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Background: Uterine fibroids are the most common form of benign uterine tumors. African women of reproductive age usually present late with large and numerous uterine fibroids. Conservative surgical treatment requires ways to reduce intraoperative bleeding. This study attempts to describe innovative methods in the efficient management of fibroids in low-and middle incomes countries. We demonstrate the efficiency of the uterine tourniquet during abdominal polymyomectomy in intraoperative bleeding reduction despite removal of numerous myomas. Methods: A prospective, descriptive and analytical review was conducted on 92 patients who underwent open myomectomy in the gynecology department of the university hospital of Cocody (Côte d’Ivoire) over 3 years (2019 to 2020). Intraoperative surgical steps include placing a uterine tourniquet before removal of the myomas. The variations in mean hemoglobin levels before and after myomectomies were compared. The significance level was set at 5% (p < 0.05). Results: The patients’ mean age was 38.5 years old, and 39% were nulliparous. Abnormal vaginal bleeding was the main symptom (67.4%). On physical exam the uterine size varied significantly from 20 to 30 cm. The average number of uterine fibroids enucleated was ten. The mean duration of the procedure was 155 minutes with an estimated average blood loss of 250 mL. The mean difference between preoperative and postoperative hemoglobin levels was not significant (p < 0.061). Only four patients (4.3%) received a blood transfusion. Conclusions: Placing a uterine tourniquet allowed enucleation of several uterine fibroids with relatively reduced blood loss in abdominal myomectomies. This technique can be an alternative to embolization in countries with limited resources.

BACKGROUND: To motivate students toward the path of lifelong learning, it is important to train them for a self-directed learning (SDL) approach, where they identify the need of learning the content as well as look forward to attaining the learning outcome, independently. The level of readiness for SDL will allow the learner to be self-disciplined, self-organized, an effective team builder and communicator, a self-assessor, and a self-reflector, thus being a self-learner with the ability to accept and give constructive feedback. The aim of the study was to develop, validate, and implement the SDL readiness scale for health professional students. MATERIALS AND METHOD: The readiness scale of 43 items was used in four sub-titles (awareness, learning strategies, and style, motivation, team building) was developed using the Delphi method with 12 experts and was implemented for the medical students at Karamsad, Gujarat as a cross-sectional survey after a pilot trial scale from May 2021 to September 2021, using mean, the standard deviation for each item, and arrived sub-titles. The ANOVA test was used to find differences in readiness scores as per different years of the medical program. RESULT: The result demonstrates that the maximum score was obtained for the first-year medical student (149.89 ± 24.72), which dropped in year 2 (136.35 ± 32.26) but increased by the final year (147.67 ± 56.66), although not as high as the initial joining year. However, a statistically significant difference per gender was identified for a few items of the scale [(items 24 (P < 0.034), 26 (P < 0.0005), 37 (P < 0.035), and 40 (P < 0.013)]. The logistic regression analysis showed no statistical significance for the DSVS-self-directed learning readiness scale (SDLRS) score and demographic variables. CONCLUSION: The outcome of the study strongly suggests training/sensitization sessions for students to highlight the importance of a SDL approach in a digital millennium. Moreover, a longitudinal follow-up needs to be conducted for the readiness score of the students based on the developed scale and subsequent training sessions need to be organized for students as well as faculty for better outcomes for the students toward SDL sessions.

Background: Medial longitudinal arch (MLA) is important as per the anatomical aspect of individual's foot. Its elastic properties reduce the risk of musculoskeletal wear and impairment. Various methods of its estimation have been presented by researchers. With this basis the aim of the study is to find the value of MLA by the devised mid-footprint planter angle method and compare it with the standard navicular height method. Methodology: Purposive analytical and comparative study done on 1st year health professional students of Sumandeep Vidyapeeth University (2015–2016 batch). MLA was estimated by the navicular height method and mid-footprint planter angle method on footprint after collecting their demographic and anthropometric data. The calculated values of MLA for both feet were compared by correlation coefficient by two different methods and Kruskal–Wallis test for the comparison as per body mass index (BMI) of participants. Results: Statistical significance was observed for right (−3.57 ± 0.85; P < 0.0001) and left (−6.4 ± 0.91; P < 0.0001) foot for MLA values by two methods, with higher level of Kappa agreement for right (0.755) and left (0.794) foot. Higher to middle level of correlation was observed for both the feet as per the two methods. Statistical significance as per gender was observed for left foot by navicular height method. While, no statistical significance was observed for MLA values as per BMI for both feet as per two methods. Conclusion: MLA values estimated by mid-footprint planter angle and compared by the standard navicular height method concludes that this method can be used in place of the gold standard in day-to-day basis, but extensive work needs to be done before considering it as a replacement, specifically in terms of sample size.

