bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient stories as a knowledge translation strategy for the sustainability of evidence-based interventions (EBIs) in healthcare: A qualitative secondary analysis
Authors: Flynn Rachel , Dobson Lauren , Milne Ella , Campbell Alyson , Mrklas Kelly , Wasylak Tracy , Scott Shannon
Published: June 2022

Background
Patient stories are a knowledge translation (KT) strategy that embody the patient experience. Patient stories are used to inform healthcare policy, delivery, and patient engagement, and have many positive impacts on the uptake of evidence-based interventions (EBIs) in healthcare. However, there is little evidence on the use and influence of patient stories for the long-term sustainability of EBIs. This study aims to understand how patient stories influenced the sustainability of two scaled EBIs in healthcare in the context of Alberta Health Services, Canada.
Methods
We conducted a secondary analysis of 20 qualitative interviews from the realist evaluation: Contextual factors and mechanisms that influence sustainability: A realist evaluation of two scaled, multi-component interventions. We employed a thematic analysis of the interview data.
Results
Patient stories positively influenced the sustainability of two EBIs by: 1) conveying the “why” behind the intervention, 2) motivating and encouraging staff to continue to engage with the intervention long-term, and 3) facilitating the spread and scale of the EBI. Success stories from patients and their families were especially impactful because they reflected positive outcomes of the EBI. Participants emphasized that patient stories should be positive in nature and be continually shared through different modalities (e.g., digital stories) for sustainability efforts.
Conclusions
The idea of patient stories as a KT strategy for sustainability is still nascent and requires more effectiveness and evaluation research. Our findings demonstrate how patient stories can facilitate the sustainability of EBIs in healthcare. In particular, our findings show how sharing stories digitally or through learning collaboratives and online toolkits, facilitates sustainability because digital stories can be saved and continually distributed to a wide audience at any time. Understanding the potential of patient stories as a KT strategy for sustainability will contribute to the long-term success of EBIs, thus improving healthcare quality.
Impact of Simulation Debriefing Structure on Knowledge and Skill Acquisition for Postgraduate Critical Care Nursing Students: three-Phase vs. Multiphase
Authors: Guerrero Jefferson Garcia , Tungpalan-Castro Grace Medalyn , Pingue-Raguini Minerva
Published: June 2022

Background: Simulation is part of the training provided to nurses enrolled in master’s degree for the critical care nursing programs in our institution. Although these are practicing nurses, many still make mistakes when performing nursing procedures related to critical care during simulation sessions, which must be addressed during the debriefing session. The aim of the study is to compare the knowledge and skills acquired by groups of postgraduate critical care nursing students who were exposed to high-fidelity simulation (HFS), by using different structures of debriefingMethods: A quasi-experimental research design was utilized during the post-tests and objective structured clinical examinations (OSCEs). The students were divided into two groups: one was exposed to HFS with a 3-phase debriefing, and the other exposed to HFS with a multiphase debriefing. Both groups involved facilitator-guided and video-assisted debriefings. Results: Overall, the post-test scores (p-value: phase 1 = .001 and phase 2 = .000) and post-OSCE scores (p-value: phase 1 = .002 and phase 2 = .002) support that the group of postgraduate students who underwent HFS with a multiphase debriefing structure gained significantly higher scores compared to the group who underwent HFS with a 3-phase debriefing structure.Conclusion: Debriefing is a critical component to successful simulation. Learning requires assessment that creates constructive criticism based on feedback and reflection. A multiphase debriefing structure, specifically the healthcare simulation after action review (AAR), provides a significant advantage for knowledge and skill acquisition.
Integration of Bulk and Single-Cell RNA-Seq Data to Construct a Prognostic Model of Membrane Tension Related Genes for Colon Cancer
Authors: Li Yong , Li Jiacheng , Fu Yugang , Zhang Kehui , Zhu Yingying , Zhe Shi , Cao Mengxing
Published: June 2022

Background: Plasma membrane provides a highly dynamic barriers for cancer cells to interact with their surrounding microenvironment. Membrane tension, a pivotal physical property of plasma membrane, has attracted more and more attention since it plays a role in the progression of various cancers. However, membrane tension related genes (MTRGs) involved in the regulation of colon cancer are not thoroughly understood. This study aimed to identify a prognostic MTRG signature in colon cancer and explore its implications for the disease.Methods: Bulk and Single-cell RNA-seq data and relevant clinical information were obtained from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) database. 44 membrane tension related genes (MTRGs) were obtained through literature. Analysis of differential expressed MTRGs was performed on the RNA-Seq data. By implementing a univariate Cox regression and a LASSO-Cox regression, we developed a prognostic model based on 4 MTRGs. We evaluated the prognostic efficacy of this model using Kaplan–Meier survival curve analysis and receiver operating characteristic (ROC) curve analysis. Moreover, the relationships between this signature and immune cell infiltration, immune status, somatic mutation, pseudo cell differentiation and drug sensitivity were further explored.Results: A 4-MTRG signature was constructed. Risk score derived from the model was further validated as an independent variable for survival prediction. Two risk groups were classified based on the risk score calculated by the 4-MTRG signature. Additionally, we observed a significant difference in immune cells infiltration, such as subsets of CD4 T cells and macrophages, between the high- and low groups. Moreover, in the pseudo-time analysis, TIMP1 was found to express higher as time goes on. Finally, three small molecule drugs, elesclomol, shikonin and bryostatin-1, exhibited binding potential to TIMP-1.Conclusion: The proposed 4-MTRG signature is a promising biomarker to predict clinical outcomes and therapeutic responses in colon cancer patients.
Perception of risk and compliance with COVID-19 safety guidelines among healthcare workers in Ghana: a cross-sectional study
Authors: Kayi Esinam Afi , Ottie-Boakye Doris , Ansa Gloria Akosua , Appiah-Agyekum Nana Nimo
Published: June 2022

