Five-point Scale Research Articles

Reducing Motion Artifacts in Craniocervical Background Subtraction Angiography with Deformable Registration and Unsupervised Deep Learning

Abstract Background In clinical practice, digital subtraction angiography (DSA) often suffers from misregistration artifact due to voluntary, respiratory, and cardiac motion during acquisition. Most prior efforts to register the background DSA mask to subsequent post-contrast images rely on key point registration using iterative optimization, which has limited real-time application. Purpose Leveraging state-of-the-art, unsupervised deep learning, we aim to develop a fast, deformable registration model to substantially reduce DSA misregistration in craniocervical angiography without compromising spatial resolution or introducing new artifacts. Methods We extend HyperMorph, an open source deep learning deformable registration framework, to reduce motion artifacts in DSA. Novel image similarity loss functions with vessel layer estimation were introduced to optimize background registration, making it robust to the variable presence of intravascular iodinated contrast. Results A total of 516 studies with 5,240 angiographic series were collected and divided into training (5046 series) and hold-out test (194 series) sets. Blinded algorithm rankings and Likert scores on five-point scales (1 = worst, 5 = best) were generated by three practicing interventional neuroradiologists using 50 series randomly selected from the hold-out test set. Compared to traditional DSA, our learning-based background subtraction angiography (BSA) significant improved vascular fidelity (2.4 ± 0.6 for DSA vs. 3.6 ± 0.5 for BSA), subtraction artifacts (2.0 ± 0.4 for DSA vs. 3.9 ± 0.3 for BSA), and overall quality (2.1 ± 0.5 for DSA vs. 3.9 ± 0.4 for BSA) (p < 0.0001). Learning-based BSA also significantly outperformed affine registration-based BSA (p < 0.0001). The average inference time for learning-based BSA was 30 milliseconds per frame on our hardware. Conclusion The results demonstrate that deep learning deformable registration, combined with an appropriate loss function, can significantly reduce the motion artifacts that degrade DSA.

The Influence of a Scientific Investigation Workshop on In-service Biology Teachers’ Attitudes Towards Scientific Investigations

Biology teachers’ attitudes play a vital role in successful scientific investigations. Some biology teachers situated in the central part of South Africa experience challenges that include a lack of the necessary scientific knowledge and skills, which hinders the presentation of scientific investigations. These challenges adversely influence these biology teachers’ attitudes towards conducting scientific investigations. The result is that they conduct the minimum number of investigations with their learners, or don’t conduct them at all. Professional, in-service training workshops allow biology teachers to develop the necessary scientific knowledge and skills to successfully conduct scientific investigations. This study aimed to understand how a scientific investigation workshop affected biology teachers’ attitudes by measuring the ABC attitude model’s affective, cognitive and behavioural components. Likert-type, five-point scale items were used for the 20 pre-surveys and the same for the 20 post-surveys that were completed and collected for analysis. This research provided information on how vital in-service training programmes such as this scientific investigation workshop are in fostering positive attitudes toward scientific investigations amongst biology teachers. The findings that emerged from this study imply that implementing this scientific investigation workshop has developed biology teachers’ confidence in their science skills and knowledge to facilitate scientific investigations. The findings also indicate that this workshop caused a significant improvement in teachers’ intended behaviours in implementing scientific investigations in the science classrooms, as they gained valuable knowledge and skills regarding the science apparatus and the use thereof in conducting scientific investigations.

Bridging the Gap: Can Large Language Models Match Human Expertise in Writing Neurosurgical Operative Notes?

