden, associated with the outcome of infection and resulting complications. The true burden of the disease is difficult to capture due to the wide range of presentation, from asymptomatic cases to non-respiratory complications such as cardiovascular events, and its seasonal variability. An understanding of the magnitude of the true annual incidence of influenza is important to support prevention and control policy development and to evaluate the impact of preventative measures such as vaccination. METHODS: We use a dynamic disease transmission model, laboratory-confirmed influenza surveillance data, and randomized-controlled trial (RCT) data to quantify the underestimation factor, expansion factor, and symptomatic influenza illnesses in the US and Canada during the 2011-2012 and 2012-2013 influenza seasons. RESULTS: Based on 2 case definitions, we estimate between 0.42-3.2% and 0.33-1.2% of symptomatic influenza illnesses were laboratory-confirmed in Canada during the 2011-2012 and 2012-2013 seasons, respectively. In the US, we estimate between 0.08-0.61% and 0.07-0.33% of symptomatic influenza illnesses were laboratory-confirmed in the 2011-2012 and 2012-2013 seasons, respectively. We estimated the symptomatic influenza illnesses in Canada to be 0.32-2.4 million in 2011-2012 and 1.8-8.2 million in 2012-2013. In the US, we estimate the number of symptomatic influenza illnesses to be 4.4-34 million in 2011-2012 and 23-102 million in 2012-2013. CONCLUSIONS: We illustrate that monitoring a representative group within a population may aid in effectively modelling the transmission of infectious diseases such as influenza. In particular, the utilization of RCTs in models may enhance the accuracy of epidemiological parameter estimation.

Ultrafast modulation of the spectral filtering properties of a THz metasurface.

We demonstrate ultrafast tuning of a plasmonic spectral filter at terahertz (THz) frequencies. The device is made of periodically spaced gold crosses deposited on the surface of an undoped silicon wafer in which transient free carriers can be optically injected with a femtosecond resonant pulse. We demonstrate the concept by measuring the transmission spectrum of a notch filter using time-domain THz spectroscopy. Proper synchronization of the THz probe and visible excitation pulses leads to an enhanced transmission at the resonance by more than two orders of magnitude. Finite-difference time-domain simulations, which are in agreement with the experimental results, show that the underlying mechanisms responsible for the resonance blueshift and linewidth broadening can be attributed to the photoinduced change in dielectric properties of the substrate. This is supported by the numerically simulated field distribution and reflection/transmission coefficients. The device can be used in future pulse shaping and ultrafast switching experiments.

What Are the Challenges and Facilitators for Implementing a 24-Hour Telephone Cancer Service in Qatar? A Literature Review.

Objective: To identify the challenges and facilitators for implementing a 24-h telephone cancer service. Data sources: English language articles were retrieved from Medline, Cumulative Index of Nursing and Allied Health Literature, and Ovid Nursing electronic databases published from 2000 to 2015. Study Design: The authors performed an integrative literature review. The qualitative and quantitative articles were evaluated using the Critical Appraisal Skills Program. All mixed-methods articles were evaluated using the Mixed Methods Appraisal Tool. Thematic analyses were used to synthesize the findings from the included articles. Findings: The literature of this review highlights the complexity of the decisions that accompany the consideration of implementing a teleoncology in Qatar. The literature review detailed challenges and facilitators for implementing 24-h call service for cancer patients. These were grouped as human, technology, documentary tools, and organizational domains. The core concept that integrates each of these domains is communication. Conclusions: If the telephone triage is to be implemented in National Center for Cancer Care and Research (NCCCR), more research is needed about the characteristics of cancer patients in Qatar. A more robust understanding of this population will inform decisions about the utility of developing a teleoncology service at NCCCR.

Dying for a smoke: how much does differential mortality of smokers affect estimated life-course smoking prevalence?

OBJECTIVE: An extensive literature uses reconstructed historical smoking rates by birth-cohort to inform anti-smoking policies. This paper examines whether and how these rates change when one adjusts for differential mortality of smokers and non-smokers. METHODS: Using retrospectively reported data from the US (Panel Study of Income Dynamics, 1986, 1999, 2001, 2003, 2005), the UK (British Household Panel Survey, 1999, 2002), and Russia (Russian Longitudinal Monitoring Study, 2000), we generate life-course smoking prevalence rates by age-cohort. With cause-specific death rates from secondary sources and an improved method, we correct for differential mortality, and we test whether adjusted and unadjusted rates statistically differ. With US data (National Health Interview Survey, 1967-2004), we also compare contemporaneously measured smoking prevalence rates with the equivalent rates from retrospective data. RESULTS: We find that differential mortality matters only for men. For Russian men over age 70 and US and UK men over age 80 unadjusted smoking prevalence understates the true prevalence. The results using retrospective and contemporaneous data are similar. CONCLUSIONS: Differential mortality bias affects our understanding of smoking habits of old cohorts and, therefore, of inter-generational patterns of smoking. Unless one focuses on the young, policy recommendations based on unadjusted smoking rates may be misleading.