Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary.

BACKGROUND: Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. AIM: This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. DESIGN: A qualitative study was carried out using semi-structured telephone interviews. SETTING: This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). METHOD: We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. RESULTS: Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. CONCLUSION: Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. PATIENT OR PUBLIC CONTRIBUTION: The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.

Dosing of 7 + 3 induction chemotherapy in a patient with acute myeloid leukemia (AML) and morbid obesity.

INTRODUCTION: Traditional chemotherapy dosing is based on body surface area (BSA) using standard formulas, which can pose challenges in dosing patients at body weight extremes. Studies suggest that chemotherapy dosing according to actual body weight does not increase toxicity in obese patients and current guidelines recommend full weight-based dosing of chemotherapy regardless of body mass index (BMI). However, the dosing of anthracyclines in obese patients can be challenging given limitations in maximum cumulative dosage, particularly in those at very extreme BMI. In this case, we highlight the difficulties of dosing anthracycline-based induction chemotherapy in a patient with newly diagnosed acute myeloid leukemia (AML) and BMI >90 kg/m2. CASE REPORT: A 40-year-old female with morbid obesity is diagnosed with AML (nucleophosmin 1 (NPMI) and isocitrate dehydrogenase-2 mutated, FMS-like tyrosine kinase 3-Internal tandem duplication negative). MANAGEMENT AND OUTCOME: The patient was initiated on induction therapy with 7 + 3 with dose capping of BSA at 2.75 m2 (cytarabine 200 mg/m2 continuous infusion over 24 h for 7 days, plus daunorubicin 60 mg/m2 slow intravenous push for 3 days), followed by two cycles of high-dose cytarabine consolidation therapy using actual BSA. The patient achieved morphologic complete remission; however, measurable residual disease testing for NPM1 remained positive after induction therapy. DISCUSSION: This case suggests that dose capping of anthracyclines in the treatment of newly diagnosed AML may be an effective and safe treatment alternative in those with extreme BMI elevations beyond what has been studied in the literature. Given the increasing incidence of morbid obesity, further studies are needed to confirm appropriate dosing of anthracycline-based regimens at upper BMI extremes (>60 kg/m2).

Vulnerability of Common Urban Forest Species to Projected Climate Change and Practitioners Perceptions and Responses.

While urban forests are often identified as part of climate change adaptation and mitigation strategies, less attention has been given to vulnerabilities urban trees may have to a changing climate and practitioners' response to those vulnerabilities. Yet, current planting and management decisions will impact how urban forests fare under future climatic conditions. We explore a case study of Mississauga (Ontario, Canada) to examine (1) if common urban forest species are vulnerable to two scenarios of projected climate change, (2) the experiences and responses of urban forestry practitioners to climate change, and (3) whether urban forestry practitioners' experience and practice are aligned with the vulnerability assessment. Vulnerabilities of 27 common species were examined based on 2071-2100 regional climate projections. Interviews were then conducted with practitioners working in the public and private sectors. The results suggest that the majority of examined species will be vulnerable to multiple conditions associated with projected climate. Practitioners all perceive recent changes in climate and extreme weather patterns, but do not prioritize future climate conditions in their species selection decisions. Moreover, they expressed uncertainty about how to make species selection decisions in light of climate change. Given the predicted vulnerabilities, alternative species need to be considered or more management resources (e.g., for watering) will be required to maintain the current composition. However, the lack of focus on future conditions by practitioners raises concerns, while also highlighting the need for more information about appropriate management strategies.

Experiments and modeling of nonlinear frequency response of oscillations of a sessile droplet subjected to horizontal vibrations.

In this paper, we experimentally studied the response frequency of oscillations of a sessile water droplet, subjected to horizontal vibrations at varying excitation frequency (5-250 Hz and 40 kHz) and amplitude (0.015 mm to 0.5 mm for low frequencies and 600nm for ultrasonic frequency), as well as static contact angle of the glass substrate ([Formula: see text], [Formula: see text] , [Formula: see text], [Formula: see text]). The droplets were pinned during the experiments and non-axisymmetric oscillation modes were excited due to the horizontal vibrations. For the first time, we observed that at a sufficiently high vibration amplitude, when the excitation frequency is lower than the smallest natural frequency of the sessile droplet, the droplet oscillates at a response frequency multiple of the excitation frequency. At higher excitation frequencies up to several hundreds of Hz, the droplet oscillates nearly at the excitation frequency. At ultrasonic excitation frequency, however, the droplet cannot follow the excitations, since there is a physical limitation for forming infinite modes (infinite wavenumber) on the surface of a small droplet. We have modeled these behaviors with a nonlinear mass-spring-damper system by combining two established models: the Duffing and Van der Pol equations, in order to simulate both nonlinear damping and stiffness.