Background: Healthcare workers are the ‘frontline’ in the provision of effective and quality healthcare delivery, yet they are beset with several occupational hazards and risks when providing care especially during a global health crisis. With limited health resources availability during patient care delivery coupled with relatively little evidence on compliance to infection prevention practices, this study investigates healthcare workers’ compliance with COVID-19 safety protocols and identifies factors associated with their perceived risk of COVID-19. Methods: This cross-sectional survey utilized non-probability sampling strategies to obtain primary data from both clinical and non-clinical health workers in various health facilities within four regions of Ghana. Structured questionnaires designed using Google forms and paper-based questionnaires were used. Binary logistic regression analysis was performed to identify the factors associated with the perceived risk of COVID-19.Results: A total of 513 questionnaires were obtained at the end of the study. The results showed that healthcare workers are highly compliant with hand hygiene practices and wearing face masks. Results from the regression analysis showed that the number of working years a healthcare worker had spent, category of health professional, type of health facility, region of work, frequency of COVID-19 test, and compliance with hand hygiene practices were strongly associated with healthcare workers’ perception of risk of COVID-19. Conclusion: Findings suggest that both individual and health system factors are significant in increasing the risk of COVID-19 among healthcare workers. Efforts at enforcing strict compliance with infection prevention should be implemented to protect the health workforce and mitigate against the transmission of the coronavirus.
Work Intensity and Workers' Sleep
Authors: Lyons Sai , Strazdins Lyndall , Doan Tinh
Published: June 2022

Experiencing poor sleep quality affects an individual’s health and wellbeing. Sleep quality may be influenced by work conditions, with working under high intensity a possible contributor. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey waves 2013 and 2017, this study investigates whether experiencing poor sleep quality is associated with work intensity. This study uses a nationally representative sample of working Australian individuals aged 25–64 from the HILDA survey and finds a strong positive association between work intensity and sleep quality, with an individual’s sleep quality worsening as their work intensity increased. The association between work intensity and sleep quality is even stronger than that between long work hours and sleep quality.
Admission glucose as a prognostic marker for all-cause mortality and cardiovascular disease
Authors: Djupsjö Catarina , Kuhl Jeanette , Andersson Tomas , Lundbäck Magnus , Holzmann Martin J. , Nyström Thomas
Published: June 2022

Background: Diabetes and prediabetes are known risk factors for cardiovascular disease and associated with increased mortality risk. Whether patients with a random elevated blood glucose level but no history of diabetes are at a higher mortality and cardiovascular risk is not entirely known.Methods: A retrospective cohort study where patients (18-80 years) with no history of diabetes between 2006-2016 attending the emergency department (ED) in Sweden were included. Based on the first (index) blood glucose level patients were categorized into four groups: hypoglycemia (<3.9 mmol/l), normal glucose tolerance (NGT) (3.9-7.8 mmol/l), dysglycemia (7.8-11.1 mmol/l), and hyperglycemia (>11.1 mmol/l). Data was collected from four nationwide registers (National Patient Register, National Cause of Death Register, Prescribed Drug Register and Statistics Sweden). Cox regression was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality and cardiovascular outcomes using NGT as reference.Results: 622018 patients were included during a mean follow-up time of 3.9 years. According to the index blood glucose level: 1877 (0.3%) had hypoglycemia, 527459 (85%) had NGT, 78416 (13%) had dysglycemia, and 14176 (2%) patients had hyperglycemia, respectively. During follow-up 45493 (7.3%) deaths occurred. After multiple adjustments, mortality risk was highest in patients with hypoglycemia HR 2.51 (2.19-2.87) followed by patients with hyperglycemia HR 1.87 (1.80-1.94) and dysglycemia HR 1.23 (1.20-1.26). Risk for cardiovascular events: i.e., myocardial infarction, stroke and heart failure, were highest among patients with hyperglycemia HR 2.26 (2.11-2.41), HR 1.59 (1.48-1.70) and HR 1.62 (1.49-1.77), respectively. Conclusion: Patients with disturbed blood glucose level at ED admission have a higher mortality risk than patients with NGT. Patients with hyperglycemia have almost a two folded increased long-term mortality risk and more than a doubled risk for cardiovascular events compared to patients with NGT.
Nephropathic cystinosis in a Chilean cohort: Clinical and genetic characterization
Authors: Krall Paola , Henríquez Jean Antoine Grandy , Bolte Lillian , Salgado Jennie , Cavagnaro Felipe , Gonzalez Claudia , Guerrero Jose Luis
Published: June 2022

