Subcutaneous Leiomyosarcoma of the Frenulum

Leiomyosarcomas of the penis are rare, with only 29 reported cases to date. We record the case of a patient who presented with a 2-year history of a seemingly indolent penile skin lesion. On histopathology of the local resection, a diagnosis of subcutaneous leiomyosarcoma was made. Specifically, leiomyosarcoma of the penile frenulum has not been clearly reported previously. The patient underwent a further excision to ensure an adequate resection margin and has had no disease recurrence at subsequent follow-up. Our case was of a lesion that, although clinically benign, was malignant and this possibility should be borne in mind when assessing patients

Video head impulse testing: Pitfalls in neurological patients

The video head impulse test (vHIT) assesses the vestibulo-ocular reflex (VOR) during a rapid high-velocity low amplitude (10°–20°) head rotation. Patients with peripheral vestibulopathy have a reduced VOR gain with corrective catch-up saccades during the head turn. There are several pitfalls, mainly technical, which may interfere with interpretation of vHIT data. In addition, intrusive eye movement disorders such as spontaneous nystagmus that affect normal eye position and tracking can affect the vHIT results. To date there has been little study of neurological saccadic eye movements that may interfere with the interpretation of vHIT data. Here, in ten patients with a range of central neurological disorders, we describe oculomotor abnormalities on vHIT in the presence of normal range VOR gain values, recorded at a tertiary vestibular neurology service

Suicide first aid guidelines for Sri Lanka: a Delphi consensus study

Background: Sri Lanka has one of the highest suicide rates in the world. Gatekeeper programs aimed at specific target groups could be a promising suicide prevention strategy in the country. The aim of this study was to develop guidelines that help members of the public to provide first aid to persons in Sri Lanka who are at risk of suicide. Methods: The Delphi method was used to elicit consensus on potential helping statements to include in the guidelines. These statements describe information members of the public should have and actions they can take to help a person who is experiencing suicidal thoughts. An expert panel, comprised of mental health and suicide experts in Sri Lanka, rated each statement. The panellists were encouraged to suggest any additional action that was not included in the original questionnaire and, in particular, to include items that were culturally appropriate or gender specific. Responses to open-ended questions were used to generate new items. These items were included in the subsequent Delphi rounds. Three Delphi rounds were carried out. Statements were accepted for inclusion in the guidelines if they were endorsed (rated as essential or important) by at least 80 % of the panel. Statements endorsed by 70–79 % of the panel were re-rated in the following round. Statements with less than 70 % endorsement, or re-rated items that did not receive 80 % or higher endorsement were rejected. Results: The output from the Delphi process was a set of endorsed statements. In the first round questionnaire 473 statements were presented to the panel and 58 new items were generated from responses to the open-ended questions. Of the total 531 statements presented, 304 were endorsed. These statements were used to develop the suicide first aid guidelines for Sri Lanka. Conclusion: By engaging Sri Lankans who are experts in the field of mental health or suicide this research developed culturally appropriate guidelines for providing mental health first aid to a person at risk of suicide in Sri Lanka. The guidelines may serve as a basis for developing training for members of the public to provide mental health first aid to persons at risk of suicide as part of Sri Lanka’s suicide prevention strategy

A mode-matching analysis of dielectric-filled resonant cavities coupled to terahertz parallelplate waveguides

We use the mode-matching technique to study parallel-plate waveguide resonant cavities that are filled with a dielectric. We apply the generalized scattering matrix theory to calculate the power transmission through the waveguide-cavities. We compare the analytical results to experimental data to confirm the validity of this approach

Efficacy of Information Extraction from Bar, Line, Circular, Bubble and Radar Graphs

With the emergence of enormous amounts of data, numerous ways to visualize such data have been used. Bar, circular, line, radar and bubble graphs that are ubiquitous were investigated for their effectiveness. Fourteen participants performed four types of evaluations: between categories (cities), within categories (transport modes within a city), all categories, and a direct reading within a category from a graph. The representations were presented in random order and participants were asked to respond to sixteen questions to the best of their ability after visually scanning the related graph. There were two trials on two separate days for each participant. Eye movements were recorded using an eye tracker. Bar and line graphs show superiority over circular and radial graphs in effectiveness, efficiency, and perceived ease of use primarily due to eye saccades. The radar graph had the worst performance. “Vibration-type” fill pattern could be improved by adding colors and symbolic fills. Design guidelines are proposed for the effective representation of data so that the presentation and communication of information are effective

Effect of spiral spacing and concrete strength on behavior of GFRP-reinforced hollow concrete columns

Hollow concrete columns (HCCs) are one of the preferred construction systems for bridge piers, piles, and poles because they require less material and have a high strength-to-weight ratio. While spiral spacing and concrete compressive strength are two critical design parameters that control HCC behavior, the deterioration of steel reinforcement is becoming an issue for HCCs. This study explored the use of glass fiber-reinforced polymer (GFRP) bars as longitudinal and lateral reinforcement for hollow concrete columns and investigated the effect of various spiral spacing and different concrete compressive strengths (f′c). Seven HCCs with inner and outer diameters of 90 and 250 mm, respectively, and reinforced with six longitudinal GFRP bars, were prepared and tested. The spiral spacing was no spirals, 50, 100, and 150 mm; the f′c varied from 21 to 44 MPa. Test results show that reducing the spiral spacing resulted in increased HCC uniaxial compression capacity, ductility, and confined strength due to the high lateral confining efficiency. Increasing f′c, on the other hand, increased the axial-load capacity but reduced the ductility and confinement efficiency due to the brittle behavior of high compressive-strength concrete. The analytical models considering the axial load contribution of the GFRP bars and the confined concrete core accurately predicted the behavior of the HCCs after the spalling of the concrete cover or at the post-loading behavior

