Strict Protocol Research Articles

The Role of Blood Pressure Control in Prevention of Hematoma After Blepharoplasty.

Hematoma formation after blepharoplasty is serious and potentially vision-threatening, with hypertension being the primary risk factor. The aim of this paper is to assess perioperative blood pressure trends and rates of complication in patients undergoing a strict blood pressure protocol designed to keep perioperative systolic blood pressure below 120 mmHg. A retrospective chart review was performed of 32 patients undergoing face lift with conomitant blepharoplasty from January 2015 to July 2018. For each patient blood pressure readings obtained before, during, and after surgery were reviewed. Two-sample one-tail T-tests were performed, and p values less than 0.05 were considered statistically significant. The mean systolic blood pressure (SBP) for all patients was highest intraoperatively. Patients with known hypertension had higher mean SBPs than patients without hypertension across all phases of care, with a statistically significant difference in immediate preoperative SBP (p=0.05). Males had a higher average blood pressure immediately postoperatively (p=0.05). A previous diagnosis of hypertension in females was associated with a higher immediate preoperative SBP (p=0.07) as well as age over 65 (p=0.07). The overall rate of complications was 37.5%. No patients experienced hematoma. This study demonstrated that keeping blood pressure below 120 mmHg after surgery was an effective method of preventing hematoma after blepharoplasty, even in patients concurrently on anti-coagulative medications. Special attention to blood pressure control should be shown to patients with known risk factors such as a previous diagnosis of hypertension, male sex, or age greater than 65. 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 .

Effect of surgical modification of deep brain stimulation lead trajectories on radiofrequency heating during MRI at 3T: from phantom experiments to clinical implementation.

Radiofrequency (RF) tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during MRI, resulting in strict imaging guidelines and limited allowable protocols. The implanted lead's trajectory and orientation with respect to the MRI electric fields contribute to variations in the magnitude of RF heating across patients. Currently, there are no surgical requirements for implanting the extracranial portion of the DBS lead, resulting in substantial variations in clinical lead trajectories and consequently RF heating. Recent studies have shown that incorporating concentric loops in the extracranial lead trajectory can reduce RF heating. However, optimal positioning of the loops and the quantitative benefit of trajectory modification in terms of added safety margins during MRI remain unknown. In this study, the authors systematically evaluated the characteristics of DBS lead trajectories that minimize RF heating during 3T MRI to develop the best surgical practices for safe access to postoperative MRI, and they present the first surgical implementation of these modified trajectories. The authors performed experiments to assess the maximum temperature increase of 244 distinct lead trajectories. They investigated the effect of the position, number, and size of the concentric loops on the skull. Experiments were performed in an anthropomorphic phantom implanted with a commercial DBS system, and RF exposure was generated by applying a high specific absorption rate sequence (B1+rms = 2.7 µT). The authors conducted test-retest experiments to assess the reliability of measurements. Additionally, they evaluated the effect of imaging landmarks and perturbations to the DBS device configuration on the efficacy of low-heating trajectories. Finally, two neurosurgeons implanted the recommended modified trajectories in patients, and the authors characterized their RF heating in comparison with unmodified trajectories. The maximum temperature increase ranged from 0.09°C to 7.34°C. The authors found that increasing the number of loops and positioning them closer to the surgical burr hole, particularly for the contralateral lead, substantially reduced RF heating. These trajectory modifications were easily incorporated during the surgical procedure and resulted in a threefold reduction in RF heating. Surgically modifying the extracranial portion of the DBS lead trajectory can substantially reduce RF heating during 3T MRI. The authors' results indicate that simple adjustments to the lead's configuration, such as small, concentric loops near the burr hole, can be readily adopted during DBS lead implantation to improve patient safety during MRI.

Protocolo de adquisición de imágenes y medición de la elasticidad pancreática mediante elastografía por onda de cizallamiento bidimensional (2D-SWE) transabdominal

IntroductionTransabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized. ObjectivesEstablish a protocol for image acquisition and measurement of TU pancreatic - 2D-SWE elastography and estimate the minimum number of measurements to be performed. Materials and methodsTen measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement. ResultsThe 70% of the participants were women, with an average age, weight, and BMI of 49.5±15.7 years, 65.9±11.9kg, and 24.5±4.2kg/m2, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46±0.25cm/sec and 6.46±2.87KPa, respectively. The ROI depth was 4.12±1cm and the SP-ROI distance was 5.2mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5-6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3-0.6cm). The measurement accuracy was higher when performed at a depth less than 4.8cm. ConclusionTo measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8cm.