Development of a novel shrouded impeller pediatric blood pump.

The aim of this work was to analyze a shrouded impeller pediatric ventricular assist device (SIP-VAD). This device has distinctive design characteristics and parameter optimizations for minimization of recirculation flow and reduction in high-stress regions that cause blood damage. Computational Fluid Dynamics (CFD) simulations were performed to analyze the optimized design. The bench-top prototype of SIP-VAD was manufactured with biocompatible stainless steel. A study on the hydrodynamic and hemodynamic performance of the SIP-VAD was conducted with predictions from CFD and actual experimentation values, and these results were compared. The CFD analysis yielded a pressure range of 29-90 mmHg corresponding to flow rates of 0.5-3 L/min over 9000-11000 rpm. The predicted value of the normalized index of hemolysis (NIH) was 0.0048 g/100 L. The experimental results with the bench-top prototype showed a pressure rise of 30-105 mmHg for the flow speed of 8000-12000 rpm and flow rate of 0.5-3.5 L/min. The maximum difference between CFD and experimental results was 4 mmHg pressure. In addition, the blood test showed the average NIH level of 0.00674 g/100 L. The results show the feasibility of shrouded impeller design of axial-flow pump for manufacturing the prototype for further animal trials.

An optimized CT-dense agent perfusion and micro-CT imaging protocol for chick embryo developmental stages.

Compared to classical techniques of morphological analysis, micro-CT (µ-CT) has become an effective approach allowing rapid screening of morphological changes. In the present work, we aimed to provide an optimized micro-CT dense agent perfusion protocol and µ-CT guidelines for different stages of chick embryo cardiogenesis. Our study was conducted over a period of 10 embryonic days (Hamburger-Hamilton HH36) in chick embryo hearts. During the perfusion of the micro-CT dense agent at different developmental stages (HH19, HH24, HH27, HH29, HH31, HH34, HH35, and HH36), we demonstrated that durations and volumes of the injected contrast agent gradually increased with the heart developmental stages contrary to the flow rate that was unchanged during the whole experiment. Analysis of the CT imaging confirmed the efficiency of the optimized parameters of the heart perfusion.

Pectin/sodium alginate films tailored with Acetyl-11-keto-beta-boswellic acid for active packaging.

The present study aimed to develop food packaging films by using a combination of pectin (PE) and sodium alginate (SA) enriched with Acetyl-11-keto-beta-boswellic acid (AKBA) as a functional or active ingredient. The fabricated films underwent comprehensive evaluation of their morphological, chemical, mechanical, barrier, optical, thermal, antioxidant, and antimicrobial properties. SEM and FTIR analysis showed that AKBA had good compatibility with film-forming components. The AKBA-loaded film samples exhibited a decrease in their barrier properties and tensile strength, but enhancements in both elongation at break and thickness values was observed. With the addition of AKBA, a significant increase (p < 0.05) in the ultraviolet barrier properties of the films and total colour variation (ΔE) was observed. TGA analysis of the films unveiled an improvement in thermal resistance with the incorporation of AKBA. Moreover, the films loaded with AKBA exhibited potent antioxidant activity in the ABTS and DPPH assay methods. Disk diffusion analysis showed the antimicrobial activity of AKBA-loaded films against P. aeruginosa, highlighting the potential of AKBA as a natural antimicrobial agent for the safety of food products. The results demonstrate the practical application of PE and SA active films loaded with AKBA, particularly within the food packaging industry.

Tuning the structure and physiochemical properties of sodium alginate and chitosan composite films through sodium tripolyphosphate (STPP) crosslinking.