Proper documentation is essential for patient care. The popularity of artificial intelligence (AI) offers the potential for improvements in neurosurgical note-writing. The study aimed to assess how AI can optimize documentation in neurosurgical procedures. Thirty-six notes were included. All identifiable data were removed. Essential information, such as perioperative data and diagnosis, was sourced from these notes. ChatGPT 4.0 was trained to draft notes from surgical vignettes using each surgeon's note template. One hundred forty-four surveys, with a surgeon or AI note, were shared with three surgeons to evaluate accuracy, content, and organization using a five-point scale. Accuracy was the factual correctness. Content was the comprehensiveness. Organization was the arrangement of the note. Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) scores quantified each note's readability. The mean AI accuracy (4.44) was not different from the mean surgeon accuracy (4.33, p = 0.512). The mean AI content (3.73) was lower than the mean surgeon content (4.42, p < 0.001). The mean AI organization (4.54) was greater than the mean surgeon organization (4.24, p = 0.064). The mean AI note's FKGL (13.13) was greater than the mean surgeon FKGL (9.99, p <0.001). The mean AI FRE (21.42) was lower than the mean surgeon FRE (41.70, p <0.001). AI notes were on par with surgeon notes in accuracy and organization, but lacked in content. Additionally, AI notes utilized language at an advanced reading level. These findings underscore the potential for ChatGPT to enhance the efficiency of neurosurgery documentation.

A Study on Measuring Spiritual Intelligence among the College Teachers

The purpose of this investigation is to study the Spirituality among the college teachers in Surat district of Gujarat. The present study consisted of 51 college teachers from management, commerce and computer application field. This was measured on a five-point Likert's scale commencing from strongly disagree to strongly agree.

Exploring ecocentrism and anthropocentrism beliefs of Gen Z: An Indonesian context

This study delved into ecological awareness among Generation Z using the New Ecological Paradigm (NEP) scale to discern ecocentric and anthropocentric environmental beliefs. The data was collected from 545 students across state and private universities with categorization based on gender, age group, year level, study program and area of residence employing a quantitative research approach. A five-point Likert-type NEP scale comprising 15 items was administered through Google Forms ensuring representation from each study program. Statistical analysis conducted using SPSS for Windows 23.0 employed independent sample T-tests to evaluate differences in Gen Z's ecological awareness. The results revealed significant disparities in Gen Z's awareness across dimensions including reality, growth limits, anti-anthropocentrism, the fragility of nature's balance and the possibility of an eco-crisis with variations observed based on study programs. Furthermore, age groups influenced awareness of the limits of growth and the possibility of an eco-crisis while gender played a role in awareness of the problem of the limits of growth. Gen Z's ecological orientations depicted differences in ecocentric beliefs by year level and anthropocentric values varied based on area of residence. These findings offer valuable insights into students' alignment with ecological principles and environmental awareness. This research contributes to the broader discourse on sustainable practices and environmental education by enhancing our understanding of how individuals particularly university students, perceive and respond to ecological and environmental challenges.

Correlation of Visual System Biomarkers With Motor Deficits in Experimental Autoimmune Encephalomyelitis-Optic Neuritis.

Experimental autoimmune encephalomyelitis (EAE) scoring, the most commonly used primary outcome metric for an in vivo model of multiple sclerosis (MS), is highly variable and subjective. Here we explored the use of visual biomarkers in EAE as more objective and clinically relevant primary outcomes. Motor impairment in myelin oligodendrocyte glycoprotein-immunized C57BL/6J mice was quantified using a five-point EAE grading scale. Pattern electroretinography (pERG) and retinal ganglion cell/inner plexiform layer (RGC/IPL) complex thickness were measured 60 days after induction. Optic nerve histopathology was analyzed at endpoint. EAE mice displayed motor impairments ranging from mild to severe. Significant correlations were seen between pERG amplitude and last EAE score, mean EAE score, and cumulative EAE score. Optical coherence tomography (OCT) analysis demonstrated a significant correlation between thinning of the RGC/IPL complex and both EAE score and pERG amplitude. Optic nerve histopathology showed significant correlations between demyelination and cumulative EAE score, pERG amplitude, and RGC/IPL complex thickness, as well as between immune cell infiltration and cumulative EAE score, pERG amplitude, and RGC/IPL complex thickness in EAE mice. Unlike EAE scoring, pERG and OCT show direct measurement of retinal structure and function. Therefore we conclude that visual outcomes are well suited as a direct assessment of optic nerve involvement in this EAE model of MS while also being indicative of motor impairment. Standardizing directly translatable measurements as primary outcome parameters in the murine EAE model could lead to more rapid and relevant testing of new therapeutic approaches for mitigating MS.

