Enhancing specimen collection skills for dried blood spots through an immersive virtual learning environment: a cross-sectional study.

OBJECTIVE: The quality of dried blood spot (DBS) specimens impacts newborn screening (NBS) results, hence proper training is crucial for DBS specimen collection. To address this, a training module for Allied Health Professionals (AHPs) and nurses was created on Moodle, a virtual learning environment (VLE). The purpose of this research was to determine the feasibility and effectiveness of this module. METHODOLOGY: Participants were trained on-site (March to December 2019), through online training sessions (January to June 2020), and the two training strategies were compared. Data analysis included the total number of participants, cost-effectiveness, trainer engagement, and the number of unacceptable samples collected by nurses/AHPs trained by the two strategies. RESULTS: A total of 55 nurses/AHPs were trained on-site, while 79 nurses/AHPs completed the online module and received certificates through online VLE-based training. The trainer engagement and cost were more for onsite training. After online training, the specimen rejection rate was reduced from 0.84% (44 rejected out of 5220 total specimens collected) to 0.38% (15/3920). CONCLUSIONS: This study shows that using VLE-based DBS specimen collection training is feasible and effective for training nurses and AHPs.

Software-Defined Networking: Categories, Analysis, and Future Directions.

Software-defined networking (SDN) is an innovative network architecture that splits the control and management planes from the data plane. It helps in simplifying network manageability and programmability, along with several other benefits. Due to the programmability features, SDN is gaining popularity in both academia and industry. However, this emerging paradigm has been facing diverse kinds of challenges during the SDN implementation process and with respect to adoption of existing technologies. This paper evaluates several existing approaches in SDN and compares and analyzes the findings. The paper is organized into seven categories, namely network testing and verification, flow rule installation mechanisms, network security and management issues related to SDN implementation, memory management studies, SDN simulators and emulators, SDN programming languages, and SDN controller platforms. Each category has significance in the implementation of SDN networks. During the implementation process, network testing and verification is very important to avoid packet violations and network inefficiencies. Similarly, consistent flow rule installation, especially in the case of policy change at the controller, needs to be carefully implemented. Effective network security and memory management, at both the network control and data planes, play a vital role in SDN. Furthermore, SDN simulation tools, controller platforms, and programming languages help academia and industry to implement and test their developed network applications. We also compare the existing SDN studies in detail in terms of classification and discuss their benefits and limitations. Finally, future research guidelines are provided, and the paper is concluded.

"Shimming a Plate" Technique to Correct the Coronal Malalignment in Metadiaphyseal Distal Femur Fracture: Case Report.

CASE: We present a case of 19-year-old male patient with right sided comminuted metadiaphyseal distal femur fracture. Fixation was done using distal femur condylar locking plate. Washers were used with the screws to shimming the plate to achieve the coronal alignment and prevent stress over the screws. 2-year follow-up shows good alignment, radiological union and functional outcome without any complications. "Shimming" a locking plate with washers helps to achieve the better coronal alignment in comminuted metadiaphyseal distal femur fractures with coronal malalignment. It reduces the stress over screws and prevents implant-related complications.

Vitamin D Deficiency and Its Associated Factors among Female Migrants in the United Arab Emirates.

Vitamin D is important for bone health, and vitamin D deficiency could be linked to noncommunicable diseases, including cardiovascular disease. The purpose of this study was to determine the prevalence of vitamin D deficiency and its associated risk factors among female migrants from Philippines, Arab, and South Asian countries residing in the United Arab Emirates (UAE). We used a cross-sectional study to recruit a random sample (N = 550) of female migrants aged 18 years and over in the city of Al Ain, UAE. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D concentrations ≤20 ng/mL (50 nmol/L). We used multivariable logistic regression analysis to identify risk factors associated with vitamin D deficiency. The mean age of participants was 35 years (SD ± 10). The overall prevalence rate of vitamin D deficiency was 67% (95% CI 60-73%), with the highest rate seen in Arabs (87%), followed by South Asians (83%) and the lowest in Filipinas (15%). Multivariate analyses showed that low physical activity (adjusted odds ratio (aOR) = 4.59; 95% CI 1.98, 10.63), having more than 5 years duration of residence in the UAE (aOR = 4.65; 95% CI: 1.31, 16.53) and being obese (aOR = 3.56; 95% CI 1.04, 12.20) were independently associated with vitamin D deficiency, after controlling for age and nationality. In summary, vitamin D deficiency was highly prevalent among female migrants, especially Arabs and South Asians. It is crucial that health professionals in the UAE become aware of this situation among this vulnerable subpopulation and provide intervention strategies aiming to rectify vitamin D deficiency by focusing more on sun exposure, physical activity, and supplementation.

