Primary sinonasal Ewing sarcoma: A case report.

BACKGROUND: Ewing sarcoma (ES) is an aggressive tumour which is typically skeletal in origin. ES involving the head and neck region is uncommon and can be easily confused with other small round blue cell tumours. We herein present a rare case of ES involving the sinonasal area. CASE PRESENTATION: A 5-year-old Somalian boy with no known medical illness presented with progressive nasal blockage associated with clear nasal discharge and intermittent spontaneous epistaxis for three months. CT paranasal sinus and neck region revealed poorly enhancing expansile mass in the right maxillary sinus with areas of necrosis within. Initial radiological differential diagnoses were lymphoma and rhabdomyosarcoma. The mass was biopsied and histologically showed diffuse sheets of small round blue cells that was positive to CD99, NSE and vimentin. The muscle and lymphoid markers were negative. Fluorescence in-situ hybridisation (FISH) study revealed the presence of EWSR1 gene rearrangement thus diagnosis of ES was rendered. CONCLUSIONS: ES of sinonasal tract is a rare entity and its pathological features significantly overlap with others small round blue cells tumour. Demonstration of EWSR1 gene translocation is recommended for the diagnosis of ES particularly at uncommon sites.

Knowledge, attitudes and practices of healthcare workers during the early COVID-19 pandemic in a main, academic tertiary care centre in Saudi Arabia.

As the Middle East respiratory syndrome coronavirus (MERS-CoV) continues to occur in small outbreaks in Saudi Arabia, we aimed to assess the knowledge, attitudes and intended practices of healthcare workers (HCWs) during the early stage of the COVID-19 pandemic and compare worry levels with previous findings during the MERS-CoV outbreak in 2015. We sent an adapted version of our previously published MERS-CoV questionnaire to the same cohort of HCWs at a tertiary hospital in Saudi Arabia. About 40% of our sample had previous experience with confirmed or suspected MERS-CoV patients, and those had a significantly higher knowledge score (13.16 ± 2.02 vs. 12.58 ± 2.27, P = 0.002) and higher adherence to protective hygienic practices (2.95 ± 0.80 vs. 2.74 ± 0.92, P = 0.003). The knowledge scores on COVID-19 were higher in the current cohort than the previous MERS-CoV outbreak cohort (68% vs. 79.7%, P < 0.001). HCWs from the current cohort who felt greater anxiety from COVID-19 compared to MERS-CoV were less likely to have been exposed to MERS-CoV infected/suspected cases (odds ratio (OR) = 0.646, P = 0.042) and were less likely to have attended the hospital awareness campaign on COVID-19 (OR = 0.654, P = 0.035). We concluded that previous experience with MERS-CoV was associated with increased knowledge and adherence to protective hygienic practices, and reduction of anxiety towards COVID-19.

Exchange unknown quantum states with almost invisible photons.

We propose a quasi-counterfactual quantum swap gate for exchanging Alice's unknown photon state and Bob's unknown atomic state under the condition that only Alice's photon may appear in the transmission channel between Alice and Bob, while the probability of the existence of photon in the transmission channel is controllable and can tend to zero. Unlike standard counterfactual quantum communication protocols, quantum states exchange in present scenario is achieved by multiple phase operations, rather than multiple measurements. The total effect of those operations can be considered as a unitary time evolution operator. Therefore, the communication fidelity and efficiency of our protocol are always one if system imperfection and channel noise are not considered. Compared to standard counterfactual communication protocols, our protocol is easy to implement. We also show that it can be easily converted to a standard counterfactual one.

Repulsive Casimir force between hyperbolic metamaterials.

The Casimir force between electric and magnetic hyperbolic metamaterial slabs is investigated. Due to hyperbolic dispersion, the electromagnetic features of these metamaterials along the optical axis are different from those perpendicular to the optical axis; consequently, these features contribute differently to the Casimir effect. The repulsive Casimir force is formed between electric and magnetic hyperbolic metamaterial slabs; moreover, hyperbolic dispersion can enhance the repulsive effect. However, by utilizing the extremely anisotropic behavior of hyperbolic metamaterials and changing the separation distance between the two slabs, the restoring Casimir force emerges. Additionally, by considering the dispersion of both the permittivity and the permeability of hyperbolic metamaterials, the Casimir force reaches several equilibrium points at different separation distances. Furthermore, the Casimir force at room temperature is discussed. Although the temperature can weaken the effect of the restoring Casimir force, stable equilibria may remain upon choosing suitable filling factors. This work shows that hyperbolic metamaterials have potential applications in micro- and nanoelectromechanical systems, especially for maintaining stability and overcoming adhesion problems.