Validation of a surgical simulator and establishment of quantitative performance thresholds—RealSpine simulation system for open lumbar decompressions

BACKGROUND CONTEXTThe majority of surgical training is conducted in real-world operations. High-fidelity surgical simulators may provide a safer environment for surgical training. However, the extent that it reflects real-world operations and surgical ability is often poorly characterized. PURPOSE(1) Assess the validity and fidelity of a surgical simulator; (2) Examine the quantitative relationship between simulation performance and markers of real-world ability; (3) Establish thresholds for surgical expertise, and estimate their external validity and accuracy. STUDY DESIGN/SETTINGA cohort study of surgeons at a British neurosurgical center. STUDY SAMPLETen early-career “novice” surgeons and 8 board-certified “expert” neurosurgeons. OUTCOMES MEASURES(1) Face and content validity, and visual and haptic fidelity; (2) Construct validity; (3) Predictive and discriminative utility of quantitative performance thresholds. METHODSParticipants performed unilateral lumbar decompressions on high-fidelity spinal simulators that replicate the bony and soft tissue anatomy along with physiological processes such as bleeding and CSF leaks. Operating times, measured from first surgical action to either self-perceived satisfactory decompression or the end of allocated time, were recorded. The performance was also assessed independently by 2 blinded spinal subspecialist neurosurgeons using OSATS, a validated surgical assessment tool that utilizes 5-point scales on a variety of technical domains to grade the overall technical proficiency. Validity and fidelity were assessed by expert neurosurgeons using quantitative questionnaires. Construct validity was assessed by ordinal regression of simulation performance against real-world surgical grade and portfolio. Thresholds of expert status by simulation performance was established, and their predictive and discriminative utility assessed by crossvalidation accuracy and AUC-ROC. RESULTSOperating time and expert assessments of simulation performance (OSATS) were strong and significant prdictors of surrogate markers of real-world surgical ability. The thresholds for expert status were operating time of 15 minutes and modified OSATS score of 15/20. These thresholds predicted expert status with 84.2% and 71.4% accuracy respectively. Strong discriminative ability was demonstrated by AUC-ROC of 0.95 and 0.83 respectively. All expert surgeons agreed that RealSpine simulators demonstrate high face validity, and high visual and haptic fidelity, with overall scores showing statistically significant agreement on these items (all scores at least 4/5, p<.0001). There was less consensus on content validity, but with still significant overall agreement (average score: 3.75/5, p=.023). CONCLUSIONSReal-world surgical ability and experience can be accurately predicted by defining objective quantitative thresholds on high-fidelity simulations. The thresholds established here, along with other data presented in this paper, may inform objectives and standards to be established in a spinal surgical training curriculum.

Evaluation of Artificial Intelligence as a Search Tool for Patients: Can ChatGPT-4 Provide Accurate Evidence-Based Orthodontic-Related Information?

Artificial intelligence (AI) is already a part of our reality. Many people started using ChatGPT in their daily life, replacing existing web browsers. The confidence people put in the ability of ChatGPT to provide accurate medical information is increasing. With that, the need for proper assessment tools for the safety and reliability of ChatGPT is also crucial. This study aimed to assess the accuracy, reliability, andquality of information provided by ChatGPT-4 on three specific orthodontic topics, namely, impacted canines, interceptive orthodontic treatment, and orthognathic surgery, as evaluated by five experienced orthodontists using a Likert scale ranking method. Using ChatGPT version 4, 20 most commonly asked questions were generated and answered on the following topics: impacted canines, interceptive treatment, and orthognathic surgery. The evaluation of the quality of the answers provided was done by five experienced orthodontists. Quality assessment was done using the Likert scale ranking method. The quality answers generated by a conversational AI system (ChatGPT4) were evaluated by five experienced orthodontists for three topics: impacted canines, interceptive orthodontics, and orthognathic surgery. The evaluators rated each question-answer pair on a five-point scale from "very poor" to "very good." The results showed that the AI system produced generally good quality information for all topics, with no significant difference between them. The inter-rater agreement among the experts was low, indicating some variability in their judgments. This study demonstrates that ChatGPT4 can provide generally good information on impacted canines, interceptive treatment, and orthognathic surgery. However, answers provided should be handled with caution due to variability and lack of reliability and should not be considered a substitute for professional opinion.

