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Elif Iliria Emin,1 Ece Emin,2 Alexios Bimpis,3 Michael Pierides,4 Aikaterini Dedeilia,5 Zibad Javed,6 Kathrine-Sofia Rallis,6 Ferha Saeed,6 Georgios Theophilou,7 Apostolos Karkanevatos,8 Dilek Kitapcioglu,9 Mehmet Emin Aksoy,9 Apostolos Papalois,10 Michail Sideris6 1Department of Acute Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 2EGA Institute for Women’s Health, University College London, London, UK; 3Department of Neurosurgery, Tzaneio General Hospital, Piraeus, Greece; 4Department of Acute Medicine, Kettering General Hospital NHS Trust, Northamptonshire, UK; 5School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; 6Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 7Department of Gynaecological Oncology, St James Institute of Oncology, Leeds, UK; 8Department of ENT Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK; 9Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; 10Special Unit for Biomedical Research and Education, Aristotle University of Thessaloniki, Thessaloniki, GreeceCorrespondence: Michail Sideris, Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary university of London, London, UK, Email m.sideris@qmul.ac.ukAbstract: Although considerable efforts have been made to incorporate simulation-based learning (SBL) in undergraduate medical education, to date, most of the medical school curricula still focus on pure knowledge or individual assessment of objective structured clinical examination skills (OSCE). To this end, we designed a case study named “iG4 (integrated generation 4) virtual on-call (iVOC)”. We aimed to simulate an on-call shift in a high-fidelity virtual hospital setting in order to assess delegates’ team-based performance on tasks related to patient handovers (prioritisation, team allocation).Methods: A total of 41 clinical year medical students were split into 3 cohorts, each of which included 3 groups of 4 or 5 people. The groups consisted of a structured mix of educational and cultural backgrounds of students to achieve homogeneity. Each performing group received the handover for 5 patients in the virtual hospital and had to identify and deal with the acutely unwell ones within 15 minutes. We used TEAMTM tool to assess team-based performances.Results: The mean handover performance was 5.44/10 ± 2.24 which was the lowest across any performance marker. The overall global performance across any team was 6.64/10 ± 2.11. The first rotating team’s global performance for each cycle was 6.44/10 ± 2.01, for the second 7.89/10 ± 2.09 and for the third 6.78/10 ± 1.64 (p = 0.099 between groups).Conclusion: This is one of the first reported, high-fidelity, globally reproducible SBL settings to assess the capacity of students to work as part of a multinational team, highlighting several aspects that need to be addressed during undergraduate studies. Medical schools should consider similar efforts with the aim to incorporate assessment frameworks for individual performances of students as part of a team, which can be a stepping-stone for enhancing safety in clinical practice.Keywords: virtual on-call, simulation based learning, team-based assessment, high fidelity simulation, handover

Michail Sideris,1,* Marios Nicolaides,2,* Jade Jagiello,3 Kathrine S Rallis,2 Elif Emin,1 Efthymia Theodorou,2 John Gerrard Hanrahan,4 Rebecca Mallick,5 Funlayo Odejinmi,6 Nikolaos Lymperopoulos,7 Apostolos Papalois,8 George Tsoulfas9 1Women’s Health Research Unit, Queen Mary University of London, London, UK; 2Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 3University College London Hospital, London, UK; 4Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK; 5Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK; 6Whipps Cross University Hospital, Barts Health NHS Trust, London, UK; 7Guy’s and St Thomas Hospitals NHS Foundation Trust, London, UK; 8Special Unit for Biomedical Research and Education, Aristotle University of Thessaloniki, Thessaloniki, Greece; 9Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece*These authors contributed equally to this workCorrespondence: Michail SiderisWomen’s Health Research Unit, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UKEmail m.sideris@qmul.ac.ukAbstract: An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students’ inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL.Keywords: in vivo simulation-based learning, medical simulation, surgical education

Persistent left superior vena cava is a rarely seen anomaly but it may be an arrhythmogenic source for paroxysmal atrial fibrillation. Furthermore, the complex anatomicregion between the left superior vena cava and the pulmonary veins may leads to misinterpretation of the pulmonary vein recordings during atrial fibrillation ablation. Approaches that might be helpful to overcome these problems are discussed in this case report.

