Robust optimization of a novel ultraviolet (UV) photoreactor for water disinfection: A neural network approach.

To optimize the ultraviolet (UV) water disinfection process, it is crucial to determine the ideal geometric dimensions of a corresponding model that enhance performance while minimizing the impact of uncertain photoreactor inputs. As water treatment directly affects people's lives, it is crucial to eliminate the risks associated with the non-ideal performance of disinfection photoreactors. Input uncertainties greatly affect photoreactor performance, making it essential to develop a robust optimization algorithm in advance to mitigate these effects and minimize the physical and financial resources required for constructing the photoreactors. In the suggested algorithm, a two-objective genetic algorithm is integrated with a non-intrusive polynomial chaos expansion (PCE) technique. Additionally, the Sobol sampling method is employed to select the necessary samples for understanding the system's behavior. An artificial neural network surrogate model is trained using sufficient data points derived from computational fluid dynamics (CFD) simulations. A novel type of UV photoreactors working based on exterior reflectors is chosen to optimize the process with three uncertain input parameters, including UV lamp power, UV transmittance of water, and diffusive fraction of the reflective surface. In addition, four geometrical design variables are considered to find the optimal configuration of the photoreactor. The standard deviation (SD) and the reciprocal of log reduction value (LRV) are set as the objective functions, calculated using PCE. The optimal design provides a LRV of 3.95 with SD of 0.2. The coefficient of variation (CoV) of the model significantly declines up to 7%, indicating the decreased sensitivity of the photoreactor to the input uncertainties. Additionally, it is discovered that the robust model exhibits minimal sensitivity to changes in reflectivity in various flow rates, and its output variability aligns with the SD obtained through robust optimization.

Implementation of Intrahospital Transfer Strategy During COVID-19 and Identify Success Factors Based on DEMATEL Technique.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID. METHODS: Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors' success. RESULTS: The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria. CONCLUSION: The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies.

Data-Driven Fundraising: Strategic Plan for Medical Education.

Unlabelled: Higher education institutions, including medical schools, increasingly rely on fundraising to bridge funding gaps and support their missions. This paper presents a viewpoint on data-driven strategies in fundraising, outlining a 4-step approach for effective planning while considering ethical implications. It outlines a 4-step approach to creating an effective, end-to-end, data-driven fundraising plan, emphasizing the crucial stages of data collection, data analysis, goal establishment, and targeted strategy formulation. By leveraging internal and external data, schools can create tailored outreach initiatives that resonate with potential donors. However, the fundraising process must be grounded in ethical considerations. Ethical challenges, particularly in fundraising with grateful medical patients, necessitate transparent and honest practices prioritizing donors' and beneficiaries' rights and safeguarding public trust. This paper presents a viewpoint on the critical role of data-driven strategies in fundraising for medical education. It emphasizes integrating comprehensive data analysis with ethical considerations to enhance fundraising efforts in medical schools. By integrating data analytics with fundraising best practices and ensuring ethical practice, medical institutions can ensure financial support and foster enduring, trust-based relationships with their donor communities.

Data-Driven Fundraising: A Strategic Plan for Medical Education.

UNSTRUCTURED: Higher education institutions, including medical schools, increasingly rely on fundraising to bridge funding gaps and support their missions. This manuscript presents a viewpoint on data-driven strategies in fundraising, outlining a four-step approach for effective planning while considering ethical implications. It outlines a four-step approach to creating an effective, end-to-end, data-driven fundraising plan, emphasizing the crucial stages of data collection, data analysis, goal establishment, and targeted strategy formulation. By leveraging internal and external data, schools can create tailored outreach initiatives that resonate with potential donors. However, the fundraising process must be grounded in ethical considerations. Ethical challenges, particularly when fundraising from grateful medical patients , necessitate transparent and honest practices prioritizing donors' and beneficiaries' rights and safeguarding public trust. This manuscript presents a viewpoint on the critical role of data-driven strategies in fundraising for medical education. It emphasizes integrating comprehensive data analysis with ethical considerations to enhance fundraising efforts in medical schools. By integrating data analytics with fundraising best practices and ensuring ethical practice, medical institutions can ensure financial support and foster enduring, trust-based relationships with their donor communities.

Comparison of Theory of Mind between Patients with Major Depressive Disorder and Stimulant-Induced Depressive Disorder.

