bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxytocin Versus Misoprostol Plus Oxytocin in the Prevention of Postpartum Hemorrhage at a Semi-Urban Hospital in sub-Saharan Africa: A Retrospective Cohort Study
Authors: Numfor Emmanuel , Fobellah Nkengafac Nyiawung , Tochie Joel Noutakdie , Njim Tsi , Ndesso Sylvester Atanga
Published: August 2020

Background: Post-partum hemorrhage (PPH) is a leading cause of maternal mortality. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa. This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital.

Methods: This was a retrospective cohort study carried out between January 2015 to April 2015 and between January 2016 to April 2016 on a group of parturients (group A) who received only oxytocin and another administered oxytocin and misoprostol (group B), respectively. All participants delivered at the Bamenda Regional Hospital, Cameroon. The two different periods represent the era before and after the implementation of misoprostol in the prevention of PPH in this semi-urban hospital. Socio-demographic data, clinical characteristics and details of delivery as well as risk factors for PPH were studied from obstetric records.

Results: We studied the obstetric records of 1778 parturients were studied; 857 in group A and 879 in group B. Their mean age was 26.3 ±5.2 years. Both groups were comparable in several baseline sociodemographic and clinical characteristics. The prevalence of PPH was 2.7% (3.4% vs 2.2%; p = 0.0744). The risk of PPH in the oxytocin only group was about 1.5 times higher than in the oxytocin plus misoprostol group. The estimated blood loss between the two groups was statistically significant (1100 ± 150 vs 800 ± 100 ml, p< 0.0001). The active management of the third stage of labor without misoprostol was the only risk factor for PPH.

Conclusion and Global Health Implications: The implementation of misoprostol plus oxytocin in the prevention of PPH in this low-resource setting improved the obstetrical outcome by reducing the risk and the amount of blood loss during delivery.

Keywords: • Misoprostol • Oxytocin • Postpartum Hemorrhage • Cameroon

 

Copyright © 2020 Numfor et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
Large-Scale Deployment of a Closed-Loop Drilling Optimization System: Implementation and Field Results
Authors: Lai Stephen W. , Ng James , Eddy Aaron , Khromov Sergey , Paslawski Dan , van Beurden Ryan , Olesen Lars , Payette Gregory S. , Spivey Benjamin J.
Published: August 2020

On a land-based rig, the driller has many responsibilities and is rarely able to adjust the main process controls—weight on bit (WOB) and revolutions per minute (RPM)—on a continuous basis. The result is suboptimal drilling and longer spud-to-target depth (TD) time than necessary. Automatic, closed-loop optimization removes this burden and results in better and more consistent drilling performance. In this paper, a closed-loop drilling optimization system is presented with results from more than 1,700 wells in the field.

The closed-loop system builds on industry-proven advisory technology and is designed uniquely for petroleum drilling. Because formation characteristics can change rapidly with depth, a fast optimization algorithm based on input signal dithering is used to continually adjust drilling parameters to search for the highest possible rate of penetration (ROP) and lowest possible mechanical-specific energy (MSE). Drilling dysfunctions, such as stick-slip and formation stringers, are treated as discrete time events and mitigated using software protocols triggered by accurate detection algorithms. Also, operation of the inner loop autodriller is of critical importance and controlled using a specialized set of autodriller management protocols.

Over the past 2 years, the system has been deployed on more than 270 rigs for construction of more than 1,700 land wells in North America. One of the main deployment challenges was the need for full organizational buy-in from both rig and office personnel. Another major challenge was the need for parameter limit roadmaps that define reasonable, but nonconservative, optimization limits to be used during the drilling of each well. Drilling performance on approximately 90 wells was analyzed and compared with equivalent offset wells. The result was an ROP improvement of 7.2% and 8.0% (2-year average) and 9.7% and 17.3% (last year average) for the vertical and lateral sections, respectively. A case study is presented highlighting improved ROP and decreased nonproductive time (NPT) when the optimization system was used.
Impacts of contracted endodontic cavities compared to traditional endodontic cavities in premolars
Authors: Juan Xia , weidong Wang , Zhengmao Li , Bingpeng Lin , Qian Zhang , Qianzhou Jiang , Yang Xuechao
Published: August 2020

