Exploring barriers and enabling factors for surgical task sharing with physician assistants in Liberia: a qualitative pre-implementation study.

Objectives: This study explores potential barriers and enabling factors that may influence the acceptance of implementation of a surgical task-sharing initiative targeting physician assistants (PAs) in Liberia.

Design: A qualitative, pre-implementation study using semistructured interviews. Data was analysed in NVivo V.

SARS-CoV-2 Neutralization Capacity in Hemodialysis Patients with and without a Fifth Vaccination with the Updated Comirnaty Original/Omicron BA.4-5 Vaccine.

Background: Hemodialysis patients have reduced serologic immunity after SARS-CoV-2 vaccination compared to the general population and an increased risk of morbidity and mortality when exposed to SARS-CoV-2.

Methods: Sixty-six hemodialysis patients immunized four times with the original SARS-CoV-2 vaccines (BNT162b2, mRNA-1273) either received a booster with the adapted Comirnaty Original/Omicron BA.4-5 vaccine 8.

Investigation of Tool Degradation during Friction Stir Welding of Hybrid Aluminum-Steel Sheets in a Combined Butt and Overlap Joint.

Friction stir welding, as a solid-state welding technique, is especially suitable for effectively joining high-strength aluminum alloys, as well as for multi-material welds. This research investigates the friction stir welding of thin aluminum and steel sheets, an essential process in the production of hybrid tailor-welded blanks employed in deep drawing applications. Despite its proven advantages, the welding process exhibits variable outcomes concerning formability and joint strength when utilizing an H13 welding tool.

Longitudinal SARS-CoV-2 neutralization of Omicron BA.1, BA.5 and BQ.1.1 after four vaccinations and the impact of breakthrough infections in haemodialysis patients.

Background: Individuals on haemodialysis (HD) are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than the general population due to end-stage kidney disease-induced immunosuppression.

Methods: A total of 26 HD patients experiencing SARS-CoV-2 infection after a third vaccination were matched 1:1 with 26 of 92 SARS-CoV-2-naïve patients by age, sex, dialysis vintage and immunosuppressive drugs receiving a fourth vaccination with a messenger RNA-based vaccine. A competitive surrogate neutralization assay was used to monitor vaccination success.

Comparable cellular and humoral immunity upon homologous and heterologous COVID-19 vaccination regimens in kidney transplant recipients.

Background: Kidney transplant recipients (KTRs) are at high risk for a severe course of coronavirus disease 2019 (COVID-19); thus, effective vaccination is critical. However, the achievement of protective immunogenicity is hampered by immunosuppressive therapies. We assessed cellular and humoral immunity and breakthrough infection rates in KTRs vaccinated with homologous and heterologous COVID-19 vaccination regimens.

Residual Stress Formation Mechanisms in Laser Powder Bed Fusion-A Numerical Evaluation.

Additive manufacturing methods, such as the laser powder bed fusion, do not need any special tool or casting mold. This enables the fast realization of complex and individual geometries with integrated functions. However, the local heat input during the manufacturing process often leads to residual stresses and distortion.

Effect of Weld Length on Strength, Fatigue Behaviour and Microstructure of Intersecting Stitch-Friction Stir Welded AA 6016-T4 Sheets.

Friction stir welding is a promising joining process for boosting lightweight construction in the industrial and automotive sector by enabling the weldability of high-strength aluminum alloys. However, the high process forces usually result in large and heavy equipment for this joining method, which conflicts with flexible application. In order to circumvent this issue, a friction stir welding gun has been developed which is capable of producing short stitch welds-either stand-alone as an alternative to spot welds or merging into each other appearing like a conventional friction stir weld.

Improved SARS-CoV-2 Neutralization of Delta and Omicron BA.1 Variants of Concern after Fourth Vaccination in Hemodialysis Patients.

Hemodialysis patients are exposed to a markedly increased risk when infected with SARS-CoV-2. To date, it is unclear if hemodialysis patients benefit from four vaccinations. A total of 142 hemodialysis patients received four COVID-19 vaccinations until March 2022.

Practical Approach to Eliminate Solidification Cracks by Supplementing AlMg4.5Mn0.7 with AlSi10Mg Powder in Laser Powder Bed Fusion.

