Enhancing medical students` confidence and performance in integrated structured clinical examinations (ISCE) through a novel near-peer, mixed model approach during the COVID-19 pandemic.

BACKGROUND: Near-peer medical education serves as an important method of delivering education to junior students by senior students. Due to the reduced clinical exposure because of the COVID-19 pandemic, we developed a mentorship scheme to help medical students with their Integrated Structured Clinical Examinations (ISCEs) by providing a combination of near-peer mentorship together with lecture-based teaching on a weekly basis for a 12-week period. Students attended a specialty-focused lecture every Tuesday followed by a small group teaching session organised by their tutor. METHODS: A longitudinal evaluative interventional study was undertaken by the international student led medical education organisation, OSCEazy. The teaching programme was organised and conducted by third year medical students to a recruited cohort of second year medical students. Students' perceptions of ISCEs (confidence, anxiety, and overall performance) were evaluated using 5-point Likert scales while their knowledge of the specialty was assessed using 10 single best answer questions which were distributed via Google® forms at the start and end of each week. In addition, we assessed tutor perceptions of their teaching and learning experience. RESULTS: Seventy-two tutees were enrolled in the programme (mean age: 24.4, female: 77.8%). 88.9% of the participants had not attended any online ISCE teaching prior to this. They preferred in-person ISCE teaching as compared to virtual sessions [median 4.5 (IQR 4-5) vs 3 (IQR 3-4), p <  0.0001), respectively]. There was a significant overall increase in knowledge when comparing pre-session and post-session performance [mean 53.7% vs 70.7%, p <  0.0001)]. There was a significant increase in student confidence [Confidence: median 3 (IQR:3-4) vs 4 (IQR 3-4), p <  0.0001] while no change was seen in the anxiety and perception of their overall performance in an ISCE. [Anxiety: median 3 (IQR 2-4) vs 3 (IQR 3-4), p = 0.37, Performance: median 3 (IQR 3-4) vs median 3 (IQR 3-4), p <  0.0001]. The tutors reported an increase in their confidence in teaching ISCEs online [median 3 (IQR 2-3.25) vs median 4 (IQR 4-5), p <  0.0001)]. CONCLUSION: Online near-peer teaching increases the confidence of both tutees and tutors involved while enhancing the tutees' knowledge of the specialty. Thus, medical schools should incorporate near-peer teaching in their curriculum to enhance the student learning experience.

Interface morphology driven exchange interaction and magnetization reversal in a Gd/Co multilayer.

Rare-earth (RE)/transition metal (TM) ferromagnetic heterostructures with competing interfacial coupling and Zeeman energy provide a rich ground to study different phase states as a function of magnetic field and temperature. The interface morphology as a knob in these RE/TM heterostructures provides an excellent opportunity to engineer the macroscopic magnetic response by tuning the interface dependent microscopic interactions between the layers. We have investigated the interface morphology driven structure and magnetic properties of a Gd/Co multilayer. The interface morphology of the multilayer was controlled by annealing the multilayer at a relatively low temperature of 573 K under vacuum conditions. Combining the different experimental techniques and a simple one-dimensional spin-based model calculation, we studied the detailed magnetic structure and magnetization reversal mechanism in this system across compensation temperature (Tcomp), which suggested a strong interface dependent coupling in the system. We showed that changes in the interface morphology of the Gd/Co multilayer strongly influence the macroscopic magnetic properties of the system. The calculation also confirms the formation of a helical magnetic structure with a 2π domain wall in this system below Tcomp. The experimental finding and the simulation of this technologically important system will help to understand the physics of all-optical switching and related applications.

Correlation of Magnetic and Superconducting Properties with the Strength of the Magnetic Proximity Effect in La0.67Sr0.33MnO3/SrTiO3/YBa2Cu3O7-δ Heterostructures.

The effect of the stacking sequence on magnetic and superconducting properties in La0.67Sr0.33MnO3 (LSMO)/YBa2Cu3O7-δ (YBCO) and LSMO/SrTiO3/YBCO heterostructures, which consequently affected the magnetic proximity effect (MPE), was investigated using spin-polarized neutron reflectivity experiments. The results established the intrinsic nature of MPE and its correlation with stacking sequence-dependent magnetic and superconducting properties in these oxide heterostructure systems. We found an increase in the superconducting transition temperature (Tsc) and magnetization for both of the heterostructures as compared to heterostructures with a reversed stacking order. The evolution of the magnetization of the interfacial ferromagnetic (FM) layer, studied as a function of temperature for both heterostructures, showed a decrease in the MPE-induced magnetic depleted layer thickness for heterostructures at a higher Tsc. A comparison of the results of different studies with the present results suggested that the average magnetization and transition temperatures of a FM and a superconductor (SC) were important parameters that dictate the strength of the proximity effect due to the complex interaction of SC and FM in these systems. Tuning the strength of MPE in FM/SC and FM/I/SC oxide heterostructures may provide a promising platform for the effective realization of devices.