Background: This study aims to compare the percentage of dentin removed, instrumentation efficacy, root canal filling and load at fracture between contracted endodontic cavities, and traditional endodontic cavities on root canal therapy in premolars. Methods: Forty extracted intact human first premolars were imaged with micro-CT and randomly assigned to the contracted endodontic cavity (CEC) or traditional endodontic cavity (TEC) groups. CEC was prepared with the aid of a 3D-printed template, canals were prepared with a 0.04 taper M-Two rotary instrument, and cavities were restored with resin. Specimens were loaded to fracture in an Instron Universal Testing Machine after a fatigue phase. The data were analyzed by the independent samples T test and Mann-Whitney U test, appropriate post hoc tests. Results: In the premolars tested in vitro, the percentage of dentin removed in the premolars with two dental roots in the CEC group (3.85% ± 0.42%) was significantly smaller (P < 0.05) than in the TEC group (4.94% ± 0.5%). The untouched canal wall (UCW) after instrumentation for TECs (16.43% ± 6.56%) was significantly lower (P< .05) than the UCW (24.42% ± 9.19%) for CECs in single-rooted premolars. No significant differences were observed in the increased canal volume and surface areas in premolars between the TEC and CEC groups (P > 0.05). CECs conserved coronal dentin in premolars with two dental roots but no impact on the instrument efficacy. There were no differences between the CEC groups and the TEC groups in the percentage of filling material and voids (P > 0.05). In addition, the mean load at failure of premolars did not significantly differ between the CEC and TEC groups and there was no significant difference in the type of fracture (P > 0.05). Conclusion: The results of this study suggest that CEC could not improve the fracture resistance of the endodontically treated premolars. The instrumentation efficacy and the percentage of filling material did not significantly differ between CECs and TECs in premolars.
Clinical outcome of surgical management for symptomatic metastatic spinal cord compression form prostate cancer.
Authors: Miyoshi Yasuhide , Kawahara Takashi , Yao Masahiro , Uemura Hiroji
Published: August 2020

Background Metastatic spinal cord compression (MSCC) from prostate cancer (PC) influences not only patients’ prognosis but also their quality of life. However, little is known about the clinical outcome of surgery for MSCC from PC. We evaluated both the oncological and functional outcomes of decompression and reconstruction surgery for patients with symptomatic MSCC from PC. Methods We assessed 19 patients who underwent decompression and reconstruction surgery for symptomatic MSCC from PC. Of these 19 patients, 8 had metastatic hormone-naïve PC (mHNPC) and 11 had metastatic castration-resistant PC (mCRPC). Results The median age of the patients with mHNPC and mCRPC was 72 and 65 years, respectively. The median prostate-specific antigen level at the time of diagnosis of MSCC in patients with mHNPC and mCRPC was 910 and 67 ng/mL, respectively. Although two of eight patients (25.0%) with mHNPC were ambulatory preoperatively, six patients (75.0%) were ambulatory postoperatively. Among 11 patients with mCRPC, only 3 (27.3%) were ambulatory preoperatively, while 6 (54.5%) were ambulatory postoperatively. The median postoperative overall survival among patients with mHNPC and mCRPC were not reached and 8 months, respectively. Conclusions Decompression and reconstruction surgery for symptomatic MSCC from PC might contribute to a favorable functional outcome among men with mHNPC and mCRPC. However, its role in improving the oncological outcome remains unclear. The treatment strategy should be chosen by shared decision-making among patients, urologists, radiation oncologists, and orthopedic surgeons.
A Needs Assessment for Postgraduate Training in Selected Public Health Disciplines: Evidence from Health Services Organisations in Lusaka, Zambia
Authors: Bulawayo Maio , Silumbwe Adam , Munakampe Margarate Nzala , Mukumbuta Nawa , Musabula Juliet , Chewe Mwimba , Mweemba Chris , Michelo Charles , Hangoma Peter
Published: August 2020

Background: As most low and middle-income countries seek to achieve universal health coverage targets, there is an ever-increasing need to train human resources with the required core skills and competencies. This study reports on the needs assessment conducted to understand postgraduate training needs for three selected public health disciplines – Health Policy and Systems, Health Economics, and Healthcare Management and Planning – at the University of Zambia. Methods: The study adopted a cross-sectional design, comprising qualitative and quantitative components. Data were collected through semi-structured interviews administered to 32 participants, identified through a comprehensive stakeholder mapping process, holding selected management positions in public and private health service organisations across Zambia. The organisations included regulatory authorities, research institutions, government ministries, insurance firms, multilateral and health services organisations. Results: Overall (n=22), more than 68% of the stakeholders reported that they had no employees that were formally trained in the three disciplines. More than 90% of the stakeholders opined that training in these disciplines would be beneficial in providing competencies to strengthen service provision. The horizontal skills mismatch for health economics, and health services management and planning were found to be 93% and 100%, respectively. Among the key public health training needs were: policy development and analysis, economic evaluation, and strategic management. Conclusions: This study confirms that introducing post graduate training in the proposed public health disciplines will not only benefit Zambian health services organisations, but also help strengthen the health systems in general. For other empirical contexts, the findings imply the need for the introduction of academic programmes which respond to ever-changing public health skills demanded; and should be matched with local priorities and service delivery.
Genetic diversity and different cross-neutralization capability of porcine circovirus type 2 isolates recently circulating in South Korea
Authors: Kang Seok-Jin , Kang Hyeonjeong , Yu Su-Hwa , Lee Hye Jeong , Lee Nakhyung , Hyun Bang-Hun , Cha Sang-Ho
Published: August 2020

