bluuebunny/crossref_metadata_2025 huggingface dataset:
A COVID-19 forecasting system for hospital needs using ANFIS and LSTM models: A graphical user interface unit
Authors: Shafiekhani Sajad , Namdar Peyman , Rafiei Sima
Published: March 2022

Background

Centers for Disease Control and Prevention data showed that about 40% of coronavirus disease 2019 (COVID-19) patients had been suffering from at least one underlying medical condition were hospitalized; in which nearly 33% of them needed to be admitted to the intensive care unit (ICU) to receive specialized medical services. Our study aimed to find a proper machine learning algorithm that can predict confirmed COVID-19 hospital admissions with high accuracy.

Methods

We obtained data on daily COVID-19 cases in regular medical inpatient units, emergency department, and ICU in the time window between 21 July 2020 and 21 November 2021. Data for the first 183 days (training data set) were used for long short-term memory (LSTM) network, adaptive neuro-fuzzy inference system (ANFIS), support vector regression (SVR) and decision tree model training, whilst the remaining data for the last 60 days (test data set) were used for model validation. To predict the number of ICU and non-ICU patients, we used these models. Finally, a user-friendly graphical user interface unit was designed to load any time series data (here the trend of population of COVID-19 patients) and train LSTM, ANFIS, SVR or tree models for the prediction of COVID-19 cases for one week ahead.

Results

All models predicted the dynamics of COVID-19 cases in ICU and non- wards. The values of root-mean-square error and R2 as model assessment metrics showed that ANFIS model had better predictive power among all models.

Conclusion

Artificial intelligence-based forecasting models such as ANFIS system or deep learning approach based on LSTM or regression models including SVR or tree regression play a key role in forecasting the required number of beds or other types of medical facilities during the coronavirus pandemic. Thus, the designed graphical user interface of the present study can be used for optimum management of resources by health care systems amid COVID-19 pandemic.
Evaluating the Association of Face Covering Mandates on COVID-19 Severity by State
Authors: Strand Mark A. , Shyllon Omobosinuola , Hohman Adam , Jansen Rick J. , Sidhu Savita , McDonough Stephen
Published: March 2022

Objective:

During the COVID-19 pandemic in the United States, mitigation measures were implemented on a state-by-state basis. Governors were responsible for establishing interventions appropriate for their states and the timing of implementation. This paper evaluated the association between the presence and timing of a mask mandate and the severity of the COVID-19 epidemic by state.

Methods:

The states were divided into 3 categories based on when the governors of each state implemented a mask mandate: Early (mask mandate implemented between March 2020 and June 2020), Late (July 2020-December 2020), and Never (no mask mandate implemented). The rates of hospitalizations and mortality (per 100 000) were assessed at the different time points during the pandemic across these categories from March to December 2020.

Results:

The mortality rates across all 3 groups were observed to be highest in the beginning and toward the end of the pandemic in 2020 with the peak observed in the Early group between April and May 2020. Also, the rates of hospitalization increased steadily across all groups. The Early mask group was comprised of 86.7% and 13.3% states with Democratic and Republican governors respectively, and no states in the Never category had Democratic governors.

Conclusion:

These results support the benefit of implementing a mask mandate to minimize the impact of the COVID-19 pandemic and the role of political affiliation of governors on that impact.
Options to Improve Service Quality to Enhance Value Co-Creation for Customers in the Aviation Industry in Taiwan
Authors: Chung Kuo Cheng , Tan Paul Juinn Bing
Published: March 2022

In recent years, domestic and international airlines alike have been faced with a number of challenges, including economic recessions, rising oil prices, and competition from other convenient travel alternatives, which have caused Taiwan’s various airlines to face substantial financial difficulties. In this study, a questionnaire was administered to examine the service quality of the aviation industry and strategies for aviation industry management were proposed from the perspective of customer value co-creation. The analytic network process approach was employed to elucidate the interactive relationships between evaluation criteria from the managers’ perspective. The entropy method was used to compute the cognitive gap between customers and managers while identifying the strategic means of diminishing these cognitive differences. The analysis results indicated that a company’s understanding of its customers can be enhanced through a four-dimensional (Dialogue, Access, Risk assessment, and Transparency) interactive model. The primary value of the present study is that it combines customers’ concepts regarding value creation with their perceptions of service quality. By doing so, it offers guidance to airlines regarding service quality that can assist them in developing sustainable competitive advantages.
The “At Home” Program: Students Residing with Older Adults
Authors: Even-Zohar Ahuva
Published: March 2022