Objectives The public health disorder gastro-oesophageal reflux disease (GORD) is linked with several comorbidities, including oesophageal adenocarcinoma (OAC), but whether life expectancy is reduced by GORD is uncertain. This study assessed all-cause and cancer-specific mortality in GORD after controlling for confounding by heredity and other factors.Design Population-based cohort study from 1998 to 2015.Setting Swedish nationwide study.Participants Twins (n=40 961) born in 1958 or earlier in Sweden.Exposure GORD symptoms reported in structured computer-assisted telephone interviews.Outcomes The primary outcome was all-cause mortality and the secondary outcome was cancer-specific mortality among twins with GORD and twins without GORD. HRs and 95% CIs were analysed using parametric survival models, both in individual twin analyses and co-twin pair analyses, with adjustment for body mass index, smoking, education and comorbidity.Results Among 40 961 individual twins, 5812 (14.2%) had GORD at baseline and 8062 (19.7%) died during follow-up of up to 16 years. The risks of all-cause mortality (HR=1.00, 95% CI: 0.94–1.07) and cancer-specific mortality (HR=0.99, 95% CI: 0.89–1.10) were not increased in individual twins with GORD compared with individual twins without GORD. Similarly, there were no differences in mortality outcomes in within-pair analyses. The OAC-specific mortality rate was 0.45 (95% CI: 0.32–0.66) per 1000 person-years in individual twins with GORD and 0.22 (95% CI: 0.18–0.27) per 1000 person-years without GORD, rendering an adjusted HR of 2.01 (95% CI: 1.35–2.98).Conclusions GORD did not increase all-cause or cancer-specific mortality when taking heredity and other confounders into account. The increased relative risk of mortality in OAC was low in absolute numbers.

Background Human cadaveric dissection is considered as a core teaching tool and plays a major role in active learning process of students. However, students’ active participation and self-directed learning in dissection hall has declined over the period of time. Group discussion in dissection hall allows students to participate actively, engage in cooperative interaction, communicate effectively, and utilize self-directed learning. Therefore, group discussion has been introduced and assessed as a teaching-learning method in dissection with the aim of improving participation, learning, and communication skill of students in dissection hall. Methods This study was conducted on 100 students of Pramukhswami Medical College, Karamsad, Anand, Gujarat, India, during the 2018-2019 academic year. Students were divided in 10 groups for dissection. Group discussion was introduced as a teaching-learning method and assessed during dissection. Data were collected through anonymous feedback and then statistically analyzed. Result There was significant increase in active participation of most students during dissection: 79% students rated this method as good or excellent; 51 to 74% students agreed that this method helped them in better understanding of subject, improving dissection skills and communication; and 68% students agreed that working in group is better as compared with traditional method of dissection. The Cronbach’s alpha of feedback questionnaire was 0.816. Conclusion Students perceived that the group discussion during dissection not only helped in creating active participation and better understanding of subject but also helped improve learning, communication, and dissection skills.