Cystinosis is a rare disease caused by CTNS gene defects. The main clinical presentations are nephropathic infantile cystinosis (NIC) and nephropathic juvenile cystinosis (NJC); both develop chronic kidney disease (CKD) and extrarenal complications. Opportune diagnosis and access to therapy are challenging in developing countries. Objectives: To describe the clinical and genetic profile of all cystinosis patients diagnosed in Chile. Methods: We performed a retrospective review of the clinical records of cystinosis patients diagnosed from 1994 to 2022. Age at diagnosis, glomerular filtration rate, metabolic variables, anthropometric values, treatment, genetics analysis and outcomes were recorded. Results: Nine patients (8NIC/1NJC) were diagnosed. Patients with NIC had a median age of 16.5 (IQR 13-23) months at diagnosis, and two patients died during follow-up. Most patients started cysteamine therapy within 5 months after diagnosis and reached CKD stages 3-4 within four years. Laboratory and clinical evaluations improved after CKD management and cysteamine therapy. During the follow-ups, all but one of the NIC patients showed height for age Z-score values between -1.5 and -4.0. Two patients received kidney transplantation, and one of them still remains functional after 15 years. The single NJC was a 21-year-old female patient who received insufficient cysteamine and rapidly reached CKD stage 4. Genetic testing was positive in 7/7 cases, with del57kb being the predominant variant (10/14 alleles). Conclusion: Developing countries still face many challenges in providing adequate healthcare to cystinosis patients. Opportune genetic testing may facilitate early diagnosis, resulting in better prognoses.
Paramedics’ Perceptions of Job Demands and Resources in Finnish Emergency Medical Services: A Qualitative Study
Authors: Ericsson Christoffer R , Lindström Veronica , Rudman Ann , Nordquist Hilla
Published: June 2022

Background: Paramedics’ fatigue is rising. Stress factors show increased risk for burnout, fatigue, leaving the profession, decreased performance and risk for patient safety. Meanwhile, paramedics’ strong community of practice, autonomy and a sense of professional respect are important factors in forming psychological resilience. We aimed to explore Finnish paramedics’ perceptions of job demands and resources. Methods: Our study design was descriptive, inductive with a constructivist approach. Using reflexive thematic analysis, we analyse open-ended questions, from a web-based survey and essays written by Finnish paramedic masters-degree students. The study followed the STROBE checklist.Results: We identified paramedics’ job demands as stress from a high workload, environmental factors and emotional burden. Performance expectations and a sense of inadequacy were further noted, as well as an organizational culture of hardiness, presenting lack of support and sense of inequality. Paramedics’ job resources were pressure management strategies, which were expressed as positive coping mechanisms, agency to affect workload and professional self-actualization, expressed as psychologically safe work community, professional pride and internal drive to professional development. Conclusions: Finnish paramedics exhibit resources and demands related to uncertainty and emotional burden as well as cultural hardiness and psychological safety in communities. Patient or Public Contribution: This study was done based on survey data collected and analysed by the authors. No patient or public contribution was utilized for this study.
Effect of concurrent beta-blocker use in patients receiving immune checkpoint inhibitors for advanced solid tumors
Authors: Mellgard George , Patel Vaibhav G. , Zhong Xiaobo , Joshi Himanshu , Qin Qian , Wang Bo , Parikh Anish , Jun Tomi , Alerasool Parissa , Garcia Philip , Gogerly-Moragoda Mahalya , Leiter Amanda , Gallagher Emily J , Oh William K. , Galsky Matthew D. , Tsao Che-Kai
Published: June 2022

Purpose: Stress-induced adrenergic signaling can suppress the immune system. In animal models, pharmacological beta-blockade stimulates CD8+ T-cell activity and improves clinical activity of immune checkpoint blockade (ICB) in inhibiting tumor growth. Herein, we investigated the effect of BB on clinical outcomes of patients receiving ICB in advanced solid tumors.Methods:We retrospectively evaluated patients with solid tumors treated with ICB at our institution from January 1, 2011 to April 28, 2017. The primary clinical outcome was disease control. Secondary clinical outcomes were overall survival (OS), and duration of therapy (DoT). The primary predictor was use of BB. Association between disease control status and BB use was assessed in univariable and multivariable logistic regression. OS was calculated using hazard ratios of BB-recipient patients versus BB non-recipient patients via Cox proportional hazards regression models. All tests were two-sided at a significance level of 0.05. ResultsOf 339 identified patients receiving ICB, 109 (32%) also received BB. In covariate-adjusted analysis, odds of disease control were significantly higher among BB recipients compared to BB-non-recipients (2.79; [1.54-5.03]; p=0.001). While we did not observe significant association of OS with the use of BB overall, significant association with better OS was observed for the urothelial carcinoma cohort (HR: 0.24; [0.09, 0.62]; P=0.0031). Conclusions:Concurrent use of BB may enhance the clinical activity of ICB and influence overall survival, particularly in patients with urothelial carcinoma. Our findings warrant further investigation to understand the interaction of beta adrenergic signaling and antitumor immune activity and explore a combination strategy.
Cough Suppression and HRQoL in adult people with Cystic Fibrosis: An Unexplored Correlation
Authors: Niehammer Ute , Steindor Mathis , Straßburg Svenja , Sutharsan Sivagurunathan , Taube Christian , Welsner Matthias , Hirtz Raphael , Stehling Florian
Published: June 2022

