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Background: Cochlear implantation performed under local anaesthesia is an increasingly accepted technique worldwide, though the literature to date includes only single-surgeon and single-centre experiences. This study explored the national experience of UK surgeons using this challenging surgical technique, with the goal of providing consensus recommendations. Methods: A qualitative analysis was conducted of semi-structured interviews with 10 UK-based cochlear implantation surgeons, focusing on common challenges, how to overcome them and candidate selection. Results: Cochlear implantation under local anaesthesia can potentially be offered to all eligible adult patients with favourable anatomy. A posterior tympanotomy and round window approach is recommended. Common challenges and recommendations are explored thematically: managing patient, surgeon and staff expectations; optimising communication; patient comfort and position; minimising pain and vertigo; and safe use of sedation. Conclusion: This is the first study of national experience of cochlear implantation performed under local anaesthesia. Key themes, including refinements to surgical technique and optimising patient comfort and communication, have been explored in depth. [ABSTRACT FROM AUTHOR]

Objective: Mentoring within surgery is increasingly recognised as a powerful development tool, but participant expectations have not previously been explored. This study aimed to explore and analyse participant expectations from the UK's first national otolaryngology mentorship programme. Method: Participants completed open-ended questionnaires. Responses were qualitatively analysed using a grounded theory approach. Iterative cycles were used to develop codes using a constant comparison technique. Emerging categories were refined to identify core themes. Results: Key mentee expectations were career, and clinical and academic guidance. Enhancing networking opportunities was highlighted by medical students and junior trainees. Psychosocial and lifestyle support were predominant themes for all trainees. Receiving impartial advice and guidance from outside their training region was expressed only by senior trainees. Mentor expectations aligned with those of mentees. Conclusion: This study identified key areas of the 'hidden curriculum' for students and trainees in otolaryngology, showing the evolving expectations and priorities as they progress through training. [ABSTRACT FROM AUTHOR]

Background: Necrotising otitis externa is a serious infective condition. Patients are typically frail, diagnostic delay is common and severe pain is a key feature. This study aimed to qualitatively analyse patient-centred data to identify key themes in the patient's experience. Methods: Open-ended questionnaires were sent to 28 patients. Responses were qualitatively analysed using a grounded theory approach. Iterative cycles were used to develop codes using a constant comparison technique. Emerging categories were refined to identify core themes. Results: Four main themes emerged: severe pain, mental health, quality of life and diagnostic delays. Conclusion: This is the first study to explore patients' perspectives in necrotising otitis externa. It indicates a need to raise awareness of necrotising otitis externa, and to improve symptom management, pain control and quality of life. This valuable information can be used to identify research priorities, guide service improvements, improve clinical care and feed into the development of a Core Outcome Set for necrotising otitis externa. [ABSTRACT FROM AUTHOR]

The transportation industry is experiencing a switch towards electrification. Availability of electric vehicle (EV) charging infrastructure is very critical for broader acceptance of EVs. The increasing use of OBCs, due to their cost-effectiveness and ease of installation, necessitates addressing key challenges. These include achieving high efficiency and power density to overcome space limitations and reduce charging times. Additionally, the growing interest in bidirectional power flow, allowing EVs to supply power back to the grid, highlights the importance of innovative OBC solutions. This review article provides a thorough analysis of the current advancements, challenges, and prospects in EV on-board charger technology. It aims to offer a comprehensive review of OBC architectures, components, technologies, and emerging trends, guiding future research and development. Addressing these challenges is essential to enhance the efficiency, reliability, and integration of OBCs within the broader EV ecosystem.

Here, we investigate the chemical as well as the structural attributes of Apigenin and Kaempferol as viable gas sensors with high sensitiveness via density functional theory (DFT). The adhesion behavior of typical gas molecules was examined on Apigenin and Kaempferol by performing DFT calculations. These compounds can sense the physisorption of SO2, NO, and NO2 because of the considerable charge transport. The adhesion of NO2 in particular led to a considerable increase in the transport performance because of the considerable charge transport, which makes Apigenin and Kaempferol) promising candidates to selectively detect NO2 with high sensitiveness. The present study can provide insights into the potential use of natural products in order to sense gasses with high toxicity.