Objective: Theory of mind (ToM) denotes the ability to understand the mental state of others and perceive their unique beliefs and emotions. In this study, we compared ToM between individuals with major depressive disorder (MDD) and stimulant-induced depressive disorder (SIDD). Method : This cross-sectional, causal-comparative study included patients with MDD or SIDD admitted to Ostad Moharary Neuropsychiatric Hospital between January and June 2022. Each diagnosis was confirmed through a semi-structured interview conducted by a single attending psychiatrist according to the DSM-5 criteria. After consecutive sampling of 110 individuals, 51 patients completed the study in each group. Demographic characteristics were recorded, and the Persian version of the revised Reading the Mind in the Eyes Test (RMET) was used to evaluate ToM. Statistical analysis was performed using SPSS v.25, employing the t-test, chi-squared test, linear regression, and analysis of covariance (ANCOVA). Results: Our analysis included 102 subjects (65.7% male) with a mean age of 35.17 ± 7.54 years. The two groups were similar in age, gender, marital status, working status, occupation, economic class, and ethnicity (P > 0.05). The RMET scores were 12.94 ± 4.03 and 11.86 ± 3.15 in the MDD and SIDD groups, respectively (P = 0.135). Almost all patients had low RMET scores (< 22); only two individuals in the MDD group achieved normal scores (22-30). ANCOVA revealed no significant confounding effects between the independent variables. Furthermore, regression analysis revealed that the level of education had a significant linear relationship (ß = 0.249) with the RMET score (P = 0.021). Conclusion: Hospitalized patients with MDD and SIDD have similar ToM deficits, as measured by the RMET.

Land evaluation approaches comparing TOPSIS and SAW with parametric methods for rice cultivation.

Population growth has resulted in an increase in land exploitation on a large scale. Therefore, to increase crop yield and sustainable use of soil, it is necessary to exploit the land according to its potential. Due to land suitability assessment's multifactor nature, it needs a method for evaluating the factors simultaneously; in this case, multi-criteria decision models can be used. Therefore, this study aimed to compare the efficiency of the parametric method (square root) with multi-criteria decision-making approaches (technique for order of preference by similarity to ideal solution (TOPSIS) and simple additive weighting (SAW)) for evaluating land suitability in some rice cultivated areas in Khuzestan province, southwest Iran. A total of 28 rice farms were selected in the study area, and a pedon was dug, examined, and sampled in each. Several physicochemical land characteristics were used for the evaluation process, such as soil, climate, and topographical factors. According to the results, soil texture is the main limiting factor for rice farming in the study region, and organic carbon, salinity, and alkalinity ranked next. The range of land index for rice cultivation calculated by the square root method was from 19.3 to 70.9, from 49 to 95.3 by TOPSIS, and from 3.57 to 74.7 by SAW. The calculated explanatory coefficients between the actual yield and land indices for rice products estimated by the square root method, the TOPSIS approach, and the SAW method were 0.44, 0.63, and 0.60, respectively. This result confirms the high accuracy of TOPSIS method compared to SAW and square root methods. TOPSIS is therefore the ideal method for prioritizing options based on the simulation of the ideal answer because it is highly technical and robust in its decision-making approach. Furthermore, it uses the standardization method, equations, mathematical matrices, and suitable weights. Overall, it can be recommended as a suitable efficiency approach for land suitability evaluation.

Prediction of difficult laryngoscopy / difficult intubation cases using upper airway ultrasound measurements in emergency department: a prospective observational study.

