bluuebunny/crossref_metadata_2025 huggingface dataset:
Botulinum Toxin Type A Alleviates Benign Prostatic Hyperplasia by Regulating Progression of Epithelial-Mesenchymal Transition via Inhibition of Hypoxia-Inducible Factor-1α
Authors: Duan Qiuyan , Li Junhua , Song Chen , Gong Xiuqing , Li Ruipeng , Zhou Peng
Published: April 2023

This study proposes to explore the impact of BTX-A on BPD and the functional mechanism. In this study, RWPE-1 cells were stimulated with 10 ng/mL DHT, followed by treatment with 5, 10, and 20 U/mL BTX-A for 24 h. Significantly increased cell viability, repressed apoptosis, upregulated
Vimentin, N-cadherin, and FN, and downregulated E-cadherin were observed in DHT-stimulated RWPE-1 cells, which were drastically rescued by BTX-A treatment. A BPH rat model was established, followed by treatment with 20, 60, and 100 U/mL BTX-A. An increased PW/BW ratio, elevated serum DHT levels,
severe pathological changes in the prostate tissue, and facilitated EMT progression were observed in BPH rats, which were drastically abolished by BTX-A. Furthermore, in DHT-handled RWPE-1 cells and prostate tissue of BPH rats, HIF-1α and VEGF were significantly upregulated and
were greatly downregulated by BTX-A treatment. Finally, the impact of BTX-A on the proliferation and apoptosis of DHT-treated RWPE-1 cells, EMT progression, and VEGF expression was significantly abolished by the overexpression of HIF-1α. Our data revealed that BTX-A alleviated
BPH by regulating the progression of EMT via inhibition of HIF-1α.
Inverted Meckel’s Diverticulum Causing Adult Intussusception after Blunt Trauma
Authors: Monreal Alberto J. , Profeta Bernadette , Bloom Scott W. , Eubanks Steve
Published: April 2023

Meckel’s diverticulum is an uncommon though well described clinical entity. There are few cases of a Meckel’s diverticulum having been identified as the lead point for adult intussusception. We report the surgical management of a 45-year-old patient with an inverted Meckel’s diverticulum causing distal ileal intussusception after blunt abdominal trauma requiring small bowel resection.
“We are captives to digital media surveillance” Netizens awareness and perception of social media surveillance
Authors: Oguafor Ifeanyichukwu Valerie , Nevzat Raziye
Published: April 2023

With the increasing use of social media and the frequent question of privacy invasion, this study aims to give an insight into young adult netizen's-citizens of the internet and people born into the digital era- perception of the existing surveillance culture surrounding social media today as studies and recent statistics have shown that young adults all over the world make up the greater percentage of social media users. While this paper is centered around privacy on social media and information capitalism as key theoretical frameworks that conceptualizes surveillance and participatory surveillance system, this study gives an exploratory understanding of netizens opinion on the issue as we investigate their awareness and perception of social media surveillance. Using a qualitative method, this study utilizes interviews with 35 university students between the ages of 18–25 as a primary source of data collection. Findings from this study show although netizens are aware of the surveillance culture on social media, they strongly believe that they are captives of social media surveillance. Participatory surveillance occurs amongst them only because they have little or no choice as surveillance is embedded in the digital world they choose to participate in. Lastly, participants believe that it is difficult to hold a faceless watcher accountable so they do not question the system.
MRI-based radiomics model for preoperative prediction of extramural venous invasion of rectal adenocarcinoma
Authors: Lin Xue , Jiang Hao , Zhao Sheng , Hu Hongbo , Jiang Huijie , Li Jinping , Jia Fucang
Published: April 2023

Background

Extramural venous invasion (EMVI) is an important prognostic factor of rectal adenocarcinoma. However, accurate preoperative assessment of EMVI remains difficult.

Purpose

To assess EMVI preoperatively through radiomics technology, and use different algorithms combined with clinical factors to establish a variety of models in order to make the most accurate judgments before surgery.

Material and Methods

A total of 212 patients with rectal adenocarcinoma between September 2012 and July 2019 were included and distributed to training and validation datasets. Radiomics features were extracted from pretreatment T2-weighted images. Different prediction models (clinical model, logistic regression [LR], random forest [RF], support vector machine [SVM], clinical-LR model, clinical-RF model, and clinical-SVM model) were constructed on the basis of radiomics features and clinical factors, respectively. The area under the curve (AUC) and accuracy were used to assess the predictive efficacy of different models. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated.

Results

The clinical-LR model exhibited the best diagnostic efficiency with an AUC of 0.962 (95% confidence interval [CI] = 0.936–0.988) and 0.865 (95% CI = 0.770–0.959), accuracy of 0.899 and 0.828, sensitivity of 0.867 and 0.818, specificity of 0.913 and 0.833, PPV of 0.813 and 0.720, and NPV of 0.940 and 0.897 for the training and validation datasets, respectively.