The coexistence of different types of wide QRS complex tachycardias induced by the same trigger has rarely been observed. The electrical instability and incessant nature of tachycardias can cause tachycardiomyopathy and will not allow accurate diagnosis during an electrophysiological study (EPS). In case of an electrical storm, elimination of the trigger may be the first approach to provide patient stability. We report a successfully managed case of repetitive initiation of pleomorphic ventricular tachycardia and Mahaim-type antidromic atrioventricular reentrant tachycardia, induced by a premature ventricular complex in the right ventricular outflow tract.

This study aims to enhance the performance of conventional single-slope basin-type solar stills by integrating phase change materials (PCMs) and nanoparticles. Calcium chloride hexahydrate, known for its high heat storage capacity, was selected as the primary PCM. Strontium chloride hexahydrate was added as a nucleating agent to address the supercooling tendency. Additionally, graphene oxide (GO) and graphene nanoplatelets (GNP), which have not been previously used in solar stills or compared for their performance, were incorporated into the PCM to utilize their photothermal properties and enhance solar energy absorption. The integration of GO and GNP with the PCM-nucleating agent combination resulted in daily total distilled water productions of 5424ml/m2 and 5032 ml/m2, respectively. The integration of GO with the PCM-nucleating agent combination provided the most significant improvement in efficiency, with a 54.44 % increase compared to the standard still, a 15.4 % increase compared to the still using only the nucleating agent, and an 8 % increase compared to the still incorporating GNP.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.05.012 Byline: Emin E. Ozcan, Sema Guneri, Bahri Akdeniz, A[degrees]lke Z. Akyildiz, Omer Senaslan, Nezihi Baris, Ozgur Aslan, Ozer Badak Abstract: Several protective therapies have been developed to prevent contrast-induced nephropathy (CIN). We aimed to investigate the efficacy of sodium bicarbonate by comparing 2 other regimens, including combination of N-acetylcysteine (NAC) plus sodium chloride and sodium chloride alone, to prevent CIN in patients undergoing cardiovascular procedures. Author Affiliation: Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey Article History: Received 2 March 2007; Accepted 18 May 2007

In this study, it was aimed to determine the antibody responses after the two doses of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations in people who were above 65 years old and to evaluate the factors affecting this response. A total of 235 participants aged 65 years and older were included. Blood samples were taken and data about age, gender, comorbid diseases, and presence of side effects after vaccination were noted. Anti-SARS-CoV-2 QuantiVac ELISA (IgG) test kit (catalogue number: EI-2606-9601-10-G, Euroimmun) was used. The mean age was 70.38 ± 4.76. Approximately 120 of 235 participants had at least one comorbid disease. The mean levels of anti-SARS-CoV-2 IgG antibody after 4 weeks from the first and second doses of vaccine were 37.70 ± 57.08 IU/ml, and 194.61 ± 174.88 IU/ml, respectively. Additionally, 134 of 235 participants (57.02%) had under 25.6 IU/ml antibody level (negative) after 4 weeks from the first vaccine dose while this rate was 11.48% (n = 27) after 4 weeks from the second vaccine dose. The 19 (70.4%) participants who had under had 25.6 IU/ml antibody level after 4 weeks from the first dose of vaccine had at least one comorbid disease including diabetes mellitus, and 8 (29.6%) participants had no comorbid disease (F = 2.352, p = 0.006). Lower rates of antibody response were detected in participants aged 65 years and older and those with comorbidities both in our study and similar studies in the current literature. Further studies should evaluate whether the low antibody titers are really associated with age and comorbidities or not. Finally, prospective studies are needed to determine how long the immunity provided by SARS-CoV-2 vaccines will continue. [ABSTRACT FROM AUTHOR]