The coronavirus disease (COVID-19) has badly impacted many sectors, particularly medical waste generation in healthcare facilities. The increasing amount of medical waste poses a serious threat to health and environmental sustainability. Traditional waste processing (burning) cannot be used for B3 medical waste and is often mixed with non-B3 medical waste. This is because it potentially generates dangerous chemicals emitted into the atmosphere. Meanwhile, pyrolysis as a superior thermochemical technology is an effective solution for treating both B3 medical waste and non-B3 medical waste. The waste used in this study has good characteristics, as indicated by the low water and high fixed carbon content. The pyrolysis process yields products with economic value, such as solid, liquid, and gas products. Therefore, this study aims to determine the levels of products that can be produced from B3 and non-B3 medical waste. The results showed that rubber bands produce the highest proportion of liquid products at 44%, the highest solid products were obtained from LDPE plastic waste with a proportion of 65%, while the highest gas product was produced by mask waste at 45%. Based on the results, waste with high product yields can be used as an alternative energy source, such as gasoline, LPG, briquettes, and battery-based materials.

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Penelitian ini bertujuan untuk mengetahui tingkat pengaruh dari masing-masing 4 kegiatan keagamaan (shalat berjamaah, tadarus pagi, infaq jumat, dan shalat dhuha) terhadap akhlak peserta didik, dengan pendekatan penelitian kuantitatif asosiatif. Penelitian ini menggunakan sampel sebanyak 77 dari jumlah populasi 342 peserta didik di SMP Muhammadiyah 8 Batu, dengan teknik pengumpulan data menggunakan angket 5 variabel yaitu shalat berjamaah, tadarus pagi, infaq jumat, dan shalat dhuha (4 kegiatan keagamaan) dan akhlak peserta didik dengan sistem random sampling. Sedangkan untuk menganalisis data, peneliti menggunakan korelasi product moment dan koefisien determinasi. Hasil dari penelitian ini menunjukkan bahwa masing-masing dari 4 kegiatan keagamaan memiliki tingkat pengaruh yang berbeda-beda terhadap akhlak peserta didik, diantaranya shalat berjamaah berpengaruh 0,358; tadarus pagi berpengaruh 0,1744; infaq jumat berpengaruh 0,5418; shalat dhuha berpengaruh 0,012, sehingga 4 kegiatan keagamaan tersebut dapat mempengaruhi akhlak peserta didik di SMP Muhammadiyah 8 Batu dengan nilai r hitung 0,706 r tabel 0,227 dengan kata lain pengaruh 4 kegiatan keagamaan terhadap akhlak peserta didik sebesar 44,67%.

The I-BAR protein IRSp53 senses membrane curvature but its physiological role is unclear. Here, the authors show that during early lumen morphogenesis, IRSp53 controls the shape of the apical plasma membrane and polarized trafficking and ensures the correct epithelial tubular architecture and if deleted, affects renal tubules morphogenesis in various organisms.

Background: Semen identification is assumed a crucial proof of sexual assault. Moreover, body fluids at the crime scene of a human being, such as blood, semen, and saliva, are often mixed. Methods: Hence, in our study, we aimed to use methylation analysis targeting DNA epigenetic markers Spectrin beta chain (B_SPTB_03) and DEAD-box protein (DDX4) to differentiate between fresh semen (less than 4 hours) and aged semen (after 24 hours) as well as to differentiate between semen alone and semen mixed with other body fluids (blood and saliva) in the fresh and dried state. Results: Our findings showed statistically significant differences in the methylation patterns of the SPTB and DDX4 loci to distinguish semen from mixed body fluids in fresh and old samples. We were able to obtain two novel cutoff values to differentiate between fresh and aged semen, which are (52.25) with the SPTB marker and (70.75) with the DDX4 marker. Conclusion: It is concluded that the methylation approach based on the epigenetic markers of Spectrin beta chain and DEAD-box protein (B_SPTB_03 and DDX4) successfully identified fresh from aged semen and semen-derived alleles from mixed stains, hence it is recommended to be employed in forensic practice.

