关键词： Vertigo   Diplopia   Ophthalmoplegia   Vertical gaze palsy   CADASIL  

摘要： Crossed vertical gaze palsy refers to a rare combination of elevation paresis in one eye and depression palsy in the fellow eye. It was once reported in a patient with unilateral infarction involving the mesodiencephalic junction, and was ascribed to selective disruption of the fibers projecting from the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) to the oculomotor nuclear complex. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare cause of ophthalmoplegia and crossed vertical gaze palsy has not been described in this disorder. Our patient with a circumscribed acute infarction involving the left mesodiencephalic junction due to CADASIL showed both upward and downward gaze palsy in both eyes, but more marked depression paresis in the ipsilesional eye and more conspicuous elevation deficit in the contralesional eye, which was consistent with crossed vertical gaze palsy. We provide alternate explanation for this rare phenotype of vertical gaze palsy. Selective disruption of riMLF fibers may cause crossed vertical gaze palsy in unilateral mesodiencephalic lesion.

关键词： SARS-COV-2   COVID-19   Sialic acids   Glycan shield   Neu5Ac   Neu5Gc   Antibodies   Vaccine   Pandemic  

摘要： Understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) highjacks epithelial cells and infiltrates the lung, as well as other organs and tissues, is essential for developing treatment strategies and vaccines against this highly contagious virus. Another major goal is to fully elucidate the mechanisms by which SARS-CoV- 2 bypasses the innate immune system and induces a cytokine storm, and its effects on mortality. Currently, SARS- CoV-2 is thought to evade innate antiviral immunity, undergo endocytosis, and fuse with the host cell membrane by exploiting ACE2 receptors and the protease TMMPRSS2, with cathepsin B/L as alternative protease, for entry into the epithelial cells of tissues vulnerable to developing coronavirus disease 2019 (COVID19) symptoms. However, the incorporation of new and unique binding sites, i.e., O-linked glycans, and the preservation and augmentation of effective binding sites (N-linked glycans) on the outer membrane of SARS-CoV2 may represent other strategies of infecting the human host. Here, I will rationalize the possibility that other host molecules-i.e., sugar molecules and the sialic acidsN-glycolylneuraminic acid, N-acetylneuraminic acid, and their derivates could be viable candidates for the use as virus receptors by SARS-CoV-2 and/or serve as determinants for the adherence on ACE2 of SARS-CoV-2.

关键词： graduate medical education   obstetrics and gynecology   opioid education  

摘要： Objective Our primary objective was to assess the current state of pain and opioid education in obstetrics and gynecology (OBGYN) by performing a detailed review of the national educational curricula guiding OBGYN residency and fellowship training programs in the United States. Methods From 2019 to 2020 we reviewed seven documents created to guide learning and structure educational training for OBGYN residency and fellowship programs in the United States: the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives Core Curriculum in Obstetrics and Gynecology, the 2016 Educational Objectives-Fellowship in Minimally Invasive Gynecologic Surgery, and the 2018 Guides to Learning in Complex Family Planning, Female Pelvic Medicine & Reconstructive Surgery, Gynecologic Oncology, Maternal Fetal Medicine, and Reproductive Endocrinology and Infertility. Each document was reviewed by two authors to assess for items referring to pain or opioids. Results The CREOG educational objectives, used to inform educational curricula for residency programs, were the most comprehensive, mentioning pain and/or opioid educational objectives the highest number of times and including the most categories. The CREOG document was followed by the Guides to Learning for Gynecologic Oncology and for Minimally Invasive Gynecologic Surgery. The Reproductive Endocrinology and Infertility Guide to Learning did not mention pain and/or opioids in the educational objectives. Conclusions Our study identifies an opportunity for consistent and appropriate opioid and pain management education in OBGYN training.

摘要： Cognitive load theory has become a leading model in educational psychology and has started to gain traction in the medical education community over the last decade. The theory is rooted in our current understanding of human cognitive architecture in which an individual's limited working memory and unlimited long-term memory interact during the process of learning. Though initially described as primarily a theory of learning, parallels between cognitive load theory and broader aspects of medical education as well as clinical practice are now becoming clear. These parallels are particularly relevant and evident in complex clinical environments, like resuscitation medicine. The authors have built on these connections to develop a recontextualized version of cognitive load theory that applies to complex professional domains and in which the connections between the theory and clinical practice are made explicit, with resuscitation medicine as a case study. Implications of the new model for medical education are also presented along with suggested applications.

关键词： CAM   Ayurveda   Yoga   Cancer   Uttarakhand   Sub-Himalayan  

摘要： Background: The use of complementary and alternative medicine (CAM) is widespread among cancer patients in India. Objective: The present study elucidated usage patterns of CAM and the factors responsible for its adoption among the patients with cancer, and the therapeutic impact of CAM. Materials and methods: This was a questionnaire-based study, conducted among patients with cancer in a tertiary care hospital in a sub-Himalayan city. Data were analyzed using statistical methods. Results: A total of 2614 patients with cancer were included. Almost half of the patients (n = 1208, 46.2%) reported to have been treated with CAM. Breast cancer (n = 274, 23.0%) was most prevalent with majority at advanced stages. Ayurveda (n = 428, 35.9%) Yoga/Naturopathy (n = 381, 32.0%) Homeopathy (n = 143, 12.0%) and Unani (n = 71, 5.9%) were used commonly. Among CAM users, 85.0% (n = 1012) of patients used CAM as the sole method of treatment, while 58.9% (n = 702) patients reported initial symptomatic benefit. Conclusion: Using CAM benefitted a significant number of patients with cancer. However, there is an urgent need to integrate CAM with modern system of medicine. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciences and Technology and World Ayurveda Foundation.