An integrative review on coping skills in nursing students: implications for policymaking.

AIM: This study critically appraised both quantitative and qualitative studies describing coping strategies utilized by nursing students when faced with stress. BACKGROUND: Stress in nursing students during clinical training is well documented in the nursing literature. The need to utilize positive-coping strategies is necessary to effectively deal with stress and its accompanying stressors. METHODS: An integrative review method was used in this review. PsycINFO, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and Scopus were the databases used in searching for relevant literature using the following search terms; 'coping', 'nursing students', clinical training', 'ways of coping' and 'clinical practice'. A total of 27 studies published from 2001 to 2016 were included in this review. FINDINGS: Findings demonstrated that nursing students utilized problem-focused coping strategies rather than emotion-focused coping strategies. Specific coping behaviours utilized included problem-solving behaviours, self-confident approaches and seeking of support from family and friends. CONCLUSION: The review contributes to the growing literature on coping strategies in nursing students and may have implications on nursing education and nursing policy. This review also demonstrated a scarcity of studies that links specific coping strategies to nursing school stressors and examines predictors of coping skills in nursing students. IMPLICATIONS FOR NURSING EDUCATION: Institutionalization of structured student orientation programme, implementation of well-planned mentoring programmes and establishment of support unit/centres may be helpful in supporting nursing students during their clinical placement. By developing empirically based interventions, nursing faculty can assist nursing students in strengthening their positive-coping skills to effectively deal with various stressors encountered.

Tunable Goos-Hänchen shift from graphene ribbon array.

The Goos-Hänchen (GH) shift of light beam incident on graphene ribbon array is investigated by Green's function method. Due to the resonance effects of leaky surface plasmons on ribbons, the zeroth-order reflection field shows both giant positive and negative GH shifts. By tuning the graphene Fermi level, we can control the shift conveniently. This effect is important to graphene-based metasurface and electro-optical devices.

Measurement of deep-subwavelength emitter separation in a waveguide-QED system.

In the waveguide quantum electrodynamics (QED) system, emitter separation plays an important role for its functionality. Here, we present a method to measure the deep-subwavelength emitter separation in a waveguide-QED system. In this method, we can also determine the number of emitters within one diffraction-limited spot. In addition, we also show that ultrasmall emitter separation change can be detected in this system which may then be used as a waveguide-QED-based sensor to measure tiny local temperature/strain variation.

Comparison of clinical and radiographic status around immediately loaded versus conventional loaded implants placed in patients with type 2 diabetes: 12- and 24-month follow-up results.

There are no studies that have compared the clinical and radiographic status around immediately loaded (IL) and conventional loaded (CL) implants placed in patients with type 2 diabetes mellitus (T2DM). The aim was to compare the clinical and radiographic status around IL and CL implants placed in T2DM patients. One hundred and eight diabetic patients [55 with IL implants (Group 1) and 53 with CL implants (Group 2)] were included in this cross-sectional study. All implants were placed in healed sites in the maxillary and mandibular premolar and molar regions and supported single restorations. All patients underwent full mouth mechanical debridement biannually. Haemoglobin A1c (HbA1c) levels, clinical [bleeding on probing (BOP) and probing depth (PD) ≥ 4 mm] and radiographic [crestal bone loss (CBL)] peri-implant parameters were measured for both groups at 12- and 24-month follow-up. Group comparisons were performed using the Mann-Whitney U-test (P < 0·05). The mean age and duration of T2DM in groups 1 and 2 were 50·6 ± 2·2 and 51·8 ± 1·7 years, and 9·2 ± 2·4 and 8·5 ± 0·4 years, respectively. At 12- and 24-month follow-up, the mean HbA1c levels in groups 1 and 2 were 5·4% (4·8-5·5%) and 5·1% (4·7-5·4%) and 5·1% (4·7-5·2%) and 4·9% (4·5-5·2%), respectively. At 12- and 24-month follow-up, there was no statistically significant difference in peri-implant BOP, PD and CBL in both groups. It was concluded that clinical and radiographic status is comparable around IL and CL implants placed in patients with T2DM. The contribution of careful case selection, oral hygiene maintenance and glycaemic control is emphasised.

Greater effects of high- compared with moderate-intensity interval training on cardio-metabolic variables, blood leptin concentration and ratings of perceived exertion in obese adolescent females.