Background: Porcine circovirus type 2 (PCV2) is a small single-stranded DNA virus and a primary cause of PCV-associated diseases (PCVAD) that result insubstantial economic loss for swine farms. Between 2016 and 2018, PCV2 field viruses were isolated from PCVAD-affected swine farms in South Korea and investigated for genetic and antigenic heterogeneity. Results: The genetic analysis of ORF2 showed that the genotype of the Korean PCV2 field isolates has been rapidly shifted from PCV2a or 2b to mutant PCV2b known as PCV2d with 82.6% to 100% amino acid sequence similarity. PCV2-specific monoclonal antibodies (mAbs) demonstrated variable antigen-binding activity to four representative Korean PCV2 field isolates [QIA215 (PCV2a), QIA418 (PCV2b), QIA169 (PCV2d), and QIA244 (PCV2d)] without genotype specificity, and one mAb showed neutralization activity to QIA215. In a cross-virus neutralization assay using anti-PCV2 sera of pigs and guinea pigs injected with a commercial vaccine and the Korean PCV2 field isolates, the anti-porcine sera of a commercial vaccine had high neutralization activity against QIA215 and QIA418 with statistically lower activity against PCV2d viruses. Anti-guinea pig sera of QIA215, QIA418, QIA169, and a commercial vaccine had high neutralization activity against all of the viruses with significantly lower activity against QIA244. Importantly, anti-guinea pig sera of QIA244 had high neutralization activity against all of the viruses. Conclusions: This study confirmed genetic and antigenic diversity among recent PCV2 field isolates in Korean swine farms, and the strain-based difference in virus neutralization capability should be considered for more effective control by vaccination.
Macronutrient, immunoglobulin A and total antioxidant capacity profiles of human milk: cross-sectional surveys at ages 6, 12, 18 and 24 months.
Authors: ongprasert krongporn , Ruangsuriya Jetsada , Malasao Rungnapa , Sapbamrer Ratana , Suppansan Pikul , Ayood Pisittawoot , Kittisakmontri Kulnipa , Siviroj Penprapa
Published: August 2020

Background: A longer duration of breastfeeding of up to two years is encouraged by many health authorities, but information regarding the composition of milk after one year postpartum is limited. The goal of this study was to determine the associations of macronutrient contents, immunoglobulin A (IgA) levels, and the total antioxidant capacity (TAC) in human milk (HM) with the month of lactation from 1 to 24 months postpartum.Methods: Milk samples were collected from mothers with healthy full-term children who had been lactating from 1 to 24 months from January 2019 to April 2019. HM was biochemically analyzed for protein and carbohydrate contents by colorimetric assays. The fat content was determined by capillary centrifugation, and the energy content was calculated from the results of centrifugation assays. IgA levels and the TAC were determined by ELISA and a Trolox equivalent antioxidant capacity (TEAC) assay, respectively. Pearson’s correlation coefficient and Spearman’s rank correlation coefficient were used to determine associations between milk composition and the month of lactation, and multiple regression analysis was used to assess the association between covariates and milk composition. Differences were considered significant at p < 0.05.Results: One hundred eighty-four milk samples were analyzed. The month of lactation was positively associated with the fat concentration (B = 0.31, SE = 0.09, p = 0.001), energy content (B = 3.11, SE = 0.92, p = 0.001), and IgA (B = 4.17, SE = 1.08, p < 0.001) but negatively associated with the carbohydrate concentration (B = -0.22, SE = 0.01, p = 0.04). No association was observed between the month of lactation and the protein concentration and TAC after adjustment for maternal age, maternal BMI, birth order, and breastfeeding frequency.Conclusions: Based on our results, fat, energy, and IgA contents in HM were positively associated with the month of lactation, and a slight but significant negative association was detected for the carbohydrate concentration up to two years postpartum.
Learning curve of digital intraoral scanning – an in vivo study
Authors: Róth Ivett , Czigola Alexandra , Joós-Kovács Gellért Levente , Dalos Magdolna , Hermann Péter , Borbély Judit
Published: August 2020

Background: The spread of digital technology in dentistry poses new challenges and sets new goals for dentists. The aim of the present in vivo study was to determine the learning curve of intraoral scanning described by (1) scanning time and (2) image number (count of images created by intraoral scanner during the scanning process).Methods: Ten dental students of Semmelweis University took part in the study. Dental students took digital study impressions using a 3Shape Trios 3® (3Shape, Copenhagen, Denmark) intraoral scanning device. Each student took 10 digital impressions on volunteers. Volunteer inclusion criteria included full dentition (except for missing third molars) and no prosthetic/restorative treatment. Digital impression taking was preceded by tuition consisting of both theoretical education and practical training. Digital impressions were taken of the upper and lower arches, and the bite was recorded according to the manufacturer's instructions. Total scanning times and image numbers were recorded.Results: The difference in scanning time between the first and the tenth digital impressions was significant (p=0.007). The average scanning time for the first impressions was 23 min 9 sec; for the tenth impressions, it was 15 min 28 sec. The difference between the scanning times of the first and the tenth procedures was 7 min 41 sec. The average image count for the first impressions was 1964.5; for the tenth impressions, it was 1468.6. The image count difference between the first and the tenth procedures was 495.9. The image count versus sequential number of measurement curve shows an initial decreasing tendency followed by a trough around the sixth measurement and a final increasing phase.Conclusion: Our results indicate an association between the sequential number of measurements and the outcome variables. The drop in scanning time is probably explained by a practice effect of repeated use, i.e. the students learned to move the scanning tip faster. The image count first showed a decreasing tendency, and after the sixth measurement, it increased; there was no consistent decline in mean scan count. Shorter scanning times are associated with poorer coverage quality, with the operator needing to make corrections by adding extra images; this manifests as the time function of image counts taking an increase after the sixth measurement.Trial registration: This study was approved by the University Ethics Committee of Semmelweis University (SE TUKEB number: 61/2016).
A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners’ support among expectant couples in Mekelle Ethiopia
Authors: Gebremariam kidane , Zelenko Oksana , Mulugeta Afework , Gallegos Danielle
Published: August 2020