Neurosurgery activity levels in the United Kingdom and republic of Ireland during the first wave of the covid-19 pandemic - a retrospective cross-sectional cohort study.

The impact of Covid-19 on surgical patients worldwide has been substantial. In the United Kingdom (UK) and the Republic of Ireland (RoI), the first wave of the pandemic occurred in March 2020. The aims of this study were to: (1) evaluate the volume of neurosurgical operative activity levels, Covid-19 infection rate and mortality rate in April 2020 with a retrospective cross-sectional cohort study conducted across 16 UK and RoI neurosurgical centres, and (2) compare patient outcomes in a single institution in April-June 2020 with a comparative cohort in 2019. Across the UK and RoI, 818 patients were included. There were 594 emergency and 224 elective operations. The incidence rate of Covid-19 infection was 2.6% (21/818). The overall mortality rate in patients with a Covid-19 infection was 28.6% (6/21). In the single centre cohort analysis, an overall reduction in neurosurgical operative activity by 65% was observed between 2020 (n = 304) and 2019 (n = 868). The current and future impact on UK neurosurgical operative activity has implications for service delivery and neurosurgical training.

Paediatric posterior fossa tumour resection rates in a small volume centre: the past decade's experience.

BACKGROUND: Paediatric brain tumour resection rates have been shown to correlate with outcome and, it is argued, are linked to operator volume and caseload. The British paediatric neurosurgery community has previously debated centralisation of paediatric neuro-oncology. At the 2018 British Paediatric Neurosurgery Group (BPNG) meeting, a commitment was made to prospectively collect tumour resection data at each Neurosurgical Unit (NSU). Here we review our prospectively-collected 10-year database of the three commonest paediatric posterior fossa tumours - astrocytomas, medulloblastomas and ependymomas. MATERIALS AND METHODS: Our primary outcome was extent of resection (EOR) on post-operative MRI scans reviewed by neuro-radiologists. Secondary outcomes comprised neurosurgical morbidity including infection, need for cerebrospinal fluid (CSF) diversion and the occurrence of posterior fossa syndrome (PFS). RESULTS: 55 children had 62 operations, where our complete resection rates for pilocytic astrocytomas, medulloblastomas and ependymomas were 77%, 79% and 63%, respectively. Both our primary and secondary outcomes were in keeping with the published literature and we discuss here some of the factors which may contribute towards favourable outcomes in a small volume centre. CONCLUSION: Our results suggest that small volume centres can expect equivalent results to larger volume NSUs with regards to paediatric brain tumour surgery. Continuing efforts nationally for data collection on resection rates and operative outcomes is a key step towards optimising management in these children.

Evolution of structural and magnetic properties of FePtCu alloy films on annealing of FePt/Cu multilayers.

Thin films of ternary (FePt)100-xCux alloys were obtained by annealing of FePt (100 Å)/Cu (d Å) multilayers with d = 50 and 100 Å deposited by sputtering at room temperature on Si substrates. The evolution of structural and magnetic properties of these multilayers induced by isochronal and isothermal annealing in a vacuum has been studied using depth dependent characterization techniques. Isochronal annealing for 0.5 h at different temperatures (300 to 600 °C) showed very low interdiffusion at the interfaces with no signature of alloy phase formation. However, isothermal annealing of multilayers at 600 °C for longer times (1.5-6.5 h) showed significantly large interdiffusion accompanied by the formation of polycrystalline ternary alloy and iron silicide phases. The iron silicide formed at the substrate-film interface assists the growth of the L10 ordered ternary alloy phase, which showed different stoichiometry for different multilayers. The L10 phase formed with higher Cu content showed drastically different magnetic properties with a reduction in saturation magnetization and an increase in coercivity (∼6 kOe) at room temperature. The iron silicide formed on high temperature annealing showed ferromagnetic nature with a magnetization of ∼140 emu cm-3 at room temperature.

Interface induced magnetic properties of Gd/Co heterostructures.