This study examined the effects of high- vs. moderate-intensity interval training on cardiovascular fitness, leptin levels and ratings of perceived exertion (RPE) in obese female adolescents. Forty-seven participants were randomly assigned to one of three groups receiving either a 1:1 ratio of 15 s of effort comprising moderate-intensity interval training (MIIT at 80% maximal aerobic speed: MAS) or high-intensity interval training (HIIT at 100% MAS), with matched 15 s recovery at 50% MAS, thrice weekly, or a no-training control group. The HIIT and MIIT groups showed improved (p < 0.05) body mass (BM), BMI Z-score, and percentage of body fat (%BF). Only the HIIT group showed decreased waist circumference (WC) (p = 0.017). The effect of exercise on maximal oxygen uptake (VO2max) was significant (p = 0.019, ES = 0.48 and p = 0.010, ES = 0.57, HIIT and MIIT, respectively). The decrease of rate-pressure product (RPP) (p < 0.05, ES = 0.53 and ES = 0.46, HIIT and MIIT, respectively) followed the positive changes in resting heart rate and blood pressures. Blood glucose, insulin level and the homeostasis model assessment index for insulin decreased (p < 0.05) in both training groups. Significant decreases occurred in blood leptin (p = 0.021, ES = 0.67 and p = 0.011, ES = 0.73) and in RPE (p = 0.001, ES = 0.76 and p = 0.017, ES = 0.57) in HIIT and MIIT, respectively. In the post-intervention period, blood leptin was strongly associated with %BF (p < 0.001) and VO2max (p < 0.01) in the HIIT and MIIT groups, respectively, while RPE was strongly associated with BM (p < 0.01) in the HIIT group. The results suggest that high-intensity interval training may produce more positive effects on health determinants in comparison with the same training mode at a moderate intensity.

Agility training in young elite soccer players: promising results compared to change of direction drills.

The aim of this study was to compare the effect of two different training programmes - change of direction (COD) vs. agility (AG) - on straight sprint (SS), COD and AG test performances in young elite soccer players. Thirty-two soccer players (age: 14.5±0.9 years; height: 171.2±5.1 cm; body mass: 56.4±7.1 kg, body fat: 10.3±2.3%) participated in a short-term (6 weeks) training study. Players were randomly assigned to two experimental groups - training with change of direction drills (COD-G, n=11) or using agility training (AG-G, n= 11) - and to a control group (CON-G, n=10). All players completed the following tests before and after training: straight sprint (15m SS), 15 m agility run with (15m-AR-B) and without a ball (15m-AR), 5-0-5 agility test, reactive agility test (RAT), and RAT test with ball (RAT-B). A significant group effect was observed for all tests (p<0.001; η2=large). In 15m SS, COD-G and AG-G improved significantly (2.21; ES=0.57 and 2.18%; ES=0.89 respectively) more than CON-G (0.59%; ES=0.14). In the 15m-AR and 5-0-5 agility test, COD-G improved significantly more (5.41%; ES=1.15 and 3.41; ES=0.55 respectively) than AG-G (3.65%; ES=1.05 and 2.24; ES=0.35 respectively) and CON-G (1.62%; ES=0.96 and 0.97; ES=0.19 respectively). Improvements in RAT and RAT-B were larger (9.37%; ES=2.28 and 7.73%; ES=2.99 respectively) in RAT-G than the other groups. In conclusion, agility performance amongst young elite soccer could be improved using COD training. Nevertheless, including a conditioning programme for agility may allow a high level of athletic performance to be achieved.

Counterintuitive dispersion violating Kramers-Kronig relations in gain slabs.

We demonstrate the counterintuitive dispersion effect that the peaks (dips) in the gain spectrum correspond to abnormal (normal) dispersion, contrary to the usual Kramers-Kronig point of view. This effect may also lead to two unique features: a broadband abnormal dispersion region and an observable Hartman effect. These results are explained in terms of interference and boundary effects. Finally, two experiments are proposed for the potential experimental verification.

Greater volumes of static and dynamic stretching within a warm-up do not impair star excursion balance performance.