Background: Cough suppression assessed by embarrassment about coughing has been shown in adolescents with cystic fibrosis (CF) and negatively affects health-related quality of life (HRQoL) and clinical indicators of disease severity in adolescent females. However, whether cough suppression exists in adults has been studied as little as its effects on clinical and psychological outcomes beyond adolescence. Methods: 71 subjects completed the self-reported 'Cystic Fibrosis Questionnaire-Revised (CFQ-R +14)' and a self-reported questionnaire about cough suppression, health-related perspectives, and therapy adherence. Status of CF disease was quantified in terms of percentage of predicted forced expiratory volume in one second (ppFEV1), body mass index (BMI), Pseudomonas aeruginosa, and pancreatic status, as well as CF-related diabetes (CFRD). Additional demographic data for sex, age, graduation, employment, and marital status were assessed.Results: CS exists in adult CF and is associated with impaired HRQoL, but not the overall CF disease status regarding BMI, ppFEV1, or health-related perspectives. Despite a higher prevalence of cough suppression in women, no effect of sex regarding either outcome measure was observed. Conclusion: The results of this study may suggest that mental health indicators have an impact on cough suppression.
Multilayer perception and radial basis function models for predicting trends of rainfall in Asian megacity Dhaka, Bangladesh
Authors: I Abu Reza Md. Towfiqul , Pal Subodh Chandra , Chakrabortty Rabin , Mallick Javed , Sarkar Showmitra Kumar , Fattah Md. Abdul , Rahman M. Safiur
Published: June 2022

Rainfall prediction is a fascinating topic, particularly in an urban city experiencing climate change; it is also required for hydrologic system analysis and design. Most real-time rainfall prediction algorithms use conceptual models that simulate the hydrological cycle in a changing climate. However, calibration of “conceptual” or “physically based models” is typically challenging and time-consuming due to the large number of variables and factors. Simpler “artificial neural network (ANN)” predictions may thus seem promising. To this end, this study aimed to evaluate the performance of two of the most commonly used ANN models, namely “Multilayer Perception (MLP)” and “Radial Bias Function (RBF)”, by predicting the rainfall trend patterns in the mega city of Dhaka, Bangladesh. In this perspective, rainfall is considered as a dependent variable and the rest of the parameters are considered as independent variables for predicting the trends of rainfall in this region. In the prediction models, fifteen conditioned atmospheric and meteorological parameters were used, and the multi-collinearity of these parameters was checked by the “Variance Inflation Factor” and “Tolerance” methods. The performance of the ANN models was evaluated by comparing the predicted and residuals and also by using AOC and ROC curves. The importance study from the MLP model revealed that PM10, O3, PM2.5, NOx, and wind speed are the highest causal factors influencing the rainfall changes in Dhaka, Bangladesh. Though both ANN models produced similar robustness in rainfall prediction, results showed that MLP performed well with an AUC value of 0.941, compared to the RBF model with an AUC value of 0.915. Therefore, the application of the MLP model can be suggested as an alternative to predict the pattern of rainfall as well as meteorological and atmospheric variables based on historical recorded datasets.
Right atrial lines as primary access for postoperative pediatric cardiac patients
Authors: ANTON-MARTIN PILAR , ZOOK NINA , KOCHANSKI JUSTIN , RAY MEREDITH , NIGRO JOHN J. , VELLORE SHILPA
Published: June 2022

Objectives: To characterize the use of right atrial lines (RALs) as primary access in the postoperative care of neonatal and pediatric patients after cardiothoracic surgery and to identify risk factors associated with RAL complications. Materials and Methods: Observational retrospective cohort study in pediatric cardiac patients who underwent RAL placement in a tertiary children’s hospital from January 2011 through June 2018.Results: A total of 692 children with congenital heart disease underwent 815 RAL placements during the same or subsequent cardiothoracic surgeries during the study period. Median age and weight were 22 days (IQR 7-134) and 3.6 kg (IQR 3.1-5.3), respectively. Neonates accounted for 53.5% of patients and those with single ventricle physiology were 35.4%. Palliation surgery (shunts and cavo-pulmonary connections) accounted for 38%. Survival to hospital discharge was 95.5%. Median RAL duration was 11 days (IQR 7-19) with a median RAL removal to hospital discharge time of 0 days (IQR 0-3). Thrombosis and migration were the most prevalent complications (1.7% each), followed by malfunction (1.4%) and infection (0.7%). Adverse events associated with complications were seen in 12 (1.4%) of these RAL placements: decrease in hemoglobin (n=1), tamponade requiring pericardiocentesis (n=3), pleural effusion requiring chest tube (n=2) and need for antimicrobials (n=6). Multivariable logistic regression showed that RAL duration (OR 1.01, p=0.006) and palliation surgery (OR 2.38, p=0.015) were significant and independent factors for complications.Conclusion: The use of RALs as primary access in postoperative pediatric cardiac patients seems to be feasible and safe. Our overall incidence of complications from prolonged use of RALs remained similar or lower to that reported with short-term use of these lines. While RAL duration and palliation surgeries seemed to be associated with complications, severity of illness could be a confounding factor. A prospective assessment of RAL complications may improve outcomes in this medically complex population.
Mental state diagnosis using Hybrid CNN with EEG signal from wearable device
Authors: S Sivasaravana babu , V Prabhu , V Parthasarathy , G Saravana Kumar
Published: June 2022