INTRODUCTION: Difficult laryngoscopy and intubation are serious problems among critically ill patients in emergency department (ED) so utility of a rapid, accurate and noninvasive method for predicting of these patients are necessary. Ultrasonography has been recently used in this regard and this study was conducted to investigate the correlation of some introduced upper airway ultrasound parameters with difficult laryngoscopy / difficult intubation in patients referred to the ED. METHOD: In this prospective observational study all patients ≥ 18-year-old who had an indication for rapid sequence intubation (RSI) were included. Ultrasound parameters including Hyoid Bone Visibility (HBV), Distance from Skin to Hyoid Bone (DSHB), Distance from Skin to Vocal Cords (DSVC), Distance from Skin to Thyroid Isthmus (DSTI), and Distance between Arytenoids Cartilages (DBAC) were measured in all cases. The patients underwent RSI and thereafter the patients' baseline characteristics, Cormack-Lehane grade, number of attempted laryngoscopy were recorded in a pre-prepared check list and compared with measured ultrasound parameters. The "difficult laryngoscopy" was defined as Cormack-Lehane classification grades III/IV; and need for more than 3 intubation attempts was considered as "difficult intubation". RESULTS: One hundred and twenty-three patients (52% male) were included of whom 10 patients (8.1%) were categorized as difficult laryngoscopy cases; and just 4 (3.3%) cases underwent more than 3 laryngoscopy attempts who considered as difficult intubation cases. The mean age of the patients in non-difficult and difficult intubation groups were 69.2 ± 15.16 and 68.77 ± 17.37 years, respectively (p > 0.05). There was no significant relationship between difficult laryngoscopy and HBV (p = 0.381) but has significant correlation with difficult intubation (p = 0.004). The DSHB had a significant correlation with difficult laryngoscopy (p = 0.002) but its correlation with difficult intubation was not significant (p = 0.629). The DSVC and DSTI had a significant relationship with both difficult laryngoscopy (p = 0.003 and p = 0.001), and difficult intubation (p = 0.025 and p = 0.001). The DBAC had not significant correlation neither with the difficult laryngoscopy (p = 0.142), nor with difficult intubation (p = 0.526). CONCLUSION: The findings showed that ultrasound parameters including soft tissue DSHB, DSVC and DSTI could be proper predictors of difficult laryngoscopy. Also, HBV, DSVC and DSTI may be proper predictors for difficult intubation. But DBAC was not useful in this regard.

An Innovative Master in Anatomy: Combining Anatomy With Educational Scholarship.

The purpose of this article is to describe the design of a unique, bilingual (English and French) Master of Applied Sciences (M.Sc.) in Anatomical Sciences Education (ASE) program at a Canadian postsecondary institution. Anatomy is a core foundational discipline that is essential to many undergraduate, graduate, and professional programs in the health sciences. However, the number of new individuals with the necessary knowledge base and the pedagogical training to teach cadaveric anatomy are in short supply and cannot satisfy the number of openings for trained educators in the field. The M.Sc. in ASE was created to meet the increasingly critical need for instructors trained in human anatomy. The program is designed to prepare students for a career teaching human anatomy to students in the health sciences, emphasizing hands-on cadaveric dissection. Moreover, this program aims to develop educational scholarship skills in trainees by leveraging faculty expertise in medical education research, particularly in the field of anatomy education research. This focus on scholarships will make graduates more competitive for future faculty positions. During their first year of the program, learners will develop clinically relevant anatomy knowledge, teaching skills, and anatomy education scholarship. In the second year, students will benefit from an immediate, hands-on application of this acquired knowledge. In the same year, students will serve as anatomy teachers in the faculty's Medical Program and conduct their education scholarship projects, culminating in a formal research paper. Although similar programs have been developed in recent years, this article provides the first description of the creation of a graduate program in anatomy education. It includes needs assessment, program development, challenges faced, and lessons learned during the approval process. The article serves as a valuable resource for other institutions aspiring to develop similar initiatives.

The Rapid Arterial oCclusion Evaluation (RACE) scale accuracy for diagnosis of acute ischemic stroke in emergency department - A multicenter study.

OBJECTIVE: It seems that the available data on performance of the Rapid Arterial oCclusion Evaluation (RACE) as a prehospital stroke scale for differentiating all AIS cases, not only large vessel occlusion (LVO), from the stroke mimics is lacking. As a result, we intend to evaluate the accuracy of the RACE criteria in diagnosing of AIS in patients transferred to the emergency department (ED). METHOD: The present study was a diagnostic accuracy cross-sectional study during 2021 in Iran. The study population consist of all suspected acute ischemic stroke (AIS) patients who transferred to the ED by emergency medical services (EMS). A 3-part checklist consisting of the basic and demographic information of the patients, items related to the RACE scale, and the final diagnosis of the patients based on interpretation of patients' brain MRI was used for data collection. All data were entered in Stata 14 software. We used the ROC analysis to evaluate the diagnostic power of the test. RESULT: In this study, data from 805 patients with the mean age of 66.9 ± 13.9 years were studied of whom 57.5% were males. Of all the patients suspected of stroke who transferred to the ED, 562 (69.8%) had a definite final diagnosis of AIS. The sensitivity and specificity of the RACE scale for the recommended cut-off point (score ≥ 5) were 50.18% and 92.18%, respectively. According to the Youden J index, the best cut-off point for this tool for differentiating AIS cases was a score > 2, at which sensitivity and specificity were 74.73% and 87.65%, respectively. CONCLUSION: It seems that, the RACE scale is an accurate diagnostic tool to detect and screen AIS patients in ED, Of course, not at the previously suggested cut-off point (score ≥ 5), but at the score > 2.

