ObjectiveTo systematically identify and analyse all published literature relating to the provision of undergraduate education for preparedness in ear, nose and throat (ENT) surgery, as perceived by ...medical students and clinicians in the UK.DesignSystematic literature review.Data sources5 major databases were searched: MEDLINE, EMBASE, ERIC, Cochrane and Web of Science. The literature search was conducted from February to April 2015.Eligibility criteria for selecting studiesPrimary research or studies that report on the provision of undergraduate education for preparedness in ENT, from the perspective of medical students and clinicians in the UK. The timescale of searches was limited from 1999 onwards (ie, the past 15 years).Data extractionThe literature search was conducted by 2 independent reviewers. Search terms used involved the combination and variation of 5 key concepts, namely: medical student, clinician, ENT, undergraduate medical education and UK. A data extraction form was designed for and used in this study, based on guidelines provided by the UK National Health Service (NHS) Centre for Reviews and Dissemination. Textual narrative synthesis was used for data analysis.ResultsA total of 7 studies were included in the final review. 4 main themes were identified: confidence in managing patients, teaching delivery, student assessment and duration of rotations. A consistent finding in this review was that the majority of final year medical students and junior doctors did not feel adequately prepared to practise ENT. Important factors influencing preparedness in ENT included the duration of clinical rotations, the opportunity for hands-on learning and formal assessment.ConclusionsThe findings of this review suggest the need for further development of the ENT undergraduate curricula across the UK. However, there is insufficient evidence from which to draw strong conclusions; this in itself is beneficial as it highlights a gap in the existing literature and supports the need for primary research.
In this work, we develop a kinetic model of tumour growth taking into account the effects of clinical uncertainties characterising the tumours’ progression. The action of therapeutic protocols trying ...to steer the tumours’ volume towards a target size is then investigated by means of suitable selective-type controls acting at the level of cellular dynamics. By means of classical tools of statistical mechanics for many-agent systems, we are able to prove that it is possible to dampen clinical uncertainties across the scales. To take into account the scarcity of clinical data and the possible source of error in the image segmentation of tumours’ evolution, we estimated empirical distributions of relevant parameters that are considered to calibrate the resulting model obtained from real cases of primary glioblastoma. Suitable numerical methods for uncertainty quantification of the resulting kinetic equations are discussed and, in the last part of the paper, we compare the effectiveness of the introduced control approaches in reducing the variability in tumours’ size due to the presence of uncertain quantities.
•New kinetic model for tumour growth with clinical uncertainties.•The action of therapeutic protocols steers the tumours’ volume towards a target size.•The introduced therapies reduce the variability due to uncertain quantities.•Calibration of the model based on MRI scans.•Examples based on UQ methods for kinetic equations.
Many engineering structures are subjected to random loading. The problem of predicting crack growth rates in this case cannot be solved without an accurate knowledge of load-time history occurring in ...service. There are many calculating models of crack propagation under spectrum loading, such as Wheeler model Wheeler O. Spectrum loading and crack growth. J Basic Eng D 1972;94:181–86, Huang et al. Huang XP, Zhang JB, Cui WC, Leng JX. Fatigue crack growth with overload under spectrum loading. Theor Appl Mech 2005;44:105–15 which use different approaches trying to explain fatigue crack growth.
In this paper we use Decoopman’s Decoopman X. Influence des conditions de chargement sur le retard à la propagation d’une fissure de fatigue après l’application d’une surcharge. Thesis, Université de Sciences et Technologies de Lille; 1999 model. He has developed an empirical model which describes the fatigue crack propagation after an overload cycle on 12NC6 steel in fatigue. This model describes how the crack growth rate evolves during the delay induced by the overload.
Nevertheless, it is limited to overload cycles. But, many authors
Rushton PA, Taheri F. Prediction of crack growth in 350 WT steel subjected to constant amplitude with over and underloads using a modified Wheeler approach. Marine Struct 2003;16:517–39; Sander M, Richard HA. Fatigue crack growth under variable amplitude loading. Part I: Experimental investigations. Fatigue Fract Eng Mater Struct 2005;29:291–301; Huang XP, Zhang JB, Cui WC, Leng JX. Fatigue crack growth with overload under spectrum loading. Theor Appl Mech 2005;44:105–15; Paris P, Erdogan F. A critical analysis of crack propagation laws. J Basic Eng Trans Am Soc Mech Eng 1963; 528–34 have shown that an underload cycle occurring after an overload cycle reduces the delay.