Evaluation of high-fidelity and virtual reality simulation platforms for assessing fourth-year medical students’ encounters with patients in need of urgent or emergent care

Background Medical students in the U.S. must demonstrate urgent and emergent care competence before graduation. Urgent and emergent care competence involves recognizing, evaluating and initiating management of an unstable patient. High-fidelity (HF) simulation can improve urgent and emergent care skills, but because it is resource intense, alternative methods are needed. Study Objective Our primary purpose was to use program evaluations to compare medical student experiences with HF and virtual reality (VR) simulations as assessment platforms for urgent and emergent care skills. Methods During their emergency medicine clerkship, students at The Ohio State University College of Medicine must demonstrate on HF manikins, competence in recognizing and initiating care of a patient requiring urgent or emergent care. Students evaluated these simulations on a five-point quality scale and answered open-ended questions about simulation strengths and weaknesses. Faculty provided feedback on student competence in delivering urgent or emergent care. In 2022, we introduced VR as an alternative assessment platform. We used Wilcoxon Signed Ranks and Boxplots to compare ratings of HF to VR and McNemar Test to compare competence ratings. Comments were analyzed with summative content analysis or thematic coding. Results We received at least one evaluation survey from 160 of 216 (74.1%) emergency medicine clerkship students. We were able to match 125 of 216 (57.9%) evaluation surveys for students who completed both. Average ratings of HF simulations were 4.6 of 5, while ratings of VR simulations were slightly lower at 4.4. Comments suggested that feedback from both simulation platforms was valued. Students described VR as novel, immersive, and good preparation for clinical practice. Constructive criticism identified the need for additional practice in the VR environment. Student performance between platforms was significantly different with 91.7% of students achieving competence in HF, but only 65.5% in VR (p≤.001, odds-ratio = 5.75). Conclusion VR simulation functions similarly to HF for formative assessment of urgent and emergent care competence. However, using VR simulation for summative assessment of urgent and emergent care competence must be considered with caution because students require considerable practice and acclimation to the virtual environment.

An Investigation into English Language Teachers’ Practices and Challenges of Alternative Assessment: Selected Teacher Education Colleges in Focus

Alternative assessment has got an important place especially in education due to the belief of education should focus on students’ totality cognitive, affective and psychomotor skills in order to produce students that are balanced physically, emotionally and intellectually. This study was aimed at examining education college English language teachers’ practices and challenges of alternative assessment with reference to Hawassa, Hossana, and Arba Minch Colleges of Teacher Education. To this end, a descriptive design with a mixed approach was employed. A questionnaire with five-point scales was used and data were collected from 56 teachers. SPSS version 23 was employed to compute descriptive statistics (frequency, percentage, mean, and standard deviation). A semi-structured interview was also conducted with 6 teachers randomly selected from among those teachers who had filled in the questionnaire and the data were thematized and analyzed qualitatively. The results of questionnaire reveal that the practice of alternative assessment was not effective and efficient due to different challenges (students related challenges, teachers related challenges, characteristics of alternative assessment related challenges and resource related challenges. It is also found that data from interview witnessed that alternative assessment was not practiced effectively due to the aforementioned challenges.

Advancements in Face and Neck Contouring: Integrating Radiofrequency-Assisted Liposuction with FaceTite and Buccal Fat Pad Excision for Facial Slimming.