Evaluation of the undergraduate family medicine programme of Faculty of Medicine, University of Kelaniya : quantitative and qualitative student feedback

Background: Worldwide there is an increasing emphasis on the importance of primary care. The ministry of health Sri Lanka issued a directive in 2016 that training of doctors in primary care should be strengthened. Medical students of the Faculty of Medicine, University of Kelaniya follow a 1 month long clinical appointment in family medicine in their fourth year of study. Methods: Feedback is taken from students on completion of the appointment. Half the students from each group complete a pre tested structured feedback questionnaire that consists of answers to questions based on a likert scale with a space for free comments. The other half provide qualitative feedback. In this evaluation data were gathered from 185 (98%) students from all eight clinical groups throughout the year 2016. Quantitative data were analysed using SPSS version 22. Inductive thematic analysis was used to analyse the qualitative data from the Round Robin activity and free comments from the questionnaire. Results: The qualitative feedback provided a richer indepth overview of student ideas on the appointment compared to the quantitative data. In reflection of a desire for learning to be of relevance students wanted clinically oriented teaching focused on management. They preferred active teaching learning methods such as the opportunity to conduct consultations and receive immediate feedback. Students had a high regard for the teaching sessions by general practitioners at their clinics. The appointment had created an interest in the discipline of family medicine which could have an impact on future choice of career. There were indications to suggest that student attitudes towards patients may have evolved to be more patient centred. Students appreciated the inclusive and low stress ambience of the learning environment. Conclusions and recommendations: Regular evaluation of teaching programmes helps maintain accountability of faculty and paves the way for more student centred teaching through the incorporation of students’ views in devising teaching methods. This evaluation found that qualitative feedback provided more descriptive material to reflect on and therefore improve teaching on the programme. It is recommended that more use should be made of qualitative methodologies in programme evaluations

Bioaccumulation of heavy metals in the selected commercially important edible fish species gray mullet (Mugil cephalus) from Negombo estuary

Consumption of fish contaminated with non essential heavy metals such as Pb, Hg and Cd metals which exceed the required limits pose a risk to human health. Bioaccumulations of heavy metals in fish depend on several factors such as increased levels of industrial pollution and domestic solid waste dumping in the estuary. Based on the pollution inputs into the estuary, it is considered that different localities within the estuary are polluted at different rates.The objectives of this study were to determine the non essential heavy metals concentration in fish tissues and assess the seasonal variations in the ecosystem. For this study, fish tissue samples were collected from nine sampling locations along the North (n =3), South (n=2), West (n=2), and East (n=2) parts of the estuary for a period of one year from January to December 2014. Fish tissue heavy metals levels were analyzed employing standard methods. Results revealed that the average concentrations (mg/kg) varied from Pb 0 to 0.15 ± 0.06, Cd 0.35 ± 0.16 to 1.04 ± 0.28 and Hg 0.0005 ± 0.0004 to 0.05 ± 0.046 mg/kg respectively. The detected levels were below the maximum permissible limits for hazardous substances in fish and fishery products for recommendation of FAO. The detected lead, mercury and cadmium contents in fish tissue were below the standard limits defined for each element < 0.5 mg/kg < 0.05 mg/kg and < 0.05 mg/kg respectively. Significant differences (P < 0.05) were observed for Pb and Hg depending on fish tissues. The levels of Pb and Hg metals in muscle tissue were lower than the standard limit for FAO. The value obtained on Cd 1.04 ± 0.28 mg/kg concentration was much higher than the permissible threshold limit observed in the north, south, east and west regions. The most prominent increases in Pb and Cd metal concentrations in fish tissue were found during the October, November and December study of 2014, which corresponded to peak periods from October, November and December which apparently coincided with the second inter monsoon of the island respectively

Fish oil omega-3 fatty acids partially prevent lipid-induced insulin resistance in human skeletal muscle without limiting acylcarnitine accumulation

This is the author accepted manuscript. The final version is available from Portland Press via the DOI in this record Acylcarnitine accumulation in skeletal muscle and plasma has been observed in numerous models of mitochondrial lipid overload and insulin resistance. Fish oil n3PUFA (omega-3 polyunsaturated fatty acids) are thought to protect against lipid-induced insulin resistance. The present study tested the hypothesis that the addition of n3PUFA to an intravenous lipid emulsion would limit muscle acylcarnitine accumulation and reduce the inhibitory effect of lipid overload on insulin action. On three occasions, six healthy young men underwent a 6-h euglycaemic-hyperinsulinaemic clamp accompanied by intravenous infusion of saline (Control), 10% Intralipid® [n6PUFA (omega-6 polyunsaturated fatty acids)] or 10% Intralipid®+10% Omegaven® (2:1; n3PUFA). The decline in insulin-stimulated whole-body glucose infusion rate, muscle PDCa (pyruvate dehydrogenase complex activation) and glycogen storage associated with n6PUFA compared with Control was prevented with n3PUFA. Muscle acetyl-CoA accumulation was greater following n6PUFA compared with Control and n3PUFA, suggesting that mitochondrial lipid overload was responsible for the lower insulin action observed. Despite these favourable metabolic effects of n3PUFA, accumulation of total muscle acylcarnitine was not attenuated when compared with n6PUFA. These findings demonstrate that n3PUFA exert beneficial effects on insulin-stimulated skeletal muscle glucose storage and oxidation independently of total acylcarnitine accumulation, which does not always reflect mitochondrial lipid overload.This research study was funded by The Royal Society [Grant RG100575]