Mental state of a person is not easy to read by humans. This mental state may include anxiety, depression and other medical conditions. There is no correct physical testing that is available. Therefore, diagnosing these mental conditions in yearly stage is very important. In our proposed model, we use EEG signal from non-intrusive wearable devices to detect depression patterns in patients. This can be done with the help of proposed Hybrid CNN (Convolutional Neural Network) algorithm. In this algorithm we are introducing adaptive wavelet kernels in convolutional layers to reduce the number of connected neurons in the network. This Mental state diagnosis using Hybrid CNN with EEG signal algorithm is also designed to be shift invariant and can handle real world online data from wearable devices. Finally, the training time requirement of neural network can be reduced with the help of improved learning rate functions. This kind of improvements will make the algorithm consume less training time and power. The algorithm has an accuracy of about 97% from data that is taken from wearable device with very poor SNR ratios. The main motive of the paper will be to construct fast, reliable, energy efficient algorithm for real world wearable applications.
Metadichol, A natural ligand for expression of Yamanaka reprogramming factors in somatic and primary cancer cell lines
Authors: Raghavan P.R.
Published: June 2022

The conversion of somatic cells back into induced pluripotent stem cells (iPSCs) or embryonic-like stem cells involves the introduction of four genes commonly called Yamanaka factors, i.e., Sox2, Oct4, Klf4, and c-Myc, into the cells. Because these genes and the viral vectors used to introduce them into cells have the potential to cause cancer, iPSC lines are not clinically useful. Most instances of direct reprogramming have achieved have been by the forced expression of defined factors using viral vectors. Here, we show that Metadichol® has the potential to generate iPSCs non-virally and may be helpful in clinical applications. Metadichol is a nanoformulation of long-chain alcohols derived from food. Quantitative real-time PCR (qRT-PCR) and western blotting showed that OCT4, SOX2, and Nanog are expressed when fibroblasts were treated with Metadichol at one picogram to 100 nanograms. Reverse-transcription PCR (RT-PCR) also revealed that OCT4, KLF4, Nanog, and Sox2 levels increased compared to controls by 4.01-, 3.51- and 1.26-, and 2.5-fold, respectively, in A549 cancer cells. In Colo-205 cells, OCT4, KLF4, and Sox2 were increased by 1.79-, 13.17-, and 2.25-folds, respectively. Metadichol treatment with triple-negative primary breast cancer (HCAF-TNPBC) primary cancer cells led to multifold increases of OKSM factors by 19-, 6-, 8.07-, 2.45-, and 6.91-folds in concentration ranges 1picogram to 100 nanograms. Metadichol is a natural product that induces the expression of Yamanaka factors needed for reprogramming and Klotho, an anti-aging gene, and curbs the expression of the TP53 gene, which is critical for reprogramming somatic cells into IPSCs.Metadichol increases endogenous vitamin C levels, leading to the efficient reprogramming of somatic cells into iPSCs. Metadichol is nontoxic and commercially available as a nutritional supplement. Thus, it can be directly tested in vivo in human subjects to confirm that cells can indeed be programmed into a state of induced pluripotency and cause the mitigation of disease conditions.
Clinical Study of Patients With Vitamin B12 Deficiency Followed at a University Hospital in Brazil
Authors: Berto Clara Rottschaefer , Frigotto Katia Gleicielly , Valviesse Vitor Ribeiro Gomes de Almeida , Bergier Lavínia Lustosa
Published: June 2022

Background: Vitamin B12 is a vitamin essential for enzymatic reactions and, as it is not synthesized by the human body, and there may be a deficiency in cases of food restriction or reduced absorption. It is estimated that the prevalence of its deficiency is 20% in the population over 60 years and the clinical manifestations may be due to hematological and neurological or neuropsychiatric disorders. Methods: This is a descriptive study, using data from the medical records of patients with vitamin B12 deficiency followed at a University Hospital in Rio de Janeiro, from 2014 to 2016. The following parameters were evaluated: hemoglobin concentration (Hb), mean corpuscular volume (MCV), erythrocyte anisocytosis index (RDW), hematoscopy, platelet count, lactate dehydrogenase (LDH) enzyme dosage, mini mental status examination (MMSE), vibratory sensitivity and strength in physical examination. Main Results: Data from the medical records of 20 patients with vitamin B12 levels <200 pg/dL were analyzed. The clinical and laboratory alterations found were: abnormal hematoscopy (90%), LDH > 200 IU/L (85%), RDW > 15% (80%), Hb < 12 g/dL (70%), MCV > 100 fL (65%), altered vibratory sensitivity (55%), platelet count < 150,000/uL (25%), altered MMSE (20%), altered strength (10%). Regarding the etiologies found, the most frequent were pernicious anemia (40%) and atrophic gastritis (20%). Conclusion: The most frequent alteration in this study was abnormal hematoscopy, and the most frequent etiology was pernicious anemia. Is important knowledge of the subject among health professionals, to identify and diagnose this deficiency at an early stage.
Dirac Equation Redux by Direct Quantization of the 4-Momentum Vector
Authors: Andoni S.
Published: June 2022