Sodium tripolyphosphate (STPP), an inorganic and non-toxic polyphosphate, has potential applications as a crosslinking agent in the fabrication of edible films. This study utilized STPP in the development of sodium alginate-chitosan composite films, with a focus on their suitability for food packaging applications. The results indicate that the incorporation of STPP led to an increase in film thickness (from 0.048 ± 0.004 to 0.078 ± 0.008 mm), elongation at break (from 11.50 ± 1.49 % to 15.88 ± 2.14 %), water permeation (from 0.364 ± 0.010 to 0.521 ± 0.021 gmm/(m2h*kPa)), and moisture content (from 25.98 ± 0.20 % to 28.12 ± 0.17 %). In contrast, there was a decrease in tensile strength (from 30.23 ± 2.08 to 25.60 ± 1.22 MPa) and swelling index (from 752.9 ± 17.1 to 533.5 ± 8.9 %). Scanning electron microscopy (SEM) analysis revealed the formation of distinctive needle-like microcrystals with the incorporation of STPP. Fourier-transform infrared spectroscopy (FTIR) analysis indicated intermolecular interactions between STPP and the film-forming biopolymers. The data obtained from Thermogravimetric analysis (TGA) and Differential Scanning Calorimetry (DSC) demonstrated enhanced thermal stability of STPP-loaded films at elevated temperatures. Furthermore, the films exhibited increased DPPH scavenging activity with the addition of STPP. This study underscores the potential of STPP as a crosslinking agent for the development of composite edible films, suggesting applications in the field of food packaging.

Evolution of the meta-neurosurgeon: A systematic review of the current technical capabilities, limitations, and applications of augmented reality in neurosurgery.

Background: Augmented reality (AR) applications in neurosurgery have expanded over the past decade with the introduction of headset-based platforms. Many studies have focused on either preoperative planning to tailor the approach to the patient's anatomy and pathology or intraoperative surgical navigation, primarily realized as AR navigation through microscope oculars. Additional efforts have been made to validate AR in trainee and patient education and to investigate novel surgical approaches. Our objective was to provide a systematic overview of AR in neurosurgery, provide current limitations of this technology, as well as highlight several applications of AR in neurosurgery. Methods: We performed a literature search in PubMed/Medline to identify papers that addressed the use of AR in neurosurgery. The authors screened three hundred and seventy-five papers, and 57 papers were selected, analyzed, and included in this systematic review. Results: AR has made significant inroads in neurosurgery, particularly in neuronavigation. In spinal neurosurgery, this primarily has been used for pedicle screw placement. AR-based neuronavigation also has significant applications in cranial neurosurgery, including neurovascular, neurosurgical oncology, and skull base neurosurgery. Other potential applications include operating room streamlining, trainee and patient education, and telecommunications. Conclusion: AR has already made a significant impact in neurosurgery in the above domains and has the potential to be a paradigm-altering technology. Future development in AR should focus on both validating these applications and extending the role of AR.

DNA-Diffusion: Leveraging Generative Models for Controlling Chromatin Accessibility and Gene Expression via Synthetic Regulatory Elements.

The challenge of systematically modifying and optimizing regulatory elements for precise gene expression control is central to modern genomics and synthetic biology. Advancements in generative AI have paved the way for designing synthetic sequences with the aim of safely and accurately modulating gene expression. We leverage diffusion models to design context-specific DNA regulatory sequences, which hold significant potential toward enabling novel therapeutic applications requiring precise modulation of gene expression. Our framework uses a cell type-specific diffusion model to generate synthetic 200 bp regulatory elements based on chromatin accessibility across different cell types. We evaluate the generated sequences based on key metrics to ensure they retain properties of endogenous sequences: transcription factor binding site composition, potential for cell type-specific chromatin accessibility, and capacity for sequences generated by DNA diffusion to activate gene expression in different cell contexts using state-of-the-art prediction models. Our results demonstrate the ability to robustly generate DNA sequences with cell type-specific regulatory potential. DNA-Diffusion paves the way for revolutionizing a regulatory modulation approach to mammalian synthetic biology and precision gene therapy.

Effect of Asymmetric Fins on Thermal Performance of Phase Change Material-Based Thermal Energy Storage Unit.