BACKGROUND: Linking anatomy with the clinical approach for creating an inquisitive mind for a millennium via the digital platform is the need of the hour. Traditional lecturing makes students have rote memorization of the human anatomy. The inquiry-based project will allow undergraduate medical students to have a deeper understanding of human anatomy along with team building and interpersonal skill development. This approach of teaching would allow students to link the content taught for human anatomy with its clinical applicability and probably generate inquisitiveness for further exploring the course content. The study aimed to appraise and assess the perception of medical students and faculty about the inquiry-based digitalized project presentation. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted for inquiry-based project presentation where students were divided into 15 groups with 15 inquiries, which were presented as projects on a digital platform under the guidance of the facilitator. The perception of students and faculty for the inquiry-based approach was collected using a validated survey questionnaire. The quantitative data were analyzed by SPSS-version 15, using descriptive statistics, Friedman's rank, and thematic analysis for qualitative data. RESULT: In total, 117 students participated in the pre-test and 129 in the post-test part of the study. Also, 79.1% of students appreciated that the inquiry-based project presentation approach allowed them to link anatomy with different courses; 73.6% agreed that this approach has a positive impact on their attitude toward learning anatomy. Then, 75.2% students appreciated of learning new skills using the digital platform. They agreed to have developed leadership (65.1%) and team-building skills (83.7%) and self-directed learning (SDL) improvement (71.3%). However, some students (9.3%) and faculty (16.7%) had been ostracized for presenting their inquiry-based projects on a digital platform, whereas 65.1% of students appreciated this approach. CONCLUSION: Inquiry-based learning approach would allow students to have a deeper understanding of the subject knowledge and skills for the SDL and learn strategies for the usage of virtual technology for literature search.

This paper describes the implementation of a control algorithm for MIMO system, which is mostly used in industries and it is a highly nonlinear system, the main aim is to control the level of a liquid in a tank. A challenge in process industries is naturally multi-input and multi-output systems, compared to the single input and single output systems. The process parameters change with the operating point and it is a difficult task in different tanks to control the level of liquid for (ITTHS). The output of the level process is nonlinear, it should be linearized by the Taylor Series method, which converts nonlinear equations to linear equations for MIMO system. The transfer function for ITTHS is derived and tuning parameters in the case of PI, PID controller. The objective is to analyse the various tuning controllers by simulation using the MATLAB SIMULINK platform. [ABSTRACT FROM AUTHOR]

With a high likelihood of being discharged into aquatic habitats, zinc oxide nanoparticles have been widely employed in a variety of industrial and commercial goods. Concerns over their effects on the environment and human health have grown. This study evaluated the developmental toxicity of zinc oxide nanoparticles (ZnO NPs) on the embryo Java medaka (Oryzias javanicus). With three replicates for each treatment group, the Java medaka embryos were subject to various concentrations of ZnO NPs (10, 25, 50, 100, and 150 μg/L). The heartbeat of treated embryos was increased compared to the control group at 5-, 8-, and 11-days post-exposure (dpe). However, the hatching and mortality of embryos decreased when the concentrations of ZnO NPs increased. Meanwhile, deformities such as low pigmentation, edema (yolk sac and pericardial edema), and spinal deformities were observed in the embryo and larva during the exposure time. Compared to previous studies, ZnO NPs show severe toxicity to selected endpoints at lower concentrations in the embryos of Java medaka. [ABSTRACT FROM AUTHOR]

Summary: Energy internet permits the power to stream lithely for broadcast and it aids in transporting energy to each user using electric vehicles (EVs). The energy that EVs utilize is generated using certain sources. Still, considering poor weather, the power station averts the production of energy and needs to acquire power transmitted to another location. One resolution is to set stations that aid to save surfeit energies and minimize energy loss during transportation. This paper devises a new model for choosing charging stations to charge EVs. Energy is transferred from the energy source to the charge station via bus station through optimal path using Battle Royale Jaya Optimization (BRJO) routing with fitness attributes like distance to select the shortest path and energy. The prediction of energy is done with a deep recurrent neural network (DRNN) and the charge is distributed optimally to EVs by employing a proposed Competitive Swarm‐Battle Royale Jaya Optimization (CSBRJO) by utilizing multi‐parameters, like priority, distance, predicted energy, waiting time, and EV count needed for charging. The CSBRJO outperformed with the smallest distance of 6.935 km, energy consumption of 1.676 J, path length of 5.05 m, and waiting time of 4.645 sec. [ABSTRACT FROM AUTHOR]