The integration of neck liposuction with FaceTite Manipulus Radiofrequency (RF) technology and buccal fat pad excision for enhanced neck rejuvenation promise heightened precision and efficacy in sculpting the neck and jawline. Neck liposuction, coupled with RF technology, provides controlled thermal energy for adipose tissue treatment and collagen remodeling, while buccal fat pad excision offers refined contouring of the lower face and neck. This integrated approach aims to optimize patient outcomes and advance the field of esthetic plastic surgery. A prospective study was conducted from 2016 to 2023 on 80 consecutive patients who presented to the author's private clinic and required neck remodeling surgery for esthetic purposes. Patients were monitored and clinic appointments were scheduled at intervals of 0, 1, 3, 6 and 12 months post-treatment for evaluation. A tape measure recorded submental length at 1 and 6 months, and a satisfaction survey was administered one week before surgery and after six months. Physicians assessed improvement using a five-point scale for patient satisfaction and a four-point scale for overall improvement. All patients underwent successful RFAL treatment, consistently achieving satisfaction with the outcomes. The average reduction in submental length measured 23 mm during the 6-month follow-up period. Additionally, the removal of buccal fat pads played a pivotal role in facial slimming and enhancing the esthetics of the upper cheek region. The integration of neck liposuction with FaceTite RF technology and buccal fat pad excision offers a promising approach for enhanced neck rejuvenation and facial contouring. This combined method demonstrates heightened precision and efficacy in sculpting the neck and jawline, aiming to optimize patient outcomes and advance the field of esthetic plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative Study of Ropivacaine and Ropivacaine With Dexmedetomidine in Transversus Abdominis Plane (TAP) Block for Post-operative Analgesia in Patients Undergoing Cesarean Sections.

Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th,and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.

Enabling AI-Generated Content for Gadolinium-Free Contrast-Enhanced Breast Magnetic Resonance Imaging.

There is increasing interest in utilizing AI-generated content for gadolinium-free contrast-enhanced breast MRI. To develop a generative model for gadolinium-free contrast-enhanced breast MRI and evaluate the diagnostic utility of the generated scans. Retrospective. Two hundred seventy-six women with 304 breast MRI examinations (49 ± 13 years, 243/61 for training/testing). ZOOMit diffusion-weighted imaging (DWI), T1-weighted volumetric interpolated breath-hold examination (T1W VIBE), and axial T2 3D SPACE at 3.0 T. A generative model was developed to generate contrast-enhanced scans using precontrast T1W VIBE and DWI images. The generated and real images were quantitatively compared using the structural similarity index (SSIM), mean absolute error (MAE), and Dice similarity coefficient. Three radiologists with 8, 5, and 5 years of experience independently rated the image quality and lesion visibility on AI-generated and real images within various subgroups using a five-point scale. Four breast radiologists, with 8, 8, 5, and 5 years of experience, independently and blindly interpreted four reading protocols: unenhanced MRI protocol alone and combined with AI-generated scans, abbreviated MRI protocol, and full-MRI protocol. Results were assessed using t-tests and McNemar tests. Using pathology diagnosis as reference standard, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each reading protocol. A P value <0.05 was considered significant. In the test set, the generated images showed similarity to the real images (SSIM: 0.935 ± 0.047 [SD], MAE: 0.015 ± 0.012 [SD], and Dice coefficient: 0.726 ± 0.177 [SD]). No significant difference in lesion visibility was observed between real and AI-generated scans of the mass, non-mass, and benign lesion subgroups. Adding AI-generated scans to the unenhanced MRI protocol slightly improved breast cancer detection (sensitivity: 92.86% vs. 85.71%, NPV: 76.92% vs. 70.00%); achieved non-inferior diagnostic utility compared to the AB-MRI protocol and full-protocol (sensitivity: 92.86%, 95.24%; NPV: 75.00%, 81.82%). AI-generated gadolinium-free contrast-enhanced breast MRI has potential to improve the sensitivity of unenhanced MRI in detecting breast cancer. 4 TECHNICAL EFFICACY: Stage 3.