Phase change material (PCM)-based thermal energy storage units (TESU) have very low thermal conductivity that compromise their charging and discharging rate. The present study focuses on an enhancement in charging rate as well as an increase in the uniformity of the melting rate. A rectangular cavity consisting of two horizontal partial fins is studied. The horizontal partial fins are placed symmetrically in a PCM-based TESU. In the current work, the melting rate of PCM was enhanced using asymmetric arrangement while keeping all other parameters the same, thus showing the positive effect of asymmetric configuration in such storage systems. The position and the pitch of each fin is optimized to improve heat transfer characteristics of the TESU. The numerical investigation of the problem is performed. TESU with asymmetrically placed fins show better performance in terms of higher charging rate as well as uniformity of the charging rate. The asymmetric placement of the fins suggested by present study increased the charging rate by 74.3% on average as compared to the symmetrically placed fins in the storage system. The charging rate uniformity is improved by 43.7%. The asymmetric fin's placement conserved the convection strength for a longer melting duration and so increased the Nusselt number by 80.2% as compared to the symmetrically placed fins. Thus, it can be concluded that the performance of asymmetric fins is better in the charging of PCMs than the symmetrically placed fins in a PCM-based TESU.

Sudden Cardiac Death in Young Individuals: A Current Review of Evaluation, Screening and Prevention.

Sudden cardiac death (SCD) can affect all age groups, including young persons. While less common in the age < 35 population, the occurrence of SCD in the young raises concern, with multiple possible etiologies and often unanswered questions. While coronary artery disease is the leading cause in those > 35 years of age, the younger population faces a different subset of pathologies associated with SCD, including arrhythmias and cardiomyopathies. The tragic nature of SCD in the young entails that we explore and implement available screening methods for this population, and perform the necessary investigations such as electrocardiography (ECG) and echocardiography. In this review, we not only explore the vast etiology associated with SCD in those age < 35, but emphasize evaluation methods, who is at risk, and delve into screening of SCD in potential victims and their family members, in an attempt to prevent this traumatic event. Future research must work towards establishing preventative measures in order to reduce SCD, particularly unexplained SCD in the young.

In vitro and in vivo study on fine-grained Mg-Zn-RE-Zr alloy as a biodegradeable orthopedic implant produced by friction stir processing.

Magnesium alloys containing biocompatible components show tremendous promise for applications as temporary biomedical devices. However, to ensure their safe use as biodegradeable implants, it is essential to control their corrosion rates. In concentrated Mg alloys, a microgalvanic coupling between the α-Mg matrix and secondary precipitates exists which results in increased corrosion rate. To address this challenge, we engineered the microstructure of a biodegradable Mg-Zn-RE-Zr alloy by friction stir processing (FSP), improving its corrosion resistance and mechanical properties simultaneously. The FS processed alloy with refined grains and broken and uniformly distributed secondary precipitates showed a relatively uniform corrosion morphology accompanied with the formation of a stable passive layer on the alloy surface. In vivo corrosion evaluation of the processed alloy in a small animal model showed that the material was well-tolerated with no signs of inflammation or harmful by-products. Remarkably, the processed alloy supported bone until it healed till eight weeks with a low in vivo corrosion rate of 0.7 mm/year. Moreover, we analyzed blood and histology of the critical organs such as liver and kidney, which showed normal functionality and consistent ion and enzyme levels, throughout the 12-week study period. These results demonstrate that the processed Mg-Zn-RE-Zr alloy offers promising potential for osseointegration in bone tissue healing while also exhibiting controlled biodegradability due to its engineered microstructure. The results from the present study will have profound benefit for bone fracture management, particularly in pediatric and elderly patients.

Understanding Effects of Visual Feedback Delay in AR on Fine Motor Surgical Tasks.

Latency is a pervasive issue in various systems that can significantly impact motor performance and user perception. In medical settings, latency can hinder surgeons' ability to quickly correct movements, resulting in an experience that doesn't align with user expectations and standards of care. Despite numerous studies reporting on the negative effects of latency, there is still a gap in understanding how it impacts the use of augmented reality (AR) in medical settings. This study aims to address this gap by examining how latency impacts motor task performance and subjective perceptions, such as cognitive load, on two display types: a monitor display, traditionally used inside an operating room (OR), and a Microsoft HoloLens 2 display. Our findings indicate that both level of latency and display type impact motor performance, and higher latencies on the HoloLens result in relatively poor performance. However, cognitive load was found to be unrelated to display type or latency, but was dependent on the surgeon's training level. Surgeons did not compromise accuracy to gain more speed and were generally well aware of the latency in the system irrespective of their performance on task. Our study provides valuable insights into acceptable thresholds of latency for AR displays and proposes design implications for the successful implementation and use of AR in surgical settings.