Development and modeling of a novel type of photoreactors with exterior ultraviolet (UV) reflector for water treatment applications.

Ultraviolet (UV) water disinfection method has emerged as an alternative to chemical methods of disinfection. In typical UV photoreactors for water treatment, water flows in the space between the lamp's sleeve and outer shell. The contact of water and sleeve causes fouling, which reduces the effectiveness of UV. To clean the photoreactor, the quartz sleeve must be replaced; this may lead to quartz or lamp breakage and mercury leakage into water during cleaning. In this study, a novel type of multi-lamp UV photoreactors is proposed, in which the UV lamps are placed out of the water channel and their UV irradiation is redirected into the channel using an outer cylindrical reflector. This allows for the installment of a self-cleaning mechanism for the water channel. A well-validated three-dimensional CFD model is utilized to model the performance of this photoreactor for microbial inactivation. The impacts of several geometrical and optical parameters are investigated on the inactivation of microorganisms. The results revealed that the difference in log reduction values (LRV) between fully specular and fully diffuse reflector ranges from 10 to 47% as the lamp-to-channel distance increases. For the volumetric flow rate of 25 GPM, the LRV of a photoreactor with fully diffuse reflector can be 46% higher than a fully specular one. In addition, the performance of the proposed photoreactor is compared against a classic L-shaped annular photoreactor. The results show that the new design can provide equal or better microbial performance compared to the classic photoreactor, but it removes many of their common issues such as quartz fouling, lamp overheating at low flow rates, and sleeve breakage during lamp replacement.

Implementation of Clean Hospital Strategy and Prioritizing Covid-19 Prevention Factors Using Best-Worst Method.

Many nations have suffered the catastrophe of COVID-19, and one of the first countries affected by the pandemic was Iran; all industries and individuals have been adversely affected by the pandemic. Health care systems and patients' conditions, in particular, were disrupted due to canceling elective surgery. To put it more sharply, a delay in performing elective surgery may potentially impact patients' survival and the quality of their lives. To cope with the new situation, in the first stage, the Clean Hospital strategy was proposed in order to minimize the effects of this pandemic on elective surgical services. The mentioned strategy is a try to provide a solution and resume elective surgeries in the pandemic period. In the second stage, panel discussion, Delphi method, and the best-worst method (BWM) were employed to prioritize the factors that inhibit Coronavirus transmission. The proposed strategy and the results of this study could be used by policymakers and health departments to resume elective surgeries and control the infection to maintain a hospital or a section of it clear. The overall result of the study showed that the most important Covid-19 prevention factors in Clean Hospitals were personal protection (w = 0.212), screening checklist (w = 0.182), and check body temperature (w = 0.126), respectively (C1 > C2 > C3). According to the financial, time, and human resource limitations, first, resources were allocated to higher priority criteria, and in order of priority, all items (C1, C2, …., C9) were used in the Clean hospital strategy.

The Outcome Predictors of the Patients with Traumatic Brain Injury; A Cross-Sectional Study.

Objective: To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admitted to emergency department (ED). Methods: This is a cross-sectional study that data gathering was performed via census methods, retrospectively. During one year, all head injury's patients who admitted to the ED of a tertiary center in Tehran, Iran were included. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS) on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration of hospitalization, and in hospital outcomes were recorded. Outcome's assessment for survivors was performed within a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes' association were assessed. Results: Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men. Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patients died. Logistic regression analysis showed the association between assessed variables and patients' outcome as follows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumatic Intracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days (OR: 0.28; p=0.001). Conclusion: The findings of the current study distinguished some variables that were associated with the poor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need close continues monitoring, early ICU admission, and some other special extra care in ED.

Clients' Satisfaction with Services Provided by Ambulances and Motor Ambulances of Tehran Emergency Medical Services: A Cross-sectional Study.