“At Home” is a program, in which students reside in the homes of older adults. Three studies were designed to evaluate the program. One study was a comparative quantitative investigation that used a cross-sectional survey design aimed at assessing ageism and knowledge of ageing among students. The other two studies were qualitative studies based on Interpretative Phenomenological Analysis, aimed at obtaining the perspective of the students and the older people. The main findings indicated satisfaction with the program among students and older adults as well, and the relationships often described by both sides as good and warm. The most common activities shared by the student and the older adult were watching television, eating dinner, having conversations, and going for walks. The contribution of the program for the older adults reflected in the relief of their loneliness. Among the students, the contribution reflected in familiarity with the world of older adults, the strengthening of intergenerational relationships, and the financial aid for their studies.
The Belt and Road Initiative as a Gateway to the Sea for Land-Locked Countries: With Reference to Nepal
Authors: Adhikari Mukunda , Ma Zhiguo
Published: March 2022

This article explores the Belt and Road Initiative (BRI) and its role as an agent to bind the relationship between the sea and landlocked countries, while pointing out the necessity of alternative sea access to the land-locked countries especially during situations like blockade. The BRI is a Chinese development project with five main objectives: connectivity of infrastructure, policy coordination, unimpeded trade, financial integration, and people-to-people bonds. The objective of connectivity of infrastructure is pivotal to land-locked countries and their access to the sea. The study establishes that the BRI’s proposed six corridors and one maritime route are useful for land-locked countries. Nepal is one of the landlocked countries and many times suffering from blockade from its neighboring country especially India. Therefore, this study aimed to identify whether the BRI is necessary or not to avoid the potential blockade from its neighboring countries. The study is mainly focused on the secondary data of import and export, and the impact of blockade on import and export in Nepal. Situations like blockade seriously impact countries’ export-import activities, and especially those of land-locked countries. The BRI and the Nepal-China Transit Transport Agreement have secured sea rights to Nepal via Chinese territory. The BRI provides a solution for land-locked countries against the continuing threat and problems created by blockade. Therefore, this study strongly recommend to Nepal Government to work seriously through BRI for further Nepal’s developmental process and country’s rapid economy growth in the future.
Self-motion with Hearing Impairment and (Directional) Hearing Aids
Authors: Hendrikse Maartje M. E. , Eichler Theda , Hohmann Volker , Grimm Giso
Published: March 2022

When listening to a sound source in everyday situations, typical movement behavior is highly individual and may not result in the listener directly facing the sound source. Behavioral differences can affect the performance of directional algorithms in hearing aids, as was shown in previous work by using head movement trajectories of normal-hearing (NH) listeners in acoustic simulations for noise-suppression performance predictions. However, the movement behavior of hearing-impaired (HI) listeners with or without hearing aids may differ, and hearing-aid users might adapt their self-motion to improve the performance of directional algorithms. This work investigates the influence of hearing impairment on self-motion, and the interaction of hearing aids with self-motion. In order to do this, the self-motion of three HI participant groups­­­—aided with an adaptive differential microphone (ADM), aided without ADM, and unaided—was measured and compared to previously measured self-motion data from younger and older NH participants. Self-motion was measured in virtual audiovisual environments (VEs) in the laboratory, and the signal-to-noise ratios (SNRs) and SNR improvement of the ADM resulting from the head movements of the participants were estimated using acoustic simulations. HI participants did almost all of the movement with their head and less with their eyes compared to NH participants, which led to a 0.3 dB increase in estimated SNR and to differences in estimated SNR improvement of the ADM. However, the self-motion of the HI participants aided with ADM was similar to that of other HI participants, indicating that the ADM did not cause listeners to adapt their self-motion.
Geoethical futures: A call for more-than-human physical geography
Authors: Sharp Emma L , Brierley Gary J , Salmond Jennifer , Lewis Nicolas
Published: March 2022

This paper aims to foster an explicit geoethical orientation in physical geography. Using examples from Aotearoa New Zealand, we approach the work of physical geography with a set of ethical coordinates derived from our research, arguing that they allow for greater sensitivity in considering what is more-than-human in our research relationships. Working with these ethical co-ordinates lays the political groundwork for thinking and doing physical geography differently in the pursuit of less exploitative social and ecological relations. Our proposition offers new potentials for the practice of geography more generally: opportunities for enactive research encounters, those that perform generative change for a decolonised, post-productivist, physical geography.
Extracellular vesicles and PD-L1 suppress macrophages, inducing therapy resistance in TP53-deficient B-cell malignancies
Authors: Izquierdo Elena , Vorholt Daniela , Blakemore Stuart , Sackey Benedict , Nolte Janica L. , Barbarino Verena , Schmitz Jan , Nickel Nadine , Bachurski Daniel , Lobastova Liudmila , Nikolic Milos , Michalik Michael , Brinker Reinhild , Merkel Olaf , Franitza Marek , Georgomanolis Theodoros , Neuhaus René , Koch Maximilian , Nasada Niklas , Knittel Gero , Chapuy Björn , Ludwig Nicole , Meese Eckart , Frenzel Lukas , Reinhardt Hans Christian , Peifer Martin , Rebollido-Rios Rocio ,  Bruns Heiko , Krüger Marcus , Hallek Michael , Pallasch Christian P.
Published: March 2022