Conclusion

The radiomics-based prediction model is a valuable tool in EMVI detection and can assist decision-making in clinical practice.
Efficacy and safety of eptinezumab for migraine prevention in patients with prior preventive treatment failures: subgroup analysis of the randomized, placebo-controlled DELIVER study
Authors: Ashina Messoud , Lanteri-Minet Michel , Ettrup Anders , Christoffersen Cecilie Laurberg , Josiassen Mette Krog , Phul Ravinder , Sperling Bjørn , Pozo-Rosich Patricia
Published: April 2023

Background

Migraine is a disabling neurological disease adversely affecting many aspects of life. Most patients are still required to have failed several older oral preventive therapies before being reimbursed for a preventive, migraine-specific anti-calcitonin gene-related peptide treatment. In the 24-week placebo-controlled portion of DELIVER, eptinezumab was shown to reduce migraine frequency and resulted in higher migraine responder rates compared with placebo in patients with two to four previous preventive treatment failures. This subgroup analysis assessed if demographic or clinical characteristics were associated with differences in preventive benefits.

Methods

Migraine frequency reductions and responder rates (i.e., the proportion of patients reaching a ≥50% and ≥75% reduction in monthly migraine days relative to baseline) were determined in the total population and predefined subgroups by sex, age, migraine frequency (chronic migraine, episodic migraine, high-frequency episodic migraine, low-frequency episodic migraine), medication overuse, medication-overuse headache, and previous preventive treatment failures (2, >2). The primary endpoint was change from baseline in monthly migraine days over weeks 1–12.

Results

Eptinezumab 100 and 300 mg reduced monthly migraine days more than placebo over weeks 1–12 (−4.8 and −5.3 vs –2.1, respectively; p < 0.0001). In most subgroups, eptinezumab-treated patients demonstrated larger monthly migraine days reductions from baseline over weeks 1–12 than patients receiving placebo, with reductions maintained or increased over weeks 13–24. For ≥50% and ≥75% migraine responder rates, the odds ratios versus placebo all numerically favored eptinezumab.

Conclusion

Eptinezumab had larger monthly migraine days reductions and higher responder rates than placebo across clinically relevant subgroups showing that, across different demographic populations and clinical characteristics, eptinezumab is effective in patients with migraine and prior preventive treatment failures. Trial Registration: ClinicalTrials.gov (Identifier: NCT04418765)
Telemedicine in British Airways
Authors: Bagshaw Michael
Published: April 2023

In the year ending March 1994, British Airways (BA) carried in excess of 30 million passengers worldwide. There was a total of 2078 reported in-flight medical incidents, with 18 unscheduled diversions for medical reasons. The commonest reported conditions were faints, diarrhoea and vomiting. The BA aircraft medical kit content exceeds the statutory minimum requirement and all cabin crew undergo training in first aid and life support. There is a BA doctor on 24 h call with whom an aircraft captain may communicate via a high-frequency radio link. This link has limitations and immediate contact is not always possible. BA is installing satellite communication facilities in new aircraft and the application of telemedicine utilizing this facility is being explored.
Inverse identification model for release rates of multiple gaseous pollution sources in an aircraft cabin
Authors: Lei Lei , Liu Wei
Published: April 2023

When gaseous pollutants are airborne in an aircraft cabin, it is important to know the release rate of pollution sources efficiently and accurately for effective mitigation. At present, it is possible to locate single or multiple pollution sources using the sensor information, but there is no fast and accurate method to determine the strength of multiple pollution sources. In this study, using the monitored pollutant concentrations, with the assumption that the location of multiple pollution sources in an aircraft cabin is known, an inverse model for determining the release rates was established. In order to improve the calculation efficiency, the cause-effect matrix between the release rates of pollution sources and the concentrations of monitored points was obtained by introducing the contribution ratio of pollutant sources (CRPS) method. Due to the direct inversion of the cause-effect matrix being ill-posed, the Tikhonov regularization method was used to enhance the stability of the inverse solution. The inverse model was validated by experiment in a three-dimensional cavity with CO2 as a tracer gas. The method was further demonstrated in a three-dimensional aircraft cabin by simulated data. The results show that the inverse modelling can accurately and efficiently quantify release rates of multiple pollution sources.
Antiracist Curriculum Implementation for Pediatric Residents
Authors: Szoko Nicholas , Ragunanthan Braveen , Radovic Ana , Garrison Jessica L. , Torres Orquidia
Published: April 2023

Objectives

Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents.

Methods

In 2020−2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation.

Results

Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation ( p = 0.03). Self-reported clinical skills improved significantly ( p < 0.001). Individual advocacy behaviors increased ( p < 0.001); there were no changes in institutional advocacy.