Background: To improve the quality of services provided by emergency medical services (EMS), a correct understanding of the current situation and analysis of possible problems is required. The purpose of this study was to investigate the level of clients' satisfaction regarding the missions performed by ambulances and motor ambulances (motorlances) of the Tehran EMS center, and also identify the factors affecting their satisfaction. Methods: This cross-sectional study was conducted for 1 month in Tehran, Iran. All clients in the age range of 18 to 87 years who were approached by Tehran EMS motorlances or ambulances were eligible. Those with wrong registered phone numbers, uninformed callers (passers, coworkers), and those who were not willing to participate in the study were excluded. A valid and reliable researcher-made questionnaire was used to assess the clients' satisfaction. Missions were surveyed routinely, 1 to 2 days following their performance. The questionnaires were filled out by the investigators via a telephone call to the patients or the patients' siblings. The collected data were statistically analyzed using IBM SPSS Statistics 24.0. An independent t test and 1-way analysis of variance were used to compare the mean satisfaction score between the groups. Other tests, such as the Pearson correlation coefficient, were also used to examine the relationship between quantitative variables. P<0.05 were considered statistically significant. Results: In total, the data of 1100 missions were analyzed. The age range of the patients was between 1 and 100 years and their mean age was 52.1 ± 19.2 years, and the mean age of interviewees was 44.4 ± 13.4 years (18-87 years); of all the interviewees, 610 (55.5%) were women. The overall satisfaction of people with the Tehran EMS was rated as "very satisfied" in 78.5% of the cases; However, 11.2% of the participants had moderate and low satisfaction. We found that overall satisfaction was related to dependence on the health group (p≤0.001), educational status (p=0.006), economic status (p=0.002), sent vehicle (p=0.040), and diagnosis (p<0.001). Conclusion: Almost 80% of the participants were highly satisfied with the services provided by Tehran EMS motorlances/ambulances, according to this study. Those with a higher educational level, higher socioeconomic class, accurate diagnosis, proper sent car, and health dependency showed a higher level of happiness than the others.

Fundraising in Education: Road Map to Involving Medical Educators in Fundraising.

Traditional funding models must change as governments decrease funding and often freeze tuition at a domestic level. As a result, universities face an increasing need to diversify their business models, including revenue streams. Therefore, interest in raising significant funds from other sources is stronger than ever, leading to the need for a fundraising approach that is more sophisticated. Medical educators and health professionals are some of the most trusted members of society, and with this paper, the authors aim to raise awareness of the critical role they play in helping universities with their global impact and fundraising efforts.

Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study.

BACKGROUND: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers' willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. OBJECTIVE: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. METHODS: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. RESULTS: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician's office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son's or daughter's mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. CONCLUSIONS: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other's perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives.

Tricuspid Annular Plane Systolic Excursion (TAPSE) Measurement by Emergency Medicine Residents in Patients Suspected of Pulmonary Emboli.

OBJECTIVES: We aimed to evaluate the ability of emergency medicine (EM) residents to measure tricuspid annular plane systolic excursion (TAPSE) by M-Mode ultrasound. METHODS: Four EM residents with prior focused cardiac ultrasound (FOCUS) experience participated in 10 hours of hands-on training and then performed TAPSE measurements in adult patients at high risk of having pulmonary emboli (PE) between December 2020 and April 2021. Patients underwent bedside echocardiography by cardiology residents, and a CT pulmonary angiogram (CTPA) was performed to confirm the diagnosis. The agreement between EM and cardiology residents was assessed by intraclass correlation coefficient (ICC). RESULTS: Sixty-six patients were included (mean age = 58.7 ± 16.7 years), of which 28 patients (42.8%) had positive CTPA. The mean TAPSE, measured by EM residents was 16.36 ± 1.59 mm in the PE positive group and 21.68 ± 2.87 mm in the PE negative group (P-value = <.0001). The mean ± SD TAPSE, measured by cardiology residents, was 17.7 ± 1.98 mm in the PE group and 22.5 ± 3.6 mm in the PE negative group (P-value = <.0001). There was significant agreement between EM and cardiology residents in terms of measuring TAPSE (ICC = 0.91, 95% confidence interval [CI] = 0.80-0.95). The receiver operating characteristic (ROC) curves of TAPSE for diagnosing PE revealed that TAPSE, measured by EM residents, had a high level of accuracy (area under the ROC curve [AUC] = 0.93, 95% CI, 0.878-0.99). CONCLUSIONS: EM residents can perform M-Mode TAPSE measurement in suspected PE cases after 10 hours of hands-on training. TAPSE measurement should be added to routine FOCUS protocols, especially when there is suspicion of PE.

Intracranial Displacement Measurements Within Targeted Anatomical Regions of a Postmortem Human Surrogate Brain Subjected to Impact.

