Ultrasound-guided peripheral nerve blocks in high-risk patients, requiring lower limb (Above and below knee) amputation

A case series of five high-risk patients with lower limb ischemia, sepsis, altered coagulation, and multi-organ dysfunction requiring emergent or urgent lower limb amputation is presented. Use of peripheral nerve blocks for below and above knee amputations is quite uncommon which provides better hemodynamic stability and pain management, especially in the very sick patients. The surgeries were successfully carried out under ultrasound-guided combined femoral and sciatic nerve blocks. All five patients obtained adequate level of block at the area of amputation. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. Combined femoral-sciatic nerve block under ultrasound guidance is safe and satisfactory alternative anesthetic technique for such patients

Use of integrated clinical scenarios in neuroanatomy laboratory sessions a strategy to foster students’ learning

Objective: Combinations of various teaching strategies have been employed to enhance neuroanatomy teaching, to little success. Herein, we describe the use of integrated clinical scenarios in anatomy laboratory sessions as an educational strategy to improve the learning process for students undertaking neuroscience course. Methods: We assessed the perception and performance of students who utilised the integrated clinical resources in the neuroanatomy labs. We also compared the performance of the students on their neuroscience course with the performance of the previous year\u27s students (who did not use the clinical scenarios). Results: A total of (130) 88% of the registered student both male and female participated by filling out a questionnaire. A majority (80%) of students supported introducing clinical cases at this early stage and agreed that cases covered learning objectives well. Students (81%) preferred a decreased faculty participation and 68% strongly agreed that cases were well integrated with other disciplines and assisted critical thinking and conceptual understanding. Most of them (90%) approved using plastic models and pictures as resource-material. The average mark obtained for all block together between the two cohorts did not differ significantly, while student performance was significantly improved in neuroscience block of the cohort which had access to the integrated clinical scenarios. Conclusions: Collectively, or specifically designed neuroanatomy lab sessions provided students with an empowering experience to help them apply critical thinking and use their basic neuroscience knowledge to solve clinical problems

An Empirical Analysis of the Relationship between Human Capital and Organizational Performance in Hospitality Sector in Pakistan

Human capital is professed as a critical factor and a special resource that can elevate the firm’s performance, generally, in most of the organizations, and specifically, in labor-intensive organizations. It is considered a special resource in the hotel industry where employees have direct interaction with customers. Although a lot of research has been done, however, the question of how much and what type of human capital is required by the organization to fight in the recent rivalry is still unanswered. This study is an effort to answer the aforesaid question about human capital in the hospitality sector in Pakistan (involving five stars, four-star, and three-star hotels separately). A theoretical framework and a research conceptual model is developed on the bases of in-depth literature. A cross-sectional field survey was conducted through an adopted and valid research instrument. Questionnaires were administered to 300 respondents selected by stratified random sampling, 275 were received and 250 were perfect for further use in SPSS version 22. Statistical analysis shows the results which clearly identify the strong and significant relationship between human capital and organizational performance. Moreover, microanalysis of components of human capital depicts that innovation and creation have the most significant impact among all of the three components, on organizational performance in all types of hotels in Pakistan. Theoretically, the current study added knowledge to the literature about the constructs of human capital, organizational performance, and organization success. Practically, in the hotel industry, it contributes to strategic decision making such as employees’ training, human capital investment, regulatory decisions, developing mechanisms in order to develop human capital as a unique and valuable resource that leads to the competitive advantage of the organizations. The current study is limited to five stars, four-star and three-star hotels in Lahore, Pakistan. It an important and initial step towards establishing a measurable and empirical value of human capital for organizations in the hospitality sector. However, It opens new vistas for researchers to further investigate the phenomenon

Aseismic and seismic impact on development of soft-sediment deformation structures in deep-marine sand-shaly Crocker fan in Sabah, NW Borneo

Abstract Soft-sediment deformation structures are present within the deep-marine fan of the West Crocker Formation, Sabah Basin, NW Borneo. Focus of this study is to highlight the impact of seismic and aseismic activities on the development of these structures and their distribution in deep-marine fan. Twenty-nine types of deformation structures were identified during the study of twelve exposed sections. These structures were grouped into five categories: i) water-escape structures, ii) sole marks, iii) clastic intrusions, iv) deformed laminations, and v) syn-depositional brittle and ductile deformation structures. The sediment deformation is interpreted to be caused either by aseismic processes like slope failure, gravity collapse, sediment overloading, density gradient, seismic induced mechanisms such as earthquakes, tectonic uplift, or combined effect of seismic and aseismic events. These structures are classified based on type of features developed during semi-consolidated phase of rock deposition. The seismite structures i.e., clastic intrusions, deformed laminations, and syn-depositional structures are correlated with active collisional tectonics during the Late Paleogene times in the Sabah Basin. In the present work, a generalized conceptual model has also been proposed for the development of soft-sediment deformation structures in a submarine fan environment. Dewatering structurers and rapid sedimentation features are associated with inner fan, load and flame structures are present within middle fan, while contorted layers, slumps and mass-transport deposits are linked with distal fan settings

Developing ideal mission statements: lessons learned from top global organizations