The Dirac equation (DE) is a cornerstone of quantum physics. We prove that direct quantization of the 4-momentum vector p with modulus equal to the rest energy m (c =1) yields a manifestly covariant equation with the frame-free operator p. In coordinate representation, this is equivalent to DE with spacetime frame vectors xu replacing Dirac’s gamma-matrices. Recall that standard DE is not manifestly covariant. Adding an independent Hermitian vector x5 to the spacetime basis {xu} allows to accommodate the momentum operator in a real vector space with a complex structure arising alone from vectors and multivectors. The real vector space generated from the action of the Clifford or geometric product onto the quintet {x0, x1, x2, x3, x5} has dimension 32, the same as the equivalent real dimension for the space of Dirac matrices. x5 proves defining for the C& CPT symmetries, distinction of axial vs. polar vectors, left and right handed rotors & spinors, etc. Therefore, we name it reflector and {x0, x1, x2, x3, x5} a basis for spacetime-reflection (STR). The pentavector I = x05123 commutes with all elements of STR and depicts the pseudoscalar in STR. We develop the formalism by deriving all essential results from the novel STR DE: spin ½ magnetic angular momentum, conserved probability currents, symmetries and nonrelativistic approximation. In simple terms, we demonstrate how Dirac matrices are a redundant representation of spacetime-reflection frame vectors.
A short decision time for transcatheter embolization can better predict mortality in patients with pelvic fracture
Authors: Miyake Takahito , Okada Hideshi , Kanda Norihide , Ishihara Takuma , Mizuno Yosuke , Ichihashi Masahiro , Kamidani Ryo , Fukuta Tetsuya , Nachi Sho , Yoshida Takahiro , Nagata Shoma , Kawada Hiroshi , Matsuo Masayuki , Yoshida Shozo , Ogura Shinji
Published: June 2022

Purpose: Early use of hemostasis strategies, such as transcatheter arterial embolization (TAE), is critical in cases of pelvic injury because of the risk of hemorrhagic shock and other fatal injuries. We investigated the influence of delays in TAE administration on mortality.Methods: This retrospective, observational study enrolled patients with pelvic injury who underwent acute TAE and were admitted to the Advanced Critical Care Center at Gifu University Hospital between January 2008 and December 2019. The time from when the doctor decided to administer TAE to the start of TAE (needling time) was defined as “decision-TAE time.”Results: We included 159 patients. The median decision-TAE time was 60 min. Twenty-four patients died. Kaplan–Meier curves for overall survival were compared between patients above and below the median cutoff value for decision-TAE time; survival was significantly better for patients below the median cutoff value (p=0.02). Multivariable Cox proportional hazards regression analysis revealed that the longer the decision-TAE time, the higher the risk of mortality (p=0.037). A short TAE duration (procedure time) with a short decision-TAE time was associated with the best survival (p for interaction=0.023).Conclusions: Decision-TAE time may play a key role in establishing resuscitation in pelvic fracture patients, and efforts to shorten this time should be pursued.
Experimental study of the effect of brake drum cooling grooves on motorcycle braking performance
Authors: Lapisa Remon , Fernandez Donny , Tarihoran Claudio , Milana Milana , Arif Ahmad , Purwantono Purwantono , Jasman Jasman
Published: June 2022

Some important indicators in the braking system performance on a motorcycle are the braking temperature and stopping distance. High temperatures due to frictional heat in the drum brake can decrease the braking force and cause a slip. To improve braking performance, an effective strategy is needed to reduce the drum temperature and shorten the stopping distance. This study aims to analyze the effect of cooling grooves on the standard brake drum to decrease the drum brake temperature and the length of stopping distance. The measurements were compared to the standard drum brake as a reference, and two types of the modified ones to increase the braking performance by adding the slant-grooved and a straight grooved on brake drum. Braking is performed by providing a compressive load of two kg on the brake pedal for three cases of motorbike speed: 20, 40, and 60 km/hour. The results show that the brake drum with straight cooling grooves provides better braking performance compared to other drum brakes. For a speed of 60 km/h, the temperature of the straight grooved brake is 3.5 ºC. The stopping distance is 29.1 % shorter compared to the standard one. It shows that adding cooling grooves on drum brake can increase the effectiveness of motorcycle braking performance at various speeds. The results show that the brake drum with straight cooling grooves provides better braking performance compared to other drum brakes
Analysis of the air exchange in livestock building through the computational fluid dynamics
Authors: Ivanov Ivan , Kostov Konstantin , Atanasov Koycho , Denev Ivan , Krystev Neven
Published: June 2022