Conclusion

We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
Radiographic Contrast Media: An Introduction to Its Use, Adverse-Effect Profile, and Economic Impact
Authors: Gersema Lisa M.
Published: April 2023

Objective

To provide an overview of the development, chemistry, adverse-effect profile, and economic impact of radiographic contrast media (CM).

Data Sources

Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of CM. References cited in published review articles and manufacturer's product information also were used.

Study Selection

Studies, review articles, and editorials were selected for review if they addressed the synthesis, clinical use, or economic impact of CM. Comparative studies conducted in humans were used to address the adverse-effect profile of CM.

Data Extraction

Data were extracted from reviews and editorials when the information from multiple sources was consistent and pertained to the purpose of this review. Comparative reviews addressing adverse reactions were reviewed by the author for appropriate methodology and reporting of results.

Data Synthesis

Radiographic CM are iodine-containing compounds that can be injected intravascularly or intrathecally for multiple diagnostic tests. CM are differentiated according to water solubility, viscosity, radiopacity, and osmolality. In the past decade, low-osmolality CM (LOCM) have been developed that may impart fewer adverse effects, such as flushing, nausea, vomiting, allergic reactions, cardiovascular effects, and nephrotoxicity. The use of LOCM has steadily increased since their introduction in 1985. The cost of LOCM is approximately 10- to 20-fold higher than previously available CM. This represents a growing financial burden to the healthcare system.

Conclusions

CM are an integral tool in diagnostic medicine. LOCM appear to be safer than previous agents; however, they are also more expensive. Balancing safety and financial concerns will be a recurring issue facing both the medical society and third-party payers when selecting appropriate CM to administer to patients.
Evaluation and Financial Impact of Imipenem/Cilastatin Dosing in Elderly Patients Based on Renal Function and Body Weight
Authors: Ritchie David J. , Reichley Richard M. , Canaday Kathryn Lindhorst , Bailey Thomas C.
Published: April 2023

Objective

To evaluate the financial impact of adjusting imipenem/cilastatin (IC) dosages in elderly patients based on estimated creatinine clearance (Clcr) and body weight.

Design

Retrospective cost-savings analysis.

Setting

A 500-bed, university-affiliated, tertiary-care hospital.

Main Outcome Measures

All courses of IC administered to patients over age 60 during a four-month period were retrospectively assessed for appropriateness based on both dosing interval and dosage. Manufacturer's guidelines for adjusting the IC dosage based on estimated Clcr and body weight were used to define appropriate dosing. The cost savings that could have been realized by appropriately adjusting IC dosage was calculated for the study period and extrapolated to project an annual cost savings.

Results

Only 37 percent of patient days of therapy and 32 percent of therapy courses were judged as appropriate based on both dose amount and interval. The projected annual cost savings that could have been realized by appropriately adjusting IC dosage based on estimated Clcr and body weight was $11,550.

Conclusions

Adjustment of IC dosages in elderly patients based on estimated Clcr and body weight can result in significant cost savings.
ecpc: an R-package for generic co-data models for high-dimensional prediction
Authors: van Nee Mirrelijn M. , Wessels Lodewyk F. A. , van de Wiel Mark A.
Published: April 2023

Background

High-dimensional prediction considers data with more variables than samples. Generic research goals are to find the best predictor or to select variables. Results may be improved by exploiting prior information in the form of co-data, providing complementary data not on the samples, but on the variables. We consider adaptive ridge penalised generalised linear and Cox models, in which the variable-specific ridge penalties are adapted to the co-data to give a priori more weight to more important variables. TheR-packageecpcoriginally accommodated various and possibly multiple co-data sources, including categorical co-data, i.e. groups of variables, and continuous co-data. Continuous co-data, however, were handled by adaptive discretisation, potentially inefficiently modelling and losing information. As continuous co-data such as externalpvalues or correlations often arise in practice, more generic co-data models are needed.

Results

Here, we present an extension to the method and software for generic co-data models, particularly for continuous co-data. At the basis lies a classical linear regression model, regressing prior variance weights on the co-data. Co-data variables are then estimated with empirical Bayes moment estimation. After placing the estimation procedure in the classical regression framework, extension to generalised additive and shape constrained co-data models is straightforward. Besides, we show how ridge penalties may be transformed to elastic net penalties. In simulation studies we first compare various co-data models for continuous co-data from the extension to the original method. Secondly, we compare variable selection performance to other variable selection methods. The extension is faster than the original method and shows improved prediction and variable selection performance for non-linear co-data relations. Moreover, we demonstrate use of the package in several genomics examples throughout the paper.