Case Report of Osteopoikilosis: Sparse Cause of Bone Pain and Mimicker of Metastasis on Radiographs.

INTRODUCTION: Osteopoikilosis (OPK) is an extremely rare benign condition with autosomal dominant inheritance characterized by sclerosing bony dysplasia with multiple benign enostoses. It is characterized by symmetrically distributed numerous, small, well-defined, homogenous circular or ovoid radiodensities clustered in epiphysis and metaphysis of long bones in periarticular region, and in some cases diffusely present throughout axial and appendicular skeleton. There is no age and sex predilection; age at the time of diagnosis ranges from 15 to 60 years. It is usually asymptomatic but rarely in 15-20% patients slight juxta-articular pain and joint effusions can be seen. These are incidental radiological findings in most of the cases, also sometimes confused as bony metastasis. There are no specific clinical features; histological features are similar to bony island and it may be associated with connective tissue disorders, synovial osteochondromatosis, and a rare bone condition melorheostosis. CASE REPORT: We present a case of OPK in a 32-year-old male with bilateral hip and shoulder pain, based on the available literature and focus on clinical significance, due to its mimicking capability of other more severe conditions such as bone metastases and an extremely uncommon cause of bone pain. CONCLUSION: OPK is an uncommon hereditary condition involving juxta-articular region of long bones with intricate etiopathogenesis, often discovered incidentally on radiographs. It is characterized by multiple, symmetrical ovoid radiodensities, and in most instances confused with osteoblastic metastasis. This concludes that OPK is a condition that should be kept in mind to avoid misdiagnosis, in particular osteoblastic metastasis and undue distress to both the patients and doctors.

Factors Influencing the Varus Deformity of Humeral Head in Proximal Humerus Fractures and Its Relation to Functional Outcome.

BACKGROUND: Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Proper reduction, stable internal fixation and early initiation of physiotherapy help to achieve a good functional outcome. Aim of this study was to evaluate varus fixation/malunion of proximal humerus fractures and its relation to functional outcome. MATERIALS AND METHODS: We retrospectively evaluated 32 patients with proximal humerus fractures who were surgically treated between 2015 and 2017 at tertiary care hospital. We divided the patients into three groups on the basis of the neck-shaft angle as valgus group, normal group and varus group to observe the influence of neck-shaft angle on efficacy. Patients were evaluated for functional outcome using the Constant-Murley score. RESULTS: Two-part fractures had better functional outcome (Constant score = 75.15) compared to three parts with the moderate functional outcome (Constant score = 68.81) and the four-part fracture had poor functional outcome (Constant score = 52.66). After 6 months of follow-up, 13 patients had a neck-shaft angle of less than 126°. The functional outcome is significantly better among patients with normal neck-shaft angle and had a mean Constant score of 76.63 as compared to patients with varus deformity had a mean Constant score 60 (p = 0.001). 10 patients did not have medial support, in which 08 patients had neck-shaft angle less than 126° and 2 had a normal neck-shaft angle. CONCLUSION: High fracture comminution, improper restoration of medial continuity causes varus deformity of the humeral head and it leads to poor functional outcome. The small sample size is the limitation of our study.

Fostering teaching-learning through workplace based assessment in postgraduate chemical pathology residency program using virtual learning environment.