The range of available aluminum alloy powders for laser powder bed fusion (LPBF) is restricted to mainly Al-Si based alloys. Currently aluminum alloy powders, designed for lightweight application, based on Al-Mg (5000 series), Al-Si-Mg (6000 series), or Al-Zn-Mg (7000 series), cannot be processed by LPBF without solidification cracks. This has an impact on the potential of LPBF for lightweight applications.

Feasibility Study on Additive Manufacturing of Ferritic Steels to Meet Mechanical Properties of Safety Relevant Forged Parts.

Additive manufacturing processes such as selective laser melting are rapidly gaining a foothold in safety-relevant areas of application such as powerplants or nuclear facilities. Special requirements apply to these applications. A certain material behavior must be guaranteed and the material must be approved for these applications.

Near-infrared optical investigations of snow, ice, and water layers on diffuse reflecting surfaces.

While most experiments on water or ice utilize rather complex, elaborate, and expensive apparatus in order to obtain reliable optical data, here we present a simple and affordable setup that enables us to perform near-infrared measurements on water, ice, and snow on top of rough diffuse reflecting surfaces such as concrete, stone, pavement, or asphalt. By using the properties of diffuse scattering instead of specular reflection, we are able to determine the imaginary part of the refraction index of water without using any liquid cells. In addition, we demonstrate that the snow spectra can be well described by newly developed two-dimensional ray tracing simulations.

Role of the temporal pole in temporal lobe epilepsy seizure networks: an intracranial electrode investigation.

OBJECTIVE A convergence of clinical research suggests that the temporal pole (TP) plays an important and potentially underappreciated role in the genesis and propagation of seizures in temporal lobe epilepsy (TLE). Understanding its role is becoming increasingly important because selective resections for medically intractable TLE spare temporopolar cortex (TPC). The purpose of this study was to characterize the role of the TPC in TLE after using dense electrocorticography (ECoG) recordings in patients undergoing invasive monitoring for medically intractable TLE.

A randomized, double-blind, placebo-controlled crossover study of the effects of levetiracetam on cognition, mood, and balance in healthy older adults.

Objective: The cognitive and mood effects of levetiracetam (LEV) in older adults are not known. This study compared the cognitive and mood effects of LEV to placebo in healthy older adults.

Methods: Cognitive, mood, and balance variables were compared between LEV and placebo using a randomized, double-blind, placebo-controlled crossover study with two 5-week treatment periods.

Gastric pneumatosis in a small-for-gestational-age neonate.

We describe a dysmature (small-for-gestational-age) neonate born at term with multiple congenital defects, who presented with bloody diarrhoea. The abdominal X-ray showed gastric pneumatosis. The patient was treated conservatively with intravenous fluids and antibiotics, and recovered uneventfully.

Low frequency stimulation of ventral hippocampal commissures reduces seizures in a rat model of chronic temporal lobe epilepsy.

Purpose: To investigate the effects of low frequency stimulation (LFS) of a fiber tract for the suppression of spontaneous seizures in a rat model of human temporal lobe epilepsy.

Methods: Stimulation electrodes were implanted into the ventral hippocampal commissure (VHC) in a rat post-status epilepticus (SE) model of human temporal lobe epilepsy (n = 7). Two recording electrodes were placed in the CA3 regions bilaterally and neural data were recorded for a minimum of 6 weeks.

Triple pathology in epilepsy: coexistence of cavernous angiomas and cortical dysplasias with other lesions.

Coexistence of cortical dysplasias (CD) with cavernomas has rarely been reported. We reviewed our surgical specimens from patients who underwent surgery for pharmacoresistant epilepsy between 2003 and 2008, and identified seven cases with cavernoma, of whom two had overlying CD. In addition, each of these patients had a third form of a potentially epileptogenic lesion: hippocampal sclerosis in one, and venous angioma in the other.

Pharmacotherapeutics of epilepsy: use of lamotrigine and expectations for lamotrigine extended release.