Based on the conflicting static stretching (SS) literature and lack of dynamic stretching (DS) literature regarding the effects of differing volumes of stretching on balance, the present study investigated the effects of 4, 8, and 12 sets of SS and DS following a 5 min aerobic running warm-up on the star excursion balance test (SEBT). The objective was to examine an optimal stretch modality and volume to enhance dynamic balance. A randomized, within-subjects experimental design with repeated measures for stretching (SS and DS) versus no-stretching treatment was used to examine the acute effects of 10 (4 sets), 20 (8 sets), and 30 (12 sets) min, of 15s repetitions per muscle of SS and/or DS following a 5 min aerobic warm-up on the performance of the SEBT. Results indicated that a warm-up employing either SS or DS of any volume generally improves SEBT by a "small" amount with effect sizes ranging from 0.06 to 0.50 (11 of 18 conditions>75% likely to exceed the 1.3-1.9% smallest worthwhile change). Secondly, the difference between static and dynamic warm-up on this observed improvement with warm-up improvement was "trivial" to "moderate" (d=0.04 to 0.57) and generally "unclear" (only two of nine conditions>75% likely to exceed the smallest worthwhile change). Finally, the effect of increasing the volume of warm-up on the observed improvement with a warm-up is "trivial" to "small" (d<0.40) and generally "unclear" (only three of 12 conditions>75% likely to exceed the smallest worthwhile change). In summary, an aerobic running warm-up with stretching that increases core and muscle temperature whether it involves SS or DS may be expected to provide small improvements in the SEBT.

Protocol for direct counterfactual quantum communication.

It has long been assumed in physics that for information to travel between two parties in empty space, "Alice" and "Bob," physical particles have to travel between them. Here, using the "chained" quantum Zeno effect, we show how, in the ideal asymptotic limit, information can be transferred between Alice and Bob without any physical particles traveling between them.

Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females.

PURPOSE: We investigate the effects of 12-week interval training of moderate- or high-intensity exercise on blood lipids and plasma levels of adiponectin. METHODS: Thirty-four obese adolescent females [age = 15.9 ± 0.3 years; BMI and BMI-Z-score = 30.8 ± 1.6 kg/m(2) and 3 ± 0.3, respectively], were randomized to high-intensity interval training (HIIT, n = 11), moderate-intensity interval training (MIIT, n = 11), or a control group (CG, n = 12). Maximal oxygen uptake ([Formula: see text]), maximal aerobic speed (MAS), plasma lipids and adiponectin levels were measured in all subjects before and after training. RESULTS: Following the training program, in both training groups, body mass, BMI-Z-score, and percentage body fat (% BF) decreased, while [Formula: see text] and MAS increased. Low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and adiponectin levels were positively altered (-12.6 and -7.4 %; 6.3 and 8.0 %; 35.8 and 16.2 %; high to moderate training program, respectively). Waist circumference, triglyceride and total cholesterol decreased only in HIIT group (-3.5; -5.3 and -7.0 %, respectively, in all P < 0.05). Significant decrease in the usual index of insulin resistance (HOMA-IR) occurred in HIIT and MIIT groups (-29.2 ± 5.3 and -18.4 ± 8.6 %, respectively; P < 0.01). CONCLUSION: The results show that HIIT positively changes blood lipids and adiponectin variables in obese adolescent girls, resulting in improved insulin sensitivity, as attested by a lower HOMA-IR, and achieving better results compared to moderate-intensity exercise.

Controllable large positive and negative Goos-Hänchen shifts with a double-Lambda atomic system.

We study the Goos-Hänchen shift (GHS) of a reflected light beam from a cavity containing a double-[Formula: see text] atomic medium that is bounded by two glass slabs. Applying both coherent and incoherent fields to the atomic medium leads to positive and negative controllability of GHS. For some specific values of the parameters of the system, the amplitude of the GHS becomes large, namely, in the order of [Formula: see text] times the wavelength of the incident light beam. These large shifts are found at more than one angle of incidence with a wide range of parameters of the atomic medium.

Wireless pressure insoles for measuring ground reaction forces and trajectories of the centre of pressure during functional activities.

Wireless pressure insoles may enable the assessment of movement biomechanics in a real-world setting, and thus play an important role in the recommendation of clinical management, but they are not yet a gold standard due to the unknown accuracy and reliability with respect to different functional activities. Here, we compare novel wireless pressure insoles with force plates and examine the test-retest reliability of the insoles for measuring vertical ground reaction forces (vGRFs) and trajectories of the center of pressure (COP). In this observational study, healthy adults underwent two data collection sessions during one day. The Bland-Altman analysis was used to compare the outcomes measured with the two instruments during squats, jumps, and the sit-to-stand test. Test-retest reliability was assessed by the interclass correlation coefficient and the standard error of measurement for the outcomes during squats, jumps, walking, and stair ambulation. Trajectories of the COP in the anterior-posterior direction were comparable between the two systems during all activities. The insoles consistently measured shorter trajectories of the COP in the medial-lateral direction (except jumps) and lower vGRFs than the force plates. Test-retest reliability of the insoles was fair to high or excellent for all outcomes during all activities. In conclusion, the insoles provide reliable measures of vGRFs and trajectories of the COP during multiple functional activities in healthy adults. Although the insoles do not produce identical results to the force plate, the qualitative similarity and consistency between the two systems confirm the insoles can be used to measure these outcomes, based on the purpose and accuracy required.