Acetone-Gasoline Blend as an Alternative Fuel in SI Engines: A Novel Comparison of Performance, Emission, and Lube Oil Degradation.

The disproportionate use of petroleum products and stringent exhaust emissions has emphasized the need for alternative green fuels. Although several studies have been conducted to ascertain the performance of acetone-gasoline blends in spark-ignition (SI) engines, limited work has been done to determine the influence of fuel on lubricant oil deterioration. The current study fills the gap through lubricant oil testing by running the engine for 120 h on pure gasoline (G) and gasoline with 10% by volume acetone (A10). Compared to gasoline, A10 produced better results in 11.74 and 12.05% higher brake power (BP) and brake thermal efficiency (BTE), respectively, at a 6.72% lower brake-specific fuel consumption (BSFC). The blended fuel A10 produced 56.54, 33.67, and 50% lower CO, CO2, and HC emissions. However, gasoline remained competitive due to lower oil deterioration than A10. The flash-point and kinematic viscosity, compared to fresh oil, decreased by 19.63 and 27.43% for G and 15.73 and 20.57% for A10, respectively. Similarly, G and A10 showed a decrease in total base number (TBN) by 17.98 and 31.46%, respectively. However, A10 is more detrimental to lubricating oil due to a 12, 5, 15, and 30% increase in metallic particles like aluminum, chromium, copper, and iron, respectively, compared to fresh oil. Performance additives like calcium and phosphorous in lubricant oil for A10 decreased by 10.04 and 4.04% in comparison to gasoline, respectively. The concentration of zinc was found to be 18.78% higher in A10 when compared with gasoline. A higher proportion of water molecules and metal particles were found in lubricant oil for A10.

Discovery of LNP1892: A Precision Calcimimetic for the Treatment of Secondary Hyperparathyroidism.

The calcium sensing receptor (CaSR) plays an important role in maintaining calcium homeostasis. The use of calcimimetic cinacalcet has been established to activate CaSR and normalize hypercalcemia. However, cinacalcet has limitations due to its high cLogP and pKa. A systematic optimization of cinacalcet to reduce its cLogP and pKa yielded compound 23a (LNP1892). Compound 23a showed excellent potency and a favorable pharmacokinetics profile, and lacked the liabilities of cinacalcet, making it a highly differentiated precision calcimimetic. In adenine-diet-induced chronic kidney disease (CKD) models, 23a demonstrated robust and dose-dependent efficacy, as measured by plasma parathyroid hormone (PTH) levels. It also showed an excellent safety profile in animal studies. Phase 1 clinical trials with 23a in healthy volunteers confirmed its excellent safety, tolerability, and effectiveness in lowering PTH levels in a dose-dependent manner, without causing symptomatic hypocalcaemia. Encouraged by these promising results, LNP1892 was taken to a Phase 2 study in CKD patients.

Metabolic syndrome in type 2 diabetes: comparison of WHO, modified ATPIII & IDF criteria.

OBJECTIVES: To determine the frequency of metabolic syndrome in type 2 diabetes according to three commonly used operational definitions {World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) and International Diabetes Federation( IDF)}. To evaluate the agreement between these classifications in the Pakistani cohort. METHODS: Data was collected retrospectively of 210 patients with type 2 diabetes visiting outpatient clinics of one of the large tertiary care hospitals at Karachi, Pakistan between June 2008 to November 2008. RESULTS: The prevalence of metabolic syndrome was found to be 81.4% (WHO), 86.7 % (IDF) and 91.9 % (NCEP ATPIII). The degree of agreement (kappa statistic) was found to be highest among IDF & NCEP ATPIII (0.728) as compared to (0.436 & 0.417) between WHO & ATP and WHO & IDF respectively. The most significant predictors for metabolic syndrome were found out to be female gender OR= 8.74 95% CI 1.51-50.53, low HDL cholesterol levels OR = 0.89 95% CI 0.84-0.94 and high systolic blood pressure OR= 1.06 95% CI 1.009-1.11. CONCLUSION: Our study results suggested that NCEP ATPIII and IDF are the most reliable criteria for diagnosing metabolic syndrome in type 2 diabetic patients, with NECP capturing more patients in comparison to IDF definition. The alarmingly high frequency of metabolic syndrome in type 2 diabetes found in this study suggests that primary prevention strategies should be initiated earlier and early in this ethnic group and our health care system should be geared up to cope with this deadly quartet.