Degradable Organic Carbon (DOC) is the important element in forming CH4 in a pile of garbage in the landfill. The calculation of the potential of methane (CH4) in the landfill become the basis for control and management of GHG sourced from landfill. Estimated value of the content of DOC used calculating the weight of municipal solid waste that goes into landfill every day, counting the value of the fraction of the composition and content of dry matter of municipal solid waste by 11 components of garbage (food, paper / cardboard, gardens and parks, nappies, wood, textiles, rubber / leather, plastic, glass, metal and sampahlain etc.), to further multiplied by the fraction of a default value content of DOC in each component of trash and garbage in total. The calculations show that the total weight of waste that goes to landfill every day at 14594.05 kg / day with the largest waste composition in the form of junk food at 49.54%, followed by plastic waste (13.76%) and the smallest is junk metal composition by 1.18%. As for the fraction of the dry matter of the highest value was found in the garbage rubber / leather by 95.31%, followed by wood waste amounted to 78.61% and the smallest value was found in the garbage nappies by 17.43% and 21.23% of food waste. Based on calculations using the value of the total garbage in, the fraction of the composition and the fraction of dry material content and the fraction of DOC.

Abstract At‐site flood frequency analysis is a direct method of flood estimation at a given site. The choice of an appropriate probability distribution and parameter estimation method plays a vital role in at‐site frequency analysis. In the current article, flood frequency analysis is carried out at five gauging sites of the Ume River in Sweden. Generalised extreme value, three‐parameter log‐normal, generalised logistic and Gumbel distributions are fitted to the annual maximum peak flow data. The L‐moment and the maximum likelihood methods are used to estimate the parameters of the distributions. Based on different goodness‐of‐fit tests and accuracy measures, the three‐parameter log‐normal distribution has been identified as the best‐fitted distribution by using the L‐moments method of estimation for gauging sites Harrsele Krv, Gardiken and Överuman Nedre. The generalised extreme value distribution with the L‐moments estimation provided the best fit to maximum annual streamflow at gauging sites Solberg and Stornorrfors Krv. Finally, the best‐fitted distribution for each gauging site is used to predict the maximum flow of water for return periods of 5, 10, 25, 50, 100, 200, 500, and 1000 years.

Aims: This study aimed to determine the types of, the frequency of, and reasons for social media usage by patients. In addition, this study attempts to explore patients' perceptions of the advantages and main challenges associated with using social media in healthcare. Subjects and Methods: This was a cross-sectional study. Questionnaires were distributed to a convenience sample of 400 patients at a teaching hospital in Eastern Province, Saudi Arabia. The data were analyzed by performing descriptive and inferential statistics. Results: Of the 400 patients, 377 patients used social media. Females were more frequent users (60.7%) of social media than males (39.3%). Young patients were more frequent users of social media than older patients. Most patients used social media daily. The patients reported that the main purpose of their usage of social media was to care for their own health. The main advantage was to enable patients to learn about the symptoms of their illness and the method of treatment. A small percentage of patients believed that using social media in healthcare might breach the confidentiality and security of their information, which was the main challenge associated with using social media in healthcare. Conclusion: Social media is revolutionizing healthcare delivery, and its benefits overcome its drawbacks.

Investigasi proses gasifikasi dilakukan dengan pemodelan termodinamik. Kuantifikasi unjuk kerja proses gasifikasi dinyatakan dengan kadar H2 dan kadar CO dalam gas produser, temperatur dan efisiensi termal. Investigasi pengaruh kadar karbon terhadap unjuk kerja proses gasifikasi dilakukan dengan simulasi menggunakan batubara: lignit, bituminus dan antrasit. Ketiga jenis batubara diharapkan mewakili tingkatan kadar karbon. Kajian termodinamika digunakan sebagai piranti prediksi kinerja gasifikasi dan dapat melihat efek berbagai faktor secara cepat. Penyimpangan kinerja gasifier aktual terhadap hasil prediksi termodinamika sering ditemui dan biasanya dianggap sebagai akibat faktor-faktor teknis yang berhubungan dengan laju proses, misalnya pengontakan partikel dengan medium gasifikasi. Pada makalah ini, kajian termodinamika disempurnakan dengan melibatkan pemodelan dekomposisi batubara yang sangat tergantung pada jenis batubara dalam hal ini mewakili kadar karbon. Harapannya, pengabungan model dekomposisi batubara yang diusulkan dalam penelitian ini dan model kesetimbangan reaksi konvensional menghasilkan kajian termodinamika yang lebih rasional. Hasil dari kajian termodinamika digunakan sebagai piranti prediksi kinerja gasifikasi dengan mempertimbangkan kadar karbon batubara. Fraksi mol gas hidrogen maksimum yang dihasilkan lignit lebih tinggi daripada antrasit dan bituminus, berturut-turut 0,43 dan 0,25. Fraksi mol maksimum gas hidrogen dari lignit berada pada laju udara/batubara sekitar 1,2 kg/kg sedangkan antrasit dan bituminus berada pada sekitar 3 kg/kg. Temperatur proses gasifikasi, seperti diduga sangat dipengaruhi oleh jenis batubara. Sesuai dengan kadar H2, temperatur gasifikasi sebaiknya dijaga sekitar 1000 oC (Ru = 2,4 dan 4 berturut-turut untuk batubara lignit, antrasit dan bituminus). Keuntungan pada temperatur sekitar 1000 oC, tar secara praktis sudah terdekomposisi lebih lanjut, sehingga gas produser hanya sedikit mengandung tar.