A mission statement is the most visible element of an organizational strategy; it ought to be effective in terms of reflecting its purpose. Particularly, top global brands, corporations, and business schools are expected to have modular mission statements that comply with the definition of an ideal mission statement. To determine how closely they adhere to the components of an ideal mission statement, this study compares the actual mission statements of the top organizations with the desired ideal mission statement. The study employed a meta-content analysis approach to analyze the mission statements of 400 organizations from diverse sectors, including Interbrand’s top 100 global brands, Financial Times ranked top 100 business schools, and top 100 conventional and top 100 Islamic banks. For each type of organization and for the whole sample, mission statements were analyzed for how many and what components they frequently include in their mission statements. The results show that only 5 percent of these organizations have perfect mission statements indicating majority do not prioritize creating mission statements that contain all the necessary components. The components such as self-concept, products and services, and customers were the most frequently communicated concerns, indicating a high level of importance on conveying identity, offerings, and relationships with customers whereas concerns for employees, public image, and technology were severely overlooked. The findings suggest a discrepancy between academia and industry regarding what constitutes an ideal mission statement inviting further research to better understand the components of an ideal mission statement and how they align with real-world statements. This research assists organizations in identifying gaps in their mission statements and aligning them with their organizational values, goals, and strategies by providing thorough theoretical and practical implications in the end

Cytotoxicity, Morphology and Chemical Composition of Two Luting Cements: An in Vitro Study

Objective: To assess the cytotoxicity, surface morphology, elemental compositions and chemical characterization of two commonly used luting cement. Material and Methods: The two luting types of cement used were Elite Cement® and Hy-Bond Resiglass®. Freshly mixed (n=6) and set form (n=6) of each cement was placed in medium to obtain extracts. The extract from each sample was exposed to L929 mouse fibroblasts (1x104cells/well). Alamar Blue Assay assessed cell viability. Surface morphology and elemental composition were evaluated using scanning electron microscopy and energy dispersive spectroscopy. The chemical characterization was performed by Fourier Transform Infrared Spectroscopy. One-way ANOVA and post-hoc Tukey analysis were conducted to assess results. Results: Hy-Bond Resiglass® was the more cytotoxic of the two types of cement in both freshly mixed (68.10 +5.16; p<0.05) and set state (87.58 +4.86; p<0.05), compared to Elite Cement® both freshly mixed (77.01 +5.45; p<0.05) and set state (89.39 +5.66; p<0.05). Scanning electron microscopy revealed a more irregular and porous structure in Hy-Bond Resiglass® compared to Elite Cement®. Similarly, intense peaks of aluminium, tungsten and fluorine were observed in energy dispersive spectroscopy in Hy-Bond Resiglass. Conclusion: All these three elements (aluminium, tungsten and fluorine) have cytotoxic potential. The Fourier transform infrared spectroscopy revealed the presence of hydroxyethyl methacrylate in Hy-Bond Resiglass®, which has a cytotoxic potential

Full-length human placental sFlt-1-e15a isoform induces distinct maternal phenotypes of preeclampsia in mice

<div><p>Objective</p><p>Most anti-angiogenic preeclampsia models in rodents utilized the overexpression of a truncated soluble fms-like tyrosine kinase-1 (sFlt-1) not expressed in any species. Other limitations of mouse preeclampsia models included stressful blood pressure measurements and the lack of postpartum monitoring. We aimed to 1) develop a mouse model of preeclampsia by administering the most abundant human placental sFlt-1 isoform (hsFlt-1-e15a) in preeclampsia; 2) determine blood pressures in non-stressed conditions; and 3) develop a survival surgery that enables the collection of fetuses and placentas and postpartum (PP) monitoring.</p><p>Methods</p><p>Pregnancy status of CD-1 mice was evaluated with high-frequency ultrasound on gestational days (GD) 6 and 7. Telemetry catheters were implanted in the carotid artery on GD7, and their positions were verified by ultrasound on GD13. Mice were injected through tail-vein with adenoviruses expressing hsFlt-1-e15a (n = 11) or green fluorescent protein (GFP; n = 9) on GD8/GD11. Placentas and pups were delivered by cesarean section on GD18 allowing PP monitoring. Urine samples were collected with cystocentesis on GD6/GD7, GD13, GD18, and PPD8, and albumin/creatinine ratios were determined. GFP and hsFlt-1-e15a expression profiles were determined by qRT-PCR. Aortic ring assays were performed to assess the effect of hsFlt-1-e15a on endothelia.</p><p>Results</p><p>Ultrasound predicted pregnancy on GD7 in 97% of cases. Cesarean section survival rate was 100%. Mean arterial blood pressure was higher in hsFlt-1-e15a-treated than in GFP-treated mice (∆MAP = 13.2 mmHg, p = 0.00107; GD18). Focal glomerular changes were found in hsFlt-1-e15a -treated mice, which had higher urine albumin/creatinine ratios than controls (109.3±51.7μg/mg vs. 19.3±5.6μg/mg, p = 4.4x10^-2; GD18). Aortic ring assays showed a 46% lesser microvessel outgrowth in hsFlt-1-e15a-treated than in GFP-treated mice (p = 1.2x10^-2). Placental and fetal weights did not differ between the groups. One mouse with liver disease developed early-onset preeclampsia-like symptoms with intrauterine growth restriction (IUGR).</p><p>Conclusions</p><p>A mouse model of late-onset preeclampsia was developed with the overexpression of hsFlt-1-e15a, verifying the <i>in vivo</i> pathologic effects of this primate-specific, predominant placental sFlt-1 isoform. HsFlt-1-e15a induced early-onset preeclampsia-like symptoms associated with IUGR in a mouse with a liver disease. Our findings support that hsFlt-1-e15a is central to the terminal pathway of preeclampsia, and it can induce the full spectrum of symptoms in this obstetrical syndrome.</p></div