Persistent postoperative granulation tissue following vaginal prolapse repair

To report rates and risk factors for persistent postoperative granulation tissue (GT) in women undergoing reconstructive vaginal prolapse surgery

Pill in the blister pack: a rare cause of dysphagia in an elderly adult

Foreign body impaction in the esophagus amongst adults is not a common cause of dysphagia. Fish bone, food bolus, dentures may cause symptoms of dysphagia, odynophagia, chest pain or respiratory distress. It needs prompt evaluation along with removal of the substance either surgically or endoscopically to avoid the  development of life threatening complications. Here we are reporting a case of an elderly male, who presented to us with a history of absolute dysphagia for one week, as a consequence of ingestion of a pill in blister pack.Key words: Foreign body, pill induced esophageal ulcer, dysphagi

Job\u27s syndrome with an atypical presentation

Hyper Immunoglobulin E syndrome also called Job\u27s or Buckley Syndrome is a rare primary immunodeficiency disease characterized by elevated serum IgE levels (\u3e 2000 IU/ml), recurrent infections and eosinophilia. Other features include coarse facies and non-immunologic abnormalities of the dentition, bones, vasculature and connective tissues. We are reporting a case of a twenty four years old male with coarse facies who presented with severe pallor and upper gastrointestinal bleeding. Investigations revealed markedly elevated serum IgE levels (11,800 IU/ml), severe anaemia, esophageoduodenal erosions, Helicobacter pylori (H. pylori) gastritis and oro-esophageal candidiasis

Players, Characters, and the Gamer's Dilemma

Is there any difference between playing video games in which the player's character commits murder and video games in which the player's character commits pedophilic acts? Morgan Luck's “Gamer's Dilemma” has established this question as a puzzle concerning notions of permissibility and harm. We propose that a fruitful alternative way to approach the question is through an account of aesthetic engagement. We develop an alternative to the dominant account of the relationship between players and the actions of their characters, and argue that the ethical difference between so-called “virtual murder” and “virtual pedophilia” is to be understood in terms of the fiction-making resources available to players. We propose that the relevant considerations for potential players to navigate concern (1) attempting to make certain characters intelligible, and (2) using aspects of oneself as resources for homomorphic representation.Peer reviewe

TRANSFORMING PUBLIC LIBRARIES INTO DIGITAL KNOWLEDGE DISSEMINATION CENTRE IN SUPPORTING LIFELONG BLENDED LEARNING PROGRAMMES FOR RURAL YOUTHS

This research aims to examine how commissioning, transforming and maximum utilization of the digital technology infrastructure in public libraries through blended mode digital education platform could support open and distance lifelong learning in upgrading knowledge, livelihood and human capital for the constant improvement and upgrading of knowledge/skills among village youths. Mixed-method research design was implemented including administration of survey, interviews and observation. The five dimensions of enhancing the innovative open and distance digital platform to support a blended-mode dissemination of knowledge were examined, including demographic, digital technology availability, Open Education Resources in public libraries, learning culture and corporate support. Findingsshow thatthere are significant differences among factors stated above which will upgrade the potential of village youths technical and livelihood knowledge to be relevant and competitive in building human capital. The use of a blended digital education platform in public libraries could be beneficial to village folks in upgrading their knowledge and skills. This model could be used as framework of practice for enhancement of life skills among developing nations as well as under-developed countries in line with SEAMEO’s Education Agenda to promote lifelong learning and 21st century skills. If such technology-enhanced skills development programme could be implemented from earlier stages in educational settings in line with Sustainable Development Goals (SDGs) and Malaysian Education Blueprint, more skilled workers could be produced to raise the performance in the workplace and contribute to the worldwide improvement of human capital. Legal and policy issues on digital facilities will be discussed as to advocate lawful and ethical application of this initiative. Future direction of studies to develop a comprehensive structural model will also be deliberated

trans-Tetra­kis(4-methyl­pyridine-κN)dioxidorhenium(V) hexa­fluorido­phosphate

The title compound, [ReO2(C6H7N)4]PF6, contains octa­hedral [ReO2(4-Mepy)4]+ cations (4-Mepy is 4-methyl­pyridine) and PF6 − anions. Both the cation and the anion reside on special positions, the Re atom on a crystallographic center of inversion and the P atom on a C 2 axis parallel to the b axis. The ReV atom in the cation exhibits an octa­hedral coordination geometry with two O atoms in the apical positions and four N atoms of the 4-Mepy ligands in the equatorial plane. The Re=O and Re—N bond lengths fall in the typical ranges of trans-dioxidorhenium(V) complexes

Neural Correlate of Filtering of Irrelevant Information from Visual Working Memory

In a dynamic environment stimulus task relevancy could be altered through time and it is not always possible to dissociate relevant and irrelevant objects from the very first moment they come to our sight. In such conditions, subjects need to retain maximum possible information in their WM until it is clear which items should be eliminated from WM to free attention and memory resources. Here, we examined the neural basis of irrelevant information filtering from WM by recording human ERP during a visual change detection task in which the stimulus irrelevancy was revealed in a later stage of the task forcing the subjects to keep all of the information in WM until test object set was presented. Assessing subjects' behaviour we found that subjects' RT was highly correlated with the number of irrelevant objects and not the relevant one, pointing to the notion that filtering, and not selection, process was used to handle the distracting effect of irrelevant objects. In addition we found that frontal N150 and parietal N200 peak latencies increased systematically as the amount of irrelevancy load increased. Interestingly, the peak latency of parietal N200, and not frontal N150, better correlated with subjects' RT. The difference between frontal N150 and parietal N200 peak latencies varied with the amount of irrelevancy load suggesting that functional connectivity between modules underlying fronto-parietal potentials vary concomitant with the irrelevancy load. These findings suggest the existence of two neural modules, responsible for irrelevant objects elimination, whose activity latency and functional connectivity depend on the number of irrelevant object

Trace and antitrace maps for aperiodic sequences, their extensions and applications

We study aperiodic systems based on substitution rules by means of a transfer-matrix approach. In addition to the well-known trace map, we investigate the so-called `antitrace' map, which is the corresponding map for the difference of the off-diagonal elements of the 2x2 transfer matrix. The antitrace maps are obtained for various binary, ternary and quaternary aperiodic sequences, such as the Fibonacci, Thue-Morse, period-doubling, Rudin-Shapiro sequences, and certain generalizations. For arbitrary substitution rules, we show that not only trace maps, but also antitrace maps exist. The dimension of the our antitrace map is r(r+1)/2, where r denotes the number of basic letters in the aperiodic sequence. Analogous maps for specific matrix elements of the transfer matrix can also be constructed, but the maps for the off-diagonal elements and for the difference of the diagonal elements coincide with the antitrace map. Thus, from the trace and antitrace map, we can determine any physical quantity related to the global transfer matrix of the system. As examples, we employ these dynamical maps to compute the transmission coefficients for optical multilayers, harmonic chains, and electronic systems.Comment: 13 pages, REVTeX, now also includes applications to electronic systems, some references adde

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.Peer reviewe