Conclusions

TheR-packageecpcaccommodates linear, generalised additive and shape constrained additive co-data models for the purpose of improved high-dimensional prediction and variable selection. The extended version of the package as presented here (version number 3.1.1 and higher) is available on (https://cran.r-project.org/web/packages/ecpc/).
Social contact patterns during the COVID-19 pandemic in 21 European countries – evidence from a two-year study
Authors: Wong Kerry L. M. , Gimma Amy , Coletti Pietro ,   CoMix Europe Working Group, Paolotti Daniela , Tizzani Michele , Cattuto Ciro , Schmidt Andrea , Gredinger Gerald , Stumpfl Sophie , Baruch Joaquin , Melillo Tanya , Hudeckova Henrieta , Zibolenova Jana , Chladna Zuzana , Rosinska Magdalena , Niedzwiedzka-Stadnik Marta , Fischer Krista , Vorobjov Sigrid , Sõnajalg Hanna , Althaus Christian , Low Nicola , Reichmuth Martina , Auranen Kari , Nurhonen Markku , Petrović Goranka , Makaric Zvjezdana Lovric , Namorado Sónia , Caetano Constantino , Santos Ana João , Röst Gergely , Oroszi Beatrix , Karsai Márton , Fafangel Mario , Klepac Petra , Kranjec Natalija , Vilaplana Cristina , Casabona Jordi , Faes Christel , Beutels Philippe , Hens Niel , Jaeger Veronika K. , Karch Andre , Johnson Helen , Edmunds WJohn , Jarvis Christopher I.
Published: April 2023

Background

Most countries have enacted some restrictions to reduce social contacts to slow down disease transmission during the COVID-19 pandemic. For nearly two years, individuals likely also adopted new behaviours to avoid pathogen exposure based on personal circumstances. We aimed to understand the way in which different factors affect social contacts – a critical step to improving future pandemic responses.

Methods

The analysis was based on repeated cross-sectional contact survey data collected in a standardized international study from 21 European countries between March 2020 and March 2022. We calculated the mean daily contacts reported using a clustered bootstrap by country and by settings (at home, at work, or in other settings). Where data were available, contact rates during the study period were compared with rates recorded prior to the pandemic. We fitted censored individual-level generalized additive mixed models to examine the effects of various factors on the number of social contacts.

Results

The survey recorded 463,336 observations from 96,456 participants. In all countries where comparison data were available, contact rates over the previous two years were substantially lower than those seen prior to the pandemic (approximately from over 10 to < 5), predominantly due to fewer contacts outside the home. Government restrictions imposed immediate effect on contacts, and these effects lingered after the restrictions were lifted. Across countries, the relationships between national policy, individual perceptions, or personal circumstances determining contacts varied.

Conclusions

Our study, coordinated at the regional level, provides important insights into the understanding of the factors associated with social contacts to support future infectious disease outbreak responses.
Trend and determinants of mortality in incident hemodialysis patients of the Lazio region
Authors: Bossola Maurizio , Di Napoli Anteo , Angelici Laura , Bargagli Anna Maria , Cascini Silvia , Kirchmayer Ursula , Agabiti Nera , Davoli Marina , Marino Claudia
Published: April 2023

Background

. In the last decades some studies observed a moderate progressive decrease in short-term mortality in incident hemodialysis patients. The aim of the study is to analyse the mortality trends in patients starting hemodialysis using the Lazio Regional Dialysis and Transplant Registry.

Methods

. Patients who started chronic hemodialysis between 2008 and 2016 were included. Annual 1-year and 3-year Crude Mortality Rate*100 Person Years (CMR*100PY) overall, by gender and age classes were calculated. Cumulative survival estimates at 1 year and 3 years since the date of starting hemodialysis were presented as Kaplan-Meier curves for the three periods and compared using the log-rank test. The association between periods of incidence in hemodialysis and 1-year and 3-year mortality were investigated by means of unadjusted and adjusted Cox regression models. Potential determinants of both mortality outcomes were also investigated.

Results

. Among 6,997 hemodialysis patients (64.5% males, 66.1% over 65 years old) 923 died within 1 year and 2,253 within 3 years form incidence; CMR*100PY were 14.1 (95%CI: 13.2–15.0) and 13.7 (95%CI: 13.2–14.3), respectively; both remained unchanged over the years. Even after stratification by gender and age classes no significant changes emerged. Kaplan-Meier mortality curves did not show any statistically significant differences in survival at 1 year and 3 years from hemodialysis incidence across periods. No statistically significant associations were found between periods and 1-year and 3-year mortality. Factors associated with a greater increase in mortality are: being over 65 years, born in Italy, not being self-sufficient, having systemic versus undetermined nephropathy, having heart disease, peripheral vascular disease, cancer, liver disease, dementia and psychiatric illness, and receiving dialysis by catheter rather than fistula.