Interim PET-guided ABVD or ABVD/escalated BEACOPP for newly diagnosed advanced-stage classic Hodgkin lymphoma (JCOG1305).

This single-arm confirmatory study (JCOG1305) aimed to evaluate the utility of interim positron emission tomography (iPET)-guided therapy for newly diagnosed advanced-stage classic Hodgkin lymphoma (cHL). Patients aged 16-60 years with cHL received two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and then underwent an iPET scan (PET2), which was centrally reviewed using a five-point Deauville scale. PET2-negative patients continued an additional four cycles of ABVD, whereas PET2-positive patients switched to six cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP). The co-primary endpoints were 2-year progression-free survival (PFS) among all eligible and PET2-positive patients. Ninety-three patients were enrolled between January 2016 and December 2019. One patient was ineligible because of a diagnostic error. The median age of the 92 eligible patients was 35 (interquartile range, 28-48) years. Forty (43%) patients had stage III disease, and 43 (47%) had stage IV disease. The remaining nine (10%) patients had stage IIB disease with risk factors. Nineteen PET2-positive (21%) patients received eBEACOPP, 18 completed six cycles of eBEACOPP, 73 PET2-negative (79%) patients continued ABVD, and 70 completed an additional four cycles of ABVD. With a median follow-up period of 41.1 months, the 2-year PFS of 92 eligible patients and 19 PET2-positive patients were 84.8% (80% confidence interval [CI], 79.2-88.9) and 84.2% (80% CI, 69.7-92.1), respectively. Both primary endpoints were met at the prespecified threshold. This study demonstrates that iPET-guided therapy is a useful treatment option for younger patients with newly diagnosed advanced-stage cHL. Registration number: jRCTs031180218.

Comparison of Physicians' Attitudes and Practice Regarding Vaccination during Pregnancy in Turkey.

This study aimed to investigate the knowledge, attitudes, and behaviors of family physicians (FPs), pediatricians (PPs), and obstetricians and gynecologists (OGs) regarding vaccine administration during pregnancy in Turkey as factors that contribute to decision-making. The survey was distributed among FPs, OGs, and PPs, and participants were asked to rate their knowledge on specific topics using a five-point scale ranging from "Not Effective" to "Effective". The tetanus and diphtheria (Td) vaccine was highly recommended by 94.9% of physicians and considered very effective. Among the physicians surveyed, 80% of PPs and 66.0% of OGs were aware of the disease burden of pertussis. We also found that 74.5% of FPs and 77.2% of PPs believed they needed more information about vaccination during pregnancy. All physicians surveyed agreed or strongly agreed that explaining the disease risks and benefits of vaccination increases the vaccine acceptance rate. The results of this survey study indicate that the knowledge and awareness of physicians need to be improved to increase vaccination rates during pregnancy in Turkey, and it is essential to incorporate influenza and tetanus, diphtheria, and pertussis (TdaP) vaccines into the standard maternal immunization schedule for newborns.

Usefulness of low-cost simulation models to learning surgical techniques for placenta accreta spectrum: An observational educational study.

To evaluate the utility of low-cost simulation models to teach surgical techniques for placenta accreta spectrum (PAS), included in a multimodal education workshop for PAS. This was an observational, survey-based study. Participants were surveyed before and after the use of low-fidelity mannequins to simulate two surgical techniques for PAS (one-step conservative surgery [OSCS] and modified subtotal hysterectomy [MSTH]), within a multimodal educational workshop. The workshops included pre-course preparation, didactics, simulated practice of the techniques using low-cost models, and viewing live surgery. Six OSCS/MSTH training workshops occurred across six countries and a total of 270 participants were surveyed. The responses of 127 certified obstetricians and gynecologists (OB-GYNs) were analyzed. Participants expressed favorable impressions of all components of the simulated session. Perceived anatomical simulator fidelity, scenario realism, educational component effectiveness, and self-assessed performance improvement received ratings of 4-5 (positive end of the Likert scale) from over 90% of respondents. When asked about simulation's role in technique comprehension, comfort level in technique performance, and likelihood of recommending this workshop to others, more than 75% of participants rated these aspects with a score of 4-5 (positively) on the five-point scale. Low-cost simulation, within a multimodal education strategy, is a well-accepted intervention for teaching surgical techniques for PAS.