The dynamic response of the human brain subjected to impulsive loading conditions is of fundamental importance to the understanding of traumatic brain injuries. Due to the complexity of such measurements, the existing experimental datasets available to researchers are sparse. However, these measurements are used extensively in the validation of complex finite element models used in the design of protective equipment and the development of injury mitigation strategies. The primary objective of this study was to develop a comprehensive methodology to measure displacement in specific anatomical regions of the brain. A state-of-the-art high-speed cineradiography system was used to capture brain motion in post-mortem human surrogate specimens at a rate of 7500 fps. This paper describes the methodology used to capture these data and presents measurements from these tests. Two-dimensional displacement fields are presented and analyzed based on anatomical regions of the brain. These data demonstrated a multi-modal displacement response in several regions of the brain. The full response of the brain consisted of an elastic superposition of a series of bulk rotations of the brain about its centre of gravity. The displacement field could be linked directly to specific anatomical regions. The methods presented mark an improvement in temporal and spatial resolution of data collection, which has implications for our developing understanding of brain trauma.

Five-Year Outcomes After Hybrid Coronary Revascularization: A Single Center Experience.

OBJECTIVE: Hybrid coronary revascularization (HCR) combines both surgical and percutaneous coronary revascularization procedures. It offers a minimally invasive strategy for multivessel coronary artery disease and combines the advantages of both. However, quantitative long-term patency and clinical outcomes remain understudied. The objective of this study was to assess clinical outcomes and graft and stent patency at 5-year follow-up. METHODS: From January 2004 to January 2015, 120 patients were enrolled in this study. They underwent robotically assisted minimally invasive coronary artery bypass grafting of left internal thoracic artery (LITA) to the left descending artery (LAD) and percutaneous coronary intervention of non-LAD vessels. Primary outcome was graft (LITA-LAD) patency determined at 5 years of follow-up, assessed by computed tomography angiography and rest and stress myocardial perfusion scintigraphy (MPS-MIBI). Secondary outcomes were stent patency and major adverse major cardiac and cerebrovascular events (MACCE). Also, freedom from recurrence of angina was assessed. RESULTS: At follow-up, 18 of 120 patients (15%) had died (in 5 patients the cause of death was cardiovascular). Among survivors, follow-up was achieved in 83 of 102 (81%). In 76 of 83 patients (92%) there was a patent LITA-LAD graft and in 75 of 83 (90%) a patent stent was demonstrated. MACCE occurred in 36 of 120 patients (30%). Freedom from recurrence of angina occurred in 92 of 120 patients (77%). CONCLUSIONS: HCR is a safe and a promising procedure. It provides a minimally invasive approach and results in complete revascularization with good 5-year patency and clinical outcomes.

Comparing Diazepam Plus Fentanyl With Midazolam Plus Fentanyl in the Moderate Procedural Sedation of Anterior Shoulder Dislocations: A Randomized Clinical Trial.

BACKGROUND: The reduction of shoulder dislocation requires adequate procedural sedation and analgesia. The mixture of midazolam and fentanyl is reported in the literature, but long-acting benzodiazepines in conjunction with fentanyl are lacking. STUDY OBJECTIVE: Our aim was to compar e IV diazepam with IV midazolam in moderate procedural sedation (based on the classification of the American Society of Anesthesiologists) for the reduction of shoulder dislocation. METHODS: This was a randomized controlled clinical trial conducted from April 2019 to December 2019 in the emergency department of a university-affiliated hospital in Tehran, Iran. Participants were adult patients (aged 18-65 years) with anterior shoulder dislocation. Group A (n = 42) received diazepam 0.1 mg/kg plus fentanyl 1 µg/kg IV and group B received midazolam 0.1 mg/kg plus fentanyl 1 µg g/kg IV. Main outcomes measured were onset of muscle relaxation, time taken to reduction, total procedure time, number of the reduction attempts, patient recovery time, the occurrence of the adverse effects, amount of the pain reported by the patients using visual analog scale, and patients and physicians overall satisfaction with the procedure using a Likert scale question. RESULTS: Eighty-one patients were included. The mean ± standard deviation time of the onset of the muscle relaxation and time taken to reduction was shorter in the diazepam plus fentanyl group (p = 0.016 and p = 0.001, respectively). Adverse effects and pain relief were not statistically different between the two groups. Patient recovery time and total procedure time was shorter in the midazolam plus fentanyl group (p = 0.008 and p = 0.02, respectively). The overall satisfaction of patients and physicians was higher in the diazepam plus fentanyl group. CONCLUSIONS: As compared with midazolam plus fentanyl, diazepam plus fentanyl was superior in terms of the onset of the muscle relaxation, patient and physician satisfaction, and time taken to reduction.

Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability.

INTRODUCTION: The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. METHODS: Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. RESULTS: For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. CONCLUSION: The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.