Systematic review of new medics’ clinical task experience by country

OBJECTIVES: There is a need for research which informs on the overall size and significance of clinical skills deficits among new medics, globally. There is also the need for a meta-review of the similarities and differences between countries in the clinical skills deficits of new medics. DESIGN: A systematic review of published literature produced 68 articles from Google/Scholar, of which 9 met the inclusion criteria (quantitative clinical skills data about new medical doctors). PARTICIPANTS: 1329 new medical doctors (e.g., foundation year-1s, interns, PGY1s). SETTING: Ten countries/regions. MAIN OUTCOME MEASURES: 123 data points and representation of a broad range of clinical procedures. RESULTS: The average rate of inexperience with a wide range of clinical procedures was 35.92% (lower CI 30.84%, upper CI 40.99%). The preliminary meta-analysis showed that the overall deficit in experience is significantly different from 0 in all countries. Focusing on a smaller selection of clinical skills such as catheterisation, IV cannulation, nasogastric tubing and venepuncture, the average rate of inexperience was 26.75% (lower CI 18.55%, upper CI 35.54%) and also significant. England presented the lowest average deficit (9.15%), followed by New Zealand (18.33%), then South Africa (19.53%), Egypt, Kuwait, Gulf Cooperation Council countries and Ireland (21.07%), after which was Nigeria (37.99%), then USA (38.5%), and Iran (44.75%). CONCLUSION: A meta-analysis is needed to include data not yet in the public domain from more countries. These results provide some support for the UK General Medical Council’s clear, detailed curriculum, which has been heralded by other countries as good practice

Prevalence of end-digit preference in recorded blood pressure by nurses: a comparison of measurements taken by mercury and electronic blood pressure-measuring devices

Objectives: When compared with the use of a mercury  sphygmomanometer, the use of a validated digital blood pressure (BP) measuring device eliminates the risk of exposure to mercury. Digital devices are also associated with a lesser degree of end-digit preference (EDP). EDP refers to the occurrence of a particular end digit more frequently than would be expected through chance alone. There have been only a few reports from Africa on the occurrence of EDP in BP measurement. This study examined EDP in BP taken by nurses before and after the introduction of a digital BP-measuring device. Design: The design was a retrospective study. Settings and subjects: We reviewed the BP readings of 58 patients who presented at the dedicated clinic for people living with human immunodeficiency virus/acquired immune deficiency syndrome of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, before and after the introduction of the digital BP-measuring device. Outcome measures: The prevalence of end-digit zero of systolic and diastolic BP readings before and after the introduction of the digital device was compared using McNemar’s test. Results: There was a large and significant fall in end-digit zero when BP readings that were taken using the mercury and digital devices were compared (systolic 98.1% vs. 10.9%, p-value < 0.001; diastolic 97.1% vs. 14.9%, p-value < 0.001 (McNemar’s test). Conclusion: There was a significant reduction in the frequency of end-digit zero when BP was taken with the digital devicerather than the mercury device. Regular training and certification of healthcare workers in BP measurement is recommended to ensure a high quality BP measurement standard.Keywords: blood pressure measurement, mercury sphygmomanometer, digital blood pressure-measuring devices, end-digit preferenc

The effect of garl ic on plasma l ipids and lipoproteins in rats fed on high cholesterol enriched diet

Gar l ic has been repor ted in some populat ions to posses s hypol ipdemic ef fect in par t icular on low densi ty l ipoprotein choles terol , thus prevent ing cardiovascular disease r isk. Sixteen male albino rats of seven weeks old were purchased for this study. These weredivided into four groups of four per group. Group A was fed on a high choles terol diet and gar l ic, group B was fed on high choles terol diet only, group C was fed on normal diet (cont rols ) and group D was fed on normal diet and gar l ic. The plasma l ipids, l ipoproteins and t issues his tological appearances were determined us ing standard procedures. Resul ts showed s igni f icant decreased in the mean wet t issue weight of the kidney (

Corrosion Resistance of AA6063-Type Al-Mg-Si Alloy by Silicon Carbide in Sodium Chloride Solution for Marine Application