Summary: Antimicrobial peptides (AMPs) are the body’s natural innate immune defense against a spectrum of pathogens and can also modulate cell proliferation, chemotaxis, angiogenesis, wound healing, and immune cell activity. Harnessing these diverse functions for prophylactic use is contingent upon understanding the regulatory mechanisms governing their unconventional secretion from cells. Analysis of the secretion of S100A7 (Psoriasin), an abundant AMP stored in differentiated keratinocytes of the skin, has revealed an unexpected biphasic secretory response to bacterial exposure. The core components regulating S100A7 secretion are NFκB/p38MAPK, caspase-1, and interleukin (IL)-1α. The initial activation of this core machinery is mediated by Toll-like receptor signaling, whereas the chronic response is mediated by Caspase-8 downregulation. Interestingly, there is a concomitant downregulation of Caspase-8 in inflammatory skin diseases wherein S100A7 is constitutively released. These results highlight the potential of targeting these components to control the release of AMPs from the skin in both homeostatic and disease conditions. : The global explosion of antibiotic-resistant microorganisms has spurred interest in alternative strategies to combat these “superbugs.” Antimicrobial peptides (AMPs) have emerged as a promising solution. Bhatt et al. show downregulation of epidermal caspase-8 can mediate sustained release of AMPs from the skin and provide an effective defense against infection. keywords: caspase, antimicrobial peptides, skin, TLR, IL-1, NFkB, psoriasis, antibiotic resistance

Introduction: The objective of this study was to assess the readability and quality of online written information on epistaxis., Methods: The terms 'epistaxis' and 'nosebleed' were entered into Google. The first six webpages generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFOG). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated., Results: A total of 37 websites met the inclusion criteria. The mean and 95% confidence intervals for FRES, FKGL, SMOG and GFOG were 58.9 (55.3-62.5), 9.65 (8.74-10.6), 9.18 (8.57-9.8) and 12.5 (11.5-13.5), respectively. The DISCERN score was 34.3 (32.0-36.5). Weak negative correlation was noted between DISCERN and FRES ( r s = -0.15, p = 0.36)., Conclusions: Online information on epistaxis is generally of poor quality and low readability.

Objective: Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS)., Methods: The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting., Results: The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research., Conclusion: The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

Purpose: Patient suitability for cochlear implant (CI) devices compatible with magnetic resonance imaging and CI processor configuration is dependent on their retro-auricular skin flap thickness. This is typically measured intra-operatively using a needle and therefore patients are not guaranteed their implant of choice prior to surgery. We aimed to identify an accurate method to measure skin flap thickness pre-operatively to streamline CI selection and simplify the consent process., Methods: Blinded prospective skin flap thickness measurements for patients undergoing CI surgery were recorded using pre-operative computed tomography (CT) and ultrasound (US), and intraoperative needle measurement., Results: Fifty-six adult patients (36 females, 20 males; mean age 59 years) were included. The mean flap thickness was measured highest by CT (6.9 mm, 95% CI 6.5-7.3 mm), followed by US (6.3 mm, 95% CI 5.9-6.7 mm) and lastly needle (5.5 mm, 95% CI 5.1-5.9 mm) ( p  < 0.0001). A strong positive correlation ( p  < 0.001) was noted between all three modalities: CT vs needle ( r  = 0.869), US vs needle ( r  = 0.865), and CT vs US ( r  = 0.849)., Conclusion: Accurate, non-invasive measurement of skin flap thickness prior to CI surgery can be achieved using CT or US. We recommend the routine use of US in the outpatient clinic to minimise unnecessary radiation exposure.