Background: Breastfeeding is considered the biological norm and essential to reduce infant morbidity and mortality. Mothers are responsible for breastfeeding but the support of others, including their partners is an influential determinant. The aim of this study was to compare antenatal breastfeeding knowledge, attitudes, and perceived breastfeeding support of expectant couples in Mekelle, Ethiopia. Methods: As part of a mHealth intervention trial , 128 couples in their third trimester from three selected health centres in Mekelle city were recruited to participate. Couples who each had a personal mobile phone, read and spoke Tigrigna, and lived together were included. Baseline data on breastfeeding knowledge, attitudes, and perceived support (breastfeeding savvy, help, appreciation, presence and responsiveness) were collected using previously validated tools through interview by health workers. Result: Compared to mothers, male partners were more likely to indicate their intention to provide breastfeeding appreciation (p=0.02), breastfeeding presence (p=0.002), and breastfeeding responsiveness (p=0.04). Mothers’ prenatal perceptions of their partners’ intended breastfeeding support was lower than fathers’ perceptions to support their partners. Multiparous mothers had more positive perceptions regarding their partners’ breastfeeding savvy (p=0.03), and breastfeeding help (p=0.02) compared to primiparous mothers.Conclusion: Fathers in Ethiopia are potentially strong supporters of breastfeeding practice. Future breastfeeding interventions should promote the involvement of fathers in breastfeeding and encourage mothers to increase their partners’ involvement in breastfeeding.
Molecular-based cross-species evaluation of bovine coronavirus infection in cattle, sheep and goats in Ghana.
Authors: Burimuah Vitus , Sylverken Augustina , Owusu Michael , El-Duah Philip , Yeboah Richmond , Lamptey Jones , Frimpong Yaw Oppong , Agbenyega Olivia , Folitse Raphael , Emikpe Ben , Tasiame William , Owiredu Eddie-Williams , Oppong Samuel , Antwi Christopher , Adu-Sarkodie Yaw , Drosten Christian
Published: August 2020

Background: Apart from the huge worldwide economic losses often occasioned by bovine coronavirus (BCoV) to the livestock industry particularly cattle, continuous surveillance of the virus in cattle and small ruminants is essential in monitoring variations in the virus that could enhance host switching. In this study, we collected rectal swabs from a total of 1,498 cattle, sheep and goats. BCoV detection was based on reverse transcriptase polymerase chain reaction. Sanger sequencing of the partial RNA-dependent RNA polymerase (RdRp) region for postive samples were done and nucleotide sequences were compared with homologous sequences from the GenBank.Results: The study reports a BCoV prevalence of 0.3% consisting of 4 positive cases; 3 goats and 1 cattle. Less than 10% of all the animals sampled showed clinical signs such as diarrhea and respiratory distress except for high temperature which occurred in > 1000 of the animals. However, none of the 4 BCoV positive animals manifested any clinical signs of the infection at the time of sample collection. Bayesian majority-rule cladogram comparing partial and full length BCoV RdRp genes obtained in the study to data from the GenBank revealed that the sequences obtained from this study formed one large monophyletic group with those from different species and countries. The goat sequences were similar to each other and clustered within the same clade. No major variations were thus observed with our isolates and those from elsewhere.Conclusion: Given that Ghana predominantly practice the extensive and semi-intensive systems of animal rearing, our study highlights the potential for spillover of BCoV to small ruminants in settings with mixed husbandry and limited separation between species.
Impact of Patron Saint Festivities on Cholera in Three Communes in Haiti
Authors: Moise Kenny , Achille Aude Mélody , Batumbo Doudou , Bourdeau Bertiny , Rebaudet Stanislas , Lerebours Gérald , Henrys Jean Hugues , Raccurt Christian
Published: August 2020