Genetic alterations in the DNA damage response (DDR) pathway are a frequent mechanism of resistance to chemoimmunotherapy (CIT) in B-cell malignancies. We have previously shown that the synergy of CIT relies on secretory crosstalk elicited by chemotherapy between the tumor cells and macrophages. Here, we show that loss of multiple different members of the DDR pathway inhibits macrophage phagocytic capacity in vitro and in vivo. Particularly, loss of TP53 led to decreased phagocytic capacity ex vivo across multiple B-cell malignancies. We demonstrate via in vivo cyclophosphamide treatment using the Eμ-TCL1 mouse model that loss of macrophage phagocytic capacity in Tp53-deleted leukemia is driven by a significant downregulation of a phagocytic transcriptomic signature using small conditional RNA sequencing. By analyzing the tumor B-cell proteome, we identified a TP53-specific upregulation of proteins associated with extracellular vesicles (EVs). We abrogated EV biogenesis in tumor B-cells via clustered regularly interspaced short palindromic repeats (CRISPR)-knockout (KO) of RAB27A and confirmed that the EVs from TP53-deleted lymphoma cells were responsible for the reduced phagocytic capacity and the in vivo CIT resistance. Furthermore, we observed that TP53 loss led to an upregulation of both PD-L1 cell surface expression and secretion of EVs by lymphoma cells. Disruption of EV bound PD-L1 by anti–PD-L1 antibodies or PD-L1 CRISPR-KO improved macrophage phagocytic capacity and in vivo therapy response. Thus, we demonstrate enhanced EV release and increased PD-L1 expression in TP53-deficient B-cell lymphomas as novel mechanisms of macrophage function alteration in CIT resistance. This study indicates the use of checkpoint inhibition in the combination treatment of B-cell malignancies with TP53 loss.
Use of single-inhaler triple therapy in the management of obstructive airway disease: Indian medical experts’ review
Authors: Dhar Raja , Talwar Deepak , Salvi Sundeep , Muralimohan B.V. , Panchal Sagar , Patil Saiprasad , Bhagat Sagar , Khatri Nishtha , Barkate Hanmant
Published: March 2022

Obstructive airway disease (OAD), which includes COPD and asthma, is the leading cause of morbidity and mortality in India. Long-acting bronchodilators (long-acting β2 agonists (LABAs) and/or long-acting muscarinic antagonists (LAMAs)) and inhaled corticosteroids (ICS) have a vital role in the management of patients with OAD. While symptom burden and exacerbations are common amongst treated patients, poor adherence to inhaler therapy is a frequent challenge. Better treatment options that optimise symptom control, improve quality of life, reduce exacerbation risk and improve adherence are desired. Triple therapy (ICS/LABA/LAMA) is recommended in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 guidelines for symptomatic COPD patients on ICS/LABA or LABA/LAMA, and who are at increased risk for frequent or severe exacerbations. Similarly, add-on LAMA is recommended in uncontrolled asthma patients on medium- to high-dose ICS/LABA by the Global Initiative for Asthma (GINA) 2021 guideline. In the real world, high-risk and overlapping phenotypes exist, which necessitate early initiation of triple therapy. We aim to provide an expert review on the use of single-inhaler triple therapy (SITT) for OAD management in global and Indian settings, knowledge from which can be extrapolated for appropriate treatment of Indian patients. The OAD population in India may benefit from early optimisation to SITT characterised by a high burden of exacerbating OAD, nonsmoker COPD and asthma–COPD overlap.
Diagnostic performance of automated, streamlined, daily updated exome analysis in patients with neurodevelopmental delay
Authors: Seo Go Hun , Lee Hane , Lee Jungsul , Han Heonjong , Cho You Kyung , Kim Minji , Choi Yunha , Choi Jeongmin , Choi In Hee , Rhie Seonkyeong , Chae Kyu Young , Kim Yoo-Mi , Cheon Chong Kun , Kim Su Jin , Lee Jieun , Kang Eungu , Byeon Jung Hye , Yu Hee Joon , Shin Young-Lim , Oh Arum , Kim Woo Jin , Yum Mi-Sun , Lee Beom Hee , Eun Baik-Lin
Published: March 2022

Background

The diagnostic yield of whole-exome sequencing (WES) varies from 30%–50% among patients with mild to severe neurodevelopmental delay (NDD)/intellectual disability (ID). Routine retrospective reanalysis of undiagnosed patients has increased the total diagnostic yield by 10–15%. Here, we performed proband-only WES of 1065 patients with NDD/ID and applied a prospective, daily reanalysis automated pipeline to patients without clinically significant variants to facilitate diagnoses.