A systematic comparison of the accuracy of monocular RGB tracking and LiDAR for neuronavigation.

With the advent of augmented reality (AR), the use of AR-guided systems in the field of medicine has gained traction. However, the wide-scale adaptation of these systems requires highly accurate and reliable tracking. In this work, the tracking accuracy of two technology platforms, LiDAR and Vuforia, are developed and rigorously tested for a catheter placement neurological procedure. Several experiments (900) are performed for each technology across various combinations of catheter lengths and insertion trajectories. This analysis shows that the LiDAR platform outperformed Vuforia; which is the state-of-the-art in monocular RGB tracking solutions. LiDAR had 75% less radial distance error and 26% less angle deviation error. Results provide key insights into the value and utility of LiDAR-based tracking in AR guidance systems.

Blood Flow Disturbance and Morphological Alterations Following the Right Atrial Ligation in the Chick Embryo.

Collectively known as congenital heart defects (CHDs), cardiac abnormalities at birth are the most common forms of neonatal defects. Being principally responsible for the heart's pumping power, ventricles are particularly affected by developmental abnormalities, such as flow disturbances or genomic defects. Hypoplastic Right Heart Syndrome (HRHS) is a rare disease where the right ventricle is underdeveloped. In this study, we introduce a surgical procedure performed on chick embryo, termed right atrial ligation (RAL) for disturbing hemodynamics within the right heart aiming in order to generate an animal model of HRHS. RAL is a new surgical manipulation, similar to the well-studied left atrial ligation (LAL) surgery but it induces the hemodynamic change into the right side of the heart. After inducing RAL, We utilized techniques such as Doppler ultrasound, x-ray micro-CT, histology, and computational fluid dynamics (CFD) analysis, for a comprehensive functional and structural analysis of a developing heart. Our results displayed that RAL does not induce severe flow disturbance and ventricular abnormalities consistent with clinical findings. This study allows us to better understand the hemodynamics-driven CHD development and sensitivities of ventricles under disturbed flows.

A Bibliometric Analysis of COVID-19 Scientific Literature From the English-Speaking Caribbean.

The COVID-19 pandemic has led to a global crisis and has affected the Caribbean islands, leading to significant health and socioeconomic consequences in this region. Efforts to mitigate the burden of this disease have led to an accelerated amount of research in the English-speaking Caribbean (ESC). This bibliometric analysis aimed to evaluate the COVID-19-related scientific literature from the ESC nations. A total of 175 articles were included and analyzed from an initial PubMed search (n = 638) for COVID-19-related scientific literature from the ESC nations published between January 1, 2020, and June 30, 2022. Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) and the VOSviewer (version 1.6.18) were used to characterize countries, authorship, journals, affiliations, and keywords of the COVID-19-related articles. Trinidad and Tobago (38%), Jamaica (22%), Barbados (20%), and Grenada (15%) contributed to the greatest number of publications. The University of the West Indies (UWI) campuses in Trinidad and Tobago, Jamaica and Barbados, and St. George's University in Grenada were the most prolific institutions. Srikanth Umakanthan from the UWI was the most prolific author. Cureus, SN Comprehensive Clinical Medicine, and Frontiers in Public Health were the first three most productive journals; 59% of the 175 articles had either the first or last author affiliated with an institution in the ESC, and 19% of the articles were country-focused: Trinidad and Tobago (16/175), Jamaica (9/175), Barbados (5/175), and Antigua and Barbuda (2/175). Among the top themes of research, 27% were outbreak response and rearrangements, epidemiological studies (23%), clinical management (23%), and medical education (13%). Over the last two years, an interest stimulated by the pandemic has expanded the research in ESC countries. However, gaps in the knowledge exist, especially in the epidemiology of COVID-19 complications in the sub-populations of chronic non-communicable diseases, post-COVID syndrome, and the long-COVID syndrome in the region. Hence, there is enormous scope for more research across the region.