Introduction Religious pilgrimages are among the anthropogenic factors known to be associated with the transmission of diarrheal diseases, such as cholera. This ecological study aimed to describe the evolution of cholera and assess the relationship between the implementation of the ‘coup de poing’ strategy during the patron saint festivities and the incidence of cholera in the three communes of Cabaret, Carrefour, and Croix-des-Bouquets in Haiti in 2017. Materials/Methods An epidemiological curve was produced to illustrate the evolution of cholera at the communal level. Generalized linear models assuming a Poisson distribution were used to weight the annual cholera incidence of communal sections against variables such as the number of patronal festivities, population density and annual precipitation rates. The number of cases in the week of the festivity as well as one and two weeks later was weighted against patronal festivities and weekly precipitation rates. Results In total, 3 633 suspected cholera cases were continuously reported in three communes in Haiti (Cabaret, Carrefour, Croix-des-bouquets) during the 52-epidemiological week period in 2017. After controlling for rainfall and population density, the implementation of the ‘coup de poing’ strategy during the patron saint festivities was associated with a significant reduction in cholera incidence of 57.23% [PR=0.4277 (97.5% CI: 0.2798-0.6193), p=0.0000244]. The implementation of the strategy was associated with a reduction in cholera incidence of 25.41% one week following patronal festivities. Conclusion This study showed a continuous presence of cholera in three communes in Haiti in 2017 and an association between the implementation of the ‘coup de poing’ strategy during patronal festivities and a reduction in cholera incidence. The findings imply that the multi-partner ‘coup de poing’ strategy may have contributed to the reduced cholera incidence following patron saint festivities and in Ouest department in Haiti 2017.
Improvement of Parent’s Awareness, Knowledge, Perception, and Acceptability of HPV Vaccination After a Structured-educational Intervention
Authors: Sitaresmi Mei Neni , Rozanti Nisrina Maulida , Besty Lamria , Wahab Abdul
Published: August 2020

Background: Regardless of the disease burden of HumanPapilloma Virus (HPV), the vaccine has not been included in the Indonesia National Immunization Program. Since 2017 there was a demonstration program of the HPV vaccination in Yogyakarta Province. This vaccine was given free to female primary school students in the 5 th and 6 th grades (11-13 years old). This study aimed to assess whether a structured-educational intervention focus on HPV increases the parental awareness, knowledge, and perceptions toward HPV and the vaccine acceptability. Methods: We conducted a pre-post structured-educational intervention study from July to August 2017 before the implementation of the HPV vaccination demonstration program, in Kulon Progo District, Yogyakarta Province, Indonesia. Parents of female primary school students grades 5 th and 6 th were selected using a school-based proportional random sampling. A pediatric resident provided a structured-educational intervention, which consists of the burden and risk of HPV disease, as well as the benefit and safety of the vaccine. Parents were required to complete validated self-administered questionnaires before and after the structured-educational intervention. Results: A total of 506 parents participated. Before receiving the structured-educational intervention, parents' awareness of HPV infection and the vaccines were low. Only 49.2% of parents had heard HPV infection, and 48.8% had heard about the vaccine. After the structured-educational intervention, there were significant improvements in parent’s awareness, knowledge, and perceptions of HPV infection, cervical cancer, and HPV vaccination (all p <0.001). HPV vaccine's acceptability increased from 74.3% to 87.4% ( p <0.001). There was a significant correlation between increasing HPV vaccine acceptability with the improvement of awareness, knowledge, and perception toward HPV infection, cervical cancer and HPV vaccination (r=0.32 to 0.53, p <0.001). After the structured-educational intervention, better knowledge and positive perceptions of HPV vaccination were predictive of HPV vaccine's acceptability with OR 1.90 (95%CI:1.40-2.57) and OR 1.31(95%CI:1.05-1.63), respectively. Conclusions: A structured-educational intervention is effective in improving parental awareness, knowledge, and perceptions toward HPV as well as the acceptability of the vaccine. The structured-educational intervention designed for parents have important implications for improving vaccine acceptability.
Evaluation of the relationship among dental fear, scaling root planning and periodontal status using periodontitis stages： a retrospective study
Authors: Liu Yeungyeung , Zhang Caimei , Wu Jingyi , Yu Huimin , Xu Duoling , Xie Chengjie
Published: August 2020

Background: The present study used the new classification of periodontitis and validated questionnaires to assess the relationship among dental fear, scaling and root planning (SRP) pain and periodontal status for clinical evaluation.

Methods: One hundred and twenty periodontitis patients were enrolled for retrospective analysis and staging according to the new classification of periodontitis. All patients included in this study from July 2018 to January 2020 were divided into periodontitis stages. Scaling and root planning (SRP) was performed and Visual analogue scale (VAS) was determined for every patient immediately after SRP. Application of questionnaires including Corah’s Dental Anxiety Scales (DAS), Dental Fear Survey (DFS), and the short-form Dental Anxiety Inventory (S-DAI) were implemented from the first attendance and consequent visits after 6 months. All patient demographic data were collected including age, gender, marital status and education level. The scores of each dental fear scale and combination scales were also recorded. Patients were further subdivided into two categories based on DAS scores (low dental fear group: DAS<13; high dental fear group: DAS≥13). Statistical analysis was performed using t-test, chi-square, pearson and spearman correlative analysis to evaluate the relationship and differences among dental fear, SRP pain and periodontal status.