Methods

The study included 1065 consecutive patients from 1056 nonconsanguineous unrelated families from 10 multimedical centers in South Korea between April 2018 and August 2021. WES data were analyzed daily using automatically updated databases with variant classification and symptom similarity scoring systems.

Results

At the initial analysis, 402 patients from 1056 unrelated families (38.0%, 402/1,056 families) had a positive genetic diagnosis. Daily prospective, automated reanalysis resulted in the identification of 34 additional diagnostic variants in 31 patients (3%), which increased our molecular diagnostic yield to 41% (433/1056 families). Among these 31 patients, 26 were diagnosed with 23 different diseases that were newly discovered after 2019. The time interval between the first analysis and the molecular diagnosis by reanalysis was 1.2 ± 0.9 years, which was shorter in the patients enrolled during the latter part of the study period.

Conclusion

Daily updated databases and reanalysis systems enhance the diagnostic performance in patients with NDD/ID, contributing to the rapid diagnosis of undiagnosed patients by applying the latest molecular genetic information.
Differential expression of enzymes in thymidylate biosynthesis in zebrafish at different developmental stages: implications for dtymk mutation-caused neurodegenerative disorders
Authors: Frisk Junmei Hu , Örn Stefan , Pejler Gunnar , Eriksson Staffan , Wang Liya
Published: March 2022

Background

Deoxythymidine triphosphate (dTTP) is an essential building block of DNA, and defects in enzymes involved in dTTP synthesis cause neurodegenerative disorders. For instance, mutations in DTYMK, the gene coding for thymidylate kinase (TMPK), cause severe microcephaly in human. However, the mechanism behind this is not well-understood. Here we used the zebrafish model and studied (i) TMPK, an enzyme required for both the de novo and the salvage pathways of dTTP synthesis, and (ii) thymidine kinases (TK) of the salvage pathway in order to understand their role in neuropathology.

Results

Our findings reveal that maternal-stored dNTPs are only sufficient for 6 cell division cycles, and the levels of dNTPs are inversely correlated to cell cycle length during early embryogenesis. TMPK and TK activities are prominent in the cytosol of embryos, larvae and adult fish and brain contains the highest TMPK activity. During early development, TMPK activity increased gradually from 6 hpf and a profound increase was observed at 72 hpf, and TMPK activity reached its maximal level at 96 hpf, and remained at high level until 144 hpf. The expression of dtymk encoded Dtymk protein correlated to its mRNA expression and neuronal development but not to the TMPK activity detected. However, despite the high TMPK activity detected at later stages of development, the Dtymk protein was undetectable. Furthermore, the TMPK enzyme detected at later stages showed similar biochemical properties as the Dtymk enzyme but was not recognized by the Dtymk specific antibody.

Conclusions

Our results suggest that active dNTP synthesis in early embryogenesis is vital and that Dtymk is essential for neurodevelopment, which is supported by a recent study of dtymk knockout zebrafish with neurological disorder and lethal outcomes. Furthermore, there is a novel TMPK-like enzyme expressed at later stages of development.
Effectiveness of single loading dose of dexmedetomidine combined with propofol for deep sedation of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients: a prospective randomized study
Authors: Chen Mo , Sun Yi , Li Xueyan , Zhang Chun , Huang Xiaochen , Xu Yiming , Gu Chengyong
Published: March 2022

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure and requires deep sedation. Deep sedation with dexmedetomidine for the respiratory drive preserved has become popular in recent years. However, the use of dexmedetomidine in elderly patients is controversial because its adverse events are more common. The objective of this study was to investigate the effectiveness of a single loading dose of dexmedetomidine combined with propofol for deep sedation of ERCP in elderly patients.

Methods

In this prospective randomized trial, 49 elderly patients undergoing ERCP were randomly allocated to the dexmedetomidine (DEX) or propofol (PRO) groups. The single loading dose of dexmedetomidine was set at 0.5 μg/kg at the start of anesthesia induction and loading for 10 min. The primary outcome was the cumulative dose of propofol. Secondary outcomes included time to awake, the frequency of airway interventions, and hemodynamics.