Introduction: Brucellosis is a zoonotic disease distributed worldwide and very important public health problem especially in the developing countries. In this study, we aimed to evaluate the clinical/laboratory findings of brucellosis patients and contribute of coombs testing to diagnosis at Iğdır State Hospital infection diseases and clinical microbiology department. Materials and Methods: One hundred and forty-five brucellosis patients followed up in our clinic between September 2012 and February 2013 were evaluated retrospectively. Demographic characteristics, laboratory findings, diagnostic methods of the patients were presented. Results: The mean age of the patients were 39±15 (18-80) and 59% (n=86) of the patients were female, 41% (n=59) were male. Most frequent risk factors were animal breeding (n=115, 79%) and using underdone milk and milk products (n=98, 69%). Most reported complaints were weakness (92%), arthralgia (89%), sweating (74%), lack of appetite (70%) and fever (68%). Fifty-seven of the brucellosis patients could not diagnosed with standard tube agglutination. Therefore, Coombs test was used for these undiagnosed patients (39%, n=57). Eighty patients were evaluated as acute (55%), 53 as subacute (37%) and 12 as chronic (8%) brucellosis. Conclusions: Brucellosis can affect all organ systems and cause different clinical manifestations. Therefore, difficulties are encountered in the diagnosis of the disease. Brucellosis should be kept in mind in the differential diagnosis especially in the endemic regions. When the clinical suspicion exists detailed laboratory evaluation must be performed.

Corruption, which adversely affects macroeconomic aspects such as growth, investment, and income distribution, causes the anticipated accomplishment from social transfers not to be realized. In this study, the income inequality effects of social transfers under the corruption threshold are investigated with the annual data of 19 Central and Eastern Europe (CEE) countries for the period 1999-2019. Following Hansen’s (1999) and Wang’s (2015) modeling, it has been detected that corruption has a significant threshold effect on this relationship. Two thresholds have been specified. Below the first threshold of 3.520, the relationship between social transfers and income inequality is inverse. Above this threshold level and the second threshold value of 3.577, the relationship is in the same direction. In 19 CEE countries, it can be concluded that an augmentation in the corruption and the abuse of social transfers by public officials may amplify income inequality.

The study attempts to gauge the impact of human development and public governance quality on economic welfare in the long term. The basic proposal of the analysis is that economic growth and/or development cannot be the measurement of the value of economic performance. For this reason, the Economic Prosperity Index, developed by the “Legatum Institute” is the dependent variable of the linear logarithmic model estimated in the paper. Besides, the measurement of economic welfare, (public) governance quality, which neoclassical economics ignored for a certain period, is considered an important input to human development. By taking these two variables into the research center, the study sights the rise in the prosperity (welfare) of 31 transition economies that achieved intense development after the 2000s from 2007 to 2020. Transition economies are selected owing to the rapid development and strong welfare effects they have reached with the millennium. So, the main hypothesis of the research is that transition economies have high human development and good governance that creates economic prosperity. By applying this research question, cross-sectional dependence and slope homogeneity tests, unit root tests, and co-integration tests, the author has conducted the lag length selection before the long-run relationship. Comprehensive analysis findings reveal that both indicators enhance economic prosperity by positively affecting them in the long run and that some of the deviations are improved.

Presented herein is the free vibration analysis of functionally graded beams (FGMs) via higher-order shear deformation theory and an artificial neural network method (ANN). The transverse displacement (w) is expressed as bending (wb) and shear (ws) components to define the deformation of the beam. The higher-order variation of the transverse shear strains is accounted for through the thickness direction of the FGM beam, and satisfies boundary conditions. The governing equations are derived with the help of Hamilton’s principle. Non-dimensional frequencies are obtained using Navier’s solution. To validate and enrich the proposed research, an artificial neural network method (ANN) was developed in order to predict the dimensionless frequencies. Material properties and previous studies were used to generate the ANN dataset. The obtained frequency values from the analytical solution and ANN method were compared and discussed with respect to the mean error. In conclusion, the solutions were demonstrated for various deformation theories, and all of the results were thereupon tabularized and visualized using 2D and 3D plots.

