Entering a new era of surgical training : developing 3-dimensional print models for hands-on surgical training and its introduction into the congenital cardiac surgical curriculum

Congenital heart surgery is a technically challenging subspecialty of cardiothoracic surgery. This is due to a combination of factors including the rarity and variety of pathology and the small patient size. This coupled with the increasing public scrutiny and the expectation of excellent patient outcomes for even the most complex pathologies has led to limitations for surgical trainees to develop their surgical competencies in an efficient manner. Simulation has been used successfully to develop technical skills in other surgical specialities but is limited in congenital heart surgery. The objectives of this work were to develop and integrate hands-on simulation methods into the training of congenital heart surgeons using anatomically accurate 3D-printed heart models and to use validated, objective assessment methods to measure performance. The simulation programme was successfully developed and integrated into the regular training of congenital heart surgeons. The objective assessments demonstrated that there was an improvement in procedural performance and time across multiple complex procedures following deliberate practice and rehearsal. Furthermore, surgeons who had participated in the programme retained their technical skills following a prolonged delay supporting the value of simulation. Overall, there is value in the incorporation of hands-on simulation training into congenital heart surgery and it has the potential to be integrated into training programmes globally

On Ray's theorem for weak firmly nonexpansive mappings in Hilbert Spaces

In this work, we introduce notions of generalized firmly nonexpansive (G-firmly non expansive) and fundamentally firmly nonexpansive (F-firmly nonexpansive) mappings and utilize to the same to prove Ray's theorem for G-firmly and F-firmly nonexpansive mappings in Hilbert Spaces. Our results extend the result due to F. Kohsaka [ Ray's theorem revisited: a fixed point free firmly nonexpansive mapping in Hilbert spaces, Journal of Inequalities and Applications (2015) 2015:86 ]

Constructing a Criterion Reference Test to Measure the Research and Statistical Competencies of Graduate Students at the Jordanian Governmental Universities

This study aimed at constructing a criterion-reference test to measure the research and statistical competencies of graduate students at the Jordanian governmental universities, the test has to be in its first form of (50) multiple choice items, then the test was introduced to (5) arbitrators with competence in measurement and evaluation to determine the cut-off score using Angoff method amounted to (0.69), the test was applied to an experimental sample of (80) students ( males and females  from the International Islamic University to check out the difficulty and discrimination coefficients of the items, based on these coefficients, (5) items have been deleted, then the test which consists of (45) items in its final form, was applied to the total sample consisting of (275) students  (males and females) from the Jordanian governmental universities  (University of Jordan, Al-Yarmouk, Mu'tah), the stability coefficient was estimated using kuder-Ritchardson-20 coefficient (0.83) to be used in the verification of Livingston stability at the cut-off score, its value reached (0.87). The results showed that there is statistically significant differences in the degree of possession of competencies attributed to gender, also showed a statistically significant differences in the possessing of competencies attributed to scientific degree in favor of the doctorate, and there was no effect of the interaction between the two variables (sex and scientific degree) to acquire skills, and the results showed that there is a clear decline in the mastery of graduate students at Jordanian universities for research and statistical competencies, the proportion of the expert students who are over the cut-off score was (0.57). Keywords: Criterion Reference Test, Research and Statistical Competencies

Harmonic enhancement in microgrid with applications on sensitive loads

Power quality issues are an important and growing problem in microgrid. There are two reasons; the more active consumer is participating in the power sector, the use of renewable energy which having a great impact on voltage variation. This paper discusses power quality disturbance and especially harmonic distortion issues in microgrid, and suggests a solution to maintain the operation of the distribution system within power quality standard. To protect sensitive loads from harmonics produced by the grid and by renewable energy sources, passive harmonic filter has been proposed in this paper. The electrical system of a nuclear research reactor as sensitive loads is designed by using Electrical Transient Analyzer Program (ETAP) software. The results show these technical issues are presented with their influence on electrical voltage and harmonic specter

Management of Small Aortic Root during Aortic Valve Replacement

Background: Concomitant aortic root enlargement (ARE) increases the risk of aortic valve replacement (AVR). The objectives of this study were to identify the patients who needed aortic root enlargement and compare the outcomes and the risk of adding ARE to AVR. Methods: We retrospectively reviewed 62 patients who underwent isolated mechanical aortic valve replacement between 2017 and 2019. We divided the patients into two groups: group A included patients with small aortic root who had AVR with one of the different surgical strategies for small aortic annulus (n= 32) and group B, which included patients with a normal aortic annulus and underwent conventional AVR (n= 30). Group A was further sub-divided based on the surgical strategy into 4 categories; patients who had supra-annular implantation of size 19 mm St. Jude prosthetic valve (n= 11; 34.4%), Nicks procedure (n= 13 40.6%), Manougian procedure (n= 4; 12.5%), Konno procedure (n= 4; 12.5%).  Results: Group A patients were significantly younger (26.16 ± 11.49 vs. 34.63 ± 8.9 years; p< 0.001) and had lower body weight (55.09 ± 21.41 vs. 69.80 ± 19.20; p= 0.01). Group A had significantly smaller valves (p = 0.03), and total cardiopulmonary bypass (148.65 ± 44.09 vs. 97.46 ± 20.90 minutes; p<0.001) and aortic cross-clamp times (118.13 ± 36.70 vs. 78.06 ± 16.01 minutes; p < 0.001) were significantly longer in group A. There was no significant difference in operative complications between groups. Among patients with small aortic root; Konno procedure had the longest bypass time (236.3 ± 19.70 minutes; p<0.001); cross-clamp time (192.5 ± 22.2 minutes; p <0.001); mechanical ventilation (4.75 ± 0.50 hours; p<0.001) and intensive care unit stay (6.50 ± 0.57 days; p <0.001). Patients with supra-annular implantation of the St. Jude valve had a significantly higher postoperative pressure gradient (14.64 ± 6.84 mmHg; p= 0.02). No difference in procedure complications was observed among aortic root enlargement procedures. Conclusion: Patients who had aortic root enlargement procedure were younger, with lower weight and body surface area. Surgical procedures used to manage small aortic root had comparable early results, and no technique was superior to the others