The goal in managing patients with epilepsy is complete seizure freedom. Pharmacotherapeutic management of epilepsy is complicated by multiple syndromes, inter-individual differences in drug sensitivities, inter-individual differences in drug disposition, and drug interactions. Most anti-epileptic drugs (AEDs) have a therapeutic window with only a 2- to 3-fold concentration range.

Subjective perception of cognition is related to mood and not performance.

Objective: Clinicians monitor cognitive effects of drugs primarily by asking patients to describe their side effects. We examined the relationship of subjective perception of cognition to mood and objective cognitive performance in healthy volunteers and neurological patients.

Methods: Three separate experiments used healthy adults treated with lamotrigine (LTG) and topiramate (TPM), adults with epilepsy on LTG or TPM, and patients with idiopathic Parkinson's disease.

Tolerability and efficacy of oral loading of levetiracetam.

Objective: Nonsedating antiepileptic drugs (AEDs) that can be initiated rapidly are desirable in a variety of clinical situations. Levetiracetam (LEV) is a newer AED, with a recently approved parenteral formulation, that can be initiated at doses effective in controlling seizures. We investigated whether oral loading of levetiracetam is well tolerated and facilitates stabilization and discharge of patients in epilepsy monitoring units (EMU).

Subjective preference for lamotrigine or topiramate in healthy volunteers: relationship to cognitive and behavioral functioning.

Objective: Outcomes research emphasizes patient self-assessment and preferences in optimizing treatment. We previously showed that lamotrigine produces significantly less cognitive and behavioral impairment compared with topiramate. In the current study we extend these observations to subject self-report of preference for lamotrigine or topiramate independent of potentially confounding effects of seizures or seizure control.

Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers.

Background: The relative cognitive and behavioral effects of lamotrigine (LTG) and topiramate (TPM) are unclear.

Methods: The authors directly compared the cognitive and behavioral effects of LTG and TPM in 47 healthy adults using a double-blind, randomized crossover design with two 12-week treatment periods. During each treatment condition, subjects were titrated to receive either LTG or TPM at a target dose of 300 mg/day for each.

Neurosarcoidosis presenting with simple partial seizures and solitary enhancing mass: case reports and review of the literature.

A 37-year old woman, who had presented 5 years earlier with suspected simple partial seizures, returned with seizures increasing in frequency and intensity, confirmed by video/electroencephalography (VEEG) monitoring with left frontotemporal onset. A low-grade tumor was suspected, given a magnetic resonance imaging (MRI) study demonstrating enlargement of the left amygdala, anterior hippocampus, and adjacent mesial temporal neocortex, with modest gadolinium enhancement, and a positron emission tomography (PET) scan showing increased metabolism within that region. Surgical resection of the left mesial temporal lobe was performed and pathology revealed pathogen-free granulomas.

Idiopathic generalized tonic-clonic seizures limited to exercise in a young adult.

Loss of consciousness limited to exercise should suggest a cardiovascular etiology even when clonic activity is reported. Infrequently, epilepsy patients report a preponderance of their seizures related to exertion. In these patients, seizures also occur independent of exercise.

Transverse myelitis associated with Acinetobacter baumanii intrathecal pump catheter-related infection.

Objective: To describe a late neurologic complication of intrathecal pump implantation and show the methods used for the diagnosis and successful treatment of transverse myelitis in this setting.

Case Report: A 32-year-old man with a chronic abdominal pain syndrome presented with right lower-extremity numbness 2 months after the placement of an intrathecal morphine pump. This progressed to bilateral lower extremity and ascending sensory loss to T12-L1 dermatome, significant lower-extremity weakness, constipation with overflow incontinence, and detrusor instability causing urinary incontinence in discrete episodes over the following 2 months consistent with a myelopathy.

Ketamine for refractory status epilepticus: a case of possible ketamine-induced neurotoxicity.

A 44-year-old man with treated neurosyphilis presented with subclinical status epilepticus (SE) refractory to intravenous high-dose lorazepam, phenytoin, and valproic acid over 4 days. Ketamine infusion was instituted after low-dose propofol sedation with gradual control of electrographic seizures over 72h. Reevaluation 3 months later revealed diffuse cerebellar and worsened cerebral atrophy, consistent with animal models of N-methyl-D-aspartate antagonist-mediated neurotoxicity.