Navigating The Pedagogical Landscape: A Qualitative Inquiry Into Teachers’ Perceptions And Preparedness For Teaching License In Sindh, Pakistan

Quality of teachers’ development, recruitment, and retention holds substantial value when it comes to delivering quality education. In this paradigm, teaching licensing epitomizes the cornerstone of development as it brings professionalism in teaching, executing strict protocols of compliance with quality measures. In the context of Pakistan, the emergence of the Sindh Teaching License Policy has served as a progressive initiative towards elevating the educational caliber in the province to ensure teachers’ adherence and compliance to certain standards of skills, knowledge, and competence and, in turn, bringing professional proficiency to them. The current study is aimed at exploring teacher’s perceptions and readiness concerning the newly introduced teacher licensing system in the context of the province of Sindh, Pakistan. Data was analysed and presented by conducting a thematic analysis of interviews. Findings revealed that when asked about their perceptions, teachers expressed skepticism about licensing policy implementation, cited resource constraints, showed transparency and accountability concerns, called for better stakeholder engagement and support, and finally demanded clarity on policy, benefits, and its impact on their professional status. Moreover, while discussing their readiness and the barriers they encountered, teachers communicated a lack of readiness for the requirements as they felt the absence of formal training and support by their institutions, and the need for supportive resources and test materials. Furthermore, personal financial constraints, resistance to change, and inequity of access were notably hindering access to licensure at the primary individual levels. On the contrary, the senior educational faculty members recognized the significance and need for the policy initiative and careful implementation of the policy. The challenges highlighted include the involvement of private sector schools, the status of existing teachers, the importance of teacher involvement, and the government's responsibility for support. This research study emphasizes the need for dedicated efforts by policymakers and educational stakeholders to enhance teacher licensing and improve the quality of education in Sindh.

COVID-19 case management in primary dental care settings in Yorkshire and the Humber.

Introduction Emerging guidance during the COVID-19 pandemic aimed to minimise transmission risk within dental settings. This service evaluation provides an overview of reported cases of COVID-19 among primary dental care staff within Yorkshire and the Humber.Methods Data for COVID-19 cases reported within dental practices between November 2020 and August 2021 were extracted from the Public Health England, Health Protection Zone database and summarised using descriptive statistics.Results In total, 421 cases across 223 dental practices were reported, with 221 close contacts and 77 outbreaks identified. Cases/contacts were highest among dental nurses (51/49%). Household and community (42/22%) were the most frequently reported sources of transmission, with the majority of staff-to-staff contacts (60%) occurring in communal/non-clinical areas.Discussion There was a low number of reported COVID-19 cases/contacts among dental professionals, with most cases suspected to have acquired the infection from outside of the dental setting. The majority of personal protective equipment breaches occurred within communal/non-clinical areas. When infection prevention and control guidance was followed, there were no incidences of staff or patients becoming contacts or cases.Conclusion With adherence to strict protocols, the risk of COVID-19 transmission in the dental setting was low within the context of this review. The evaluation highlighted the importance of collaborative working during the pandemic.

Towards personalized management of early esophageal adenocarcinoma.

This review aims to discuss recent advancements in the endoscopic management of early esophageal adenocarcinoma (T1 EAC). Patients with high-risk EAC (defined by the presence of deep submucosal invasion, and/or lymphovascular invasion, and/or poor differentiation) have a higher risk of lymph node metastases than those with low-risk EAC. However, more recent, endoscopically-focused studies report a lower risk of lymph node metastases and distant metastases for high-risk EAC than previously assumed. Instead of referring all high-risk EAC patients for esophagectomy after a radical endoscopic resection, an alternative approach involving regular upper endoscopy with endoscopic ultrasound may allow for detection of intra-luminal recurrence and lymph node metastases at an early and potentially curable stage. Endoscopic resection of mucosal and submucosal EAC might prove to be safe and curative for selected cases in the future, when followed by a strict follow-up protocol. Despite the promising results of preliminary studies, there is an ongoing need for personalized strategies and new risk stratification methods to decide on the best management for individual patients with high-risk T1 EAC.