Characterisation and cytotoxicity assessment of UV absorbers-intercalated zinc/aluminium-layered double hydroxides on dermal fibroblast cells

Zn/Al-layered double hydroxide (LDH) was used as a host to intercalate various organic ultraviolet (UV) radiation absorbers. The intercalation compounds were prepared via the co-precipitation method. Powder X-ray diffraction (PXRD) confirmed the successful intercalation of anions into the interlayer regions of the LDH nanocomposites. As a result of intercalation, the resulting nanocomposites loaded with UV-ray absorbers, cinnamic acid (CA), benzophenone 4 (B4) and Eusolex®232 (EUS)—exhibited basal spacings of 17.9 Å, 21.3 Å and 21.0 Å, respectively. Photochemical analysis revealed an increase in the UV-ray absorption capability of UV absorber/LDH nanocomposites compared to pure UV-ray absorbers. The retention ability of the organic moieties in the LDH host was tested in a skin pH simulation and was found to demonstrate low release over an extended period of time. Cytotoxicity findings indicated that none of the nanocomposites exhibit significant cytotoxicity towards human dermal fibroblast (HDF) cells up to the test concentration of 25 μg/mL

The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: A systematic review

OBJECTIVES: With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula. METHODS: Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS: Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity. CONCLUSIONS: Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons

The Religious Authorities in the Poetry of Ahmad al-Khayal

        من جماليات الشعر الحديث والمعاصر احتواء لغتهُ الشعريةِ على ثقافات ومرجعيات مختلفة، مما دعا الشعراء إلى التنافس إلى لغةٍ خاصة يكاد يكون محترف فيها، وهذا ما نصبوا إليه في دراسة قصائد الشاعر أحمد الخيال، وكيفية أدلجة لغتهِ مع المرجعية الدينية، عبر النص القصصي الديني (القرآني)، أو عبر العبارة أو الكلمة المستوحاة قرآنيًا أو عقائديًا، مما يمكّن الشاعر أن يكونَ فارسًا في هذا المجال.One of the aesthetics of modern and contemporary poetry is that his poetic language contains different cultures and references, which called poets to compete for a special language in which he is almost a professional. Quranic), or through the phrase or word inspired by the Qur’anic or doctrinal, which enables the poet to be a knight in this field

Controlling a switched reluctance motor with a conventional three phase bridge instead of asymmetric H-bridges

This paper proposes a new driving method for switched reluctance motor (SRM), by using the standard full-bridge inverter. In spite of changing the internal structure of an SRM, the proposed method uses an extra ring structure circuit to make it possible for the inverter to drive the SRM. Next to the standard converter, a controllable DC source is needed. With the theoretical analysis and calculation, the reference value of the circulating current in the ring structure is determined and the new method is proven via simulation. A comparison is made with the conventional method for driving an SRM: the asymmetric H-bridges. Also the current studies are then made to confirm that the SRM can be controlled without lowering the performance of the machine. The experimental verification is also made under different conditions, as well as the comparison with the simulation results

Post-transplant anemia in pediatric patients and its impact on patient and graft survival: single center experience

Introduction: Post-transplantation anemia (PTA)occurs frequently, with prevalence rates between 20and 60% depending on the criteria used for defininganemia.Aim of the work: We aimed to assess the prevalenceof anemia after 6 months of transplantation inpediatric renal transplant patients under differentprotocols of immunosuppression, and to determinethe impact of anemia upon long-term patient andgraft survival.Patients and methods: Based on the data of 108renal transplants performed in our center, patientswere categorized after 6 months according to theirhemoglobin (Hb) levels into two groups. The firstgroup with Hb more than 11gm/dl (group I, 29cases) and the second group with Hb lessthan11gm/dl (group II, 79cases). We compared thetwo groups regarding post transplant complications(rejection episodes, hypertension, diabetes mellitus,infections, hepatic dysfunction, and patient andgraft survival.Results: we found no significant difference betweenthe two groups regarding rejection episodes.However, the percentage of cases with chronicallograft nephropathy was significantly higher in the anemic group. The survivors with functioning graftswere significantly higher in cases with normal Hb.Moreover, living cases with graft failure weresignificantly higher in anemic group. Graft survivalrate was better in the non anemic group. However,no difference in patient survival was detected. Also,we found no difference between the two groupsregarding post-transplant complications.Conclusions: From this study, we can conclude thatthe prevalence of post-transplant anemia is highpediatric renal transplant patients especially thosereceiving CNI and MMF, and it was associated withpoorer graft outcome but no effect on patientsurvival