The present work focused on corrosion inhibition of AA6063 type Al-Mg-Si alloy in sodium chloride (NaCl) solution with a silicon carbide inhibitor, using the potentiodynamic electrochemical method. The aluminium alloy surface morphology was examined, in the as-received and as-corroded in the un-inhibited state, with scanning electron microscopy equipped with energy dispersive spectroscopy (SEM-EDS). The results obtained via linear polarization indicated a high corrosion potential for the unprotected as-received alloy. Equally, inhibition efficiency as high as 98.82% at 10.0 g/v silicon carbide addition was obtained with increased polarization resistance (Rp), while the current density reduced significantly for inhibited samples compared to the un-inhibited aluminium alloy. The adsorption mechanism of the inhibitor aluminium alloy follows the Langmuir adsorption isotherm. This shows that the corrosion rate of aluminium alloy with silicon carbide in NaCl environment decreased significantly with addition of the inhibito

Effect of WO3 Nanoparticle Loading on the Microstructural, Mechanical and Corrosion Resistance of Zn Matrix/TiO2-WO3 Nanocomposite Coatings for Marine Application

In this study, for marine application purposes, we evaluated the effect of process parameter and particle loading on the microstructure, mechanical reinforcement and corrosion resistance properties of a Zn-TiO2-WO3 nanocomposite produced via electrodeposition. We characterized the morphological properties of the composite coatings with a Scanning Electron Microscope (SEM) equipped with an Energy Dispersive Spectrometer (EDS). We carried out mechanical examination using a Dura Scan hardness tester and a CERT UMT-2 multi-functional tribological tester. We evaluated the corrosion properties by linear polarization in 3.5% NaCl. The results show that the coatings exhibited good stability and the quantitative particle loading greatly enhanced the structural and morphological properties, hardness behavior and corrosion resistance of the coatings. We observed the precipitation of this alloy on steel is greatly influenced by the composite characteristics

Memory-efficient deep learning for botnet attack detection in IoT networks

Cyber attackers exploit a network of compromised computing devices, known as a botnet, to attack Internet-of-Things (IoT) networks. Recent research works have recommended the use of Deep Recurrent Neural Network (DRNN) for botnet attack detection in IoT networks. However, for high feature dimensionality in the training data, high network bandwidth and a large memory space will be needed to transmit and store the data, respectively in IoT back-end server or cloud platform for Deep Learning (DL). Furthermore, given highly imbalanced network traffic data, the DRNN model produces low classification performance in minority classes. In this paper, we exploit the joint advantages of Long Short-Term Memory Autoencoder (LAE), Synthetic Minority Oversampling Technique (SMOTE), and DRNN to develop a memory-efficient DL method, named LS-DRNN. The effectiveness of this method is evaluated with the Bot-IoT dataset. Results show that the LAE method reduced the dimensionality of network traffic features in the training set from 37 to 10, and this consequently reduced the memory space required for data storage by 86.49%. SMOTE method helped the LS-DRNN model to achieve high classification performance in minority classes, and the overall detection rate increased by 10.94%. Furthermore, the LS-DRNN model outperformed state-of-the-art models

Pentagalloylglucose, isolated from the leaf extract ofAnacardium occidentaleL., could elicit rapid and selective cytotoxicity in cancer cells