Conclusions

. The study shows that the mortality rate in patients with end-stage renal disease starting hemodialysis in the Lazio region was stable over 9 years.
Subacute cutaneous lupus erythematosus as a rare complication of disease-modifying therapy administration in multiple sclerosis: case report
Authors: Xu Ke , Zhang Mengjie , Yang Shilin , Yu Gang , Zheng Peng , Qin Xinyue , Feng Jinzhou
Published: April 2023

Background

Teriflunomide, the active metabolite of leflunomide, is a disease-modifying therapy drug used for the treatment of multiple sclerosis (MS), yet the complications associated with this drug remain not fully understood. Here we present the rare case of a 28-year-old female MS patient who developed subacute cutaneous lupus erythematosus (SCLE) following teriflunomide treatment. Though SCLE has been reported to be associated with leflunomide, the current report represents the first documented evidence demonstrating SCLE as a potential teriflunomide treatment-related complication. Additionally, a literature review on the leflunomide-induced SCLE was conducted to emphasize the association of SCLE with teriflunomide, specifically amongst the female demographic with a preexisting autoimmune diathesis.

Case presentation

A 28-year-old female first presented with MS symptoms in the left upper limb along with blurred vision in the left eye. Medical and family histories were unremarkable. The patient exhibited positive serum biomarkers including ANA, Ro/SSA, La/SSB, and Ro-52 antibodies. Relapsing–remitting MS was diagnosed according to the 2017 McDonald’s diagnostic criteria, and remission was achieved upon intravenous administration of methylprednisolone followed by teriflunomide sequential therapy. Three months post-teriflunomide treatment, the patient developed multiple facial cutaneous lesions. SCLE was subsequently diagnosed and was attributed to treatment-related complication. Interventions include oral administration of hydroxychloroquine and tofacitinib citrate effectively resolved cutaneous lesions. Discontinuation of hydroxychloroquine and tofacitinib citrate treatment led to recurring SCLE symptoms under continuous teriflunomide treatment. Full remission of facial annular plaques was achieved after re-treatment with hydroxychloroquine and tofacitinib citrate. The patient’s clinical condition remained stable in long-term outpatient follow-ups.

Conclusions

As teriflunomide has become a standard disease-modifying therapy for MS, the current case report highlights the importance of monitoring treatment-related complications, specifically in relation to SCLE symptoms.
Interventions to promote healthy lifestyle behaviors in children and adolescents in summer day camps: a scoping review
Authors: Larose David , Chih-Shing Chen Melvin , Panahi Shirin , Yessis Jennifer , Tremblay Angelo , Drapeau Vicky
Published: April 2023

Background

Children and adolescents have suboptimal physical activity and eating habits during summer breaks. Unlike the school setting, there is little evidence on interventions to promote healthy lifestyle behaviors in Summer Day Camps (SDCs).

Methods

The aim of this scoping review was to examine physical activity, healthy eating, and sedentary behavior interventions in the SDCs. A systematic search on four platforms (EBSCOhost, MEDLINE, EMBASE, and Web of Science) was performed in May 2021 and was updated in June 2022. Studies related to promoting healthy behaviors, physical activity, sedentary behaviors and/or healthy eating among campers aged 6 to 16 in Summer Day Camps were retained. The protocol and writing of the scoping review were done according to the guidelines of the “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR)”.

Results

Most interventions had a positive effect on the behavioral determinants or the behaviors themselves (i.e., physical activity, sedentary behaviors, or healthy eating). Involving counsellors and parents, setting camp goals, gardening, and education are all relevant strategies in promoting healthy lifestyle behaviors in SDCs.

Conclusions

Since only one intervention directly targeted sedentary behaviors, it should strongly be considered for inclusion in future studies. In addition, more long-term and experimental studies are needed to establish cause-and-effect relationships between healthy behavior interventions in SDCs and behaviors of children and young adolescents.
COVID-19 and the law in Uganda: a case study on development and application of the public health act from 2020 to 2021
Authors: Achan Martha Isabella , Nabukenya Immaculate , Mitanda Sarah , Nakacwa Joanita , Bakiika Herbert , Nabatanzi Maureen , Bukirwa Justine , Nakanwagi Aisha , Nakiire Lydia , Aperce Cedric , Schwid Aaron , Okware Solome , Obuku Ekwaro A. , Lamorde Mohammed , Luswata Brian , Makumbi Issa , Muruta Allan , Mwebesa Henry G. , Aceng Ocero Jane Ruth
Published: April 2023

Background

Despite the discovery of vaccines, the control, and prevention of Coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions (NPIs). This article describes the development and application of the Public Health Act to implement NPIs for COVID-19 pandemic control in Uganda.

Methods

This is a case study of Uganda’s experience with enacting COVID-19 Rules under the Public Health Act Cap. 281. The study assessed how and what Rules were developed, their influence on the outbreak progress, and litigation. The data sources reviewed were applicable laws and policies, Presidential speeches, Cabinet resolutions, statutory instruments, COVID-19 situation reports, and the registry of court cases that contributed to a triangulated analysis.

Results

Uganda applied four COVID-19 broad Rules for the period March 2020 to October 2021. The Minister of Health enacted the Rules, which response teams, enforcement agencies, and the general population followed. The Presidential speeches, their expiry period and progress of the pandemic curve led to amendment of the Rules twenty one (21) times. The Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management supplemented the enacted COVID-19 Rules. However, these Rules attracted specific litigation due to perceived infringement on certain human rights provisions.