This study proposes to implement the underload effect in order to decrease the conservative results expected from this model. Decoopman’s model proposes a delay weighting factor after an overload cycle. In order to take into account of an underload cycle, we suggest an acceleration coefficient to correct the model. The main advantage of this model is that the delay weighting factor and the acceleration coefficient are only dependent on yield stress
σ
Y, the crack length
a, and the various plastic zone sizes. Many experimental results have been compared to simulated results. These comparisons show a good agreement.
The aim of this study is to simulate fatigue crack propagation under random loading conditions using a simple algorithm based on the Wheeler model
Wheeler O. Spectrum loading and crack growth. J ...Basic Eng D 1972;94:181–86. To create the computer simulation, a model based on the mechanical properties of the material has been used. These properties include the yield stress (
σ
y) and Paris’s constants
C and
m. The loading conditions (baseline loading ratio
R, baseline stress intensity factor range Δ
K and overload stress intensity factor
K
ol,
R
ol) are also required. The present model is validated with fatigue crack growth test data conducted on 12NC6 steel samples with four different heat treatments in order to have different types of mechanical behavior. The computer simulation and experimental results for crack propagation for different overload distributions (a single overload, a repeated overload, different overload magnitudes, random overload) are in good agreement.
Abstract
Background
beam radiotherapy (IBRT) is increasingly used for the treatment of head/neck cancers in order to spare radiosensitive structures. The occurrence of brain radiation necrosis (RN) ...following this modality has been reported in small case series, although its long-term outcome has not been clarified yet. The aim of this study is to define the clinical and radiological course of brain RN after IBRT, with a focus on neuropsychological (NPS) deficits and epilepsy.
Material and Methods
Patients were prospectively identified from 07/2014 to 10/2017 during their follow-up at CNAO Foundation. Inclusion criteria were: 1) history of IBRT for a head/neck cancer; 2) age ≥18 years at the time of IBRT; 3) new MRI alterations compatible with brain RN. Enrolled patients underwent multimodal evaluations (including neurological examination, contrast brain MRI, EEG,and NPS testing), at the time of RN detection, after three months and then every six months.
Results
A total of 22 patients were identified. All of them had received IBRT for intracranial extraparenchymal tumors. Median age at the time of IBRT was 49 years (range 29–64). IBRT consisted of protons in 9 cases and of carbon ions in 13 cases. Median total dose was 68.8 GyRBE (range 14–76.8). Six patients had been previously irradiated. Median time from the end of IBRT to RN identification was 16 months (range 3–37). In 86% of cases, RN was identified during scheduled MRI scans. RN was located in the temporal lobes in 21 cases (95%). At the time of RN detection, 71% of the patients tested had NPS deficits. Six patients developed seizures (27%). Patients were followed for a median of 23 months (range 4–41). Sixteen patients (73%) needed corticosteroid therapy and 9 (41%) were started on antiepileptic drugs. At last follow-up, 35% of patients still had multidomain NPS deficits. Within the first six months of follow-up, 74% of patients had the appearance of new enhancing lesions o enlargement of previously described lesions on MRI, though in most cases RN was reduced at last radiological follow-up.
Conclusion
The incidence of RN peaks during the second year after IBRT. Although in most cases RN was identified during scheduled MRI scans, cognitive deficits and symptomatic epilepsy were detected in a large proportion of patients. Long-term outcome is not predictable, as some patients tend to improve over time, while others develop new symptoms. Corticosteroids and antiepileptic drugs are needed in most patients to control symptoms.
Introduction
During the Corona virus pandemic, anxiety was one of the most felt emotions. Anxiety can lead to maladaptive coping behaviors, including decreased productivity at work. There are some ...mechanisms that buffer the devastaing effect that anxiety can have, and one of them is self-compassion. The impact on mental health during the pandemic has increased, especially among healthcare professionals, and needs further exploration
Objectives
This study aims to investigate the relationships between anxiety, productivity and self-compassion at work among healthcare professionals, as well as, the possibility of self-compassion playing the role of a relationship’s moderator, in a pandemic context.