Results

The intraoperative cumulative dose of propofol was lower in the DEX group (111.0 ± 12.6 μg/kg/min) than the PRO group (143.7 ± 23.4 μg/kg/min) (P < 0.001). There was no statistically significant difference in the time to awake between the two groups. The incidence of artificial airway interventions and hypotension in the PRO group (36%, 60%) were significantly higher than those in the DEX group (4.2%, 16.7%) (P = 0.011, P = 0.003, respectively). In addition, the occurrence of bradycardia increased significantly in the DEX group (58.3%) compared with the PRO group (12%) (P < 0.001).

Conclusions

The single loading dose of dexmedetomidine combined with propofol can reduce propofol consumption and artificial airway intervention and provide better hemodynamic stability than propofol for deep sedation in elderly patients during ERCP.

Trial registration

www.chictr.org.cn (Registration number ChiCTR1900028069, Registration date 10/12/2019).
Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols
Authors: Lin Yu-Yuan , Lai Yin-Yu , Chang Hung-Chieh , Lu Chien-Hsin , Chiu Po-Wei , Kuo Yuh-Shin , Huang Shao-Peng , Chang Ying-Hsin , Lin Chih-Hao
Published: March 2022

Background

Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA).

Methods

A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value.

Results

Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule.

Conclusions

Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly.
“This path I must walk alone”. Challenges experienced by older patients while recovering from severe COVID-19 – a qualitative study
Authors: Heiberg Kristi Elisabeth , Jøranson Nina , Heggestad Anne Kari Tolo , Breievne Grete , Lausund Hilde , Myrstad Marius , Ranhoff Anette Hylen , Walle-Hansen Marte Meyer , Bruun-Olsen Vigdis
Published: March 2022

Background

In March 2020, the COVID-19 pandemic challenged both the Norwegian population and healthcare system. In this study we explored how older men and women experienced rehabilitation and recovery after hospitalisation due to severe COVID-19.

Methods

Semi-structured interviews with 17 participants aged 60–96 years were performed 6 months after discharge from hospital. A thematic descriptive analysis was conducted.

Results

The results revealed that the participants experienced a challenging span between loneliness and companionship in recovering from severe COVID-19. The four subthemes highlighted experiences of being discharged to home and left to themselves, the importance of exercise and companionship at rehabilitation stay, requirement of self-effort and time to recover, and the challenging span between loneliness and companionship when being with family.

Conclusion

Among participants, the experiences of loneliness throughout the recovery period were striking. An individualised approach including psychological support should be emphasized in primary healthcare to promote recovery in older survivors after severe COVID-19 and their next-of-kin.
Applying the behaviour change wheel to develop a smartphone application ‘stay-active’ to increase physical activity in women with gestational diabetes
Authors: Smith R. , Michalopoulou M. , Reid H. , Riches S. Payne , Wango Y. N. , Kenworthy Y. , Roman C. , Santos M. , Hirst J. E. , Mackillop L.
Published: March 2022

Background

Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population.

Methods

The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active’s development.

Results

We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages.

Conclusion

The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.
Can cell salvage be used for resuscitation in a patient with amniotic fluid embolism and hepatic laceration? A case report
Authors: Li Ping , Luo Linli , Luo Dong , Wang Rurong
Published: March 2022

Background

Amniotic fluid embolism (AFE) is a rare disease that can lead to profound coagulopathy and hemorrhage, especially when combined with the laceration and bleeding of other organs. Intraoperative cell salvage (ICS) has been widely used for treating obstetric hemorrhage, but it remains unclear whether ICS can be used in the treatment of AFE.

Case presentation

We report the case of a 27-year-old woman at 39 weeks’ gestation who suddenly developed severe abdominal pain, convulsions, loss of consciousness, and decreased vital signs during labor. Despite an emergency cesarean section being performed, the parturient experienced sudden cardiac arrest. Fortunately, the heart rate spontaneously recovered after effective cardiopulmonary resuscitation (CPR). Further abdominal exploration revealed right hepatic laceration with active bleeding. ICS was performed and the salvaged blood was promptly transfused back to the patient. Subsequently, the patient was diagnosed with AFE based on hypotension, hypoxia, coagulopathy, and cardiac arrest. The patient was transfused with 2899 mL salvaged blood during surgery with no adverse effects. At 60- and 90-day follow-ups, no complaints of discomfort or abnormal laboratory test results were observed in the mother or the baby.

Conclusion

ICS was used to rescue patient with AFE, and ICS did not worsen the condition of patients with AFE. For pregnant women who received CPR, clinicians should explore the presence of hepatic laceration which can be fatal to patients.
Prognostic variables for conditional survival in patients with esophageal squamous cell carcinoma who underwent minimally invasive surgery
Authors: Liang Mingqiang , Xiao Jiazhou , Chen Maohui , Zheng Bin , Chen Chun
Published: March 2022

Background

Esophageal squamous cell carcinoma (ESCC) survival is mainly reported at the time of treatment. Conditional survival is another prognostic tool to evaluate ESCC patients who has survived more than one year since treatment.