Prospective Analysis of Acute Encephalitis Syndrome: Clinical Characteristics and Patient Outcomes in a Tertiary Care Pediatric Setting

Background: One of the most frequent neurological emergencies in pediatrics, central nervous system infections cause a considerable amount of death and morbidity. Especially in newborns, the symptoms are frequently modest, therefore a strong index of suspicion is needed to make the diagnosis. Inadequate or delayed treatment may result in fatalities or other severe consequences.  Objective: To ascertain the frequency, clinical characteristics, and etiological makeup of kids hospitalized in tertiary PICU due to acute encephalitis syndrome. Results of kids referred to tertiary PICUs with acute encephalitis symptoms.  Study Design: Hospital based prospective study.  Participants: Children with AES from one month up to 18 years of age admitted in PICU of hospitals.  Intervention: Thorough clinical assessments were completed, and blood samples will be sent for various baseline biochemical analyses. In every instance, samples of blood and urine were sent for sensitivity and culture while adhering to strict aseptic protocol. In every incidence of fever with altered sensorium, neuroimaging and CSF analysis will be carried out.The history, clinical examination, and pertinent laboratory investigations are used to determine the etiology of AES.  Results: Out of the one hundred cases that were examined, five had J.E., thirty had rickettsia, twenty had dengue, one had varicella, twelve had COVID-19, five had measles, four were pyogenic, one had tuberculosis, twelve had ADEM, and nine were undiagnosed. A total of 45 patients were lost to follow-up throughout the follow-up period. Of the patients, 16 had hearing loss, 10 had speech loss, 15 had extra pyramidal abnormality, 21 had behavioral abnormality, and 21 had cranial nerve impairments.  Conclusion: AES is a persistent public health issue that requires immediate attention, as well as cooperation and support from other sectors. Strengthening primary health care is urgently needed to provide access to both routine and emergency care, both of which are essential for better results.

Outcomes of Surgical Management of Turf Toe: 12-Year Results.

Background "Turf toe" is a classical capsuloligamentous injury to the plantar surface of the metatarsophalangeal (MTP) joint of the great toe. The name is synonymous with injuries sustained on artificial turf or hard grounds. The classical injury pattern is a hyperdorsiflexion injury with an axial load. The outcomes of these injuries are unpredictable and there are no clear guidelines for the management of these injuries. These injuries are debilitating and can lead to long-term problems and inability to return to pre-injury activity level if missed. We present a long-term surgical follow-up of severe grade 3 turf toe injuries. Methods In the period from 2011 to 2022, we treated 20 patients with turf toe/MTP joint instability. There were 10 football injuries (50%), six running injuries (30%), two gymnastic injuries (10%), one motorcycle injury (0.5%), and one was a ballet dancer (0.5%). All the grade 1 and 2 injuries were treated conservatively with rest, ice application, and splinting of the toe. Grade 3 injuries were treated surgically and strict rehabilitation protocol was followed. Results The mean age at surgery was 32.7 years and the average patient follow-up was 7.5 months after surgery. The Manchester-Oxford Foot Questionnaire (MOXFQ) score showed a statistically significant improvement from a mean of 73.0 (median = 75) preoperatively to 28.1 (median = 28.6) postoperatively (median improvement = 46.4, P = 0.022). Similarly, there was a significant improvement in pain score, which showed an improvement from a mean of 72.9 (median = 70.0) preoperatively to a mean of 22.9 (median = 25.0) postoperatively (median improvement = 51.3, P = 0.022). Conclusion Turf toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. The correct identification, classification, and grading of the first MTP joint instability helps in decision-making and achieving good surgical outcomes.

Analysis of a Large Severe Acute Respiratory Syndrome Coronavirus 2 (Alpha) Outbreak in a Catalan Prison Using Conventional and Genomic Epidemiology.