Methods
The study gathers the result from 202 participants, who completed a questionnaire on an online platform. We examined the link between anxiety, respectively COVID-19 anxiety, productivity and self-compassion, as well as the link between self-compassion and productivity among healthcare workers in a pandemic context. In order to emphasize the objectives, the validated BAI, CAS, SPS-SV and SCS-SV scales were used.
Results
In terms of results, significant negative correlations were identified in the relationships between anxiety, COVID-19 anxiety, productivity and self-compassion, and a significantly positive correlation in the self-compassion-productivity relationship. Also, we studied if self-compassion could be a relationship moderator. As the results show, the study identified a statistically insignificant effect of self-compassion on the relationships anxiety-productivity and anxiety of COVID-19-productivity, among health workers.
Conclusions
The present study has achieved its proposed objectives, so that through future research, anxiety, productivity and self-compassion can be explored not only in a pandemic context, but also in a normal context of professional activity in the medical field, and it can also contribute to the identification of other moderators of the anxiety-productivity relationship.
Disclosure of Interest
None Declared
Steroid biosynthesis is a complex process in which cholesterol is converted to steroid hormones with the involvement of multiple enzymes and cofactors. Inborn conditions affecting adrenal ...steroidogenesis are relatively common in paediatric practice and have serious implications on patient mortality and morbidity. This paper provides an overview of novel insights into human adrenal steroid biosynthesis. Inborn errors of steroidogenesis associated with congenital adrenal hyperplasia are discussed, with a particular focus on the pathophysiology and clinical features of 21-hydroxylase deficiency. The final section of the review presents more recent findings and clinical implications of adrenal-specific androgen biosynthesis.
Although ovarian cystic teratoma is the most common ovarian tumor, complications are quite rare. However, it is important to be recognized by the radiologist in order to avoid inaccurately diagnosing ...them as malignant lesions. This case report describes a 61-year-old postmenopausal woman, who presented to the emergency room with abdominal pain following a minor blunt abdominal trauma. In this context, a CT scan was performed, which showed the presence of round, hypodense masses randomly distributed in the peritoneum, with coexisting ascites in moderate amount; ovarian carcinoma with peritoneal carcinomatosis was suspected. The patient was hospitalized and an MRI of the abdomen and pelvis was recommended for a more detailed lesion characterization. Following this examination, the patient was diagnosed with mature cystic ovarian teratoma complicated by rupture. Surgery was performed, and the outcome was favorable. The cases of ruptured cystic teratomas are rare, and to our knowledge, this is the first occurrence described in literature. Special attention must be paid when confronting with such a case in medical practice, since it can easily misdiagnosed as peritoneal carcinomatosis.
Introduction
Starting with December 2019, the first cases of SARS-CoV2 virus appeared in the Wuhan region of China, which will become the COVID-19 pandemic and will have an impact on the ...bio-psycho-socio-cultural environment. Lockdown and social isolation measures have been imposed in an attempt to gain time and find a viable treatment and a vaccine, for this new infection. The media, in an attempt to promote these measures and information about COVID-19 symptoms, have further increased fear of the virus in population.
Objectives
This presentation tried to observe the impact of the COVID-19 pandemic on patients confirmed positive with SARS- CoV2 infection, treated in hospitals, inpatients who died by suicide.
Methods
As methods a brief review of the literature was made, based on research in scientific articles published in PubMed, APA PsychNet, The BMJ, Who.int, using as keywords the terms “pandemic covid-19”, “inpatients” and “suicide”, published between January 2020 - October 2020.
Results
Several studies conducted to assess the impact of the pandemic on mental health found a significant increase in dysphoria, unhappiness, irritability, anxiety, dominant thoughts related to the transmission of the SARS-CoV2 virus, a tendency to worry about their health and culminating with suicide in the medical unit.
Conclusions
Depending on the psychological structure of each person and the socio-cultural context, different behaviors were observed related to the impact of this pandemic on mental health. The most important is, however, the occurrence of a significant number of deaths by suicide in hospitals in the context of social isolation, patients without a psychiatric history.
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