Methods

We analyzed data from 705 ESCC patients who underwent minimally invasive surgery between 2013 and 2016. Using the Kaplan–Meier method, we computed a 5-year relative conditional survival. We also investigated the prognostic factors associated with survival using Cox proportional hazards models.

Results

Conditional survival improved over time for all cohorts of ESCC patients who survived a period after surgery. The greatest improve in conditional survival were observed in patients 2 years after surgery. In addition, the results of the Cox survival model from the time of surgery, T stage (p < 0.001), N stage (p < 0.001), and anastomotic leak (p = 0.022), were significantly associated with survival. However, the results of the Cox survival model from 2 years after surgery, N stage (p < 0.001), and anastomotic leak (p = 0.032) were significantly associated with survival.

Conclusion

For ESCC patients who survived a period after surgery, the largest increases in conditional survival were observed in patients 2 years after surgery. We suggest that patients with anastomotic leakage and higher T and N stages should be strictly screened according to various time, and that conditional survival should be used as a powerful prognostic tool for ESCC patients.
Vernal keratoconjunctivitis with a limbal mass lesion developing independently of severe papillae formation at the tarsal conjunctiva: a case report
Authors: Shinji Koichiro , Chikama Taiichiro , Masuda Shun , Arihiro Koji , Kiuchi Yoshiaki
Published: March 2022

Background

A hypertrophic limbal mass lesion is an uncommon finding of vernal keratoconjunctivitis; it normally occurs in eyes with severe papillae formation in the tarsal conjunctiva. We present a case with a limbal mass lesion in a patient with relatively mild allergic findings in the tarsal conjunctiva.

Case presentation

A 12-year-old Japanese boy displaying allergic conjunctivitis presented with a mass lesion at the inferior limbus in the left eye. Relatively mild papillae formation was found on the tarsal conjunctiva in both eyes. We diagnosed that the mass lesion resulted from limbal vernal keratoconjunctivitis and resected it for therapeutic purposes. Histopathological examination showed that eosinophils, lymphocytes, and fibroblasts were present in the subepithelial lesion and the substantia propria of the mass lesion. Immunohistochemical staining detected diffuse and rich infiltration of CD3-positive T lymphocytes and a relatively small number of CD20-positive B lymphocytes and CD138-positive plasma cells that tended to aggregate. The histopathologic features suggested that the limbal mass lesion had similar structures to the papillae at the tarsal conjunctiva of vernal keratoconjunctivitis.

Conclusion

The limbal mass lesion as a finding of vernal keratoconjunctivitis can occur even if the papillae formation at the patient’s tarsal conjunctiva is mild.
Considering intermittent fasting among Saudis: insights into practices
Authors: Alnasser Aroub , Almutairi Mashael
Published: March 2022

Background

There is a dearth of studies on intermittent fasting in Saudi Arabia outside of Ramadan. The aim of this research was to study and describe the practice of intermittent fasting outside of Ramadan among Saudi people.

Methods

A web-based survey that focused on intermittent fasting practices—specifically the use of intermittent fasting applications, goal setting, and the effects of fasting on an individual’s state of health—was administered, collected, and analyzed.

Results

The study revealed that 58% (298/514) of the respondents practiced intermittent fasting for a duration of less than 3 months. The most-practiced pattern of intermittent fasting was a 16/8 fasting pattern (43.8%, 225/514). About 88.3% (454/514) of those who followed intermittent fasting drank fluids while fasting. Additionally, the amount of weight loss after intermittent fasting was less than 2.2 kg for 35% (180/514) of the participants. The primary goal of intermittent fasting for 44.9% (231/514) of the respondents was to lose weight. The majority of the participants (84.6%, 435/514) did not use any fasting applications.

Conclusion

The results of the current research on intermittent fasting outside of Ramadan are preliminary and inconclusive. The findings of the present study advance the idea that for some Saudis, the practice of intermittent fasting does not necessarily begin and end with Ramadan; this finding may present a strategic opportunity for Saudi health professionals who are focused on the obesity epidemic and other public health issues in Saudi Arabia. This study sought to help start a discussion on this topic and fill the knowledge gap.
'Toothless’—the absence of political priority for oral health: a case study of Ireland 1994–2021
Authors: McAuliffe Úna , Whelton Helen , Harding Máiréad , Burke Sara
Published: March 2022

Background

Calls are emerging for oral health system reform under the Universal Healthcare (UHC) domain, while internationally there is an absence of political priority for oral health. In the Republic of Ireland there is very limited coverage of oral healthcare for the whole population. ‘Smile agus Sláinte’ Ireland’s oral health policy published in 2019, represents the first change to national policy in over 25 years.