Conclusions

Countries can enact supportive legislation within the course of an outbreak. The balance of enforcing public health interventions and human rights infringements is an important consideration in future. We recommend public sensitization about legislative provisions and reforms to guide public health responses in future outbreaks or pandemics.
Effectiveness of family support health education intervention to improve health-related quality of life among pulmonary tuberculosis patients in Melaka, Malaysia
Authors: Saidi Syafiq Sidqi , Abdul Manaf Rosliza
Published: April 2023

Background

Pulmonary Tuberculosis (PTB) is an important public health problem in Malaysia. In this country, limited research has been carried out on the impact of the disease on the health-related quality of life (HRQoL). Family support interventions had been shown to be effective in improving the PTB treatment outcomes.

Objectives

This study aims to determine the effectiveness of a newly developed Family Support Health Education (FASTEN) intervention in improving the health-related quality of life (HRQoL) among PTB patients in Melaka, as compared to the current conventional disease management.

Materials and methods

A single-blinded, randomized controlled field trial study design was conducted in Melaka from September 2019 until August 2021, involving newly diagnosed PTB patients. The participants were randomized either into the intervention group (FASTEN intervention) or into the control group (conventional management). They were interviewed by using a validated questionnaire that includes the Short Form 36 Health Survey version 2 (SF-36v2), at three time points: at diagnosis, two months and six months after diagnosis. Data were analyzed using IBM SPSS Statistics for Windows version 24. The Generalized Estimating Equations (GEE) analysis was used to evaluate the effectiveness of the intervention, in terms of the HRQoL score difference between the groups, adjusted for baseline covariates.

Results

The HRQoL among PTB patients was lower than the HRQoL of general Malaysian population. Among the total 88 respondents, the three lowest HRQoL domains scores at baseline were Social Functioning (SF), Role limitation due to Physical condition (RP) and Vitality (VT) with the median (IQR) scores of 27.26 (10.03), 30.21 (11.23) and 34.77 (8.92) respectively. The median (IQR) for Physical Component Score (PCS) was 43.58 (7.44) and for Mental Component Score (MCS) was 40.71 (8.77). There were significant difference in the HRQoL median scores between the intervention group compared to the control group, as the Physical Functioning (PF) (p = 0.018), RP (p < 0.001), General Health (GH) (p < 0.001), VT (p < 0.001), SF (p < 0.001), Role limitation due to Emotional condition (RE) (p < 0.001), General Mental Health (MH) (p < 0.001), and the MCS (p < 0.001).

Conclusion

The FASTEN intervention is effective to improve the overall HRQoL among PTB patients, as the HRQoL scores were significantly higher in the intervention group compared to the control group who received conventional management. Therefore, it is recommended that the TB program should incorporate the involvement of family members in the patient’s management.

Date of registration and number

The protocol was registered with RCT registered body on 05/12/2019 (Australian New Zealand Clinical Trial Registry – Registration Number: ACTRN12619001720101).
Internationalisation of the curriculum in health programs
Authors: Davey Andrew Keith
Published: April 2023

Internationalisation is a broad term that has been used to encompass a range of activities including international student recruitment, student mobility and exchange, international teaching and research collaborations, institutional partnerships, and embedding international and/or intercultural perspectives within curricula.

There are numerous drivers for institutions to develop an internationalisation strategy including building global reputation and influence, having a positive influence on communities, income generation, and helping their students gain a global perspective or develop intercultural competencies. Health students benefit from internationalisation activities as they will enter a workforce that increasingly engages with global diseases and works within multicultural societies.

However, there are risks associated with internationalisation that stem from disjointed institutional decision making, power imbalances, and neo-colonial attitudes. There are also multiple barriers to effectively engaging in internationalisation including individual student circumstances, staff and institutional preparedness, and geopolitical factors.

Within this broader context, internationalisation of the curriculum (IoC) is aimed at incorporating international, intercultural, and global dimensions into the curriculum, including consideration of content, teaching methods, learning outcomes, and how these are supported at a program and institutional level. This is a major undertaking requiring alignment of philosophy between teaching academics, senior university leadership, and the relevant professional body. Examples of IoC within health programs, and the significant challenges involved, are critically discussed in this paper, and strategies to overcome these challenges highlighted.