Enforcing strict protocols that prevent transmission of airborne infections in prisons is challenging. We examine a large severe acute respiratory syndrome coronavirus 2 outbreak in a Catalan penitentiary center in February-April 2021, prior to vaccination deployment. The aim was to describe the evolution of the outbreak using classical and genomic epidemiology and the containment strategy applied. The outbreak was initially detected in 1 module but spread to 4, infecting 7 staff members and 140 incarcerated individuals, 6 of whom were hospitalized (4.4%). Genomic analysis confirmed a single origin (B.1.1.7). Contact tracing identified transmission vectors between modules and prevented further viral spread. In future similar scenarios, the control strategy described here may help limit transmission of airborne infections in correctional settings.

Challenges in the Metabolomics-Based Biomarker Validation Pipeline.

As end-products of the intersection between the genome and environmental influences, metabolites represent a promising approach to the discovery of novel biomarkers for diseases. However, many potential biomarker candidates identified by metabolomics studies fail to progress beyond analytical validation for routine implementation in clinics. Awareness of the challenges present can facilitate the development and advancement of innovative strategies that allow improved and more efficient applications of metabolite-based markers in clinical settings. This minireview provides a comprehensive summary of the pre-analytical factors, required analytical validation studies, and kit development challenges that must be resolved before the successful translation of novel metabolite biomarkers originating from research. We discuss the necessity for strict protocols for sample collection, storage, and the regulatory requirements to be fulfilled for a bioanalytical method to be considered as analytically validated. We focus especially on the blood as a biological matrix and liquid chromatography coupled with tandem mass spectrometry as the analytical platform for biomarker validation. Furthermore, we examine the challenges of developing a commercially viable metabolomics kit for distribution. To bridge the gap between the research lab and clinical implementation and utility of relevant metabolites, the understanding of the translational challenges for a biomarker panel is crucial for more efficient development of metabolomics-based precision medicine.

A Comparative Analysis of Outcomes using PROMIS after Operative vs Non-operative Treatment of Achilles Rupture

Introduction/Purpose: Achilles tendon rupture is a common injury in the adult population. The role of operative and non- operative management remains controversial with the development of functional rehabilitation programs. The purpose of this study is to evaluate and compare the patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and non-operative treatment of acute Achilles rupture. PROMIS is a valid, reliable, and effective tool to evaluate patient outcomes after treatment for Achilles ruptures. Our hypothesis is that there is no significant difference in PROMIS scores between patients undergoing operative compared to non-operative treatment of Achilles rupture. Methods: Under an IRB-approved protocol, Achilles rupture was identified using ICD 9 and ICD10 codes of 727.67 and S86.0. Patients who underwent Achilles tendon primary repair were identified using CPT code 27650 (Repair, primary open or percutaneous, ruptured Achilles tendon). Revision Achilles repair and chronic Achilles ruptures were excluded. All patients treated non-operative underwent a strict functional rehabilitation protocol. We included patients treated between 1/1/2015 and 11/30/2022. PROMIS physical function (PF), pain interference (PI), and depression scores were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method used to determine the minimal clinically important difference (MCID), which was 1/2 standard deviation of each PROMIS domain. A medical records review was performed to collect patient demographic data. Statistical analysis was used to compare preoperative and postoperative scores and significance was indicated when P< 0.05. Results: 216 patients with Achilles tendon ruptured were included (115 Nonoperative versus 101 Operative). Patients treated non-operatively were older than those treated surgically (mean age: 45.1 vs 35.6; p< 0.001). The operative group had a lower BMI compared to non-operative group (27.8 vs. 29.5; p=0.004). There is no statistical difference in the Achilles tendon re-rupture rate between both groups (operative: 2% vs. 4.3%; p=0.344). Both groups are effective in improving PROMIS PF, PI, and depression scores (p < 0.001). The mean PROMIS PF change (pre- to post-treatment) is significantly greater in the operative, compared to the non-operative group (13.2 vs. 9.5; p=0.042). Both treatments had similar mean PROMIS PI change, mean PROMIS depression change, and rates of meeting MCID for all 3 PROMIS domains at 6 months. Conclusion: In patients with Achilles tendon rupture, operative management may lead to statistically significant higher improvements in physical function compared to non-operative management. However, non-operative management was associated with similar overall rates of re-rupture, PROMIS PI and depression outcomes, and chances of meeting MCID as those who underwent operative intervention. Nonoperative management of Achilles tendon rupture, similar to operative treatment, is a successful treatment option and leads to significant improvement in physical function, pain interference, and depression PROMIS scores.