Results: Compared to pre-SRP treatment, dental fear level of DFS and combination scales were significantly decreased in the post-treatment period for all the periodontitis stages. There was no statistically significant difference between the pre-treatment and post-treatment periods on S-DAI and DAS in stage I and II; meanwhile, there were statistically significant differences between pre-treatment and post-treatment periods on S-DAI and DAS in stage III and IV. The correlation among periodontitis stages, VAS and dental fear level assessed via DAS, DFS and S-DAI, was statistically significant. In the categories divided according to DAS scale, the proportion of high periodontitis stages was significantly increased in high dental fear group (DAS≥13).

Conclusion: SRP can reduce dental fear level in all periodontitis stages, especially in stage III and IV. Correlations exists among periodontal status, dental fear and SRP pain. High dental fear is associated with poor periodontal status.
Vaccination concerns, beliefs and practices among Ukrainian migrants in Poland: A qualitative study
Authors: Ganczak Maria , Bielecki Klaudia , Drozd-Dąbrowska Marzena , Topczewska Katarzyna , Biesiada Daniel , Molas-Biesiada Agnieszka , Dubiel Paulina , Gorman Dermot
Published: August 2020

Objectives

Ukrainians numbering approximately 1.2 million are the largest migrant group in Poland. Data on vaccination coverage among migrants are not collected in EU, including Poland. Therefore, this qualitative study aimed to identify vaccination practices in this migrant group, to explore facilitators and barriers to vaccination and related access to Polish healthcare services.

Methods

In September 2019, a qualitative study of Ukrainian migrants (UMs) living in Szczecin, Poland, and recruited through a snowball sampling method, was conducted. Using a semi-structured topic guide, four focus groups were held with 22 UMs aged 18-45. Participants were asked about their attitudes towards vaccination in general with comparison between services in Poland and Ukraine. Following transcription and translation, a thematic analysis was conducted.

Results

Respondents were distrustful of Ukrainian vaccination policy, medical personnel and individual vaccines, however, they often returned to Ukraine for dental and gynaecological appoint-ments. While critical with regards to registering with Polish GPs practices, UMs were confident in health professionals, as well as vaccine delivery. Vaccines were perceived as safer and of better quality than in Ukraine. Difficulties in translating vaccination records were rarely reported, verbal communi-cation was not problematic due to language similarities. All UM parents reported vaccinating their children according to the Polish schedule. However, a significant number of adult UMs have not completed mandatory vaccinations, although they may have obtained false immunization certificates; according to UMs those can be obtained by bribing. Participants reported lower acceptance of the influenza vaccine, mainly due to perceptions around its importance; none had been vaccinated against influenza. None of UMs had heard of the HPV vaccine. UMs experienced challenges in accessing credible online vaccination information in Ukrainian, no official local health authority vaccination material existed either, except for information about measles.

Conclusions

This study pinpointed positive UM attitudes and practices regarding child vaccination in the Polish healthcare system and identified issues for improvement, such as adult vaccination. Health communication should be more tailored within UMs information delivery systems to enable migrants to make informed choices about vaccination. Further research is needed to better assess factors affecting vaccine uptake identified in this study.
Systemic inflammation and chronic kidney disease in a patient due to the RNASEH2B defect
Authors: He Tingyan , Xia Yu , Yang Jun
Published: August 2020

Introduction: Aicardi-Goutières (AGS) is a rare immune dysregulated disease due to mutations in TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR1, or IFIH1. Clinical features include basal ganglia calcifications, white matter abnormalities, and cerebral atrophy. Severe systemic inflammation and chronic kidney disease (CKD) are extremely rare in AGS. Herein, we report a patient presenting with systemic inflammation and CKD to broaden the clinical phenotype spectrum of the RNASEH2B defect. Methods: All testing and molecular genetic analysis were performed after obtaining the informed consent of the parents. Demographic, clinical, and laboratory findings were abstracted from outpatient and inpatient encounters. Cerebral magnetic resonance imaging (MRI), computed tomography (CT) scans, and renal biopsy histopathology reports were reviewed and summarized. Whole exome sequencing (WES) was performed on peripheral blood cells. After exposure to cGAMP in vitro for 24 hours, mRNA expression of twelve IFN-stimulated cytokine genes in PBMCs was assessed. Serum cytokine levels were detected by Milliplex. Results: A 11-year-old girl presented with recurrent aseptic fever, arthritis, chilblains, failure to thrive, mild hearing loss, and neurological manifestations. Laboratory and immunologic findings demonstrated lymphopenia, low complement levels, positive autoantibodies, elevated levels of acute-phase reactants and inflammatory cytokines. Cerebral imaging showed cerebral atrophy, white matter abnormalities, and intracranial calcification. Renal biopsy showed glomerular sclerosis in three of fourteen glomeruli, infiltration of lymphocytes and other mononuclear cells. WES revealed a homozygous and heterozygous mutations in RNASEH2B . Over-expression of IFN-stimulated cytokine genes was observed, including IFI44, IFI27, IFIT1, IFIT2, IFIT3, ISG15, OAS1, and SIGLEC1. Conclusions: To date, only two cases with AGS have been reported to have renal disease. Here, we describe a patient with both homozygous and heterozygous variants in RNASEH2B, presenting with neurological manifestations, persistently systemic autoinflammation, and CKD. CKD has never been reported in patients with AGS due to the RNASEH2B defect .
Electrocardiographic findings of methanol toxicity: A cross-sectional study on 356 cases in Iran
Authors: Nikoo Mohammad Hossein , Arjangzadeh Alireza , Pakfetrat Maryam , Boogar Shahrokh Sadeghi , Mohammadkarimi Vahid , Ostovan Vahid Reza , Khodamoradi Zohre , Roozbeh Jamshid , Khalili Mohammadreza , Shirazi Farnaz Kamali Haghighi , Kouhi Paryia , Heydari Seyyed Taghi
Published: August 2020

