Knowledge and Awareness of Stroke among the Elderly Population: Analysis of Data from a Sample of Older Adults in a Developing Country.

Background and Objectives: Stroke prevention has traditionally concentrated on research to improve knowledge and awareness of the disease in the general population. Since stroke incidents increase with age, there is a need to focus on the elderly, a high-risk group for developing the disease. This study aimed to examine the level of stroke awareness and knowledge, their predictors, and their source of information. Materials and Methods: A prospective cross-sectional study targeted Lebanese senior citizens aged 65 years and above. A total of 513 participants enrolled in the study through a self-administered survey distributed using a snowball sampling technique. Results: Most participants had appropriate baseline knowledge (more than 75% correct answers) of stroke, including risk factors, alarming signs, and preventive measures. Better knowledge of disease risks was significantly associated with having a university degree (ORa = 1.609; p = 0.029). Participants who had previous ischemic attacks showed significantly lower knowledge of the alarming signs (ORa = 0.467; p = 0.036) and prevention measures (ORa = 0.427; p = 0.029). Those suffering from depression had better knowledge of stroke alarming signs (ORa = 2.060.; p = 0.050). Seeking information from pharmacists, physicians, or the internet was not significantly associated with better knowledge of stroke risks, alarming signs, and preventive measures. Conclusions: The present study showed that seniors had fair knowledge of stroke, despite gaps in stroke prevention measures. Healthcare providers could play a leading role in improving public health by educating seniors to enhance awareness about prevention measures, detecting alarming signs, and acting fast to save a life.

Maintaining quality of life after major lung resection for carcinoid tumor.

BACKGROUND: Pulmonary carcinoid is a rare diagnosis with surgery remaining the standard treatment of choice. However, resection may impact patients' daily activities due to decreased lung volume reserve and postoperative pain. Our study aims to compare the impact of different types of surgical resection on the post-operative quality of life with the application of a strict peri-operative pulmonary care program. METHODS: Patients who underwent surgery for bronchopulmonary carcinoid tumors in a tertiary cancer center between August, 2017 and March, 2020 were identified and demographic data was collected. Patients were contacted via phone for the qualitative and quantitative assessment of pain and quality of life, utilizing the Arabic version of Short-form McGill Pain Questionnaire and Activity of Daily Living (ADL) instrument respectively. Lung reserve was assessed before and after surgery. Statistical analysis used Chi-Square for categorical variables and ANOVA for continuous variables. RESULTS: A total of 16 patients underwent different type of resection. The majority were male (n = 10; 63%) with a mean age of 44 years (19-81). Most common clinical stage was stage I (n = 12, 75%) with typical carcinoid features recorded in more than half of the cases (n = 11, 69%). Almost all patients underwent surgical excision (n = 15, 94%) with negative resection margin and no major post-operative complications. Bilobectomy was the most frequent procedure (n = 6, 40%) and video-assisted thoracoscopic surgery (VATS) was utilized in 8 patients (50%). Expected changes were recorded in pre- and postoperative pulmonary function test with an average drop of 10 in FEV1 and 14 mL/min/mmHg in DLCO. The majority of patients (n = 15, 94%) were totally independent doing daily activities. Mild intermittent pain was found in 7 patients (44%) who scored an average intensity of 1.6 out of 10. CONCLUSIONS: Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoid tumors with little to no effect on patients' lung function and quality of life in regard to performance status and post-operative pain when a good peri-operative pulmonary, physical rehabilitation, and pain management programs are adopted and strictly implemented.

Locally advanced thymoma; does neoadjuvant chemotherapy make a difference?

BACKGROUND: Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy (NACT) may be utilized to increase the chance of R0 resection, raising the question of its efficacy and safety. METHODS: Demographic and clinical data from patients who presented to a tertiary cancer center between January 2015-October 2021 with a diagnosis of thymoma and underwent curative surgical resection was collected. Computed tomography scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of NACT on tumor burden. The pathological response was determined by measuring the percentage of necrotic tissue. RESULTS: A total of 23 patients were diagnosed with thymoma. Most patients were male with a mean age 46 (± 15) years at diagnosis. The most common clinical stage was stage II with 5 patients (22%). A total of 12 patients had NACT as compared to 11 patients who had upfront surgery. The mean change in tumor volume was 165 cm3 (p = 0.079) and the change in and maximum diameter was 1.53 ± 1.49 cm (p < 0.01). The effect of NACT on tumor burden based on RECIST criteria was minimal as 8 patients had stable disease. Based on pathological findings, the average necrotic portion of the tumor was 39.5% (p = 0.152). The overall survival rate is 95.65%, mean survival was 115 months (4-125). Recurrence occurred in 5 patients. The NACT group had a higher risk for recurrence (4; 33.3%) with a mean survival of 43.8 months compared to 59.6 months in those who did not receive induction therapy. CONCLUSIONS: The exact role of induction chemotherapy in locally advanced thymoma patients remains controversial. NACT effect after utilizing radiological and pathological assessment tools was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease, with minimal radiologic and pathologic effect. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies.