Effectiveness of a modified tutorless problem-based learning method in dermatology - a pilot study.

BACKGROUND AND AIMS: Problem-Based Learning (PBL) is a student-centred instructional strategy in which students learn in a collaborative manner, the learning process being guided by a facilitator. One of the limitations of conventional PBL in medical education is the need for adequate resources in terms of faculty and time. Our study aimed to compare conventional PBL in dermatology with a modified tutorless PBL in which pre-listed cues and the use of digital media help direct the learning process. METHODS: Thirty-one-fifth year medical students were divided into two groups: the study group comprising 16 students were exposed to the modified PBL, whereas the control group comprising 15 students were given the same scenarios and triggers, but in a conventional tutor-facilitated PBL. Knowledge acquisition and student feedback were assessed using a post-test and a Likert scale-based questionnaire, respectively. RESULTS: The post-test marks showed no significant statistical differences between the two groups. The general feedback regarding the modified PBL was positive and the students felt comfortable with the module. The learning objectives were met satisfactorily in both groups. CONCLUSION: Modified tutorless PBL modules might be an effective method to incorporate student-centred learning in dermatology without constraints in terms of faculty resources or time.

[Atopic dermatitis and prolonged exclusive breast-feeding]. / Dermatite atopique et allaitement maternel exclusif prolongé

BACKGROUND: We sought to compare the prevalence of exclusive breastfeeding throughout at least the first 6 months of life in patients presenting atopic dermatitis (AD) with a control group, and to check for a correlation between the duration of exclusive breastfeeding and the severity of AD. PATIENTS AND METHODS: We conducted a case-control study with prospective inclusion over a period of 3 years. The study group consisted of 114 patients aged less than 15 years, from an urban area, presenting AD but with no personal or family history of atopy. Each patient was compared with two controls from the same town, matched for age and gender, with no personal or family history of atopy, and free of AD. Data analysis was performed using the SPSS software package, version 15.0. A P-value of less than 0.05 was considered as statistically significant. RESULTS: The prevalence of exclusive breastfeeding for at least the first 6 months of life in the patient group was significantly lower than in the control group (P=0.0413). On the other hand, AD was significantly less severe in patients exclusively breastfed for longer than 9 months (P=0.0079). CONCLUSION: The correlations recorded in our study do not allow us to draw any definite conclusions about a protective effect of exclusive breastfeeding with regard to AD. However, other benefits of extended exclusive breastfeeding justify supporting breastfeeding in a community with an existing sociocultural predisposition for this feeding method.

A standardised template for reporting lower limb kinematic waveform movement compensations from a sensor-based portable clinical movement analysis toolkit.

Objectives: To develop a standardised template to support physiotherapist reporting of lower limb kinematic waveform data. Design: Within and between user agreement identification of movement compensation strategies. Setting: University Health Board Physiotherapy Department. Participants: Fourteen individuals with anterior cruciate ligament reconstruction performed overground gait, double-leg squat, and stair ascent wearing body-worn sensors. Six users viewed 252 kinematic waveforms of hip, knee and ankle joint angles in the sagittal and frontal planes. Main outcome measures: Between and within-user observed agreement and themes from movement analysis reports. Results: Between-user observed agreement for presence of a movement compensation was 0.6-0.9 for the sagittal plane and 0.75-1.0 for the frontal place. Within-user observed agreement was 0.57-1.00 for the sagittal plane and 0.71-1.00 for the frontal plane. Three themes and seven categories were identified from the waveform interpretations: Amount (qualitative and quantitative description), timing (phase, discrete time point, cycle), and nature (peak, range of motion, timing) of the compensation. Conclusion: There was good agreement between users at identifying the presence of movement compensation from the kinematic waveforms, but there was variation in how movement compensations were described. An interactive report, a standardised template for interpretation of kinematic waveforms, and training to support the clinical application of a movement analysis toolkit are proposed.