Methods

This research examined the key factors influencing oral health policy, development, and implementation in Ireland during the period 1994–2021. A case study approach was adopted with two strands of data collection: documentary analysis and semi-structured interviews with elite participants. Analysis was guided by Howlett’s five stream framework.

Results

Ireland shares the international experience of oral health having very low political priority. This has perpetuated unequal access to public dental services for children and special needs populations while austerity measures applied to adult schemes resulted in increased unmet need with no universal coverage for dental care. The only area where there is political interest in oral health is orthodontic care. This low political priority combined with a lack of actor power in national leadership positions in the Department of Health and Health Service Executive has contributed to successive non-implementation of oral health policy recommendations. This is most evident in the failure to publish the Draft National Oral Health Policy in 2009. The research finds a failure to adequately engage with key stakeholders, particularly the dental profession in the development of the 2019 policy. All these weaknesses have been exacerbated by the COVID-19 pandemic.

Conclusions

Ireland’s new oral health policy, ‘Smile agus Sláinte’, presents an opportunity for the provision of much needed public dental services. However, successful reform will require strong political will and collaboration with dental leadership to provide advocacy at national level. Global calls to incorporate oral health into the UHC agenda and an agreed political consensus for UHC in Ireland may provide an opportunity for change. Genuine engagement of all stakeholders to develop an implementation strategy is necessary to harness this potential window of opportunity for oral health system reform.
Use of reusable menstrual management materials and associated factors among women of reproductive age in Ghana: analysis of the 2017/18 Multiple Indicator Cluster Survey
Authors: Anaba Emmanuel Anongeba , Udofia Emilia Asuquo , Manu Adom , Daniels Anita Anima , Aryeetey Richmond
Published: March 2022

Background

The use of unsafe materials to collect menstrual blood predisposes women and girls to infections. There is a paucity of literature on the utilization of reusable menstrual materials in sub-Saharan Africa. This study examined factors associated with the use of reusable menstrual management materials among women of reproductive age in Ghana. Findings from this study can inform menstrual health programmes and reproductive health policy to address menstrual hygiene and specific areas of emphasis.

Methods

We analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. Descriptive statistics were employed to compute frequencies and percentages, while Chi-square and complex sample Binomial Logistic Regression was conducted to identify factors associated with the use of reusable menstrual materials.

Results

Half (52%) of the respondents were below 30 years old; mean (± sd) = 30.7(9.0). Thirteen percent used reusable materials to collect menstrual blood during their last period. Women aged 45–49 years (AOR = 5.34; 95% CI 3.47–8.19) were 5 times more likely to manage menstruation with reusable materials compared with those aged 15–19 years (p < 0.05). Women classified in the middle wealth quintile (AOR = 0.66; 95% CI 0.50–0.88) were 34% less likely to use reusable materials to collect menstrual blood compared with women in the poorest wealth quintile (p < 0.05). Also, women who were exposed to television (AOR = 0.78; 95% CI 0.61–0.99) had less odds of using reusable materials compared with women who were not exposed to television (p < 0.05).

Conclusion

This study showed that the use of reusable menstrual materials was influenced by socio-demographic factors, economic factors and exposure to mass media. Therefore, policies and programmes aimed at promoting menstrual health should focus on less privileged women. The mass media presents an opportunity for communicating menstrual hygiene.
The prevalence of using complementary and alternative medicine products among patients with pressure ulcer
Authors: Karimianfard Niloofar , Jaberi Azita
Published: March 2022

Background

The use of complementary and alternative medicine (CAM) therapies has increased in recent years throughout the world and in Iran. Nonetheless, there are limited data about the prevalence of their use. This study aimed to assess the prevalence of using CAM therapies among patients with pressure ulcer (PU).

Methods

This cross-sectional study was conducted in 2019–2020. Participants were 299 patients with PU conveniently selected from wound clinics and healthcare settings in Shiraz, Iran. A demographic questionnaire and the International Questionnaire to Measure Use of CAM were used for data collection. The data were analyzed using the SPSS software (v. 22.0).

Results

All 299 participants completed the study. Their mean age was 59.56 ± 18.76 years. The most common CAM therapies used for PU management were herbal products (100%), vitamin supplementation therapy (45.2%), spiritual therapies (21.7%), wet cupping therapy (16.4%), leech therapy (9.4%), acupuncture (1.7%), dry cupping therapy (1.3%), and massage therapy (1.3%). The most common herbal product used for PU management was Pistacia atlantica gum either alone or in combination with other herbal products (15.5%). The use of CAM therapies had significant relationship with participants’ age, underlying conditions, and PU stage (P < 0.05) and the most significant predictor of using herbal products for PU was educational level (P < 0.05, OR = 5.098).