Whilst recognising the challenges, this paper concludes that undertaking purposeful IoC is a critical step towards ensuring that the future health workforce is adequately prepared for the 21st Century environment.
An early detection and segmentation of Brain Tumor using Deep Neural Network
Authors: Aggarwal Mukul , Tiwari Amod Kumar , Sarathi M Partha , Bijalwan Anchit
Published: April 2023

Background

Magnetic resonance image (MRI) brain tumor segmentation is crucial and important in the medical field, which can help in diagnosis and prognosis, overall growth predictions, Tumor density measures, and care plans needed for patients. The difficulty in segmenting brain Tumors is primarily because of the wide range of structures, shapes, frequency, position, and visual appeal of Tumors, like intensity, contrast, and visual variation. With recent advancements in Deep Neural Networks (DNN) for image classification tasks, intelligent medical image segmentation is an exciting direction for Brain Tumor research. DNN requires a lot of time & processing capabilities to train because of only some gradient diffusion difficulty and its complication.

Methods

To overcome the gradient issue of DNN, this research work provides an efficient method for brain Tumor segmentation based on the Improved Residual Network (ResNet). Existing ResNet can be improved by maintaining the details of all the available connection links or by improving projection shortcuts. These details are fed to later phases, due to which improved ResNet achieves higher precision and can speed up the learning process.

Results

The proposed improved Resnet address all three main components of existing ResNet: the flow of information through the network layers, the residual building block, and the projection shortcut. This approach minimizes computational costs and speeds up the process.

Conclusion

An experimental analysis of the BRATS 2020 MRI sample data reveals that the proposed methodology achieves competitive performance over the traditional methods like CNN and Fully Convolution Neural Network (FCN) in more than 10% improved accuracy, recall, and f-measure.
Undervalued professionals: placement of nutritionist in the Ecuadorian health system
Authors: Román A. C. , Villar M. A. , Belmont-Guerron P. , Ocampo M. B.
Published: April 2023

Background

Currently, many public health issues are directly related to malnutrition, and are made worse by social inequities. Nutrition professionals must be a key player in improving epidemiological aspects of nutrition-related diseases and must be part of clinical teams to control nutritional concerns.

Objective

To identify and analyze the nutritionists´ employment situation in Ecuador and areas of work covered and determine if type of university has an impact over work situation.

Methodology

A cross-sectional study was conducted, approved by the ethics committee of Universidad San Francisco de Quito. It included 442 nutritionists in Ecuador who graduated in 13 universities (5 private (PR) and 8 public (PU)) between 2008 and 2019. It implied an online survey that questioned their satisfaction with their education and current work situation. All the statistical analyses were performed using R version 4.0.3, two-sided weighted chi-square test was performed to estimate the difference between public and private university graduates, IC 95%, p between 0.01 and 0.05.

Results

38,6% of participants are unemployed, 68,28% private university graduates (PR) are currently employed and 58.87% work as nutritionists, compared to 56,86% from a public university (PU) currently working and 44.69% working in the field. 76% have reported being unemployed at some point in their careers, being difficulty finding jobs the main reason. Regarding the professional field, most professionals have their own business, and the less common area of work was public and community nutrition. One third of the participants had another paid activity. The main salary is 800USD per month and graduated from PR perceived better salaries than from PU.

Conclusion

There is a lack of job opportunities for Ecuadorian nutritionists despite the high demand in every level of the health system. Most have been unemployed at some point in their careers due to difficulties finding jobs. There is a minimum nutrition staff working in community and public health nutrition.
Dancers with non-specific low back pain have less lumbar movement smoothness than healthy dancers
Authors: Lin Chai-Wei , Fang Yi-Ting , Yang Jeng-Feng , Hsue Bih-Jen , Lin Cheng-Feng
Published: April 2023

Background

Ballet is a highly technical and physically demanding dance form involving extensive end-range lumbar movements and emphasizing movement smoothness and gracefulness. A high prevalence of non-specific low back pain (LBP) is found in ballet dancers, which may lead to poor controlled movement and possible pain occurrence and reoccurrence. The power spectral entropy of time-series acceleration is a useful indicator of random uncertainty information, and a lower value indicates a greater smoothness or regularity. The current study thus applied a power spectral entropy method to analyze the movement smoothness in lumbar flexion and extension in healthy dancers and dancers with LBP, respectively.

Method

A total of 40 female ballet dancers (23 in the LBP group and 17 in the control group) were recruited in the study. Repetitive end-range lumbar flexion and extension tasks were performed and the kinematic data were collected using a motion capture system. The power spectral entropy of the time-series acceleration of the lumbar movements was calculated in the anterior–posterior (AP), medial–lateral (ML), vertical (VT), and three-directional (3D) vectors. The entropy data were then used to conduct receiver operating characteristic curve analyses to evaluate the overall distinguishing performance and thus cutoff value, sensitivity, specificity, and area under the curve (AUC) were calculated.

Results

The power spectral entropy was significantly higher in the LBP group than the control group in the 3D vector in both lumbar flexion and lumber extension (flexion: p = 0.005; extension: p < 0.001). In lumbar extension, the AUC in the 3D vector was 0.807. In other words, the entropy provides an 80.7% probability of distinguishing between the two groups (i.e., LBP and control) correctly. The optimal cutoff entropy value was 0.5806 and yielded a sensitivity of 75% and specificity of 73.3%. In lumbar flexion, the AUC in the 3D vector was 0.777, and hence the entropy provided a probability of 77.7% of distinguishing between the two groups correctly. The optimal cutoff value was 0.5649 and yielded a sensitivity of 90% and a specificity of 73.3%.