Background : Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature. Method : A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results : The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC>500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P<0.05 for all) , respectively. Conclusion : Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.
Aspects of cultivar variation in physiological traits related to Cd distribution in rice plants with a short-term stress
Authors: Chiao Wan-Ting , Chen Bo-Ching , Syu Chien-Hui , Juang Kai-Wei
Published: August 2020

Background

Genotypic variations are seen in cadmium (Cd) tolerance and accumulation in rice plants. Cultivars that show low Cd translocation from the root into shoot can be selected to reduce Cd contamination in rice grains. This study aims to clarify the physiological regulation related to Cd absorption by rice plants for screening out the cultivars, which have relatively low Cd accumulation in grains. Eight Taiwan mega cultivars of paddy rice: japonica (TY3, TK9, TNG71, and KH145 cultivars), indica (TCS10 and TCS17 cultivars), and glutinous (TKW1 and TKW3 cultivars), which are qualified with the criteria for rice grain quality by the Council of Agriculture, Taiwan, were used for illustration. An experiment in hydroponics was conducted for the rice seedlings with a treatment of 50 μM CdCl 2 for 7 days.

Results and discussion

After the Cd treatment, the reductions in shoot growth were more significant than those in root growth; however, Cd absorbed in the rice plant was sequestered much more in the root. The malondialdehyde (MDA) was preferentially accumulated in rice root but the hydrogen peroxide (H 2 O 2 ) was increased more significantly in the shoot; the antioxidative enzymes, superoxide dismutase (SOD) and ascorbate peroxidase (APX), were pronounced more in rice shoot.

Conclusions

The rice cultivars preferentially accumulated Cd in the root rather than the shoot with the Cd treatment, which resulted in significant enhancements of MDA and growth reductions in the root. However, H 2 O 2 accumulation was toward the shoot to retard shoot growth suddenly and then the root could keep a gradual growth. Also, the rice cultivars, which preferentially accumulate Cd in the root, would have the regulation tendency of SOD toward the shoot. Due to that SOD is responsible for H 2 O 2 production, H 2 O 2 accumulation would be thus toward the shoot. Moreover, the cultivars, which have a less regulation tendency of APX toward the shoot, would present higher translocation of Cd into the shoot.
The Relationship between Learner Engagement and Teaching Effectiveness: A Novel Assessment of Student Engagement in Continuing Medical Education
Authors: Stephenson Christopher R. , Bonnes Sara L. , Sawatsky Adam P. , Richards Lukas W. , Schleck Cathy D. , Mandrekar Jayawant N. , Beckman Thomas J , Wittich Christopher M.
Published: August 2020

Background: Continuing medical education (CME) often uses passive educational models including lectures. However, numerous studies have questioned the effectiveness of these less engaging educational strategies. Studies outside of CME suggest that engaged learning is associated with improved educational outcomes. However, measuring participants’ engagement can be challenging. We developed and determined the validity evidence for a novel instrument to assess learner engagement in CME.Methods: We conducted a cross-sectional validation study at a large, didactic-style CME conference. Content validity evidence was established through review of literature and previously published engagement scales and conceptual frameworks on engagement, along with an iterative process involving experts in the field, to develop an eight-item Learner Engagement Instrument (LEI). Response process validity was established by vetting LEI items on item clarity and perceived meaning prior to implementation, as well as using a well-developed online platform with clear instructions.. Internal structure validity evidence was based on factor analysis and calculating internal consistency reliability. Relations to other variables validity evidence was determined by examining associations between LEI and previously validated CME Teaching Effectiveness (CMETE) instrument scores. Following each presentation, all participants were invited to complete the LEI and the CMETE. Results: 51 out of 206 participants completed the LEI and CMETE (response rate 25%) Correlations between the LEI and the CMETE overall scores were strong (r=0.80). Internal consistency reliability for the LEI was excellent (Cronbach’s alpha=0.96). To support validity to internal structure, a factor analysis was performed and revealed a two dimensional instrument consisting of internal and external engagement domains. The internal consistency reliabilities were 0.96 for the internal engagement domain and 0.95 for the external engagement domain.Conclusion: Engagement, as measured by the LEI, is strongly related to teaching effectiveness. The LEI is supported by robust validity evidence including content, response process, internal structure, and relations to other variables. Given the relationship between learner engagement and teaching effectiveness, identifying more engaging and interactive methods for teaching in CME is recommended.
Professional development arising from multiple-site workplace learning: boundary crossing between the education and clinical contexts.
Authors: Barry Margot , Kuijer-Siebelink Wietske , Niewenhuis Loek A.F.M. , Scherpbier Nynke
Published: August 2020