Climate change extreme events and exposure of local communities to water scarcity: a case study of QwaQwa in South Africa

ABSTRACT The exposure of local communities to multiple climate change-related events is on the rise across the globe. Despite extensive disaster research on climate change, exposure and vulnerability, few studies have focused on the exposure of local communities to multiple climate change-related events. For over a decade QwaQwa, in South Africa, has experienced persistent water crises which have been attributed to climate change and socio-economic drivers. However, there is a lack of understanding of the risk drivers to provide a solid basis for disaster risk reduction and resilience-building. This paper; therefore, aims to conduct analyses of hazards and exposure as part of risk analysis of climate change-related events; notably drought, flooding, wildfires, and water scarcity in QwaQwa. Quantitative and qualitative data sources included key informant interviews, household surveys, and field observations. The study employed the indicator method to analyse both the hazard and exposure. Qualitative data were anlysed using thematic analysis. On a five-point scale, the findings showed high indices of multiple hazards (3.6) and exposure (3.2). Analysis results were validated at a stakeholders’ workshop. The study recommends efficiency in implementing risk-sensitive land use plans, improving early warning systems, and the use of unmanned aerial vehicles to mitigate disaster risks.

Pulsed-field ablation: an alternative ablative method for gastric electrophysiological intervention.

Pulsed-field ablation (PFA) is an emerging ablative technology that has been used successfully to eliminate cardiac arrhythmias. As a nonthermal technique, it has significant benefits over traditional radiofrequency ablation with improved target tissue specificity and reduced risk of adverse events during cardiac applications. We investigated whether PFA is safe for use in the stomach and whether it could modulate gastric slow waves. Female weaner pigs were fasted overnight before anesthesia was induced using tiletamine hydrochloride (50 mg·mL-1) and zolazepam hydrochloride (50 mg·mL-1) and maintained with propofol (Diprivan 2%, 0.2-0.4 mg·kg-1·min-1). Pulsed-field ablation was performed on their gastric serosa in vivo. Adjacent point lesions (n = 2-4) were used to create a linear injury using bipolar pulsed-field ablation consisting of 40 pulses (10 Hz frequency, 0.1 ms pulse width, 1,000 V amplitude). High-resolution electrical mapping defined baseline and postablation gastric slow-wave patterns. A validated five-point scale was used to evaluate tissue damage in hematoxylin and eosin-stained images. Results indicated that PFA successfully induced complete conduction blocks in all cases, with lesions through the entire thickness of the gastric muscle layers. Consistent postablation slow-wave patterns emerged immediately following ablation and persisted over the study period. Pulsed-field ablation induces rapid conduction blocks as a tool to modulate slow-wave patterns, indicating it may be suitable as an alternative to radiofrequency ablation.NEW & NOTEWORTHY Results show that pulsed-field ablation can serve as a gastric slow-wave intervention by preventing slow-wave propagation across the lesion site. Stable conduction blocks were established immediately following energy delivery, faster than previous examples of radiofrequency gastric ablation. Pulsed-field ablation may be an alternative for gastric slow-wave intervention, and further functional and posthealing studies are now warranted.