关键词： education   evaluation   history   pain   residency  

摘要： Objectives The concept of "historical alternans" (HA), a teaching folklore term referring to different descriptions of patient histories to trainees versus attending clinicians, can cause disjointed care and be a source of frustration for the trainee. Increased focus on the proper evaluation and treatment of pain in the emergency department (ED) setting prompts an evaluation of the HA concept as it relates to pain. Methods We conducted a prospective observational pilot study comparing pain descriptions given to attending and trainee clinicians in the ED using a five-question pain description survey. Trainees included emergency medicine physician residents, emergency medicine physician assistant residents, off-service residents, and students. Trainees completed the first survey and attending clinicians repeated survey questions after at least a 10-minute washout. Surveys include descriptions of pain as part of patients' primary concern, severity indicated by a verbal numerical rating score (VNRS), and pain location, quality, and duration. Results During a 10-day period, surveys were completed for 97 patient encounters. Most trainee clinicians were emergency medicine physician residents (53%), followed by emergency medicine physician assistants (32%), students (13%), and off-service residents (2%). Pain complaints centered on the abdomen (18.5%), chest (12%), and knee (6%). Differences in pain description were found in the majority of cases (55%), with most having one categorical difference. The majority of categorical differences were VNRS (38%), although the difference in scores was not statistically significant (P = 0.20). Medical students had the highest variance in VNRS difference compared with attending clinicians. There was no significant difference in described duration (P = 0.99) or quality of pain (P = 0.99) between trainee and attending clinicians. Conclusions Most patient encounters had at least one difference in categorical pain descriptors between traine

关键词： Panel data   Interactive fixed effects   CCE estimator   GMM  

摘要： In this paper, we compare alternative estimation approaches for factor augmented panel data models. Our focus lies on panel data sets where the number of panel groups (N) is large relative to the number of time periods (T). The principal component (PC) and common correlated effects (CCE) estimators were originally developed for panel data with largeNandT, whereas the GMM approaches of Ahn et al. (J Econ 728 174:1-14, 2013) and Robertson and Sarafidis (J Econ 185(2):526-541, 2015) assume thatTis small (that isTis fixed in the asymptotic analysis). Our comparison of existing methods addresses three different issues. First, we analyze the possibility of an inappropriate normalization of the factor space (the so-called normalization failure). In particular we propose a variant of the CCE estimator that avoids the normalization failure by adapting a weighting scheme inspired by the analysis of Mundlak (Econometrica 46(1):69-85, 1978). Second, we analyze the effects of estimating versus fixing the number of factors in advance. Third, we demonstrate how the design of the Monte Carlo simulations favors some estimators, which explains the conflicting findings from existing Monte Carlo experiments.

摘要： The Medical Student Performance Evaluation (MSPE), which summarizes a medical student's academic and professional undergraduate medical education performance and provides salient information during the residency selection process, faces persistent criticisms regarding heterogeneity and obscurity. Specifically, MSPEs do not always provide the same type or amount of information about students, especially from diverse schools, and important information is not always easy to find or interpret. To address these concerns, a key guiding principle from the Recommendations for Revising the MSPE Task Force of the Association of American Medical Colleges (AAMC) was to achieve "a level of standardization and transparency that facilitates the residency selection process." Benefits of standardizing the MSPE format include clarification of performance benchmarks or metrics, consistency across schools to enhance readability, and improved quality. In medical education, standardization may be an important mechanism to ensure accountability of the system for all learners, including those with varied backgrounds and socioeconomic resources. In this article, members of the aforementioned AAMC MSPE task force explore 5 tensions inherent in the pursuit of standardizing the MSPE: (1) presenting each student's individual characteristics and strengths in a way that is relevant, while also working with a standard format and providing standard content;(2) showcasing school-specific curricular strengths while also demonstrating standard evidence of readiness for internship;(3) defining and achieving the right amount of standardization so that the MSPE provides useful information, adds value to the residency selection process, and is efficient to read and understand;(4) balancing reporting with advocacy;and (5) maintaining standardization over time, especially given the tendency for the MSPE format and content to drift. Ongoing efforts to promote collaboration and trust across the undergraduate

关键词： CZTS-MWCNT composite HTM   MWCNT electrode   n-i-p perovskite solar cell  

摘要： Metal electrode contact (i.e., Al, Ag, and Au) used for charge collection at perovskite solar cells (PSCs) needs an alternative replacement due to their expensive processing cost. Chemically reactive organic hole-transporting material (HTM) easily exposes corrosion threat to these metal electrode contacts at the Metal/organic-HTM junction. Including these two critical factors, PSC also faces a challenging issue of interface instability at perovskite/organic HTM junction. Therefore, in this work, metal contact has been replaced by Multi-wall Carbon Nanotube (MWCNT) with a simple drop-casting deposition process, and inorganic semiconductor material Cu2ZnSnS4 (CZTS) has been applied as HTM by spin coating technique. However, to improve the efficiency of PSC, CZTS-MWCNT composite has been used here as HTM due to its significant optoelectronics properties. These materials CZTS, MWCNT, and CZTS-MWCNT composites have been synthesized and characterized by XRD, FESEM, TEM, UV-Vis, and Raman spectroscopy, respectively. The fabrication process of the regular (n-i-p) structured PSCs has been described, and the photovoltaic performances have been investigated by their current voltage characteristics. It has been observed that MWCNT embedded composite HTM (i.e., CZTS-MWCNT) has not only successfully delivered 7.60% PCE but also improved the stability of the PSC.