Conclusions

The use of CAM therapies, particularly herbal products, for PU management is high in Iran. Quality public education and close professional supervision are needed for the safe use of these products.
Study of patients' attitude to automatic interpretation of laboratory test results and its influence on follow-up rate
Authors: Kopanitsa Georgy
Published: March 2022

Background

One of the current major factors of not following up on the abnormal test results is the lack of information about the test results and missing interpretations. Clinical decision support systems (CDSS) can become a solution to this problem. However, little is known how patients react to the automatically generated interpretations of the test results, and how this can affect a decision to follow up. In this research, we study how patients perceive the interpretations of the laboratory tests automatically generated by a clinical decision support system depending on how they receive these recommendations and how this affects the follow-up rate.

Methods

A study of 3200 patients was done querying the regional patient registry. The patients were divided into 4 groups who received:

Recommendations automatically generated by a CDSS with a clear indication of their automatic nature.

Recommendations received personally from a doctor with a clear indication of their automatic nature.

Recommendations from a doctor with no indication of their automated generation.

No recommendations, only the test results.

A follow-up rate was calculated as the proportion of patients referred to a laboratory service for a follow-up investigation after receiving a recommendation within two weeks after the first test with abnormal test results had been completed and the interpretation was delivered to the patient. The second phase of the study was a research of the patients’ motivation. It was performed with a group of 789 patients.

Results

All the patients who received interpretations on the abnormal test results demonstrated a significantly higher rate of follow-up (71%) in comparison to the patients who received only test results without interpretations (49%). Patients mention a time factor as a significant benefit of the automatically generated interpretations in comparison to the interpretations they can receive from a doctor.

Conclusion

The results of the study show that delivering automatically generated interpretations of test results can support patients in making a decision to follow up. They are trusted by patients and raise their motivations and engagement.
Intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine and parasite resistance: cross-sectional surveys from antenatal care visit and delivery in rural Ghana
Authors: Mama Atikatou , Ahiabor Charity , Tornyigah Bernard , Frempong Naa Adjeley , Kusi Kwadwo A. , Adu Bright , Courtin David , Houzé Sandrine , Deloron Philippe , Ofori Michael F. , Anang Abraham K. , Ariey Frédéric , Ndam Nicaise Tuikue
Published: March 2022

Background

Despite decades of prevention efforts, the burden of malaria in pregnancy (MiP) remains a great public health concern. Sulfadoxine-pyrimethamine (SP), used as intermittent preventive treatment in pregnancy (IPTp-SP) is an important component of the malaria prevention strategy implemented in Africa. However, IPTp-SP is under constant threat from parasite resistance, thus requires regular evaluation to inform decision-making bodies.

Methods

In two malaria endemic communities in the Volta region (Adidome and Battor), a cross-sectional hospital-based study was conducted in pregnant women recruited at their first antenatal care (ANC) visit and at delivery. Basic clinical and demographic information were documented and their antenatal records were reviewed to confirm IPTp-SP adherence. Peripheral and placental blood were assayed for the presence of Plasmodium falciparum parasites by quantitative polymerase chain reaction (qPCR). One hundred and twenty (120) positive samples were genotyped for mutations associated with SP resistance.

Results

At first ANC visit, P. falciparum prevalence was 28.8% in Adidome and 18.2% in Battor. At delivery, this decreased to 14.2% and 8.2%, respectively. At delivery, 66.2% of the women had taken at least the recommended 3 or more doses of IPTp-SP and there was no difference between the two communities. Taking at least 3 IPTp-SP doses was associated with an average birth weight increase of more than 360 g at both study sites compared to women who did not take treatment (p = 0.003). The Pfdhfr/Pfdhps quintuple mutant IRNI-A/FGKAA was the most prevalent (46.7%) haplotype found and the nonsynonymous Pfdhps mutation at codon A581G was higher at delivery among post-SP treatment isolates (40.6%) compared to those of first ANC (10.22%). There was also an increase in the A581G mutation in isolates from women who took 3 or more IPTp-SP.

Conclusions

This study confirms a positive impact following the implementation of the new IPTp-SP policy in Ghana in increasing the birth weight of newborns. However, the selection pressure exerted by the recommended 3 or more doses of IPTp-SP results in the emergence of parasites carrying the non-synonymous mutation on codon A581G. This constant selective pressure calls into question the time remaining for the clinical utility of IPTp-SP treatment during pregnancy in Africa.