Conclusions

The LBP group showed significantly lower lumbar movement smoothness than the control group. The lumbar movement smoothness in the 3D vector had a high AUC and thus provided a high differentiating capacity between the two groups. It may therefore be potentially applied in clinical contexts to screen dancers with a high risk of LBP.
A study on the equity of self-rated health of older adults at the family level
Authors: Ren Weicun , Xing Yiqing , Tarimo Clifford Silver , He Ruibo , Liang Zhang
Published: April 2023

Background

The self-rated health of older adults (SHOA) plays an important role in enhancing their medical service utilization and quality of life. However, the determinants and magnitude variations in SHOA at the family level (SHOAFL) remain unknown. The purpose of this study was to assess the status and equitable level of SHOAFL in China, as well as to analyze the influencing factors and the precise nature and scope of their impacts.

Methods

This study analyzed the data from the "Chinese residents' health service needs survey in the New Era", and included a total of 1413 families with older adults. The status and influencing factors of SHOAFL were analyzed using mean comparison and Logistic regression (LR) models. The Concentration Index method was used to explore the equity of the distribution of SHOAFL. The relationship between differences in personal characteristics among family members and differences in SHOA was determined by the method of Coupling Coordination Degree (CCD).

Results

The total score of SHOAFL was 66.36 ± 15.47, and LR results revealed that the factors with a significant impact on SHOAFL were number of people living in family, distance to the nearest medical service institution, travel time to the nearest medical service institution, annual family income, yearly family medical and health expenditures, average age, and residence (all P < 0.05). The Concentration index of SHOAFL ranged from -0.0315 to 0.0560. CCD of the differences between SHOA and medical insurance and smoking status were 0.9534 and 0.7132, respectively.

Conclusion

The SHOAFL was found to be generally but more inclined towards urban families with high incomes and a short time to medical service institution. The observed disparities in SHOA among family members were mostly attributable to differences in health insurance and pre-retirement occupations. The status and equality of SHOAFL may be improved if policymakers prioritize making services more accessible to older rural residents with low incomes. Concurrently, reducing the existing discrepancy in health insurance coverage between older couples may also enhance their health.
Proteomics profiling for the global and acetylated proteins of papillary thyroid cancers
Authors: Wei Wei , Wu Yuezhang , Chen Dong-Dong , Song Yuntao , Xu Guohui , Shi Qi , Dong Xiao-Ping
Published: April 2023

Background

Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy cancer among the malignancies of thyroid. Despite of wide usages of proteomics in PTC, the profile of acetylated proteins in PTC remains unsettled, which is helpful for understanding the carcinogenesis mechanism and identifying useful biomarkers for PTC.

Methods

The surgically removed specimens of cancer tissues (Ca-T) and adjacent normal tissues (Ca-N) from 10 female patients pathological diagnosed as PTC (TNM stage III) were enrolled in the study. After preparing the pooled extracts of the whole proteins and the acetylated proteins from 10 cases, TMT labeling and LC/MS/MS methods were applied to the assays of global proteomics and acetylated proteomics separately. Bioinformatics analysis, including KEGG, gene ontology (GO) and hierarchical clustering were performed. Some differentially expressed proteins (DEPs) and differentially expressed acetylated proteins (DEAPs) were validated by individual Western blots.

Results

Controlled with the normal tissues adjacent to the lesions, 147 out of 1923 identified proteins in tumor tissues were considered as DEPs in global proteomics, including 78 up-regulated and 69 down-regulated ones, while 57 out of 311 identified acetylated proteins in tumor tissues were DEAPs in acetylated proteomics, including 32 up-regulated and 25 down-regulated, respectively. The top 3 up- and down-regulated DEPs were fibronectin 1, KRT1B protein and chitinase-3-like protein 1, as well as keratin, type I cytoskeletal 16, A-gamma globin Osilo variant and Huntingtin interacting protein-1. The top 3 up- and down-regulated DEAPs were ribosomal protein L18a-like protein, alpha-1-acid glycoprotein 2 and eukaryotic peptide chain release factor GTP-binding subunit ERF3A, as well as trefoil factor 3, thyroglobulin and histone H2B. Functional GO annotation and KEGG pathway analysis based on the DEPs and DEAPs showed completely different changing pictures. Contrary to the top 10 up- and -down regulated DEPs, most of which were addressed in PTC and other types of carcinomas, changes of the majority DEAPs were not mentioned in the literatures.

Conclusions

Taken the profiling of the global and acetylated proteomics together will provide more broad view of protein alterations on the carcinogenesis and new direction for selecting biomarker for diagnosis of PTC.