BACKGROUND: The principle of workplace based assessment (WBA) is to assess trainees at work with feedback integrated into the program simultaneously. A student driven WBA model was introduced and perception evaluation of this teaching method was done subsequently by taking feedback from the faculty as well as the postgraduate trainees (PGs) of a residency program. METHODS: Descriptive multimethod study was conducted. A WBA program was designed for PGs in Chemical Pathology on Moodle and forms utilized were case-based discussion (CBD), direct observation of practical skills (DOPS) and evaluation of clinical events (ECE). Consented assessors and PGs were trained on WBA through a workshop. Pretest and posttest to assess PGs knowledge before and after WBA were conducted. Every time a WBA form was filled, perception of PGs and assessors towards WBA, time taken to conduct single WBA and feedback were recorded. Faculty and PGs qualitative feedback on perception of WBA was taken via interviews. WBA tools data and qualitative feedback were used to evaluate the acceptability and feasibility of the new tools. RESULTS: Six eligible PGs and seventeen assessors participated in this study. A total of 79 CBDs (assessors n = 7 and PGs n = 6), 12 ECEs (assessors n = 6 and PGs n = 5), and 20 DOPS (assessors n = 6 and PGs n = 6) were documented. PGs average pretest score was 55.6%, which was improved to 96.4% in posttest; p value< 0.05. Scores of annual assessment before and after implementation of WBA also showed significant improvement, p value 0.039, Overall mean time taken to evaluate PG's was 12.6 ± 9.9 min and feedback time 9.2 ± 7.4 min. Mean WBA process satisfaction of assessors and PGs on Likert scale of 1 to 10 was 8 ± 1 and 8.3 ± 0.8 respectively. CONCLUSION: Both assessors and fellows were satisfied with introduction and implementation of WBA. It gave the fellows opportunity to interact with assessors more often and learn from their rich experience. Gain in knowledge of PGs was identified from the statistically significant improvement in PGs' assessment scores after WBA implementation.

Incisional Hernia Secondary to Iliac Crest Bone Graft: A Rare Case Report and Review of Literature.

INTRODUCTION: Autologous bone graft is a commonly used procedure in orthopaedic surgery. Autologous bone is used to promote bone healing in fractures and to provide structural support for reconstructive surgery. Iliac bone is one of the common sites for harvesting autologous bone graft. Hernia through an iliac crest defect following bone graft harvesting is a major but very rare complication. CASE REPORT: An 80-year-old female patient operated for left subtrochanteric femur fracture with dynamic condylar screw and iliac bone graft. Ten months after the surgery, the patient came with the complaints of reducible swelling in the left flank over the incision site. On the basis of clinical examination and investigations, the swelling was diagnosed as an incisional hernia from the defect in the iliac bone graft site. CONCLUSION: Hernia through an iliac crest defect following bone graft harvesting is very rare but a major complication. Attention should be paid while harvesting bone graft to avoid this complication.

Hazardous impact of organic arsenical compounds in chicken feed on different tissues of broiler chicken and manure.

The purpose of this study was to evaluate the translocation of arsenic (As) from feed to different tissues of broiler chicken (leg, breast, liver and heart) and excretory product (manure). The feed, broiler chicken and manure samples were collected from five selected poultry farms. The As concentrations in all samples were determined by electrothermal atomic absorption spectrometry, after microwave assisted acid digestion in closed vessels. The concentrations of As in different chicken feeds were found in the range of 21.3-43.7 µg g⁻¹. The contents of As in different tissues of broiler chicken, liver, muscles and heart were found in the range of 3.07-7.17, 2.15-5.28 and 2.11-6.36 µg g⁻¹, respectively, while manure samples contains 22.8-50.3 µg g⁻¹. The obtained data shows the high correlation coefficient between As contents in feed, excretory product or manure and tissues of broiler chicken in the range of r=0.41-0.83. The high level of As in excretory product may add toxicant to environment, on their disposal.