The Understanding and Impact of COVID-19 and Pandemic Policies on Syrian and Other Arabic-Speaking Refugees in Tampa, Florida.

Background Vulnerable communities around the world, such as Syrian refugees, faced increased social and financial strain due to coronavirus disease 2019 (COVID-19). We evaluated the underlying issues and inequities of Arabic-speaking refugees during the pandemic. Methods Data were collected from Arabic-speaking refugees ( N = 20) in July 2020, using an online 97-item questionnaire, in short response and multiple-choice formats. Results Participants' reports indicate adequate knowledge about COVID-19 symptoms and preventative measures, but experienced linguistic, financial, and cultural challenges during the pandemic. "Essential" low-paying occupations put the population at risk for COVID-19. Local mosques and nonprofits have provided essential social support and food. Conclusion Syrian and Arabic-speaking refugees reported several problems suggesting the need for increased understanding of this understudied, marginalized, and vulnerable population. Making resources and governmental programs more accessible is critical, so refugees can better access information regarding jobs, housing, and education. Organizations central to community support, including mosques, should be assisted.

Effects of biophilic virtual reality on cognitive function of patients undergoing laparoscopic surgery: study protocol for a sham randomised controlled trial.

INTRODUCTION: Virtual reality (VR) is already being used for cognitive or emotional rehabilitation. However, its role in postoperative cognitive dysfunction (POCD) has not been fully recognised. Due to the lack of an effective postoperative follow-up system, the incidence of POCD in China is not clear, and although many drugs have been proposed to improve POCD in the animal study, their clinical applications are limited, while VR provides an innovative method to provide non-pharmacological management. METHODS AND DESIGN: This is a single-centre, randomised, double-blind, sham-controlled clinical trial. In this study, 600 patients over 55 years old undergoing laparoscopic surgery will be recruited. Participants will be randomly assigned to receive biophilic VR or sham VR (1:1 ratio), all patients have 20 min of exposure per day during the hospital stay. The primary outcome is the impact of VR on the incidence of POCD. Secondary outcomes include perioperative anxiety and instrumental activities of daily living. Changes in the performance of the neurocognitive batteries are measured by a local resident doctor. Serum samples will be collected on the day before surgery and 7 days after surgery. ETHICS AND DISSEMINATION: This trial has ethical approval from the Medical Ethics Committee of the Affiliated Hospital of Medical School of Ningbo University (KY20210302). The study is sponsored by Ningbo University and Ningbo Science and Technology Bureau. CONTACT: Dr. Mao Haijiao, Chair of the hospital medical Ethics committee (ndfylunli@126.com). Trial results will be submitted for publication in peer-reviewed journals, patient recruitment began in April 2021. Written informed consent is obtained for all participants. All information acquired will be disseminated via national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2000040919.

Sleep Monitoring of Children With Nocturnal Enuresis: A Narrative Review.

The purpose of this article is to provide a succinct summary of the sleep monitoring efforts that have been used in nocturnal enuresis (NE) and an overview of the knowledge that has accrued. This is not intended to be a comprehensive review, but rather is intended to highlight how polysomnography (PSG), a common sleep detection tool, has contributed to our understanding of NE, as arousal disorder is considered to be one of the important mechanisms. The authors have organized this report by analysis and display of different ingredients of PSG, starting with comparing the electroencephalogram (EEG) of controls and the enuretic children and then moving to evaluation of respiratory patterns of NE and comorbid disease obstructive sleep apnea (OSA). In addition, the authors' goal is to better understand the mechanism of NE by integrating various levels of sleep monitoring; those sleep-related clinical scale scores for NE are presented to date. Finally, we propose further research of NE to explore the microstructure alterations via PSG combined with EEG-fMRI or to use novel technology like portable device internet and deep learning strategy.