Comparative literature review of student preferences and activity patterns on the use of campus open space before and during The Covid-19 Pandemic at the ITB Ganesha Campus

A campus is a place where students can spend most of their time. There are various activities carried out both academic and non-academic, for self-development and positive socialization. Campus open space is one area that can accommodate these activities. However, the Covid-19 pandemic has had an impact on the loss of various activities on campus. After the effects of the Covid-19 pandemic began to diminish, campus activities have slowly started to becarried out again offline, including activities in campus open spaces. Therefore, it is necessary to review the possibility of changes to preferences and activity patterns in campus open spaces related to the limitations of joint activities as a form of prevention of transmission during the Covid-19 Pandemic. This article would like to review various literature studies related to preferences for the use of open spaces and student activity patterns before the onset of Covid-19, including literature studies related to landscape elements that form spaces that can support student activities in open spaces. This article also reviews the literature on changes in the use of open spaces during the Covid-19 pandemic which was influenced by activity restrictions from the application of strict health protocols.

Development and Validation of a Plaque Assay to Determine the Titer of a Recombinant Live-Attenuated Viral Vaccine for SARS-CoV-2.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in more than seven million deaths worldwide. To reduce viral spread, the Israel Institute for Biological Research (IIBR) developed and produced a new rVSV-SARS-CoV-2-S vaccine candidate (BriLife®) based on a platform of a genetically engineered vesicular stomatitis virus (VSV) vector that expresses the spike protein of SARS-CoV-2 instead of the VSV-G protein on the virus surface. Quantifying the virus titer to evaluate vaccine potency requires a reliable validated assay that meets all the stringent pharmacopeial requirements of a bioanalytical method. Here, for the first time, we present the development and extensive validation of a quantitative plaque assay using Vero E6 cells for the determination of the concentration of the rVSV-SARS-CoV-2-S viral vector. Three different vaccine preparations with varying titers (DP_low, DP_high, and QC sample) were tested according to a strict validation protocol. The newly developed plaque assay was found to be highly specific, accurate, precise, and robust. The mean deviations from the predetermined titers for the DP_low, DP_high, and QC preparations were 0.01, 0.02, and 0.09 log10, respectively. Moreover, the mean %CV values for intra-assay precision were 18.7%, 12.0%, and 6.0%, respectively. The virus titers did not deviate from the established values between cell passages 5 and 19, and no correlation was found between titer and passage. The validation results presented herein indicate that the newly developed plaque assay can be used to determine the concentration of the BriLife® vaccine, suggesting that the current protocol is a reliable methodology for validating plaque assays for other viral vaccines.

Rethinking antipsychotic use in dementia: a literature review on efficacy, safety, and alternatives

Background an objectives. Dementia and its associated behavioral and psychological symptoms (BPSD) significantly impact patients’ quality of life, healthcare systems, and caregivers. Current treatments often include antipsychotic medications; however, their efficacy and safety profiles require careful evaluation. This review aimed to examine the use of antipsychotics in dementia, focusing on their role, efficacy, adverse effects, and clinical monitoring guidelines. Materials and methods. We conducted a thorough literature review in PubMed and Medline databases, using search terms like “dementia”, “BPSD”, “antipsychotics”, “adverse effects”, and “clinical guidelines”. Our analysis encompassed a range of research studies, including meta-analyses, randomized controlled trials, observational studies, and clinical practice guidelines. Results. While antipsychotics can be effective in managing severe BPSD symptoms like agitation and psychosis, their use carries an increased risk of mortality, stroke, and other adverse effects. Therefore, strict adherence to clinical guidelines and close monitoring are crucial to minimize these risks. Importantly, non-pharmacological interventions should always be the first-line treatment for BPSD whenever possible. Conclusions. Antipsychotics may be necessary for severe BPSD when nonpharmacological approaches are insufficient. Clinicians must carefully weigh the potential benefits against significant risks, utilizing the lowest effective doses, strict monitoring protocols, and considering alternative pharmacological options when possible. Unveiling safer and more specific BPSD treatments is a critical area for continued research.