Background: This research explores the value of an inter-organisational jurisdiction, on the professional development of faculty members in their roles of researcher and educator. Faculty members from a Dutch university of applied sciences, who work in both the education and clinical practice contexts, participated in this research. Methods: Individual semi-structured interview were conducted with nine faculty members, from various academic health professions, on their experiences of professional development arising from working in both the clinical and education contexts. In this exploratory, post-positive interview study, interview transcripts were analysed thematically.Results: Participants reported that working in two organisational contexts, whilst performing two faculty roles that span both contexts, enhances their ability to broker connections between research, teaching and practice. The boundary crossing activities which participants performed, contributed to professional development in all faculty roles. The broker role was not seen as being a unique role which is distinct from research and practice roles. Broker activities were seen as generic and supportive of the roles that bestow academic status and expertise. Conclusions: To the participants in this research, tThe relevance of the broker role in professional development is not as evident as the relevance of roles that enhance specialisation and subject specific expertise. They consider broker activities as supportive to the roles of researcher and teacher.This could be due to the fact that t The broker role is time consuming, but not yet visible as a distinct professionalisable work-package in its own right. It is also not well defined in literature. and it is not yet visible as a distinct professionalisable work-package. A better understanding of the broker role could lead to its development in order to harness its professional development potential tenably across academic roles.
Virtuelle Labore im Biologieunterricht
Authors: Schäfers Maria Sophie , Schmiedebach Mario , Wegner Claas
Published: August 2020

Obwohl Experimente nachweislich zum Wissenserwerb und Steigerung des Fachinteresses Lernender beitragen, ist die Planung und Durchführung aufgrund materieller und zeitlicher Voraussetzungen im Biologieunterricht nicht immer umsetzbar. Schülerinnen und Schülern wird in virtuellen Laboren die Möglichkeit gegeben, authentische Lernerfahrungen in einem Labor zu sammeln, um dadurch ähnliche Effekte in Bezug auf die (nicht-) kognitiven Fähigkeiten und Kompetenzen der Lernenden zu bewirken. In dieser empirischen Studie wurden in einem Kontrollgruppendesign mit insgesamt N = 94 Schülerinnen und Schüler der Oberstufe zu den Auswirkungen des Simulationsprogramms Labster im Fachbereich Genetik auf unterschiedliche Persönlichkeitsmerkmale untersucht. Die Ergebnisse der Vergleichsstudie zeigen, dass sowohl hinsichtlich des biologischen Selbstkonzepts, der Selbstwirksamkeit in Genetik, der Berufswahl sowie der konstruktiven Prozessmerkmale des gemässigten Konstruktivismus und den prozessbezogenen Kompetenzen im Bereich Erkenntnisgewinnung geschlechterunabhängig positive Effekte zu verzeichnen sind. Lediglich die sozialen Prozessmerkmale des gemässigten Konstruktivismus bringen für die Kontrollgruppe signifikant höhere Ergebnisse hervor, was sich jedoch mit der eingesetzten Interaktionsform begründen lässt. Die Pilotstudie zeigt, dass virtuelle Labore zahlreiche Potenziale für den Biologieunterricht mitbringen könnten, die in Folgestudien mit grösseren Stichproben untersucht werden. Besonders in der aktuellen Zeit, in der Besuche in Laboren oder labortechnische Arbeiten in Schulen nicht durchführbar sind, bieten die virtuellen Labore somit eine gewinnbringende Alternative.
SEDATION IN MEDICAL RETRIEVAL – CHALLENGES AND FUTURE PRACTICE
Authors: Stewart Matthew
Published: August 2020

Anaesthetic Awareness is the recall of events that occur during sedation and is a serious complication thought to occur in 0.1 to 0.2 % of the general surgical population. Sedation is an important tool used in medical retrieval, however its use in the aerospace environment is unique in its challenges for clinicians. Many of the patients carry risk factors for anaesthetic awareness and the mode of anaesthesia appropriate for the aerospace environment, total intravenous anaesthesia, also carries a higher risk compared to other methods. In addition the aerospace environment has other challenges not specific to sedation including noise distractions and the physiological effects of high altitude on patients which can impact on the ability to provide adequate sedation. Given all this, patients receiving sedation during medical retrieval would seem to be at a higher risk of anaesthetic awareness than many of their counterparts on the ground. For many high risk patients in hospitals technology such as brain monitoring has been shown to be effective in reducing awareness. Therefore as patients in the air are as likely, if not more likely to be at risk of awareness the use of this aid in medical retrieval is raised for consideration. However this technology will only ever be an adjunct to clinical expertise and an overall understanding of the flight environment and its challenges will allow for best patient care possible and the reduction of awareness during sedation.