The vestibular maculae of the inner ear contain sensory receptor hair cells that detect linear acceleration and contribute to equilibrioception to coordinate posture and ambulatory movements. These hair cells are divided between two groups, separated by a line of polarity reversal (LPR), with oppositely oriented planar-polarized stereociliary bundles that detect motion in opposite directions. The transcription factor EMX2 is known to establish this planar polarized organization in mouse by regulating the distribution of the transmembrane receptor GPR156 at hair cell boundaries in one group of cells. However, the genes regulated by EMX2 in this context were previously not known. Using mouse as a model, we have identified the serine threonine kinase STK32A as a downstream effector negatively regulated by EMX2. Stk32a is expressed in hair cells on one side of the LPR in a pattern complementary to Emx2 expression in hair cells on the opposite side. Stk32a is necessary to align the intrinsic polarity of the bundle with the core planar cell polarity (PCP) proteins in EMX2-negative regions, and is sufficient to reorient bundles when ectopically expressed in neighboring EMX2-positive regions. We demonstrate that STK32A reinforces LPR formation by regulating the apical localization of GPR156. These observations support a model in which bundle orientation is determined through separate mechanisms in hair cells on opposite sides of the maculae, with EMX2-mediated repression of Stk32a determining the final position of the LPR., Competing Interests: SJ, ER, EG, RA, LH, BT, MD No competing interests declared, (© 2023, Jia, Ratzan et al.)

Objectives: Magnetic resonance imaging (MRI)-compatible cochlear implants have weaker internal magnets than non-MRI-compatible devices. Their suitability for individual patients is limited by skin flap thickness, traditionally measured with a needle in the operating theatre. We aimed to establish the accuracy of imaging modalities to measure skin flap thickness pre-operatively, with the goal of streamlining device selection and simplifying the consent process., Methods: Skin flap measurements were taken using ultrasound (US), computed tomography (CT) and MRI and compared for agreement with intra-operative needle measurement., Results: Twenty-seven skin flaps were included. Absolute agreement between needle and imaging methods was low: needle/US: 44.4% (95% confidence interval [CI]: 27.7-62.7), needle/CT: 39.1% (95% CI: 22.2-59.2), needle/MRI: 20.8% (95% CI: 9.2-40.5). However, US and CT showed 95.7% agreement (95% CI: 76.0-99.8) with intraclass correlation of 0.996 (95% CI: 0.991-0.998) and narrow Bland-Altman limits of agreement (-0.37, 0.45 mm). BMI and skin flap thickness showed a significant positive correlation ( r s  = 0.664, P  =  0.002) but no significant correlation was observed for age (P   = 0.659)., Discussion: The high level of agreement between US and CT suggests that there are more accurate measurements of skin flap thickness compared with needle or MRI. Needle measurements are consistently smaller., Conclusion: The use of CT or US should be considered when making pre-operative device choices.

Background Opportunities for new otolaryngology trainees to develop their skills as they embark on specialty training can be limited. Our facility hosted a national simulation-based boot camp for new otolaryngology trainees in the UK. This study aimed to assess the effectiveness of the boot camp in improving trainee confidence as they transitioned from core surgical training (CST) to higher specialty training (HST) in otolaryngology. Methodology We conducted a prospective study on the effectiveness of the boot camp on trainee induction. The boot camp included hands-on simulation, small group teaching and didactic lectures addressing technical skills in the fields of otology, laryngology, rhinology, facial plastics, and paediatrics, as well as non-technical skills involving human factors, simulated ward round, and cognitive simulation. The boot camp curriculum reflected the competencies expected by the Joint Committee of Surgical Training (JCST) at this level of training. Participants completed a pre- and post-course questionnaire addressing their self-confidence for the technical and non-technical skills they developed during the boot camp. All participants were invited to participate in an interview 12 months after the boot camp. Results A total of 27 new otolaryngology trainees (approximately half of all new otolaryngology trainees in the UK) participated in the boot camp. A significant increase in median confidence was observed for all technical and non-technical stations (p < 0.0001). The increase in confidence observed was similar for participants regardless of prior experience in otolaryngology. Five candidates were interviewed a year after the boot camp. Analysis of the transcripts generated distinct comments that were grouped into five key themes. Conclusions A simulation-based boot camp mapped to the JCST curriculum can increase the confidence of new otolaryngology Specialty Training 3 trainees during their transition from CST to HST. It can provide valuable and durable technical and non-technical skills to aid trainees in the clinic, theatre environment, and when on-call during their inaugural year of training., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Anmolsingh et al.)