Atrial fibrillation (AF) is the most common arrhythmia, and amiodarone is one of the most commonly used drugs for medical cardioversion of AF, which should be used carefully due to its toxic effects. Amiodarone-induced thyrotoxicosis (AIT) may develop in amiodarone-treated patients. In contrast, the most common rhythm disturbance accompanying a thyroid storm is AF. This association may put both AF and thyrotoxicosis treatment into a vicious circle, leading to AI cardiomyopathy. Herein, we aimed to present atrioventricular node ablation as a salvage therapy in a patient with AIT who had AF-causing hemodynamic impairment, resistance to medical therapy, and cardioversion.

Purpose: This paper gauges the nexus between government expenditures and the output level in Turkey. Our primary research objective is to evaluate the extent to which government expenditures give rise to an increase in GDP taking the Armey curve theory as a basis for the analysis. Succinctly speaking, this theory suggests that the expansionary impact of government expenditure on income level has diminishing nature and beyond a certain threshold public spending impairs rather than accelerates economic activities for several reasons including crowding out, rent-seeking, tax hikes, and public debt surges. Methodology: In order to test the validity of this theory, we use a dataset with annual frequency covering the 1968-2019 period, which is the longest dataset used to carry out this analysis in the literature for Turkey. We set up an ARDL model to estimate the long-run coefficients required for quantifying the optimal level of government spending in Turkey. Results: According to our findings, the estimated function exhibits a concave down functional form, which implies a diminishing marginal effect of government spending on GDP, suggesting thereby that the Armey curve theory is valid for Turkey. In addition, even though government expenditure has topped out in recent years, it is still below the GDP maximising optimal level, which indicates that there is sufficient room for expansionary fiscal policies, with the caveat of a potential negative marginal impact on GDP once the optimal threshold is exceeded. Conclusion: The long-run coefficients from the ARDL estimation reveal that despite a consistent upward trend, government expenditures are still below their optimal level, which implies that there is fiscal space available to the government as far as output maximisation is concerned. However, government expenditures have been on a downward trend recently, which is contrary to output maximisation.

Titanium alloys are widely used in the aerospace industry due to their good mechanical properties. Especially Ti6Al4V alloy is preferred in machine parts that require specific strength in aerospace. However, the tribological properties of the Ti6Al4V alloy are poor and need improvement. It is possible to increase the life of Ti6Al4V alloys and improve their surface properties with various heat treatment and surface coating techniques. For this purpose, in this study, plasma nitriding heat treatment was first applied to the samples prepared from Ti6Al4V alloy. Then, TiN coating was carried out by the magnetron sputtering method. Surface roughness and surface hardness were measured before and after coating. Wear tests were performed with dry friction and room temperature conditions on Ti6Al4V alloys using the sliding velocity and normal load as variable parameters. The wear track widths, the weight loss of the samples, and the abrasive disc were measured. The steady‐state sliding regime average friction coefficients were determined from the recorded friction forces depending on the sliding distance. Normal load ‐ wear track widths, normal load ‐ friction coefficient graphics were created. Load wear track width plots showed that the wear track widths on the TiN coated and uncoated samples increased with the load. The fact that the track width values of the uncoated samples with the same load and velocity values were higher than the TiN‐coated samples showed that the TiN‐coated samples had higher wear resistance. In addition, it was observed that the friction coefficient values in the uncoated samples under constant sliding speed were relatively higher than the TiN‐ coated samples.

Motor lateralization is viewed as anatomical or functional asymmetry of the two sides of the body. Functional motor asymmetry can be influenced by musical practice. This study explored whether piano playing experience modulates motor asymmetry and leads to an altered pattern of hand selection, reflecting an altered handedness. We asked two groups of right-handed participants—piano players and non-piano players—to reach targets in their frontal space with both arms, and we tested the motor performance of each arm on this task and then on an arm preference test. As musical practice can decrease motor asymmetry between arms, we hypothesized that participants with piano playing experience would display less interlimb asymmetry and that this, in turn, would change their arm preference pattern, compared with participants without piano playing experience. We found support for both hypotheses, and we conclude that arm selection (preference) is not biologically fixed, but, rather, can be modulated through long-term piano playing. [ABSTRACT FROM AUTHOR]

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.