Increasing consumption of meat and meat products worldwide is closely linked to improving the living environment for livestock. According to zoo experts, the appropriate microclimate in buildings leads to improved metabolic processes in their cultivation and contributes to their rapid weight gain. The issue of raising new-borns and young animals is especially relevant. Achieving optimal parameters of the microclimate in the premises, together with the necessary veterinary care for new-borns reduces stress and mortality in them. The above requires the implementation of new and modern engineering solutions in the design and construction of livestock buildings. The use of numerical simulations, through CFD programs for modelling and solving engineering problems, as well as the creation of adequate mathematical models, is a prerequisite for reducing the time and resources to solve a problem. Based on the accumulated experience of the authors on the microclimate in livestock farms in this publication, a numerical simulation of air exchange in a livestock building for breeding sows with young piglets is presented. The physical model, research and analysis are realized in the middle of Ansys Fluent. Two models of air exchange organization in the livestock building are proposed. The obtained data on the temperature and speed fields in the building will lead to an improvement of the microclimate in the considered site. In addition, they could serve as a basis for conducting the next series of computer simulations. The built models can be adapted for other building constructions for breeding other types of animals. The analysis of the data and a more in-depth examination of the factors related to animal husbandry could help to increase pork yields on livestock farms
Design and practice of simple first-order all-pass filters using commercially available IC and their applications
Authors: Suksawad Atirarj , Charoenmee Angkana , Panikhom Suphaphorn , Patimaprakorn Khunpan , Jantakun Adirek
Published: June 2022

First-order all-pass filter circuits, both non-inverting and inverting, could be the focus of this article, which could include the design and implementation of first-order all-pass filter circuits. Using a standard integrated circuit (IC): AD830, as well as a single resistor and a single capacitor, the proposed first-order all-pass filters could well be built. The AD830 is an integrated circuit (IC) manufactured by Analog Devices Corporation that is available for purchase. The pole frequency and phase response of the proposed all-pass filters could well be directly modified by attuning the resistor in the circuit. Aside from that, the output voltage has a low impedance, making it appropriate for use in voltage-mode circuits. In addition, the proposed first-order all-pass filter is used to design the multiphase sinusoidal oscillator, which serves as an example of an application wherein the oscillation condition can be adjusted without impacting the frequency. The gain and phase responses of the proposed all-pass filters, as well as their phase response adjustment, time-domain response, and total harmonic distortion of signals, are all shown via computer simulation using the PSPICE software, as well as their experimental results. For the proposed circuits, a statistical analysis is coupled with a Monte Carlo simulation to estimate the performance of the circuits. In accordance with the results of this study, a theoretical design suitable for developing a worksheet for teaching and learning in electrical and electronic engineering laboratories has already been developed
Synthesis and characterization of MgB2 superconductors with carbon nanotubes (CNTs) and tin (Sn) addition
Authors: Hendrik Hendrik , Nur Farhanudin Muhammad , Darsono Nono , Herbirowo Satrio , Darminto Darminto , Pramono Andika Widya , Imaduddin Agung
Published: June 2022

MgB2/CNT is a promising candidate for superconducting wire application due to its excellent mechanical properties and carbon nanotube’s low density. However, strong interfacial adhesion between the CNT reinforcement and the MgB2 matrix is difficult to manage. Therefore, this study examines the synthesis and characterization of magnesium diboride (MgB2) superconductors with carbon nanotubes (CNTs) and tin (Sn) addition. Determining the proper method and combination of CNT & Sn affects MgB2 superconductors is crucial. Raw materials of magnesium (Mg), boron (B), Sn, and multi-walled carbon nanotubes (MWCNTs) were used for a solid-state reaction process to determine the proper synthesis method and the effect of CNT on superconductors’ critical temperature. Each sample was obtained by weighing the raw material first, followed by hand grinding with agate mortars for 3 hours. The pelletization was then conducted by using a compact pressing machine with a pressure of 350 MPa. The compacted samples were then sintered at 800 °C for 2 hours either through the vacuum or PIST process. Finally, all were characterized, and MgB2 was discovered to be the dominant phase with minor impurity phases such as MgO, Mg, Mg2Sn, C, and Sn. Based on SEM morphological analysis, the grain boundaries of sample A1 were more precise than B2. In both, the grain size also varies, and the distribution of elements is uneven. Subsequently, Cryogenic Magnet Characterization indicated that at 40 K, almost all samples possess superconducting characteristics. For future studies, the potential impact of MgB2 on critical current density (Jc) and magnetic density (Hc) in several commercial applications such as Magnetic Resonance Imaging (MRI), magnetic levitation, and transformers needs to be investigated
Development of methodological principles of routing in networks of special communication in conditions of fire storm and radio-electronic suppression
Authors: Sova Oleg , Zhuravskyi Yurii , Vakulenko Yuliia , Shyshatskyi Andrii , Salnikova Olha , Nalapko Oleksii
Published: June 2022

Decision making support systems are actively used in the processing of large data sets, process forecasting, providing information support to the decision-making process by decision-makers. However, there are problems with the transmission of information: the transmission of information takes place in a complex electronic environment against the background of interference; radio communication systems are the objects of primary fire damage due to high radio visibility. This article develops the methodological principles of routing in special communication networks in the conditions of fire damage and electronic suppression. The purpose of this research is to increase the efficiency of information transfer under the influence of destabilizing factors. The proposed methodological principles are based on the theory of artificial intelligence. The research presents a mathematical formulation of the problem of routing in special-purpose radio networks and developed a method of routing in special-purpose radio networks.