Genetically determined metabolites in allergic conjunctivitis: A Mendelian randomization study

BackgroundAllergic conjunctivitis (AC) afflicts a significant portion of the global populace. Yet, its metabolic foundations remain largely unexplored. MethodsWe applied Mendelian Randomization (MR) and Linkage Disequilibrium Score Regression (LDSC) to scrutinize a cohort comprising 20 958 AC cases and 356 319 controls. Data were amalgamated from the metabolomics GWAS server and the FinnGen project, under strict quality control protocols. ResultsUsing two-sample MR analysis, 486 blood metabolites were investigated in relation to AC. The IVW approach highlighted 18 metabolites as closely tied to AC risk; of these, 16 retained significance post sensitivity assessments for heterogeneity and horizontal pleiotropy. LDSC analysis, adopted to bolster our findings and negate confounders from shared genetic markers, revealed 8 metabolites with marked heritability, including: palmitate (OR = 0.614), 3-methoxytyrosine (OR = 0.657), carnitine (OR = 1.368), threonate (OR = 0.828), N-[3-(2-Oxopyrrolidin-1-yl)propyl]acetamide (OR = 1.257), metoprolol acid metabolite (OR = 0.982), oleoylcarnitine (OR = 0.635), and 2-palmitoylglycerophosphocholine (OR = 1.351). ConclusionAC is precipitated by ocular responses to environmental allergens. Our study unveils a causal link between 8 blood metabolites and AC. This insight accentuates the role of metabolites in AC onset, suggesting novel avenues for its early prediction, targeted prevention, and tailored therapeutic interventions.

Determinants of university students' safety behavior during a pandemic

After the government allowed onsite classes in the Philippines, strict COVID-19 protocols were implemented in educational institutions as a precautionary measure. This research investigated the safety behavior of students to determine areas of weaknesses and identify suitable interventions in the event of another pandemic. The influence of safety belief, fear of COVID-19, perceived behavioral control, and social impact on the safety behavior of university students was explored using structural equation modeling. Data were gathered from students who attended onsite classes during the pandemic from October to November 2022. A total of 422 students from 19 schools and universities in the Philippines participated. Participants experienced a moderate level of anxiousness thinking about COVID-19 but were generally not worried about getting infected. The feeling of control in adhering to safety measures inside the campus is primarily low, especially wearing face masks and practicing hand hygiene. However, despite this feeling of low control, the participants exhibited positive safety behavior, especially in wearing face masks and/or face shields and practicing proper hand hygiene. A sense of control over safety actions favorably translates into actual safe behavior. Belief significantly influences behavioral control, and confidence in safety practices brings self-efficacy. Anxiety and worry about COVID-19 infection have a relatively strong effect on safety behavior. This study's findings would help policymakers develop safety guidelines to ensure the safety and well-being of the university population. In addition, this would help school authorities to create suitable interventions to ensure students follow safety protocols.

Customised pre-operative cranioplasty to achieve maximal surgical resection of tumours with osseous involvement-a case series.

Surgical resection with bony margins would be the treatment of choice for tumours with osseous involvement such as meningiomas and metastasis. By developing and designing pre-operative customised 3D modelled implants, the patient can undergo resection of meningioma and repair of bone defect in the same operation. We present a generalisable method for designing pre-operative cranioplasty in patients to repair the bone defect after the resection of tumours. We included six patients who presented with a tumour that was associated with overlying bone involvement. They underwent placement of customised cranioplasty in the same setting. A customised implant using a pre-operative imaging was designed with a 2-cm margin to allow for any intra-operative requirements for extending the craniectomy. Six patients were evaluated in this case series. Four patients had meningiomas, 1 patient had metastatic breast cancer on final histology, and 1 patient was found to have an intra-osseous arteriovenous malformation. Craniectomy based on margins provided by a cutting guide was fashioned. After tumour removal and haemostasis, the cranioplasty was then placed. All patients recovered well post-operatively with satisfactory cosmetic results. No wound infection was reported in our series. Our series demonstrate the feasibility of utilising pre-designed cranioplasty for meningiomas and other tumours with osseous involvement. Following strict infection protocols, minimal intra-operative handling/modification of the implant, and close follow-up has resulted in good cosmetic outcomes with no implant-related infections.