Background: The leaf of Anacardium occidentale L. has been a component of many herbal recipes in South-Western Nigeria. The work reported herein, therefore, explored the phytochemical composition of this plant and the potential anti-cancer activity of an isolated chemical constituent. Methods: Phytochemical methods (including chromatographic analysis) combined with spectroscopic and spectrometric analyses (IR, HRMS and NMR (1D and 2D)) were used to identify chemical constituents. Cytotoxic effects were determined using the MTT viability assay and bright-field imaging. Induction of oxidative stress was determined using the fluorescence-based 2′,7′-dichlorofluorescein diacetate (DCFDA) assay. Results: For the first time in the plant, Compound 1 was isolated from the leaf extract and identified as pentagalloylglucose. Compound 1 was significantly cytotoxic against the cancer cell lines HeLa (human cervical adenocarcinoma cell line) and MRC5-SV2 (human foetal lung cancer cell line), with IC50 of 71.45 and 52.24 μg/ml, respectively. The selectivity index (SI) for Compound 1 was 1.61 (IC50 against the normal human foetal lung fibroblast cell line MRC-5 was 84.33μg/ml), demonstrating better cancer cell-selectivity compared to doxorubicin with a SI of 1.28. The cytotoxic activity of Compound 1 in HeLa cells was also rapid, as shown by its concentration- and time-dependent 3 h and 6 h cytotoxicity profiles, an effect not observed with doxorubicin. Generation of reactive oxygen species at high concentrations of pentagalloylglucose to induce oxidative stress in cancer cells was identified as a mechanistic event that led to or resulted from its cytotoxicity. Conclusions: We suggest that pentagalloylglucose is selectively cytotoxic to cancer cells, and at high concentrations could exhibit pro-oxidant effects in those cells, as opposed to its general anti-oxidant effects in cells. Also, the presence of Compound 1 (pentagalloylglucose) in the plant and its cancer cell-selective cytotoxicity provide some rationale for the ethno-medicinal use of the plant’s leaf extract for treating diseases associated with excessive cell proliferation. Further studies are required to dissect the molecular mechanisms and players differentially regulating the biphasic anti-oxidant and pro-oxidant effects of pentagalloylglucose in normal and cancer cells

Osteogenesis Imperfecta – A Case Series and Review of Recent Advances in Management

Osteogenesis Imperfecta (OI) is an uncommon congenital abnormality of the connective tissues in which diagnosis and management pose significant challenges especially in Low and Middle-Income Countries. The objective of this report is to draw attention to this uncommon congenital anomaly. Two cases of OI were seen at birth and managed in Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. One of the babies died shortly after birth while the other baby was managed and discharged home. The discharged baby was on follow-up care in the clinic until the parents defaulted from further care. She eventually died at home after series of hospitalisations for recurrent respiratory tract infections. In conclusion, a high index of suspicion is required during prenatal care visit. When detected at birth, parents are to be educated on the multidisciplinary approach to management, challenges and possible outcome as there is yet no cure for this condition

Potent Nrf2-inducing, antioxidant, and anti-inflammatory effects and identification of constituents validate the anti-cancer use of Uvaria chamae and Olax subscorpioidea

Background: Uvaria chamae (UC) and Olax subscorpioidea (OS) roots are included in traditional anti-cancer remedies and some studies have identified their chemopreventive/chemotherapeutic potential. This study aimed to identify some cellular/molecular mechanisms underlying such potential and the associated chemical constituents. Methods: Effect on the viability of cancer cells was assessed using the Alamar Blue assay; ability to modulate oxidative stress was assessed using the 2′,7′-dichlorofluorescein diacetate (DCFDA) assay; potential to modulate Nuclear factor erythroid 2-related factor like-2 (Nrf2) activity was assessed in the AREc32 luciferase reporter cell line; and anti-inflammatory effect was assessed using lipopolysaccharide-induced nitric oxide release model in the RAW264.7 cells (Griess Assay). Chemical constituents were identified through liquid chromatography-mass spectrometry (LC-MS). Results: Extracts up to 100 μg/ml were non-toxic or mildly toxic to HeLa, AREc32, PC3 and A549 cells (IC50 > 200 μg/ml). Each extract reduced basal and peroxide-induced levels of reactive oxygen species (ROS) in HeLa cells. OS and UC activated Nrf2, with UC producing nearly four-fold induction. Both extracts demonstrated anti-inflammatory effects. Chamanetin, isochamanetin, isouvaretin, uvaricin I and other compounds were found in U. chamae root extract. Conclusion: As Nrf-2 induction, antioxidant and anti-inflammatory activities are closely linked with chemoprevention and chemotherapy of cancers, the roles of these plants in traditional anti-cancer remedies are further highlighted, as is their potential as sources of drug leads