Neuropsychological Tests in Post-operative Cognitive Dysfunction: Methods and Applications.

Post-operative cognitive dysfunction (POCD) is a neurological complication that relatively frequently occurs in older people after anesthesia/surgery, with varying durations and significant differences in the severity of cognitive impairment. POCD is mainly characterized by memory loss mostly without consciousness disorders, accompanied by abnormal emotions, behaviors, and language, mostly without consciousness disorder. The clinical performance of POCD lacks specificity but can reflect the severity of cognitive impairment in patients. The diagnosis of POCD cannot be separated from the evaluation of perioperative cognitive function of patients, and the more popular and accepted method is neuropsychological tests (NPTs).

Corona COVID-19 spread - a nonlinear modeling and simulation.

This paper presents a non-linear model to simulate and predict the spreading of the newly discovered disease caused by a new series of a Novel Coronavirus (COVID-19). The mathematical modeling in this study is based on the Susceptible Infected Recovery (SIR) model, where key controlling parameters are considered, namely: human contact factor b, transmit factor (a), health medication factor (m) and initial infected (I0). The simulation results show the effect of these parameters, and their role in spreading the COVID-19. The results also show that by keeping a high medication factor and a low contact factor, the spreading of COVID-19 will slow down. The medication health factor depends on the infrastructure of a country, and it is difficult to improve it instantly. On the other hand, the contact factor can be easily controlled. Enforcing the physical social distancing, drastically decreases the contact factor. Hence, slow down the spreading of the virus. Also, the effect of medication factor on the number deaths caused by COVID-19 is studied. The results show that as medication factor increases the number of deaths decreases.

Holographically formed three-dimensional Penrose-type photonic quasicrystal through a lab-made single diffractive optical element.

Large-area three-dimensional Penrose-type photonic quasicrystals are fabricated through a holographic lithography method using a lab-made diffractive optical element and a single laser exposure. The diffractive optical element consists of five polymer gratings symmetrically orientated around a central opening. The fabricated Penrose-type photonic quasicrystal shows ten-fold rotational symmetry. The Laue diffraction pattern from the photonic quasi-crystal is observed to be similar to that of the traditional alloy quasi-crystal. A golden ratio of 1.618 is also observed for the radii of diffraction rings, which has not been observed before in artificial photonic quasicrystals.

Five beam holographic lithography for simultaneous fabrication of three dimensional photonic crystal templates and line defects using phase tunable diffractive optical element.

This paper demonstrates an approach for laser holographic patterning of three-dimensional photonic lattice structures using a single diffractive optical element. The diffractive optical element is fabricated by recording gratings in a photosensitive polymer using a two-beam interference method and has four diffraction gratings oriented with four-fold symmetry around a central opening. Four first-order diffracted beams from the gratings and one non-diffracted central beam overlap and form a three-dimensional interference pattern. The phase of one side beam is delayed by inserting a thin piece of microscope glass slide into the beam. By rotating the glass slide, thus tuning the phase of the side beam, the five beam interference pattern changes from face-center tetragonal symmetry into diamond-like lattice symmetry with an optimal bandgap. Three-dimensional photonic crystal templates are produced in a photoresist and show the phase tuning effect for bandgap optimization. Furthermore, by integrating an amplitude mask in the central opening, line defects are produced within the photonic crystal template. This paper presents the first experimental demonstration on the holographic fabrication approach of three-dimensional photonic crystal templates with functional defects by a single laser exposure using a single optical element.

Fabrication of two-layer integrated phase mask for single-beam and single-exposure fabrication of three-dimensional photonic crystal.

In this paper, we report a new design and fabrication of an integrated two-layer phase mask for five-beam holographic fabrication of three-dimensional photonic crystal templates. The phase mask consists of two layers of orthogonally oriented gratings produced in a polymer. The vertical spatial separation between two layers produces a phase shift among diffractive laser beams, which enables the holographic fabrication of inter-connected three-dimensional photonic structures. A three-dimensional photonic crystal template was fabricated using the two-layer phase mask and was consistent with simulations based on the five beam interference. The reported method simplifies the fabrication of photonic crystals and is amendable for massive production and chip-scale integration of three-dimensional photonic structures.