Towards to Battery Digital Passport: Reviewing Regulations and Standards for Second-Life Batteries

Greenhouse gas emissions from transportation harm the environment. In response to these environmental concerns, numerous countries encourage the adoption of electric vehicles (EVs) as a more environmentally friendly option than traditional gasoline-powered vehicles. Advances in battery technology have made batteries an alternative solution for energy storage in stationary applications and for electric mobility. Reduced lithium-ion batteries (LIBs) production costs due to economies of scale, electrode material and cell design developments, and manufacturing process improvements have driven this success. This trend is expected to increase the number of LIBs on the market that may be discarded in the environment at the end of their useful life if more sustainable alternatives are not technologically mature. This coming environmental concern can be mitigated by collecting wasted EV batteries, reconfiguring them, and reusing them for applications with less stringent weight, performance, and size requirements. This method would extend battery life and reduce environmental effects. The present work investigates the main regulatory structures of the second-life battery industry that require rules, technical standards, and laws. To achieve this objective, a systematic review was carried out following a strict protocol that includes identifying relevant studies, extracting data and information, evaluating, and summarizing information. This paper explains the primary rules and technical standards governing the second-life battery business. The findings highlight the need for universities, research institutions, and government agencies to evaluate the second-life battery industry objectively. This would enable the creation of new technological regulations and laws for this burgeoning industry.

Laboratory Risk Analysis in a Branch Hospital: The L-type Matrix

Introduction: Laboratory workers are often exposed to various risk factors, which can be classified as biological, physical, chemical, psychosocial, and ergonomic. This study aims to conduct a risk analysis in the workers of microbiology and biochemistry laboratories of a branch hospital in Istanbul, Türkiye to identify occupational health and safety risks and provide recommendations for measures to be taken. Methods: The investigators conducted the risk analysis with a five-person team including occupational health and safety experts, a laboratory manager, and technicians. Risk assessments were performed using the L-type matrix 5x5 diagram. The level of risk was determined with the product of probability and severity. Results: Risk analysis in the microbiology laboratory showed ten risk factors. Three of them had moderate level scores as following "working with xylene", “continuous standing work” and "insufficient free space". The remaining risks have low-risk scores, including "working in a noisy environment, "microscope light and ambient light", "working with blood", "working with feces", "non-ergonomic chairs", "insufficient airflow in the environment" and "continuous presence in a closed space". In the biochemistry laboratory, four were classified as moderate risk, including working in constant standing, exposure to bodily fluids, blood tests for bacteria and viruses and non-ergonomic furniture. Conclusion: The priority should be to minimize the risks associated with contact with blood and body fluids. This could involve the implementation of strict safety measures and protocols, as well as providing appropriate personal protective equipment to all personnel who may encounter these fluids.

Detection and impact estimation of social bots in the Chilean Twitter network

The rise of bots that mimic human behavior represents one of the most pressing threats to healthy information environments on social media. Many bots are designed to increase the visibility of low-quality content, spread misinformation, and artificially boost the reach of brands and politicians. These bots can also disrupt civic action coordination, such as by flooding a hashtag with spam and undermining political mobilization. Social media platforms have recognized these malicious bots’ risks and implemented strict policies and protocols to block automated accounts. However, effective bot detection methods for Spanish are still in their early stages. Many studies and tools used for Spanish are based on English-language models and lack performance evaluations in Spanish. In response to this need, we have developed a method for detecting bots in Spanish called Botcheck. Botcheck was trained on a collection of Spanish-language accounts annotated in Twibot-20, a large-scale dataset featuring thousands of accounts annotated by humans in various languages. We evaluated Botcheck’s performance on a large set of labeled accounts and found that it outperforms other competitive methods, including deep learning-based methods. As a case study, we used Botcheck to analyze the 2021 Chilean Presidential elections and discovered evidence of bot account intervention during the electoral term. In addition, we conducted an external validation of the accounts detected by Botcheck in the case study and found our method to be highly effective. We have also observed differences in behavior among the bots that are following the social media accounts of official presidential candidates.