The efficiency of information processing is achieved through training in the architecture of artificial neural networks; taking into account the type of uncertainty of the information to be assessed; use of the ant algorithm. The approbation of the use of the offered technique on the example of the estimation of information transfer in the conditions of influence of destabilizing factors is carried out. The proposed methodological principles should be used in the development of software for programmable devices of communication and in the modernization of existing and development of new radio communication devices. This example showed an increase in the efficiency of information transmission in radio communication systems at the level of 15–25 % on the criterion of efficiency
Numerical modeling and experimental evaluation of machining parameters for 2-dimensions ultrasonic-assisted micro-milling at low and high-speed machining
Authors: Libyawati Wina , Kiswanto Gandjar , Saragih Agung Shamsuddin , Ko Tae Jo
Published: June 2022

Vibration assisted machining (VAM) is one of the hybrid machining processes for improving the machined surface quality. VAM performance is mainly influenced by the combination of machining and vibration control parameters, where surface roughness value (Ra) became the benchmarking indicator. It is difficult to determine the optimum parameter combination to produce high precision products, especially for micro-milling, due to the interconnected correlation among parameters. The benefits of high-speed machining with VAM are high material removal rate and shorter machining time than low-speed machining. VAM operation at high-speed machining is still limited due to the high possibility of chatter occurrence. Therefore, this research aims to evaluate the 2D VAM resonant performance at low-speed and high-speed machining, operated at ultrasonic vibration and amplitude below one μm. The mathematical model and experimental evaluate the vibration effect based on machining mode, amplitude, and spindle speed variation. The mathematical modelling and experiment result complement each other, where the mathematical model can characterize the effect of resonant vibration, amplitude, and spindle speed increment on the tool path trajectory. The 2D resonant vibration at the feed direction causes interrupting cutting and transforms the tool path trajectory from linear to wavy. The mathematical model and experiment result show the dominant influence of spindle speed and feed rate on the toolpath trajectory and Ra, where low spindle speed and feed rate result in better machine surface roughness. The low-speed machining with VAM results in Ra value between 0.1–0.155 μm, which is below the high-speed machining result, between 0.2–0.38 μm
The challenges in employing digital marketing as a tool for improving sales at selected retail stores in the transkei region
Authors: Guzana Mpumzi , Msosa Steven Kayambazinthu
Published: June 2022

During the last decade, the internet has introduced the information age and electronic commerce (e-Commerce) to millions of individuals worldwide, even those living in rural places, thus providing companies with an alternative platform for customer contact than brick-and-mortar stores. Therefore, businesses must alter their conventional marketing techniques and develop new approaches to engage consumers on the platforms where they want to connect and make purchases. This study assessed the perceived challenges in using Digital Marketing to boost sales at retail stores in the Transkei region. A qualitative and exploratory research design was used to collect data from store managers through face-to-face interviews. A non-probability sampling technique, known as purposive sampling, was employed to identify 14 store managers based on their knowledge of the subject matter. The findings of this study show that several factors, such as government legislation [the Protection of Personal Information (POPI) Act of 2016], which states that customers cannot be contacted without their express consent; customers' perceptions; poor connectivity in rural areas; costs and angry customer responses are some of the retailers'challenges in employing Digital Marketing. This research could assist the management of retail stores to comprehend the company's challenges and facilitate the implementation of Digital Marketing initiatives to improve service quality, especially during this period of the Covid-19 pandemic. This study has contributed to the Digital Marketing literature in developing countries and laid the groundwork for future research.
Social comparison and academic buoyancy among freshmen in one selected public university
Authors: Aloka Peter J. O.
Published: June 2022

The study examined the relationship between social comparison and academic buoyancy among freshmen in one selected public university in Kenya. The study adopted cross-sectional survey research design. The social comparison and academic buoyancy scales were used to collect data. The sample size of the study consisted of 213 freshmen from one selected public university in the western part of Kenya. The data collected were analyzed using descriptive statistics, and inferential statistics, such as Pearson correlation coefficient and regression analysis statistical techniques. It was established, that there was a low positive (r=0.187, n=213, p=0.006) relationship between social comparison and academic buoyancy among the first year university students. The social comparison regression model was adequate to predict the level of academic buoyancy among first year university students, [F (1, 211)=7.641, p=0.006, accounting for 3.5 % (R2=0.035)] of the variation in academic buoyancy levels. The study recommends that counseling staff at universities should develop specific orientation programmes to enhance the academic buoyancy of freshmen with inappropriate social comparisons. Future studies could also focus on institutional based factors, influencing academic buoyancy among freshmen at universities.