The demand for agricultural credit in central Chile

PurposeThe design of effective policies that increase access to agricultural credit should consider understanding credit constraint farmers’ groups and their response to changes in the credit conditions. To contribute to this understanding, this study surveyed farmers from Chile and classified them into five credit constraint categories discussed in credit literature. In addition, these farmers indicated how they would react to a series of hypothetical conditions related to changing interest rates, loan maturity and grace periods. Their responses were employed to measure credit demand scores (i.e. relative elasticities). Regression tests evaluated how different types of farmers reacted to changing credit conditions.Design/methodology/approachFarmers from Chile were surveyed using a mix of random and convenience sampling. Surveyed farmers were classified into five credit constraint categories proposed by previous research. Farmers rated their demand for credit on a five-point Likert-type scale for hypothetical changes in interest rates, loan maturities and grace periods. Their responses were employed to measure credit demand scores or relative credit elasticities. The study evaluated credit elasticity as a function of farmers’ credit constraint and some control variables using several regressions, including OLS, ordered probit and hierarchical regression.FindingsThe study identified 44% unconstrained nonborrowing farmers, 23% unconstrained borrowers, 14% quantity-constrained, 16% risk-constrained and 3% transaction cost-constrained farmers. Unconstrained borrowers and quantity-constrained farmers responded most to changing interest rates and loan maturity conditions. In addition, unconstrained nonborrowers and risk-constrained farmers were statistically less sensitive to changes in credit conditions than unconstrained borrowers. This finding is significant because, as discussed, unconstrained nonborrowers represent 44% of our sample. Furthermore, risk-constrained farmers were the least sensitive to changes in interest rates and loan maturity across all other credit categories.Practical implicationsThis study gives insights that can guide agribusiness policies to enhance access to credit in developing countries such as Chile. Agricultural credit capital institutions can better target their clientele by identifying farmers’ possible reactions before implementing policy changes to increase access to credit. This study’s credit constraint categorization and the results discussed can guide that identification. For instance, policies directed toward unconstrained borrowing farmers may find positive responses. However, implementing policies targeting the other three groups (unconstrained nonborrowing, risk-constrained and transaction cost-constrained farmers) is more challenging because these farmers are less responsive to changing credit conditions.Originality/valueThis article correlates farmers’ propensity to borrow and credit constraints across five categories of farmers. Prior research using this categorization framework has not identified farmers into the five groups. Furthermore, in addition to interest rate and loan maturity credit demand relative elasticity, this study adds the grace period elasticity, which has not been included in previous studies on agricultural credit.

Is Community Pharmacies’ Personnel Well-Oriented about Cosmeceuticals? A Cross-sectional Survey and Costumer Simulation

Background: The cosmetics business is one of the most profitable and advanced global trade sectors, and academic and industrial investments have expanded to provide high-quality products to the right consumers. Thus, this cross-sectional survey assessed Iranian pharmacists and pharmacy technicians' (PT) cosmetic product knowledge, attitudes, and behaviors. Methods: Between December 2021 and July 2022, pharmacists and PTs who worked in CPs in Tehran province. Demographics were the first questionnaire section after eligibility and consent. Ten questions test knowledge in the second phase. The third portion has nine pharmacist cosmetic product attitudes self-developed questions. We used five-point Likert spectrum scaling. The final component of the questionnaire includes a pharmacist practice checklist. This fulfilled 12 pharmacists' obligations. PT demographics, knowledge, and attitude were measured using an eight-, five-, and eight-item questionnaire. A cosmetic sales checklist with eight practice items was devised to evaluate PTs. Pharmacists and PTs were evaluated for scientific advice on exfoliating lotion and anti-stain sunscreen use, skin type, history, and brand presentation. Using a 95% confidence interval, binary logistic regression found significant relationships between categorical dependent and independent variables. Pearson correlation measured knowledge-performance linearity. Results: The study included 325 pharmacists and 324 PTs. The average knowledge score for pharmacists was 6.38 ± 1.95, while their practice score was 6.35 ± 1.92 out of 10. The overall knowledge score for PTs was 2.8 ± 0.92 out of 5. Results indicate a strong association between pharmacist and PT knowledge and cosmeceutical performance (r= +0.635 and +0.564, respectively, P &lt; 0.001). Conclusion: This study indicates community pharmacists and PTs in Tehran have a moderate knowledge about cosmeceuticals. Also, a significant correlation between knowledge and performance was observed in both groups.