Antiferromagnetic coupling between rare-earth and transition metal ferromagnetic layers gives rise to various magnetic ground states in heterostructures of these materials. Interface structure and morphology tend to play important roles in magnetic properties of such systems. Interface induced magnetization in Gd/Co heterostructures has been studied using a combination of structural and magnetic characterization techniques. The interface morphology of the Gd/Co system was varied by growing Gd/Co multilayers using magnetron sputtering under different argon partial pressures. Interfacial properties were further modified by annealing the multilayers under high vacuum. The macroscopic magnetization measurements have been correlated with depth dependent structure and magnetic properties of multilayers studied using X-ray and polarized neutron reflectometry techniques. Secondary ion mass spectrometry measurements from both as-deposited and annealed samples also confirmed modification at the interfaces. It has been shown that the interface structure, together with roughness, leads to a unique low-temperature magnetic phase characterized by twisting of Gd and Co moments.

Prostate cancer leading to monoclonal gammopathy of undetermined significance: A case report.

Prostate cancer is one of the most common cancer types, affecting millions of individuals worldwide. The present study reported two cases of metastatic prostate cancer presenting with newly diagnosed monoclonal gammopathy of undetermined significance (MGUS). To the best of our knowledge, prostate cancer leading to MGUS has not been documented previously. MGUS is generally thought to be benign and has been demonstrated to convert into multiple myeloma (MM), as well as other lymphoproliferative disorders. Due to the high mortality rate associated with MM, further studies are required to confirm and clarify the association between prostate cancer and MGUS. Additionally, patients can be counseled on the requirement for follow up studies following a diagnosis of prostate cancer.

Orbitocerebral mucormycosis and intracranial haemorrhage: a role for caution with steroids in suspected giant cell arteritis.

A 75-year-old man with type 2 diabetes mellitus presented with complete loss of vision in his right eye and severe headaches for the past 24 hours. He had been treated for suspected giant cell arteritis (GCA) with high-dose corticosteroids which were being tapered to stop after an inconclusive right temporal artery biopsy and an erythrocyte sedimentation rate (ESR) value of 8. His current acute presentation, however, raised further concern for partially treated GCA and precipitated treatment with pulsed methylprednisolone. The patient, taking metformin, developed diabetic ketoacidosis and was transferred to the intensive care unit where a swollen, painful right eye with chemosis and complete ophthalmoplegia was subsequently revealed to be secondary to cavernous sinus thrombosis. Rhino-orbital skin necrosis with positive samples for the organism Rhizopus on eventual orbital exenteration revealed angioinvasive fungal infection, mucormycosis, to be the cause. We discuss here the lessons learnt, and how best to treat a susceptible cohort within our ageing western population.

Cerebral salt wasting following traumatic brain injury.

SUMMARY: Hyponatraemia is the most commonly encountered electrolyte disturbance in neurological high dependency and intensive care units. Cerebral salt wasting (CSW) is the most elusive and challenging of the causes of hyponatraemia, and it is vital to distinguish it from the more familiar syndrome of inappropriate antidiuretic hormone (SIADH). Managing CSW requires correction of the intravascular volume depletion and hyponatraemia, as well as mitigation of on-going substantial sodium losses. Herein we describe a challenging case of CSW requiring large doses of hypertonic saline and the subsequent substantial benefit with the addition of fludrocortisone. LEARNING POINTS: The diagnosis of CSW requires a high index of suspicion. Distinguishing it from SIADH is essential to enable prompt treatment in order to prevent severe hyponatraemia.The hallmarks of substantial CSW are hyponatraemia, reduced volume status and inappropriately high renal sodium loss.Substantial volumes of hypertonic saline may be required for a prolonged period of time to correct volume and sodium deficits.Fludrocortisone has a role in the management of CSW. It likely reduces the doses of hypertonic saline required and can maintain serum sodium levels of hypertonic saline.

A New Early Finding of Moyamoya-Like Phenomena.

Moyamoya disease (MMD) primarily causes constriction of internal carotid artery, but it is known to extend to the middle and anterior cerebral arteries. Some of the symptoms caused by MMD include transient ischemic attack (TIA) and seizures. The etiology of MMD from Graves' disease (GD) is mostly caused by thyrotoxicosis, but our finding of leukocytosis indicates a new finding that may help physicians prepare for the pending outcome of MMD from GD with leukocytosis. A 26-year-old Hispanic woman with a significant past medical history of GD and hypertension presented to the emergency department complaining of cough and shortness of breath for the past 5 days. During the patient's stay in the hospital, the patient suddenly developed numbness of the right arm with subsequent right arm weakness 10 minutes later. The head CT showed no acute intercranial hemorrhage, but MRA showed right intracranial internal carotid artery stenosis, with marked focal stenosis along the proximal supraclinoid segment, moderate stenosis along its distal supraclinoid segment with marked stenosis along the origin of the right A1 segment. It was therefore believed to be moyamoya-like phenomena. We discuss an atypical presentation that led to moyamoya-like phenomena which we believe has not been described before. We believe that presentation of idiopathic leukocytosis may have triggered the cerebral stenosis.